Text of US SB 4486 (2022)

II 117TH CONGRESS 2D SESSION S. 4486 To improve the health of minority individuals, and for other purposes. IN THE SENATE OF THE UNITED STATES JUNE 23, 2022 Mr. BOOKER (for himself, Mr. WARNOCK, Mr. BROWN, Mr. MERKLEY, Mr. CARDIN, Mr. KAINE, Ms. HIRONO, Ms. WARREN, Ms. DUCKWORTH, Mrs. GILLIBRAND, and Mr. SANDERS) 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 2022’’. 5 SEC. 2. TABLE OF CONTENTS. 6 The table of contents of this Act is as follows: 7 Sec. 1. Short title. Sec. 2. Table of contents. Sec. 3. Findings. TITLE I—DATA COLLECTION AND REPORTING VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6211 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •S 4486 IS Sec. 1001. Strengthening data collection, improving data analysis, and expand- ing data reporting. Sec. 1002. Elimination of prerequisite of direct appropriations for data collec- tion and analysis. Sec. 1003. Collection of data for the Medicare program. Sec. 1004. Revision of HIPAA claims standards. Sec. 1005. National Center for Health Statistics. Sec. 1006. Disparities data collected by the Federal Government. Sec. 1007. Data collection and analysis grants to minority-serving institutions. Sec. 1008. Safety and effectiveness of drugs with respect to racial and ethnic background. Sec. 1009. Improving health data regarding Native Hawaiians and Pacific Is- landers. Sec. 1010. Clarification of simplified administrative reporting requirement. Sec. 1011. Data collection regarding pandemic preparedness, testing, infections, and deaths. Sec. 1012. Commission on Ensuring Data for Health Equity. Sec. 1013. Task Force on Preventing Bias in AI and Algorithms. TITLE II—CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH AND HEALTH CARE Sec. 2001. Definitions; findings. Sec. 2002. Improving access to services for individuals with limited English proficiency. Sec. 2003. Ensuring standards for culturally and linguistically appropriate services in health care. Sec. 2004. Culturally and linguistically appropriate health care in the Public Health Service Act. Sec. 2005. Pilot program for improvement and development of State medical interpreting services. Sec. 2006. Training tomorrow’s doctors for culturally and linguistically appro- priate care: graduate medical education. Sec. 2007. Federal reimbursement for culturally and linguistically appropriate services under the Medicare, Medicaid, and State Children’s Health Insurance Programs. Sec. 2008. Increasing understanding of and improving health literacy. Sec. 2009. Requirements for health programs or activities receiving Federal funds. Sec. 2010. Report on Federal efforts to provide culturally and linguistically ap- propriate health care services. Sec. 2011. English instruction for individuals with limited English proficiency. Sec. 2012. Implementation. Sec. 2013. Language access services. Sec. 2014. Medically underserved populations. TITLE III—HEALTH WORKFORCE DIVERSITY Sec. 3001. Amendment to the Public Health Service Act. Sec. 3002. Hispanic-serving institutions, historically Black colleges and univer- sities, historically Black professional or graduate institutions, Asian American and Native American Pacific Islander-serving institutions, Tribal Colleges, regional community-based organi- zations, and national minority medical associations. Sec. 3003. Loan repayment program of Centers for Disease Control and Pre- vention. VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •S 4486 IS Sec. 3004. Allied health workforce diversity. Sec. 3005. Cooperative agreements for online degree programs at schools of public health and schools of allied health. Sec. 3006. National Health Care Workforce Commission. Sec. 3007. Scholarship and fellowship programs. Sec. 3008. McNair Postbaccalaureate Achievement Program. Sec. 3009. Rules for determination of full-time equivalent residents for cost-re- porting periods. Sec. 3010. Developing and implementing strategies for local health equity. Sec. 3011. Health Professions Workforce Fund. Sec. 3012. Future advancement of academic nursing. Sec. 3013. Findings; sense of Congress relating to graduate medical education. Sec. 3014. Career support for skilled, internationally educated health profes- sionals. Sec. 3015. Study and report on strategies for increasing diversity. Sec. 3016. Conrad State 30 program; physician retention. Sec. 3017. National Hispanic Nurses Day. Sec. 3018. Expanding medical education. TITLE IV—IMPROVING HEALTH CARE ACCESS AND QUALITY Sec. 4000. Definition. Subtitle A—Reducing Barriers to Accessing Care Sec. 4001. Protecting protected areas. Sec. 4002. Repeal of requirement for documentation evidencing citizenship or nationality under the Medicaid program. Sec. 4003. Availability of basic assistance to lawfully present noncitizens. Sec. 4004. Improve affordability and reduce premium costs of health insurance for consumers. Sec. 4005. Removing citizenship and immigration barriers to access to afford- able health care under the ACA. Sec. 4006. Removing barriers to access to affordable health care for lawfully re- siding immigrants under Medicaid and CHIP. Sec. 4007. Consistency in health insurance coverage for individuals with feder- ally authorized presence, including deferred action. Sec. 4008. Study on the uninsured. Sec. 4009. Medicaid fallback coverage program for low-income adults in non- expansion States. Sec. 4010. Increase and extension of temporary enhanced FMAP for States which begin to expend amounts for certain mandatory individ- uals. Subtitle B—Improvement of Coverage Sec. 4101. Medicaid in the territories. Sec. 4102. Extension of the Supplemental Security Income Program to Puerto Rico, the United States Virgin Islands, Guam, and American Samoa. Sec. 4103. Extension of Medicare secondary payer. Sec. 4104. Indian defined in title I of the Patient Protection and Affordable Care Act. Sec. 4105. Removing Medicare barrier to health care. Sec. 4106. Lowering Medicare premiums and prescription drug costs. VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6211 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •S 4486 IS Sec. 4107. Reducing cost-sharing, aligning income and resource eligibility tests, simplifying enrollment, and other program improvements for low-income beneficiaries. Sec. 4108. 100 percent FMAP for medical assistance provided by urban Indian organizations. Sec. 4109. 100 percent FMAP for medical assistance provided to a Native Ha- waiian through a federally qualified health center or a Native Hawaiian health care system under the Medicaid program. Sec. 4110. Repeal of requirement for estate recovery under the Medicaid pro- gram. Sec. 4111. Allow for suspension of Medicare benefits and premium liability for individuals who are incarcerated and provide a special enroll- ment period around the date of release. Sec. 4112. Federal Employee Health Benefit Plans. Sec. 4113. Continuation of Medicaid income eligibility standard for pregnant individuals and infants. Subtitle C—Expansion of Access PART 1—GENERAL PROVISIONS Sec. 4201. Amendment to the Public Health Service Act. Sec. 4202. Border health grants. Sec. 4203. Critical access hospital improvements. Sec. 4204. Medicare remote monitoring pilot projects. Sec. 4205. Community health center collaborative access expansion. Sec. 4206. Facilitating the provision of telehealth services across State lines. Sec. 4207. Scoring of preventive health savings. Sec. 4208. Sense of Congress on maintenance of effort provisions regarding children’s health. Sec. 4209. Protection of the HHS Offices of Minority Health. Sec. 4210. Office of Minority Health in Veterans Health Administration of De- partment of Veterans Affairs. Sec. 4211. Study of DSH payments to ensure hospital access for low-income patients. Sec. 4212. Reauthorization of programs under the Native Hawaiian Health Care Improvement Act. PART 2—RURAL Sec. 4221. Establishment of Rural Community Hospital (RCH) Program. Sec. 4222. Rural Health Quality Advisory Commission and demonstration projects. Sec. 4223. Rural health care services. PART 3—INDIAN COMMUNITIES Sec. 4231. Assistant Secretary of the Indian Health Service. Sec. 4232. Extension of full Federal medical assistance percentage to Indian health care providers. Sec. 4233. Conferring with urban Indian organizations. PART 4—PROVIDERS Sec. 4241. Availability of non-English language speaking providers. Sec. 4242. Access to essential community providers. Sec. 4243. Provider network adequacy in communities of color. VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6211 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •S 4486 IS PART 5—DENTAL Sec. 4251. Improving access to dental care. Sec. 4252. Oral health literacy and awareness campaign. Subtitle D—Advancing Health Equity Through Payment and Delivery Reform Sec. 4301. Sense of Congress. Sec. 4302. Centers for Medicare & Medicaid Services reporting and value-based programs. Sec. 4303. Development and testing of disparity reducing delivery and payment models. Sec. 4304. Diversity in Centers for Medicare and Medicaid consultation. Sec. 4305. Supporting safety net and community-based providers to compete in value-based payment systems. Subtitle E—Health Empowerment Zones Sec. 4401. Designation of health empowerment zones. Sec. 4402. Assistance to those seeking designation. Sec. 4403. Benefits of designation. Sec. 4404. Definition of Secretary. Sec. 4405. Authorization of appropriations. Subtitle F—Equitable Health Care for All Sec. 4501. Findings. Sec. 4502. Data collection and reporting. Sec. 4503. Requiring equitable health care in the hospital value-based pur- chasing program. Sec. 4504. Provision of inequitable health care as a basis for permissive exclu- sion from Medicare and State health care programs. Sec. 4505. Office for Civil Rights and Health Equity of the Department of Health and Human Services. Sec. 4506. Prohibiting discrimination in health care. Sec. 4507. Federal Health Equity Commission. Sec. 4508. Grants for hospitals to promote equitable health care and outcomes. Subtitle G—Investing in Equity Sec. 4601. Definitions. Sec. 4602. Strategy to incentivize health equity. Sec. 4603. Pay for Equity Advisory Council. TITLE V—IMPROVING HEALTH OUTCOMES FOR WOMEN, CHILDREN, AND FAMILIES Subtitle A—In General Sec. 5001. Grants to promote health for underserved communities. Subtitle B—Pregnancy Screening Sec. 5101. Pregnancy intention screening initiative demonstration program. Sec. 5102. Birth defects prevention, risk reduction, and awareness. Subtitle C—Pregnancy-Related Care Sec. 5201. Mothers and offspring mortality and morbidity awareness. VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6211 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •S 4486 IS Sec. 5202. MOMMIES. Sec. 5203. Justice for incarcerated moms. Sec. 5204. IMPACT To Save Moms Act. Sec. 5205. Protecting moms and babies against climate change. Sec. 5206. Tech to save moms. Sec. 5207. Social determinants for moms. Sec. 5208. Data to save moms. Sec. 5209. Kira Johnson Act. Sec. 5210. Moms matter. Sec. 5211. Taskforce Recommending Improvements for Unaddressed Mental Perinatal & Postpartum Health (TRIUMPH) for New Moms. Sec. 5212. Protect moms from domestic violence. Sec. 5213. Perinatal workforce. Sec. 5214. Midwives schools and programs expansion. Sec. 5215. Gestational diabetes. Sec. 5216. Consumer education campaign. Sec. 5217. Bibliographic database of systematic reviews for care of childbearing individuals and newborns. Sec. 5218. Development of interprofessional maternity care educational models and tools. Sec. 5219. Dissemination of the quality family planning guidelines. Subtitle D—Federal Agency Coordination on Maternal Health Sec. 5301. Interagency Coordinating Committee on the Promotion of Optimal Maternity Outcomes. Sec. 5302. Expansion of CDC Prevention Research Centers Program to include Centers on Optimal Maternity Outcomes. Sec. 5303. Expanding models to be tested by Center for Medicare and Medicaid Innovation to explicitly include maternity care and children’s health models. Sec. 5304. Interagency update to the quality family planning guidelines. Subtitle E—Reproductive and Sexual Health Sec. 5401. Findings; sense of Congress on urgent barriers to abortion access and vital solutions. Sec. 5402. Emergency contraception education and information programs. Sec. 5403. Access to birth control duties of pharmacies to ensure provision of FDA-approved contraception. Sec. 5404. Real education and access for healthy youth. Sec. 5405. Compassionate assistance for rape emergencies. Sec. 5406. Menstrual Equity for All Act of 2022. Sec. 5407. Additional focus area for the Office on Women’s Health. Sec. 5408. Including services furnished by certain students, interns, and resi- dents supervised by certified nurse midwives or certified mid- wives within inpatient hospital services under Medicare. Sec. 5409. Grants to professional organizations and minority-serving institu- tions to increase diversity in maternal, reproductive, and sexual health professionals. Subtitle F—Children’s Health Sec. 5501. CARING for Kids Act. Sec. 5502. End Diaper Need Act of 2022. VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6211 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •S 4486 IS Sec. 5503. Decreasing the risk factors for sudden unexpected infant death and sudden unexplained death in childhood. Subtitle G—Nutrition for Women, Children, Families Sec. 5601. Closing the meal gap. Sec. 5602. Repeal of denial of Supplemental Nutrition Assistance Program ben- efits. Subtitle H—Universal School Meals Program Sec. 5701. Short title. Sec. 5702. Effective date. Sec. 5703. Free school breakfast program. Sec. 5704. Apportionment to States. Sec. 5705. Nutritional and other program requirements. Sec. 5706. Special assistance program. Sec. 5707. Price for a paid lunch. Sec. 5708. Summer food service program for children. Sec. 5709. Summer Electronic Benefit Transfer for Children Program. Sec. 5710. Child and adult care food program. Sec. 5711. Meals and supplements for children in afterschool care. Sec. 5712. Access to local foods: farm to school program. Sec. 5713. Fresh fruit and vegetable program. Sec. 5714. Training, technical assistance, and Food Service Management Insti- tute. Sec. 5715. Reimbursement of school meal delinquent debt program. Sec. 5716. Conforming amendments. Sec. 5717. Measure of poverty. Sec. 5718. Supplemental nutrition assistance program. Sec. 5719. Higher Education Act of 1965. Sec. 5720. Elementary and Secondary Education Act of 1965. Sec. 5721. America COMPETES Act. Sec. 5722. Workforce Innovation and Opportunity Act. Sec. 5723. National Science Foundation Authorization Act of 2002. Sec. 5724. Child care and development block grant. Sec. 5725. Children’s Health Act of 2000. Sec. 5726. Juvenile justice and delinquency prevention. Subtitle I—Elder Care Sec. 5801. Expenses for household and elder care services necessary for gainful employment. Subtitle J—Miscellaneous Provisions Sec. 5901. Clarification supporting permissible use of funds for stillbirth pre- vention activities. TITLE VI—MENTAL HEALTH AND SUBSTANCE USE DISORDERS Sec. 6001. Mental health findings. Sec. 6002. Sense of Congress. Subtitle A—Access to Care and Funding Streams VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6211 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •S 4486 IS Sec. 6011. Coverage of marriage and family therapist services, mental health counselor services, substance abuse counselor services, and peer support specialist services under part B of the Medicare pro- gram. Sec. 6012. Reauthorization of Minority Fellowship Program. Sec. 6013. Additional funds for National Institutes of Health. Sec. 6014. Additional funds for National Institute on Minority Health and Health Disparities. Sec. 6015. Grants for increasing racial and ethnic minority access to high-qual- ity trauma support services and mental health care. Sec. 6016. Grants for unarmed 9–1–1 response programs. Subtitle B—Interprofessional Care Sec. 6021. Health professions competencies to address racial and ethnic mental health inequities. Sec. 6022. Interprofessional health care teams for behavioral health care. Sec. 6023. Integrated Health Care Demonstration Program. Subtitle C—Workforce Development Sec. 6031. Building an effective workforce in mental health. Sec. 6032. Pilot program to increase language access at Federally qualified health centers. Sec. 6033. Health professions competencies to address racial and ethnic minor- ity mental health disparities. Subtitle D—Children’s Mental Health Sec. 6041. Pediatric behavioral health care. Sec. 6042. Mental health in schools. Sec. 6043. Additional support for youth and young adult mental health service provision. Sec. 6044. Early intervention and prevention programs for transition-age youth. Sec. 6045. Strategies to increase access to telehealth under Medicaid and Chil- dren’s Health Insurance Program. Sec. 6046. Youth and young adult mental health promotion, prevention, inter- vention, and treatment. Sec. 6047. Study on the effects of smartphone and social media use on adoles- cents. Subtitle E—Community-Based Care Sec. 6051. Mental health at the border. Sec. 6052. Asian American, African American, Native Hawaiian, Pacific Is- lander, Indigenous, Middle Eastern and North African, and Hispanic and Latino behavioral and mental health outreach and education strategy. Subtitle F—Reports Sec. 6061. Addressing racial and ethnic mental health inequities research gaps. Sec. 6062. Research on adverse health effects associated with interactions with law enforcement. Sec. 6063. GeoAccess study. Sec. 6064. Co-occurring conditions. VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6211 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •S 4486 IS Sec. 6065. Technical correction. Subtitle G—Miscellaneous Provisions Sec. 6071. Children’s Mental Health Infrastructure Act. Sec. 6072. Mental health for Latinos. Sec. 6073. Strengthening mental health supports for BIPOC communities. Sec. 6074. STRONG support for children. Sec. 6075. Improving access to mental health. Sec. 6076. Mental Health in Schools Excellence Program. Sec. 6077. School social workers improving student success. Sec. 6078. Opioid grants to support caregivers, kinship care families, and kin- ship caregivers. TITLE VII—ADDRESSING HIGH-IMPACT MINORITY DISEASES Subtitle A—Cancer Sec. 7001. Lung cancer mortality reduction. Sec. 7002. Expansion of prostate cancer research, outreach, screening, testing, access, and treatment effectiveness. Sec. 7003. Prostate research, imaging, and men’s education. Sec. 7004. Prostate cancer detection research and education. Sec. 7005. National Prostate Cancer Council. Sec. 7006. Improved Medicaid coverage for certain breast and cervical cancer patients in the territories. Sec. 7007. Cancer prevention and treatment demonstration for ethnic and ra- cial minorities. Sec. 7008. Reducing cancer disparities within Medicare. Subtitle B—Viral Hepatitis and Liver Cancer Control and Prevention Sec. 7051. Viral hepatitis and liver cancer control and prevention. Sec. 7052. Liver cancer and disease prevention, awareness, and patient track- ing grants. Subtitle C—Acquired Bone Marrow Failure Diseases Sec. 7101. Acquired bone marrow failure diseases. Subtitle D—Cardiovascular Disease, Chronic Disease, Obesity, and Other Disease Issues Sec. 7151. Guidelines for disease screening for minority patients. Sec. 7152. CDC Wisewoman Screening Program. Sec. 7153. Report on cardiovascular care for women and minorities. Sec. 7154. Coverage of comprehensive tobacco cessation services in Medicaid, CHIP, and private health insurance. Sec. 7155. Clinical research funding for oral health. Sec. 7156. Guide on evidence-based strategies for public health department obe- sity prevention programs. Sec. 7157. Stephanie Tubbs Jones Uterine Fibroid Research and Education Act. Subtitle E—HIV/AIDS Sec. 7201. Statement of policy. Sec. 7202. Findings. VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6211 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 10 •S 4486 IS Sec. 7203. Additional funding for AIDS drug assistance program treatments. Sec. 7204. Enhancing the national HIV surveillance system. Sec. 7205. Evidence-based strategies for improving linkage to, and retention in, appropriate care. Sec. 7206. Improving entry into, and retention in, care and antiretroviral ad- herence for persons with HIV. Sec. 7207. Services to reduce HIV/AIDS in racial and ethnic minority commu- nities. Sec. 7208. Minority AIDS initiative. Sec. 7209. Health care professionals treating individuals with HIV. Sec. 7210. HIV/AIDS provider loan repayment program. Sec. 7211. Dental education loan repayment program. Sec. 7212. Reducing new HIV infections among injecting drug users. Sec. 7213. Report on impact of HIV/AIDS in vulnerable populations. Sec. 7214. National HIV/AIDS observance days. Sec. 7215. Review of all Federal and State laws, policies, and regulations re- garding the criminal prosecution of individuals for HIV-related offenses. Sec. 7216. Expanding support for condoms in prisons. Sec. 7217. Automatic reinstatement or enrollment in Medicaid for people who test positive for HIV before reentering communities. Sec. 7218. Stop HIV in prison. Sec. 7219. Transfer of funds for implementation of Ending the HIV Epidemic: A Plan for America. Sec. 7220. PrEP access and coverage. Subtitle F—Diabetes Sec. 7251. Research, treatment, and education. Sec. 7252. Research, education, and other activities. Sec. 7253. Programs to educate health providers on the causes and effects of diabetes in minority populations. Sec. 7254. Research, education, and other activities regarding diabetes in American Indian populations. Sec. 7255. Updated report on health disparities. Subtitle G—Lung Disease Sec. 7301. National asthma burden. Sec. 7302. Asthma-related activities of the Centers for Disease Control and Prevention. Sec. 7303. Influenza and pneumonia vaccination campaign. Sec. 7304. Chronic obstructive pulmonary disease. Subtitle H—Tuberculosis Sec. 7351. Elimination of all forms of tuberculosis. Sec. 7352. Additional funding for States in combating and eliminating tuber- culosis. Sec. 7353. Strengthening clinical research funding for tuberculosis. Subtitle I—Osteoarthritis and Musculoskeletal Diseases Sec. 7401. Findings. Sec. 7402. Osteoarthritis and other musculoskeletal health-related activities of the Centers for Disease Control and Prevention. VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6211 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 11 •S 4486 IS Sec. 7403. Grants for comprehensive osteoarthritis and musculoskeletal disease health education within health professions schools. Subtitle J—Sleep and Circadian Rhythm Disorders Sec. 7451. Short title; findings. Sec. 7452. Sleep and circadian rhythm disorders research activities of the Na- tional Institutes of Health. Sec. 7453. Sleep and circadian rhythm health disparities-related activities of the Centers for Disease Control and Prevention. Sec. 7454. Grants for comprehensive sleep and circadian health education with- in health professions schools. Sec. 7455. Report on impact of sleep and circadian health disorders in vulner- able and racial/ethnic populations. Subtitle K—Kidney Disease Research, Surveillance, Prevention, and Treatment Sec. 7501. Kidney disease, research, surveillance, prevention, and treatment. Sec. 7502. Kidney disease research in minority populations. Sec. 7503. Kidney disease action plan. Sec. 7504. Home dialysis and increasing end-stage renal disease treatment mo- dalities in minority communities action plan. Sec. 7505. Increasing kidney transplants in minority populations. Sec. 7506. Environmental and occupational health programs. Sec. 7507. Understanding the treatment patterns associated with providing care and treatment of kidney failure in minority populations. Sec. 7508. Improving access in underserved areas. Sec. 7509. The Jack Reynolds Memorial Medigap Expansion Act; Medigap cov- erage for beneficiaries with end-stage renal disease. Subtitle L—Diversity in Clinical Trials Sec. 7551. FDA review of clinical trial best practices. Sec. 7552. Diversifying Investigations Via Equitable Research Studies for Ev- eryone Trials Act. Sec. 7553. Clinical trial diversity. Sec. 7554. Patient experience data. Subtitle M—Additional Provisions Addressing High-Impact Minority Diseases Sec. 7601. Medicare coverage of multi-cancer early detection screening tests. Sec. 7602. Amputation Reduction and Compassion Act. Sec. 7603. Eliminating the coinsurance requirement for certain colorectal can- cer screening tests furnished under the Medicare program. Sec. 7604. Expanding the availability of medical nutrition therapy services under the Medicare program. Sec. 7605. Encouraging the development and use of DISARM antimicrobial drugs. Sec. 7606. Treat and Reduce Obesity Act. Sec. 7607. Incentives, improvements, and outreach to increase diversity in Alz- heimer’s disease research. TITLE VIII—HEALTH INFORMATION TECHNOLOGY Sec. 8001. Definitions. Subtitle A—Reducing Health Disparities Through Health IT VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6211 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 12 •S 4486 IS Sec. 8101. HRSA assistance to health centers for promotion of Health IT. Sec. 8102. Assessment of impact of Health IT on racial and ethnic minority communities; outreach and adoption of Health IT in such com- munities. Sec. 8103. Nondiscrimination and health equity in health information tech- nology. Sec. 8104. Language access in health information technology. Subtitle B—Modifications To Achieve Parity in Existing Programs Sec. 8201. Extending funding to strengthen the Health IT infrastructure in ra- cial and ethnic minority communities. Sec. 8202. Extending competitive grants for the development of loan programs to facilitate adoption of certified EHR technology by providers serving racial and ethnic minority groups. Sec. 8203. Authorization of appropriations. Subtitle C—Additional Research and Studies Sec. 8301. Data collection and assessments conducted in coordination with mi- nority-serving institutions. Sec. 8302. Study of health information technology in medically underserved communities. Sec. 8303. Assessment of use and misuse of de-identified health data. Subtitle D—Closing Gaps in Funding To Adopt Certified EHRs Sec. 8401. Extending Medicaid EHR incentive payments to rehabilitation facili- ties, long-term care facilities, and home health agencies. Sec. 8402. Extending physician assistant eligibility for Medicaid electronic health record incentive payments. Subtitle E—Expanding Access to Telehealth Services Sec. 8501. Removing geographic requirements for telehealth services. Sec. 8502. Expanding originating sites. TITLE IX—ACCOUNTABILITY AND EVALUATION Sec. 9001. Prohibition on discrimination in Federal assisted health care serv- ices and research on the basis of sex (including sexual orienta- tion, gender identity, and pregnancy, including termination of pregnancy), race, color, national origin, marital status, familial status, or disability status. Sec. 9002. Treatment of Medicare payments under title VI of the Civil Rights Act of 1964. Sec. 9003. Accountability and transparency within the Department of Health and Human Services. Sec. 9004. United States Commission on Civil Rights. Sec. 9005. Sense of Congress concerning full funding of activities to eliminate racial and ethnic health disparities. Sec. 9006. GAO and NIH reports. Sec. 9007. Investigative and enforcement actions. Sec. 9008. Federal Health Equity Commission. TITLE X—ADDRESSING SOCIAL DETERMINANTS AND IMPROVING ENVIRONMENTAL JUSTICE VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6211 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 13 •S 4486 IS Subtitle A—In General Sec. 10001. Definitions. Sec. 10002. Findings. Sec. 10003. Health impact assessments. Sec. 10004. Grant program to conduct environmental health improvement ac- tivities and to improve social determinants of health. Sec. 10005. Additional research on the relationship between the built environ- ment and the health of community residents. Sec. 10006. Environment and public health restoration. Sec. 10007. GAO report on health effects of Deepwater Horizon oil rig explo- sion in the Gulf Coast. Sec. 10008. Establish an interagency counsel and grant programs on social de- terminants of health. Sec. 10009. Correcting Hurtful and Alienating Names in Government Expres- sion (CHANGE). Sec. 10010. Andrew Kearse Accountability for Denial of Medical Care. Sec. 10011. Investing in community healing. Sec. 10012. Environmental justice mapping and data collection. Sec. 10013. Antiracism in public health. Sec. 10014. LGBTQ essential data. Sec. 10015. Social determinants accelerator. Sec. 10016. Improving social determinants of health. Subtitle B—Gun Violence Sec. 10101. Reaffirming research authority of the Centers for Disease Control and Prevention. Sec. 10102. National Violent Death Reporting System. Sec. 10103. Report on effects of gun violence on public health. Sec. 10104. Report on effects of gun violence on mental health in minority communities. SEC. 3. FINDINGS. 1 The Congress finds as follows: 2 (1) The population of racial and ethnic minori- 3 ties is expected to increase over the next few dec- 4 ades, yet racial and ethnic minorities have the poor- 5 est health status and face substantial cultural, so- 6 cial, and economic barriers to obtaining high-quality 7 health care. 8 (2) Health disparities are a function of not only 9 access to health care, but also the social deter- 10 minants of health—including the environment, the 11 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 14 •S 4486 IS physical structure of communities, nutrition and 1 food options, educational attainment, employment, 2 race, ethnicity, sex, geography, language preference, 3 immigrant or citizenship status, sexual orientation, 4 gender identity, socioeconomic status, or disability 5 status—that directly and indirectly affect the health, 6 health care, and wellness of individuals and commu- 7 nities. 8 (3) Over the next few decades, the United 9 States will face a shortage of health care providers 10 and allied health workers. 11 (4) All efforts to reduce health disparities and 12 barriers to high-quality health services require better 13 and more consistent data, and better and more con- 14 sistent collection of and access to data. 15 (5) A full range of culturally and linguistically 16 appropriate health care and public health services 17 must be available and accessible in every community. 18 (6) Racial and ethnic minorities and under- 19 served populations must be included early and equi- 20 tably in health reform innovations. 21 (7) Efforts to improve minority health have 22 been limited by inadequate resources in funding, 23 staffing, stewardship, and accountability. Targeted 24 investments that are focused on disparities elimi- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 15 •S 4486 IS nation must be made in providing care and services 1 that are community-based, including prevention and 2 policies addressing social determinants of health. 3 (8) In 2011, the Department of Health and 4 Human Services developed the HHS Action Plan to 5 Reduce Racial and Ethnic Health Disparities and 6 the National Stakeholder Strategy for Achieving 7 Health Equity, which are 2 strategic plans that rep- 8 resent the first coordinated roadmap in the United 9 States to reducing health disparities. These com- 10 prehensive plans, along with the National Prevention 11 Strategy issued by the National Prevention Council 12 of the Department of Health and Human Services, 13 Healthy People 2030, and the National Quality 14 Strategy of the Agency for Healthcare Research and 15 Quality, as well as critical resources such as the 16 2012 National Healthcare Quality and Disparities 17 Reports, will work to increase the number of people 18 in the United States who are healthy at every stage 19 of life. 20 (9) The Secretary of Health and Human Serv- 21 ices has also reviewed and advanced updated clinical 22 guidelines and developed other strategic planning 23 documents to combat health disparities with a high 24 impact on minority populations and to provide high- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 16 •S 4486 IS quality family planning services. Such guidelines and 1 documents include the National HIV/AIDS Strategy, 2 the Action Plan for the Prevention, Care, and Treat- 3 ment of Viral Hepatitis, and recommendations of the 4 Centers for Disease Control and Prevention and the 5 Office of Population Affairs. 6 (10) The Patient Protection and Affordable 7 Care Act (Public Law 111–148), as amended by the 8 Health Care and Education Reconciliation Act of 9 2010 (Public Law 111–152), represents the biggest 10 advancement for minority health in the 40 years im- 11 mediately preceding the enactment of this Act. 12 (11) The Health Information Technology for 13 Economic and Clinical Health Act, part of the 14 American Recovery and Reinvestment Act of 2009 15 (Public Law 111–5), provides that the nationwide 16 health information exchange infrastructure be devel- 17 oped and used to reduce health disparities, among 18 other purposes. 19 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 17 •S 4486 IS TITLE I—DATA COLLECTION 1 AND REPORTING 2 SEC. 1001. STRENGTHENING DATA COLLECTION, IMPROV- 3 ING DATA ANALYSIS, AND EXPANDING DATA 4 REPORTING. 5 (a) AMENDMENTS TO THE PUBLIC HEALTH SERVICE 6 ACT.— 7 (1) PURPOSE.—The purpose of the amend- 8 ments made by this subsection is to promote cul- 9 turally and linguistically appropriate data collection, 10 analysis, and reporting by race, ethnicity, sex, pri- 11 mary language, sexual orientation, disability status, 12 gender identity, age, and socioeconomic status in 13 federally supported health programs. 14 (2) AHRQ GENERAL AUTHORITIES.—Section 15 902(a) of the Public Health Service Act (42 U.S.C. 16 299a(a)) is amended— 17 (A) in paragraph (8), by striking ‘‘and’’ at 18 the end; 19 (B) in paragraph (9), by striking the pe- 20 riod at the end and inserting ‘‘; and’’; and 21 (C) by adding at the end the following: 22 ‘‘(10) cultural and linguistic competence of 23 health care services and of data collection activities 24 described under section 3101.’’. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 18 •S 4486 IS (3) OFFICE OF MINORITY HEALTH.—Section 1 1707(g)(1) of the Public Health Service Act (42 2 U.S.C. 300u–6(g)(1)) is amended by inserting ‘‘Mid- 3 dle Easterners and North Africans;’’ after 4 ‘‘Blacks;’’. 5 (4) OFFICE OF THE NATIONAL COORDINATOR 6 FOR HEALTH INFORMATION TECHNOLOGY.—Section 7 3001 of the Public Health Service Act (42 U.S.C. 8 300jj–11) is amended— 9 (A) in subsection (b)— 10 (i) in paragraph (10), by striking 11 ‘‘and’’ at the end; 12 (ii) in paragraph (11), by striking the 13 period at the end and inserting ‘‘; and’’; 14 and 15 (iii) by adding at the end the fol- 16 lowing: 17 ‘‘(12) ensures the interoperability of health in- 18 formation systems among federally conducted or 19 supported health care or public health programs, 20 State health agencies, and social service agencies.’’; 21 and 22 (B) by amending clause (vii) in subsection 23 (c)(3)(A) to read as follows: 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 19 •S 4486 IS ‘‘(vii) Strategies to enhance the use of 1 health information technology in improving 2 the quality of health care; reducing medical 3 errors; reducing health disparities and en- 4 suring the provision of equitable health 5 services; improving public health; increas- 6 ing prevention and coordination with com- 7 munity resources; ensuring interoperability 8 among federally conducted or supported 9 health care or public health programs, 10 State health agencies, and social service 11 agencies; and improving the continuity of 12 care among health care settings.’’. 13 (5) DATA COLLECTION, ANALYSIS, AND QUAL- 14 ITY.—Section 3101 of the Public Health Service Act 15 (42 U.S.C. 300kk) is amended— 16 (A) in subsections (a)(1)(A), (a)(1)(C), 17 (a)(2)(B), and (a)(2)(E), by striking ‘‘and dis- 18 ability status’’ and inserting ‘‘sexual orienta- 19 tion, gender identity, age, disability status, and 20 socioeconomic status’’; 21 (B) in subsection (a)(1), by amending sub- 22 paragraph (D) to read as follows: 23 ‘‘(D) data for additional population groups 24 if such groups can be aggregated into the data 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 20 •S 4486 IS collection standards described under paragraph 1 (2).’’; 2 (C) in subsection (a)(2)— 3 (i) in subparagraph (C)— 4 (I) in clause (i), by striking 5 ‘‘and’’ at the end; 6 (II) in clause (ii)— 7 (aa) by striking ‘‘is a minor 8 or legally incapacitated’’ and in- 9 serting ‘‘is a minor, requires as- 10 sistance with communication in 11 speech or writing, or is legally in- 12 capacitated’’; and 13 (bb) by striking the semi- 14 colon at the end and inserting ‘‘; 15 and’’; and 16 (III) by adding at the end the 17 following: 18 ‘‘(iii) collects data in a manner that is 19 culturally and linguistically appropriate;’’; 20 (ii) in subparagraph (D)(iii), by strik- 21 ing ‘‘and’’ at the end; 22 (iii) in subparagraph (E), by striking 23 the period at the end and inserting ‘‘; 24 and’’; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 21 •S 4486 IS (iv) by adding at the end the fol- 1 lowing: 2 ‘‘(F) use, where practicable, the standards 3 developed by the Health and Medicine Division 4 of the National Academies of Sciences, Engi- 5 neering, and Medicine (formerly known as the 6 ‘Institute of Medicine’) in the 2009 publication 7 titled ‘Race, Ethnicity, and Language Data: 8 Standardization for Health Care Quality Im- 9 provement’.’’; and 10 (6) in subsection (a)(3), by amending subpara- 11 graph (B) to read as follows: 12 ‘‘(B) develop interoperability and security 13 systems for data management among federally 14 conducted or supported health care or public 15 health programs, State health agencies, and so- 16 cial service agencies.’’. 17 (b) COROLLARY PROVISIONS.— 18 (1) RECOMMENDATIONS BY THE DATA COUN- 19 CIL.—The Data Council of the Department of 20 Health and Human Services, in consultation with 21 the Director of the National Center for Health Sta- 22 tistics, the Deputy Assistant Secretary for Minority 23 Health, the Deputy Assistant Secretary for Women’s 24 Health, the Administrator of the Centers for Medi- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 22 •S 4486 IS care & Medicaid, the National Coordinator for 1 Health Information Technology, and other appro- 2 priate public and private entities and officials, shall 3 make recommendations to the Secretary of Health 4 and Human Services concerning how to— 5 (A) implement the amendments made by 6 this section, while minimizing the cost and ad- 7 ministrative burdens of data collection and re- 8 porting on all parties, including patients and 9 providers; 10 (B) expand awareness among Federal 11 agencies, States, territories, Indian Tribes, 12 counties, municipalities, health providers, health 13 plans, and the general public that data collec- 14 tion, analysis, and reporting by race, ethnicity, 15 sex, primary language, sexual orientation, gen- 16 der identity, age, socioeconomic status, and dis- 17 ability status is legal and necessary to ensure 18 equity and nondiscrimination in the quality of 19 health care services; 20 (C) ensure that future patient record sys- 21 tems follow Federal standards promulgated 22 under the HITECH Act (42 U.S.C. 201 note) 23 for the collection and meaningful use of elec- 24 tronic health data on race, ethnicity, sex, pri- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 23 •S 4486 IS mary language, sexual orientation, gender iden- 1 tity, age, socioeconomic status, and disability 2 status; 3 (D) improve health and health care data 4 collection and analysis for more population 5 groups if such groups can be aggregated into 6 minimum race and ethnicity categories, includ- 7 ing exploring the feasibility of enhancing collec- 8 tion efforts in States, counties, and municipali- 9 ties for racial and ethnic groups that comprise 10 a significant proportion of the population of the 11 State, county, or municipality; 12 (E) provide researchers with greater access 13 to racial, ethnic, primary language, sex, sexual 14 orientation, gender identity, age, socioeconomic 15 status, and disability status data, subject to all 16 applicable privacy and confidentiality require- 17 ments, including HIPAA privacy and security 18 law as defined in section 3009(a) of the Public 19 Health Service Act (42 U.S.C. 300jj–19(a)); 20 (F) ensure the cultural and linguistic com- 21 petence of entities that receive Federal support 22 to collect and report data pursuant to the 23 amendments made by subsection (a); and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 24 •S 4486 IS (G) safeguard and prevent the misuse of 1 data collected under section 3101 of the Public 2 Health Service Act (42 U.S.C. 300kk), as 3 amended by subsection (a)(5). 4 (2) RULES OF CONSTRUCTION.—Nothing in 5 this section shall be construed to— 6 (A) permit the use of information collected 7 under this section or any provision amended by 8 this section in a manner that would adversely 9 affect any individual providing any such infor- 10 mation; or 11 (B) diminish any requirements on health 12 care providers to collect data, including such re- 13 quirements in effect on or after the date of en- 14 actment of this Act. 15 (3) TECHNICAL ASSISTANCE FOR THE ANALYSIS 16 OF HEALTH DISPARITY DATA.—The Secretary of 17 Health and Human Services, acting through the Di- 18 rector of the Agency for Healthcare Research and 19 Quality, and in coordination with the Assistant Sec- 20 retary for Planning and Evaluation, the Adminis- 21 trator of the Centers for Medicare & Medicaid Serv- 22 ices, the Director of the National Center for Health 23 Statistics, the Director of the National Institutes of 24 Health, and the National Coordinator for Health In- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 25 •S 4486 IS formation Technology, shall provide technical assist- 1 ance to agencies of the Department of Health and 2 Human Services in meeting Federal standards for 3 health disparity data collection and for analysis of 4 racial, ethnic, and other disparities in health and 5 health care in programs conducted or supported by 6 such agencies by— 7 (A) identifying appropriate quality assur- 8 ance mechanisms to monitor for health dispari- 9 ties; 10 (B) specifying the clinical, diagnostic, or 11 therapeutic measures which should be mon- 12 itored; 13 (C) developing new quality measures relat- 14 ing to racial and ethnic disparities and their 15 overlap with other disparity factors in health 16 and health care; 17 (D) identifying the level at which data 18 analysis should be conducted; 19 (E) sharing data with external organiza- 20 tions for research and quality improvement pur- 21 poses; and 22 (F) identifying and addressing issues relat- 23 ing to the interoperability of Federal- and 24 State-level health information systems which 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 26 •S 4486 IS undermine the ability of health-related pro- 1 grams collecting data under this section to 2 achieve the purpose described in subsection 3 (a)(1). 4 (4) REFERENCES.—Except as otherwise speci- 5 fied, any reference to the term ‘‘racial and ethnic 6 minority group’’ in any Federal regulation, guid- 7 ance, order, or document for establishment or imple- 8 mentation of any federally conducted or supported 9 health care or public health program, activity, or 10 survey shall be treated as having the definition given 11 to such term in section 1707(g) of the Public Health 12 Service Act (42 U.S.C. 300u–6(g)). 13 (5) AUTHORIZATION OF APPROPRIATIONS.—To 14 carry out this subsection, subsection (a), and the 15 amendments made by subsection (a), there are au- 16 thorized to be appropriated such sums as may be 17 necessary for each of fiscal years 2023 through 18 2027. 19 (c) ADDITIONS TO THE PUBLIC HEALTH SERVICE 20 ACT.—Title XXXIV of the Public Health Service Act, as 21 added by titles II and III of this Act, is further amended 22 by inserting after subtitle B the following: 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 27 •S 4486 IS ‘‘Subtitle C—Strengthening Data 1 Collection, Improving Data 2 Analysis, and Expanding Data 3 Reporting 4 ‘‘SEC. 3431. ESTABLISHING GRANTS FOR DATA COLLECTION 5 IMPROVEMENT ACTIVITIES. 6 ‘‘(a) IN GENERAL.—The Secretary, acting through 7 the Director of the Agency for Healthcare Research and 8 Quality and in consultation with the Deputy Assistant 9 Secretary for Minority Health, the Director of the Na- 10 tional Institutes of Health, the Assistant Secretary for 11 Planning and Evaluation, the National Coordinator for 12 Health Information Technology, and the Director of the 13 National Center for Health Statistics, shall establish a 14 technical assistance program under which the Secretary 15 provides grants to eligible entities to assist such entities 16 in complying with section 3101. 17 ‘‘(b) TYPES OF ASSISTANCE.—A grant provided 18 under this section may be used to— 19 ‘‘(1) enhance or upgrade computer technology 20 that will facilitate collection, analysis, and reporting 21 of racial, ethnic, primary language, sexual orienta- 22 tion, sex, gender identity, socioeconomic status, and 23 disability status data; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 28 •S 4486 IS ‘‘(2) improve methods for health data collection 1 and analysis, including additional population groups 2 if such groups can be aggregated into the race and 3 ethnicity categories outlined by standards developed 4 under section 3101; 5 ‘‘(3) develop mechanisms for submitting col- 6 lected data subject to any applicable privacy and 7 confidentiality regulations; 8 ‘‘(4) develop educational programs to inform 9 health plans, health providers, health-related agen- 10 cies, and the general public that data collection and 11 reporting by race, ethnicity, primary language, sex- 12 ual orientation, sex, gender identity, disability sta- 13 tus, and socioeconomic status are legal and essential 14 for eliminating health and health care disparities; 15 and 16 ‘‘(5) develop educational programs to train 17 health providers, health care organizations, health 18 plans, health-related agencies, and frontline health 19 care workers on how to collect and report 20 disaggregated data in a culturally and linguistically 21 appropriate manner. 22 ‘‘(c) ELIGIBLE ENTITY.—To be eligible for grants 23 under this section, an entity shall be a State, territory, 24 Indian Tribe, municipality, county, health provider, health 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 29 •S 4486 IS care organization, or health plan making a demonstrated 1 effort to bring data collections into compliance with sec- 2 tion 3101. 3 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 4 are authorized to be appropriated to carry out this section 5 such sums as may be necessary for each of fiscal years 6 2023 through 2027. 7 ‘‘SEC. 3432. OVERSAMPLING OF UNDERREPRESENTED 8 GROUPS IN FEDERAL HEALTH SURVEYS. 9 ‘‘(a) NATIONAL STRATEGY.— 10 ‘‘(1) IN GENERAL.—The Secretary, acting 11 through the Director of the National Center for 12 Health Statistics, and other officials within the De- 13 partment of Health and Human Services as the Sec- 14 retary determines appropriate, shall develop and im- 15 plement a sustainable national strategy for oversam- 16 pling underrepresented populations within the cat- 17 egories of race, ethnicity, sex, primary language, sex- 18 ual orientation, disability status, gender identity, 19 and socioeconomic status as determined appropriate 20 by the Secretary in Federal health surveys and pro- 21 gram data collections. Such national strategy shall 22 include a strategy for oversampling of Middle East- 23 erners and North Africans, Asian Americans, Native 24 Hawaiians, and Pacific Islanders. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 30 •S 4486 IS ‘‘(2) CONSULTATION.—In developing and imple- 1 menting a national strategy, as described in para- 2 graph (1), not later than 180 days after the date of 3 the enactment of this section, the Secretary shall— 4 ‘‘(A) consult with representatives of com- 5 munity groups, nonprofit organizations, non- 6 governmental organizations, and government 7 agencies working with underrepresented popu- 8 lations; 9 ‘‘(B) solicit the participation of representa- 10 tives from other Federal departments and agen- 11 cies, including subagencies of the Department 12 of Health and Human Services; and 13 ‘‘(C) consult on, and use as models, the 14 2014 National Health Interview Survey over- 15 sample of Native Hawaiian and Pacific Islander 16 populations, the 2016 Behavioral Risk Factor 17 Survey of Health Risk Behaviors Among Arab 18 Adults Within the State of Michigan, and the 19 2017 Behavioral Risk Factor Surveillance Sys- 20 tem oversample of American Indian and Alaska 21 Native communities. 22 ‘‘(b) PROGRESS REPORT.—Not later than 2 years 23 after the date of enactment of this section, the Secretary 24 shall submit to the Congress a progress report, which shall 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 31 •S 4486 IS include the national strategy required by subsection 1 (a)(1). 2 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To 3 carry out this section, there are authorized to be appro- 4 priated such sums as may be necessary for fiscal years 5 2023 through 2027.’’. 6 SEC. 1002. ELIMINATION OF PREREQUISITE OF DIRECT AP- 7 PROPRIATIONS FOR DATA COLLECTION AND 8 ANALYSIS. 9 Section 3101 of the Public Health Service Act (42 10 U.S.C. 300kk), as amended by section 1001(a), is further 11 amended— 12 (1) by striking subsection (h); and 13 (2) by redesignating subsection (i) as subsection 14 (h). 15 SEC. 1003. COLLECTION OF DATA FOR THE MEDICARE PRO- 16 GRAM. 17 Part A of title XI of the Social Security Act (42 18 U.S.C. 1301 et seq.) is amended by adding at the end 19 the following: 20 ‘‘COLLECTION OF DATA FOR THE MEDICARE PROGRAM 21 ‘‘SEC. 1150D. 22 ‘‘(a) REQUIREMENT.— 23 ‘‘(1) IN GENERAL.—The Commissioner of So- 24 cial Security, in consultation with the Administrator 25 of the Centers for Medicare & Medicaid Services, 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 32 •S 4486 IS shall collect data on the race, ethnicity, sex, primary 1 language, sexual orientation, gender identity, socio- 2 economic status, and disability status of all appli- 3 cants for social security benefits under title II or 4 Medicare benefits under title XVIII. 5 ‘‘(2) DATA COLLECTION STANDARDS.—In col- 6 lecting data under paragraph (1), the Commissioner 7 of Social Security shall at least use the standards 8 for data collection developed under section 3101 of 9 the Public Health Service Act or the standards de- 10 veloped by the Office of Management and Budget, 11 whichever is more disaggregated. In the event there 12 are no standards for the demographic groups listed 13 under paragraph (1), the Commissioner shall consult 14 with stakeholder groups representing the various 15 identities as well as with the Office of Minority 16 Health within the Centers for Medicare & Medicaid 17 Services to develop appropriate standards. 18 ‘‘(3) DATA FOR ADDITIONAL POPULATION 19 GROUPS.—Where practicable, the information col- 20 lected by the Commissioner of Social Security under 21 paragraph (1) shall include data for additional popu- 22 lation groups if such groups can be aggregated into 23 the race and ethnicity categories outlined by the 24 data collection standards described in paragraph (2). 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 33 •S 4486 IS ‘‘(4) COLLECTION OF DATA FOR MINORS AND 1 LEGALLY INCAPACITATED INDIVIDUALS.—With re- 2 spect to the collection of the data described in para- 3 graph (1) of applicants who are under 18 years of 4 age or otherwise legally incapacitated, the Commis- 5 sioner of Social Security shall require that— 6 ‘‘(A) such data be collected from the par- 7 ent or legal guardian of such an applicant; and 8 ‘‘(B) the primary language of the parent 9 or legal guardian of such an applicant or recipi- 10 ent be used in collecting the data. 11 ‘‘(5) QUALITY OF DATA.—The Commissioner of 12 Social Security shall periodically review the quality 13 and completeness of the data collected under para- 14 graph (1) and make adjustments as necessary to im- 15 prove both. 16 ‘‘(6) TRANSMISSION OF DATA.—Upon enroll- 17 ment in Medicare benefits under title XVIII, the 18 Commissioner of Social Security shall transmit an 19 individual’s demographic data as collected under 20 paragraph (1) to the Centers for Medicare & Med- 21 icaid Services. 22 ‘‘(7) ANALYSIS AND REPORTING OF DATA.— 23 With respect to data transmitted under paragraph 24 (5), the Administrator of the Centers for Medicare 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 34 •S 4486 IS & Medicaid Services, in consultation with the Com- 1 missioner of Social Security, shall— 2 ‘‘(A) require that such data be uniformly 3 analyzed and that such analysis be reported at 4 least annually to Congress; 5 ‘‘(B) incorporate such data in other anal- 6 ysis and reporting on health disparities and the 7 provision of inequitable health care services by 8 a health care provider, as appropriate; 9 ‘‘(C) make such data available to research- 10 ers, under the protections outlined in paragraph 11 (7); 12 ‘‘(D) provide opportunities to individuals 13 enrolled in Medicare to submit updated data; 14 and 15 ‘‘(E) ensure that the provision of assist- 16 ance or benefits to an applicant is not denied 17 or otherwise adversely affected because of the 18 failure of the applicant to provide any of the 19 data collected under paragraph (1). 20 ‘‘(8) PROTECTION OF DATA.—The Commis- 21 sioner of Social Security shall ensure (through the 22 promulgation of regulations or otherwise) that all 23 data collected pursuant to subsection (a) is pro- 24 tected— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 35 •S 4486 IS ‘‘(A) under the same privacy protections as 1 the Secretary applies to health data under the 2 regulations promulgated under section 264(c) of 3 the Health Insurance Portability and Account- 4 ability Act of 1996 (relating to the privacy of 5 individually identifiable health information and 6 other protections); and 7 ‘‘(B) from all inappropriate internal use by 8 any entity that collects, stores, or receives the 9 data, including use of such data in determina- 10 tions of eligibility (or continued eligibility) in 11 health plans, and from other inappropriate 12 uses, as defined by the Secretary. 13 ‘‘(b) RULE OF CONSTRUCTION.—Nothing in this sec- 14 tion shall be construed to permit the use of information 15 collected under this section in a manner that would ad- 16 versely affect any individual providing any such informa- 17 tion. 18 ‘‘(c) TECHNICAL ASSISTANCE.—The Secretary of 19 Health and Human Services may, either directly or by 20 grant or contract, provide technical assistance to enable 21 any entity to comply with the requirements of this section 22 or with regulations implementing this section. 23 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 24 are authorized to be appropriated to carry out this section 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 36 •S 4486 IS $500 million for 2022 and $100 million for each fiscal 1 year thereafter.’’. 2 SEC. 1004. REVISION OF HIPAA CLAIMS STANDARDS. 3 (a) IN GENERAL.—Not later than 1 year after the 4 date of enactment of this Act, the Secretary of Health and 5 Human Services shall revise the regulations promulgated 6 under part C of title XI of the Social Security Act (42 7 U.S.C. 1320d et seq.) (relating to the collection of data 8 on demographics in a health-related transaction) to re- 9 quire— 10 (1) the use, at a minimum, of standards for 11 data collection on race, ethnicity, sex, primary lan- 12 guage, sexual orientation, gender identity, age, dis- 13 ability status, and socioeconomic status developed 14 under section 3101 of the Public Health Service Act 15 (42 U.S.C. 300kk), as amended by section 16 1001(a)(5); and 17 (2) in consultation with the Office of the Na- 18 tional Coordinator for Health Information Tech- 19 nology, the designation of the appropriate racial, 20 ethnic, primary language, disability, sex, and other 21 code sets as required for claims and enrollment data. 22 (b) DISSEMINATION.—The Secretary of Health and 23 Human Services shall disseminate the new standards de- 24 veloped under subsection (a) to all entities that are subject 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00036 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 37 •S 4486 IS to the regulations described in such subsection and provide 1 technical assistance with respect to the collection of the 2 data involved. 3 (c) COMPLIANCE.—The Secretary of Health and 4 Human Services shall require that entities comply with the 5 new standards developed under subsection (a) not later 6 than 2 years after the final promulgation of such stand- 7 ards. 8 SEC. 1005. NATIONAL CENTER FOR HEALTH STATISTICS. 9 Section 306(n) of the Public Health Service Act (42 10 U.S.C. 242k(n)) is amended— 11 (1) in paragraph (1), by striking ‘‘2003’’ and 12 inserting ‘‘2024’’; 13 (2) in paragraph (2), in the first sentence, by 14 striking ‘‘2003’’ and inserting ‘‘2024’’; and 15 (3) in paragraph (3), by striking ‘‘2002’’ and 16 inserting ‘‘2024’’. 17 SEC. 1006. DISPARITIES DATA COLLECTED BY THE FED- 18 ERAL GOVERNMENT. 19 (a) REPOSITORY OF GOVERNMENT DATA.—The Sec- 20 retary of Health and Human Services, in coordination 21 with the officials referenced in subsection (b), shall estab- 22 lish a centralized electronic repository of Federal Govern- 23 ment data on factors related to the health and well-being 24 of the population of the United States. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 38 •S 4486 IS (b) COLLECTION; SUBMISSION.—Not later than 180 1 days after the date of enactment of this Act, and January 2 31 of each year thereafter, each department, agency, and 3 office of the Federal Government that has collected data 4 on race, ethnicity, sex, primary language, sexual orienta- 5 tion, gender identity, age, disability status, or socio- 6 economic status during the preceding calendar year shall 7 submit such data to the repository of Federal Government 8 data established under subsection (a). 9 (c) ANALYSIS; PUBLIC AVAILABILITY; REPORTING.— 10 Not later than April 30, 2021, and April 30 of each year 11 thereafter, the Secretary of Health and Human Services, 12 acting through the Assistant Secretary for Planning and 13 Evaluation, the Assistant Secretary for Health, the Direc- 14 tor of the Agency for Healthcare Research and Quality, 15 the Director of the National Center for Health Statistics, 16 the Administrator of the Centers for Medicare & Medicaid 17 Services, the Director of the National Institute on Minor- 18 ity Health and Health Disparities, and the Deputy Assist- 19 ant Secretary for Minority Health, shall— 20 (1) prepare and make available datasets for 21 public use that relate to disparities in health status, 22 health care access, health care quality, health out- 23 comes, public health, the provision of equitable 24 health services, and other areas of health and well- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00038 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 39 •S 4486 IS being by factors that include race, ethnicity, sex, pri- 1 mary language, sexual orientation, gender identity, 2 disability status, and socioeconomic status; 3 (2) ensure that these datasets are publicly iden- 4 tified on the repository established under subsection 5 (a) as ‘‘disparities’’ data; and 6 (3) submit a report to the Congress on the 7 availability and use of such data by public stake- 8 holders. 9 SEC. 1007. DATA COLLECTION AND ANALYSIS GRANTS TO 10 MINORITY-SERVING INSTITUTIONS. 11 (a) AUTHORITY.—The Secretary of Health and 12 Human Services, acting through the Director of the Na- 13 tional Institute on Minority Health and Health Disparities 14 and the Deputy Assistant Secretary for Minority Health, 15 shall award grants to eligible entities to access and analyze 16 racial and ethnic data on disparities in health and health 17 care, and where possible other data on disparities in health 18 and health care, to monitor and report on progress to re- 19 duce and eliminate disparities in health and health care. 20 (b) ELIGIBLE ENTITY.—In this section, the term ‘‘el- 21 igible entity’’ means an entity that has an accredited pub- 22 lic health, health policy, or health services research pro- 23 gram and is any of the following: 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 40 •S 4486 IS (1) A part B institution, as defined in section 1 322 of the Higher Education Act of 1965 (20 2 U.S.C. 1061). 3 (2) A Hispanic-serving institution, as defined in 4 section 502 of such Act (20 U.S.C. 1101a). 5 (3) A Tribal College or University, as defined in 6 section 316 of such Act (20 U.S.C. 1059c). 7 (4) An Asian American and Native American 8 Pacific Islander-serving institution, as defined in 9 section 371(c) of such Act (20 U.S.C. 1067q(c)). 10 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 11 out this section, there are authorized to be appropriated 12 such sums as may be necessary for fiscal years 2023 13 through 2027. 14 SEC. 1008. SAFETY AND EFFECTIVENESS OF DRUGS WITH 15 RESPECT TO RACIAL AND ETHNIC BACK- 16 GROUND. 17 (a) IN GENERAL.—Chapter V of the Federal Food, 18 Drug, and Cosmetic Act (21 U.S.C. 351 et seq.) is amend- 19 ed by inserting after section 505G (21 U.S.C. 355h) the 20 following: 21 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 41 •S 4486 IS ‘‘SEC. 505H. SAFETY AND EFFECTIVENESS OF DRUGS WITH 1 RESPECT TO RACIAL AND ETHNIC BACK- 2 GROUND. 3 ‘‘(a) PREAPPROVAL STUDIES.—If there is evidence of 4 a racial or ethnic disparity in safety or effectiveness with 5 respect to a drug or biological product, then— 6 ‘‘(1)(A) in the case of a drug, the investigations 7 required under section 505(b)(1)(A) shall include 8 adequate and well-controlled investigations of the 9 disparity; or 10 ‘‘(B) in the case of a biological product, the evi- 11 dence required under section 351(a) of the Public 12 Health Service Act for approval of a biologics license 13 application for the biological product shall include 14 adequate and well-controlled investigations of the 15 disparity; and 16 ‘‘(2) if the investigations described in subpara- 17 graph (A) or (B) of paragraph (1) confirm that 18 there is such a disparity, the labeling of the drug or 19 biological product shall include appropriate informa- 20 tion about the disparity. 21 ‘‘(b) POSTMARKET STUDIES.— 22 ‘‘(1) IN GENERAL.—If there is evidence of a ra- 23 cial or ethnic disparity in safety or effectiveness with 24 respect to a drug for which there is an approved ap- 25 plication under section 505 of this Act or of a bio- 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 42 •S 4486 IS logical product for which there is an approved li- 1 cense under section 351 of the Public Health Service 2 Act, the Secretary may by order require the holder 3 of the approved application or license to conduct, by 4 a date specified by the Secretary, postmarket studies 5 to investigate the disparity. 6 ‘‘(2) LABELING.—If the Secretary determines 7 that the postmarket studies confirm that there is a 8 disparity described in paragraph (1), the labeling of 9 the drug or biological product shall include appro- 10 priate information about the disparity. 11 ‘‘(3) STUDY DESIGN.—The Secretary may, in 12 an order under paragraph (1), specify all aspects of 13 the design of the postmarket studies required under 14 such paragraph for a drug or biological product, in- 15 cluding the number of studies and study partici- 16 pants, and the other demographic characteristics of 17 the study participants. 18 ‘‘(4) MODIFICATIONS OF STUDY DESIGN.—The 19 Secretary may, by order and as necessary, modify 20 any aspect of the design of a postmarket study re- 21 quired in an order under paragraph (1) after issuing 22 such order. 23 ‘‘(5) STUDY RESULTS.—The results from a 24 study required under paragraph (1) shall be sub- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 43 •S 4486 IS mitted to the Secretary as a supplement to the drug 1 application or biologics license application. 2 ‘‘(c) APPLICATIONS UNDER SECTION 505(j).— 3 ‘‘(1) IN GENERAL.—A drug for which an appli- 4 cation has been submitted or approved under section 5 505(j) shall not be considered ineligible for approval 6 under that section or misbranded under section 502 7 on the basis that the labeling of the drug omits in- 8 formation relating to a disparity on the basis of ra- 9 cial or ethnic background as to the safety or effec- 10 tiveness of the drug, whether derived from investiga- 11 tions or studies required under this section or de- 12 rived from other sources, when the omitted informa- 13 tion is protected by patent or by exclusivity under 14 section 505(j)(5)(F). 15 ‘‘(2) LABELING.—Notwithstanding paragraph 16 (1), the Secretary may require that the labeling of 17 a drug approved under section 505(j) that omits in- 18 formation relating to a disparity on the basis of ra- 19 cial or ethnic background as to the safety or effec- 20 tiveness of the drug include a statement of any ap- 21 propriate contraindications, warnings, or precautions 22 related to the disparity that the Secretary considers 23 necessary. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 44 •S 4486 IS ‘‘(d) DEFINITION.—In this section, the term ‘evi- 1 dence of a racial or ethnic disparity in safety or effective- 2 ness’, with respect to a drug or biological product, in- 3 cludes— 4 ‘‘(1) evidence that there is a disparity on the 5 basis of racial or ethnic background as to safety or 6 effectiveness of a drug or biological product in the 7 same chemical class as the drug or biological prod- 8 uct; 9 ‘‘(2) evidence that there is a disparity on the 10 basis of racial or ethnic background in the way the 11 drug or biological product is metabolized; and 12 ‘‘(3) other evidence as the Secretary may deter- 13 mine appropriate.’’. 14 (b) ENFORCEMENT.—Section 502 of the Federal 15 Food, Drug, and Cosmetic Act (21 U.S.C. 352) is amend- 16 ed by adding at the end the following: 17 ‘‘(gg) If it is a drug and the holder of the approved 18 application under section 505 or license under section 351 19 of the Public Health Service Act for the drug has failed 20 to complete the investigations or studies required under 21 section 505H, or comply with any other requirement of 22 such section 505H.’’. 23 (c) DRUG FEES.—Section 736(a)(1)(A)(ii) of the 24 Federal Food, Drug, and Cosmetic Act (21 U.S.C. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 45 •S 4486 IS 379h(a)(1)(A)(ii)) is amended by inserting after ‘‘are not 1 required’’ the following: ‘‘, including postmarket studies 2 required under section 505H,’’. 3 SEC. 1009. IMPROVING HEALTH DATA REGARDING NATIVE 4 HAWAIIANS AND PACIFIC ISLANDERS. 5 Part B of title III of the Public Health Service Act 6 (42 U.S.C. 243 et seq.) is amended by inserting after sec- 7 tion 317U the following: 8 ‘‘SEC. 317V. NATIVE HAWAIIAN AND PACIFIC ISLANDER 9 HEALTH DATA. 10 ‘‘(a) DEFINITIONS.—In this section: 11 ‘‘(1) INSULAR AREA.—The term ‘insular area’ 12 means Guam, the Commonwealth of the Northern 13 Mariana Islands, American Samoa, the United 14 States Virgin Islands, the Federated States of Mi- 15 cronesia, the Republic of Palau, or the Republic of 16 the Marshall Islands. 17 ‘‘(2) NATIVE HAWAIIANS AND PACIFIC ISLAND- 18 ERS (NHPI).—The term ‘Native Hawaiians and Pa- 19 cific Islanders’ or ‘NHPI’ means people having ori- 20 gins in any of the original peoples of American 21 Samoa, the Commonwealth of the Northern Mariana 22 Islands, the Federated States of Micronesia, Guam, 23 Hawaii, the Republic of the Marshall Islands, the 24 Republic of Palau, or any other Pacific Island. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 46 •S 4486 IS ‘‘(3) NHPI STAKEHOLDER GROUPS.—The term 1 ‘NHPI stakeholder group’ includes each of the fol- 2 lowing: 3 ‘‘(A) COMMUNITY GROUP.—A group of 4 NHPI who are organized at the community 5 level, and may include a church group, social 6 service group, national advocacy organization, 7 or cultural group. 8 ‘‘(B) NONPROFIT, NONGOVERNMENTAL 9 ORGANIZATION.—A group of NHPI with a dem- 10 onstrated history of addressing NHPI issues, 11 including a NHPI coalition. 12 ‘‘(C) DESIGNATED ORGANIZATION.—An 13 entity established to represent NHPI popu- 14 lations and which has statutory responsibilities 15 to provide, or has community support for pro- 16 viding, health care. 17 ‘‘(D) GOVERNMENT REPRESENTATIVES OF 18 NHPI POPULATIONS.—Representatives from Ha- 19 waii, American Samoa, the Commonwealth of 20 the Northern Mariana Islands, the Federated 21 States of Micronesia, Guam, the Republic of 22 Palau, and the Republic of the Marshall Is- 23 lands. 24 ‘‘(b) PRELIMINARY HEALTH SURVEY.— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 47 •S 4486 IS ‘‘(1) IN GENERAL.—The Secretary, acting 1 through the Director of the National Center for 2 Health Statistics of the Centers for Disease Control 3 and Prevention (referred to in this section as 4 ‘NCHS’), shall conduct a preliminary health survey 5 in order to identify the major areas and regions in 6 the continental United States, Hawaii, American 7 Samoa, the Commonwealth of the Northern Mariana 8 Islands, the Federated States of Micronesia, Guam, 9 the Republic of Palau, and the Republic of the Mar- 10 shall Islands in which NHPI people reside. 11 ‘‘(2) CONTENTS.—The health survey described 12 in paragraph (1) shall include health data and any 13 other data the Secretary determines to be— 14 ‘‘(A) useful in determining health status 15 and health care needs of NHPI populations; or 16 ‘‘(B) required for developing or imple- 17 menting the national strategy under subsection 18 (c). 19 ‘‘(3) METHODOLOGY.—Methodology for the 20 health survey described in paragraph (1), including 21 plans for designing questions, implementation, sam- 22 pling, and analysis, shall be developed in consulta- 23 tion with NHPI stakeholder groups. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00047 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 48 •S 4486 IS ‘‘(4) TIMEFRAME.—The survey required under 1 this subsection shall be completed not later than 18 2 months after the date of enactment of the Health 3 Equity and Accountability Act of 2022. 4 ‘‘(c) NATIONAL STRATEGY.— 5 ‘‘(1) IN GENERAL.—The Secretary, acting 6 through the Director of the NCHS and other agen- 7 cies within the Department of Health and Human 8 Services as the Secretary determines appropriate, 9 shall develop and implement a sustainable national 10 strategy for identifying and evaluating the health 11 status and health care needs of NHPI populations 12 living in the continental United States, Hawaii, 13 American Samoa, the Commonwealth of the North- 14 ern Mariana Islands, the Federated States of Micro- 15 nesia, Guam, the Republic of Palau, and the Repub- 16 lic of the Marshall Islands. 17 ‘‘(2) CONSULTATION.—In developing and imple- 18 menting a national strategy, as described in para- 19 graph (1), not later than 180 days after the date of 20 enactment of the Health Equity and Accountability 21 Act of 2022, the Secretary— 22 ‘‘(A) shall consult with representatives of 23 NHPI stakeholder groups; and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 49 •S 4486 IS ‘‘(B) may solicit the participation of rep- 1 resentatives from other Federal agencies. 2 ‘‘(d) PROGRESS REPORT.—Not later than 2 years 3 after the date of enactment of the Health Equity and Ac- 4 countability Act of 2022, the Secretary shall submit to 5 Congress a progress report, which shall include the na- 6 tional strategy described in subsection (c)(1). 7 ‘‘(e) STUDY AND REPORT BY THE HEALTH AND 8 MEDICINE DIVISION.— 9 ‘‘(1) IN GENERAL.—The Secretary shall seek to 10 enter into an agreement with the Health and Medi- 11 cine Division of the National Academies of Sciences, 12 Engineering, and Medicine to conduct a study, with 13 input from stakeholders in insular areas, on each of 14 the following: 15 ‘‘(A) The standards and definitions of 16 health care applied to health care systems in in- 17 sular areas and the appropriateness of such 18 standards and definitions. 19 ‘‘(B) The status and performance of health 20 care systems in insular areas, evaluated based 21 upon standards and definitions, as the Sec- 22 retary determines appropriate. 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00049 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 50 •S 4486 IS ‘‘(C) The effectiveness of donor aid in ad- 1 dressing health care needs and priorities in in- 2 sular areas. 3 ‘‘(D) The progress toward implementation 4 of recommendations of the Committee on 5 Health Care Services in the United States—As- 6 sociated Pacific Basin that are set forth in the 7 1998 report entitled ‘Pacific Partnerships for 8 Health: Charting a New Course’. 9 ‘‘(2) REPORT.—An agreement described in 10 paragraph (1) shall require the Health and Medicine 11 Division to submit to the Secretary and to Congress, 12 not later than 2 years after the date of the enact- 13 ment of the Health Equity and Accountability Act of 14 2022, a report containing a description of the results 15 of the study conducted under paragraph (1), includ- 16 ing the conclusions and recommendations of the 17 Health and Medicine Division for each of the items 18 described in subparagraphs (A) through (D) of such 19 paragraph. 20 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To 21 carry out this section, there are authorized to be appro- 22 priated such sums as may be necessary for fiscal years 23 2023 through 2027.’’. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 51 •S 4486 IS SEC. 1010. CLARIFICATION OF SIMPLIFIED ADMINISTRA- 1 TIVE REPORTING REQUIREMENT. 2 Section 11(a) of the Food and Nutrition Act of 2008 3 (7 U.S.C. 2020(a)) is amended by adding at the end the 4 following: 5 ‘‘(5) SIMPLIFIED ADMINISTRATIVE REPORTING 6 REQUIREMENT.—With respect to any obligation of a 7 State agency to comply with the notification require- 8 ment under paragraph (2) of section 421(e) of the 9 Personal Responsibility and Work Opportunity Rec- 10 onciliation Act of 1996 (8 U.S.C. 1631(e)), notwith- 11 standing the requirement to include in that notifica- 12 tion the names of the sponsor and the sponsored 13 alien involved, the State agency shall be considered 14 to have complied with the notification requirement if 15 the State agency submits to the Attorney General a 16 report that includes the aggregate number of excep- 17 tions granted by the State agency under paragraph 18 (1) of that section.’’. 19 SEC. 1011. DATA COLLECTION REGARDING PANDEMIC PRE- 20 PAREDNESS, TESTING, INFECTIONS, AND 21 DEATHS. 22 (a) SKILLED NURSING FACILITIES QUALITY RE- 23 PORTING.—Section 1819 of the Social Security Act (42 24 U.S.C. 1395i–3) is amended by adding at the end the fol- 25 lowing new subsection: 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 52 •S 4486 IS ‘‘(l) REQUIREMENTS RELATING TO REPORTING DUR- 1 ING PUBLIC HEALTH EMERGENCIES.—During a public 2 health emergency declared by the Secretary pursuant to 3 section 319 of the Public Health Service Act, a skilled 4 nursing facility shall, not later than one year after the first 5 day of such declaration, and monthly thereafter during the 6 application of such declaration, submit to the Secretary 7 the following information, with respect to such facility and 8 the residents of such facility: 9 ‘‘(1) Information described in section 10 483.80(g)(1) of title 42, Code of Federal Regula- 11 tions. 12 ‘‘(2) The age, race, ethnicity, sex, sexual ori- 13 entation, gender identity, socioeconomic status, dis- 14 ability status, and preferred language of the resi- 15 dents of such skilled nursing facility.’’. 16 (b) TRANSPARENCY OF DEMOGRAPHIC INFORMATION 17 IN CERTAIN SETTINGS.— 18 (1) DEMOGRAPHIC INFORMATION.—The Sec- 19 retary of Health and Human Services shall post the 20 following information with respect to skilled nursing 21 facilities (as defined in section 1819(a) of the Social 22 Security Act (42 U.S.C. 1395i–3(a))), congregate 23 care settings (including skilled nursing facilities, as- 24 sisted living facilities, prisons and jails, residential 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00052 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 53 •S 4486 IS behavioral health care and psychiatric facilities, and 1 facilities providing services for aging adults and peo- 2 ple with disabilities), and nursing facilities (as de- 3 fined in section 1919(a) of such Act (42 U.S.C. 4 1396r(a))) on the Nursing Home Compare website 5 (as described in section 1819(i) of the Social Secu- 6 rity Act (42 U.S.C. 1395i–3(i))), or a successor 7 website, aggregated by State: 8 (A) The age, race, ethnicity, sex, sexual 9 orientation, gender identity, socioeconomic sta- 10 tus, disability status, and preferred language of 11 the residents of such skilled nursing facilities, 12 congregate care settings (including skilled nurs- 13 ing facilities, assisted living facilities, prisons 14 and jails, residential behavioral health care and 15 psychiatric facilities, and facilities providing 16 services for aging adults and people with dis- 17 abilities), and nursing facilities with suspected 18 or confirmed infections, including residents pre- 19 viously treated for COVID–19. 20 (B) The age, race, ethnicity, sex, sexual 21 orientation, gender identity, socioeconomic sta- 22 tus, disability status, and preferred language 23 relating to total deaths and public health emer- 24 gency-related deaths among residents of such 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00053 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 54 •S 4486 IS skilled nursing facilities, congregate settings 1 (including skilled nursing facilities, assisted liv- 2 ing facilities, prisons and jails, residential be- 3 havioral health care and psychiatric facilities, 4 and facilities providing services for aging adults 5 and people with disabilities), and nursing facili- 6 ties. 7 (2) CONFIDENTIALITY.—Any information re- 8 ported under this subsection that is made available 9 to the public shall be made so available in a manner 10 that protects the identity of residents of skilled nurs- 11 ing facilities, congregate care settings (including 12 skilled nursing facilities, assisted living facilities, 13 prisons and jails, residential behavioral health care 14 and psychiatric facilities, and facilities providing 15 services for aging adults and people with disabil- 16 ities), and nursing facilities. 17 (3) IMPLEMENTATION.—Notwithstanding any 18 other provision of law, the Secretary of Health and 19 Human Services may implement the provisions of 20 this subsection by program instruction or otherwise. 21 (c) EQUITABLE DATA COLLECTION AND DISCLOSURE 22 REGARDING PANDEMICS.—Part A of title XI of the Social 23 Security Act (42 U.S.C. 1301 et seq.) as amended by sec- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 55 •S 4486 IS tion 1003, is further amended by adding at the end the 1 following new section: 2 ‘‘SEC. 1150E. EQUITABLE DATA COLLECTION AND DISCLO- 3 SURE REGARDING PANDEMICS. 4 ‘‘(a) IN GENERAL.—Not later than 60 days after the 5 Secretary submits to Congress written notification of the 6 determination that a disease or disorder presents a public 7 health emergency or that a public health emergency other- 8 wise exists, subject to the succeeding subsections, the Sec- 9 retary, acting through the Director of the Centers for Dis- 10 ease Control and Prevention and the Administrator of the 11 Centers for Medicare & Medicaid Services and in consulta- 12 tion with the Director of the Indian Health Service, shall 13 collect and make publicly available on the website of the 14 Centers for Disease Control and Prevention and the Cen- 15 ters for Medicare & Medicaid Services, and update every 16 day during a pandemic, data collected across all surveil- 17 lance systems relating to a public health emergency de- 18 clared under section 319 of the Public Health Service Act 19 that is caused by a disease (as determined by the Sec- 20 retary), disaggregated by race, ethnicity, sex, sexual ori- 21 entation, gender identity, age, preferred language, socio- 22 economic status, disability status, and county, including 23 the following: 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00055 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 56 •S 4486 IS ‘‘(1) Data relating to all testing for the patho- 1 gen or pathogens causing the pandemic, including 2 the number of individuals tested and the number of 3 tests that were positive. 4 ‘‘(2) Data relating to treatment for the patho- 5 gen causing the pandemic, including hospitalizations 6 and intensive care unit admissions. 7 ‘‘(3) Data relating to pandemic outcomes, in- 8 cluding total fatalities and case fatality rates (ex- 9 pressed as the proportion of individuals who were in- 10 fected with the pathogen causing the pandemic and 11 died from the pathogen). 12 ‘‘(4) In the case a vaccine is developed in re- 13 sponse to a pandemic, data relating to such vaccina- 14 tion, including— 15 ‘‘(A) the number of vaccines administered; 16 ‘‘(B) the number of vaccinations offered, 17 accepted, and refused; 18 ‘‘(C) the most common reasons for refusal; 19 and 20 ‘‘(D) the percentage of vaccine doses allo- 21 cated and administered to each priority group. 22 ‘‘(b) APPLICATION OF CERTAIN STANDARDS WITH 23 RESPECT TO DATA COLLECTION.—To the extent prac- 24 ticable, data collected under subsection (a) shall follow 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00056 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 57 •S 4486 IS standards developed by the Department of Health and 1 Human Services Office of Minority Health and be col- 2 lected, analyzed, and reported in accordance with the 3 standards promulgated by the Assistant Secretary for 4 Planning and Evaluation under title XXXI of the Public 5 Health Service Act. 6 ‘‘(c) PRIVACY.—In publishing data pursuant to sub- 7 section (a), the Secretary shall take all necessary steps to 8 protect the privacy of individuals whose information is in- 9 cluded in such data, including— 10 ‘‘(1) complying with privacy protections pro- 11 vided under the regulations promulgated under sec- 12 tion 264(c) of the Health Insurance and Account- 13 ability Act of 1996; and 14 ‘‘(2) protections from all inappropriate internal 15 use by an entity that collects, stores, or receives the 16 data, including use of such data in determinations of 17 eligibility (or continued eligibility) in health plans, 18 and from inappropriate uses.’’. 19 (d) REPORT REQUIREMENTS FOLLOWING PUBLIC 20 HEALTH EMERGENCIES.— 21 (1) PUBLICLY AVAILABLE SUMMARY.—Not later 22 than 60 days after the date on which the Secretary 23 of Health and Human Services certifies that a public 24 health emergency declared under section 319 of the 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00057 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 58 •S 4486 IS Public Health Service Act has ended, the Secretary 1 shall make publicly available on the website of the 2 Department of Health and Human Services a sum- 3 mary of the final statistics related to such emer- 4 gency. 5 (2) REPORT TO CONGRESS.—Not later than 60 6 days after the date on which the Secretary of Health 7 and Human Services certifies that a public health 8 emergency declared under section 319 of the Public 9 Health Service Act has ended, the Secretary shall 10 submit to the Committee on Health, Education, 11 Labor, and Pensions and the Committee on Finance 12 of the Senate and the Committee on Energy and 13 Commerce and the Committee on Ways and Means 14 of the House of Representatives a report— 15 (A) describing the testing, hospitalization, 16 mortality rates, vaccination rates, and preferred 17 language of patients associated with the pan- 18 demic by race and ethnicity, rural and urban 19 areas (as defined in section 1886(d)(2)(D) of 20 the Social Security Act (42 U.S.C. 21 1395ww(d)(2)(D)), and congregate care set- 22 tings (including skilled nursing facilities, as- 23 sisted living facilities, prisons and jails, residen- 24 tial behavioral health care and psychiatric facili- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00058 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 59 •S 4486 IS ties, and facilities providing services for aging 1 adults and people with disabilities) and noncon- 2 gregate care settings (as such terms are defined 3 by the Secretary); and 4 (B) proposing evidenced-based response 5 strategies to safeguard the health of these com- 6 munities in future pandemics. 7 SEC. 1012. COMMISSION ON ENSURING DATA FOR HEALTH 8 EQUITY. 9 (a) IN GENERAL.—Not later than 30 days after the 10 date of enactment of this Act, the Secretary of Health and 11 Human Services (referred to in this section as the ‘‘Sec- 12 retary’’) shall establish a commission, to be known as the 13 ‘‘Commission on Ensuring Data for Health Equity’’ (re- 14 ferred to in this section as the ‘‘Commission’’) to provide 15 clear and robust guidance to improve the collection, anal- 16 ysis, and use of demographic data in responding to future 17 public health emergencies. 18 (b) MEMBERSHIP AND CHAIRPERSON.— 19 (1) MEMBERSHIP.—The Commission shall be 20 composed of— 21 (A) the Assistant Secretary for Prepared- 22 ness and Response; 23 (B) the Director of the Centers for Disease 24 Control and Prevention; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00059 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 60 •S 4486 IS (C) the Director of the National Institutes 1 of Health; 2 (D) the Commissioner of Food and Drugs; 3 (E) the Administrator of the Federal 4 Emergency Management Agency; 5 (F) the Director of the National Institute 6 on Minority Health and Health Disparities; 7 (G) the Director of the Indian Health 8 Service; 9 (H) the Administrator of the Centers for 10 Medicare & Medicaid Services; 11 (I) the Director of the Agency for 12 Healthcare Research and Quality; 13 (J) the Surgeon General; 14 (K) the Administrator of the Health Re- 15 sources and Services Administration; 16 (L) the Director of the Office of Minority 17 Health; 18 (M) the Director of the Office of Women’s 19 Health; 20 (N) the Chairperson of the National Coun- 21 cil on Disability; 22 (O) at least 4 State, local, territorial, and 23 Tribal public health officials representing de- 24 partments of public health, or an Urban Indian 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00060 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 61 •S 4486 IS health representative, who shall represent juris- 1 dictions from different regions of the United 2 States with relatively high concentrations of 3 historically marginalized populations and rural 4 populations, to be appointed by the Secretary; 5 (P) the National Coordinator for Health 6 Information Technology; 7 (Q) at least 3 independent individuals with 8 expertise on racially and ethnically diverse rep- 9 resentation with knowledge or field experience 10 with community-based participatory research on 11 racial and ethnic disparities in public health, to 12 be appointed by the Secretary; and 13 (R) at least 4 individuals with expertise on 14 health equity and demographic data disparities 15 with knowledge of, or field experience in, lan- 16 guage, disability status, sex, sexual orientation, 17 gender identity, or socioeconomic status. 18 (2) CHAIRPERSON.—The Assistant Secretary 19 for Preparedness and Response shall serve as the 20 Chairperson of the Commission. 21 (c) DUTIES.—The Commission shall— 22 (1) examine barriers to collecting, analyzing, 23 and using demographic data in public health; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00061 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 62 •S 4486 IS (2) determine how to best use such data to pro- 1 mote health equity across the United States and re- 2 duce racial, Tribal, and other demographic dispari- 3 ties in health outcomes; 4 (3)(A) gather available data related to treat- 5 ment of individuals with disabilities during the 6 COVID–19 pandemic and other public health emer- 7 gencies, including access to vaccinations, denial of 8 treatment for preexisting conditions, removal or de- 9 nial of disability related equipment (including ven- 10 tilators and continuous positive airway pressure 11 (commonly referred to as ‘‘CPAP’’) machines), and 12 data on completion of do-not-resuscitate orders; and 13 (B) identify barriers to obtaining accurate and 14 timely data related to treatment of such individuals; 15 (4) solicit input from public health officials, 16 community-connected organizations, health care pro- 17 viders, State and local agency officials, Tribal offi- 18 cials, and other experts on barriers to, and best 19 practices for, collecting demographic data; and 20 (5) recommend policy changes that the data in- 21 dicates are necessary to reduce demographic dispari- 22 ties in health outcomes. 23 (d) REPORT.—Not later than 1 year after the date 24 of the enactment of this Act, the Commission shall submit 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00062 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 63 •S 4486 IS to Congress, and publish on the website of the Department 1 of Health and Human Services, a report containing— 2 (1) the findings of the Commission pursuant to 3 subsection (c); 4 (2) to the extent possible, an analysis of— 5 (A) racial and other demographic dispari- 6 ties in COVID–19 mortality, including an anal- 7 ysis of comorbidities and case fatality rates; 8 (B) sex, sexual orientation, and gender 9 identity disparities in COVID–19 treatment and 10 mortality; and 11 (C) Federal Government policies that dis- 12 parately exacerbate the COVID–19 impact, and 13 recommendations to improve racial and other 14 demographic disparities in health outcomes; 15 (3) an analysis of COVID–19 treatment of indi- 16 viduals with disabilities, including equity of access to 17 treatment and equipment and intersections of dis- 18 ability status with other demographic factors, includ- 19 ing race; 20 (4) an analysis of what demographic data is 21 currently being collected, the accuracy of that data 22 and any gaps, how this data is currently being used 23 to inform efforts to combat COVID–19, and what 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00063 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 64 •S 4486 IS resources are needed to supplement existing public 1 health data collection; and 2 (5) the Commission’s recommendations with re- 3 spect to— 4 (A) how to enhance State, local, territorial, 5 and Tribal capacity to conduct public health re- 6 search on COVID–19 and in future public 7 health emergencies, with a focus on expanded 8 capacity to analyze data on disparities cor- 9 related with race, ethnicity, income, sex, sexual 10 orientation, gender identity, age, disability sta- 11 tus, specific geographic areas, and other rel- 12 evant demographic characteristics; 13 (B) how to collect, process, and disclose to 14 the public the data described in subparagraph 15 (A) in a way that maintains individual privacy 16 while helping direct the State, local, and Tribal 17 response to public health emergencies; 18 (C) how to improve demographic data col- 19 lection related to COVID–19 and other public 20 health emergencies in the short-term and long- 21 term, including how to continue to grow and 22 value the Tribal sovereignty of data and infor- 23 mation concerning urban and rural Tribal com- 24 munities; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00064 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 65 •S 4486 IS (D) how to improve transparency and eq- 1 uity of treatment for individuals with disabil- 2 ities during the COVID–19 public health emer- 3 gency and future public health emergencies; and 4 (E) how to support State, local, and Tribal 5 capacity to eliminate barriers to vaccinations, 6 testing, and treatment during the COVID–19 7 public health emergency and future public 8 health emergencies. 9 (e) STAFF OF COMMISSION.— 10 (1) ADDITIONAL STAFF.—The Chairperson of 11 the Commission may appoint and fix the pay of ad- 12 ditional staff to the Commission as the Chairperson 13 considers appropriate. 14 (2) APPLICABILITY OF CERTAIN CIVIL SERVICE 15 LAWS.—The staff of the Commission may be ap- 16 pointed without regard to the provisions of title 5, 17 United States Code, governing appointments in the 18 competitive service, and may be paid without regard 19 to the provisions of chapter 51 and subchapter III 20 of chapter 53 of that title relating to classification 21 and General Schedule pay rates. 22 (3) DETAILEES.—Any Federal Government em- 23 ployee may be detailed to the Commission without 24 reimbursement from the Commission, and the 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00065 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 66 •S 4486 IS detailee shall retain the rights, status, and privileges 1 of his or her regular employment without interrup- 2 tion. 3 (f) COORDINATION WITH OTHER EFFORTS.—The 4 Secretary shall, in establishing the Commission under this 5 section, take such steps as may be necessary to ensure 6 that the work of the Commission does not overlap with, 7 or otherwise duplicate, other Federal Government efforts 8 with respect to ensuring health equity in data collection 9 in public health emergencies. 10 (g) AUTHORIZATION OF APPROPRIATIONS.—There 11 are authorized to be appropriated such sums as may be 12 necessary to carry out this section. 13 SEC. 1013. TASK FORCE ON PREVENTING BIAS IN AI AND 14 ALGORITHMS. 15 (a) IN GENERAL.—Not later than 30 days after the 16 date of enactment of this Act, the Secretary of Health and 17 Human Services (referred to in this section as the ‘‘Sec- 18 retary’’) shall establish a Task Force to be known as the 19 ‘‘Task Force on Preventing AI and Algorithmic Bias in 20 Healthcare’’ (referred to in this section as the ‘‘Task 21 Force’’) to provide clear and robust guidance on how to 22 ensure that the development and integration of artificial 23 intelligence and algorithmic technologies within the health 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00066 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 67 •S 4486 IS care service delivery process does not exacerbate health 1 disparities and expands access to health care services. 2 (b) MEMBERSHIP AND CHAIRPERSON.— 3 (1) MEMBERSHIP.—The Task Force shall be 4 composed of— 5 (A) the Chief Information Officer of the 6 Department of Health and Human Services; 7 (B) the Director of the Centers for Disease 8 Control and Prevention; 9 (C) the Director of the National Institutes 10 of Health; 11 (D) the Commissioner of Food and Drugs; 12 (E) the Administrator of the Federal 13 Emergency Management Agency; 14 (F) the Director of the National Institute 15 on Minority Health and Health Disparities; 16 (G) the Director of the Indian Health 17 Service; 18 (H) the Administrator of the Centers for 19 Medicare & Medicaid Services; 20 (I) the Director of the Agency for 21 Healthcare Research and Quality; 22 (J) the Surgeon General; 23 (K) the Administrator of the Health Re- 24 sources and Services Administration; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00067 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 68 •S 4486 IS (L) the Director of the Office of Minority 1 Health; 2 (M) the Director of the Office of Women’s 3 Health; 4 (N) the Chairperson of the National Coun- 5 cil on Disability; 6 (O) the National Coordinator for Health 7 Information Technology; 8 (P) at least 4 State, local, territorial, and 9 Tribal public health officials representing de- 10 partments of public health, or an Urban Indian 11 health representative, who shall represent juris- 12 dictions from different regions of the United 13 States with relatively high concentrations of 14 historically marginalized populations, to be ap- 15 pointed by the Secretary; 16 (Q) at least 3 independent individuals with 17 expertise on racially and ethnically diverse rep- 18 resentation with knowledge or field experience 19 with community-based participatory research on 20 racial and ethnic disparities in public health, to 21 be appointed by the Secretary; and 22 (R) at least 4 individuals with expertise on 23 health equity and demographic data disparities 24 with knowledge of, or field experience in, lan- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00068 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 69 •S 4486 IS guage, disability status, sex, sexual orientation, 1 gender identity, or socioeconomic status. 2 (2) CHAIRPERSON.—The Chief Information Of- 3 ficer of the Department of Health and Human Serv- 4 ices (or the Chief Information Officer’s designee) 5 shall serve as the Chairperson of the Task Force. 6 (c) DUTIES.—The Task Force shall— 7 (1) examine where to place artificial intelligence 8 and algorithms in the health care service delivery 9 process relative to the use of autonomous human de- 10 cision makers; 11 (2) identify the risks of health care system utili- 12 zation of artificial intelligence and algorithms in 13 terms of civil rights, civil liberties, and discrimina- 14 tory bias in health care access, quality, and out- 15 comes; and 16 (3) prepare and submit the report under sub- 17 section (d). 18 (d) REPORT.—Not later than 1 year after the date 19 of enactment of this Act, the Task Force shall— 20 (1) submit a written report of the findings of 21 the examination under paragraph (1) and rec- 22 ommendations to Congress with respect to imple- 23 mentation of artificial intelligence and algorithms in 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00069 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 70 •S 4486 IS health care delivery and mitigation of the risks asso- 1 ciated with that implementation; and 2 (2) publish such report on the website of the 3 Department of Health and Human Services. 4 (e) PUBLIC COMMENT.—Not later than 60 days after 5 the date of the enactment of this Act, the Task Force shall 6 publish in the Federal Register a notice providing for a 7 public comment period on the duties and activities of the 8 Task Force of not less than 90 days, beginning on the 9 date of that publication. 10 (f) STAFF OF COMMISSION.— 11 (1) ADDITIONAL STAFF.—The Chairperson of 12 the Task Force may appoint and fix the pay of addi- 13 tional staff to the Task Force as the Chairperson 14 considers appropriate. 15 (2) APPLICABILITY OF CERTAIN CIVIL SERVICE 16 LAWS.—The staff of the Task Force may be ap- 17 pointed without regard to the provisions of title 5, 18 United States Code, governing appointments in the 19 competitive service, and may be paid without regard 20 to the provisions of chapter 51 and subchapter III 21 of chapter 53 of that title relating to classification 22 and General Schedule pay rates. 23 (3) DETAILEES.—Any Federal Government em- 24 ployee may be detailed to the Task Force without re- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00070 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 71 •S 4486 IS imbursement from the Task Force, and the detailee 1 shall retain the rights, status, and privileges of his 2 or her regular employment without interruption. 3 TITLE II—CULTURALLY AND LIN- 4 GUISTICALLY APPROPRIATE 5 HEALTH AND HEALTH CARE 6 SEC. 2001. DEFINITIONS; FINDINGS. 7 (a) DEFINITIONS.—In this title, the definitions in 8 section 3400 of the Public Health Service Act, as added 9 by section 2004, shall apply. 10 (b) FINDINGS.—Congress finds the following: 11 (1) Effective communication is essential to 12 meaningful access to quality physical and mental 13 health care. 14 (2) Research indicates that the lack of appro- 15 priate language services creates language barriers 16 that result in increased risk of misdiagnosis, ineffec- 17 tive treatment plans, and poor health outcomes for 18 individuals with limited English proficiency and indi- 19 viduals with communication disabilities such as cog- 20 nitive, hearing, vision, or print impairments. 21 (3) The number of limited English speaking 22 residents in the United States who speak English 23 less than very well and, therefore, cannot effectively 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00071 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 72 •S 4486 IS communicate with health and social service providers 1 continues to increase significantly. 2 (4) The responsibility to fund language services 3 in the provision of health care and health care-re- 4 lated services to individuals with limited English 5 proficiency and individuals with communication dis- 6 abilities such as cognitive, hearing, vision, or print 7 impairments is a societal one that cannot fairly be 8 placed solely upon the health care, public health, or 9 social services community. 10 (5) Title VI of the Civil Rights Act of 1964 (42 11 U.S.C. 2000d et seq.) prohibits discrimination based 12 on the grounds of race, color, or national origin by 13 any entity receiving Federal financial assistance. In 14 order to avoid discrimination on the grounds of na- 15 tional origin, all programs or activities administered 16 by the Federal Government must take adequate 17 steps to ensure that their policies and procedures do 18 not deny or have the effect of denying individuals 19 with limited English proficiency with equal access to 20 benefits and services for which such persons qualify. 21 (6) Both the Americans with Disabilities Act of 22 1990 (42 U.S.C. 12101 et seq.) and the Rehabilita- 23 tion Act of 1973 (29 U.S.C. 701 et seq.) prohibit 24 discrimination on the basis of disability and require 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00072 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 73 •S 4486 IS the provision of appropriate auxiliary aids and serv- 1 ices necessary to ensure effective communication 2 with individuals with disabilities. The type of auxil- 3 iary aid or service necessary to ensure effective com- 4 munication will vary in accordance with the method 5 of communication used by the individual, the nature, 6 length, and complexity of the communication in- 7 volved, and the context in which the communication 8 is taking place. A public accommodation should con- 9 sult with individuals with disabilities whenever pos- 10 sible to determine what type of auxiliary aid is need- 11 ed to ensure effective communication. The public ac- 12 commodation should use the individual’s preferred 13 method of communication whenever possible, unless 14 it would be an undue burden to the public accommo- 15 dation and an alternative would provide an equally 16 effective means of communication. The ultimate de- 17 cision as to what measures to take rests with the 18 public accommodation, provided that the method 19 chosen results in effective communication. 20 (7) Section 1557 of the Patient Protection and 21 Affordable Care Act (42 U.S.C. 18116) builds on 22 title VI of the Civil Rights Act of 1964 (42 U.S.C. 23 2000d et seq.) and section 504 of the Rehabilitation 24 Act of 1973 (29 U.S.C. 794), prohibits discrimina- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00073 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 74 •S 4486 IS tion on the basis of race, color, national origin, dis- 1 ability, sex, and age, requires the provision of lan- 2 guage services to ensure effective communication 3 with individuals with limited English proficiency, 4 and requires the provision of appropriate auxiliary 5 aids and services necessary to ensure effective com- 6 munication with individuals with disabilities. 7 (8) Linguistic diversity in the health care and 8 health care-related services workforce is important 9 for providing all patients the environment most con- 10 ducive to positive health outcomes. 11 (9) All members of the health care and health 12 care-related services community should continue to 13 educate their staff and constituents about limited 14 English proficient and disability communication 15 issues and help them identify resources to improve 16 access to quality care for individuals with limited 17 English proficiency and individuals with communica- 18 tion disabilities such as cognitive, hearing, vision, or 19 print impairments. 20 (10) Access to English as a second language, 21 foreign language, and sign language interpreters, 22 translated and alternative format documents, read- 23 ers, and other auxiliary aids and services, are essen- 24 tial to ensure effective communication and eliminate 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00074 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 75 •S 4486 IS the language barriers that impede access to health 1 care. 2 (11) Culturally competent language services in 3 health care settings should be available as a matter 4 of course. 5 SEC. 2002. IMPROVING ACCESS TO SERVICES FOR INDIVID- 6 UALS WITH LIMITED ENGLISH PROFICIENCY. 7 (a) PURPOSE.—Consistent with the goals provided in 8 Executive Order 13166 (42 U.S.C. 2000d–1 note; relating 9 to improving access to services for persons with limited 10 English proficiency), it is the purpose of this section— 11 (1) to improve Federal agency performance re- 12 garding access to federally conducted and federally 13 assisted programs and activities for individuals with 14 limited English proficiency; 15 (2) to require each Federal agency to examine 16 the services it provides and develop and implement 17 a system by which individuals with limited English 18 proficiency can obtain culturally competent services 19 and meaningful access to those services consistent 20 with, and without substantially burdening, the fun- 21 damental mission of the agency; 22 (3) to require each Federal agency to translate 23 any English language written material prepared for 24 the general public relating to a public health emer- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00075 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 76 •S 4486 IS gency, including vaccine distribution and education, 1 into the top 15 non-English languages in the United 2 States (according to the most recent data from the 3 American Community Survey or its replacement) not 4 later than 7 days after any such material is made 5 available in English; 6 (4) to require each Federal agency to ensure 7 that recipients of Federal financial assistance pro- 8 vide culturally competent services and meaningful 9 access to applicants and beneficiaries who are indi- 10 viduals with limited English proficiency; 11 (5) to ensure that recipients of Federal finan- 12 cial assistance take reasonable steps, consistent with 13 the guidelines set forth in the ‘‘Guidance to Federal 14 Financial Assistance Recipients Regarding Title VI 15 Prohibition Against National Origin Discrimination 16 Affecting Limited English Proficient Persons’’ (67 17 Fed. Reg. 41455 (June 18, 2002)), to ensure cul- 18 turally and linguistically appropriate access to their 19 programs and activities by individuals with limited 20 English proficiency; and 21 (6) to ensure compliance with title VI of the 22 Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) 23 and section 1557 of the Patient Protection and Af- 24 fordable Care Act (42 U.S.C. 18116) (prohibiting 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00076 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 77 •S 4486 IS health care providers and organizations from dis- 1 criminating in the provision of services). 2 (b) FEDERALLY CONDUCTED PROGRAMS AND AC- 3 TIVITIES.— 4 (1) IN GENERAL.—Not later than 120 days 5 after the date of enactment of this Act, each Federal 6 agency providing financial assistance to, or admin- 7 istering, a health program or activity described in 8 section 2003(a) shall prepare a plan or update a 9 plan to improve culturally and linguistically appro- 10 priate access to such program or activity with re- 11 spect to individuals with limited English proficiency. 12 Not later than 1 year after the date of enactment 13 of this title, each such Federal agency shall ensure 14 that such plan is fully implemented. 15 (2) PLAN REQUIREMENT.—Each plan under 16 paragraph (1) shall include— 17 (A) the steps the agency will take to en- 18 sure that individuals with limited English pro- 19 ficiency have access to each health program or 20 activity supported or administered by the agen- 21 cy; 22 (B) the policies and procedures for identi- 23 fying, assessing, and meeting the culturally and 24 linguistically appropriate language needs of its 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00077 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 78 •S 4486 IS beneficiaries that are individuals with limited 1 English proficiency served by such program or 2 activity; 3 (C) the steps the agency will take for such 4 program or activity to be culturally and linguis- 5 tically appropriate by— 6 (i) providing a range of language as- 7 sistance options; 8 (ii) giving notice to individuals with 9 limited English proficiency of the right to 10 competent language services; 11 (iii) training staff (at least annually); 12 and 13 (iv) monitoring and assessing the 14 quality of the language services (at least 15 annually); 16 (D) the steps the agency will take for such 17 program or activity to provide reasonable ac- 18 commodations necessary for individuals with 19 limited English proficiency, including those in- 20 dividuals with a communication disability, to 21 understand communications from the agency; 22 (E) the steps the agency will take to en- 23 sure that applications, forms, and other signifi- 24 cant documents for such program or activity 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00078 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 79 •S 4486 IS are competently translated into the primary 1 language of a client that is an individual with 2 limited English proficiency where such mate- 3 rials are needed to improve access of such client 4 to such program or activity; 5 (F) the resources the agency will provide 6 to improve cultural and linguistic appropriate- 7 ness to assist recipients of Federal funds to im- 8 prove access to health care-related programs 9 and activities for individuals with limited 10 English proficiency; 11 (G) the resources the agency will provide 12 to ensure that competent language assistance is 13 provided to patients that are individuals with 14 limited English proficiency by interpreters or 15 trained bilingual staff; 16 (H) the resources the agency will provide 17 to ensure that family, particularly minor chil- 18 dren, and friends are not used to provide inter- 19 pretation services, except as permitted under 20 section 1557 of the Patient Protection and Af- 21 fordable Care Act (42 U.S.C. 18116); and 22 (I) the steps the agency will take and re- 23 sources the agency will provide to ensure that 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00079 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 80 •S 4486 IS individuals know their rights, including the abil- 1 ity to file a complaint. 2 (3) SUBMISSION OF PLAN TO DOJ.—Each agen- 3 cy that is required to prepare a plan under para- 4 graph (1) shall— 5 (A) consult with populations who are di- 6 rectly impacted by policies in the plan and their 7 representatives in the development of the plan; 8 and 9 (B) when the plan is finalized, send a copy 10 of such plan to the Attorney General, to serve 11 as the central repository of all such plans. 12 SEC. 2003. ENSURING STANDARDS FOR CULTURALLY AND 13 LINGUISTICALLY APPROPRIATE SERVICES IN 14 HEALTH CARE. 15 (a) APPLICABILITY.—This section shall apply to any 16 health program or activity— 17 (1) of which any part is receiving Federal fi- 18 nancial assistance, including credits, subsidies, or 19 contracts of insurance; or 20 (2) that is carried out (including indirectly 21 through contracts, subcontracts, or other support) 22 by an executive agency or any entity established 23 under title I of the Patient Protection and Afford- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00080 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 81 •S 4486 IS able Care Act (42 U.S.C. 18001 et seq.) (or amend- 1 ments made thereby). 2 (b) STANDARDS.—Each program or activity de- 3 scribed in subsection (a)— 4 (1) shall implement strategies to recruit, retain, 5 and promote individuals at all levels to maintain a 6 diverse staff and leadership that can provide cul- 7 turally and linguistically appropriate health care to 8 patient populations of the service area of the pro- 9 gram or activity; 10 (2) shall educate and train governance, leader- 11 ship, and workforce at all levels and across all dis- 12 ciplines of the program or activity in culturally and 13 linguistically appropriate policies and practices on an 14 ongoing basis at least yearly; 15 (3) shall offer and provide language assistance, 16 including trained and competent bilingual staff and 17 interpreter services, to individuals with limited 18 English proficiency or who have other communica- 19 tion needs, at no cost to the individual at all points 20 of contact, and during all hours of operation, to fa- 21 cilitate timely access to health care services and 22 health care-related services; 23 (4) shall for each language group consisting of 24 individuals with limited English proficiency that con- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00081 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 82 •S 4486 IS stitutes 5 percent or 500 individuals, whichever is 1 less, of the population of persons eligible to be 2 served or likely to be affected or encountered in the 3 service area of the program or activity, make avail- 4 able at a fifth grade reading level— 5 (A) easily understood patient-related mate- 6 rials, including print and multimedia materials, 7 in the language of such language group; 8 (B) information or notices about termi- 9 nation of benefits in such language; 10 (C) signage; and 11 (D) any other documents or types of docu- 12 ments designated by the Secretary; 13 (5) shall develop and implement clear goals, 14 policies, operational plans, and management, ac- 15 countability, and oversight mechanisms to provide 16 culturally and linguistically appropriate services and 17 infuse them throughout the planning and operations 18 of the program or activity; 19 (6) shall conduct initial and ongoing, at least 20 annually, organizational assessments of culturally 21 and linguistically appropriate services-related activi- 22 ties and integrate valid linguistic, competence-related 23 National Standards for Culturally and Linguistically 24 Appropriate Services (CLAS) measures into the in- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00082 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 83 •S 4486 IS ternal audits, performance improvement programs, 1 patient satisfaction assessments, continuous quality 2 improvement activities, and outcomes-based evalua- 3 tions of the program or activity and develop ways to 4 standardize assessments; 5 (7) shall ensure that, consistent with the pri- 6 vacy protections provided for under the regulations 7 promulgated under section 264(c) of the Health In- 8 surance Portability and Accountability Act of 1996, 9 data on an individual required to be collected pursu- 10 ant to section 3101, including the individual’s alter- 11 native format preferences and policy modification 12 needs, are— 13 (A) collected in health records; 14 (B) integrated into the management infor- 15 mation systems of the program or activity; 16 (C) reported in such a way as to be inter- 17 operable with health information systems at the 18 Federal and State levels; and 19 (D) periodically updated; 20 (8) shall maintain a current demographic, cul- 21 tural, and epidemiological profile of the community, 22 conduct regular assessments of community health 23 assets and needs, and use the results of such assess- 24 ments to accurately plan for and implement services 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00083 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 84 •S 4486 IS that respond to the cultural and linguistic character- 1 istics of the service area of the program or activity; 2 (9) shall develop participatory, collaborative 3 partnerships with community-based organizations 4 and utilize a variety of formal and informal mecha- 5 nisms to facilitate community and patient involve- 6 ment in designing, implementing, and evaluating 7 policies and practices to ensure culturally and lin- 8 guistically appropriate service-related activities; 9 (10) shall ensure that conflict and grievance 10 resolution processes are culturally and linguistically 11 appropriate and capable of identifying, preventing, 12 and resolving cross-cultural conflicts or complaints 13 by patients; 14 (11) shall annually make available to the public 15 information about their progress and successful in- 16 novations in implementing the standards under this 17 section, translated materials of such information 18 that is culturally and linguistically appropriate to 19 the communities served under this section, and pro- 20 vide public notice in such communities about the 21 availability of this information; and 22 (12) shall, if requested, regularly make avail- 23 able to the head of each Federal entity from which 24 Federal funds are provided, information about the 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00084 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 85 •S 4486 IS progress and successful innovations of the program 1 or activity in implementing the standards under this 2 section as required by the head of such entity. 3 (c) COMMENTS ACCEPTED THROUGH NOTICE AND 4 COMMENT RULEMAKING.—An agency carrying out a pro- 5 gram or activity described in subsection (a)— 6 (1) shall ensure that comments with respect to 7 such program or activity that are accepted through 8 notice and comment rulemaking are accepted in all 9 languages; 10 (2) may not require such comments to be sub- 11 mitted only in English; and 12 (3) shall ensure that any such comments that 13 are not submitted in English are considered, during 14 the agency’s review of such comments, equally as 15 such comments that are submitted in English. 16 SEC. 2004. CULTURALLY AND LINGUISTICALLY APPRO- 17 PRIATE HEALTH CARE IN THE PUBLIC 18 HEALTH SERVICE ACT. 19 The Public Health Service Act (42 U.S.C. 201 et 20 seq.) is amended by adding at the end the following: 21 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00085 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 86 •S 4486 IS ‘‘TITLE XXXIV—CULTURALLY 1 AND LINGUISTICALLY APPRO- 2 PRIATE HEALTH CARE 3 ‘‘SEC. 3400. DEFINITIONS. 4 ‘‘(a) IN GENERAL.—In this title: 5 ‘‘(1) BILINGUAL.—The term ‘bilingual’, with 6 respect to an individual, means an individual who 7 has a sufficient degree of proficiency in 2 languages. 8 ‘‘(2) CULTURAL.—The term ‘cultural’ means 9 relating to integrated patterns of human behavior 10 that include the language, thoughts, communica- 11 tions, actions, customs, beliefs, values, age, and in- 12 stitutions of racial, ethnic, religious, or social 13 groups, including lesbian, gay, bisexual, transgender, 14 queer, and questioning individuals, and individuals 15 with physical and mental disabilities. 16 ‘‘(3) CULTURALLY AND LINGUISTICALLY AP- 17 PROPRIATE.—The term ‘culturally and linguistically 18 appropriate’ means being respectful of and respon- 19 sive to the cultural and linguistic needs of all indi- 20 viduals. 21 ‘‘(4) EFFECTIVE COMMUNICATION.—The term 22 ‘effective communication’ means an exchange of in- 23 formation between the provider of health care or 24 health care-related services and the recipient of such 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00086 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 87 •S 4486 IS services who is limited in English proficiency, or has 1 a communication impairment such as a hearing, vi- 2 sion, speaking, or cognitive disability, that enables 3 access to, understanding of, and benefit from health 4 care or health care-related services, and full partici- 5 pation in the development of their treatment plan. 6 ‘‘(5) GRIEVANCE RESOLUTION PROCESS.—The 7 term ‘grievance resolution process’ means all aspects 8 of dispute resolution including filing complaints, 9 grievance and appeal procedures, and court action. 10 ‘‘(6) HEALTH CARE GROUP.—The term ‘health 11 care group’ means a group of physicians organized, 12 at least in part, for the purposes of providing physi- 13 cian services under the Medicaid program under title 14 XIX of the Social Security Act, the State Children’s 15 Health Insurance Program under title XXI of such 16 Act, or the Medicare program under title XVIII of 17 such Act, including a provider of services under part 18 B of such title XVIII, and may include a hospital, 19 a hospice provider, a palliative care provider, and 20 any other individual or entity furnishing services 21 covered under any such program that is affiliated 22 with the health care group. 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00087 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 88 •S 4486 IS ‘‘(7) HEALTH CARE.—The term ‘health care’ 1 includes all health care needed throughout the life 2 cycle and the end of life. 3 ‘‘(8) HEALTH CARE SERVICES.—The term 4 ‘health care services’ means services that address 5 physical and mental health conditions, as well as 6 conditions impacted by social determinants of health, 7 in all care settings throughout the life cycle and the 8 end of life. 9 ‘‘(9) HEALTH CARE-RELATED SERVICES.—The 10 term ‘health care-related services’ means human or 11 social services programs or activities that provide ac- 12 cess, referrals, or links to health care services. 13 ‘‘(10) HEALTH EDUCATOR.—The term ‘health 14 educator’ includes a professional with a bacca- 15 laureate degree who is responsible for designing, im- 16 plementing, and evaluating individual and population 17 health promotion, health education (including edu- 18 cation on end-of-life care options), end-of-life care, 19 or chronic disease prevention programs. 20 ‘‘(11) INDIAN; INDIAN TRIBE.—The terms ‘In- 21 dian’ and ‘Indian Tribe’ have the meanings given 22 such terms in section 4 of the Indian Self-Deter- 23 mination and Education Assistance Act. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00088 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 89 •S 4486 IS ‘‘(12) INDIVIDUAL WITH A DISABILITY.—The 1 term ‘individual with a disability’ means any indi- 2 vidual who has a disability as defined for the pur- 3 pose of section 504 of the Rehabilitation Act of 4 1973. 5 ‘‘(13) INDIVIDUAL WITH LIMITED ENGLISH 6 PROFICIENCY.—The term ‘individual with limited 7 English proficiency’ means an individual who self- 8 identifies on the Census as speaking English less 9 than ‘very well’. 10 ‘‘(14) INTEGRATED HEALTH CARE DELIVERY 11 SYSTEM.—The term ‘integrated health care delivery 12 system’ means an interdisciplinary system that 13 brings together providers from the primary health, 14 mental health, substance use disorder, hospice and 15 palliative care, and related disciplines to improve the 16 health outcomes of an individual and the community. 17 Such providers may include hospitals, health, mental 18 health, or substance use prevention and treatment 19 clinics and providers, home health agencies, home- 20 and community-based services providers, congregate 21 care settings (including any skilled nursing facilities, 22 assisted living facilities, prisons and jails, residential 23 behavioral health care and psychiatric facilities, and 24 facilities providing services for aging adults and peo- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00089 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 90 •S 4486 IS ple with disabilities), ambulatory surgery centers, re- 1 habilitation centers, and employed, independent, or 2 contracted physicians. 3 ‘‘(15) INTERPRETING; INTERPRETATION.—The 4 terms ‘interpreting’ and ‘interpretation’ mean the 5 transmission of a spoken, written, or signed message 6 from one language or format into another, faithfully, 7 accurately, and objectively. 8 ‘‘(16) LANGUAGE ACCESS.—The term ‘language 9 access’ means the provision of language services to 10 an individual with limited English proficiency or an 11 individual with communication disabilities designed 12 to enhance that individual’s access to, understanding 13 of, or benefit from health care services or health 14 care-related services. 15 ‘‘(17) LANGUAGE ASSISTANCE SERVICES.—The 16 term ‘language assistance services’ includes— 17 ‘‘(A) oral language assistance, including in- 18 terpretation in non-English languages provided 19 in person or remotely by a qualified interpreter 20 for an individual with limited English pro- 21 ficiency, and the use of qualified bilingual or 22 multilingual staff to communicate directly with 23 individuals with limited English proficiency; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00090 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 91 •S 4486 IS ‘‘(B) written translation, performed by a 1 qualified translator, of written content in paper 2 or electronic form into languages other than 3 English; and 4 ‘‘(C) taglines. 5 ‘‘(18) MINORITY.— 6 ‘‘(A) IN GENERAL.—The terms ‘minority’ 7 and ‘minorities’ refer to individuals from a mi- 8 nority group. 9 ‘‘(B) POPULATIONS.—The term ‘minority’, 10 with respect to populations, refers to racial and 11 ethnic minority groups, members of sexual and 12 gender minority groups, and individuals with a 13 disability. 14 ‘‘(19) MINORITY GROUP.—The term ‘minority 15 group’ means a racial and ethnic minority group as 16 defined in this section. 17 ‘‘(20) ONSITE INTERPRETATION.—The term 18 ‘onsite interpretation’ means a method of inter- 19 preting or interpretation for which the interpreter is 20 in the physical presence of the provider of health 21 care services or health care-related services and the 22 recipient of such services who is limited in English 23 proficiency or has a communication impairment such 24 as an impairment in hearing, vision, or learning. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00091 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 92 •S 4486 IS ‘‘(21) QUALIFIED INDIVIDUAL WITH A DIS- 1 ABILITY.—The term ‘qualified individual with a dis- 2 ability’ means, with respect to a health program or 3 activity, an individual with a disability who, with or 4 without reasonable modifications to policies, prac- 5 tices, or procedures, the removal of architectural, 6 communication, or transportation barriers, or the 7 provision of auxiliary aids and services, meets the es- 8 sential eligibility requirements for the receipt of aids, 9 benefits, or services offered or provided by the health 10 program or activity. 11 ‘‘(22) QUALIFIED INTERPRETER FOR AN INDI- 12 VIDUAL WITH A DISABILITY.—The term ‘qualified 13 interpreter for an individual with a disability’, with 14 respect to an individual with a disability— 15 ‘‘(A) means an interpreter for such indi- 16 vidual who by means of a remote interpreting 17 service or an onsite appearance— 18 ‘‘(i) adheres to generally accepted in- 19 terpreter ethics principles, including client 20 confidentiality; and 21 ‘‘(ii) is able to interpret effectively, ac- 22 curately, and impartially, both receptively 23 and expressively, using any necessary spe- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00092 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 93 •S 4486 IS cialized vocabulary, terminology, and phra- 1 seology; and 2 ‘‘(B) may include— 3 ‘‘(i) sign language interpreters; 4 ‘‘(ii) oral transliterators, which are in- 5 dividuals who represent or spell in the 6 characters of another alphabet; and 7 ‘‘(iii) cued language transliterators, 8 which are individuals who represent or 9 spell by using a small number of 10 handshapes. 11 ‘‘(23) QUALIFIED INTERPRETER FOR AN INDI- 12 VIDUAL WITH LIMITED ENGLISH PROFICIENCY.— 13 The term ‘qualified interpreter for an individual with 14 limited English proficiency’ means an interpreter 15 who by means of a remote interpreting service or an 16 onsite appearance— 17 ‘‘(A) adheres to generally accepted inter- 18 preter ethics principles, including client con- 19 fidentiality; 20 ‘‘(B) has demonstrated proficiency in 21 speaking and understanding both spoken 22 English and one or more other spoken lan- 23 guages; and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00093 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 94 •S 4486 IS ‘‘(C) is able to interpret effectively, accu- 1 rately, and impartially, both receptively and ex- 2 pressly, to and from such languages and 3 English, using any necessary specialized vocab- 4 ulary, terminology, and phraseology. 5 ‘‘(24) QUALIFIED TRANSLATOR.—The term 6 ‘qualified translator’ means a translator who— 7 ‘‘(A) adheres to generally accepted trans- 8 lator ethics principles, including client confiden- 9 tiality; 10 ‘‘(B) has demonstrated proficiency in writ- 11 ing and understanding both written English 12 and one or more other written non-English lan- 13 guages; and 14 ‘‘(C) is able to translate effectively, accu- 15 rately, and impartially to and from such lan- 16 guages and English, using any necessary spe- 17 cialized vocabulary, terminology, and phrase- 18 ology. 19 ‘‘(25) RACIAL AND ETHNIC MINORITY GROUP.— 20 The term ‘racial and ethnic minority group’ means 21 Indians and Alaska Natives, African Americans (in- 22 cluding Caribbean Blacks, Africans, and other 23 Blacks), Asian Americans, Hispanics (including 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00094 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 95 •S 4486 IS Latinos), Middle Easterners and North Africans, 1 and Native Hawaiians and other Pacific Islanders. 2 ‘‘(26) SECRETARY.—The term ‘Secretary’ 3 means the Secretary of Health and Human Services, 4 acting through the Director of the Agency for 5 Healthcare Research and Quality. 6 ‘‘(27) SEXUAL AND GENDER MINORITY 7 GROUP.—The term ‘sexual and gender minority 8 group’ encompasses lesbian, gay, bisexual, and 9 transgender populations, as well as those whose sex- 10 ual orientation, gender identity and expression, or 11 reproductive development varies from traditional, so- 12 cietal, cultural, or physiological norms. 13 ‘‘(28) SIGHT TRANSLATION.—The term ‘sight 14 translation’ means the transmission of a written 15 message in one language into a spoken or signed 16 message in another language, or an alternative for- 17 mat in English or another language. 18 ‘‘(29) STATE.—Notwithstanding section 2, the 19 term ‘State’ means each of the several States, the 20 District of Columbia, the Commonwealth of Puerto 21 Rico, the United States Virgin Islands, Guam, 22 American Samoa, and the Commonwealth of the 23 Northern Mariana Islands. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00095 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 96 •S 4486 IS ‘‘(30) TELEPHONIC INTERPRETATION.—The 1 term ‘telephonic interpretation’ (also known as ‘over 2 the phone interpretation’ or ‘OPI’) means, with re- 3 spect to interpretation for an individual with limited 4 English proficiency, a method of interpretation in 5 which the interpreter is not in the physical presence 6 of the provider of health care services or health care- 7 related services and such individual receiving such 8 services, but the interpreter is connected via tele- 9 phone. 10 ‘‘(31) TRANSLATION.—The term ‘translation’ 11 means the transmission of a written message in one 12 language into a written or signed message in an- 13 other language, and includes translation into an- 14 other language or alternative format, such as large 15 print font, Braille, audio recording, or CD. 16 ‘‘(32) UNDERSERVED COMMUNITIES.—The 17 term ‘underserved communities’ means populations 18 sharing a particular characteristic, as well as geo- 19 graphic communities, who have been systematically 20 denied a full opportunity to participate in aspects of 21 economic, social, and civic life, such as— 22 ‘‘(A) Black, Latino, and Indigenous and 23 Native American persons, Asian Americans and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00096 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 97 •S 4486 IS Pacific Islanders, Middle Easterners and North 1 Africans, and other persons of color; 2 ‘‘(B) members of religious minorities; 3 ‘‘(C) lesbian, gay, bisexual, transgender, 4 and queer persons; 5 ‘‘(D) persons with disabilities; 6 ‘‘(E) persons who live in rural areas; and 7 ‘‘(F) persons otherwise adversely affected 8 by persistent poverty or inequality as defined in 9 Executive Order 13985. 10 ‘‘(33) UNDERSERVED POPULATIONS.—The 11 term ‘underserved populations’ means populations 12 sharing a particular characteristic, as well as geo- 13 graphic communities, who have been systematically 14 denied a full opportunity to participate in aspects of 15 economic, social, and civic life, as defined in Execu- 16 tive Order 13985. 17 ‘‘(34) VIDEO REMOTE INTERPRETING SERV- 18 ICES.—The term ‘video remote interpreting services’ 19 means the provision, in health care services or health 20 care-related services, through a qualified interpreter 21 for an individual with limited English proficiency, of 22 video remote interpreting services that are— 23 ‘‘(A) in real-time, full-motion video, and 24 audio over a dedicated high-speed, wide-band- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00097 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 98 •S 4486 IS width video connection or wireless connection 1 that delivers high-quality video images that do 2 not produce lags, choppy, blurry, or grainy im- 3 ages, or irregular pauses in communication; and 4 ‘‘(B) in a sharply delineated image that is 5 large enough to display. 6 ‘‘(35) VITAL DOCUMENT.—The term ‘vital doc- 7 ument’ includes applications for government pro- 8 grams that provide health care services, medical or 9 financial consent forms, financial assistance docu- 10 ments, letters containing important information re- 11 garding patient instructions (such as prescriptions, 12 referrals to other providers, and discharge plans) 13 and participation in a program (such as a Medicaid 14 managed care program), notices pertaining to the 15 reduction, denial, or termination of services or bene- 16 fits, notices of the right to appeal such actions, and 17 notices advising individuals with limited English pro- 18 ficiency with communication disabilities of the avail- 19 ability of free language services, alternative formats, 20 and other outreach materials. 21 ‘‘(b) REFERENCE.—In any reference in this title to 22 a regulatory provision applicable to a ‘handicapped indi- 23 vidual’, the term ‘handicapped individual’ in such provi- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00098 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 99 •S 4486 IS sion shall have the same meaning as the term ‘individual 1 with a disability’ as defined in subsection (a). 2 ‘‘Subtitle A—Resources and Innova- 3 tion for Culturally and Linguis- 4 tically Appropriate Health Care 5 ‘‘SEC. 3401. ROBERT T. MATSUI CENTER FOR CULTURALLY 6 AND LINGUISTICALLY APPROPRIATE HEALTH 7 CARE. 8 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab- 9 lish and support a center to be known as the ‘Robert T. 10 Matsui Center for Culturally and Linguistically Appro- 11 priate Health Care’ (referred to in this section as the 12 ‘Center’) to carry out each of the following activities: 13 ‘‘(1) INTERPRETATION SERVICES.— 14 ‘‘(A) IN GENERAL.—The Center shall pro- 15 vide resources via the internet to identify and 16 link health care providers to competent and 17 qualified interpreter and translation services. 18 ‘‘(B) TRAINING.—For purposes of pro- 19 viding the services described in subparagraph 20 (A), the Center shall adopt a language access 21 plan that includes training requirements for 22 Center staff to provide such services. 23 ‘‘(2) TRANSLATION OF WRITTEN MATERIAL.— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00099 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 100 •S 4486 IS ‘‘(A) VITAL DOCUMENTS.—The Center 1 shall provide, directly or through contract, to 2 providers of health care services and health 3 care-related services, at no cost to such pro- 4 viders and in a timely and reasonable manner, 5 vital documents— 6 ‘‘(i) which may be submitted by cov- 7 ered entities (as defined in section 92.4 of 8 title 45, Code of Federal Regulations, as in 9 effect on May 18, 2016) for translation 10 into non-English languages or alternative 11 formats at a fifth-grade reading level; and 12 ‘‘(ii) from competent translation serv- 13 ices, the quality of which shall be mon- 14 itored and reported publicly. 15 ‘‘(B) FORMS.—For each form developed or 16 revised by the Secretary that will be used by in- 17 dividuals with limited English proficiency in 18 health care or health care-related settings, the 19 Center shall, not later than 45 calendar days of 20 the Secretary receiving final approval of the 21 form from the Office of Management and 22 Budget— 23 ‘‘(i) translate the form, at a min- 24 imum, into the top 15 non-English lan- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00100 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 101 •S 4486 IS guages in the United States according to 1 the most recent data from the American 2 Community Survey or its replacement; and 3 ‘‘(ii) post all translated forms on the 4 Center’s website. 5 ‘‘(3) TOLL-FREE CUSTOMER SERVICE TELE- 6 PHONE NUMBER.—The Center shall provide, 7 through a toll-free number, a customer service line 8 for individuals with limited English proficiency that 9 is linked to the toll-free telephone number 1–800– 10 MEDICARE and a toll-free telephone hotline pro- 11 vided for pursuant to section 1311(d)(4)(B) of the 12 Patient Protection and Affordable Care Act by an 13 Exchange established under title I of such Act— 14 ‘‘(A) to obtain information about federally 15 conducted or funded health programs, including 16 the Medicare program under title XVIII of the 17 Social Security Act, the Medicaid program 18 under title XIX of such Act, and the State Chil- 19 dren’s Health Insurance Program under title 20 XXI of such Act, and coverage available 21 through an Exchange established under title I 22 of the Patient Protection and Affordable Care 23 Act, and other sources of free or reduced care 24 including federally qualified health centers, enti- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00101 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 102 •S 4486 IS ties receiving assistance under title X, and pub- 1 lic health departments; 2 ‘‘(B) to obtain assistance with applying for 3 or accessing these programs and understanding 4 Federal notices written in English; and 5 ‘‘(C) to learn how to access language serv- 6 ices. 7 ‘‘(4) HEALTH INFORMATION CLEARING- 8 HOUSE.— 9 ‘‘(A) IN GENERAL.—The Center shall de- 10 velop and maintain, and make available on the 11 internet and in print, an information clearing- 12 house that includes the information described in 13 subparagraphs (B) through (F)— 14 ‘‘(i) to facilitate the provision of lan- 15 guage services by providers of health care 16 services and health care-related services to 17 reduce medical errors; 18 ‘‘(ii) to improve medical outcomes, im- 19 prove cultural competence, reduce health 20 care costs caused by miscommunication 21 with individuals with limited English pro- 22 ficiency; and 23 ‘‘(iii) to reduce or eliminate the dupli- 24 cation of efforts to translate materials. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00102 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 103 •S 4486 IS ‘‘(B) DOCUMENT TEMPLATES.—The Cen- 1 ter shall collect and evaluate for accuracy, de- 2 velop, and make available templates for stand- 3 ard documents that are necessary for patients 4 and consumers to access and make educated de- 5 cisions about their health care, including tem- 6 plates for each of the following: 7 ‘‘(i) Administrative and legal docu- 8 ments, including— 9 ‘‘(I) intake forms; 10 ‘‘(II) forms related to the Medi- 11 care program under title XVIII of the 12 Social Security Act, the Medicaid pro- 13 gram under title XIX of such Act, 14 and the State Children’s Health In- 15 surance Program under title XXI of 16 such Act, including eligibility informa- 17 tion for such programs; 18 ‘‘(III) forms informing patients 19 of the compliance and consent re- 20 quirements pursuant to the regula- 21 tions under section 264(c) of the 22 Health Insurance Portability and Ac- 23 countability Act of 1996 (42 U.S.C. 24 1320–2 note); and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00103 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 104 •S 4486 IS ‘‘(IV) documents concerning in- 1 formed consent, advanced directives, 2 and waivers of rights. 3 ‘‘(ii) Clinical information, such as how 4 to take medications, how to prevent trans- 5 mission of a contagious disease, and other 6 prevention and treatment instructions. 7 ‘‘(iii) Public health, patient education, 8 and outreach materials, such as immuniza- 9 tion notices, health warnings, or screening 10 notices. 11 ‘‘(iv) Additional health or health care- 12 related materials as determined appro- 13 priate by the Director of the Center. 14 ‘‘(C) STRUCTURE OF FORMS.—In oper- 15 ating the clearinghouse, the Center shall— 16 ‘‘(i) ensure that the documents posted 17 in English and non-English languages are 18 culturally and linguistically appropriate; 19 ‘‘(ii) allow public review of the docu- 20 ments before dissemination in order to en- 21 sure that the documents are understand- 22 able and culturally and linguistically ap- 23 propriate for the target populations; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00104 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 105 •S 4486 IS ‘‘(iii) allow health care providers to 1 customize the documents for their use; 2 ‘‘(iv) facilitate access to such docu- 3 ments; 4 ‘‘(v) provide technical assistance with 5 respect to the access and use of such infor- 6 mation; and 7 ‘‘(vi) carry out any other activities the 8 Secretary determines to be useful to fulfill 9 the purposes of the clearinghouse. 10 ‘‘(D) LANGUAGE ASSISTANCE PRO- 11 GRAMS.—The Center shall provide for the col- 12 lection and dissemination of information on cur- 13 rent examples of language assistance programs 14 and strategies to improve language services for 15 individuals with limited English proficiency, in- 16 cluding case studies using de-identified patient 17 information, program summaries, and program 18 evaluations. 19 ‘‘(E) CULTURALLY AND LINGUISTICALLY 20 APPROPRIATE MATERIALS.—The Center shall 21 provide, at no cost, to all health care providers 22 and all providers of health care-related services, 23 information relating to culturally and linguis- 24 tically appropriate health care for minority pop- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00105 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 106 •S 4486 IS ulations residing in the United States, includ- 1 ing— 2 ‘‘(i) tenets of culturally and linguis- 3 tically appropriate care; 4 ‘‘(ii) culturally and linguistically ap- 5 propriate self-assessment tools; 6 ‘‘(iii) culturally and linguistically ap- 7 propriate training tools; 8 ‘‘(iv) strategic plans to increase cul- 9 tural and linguistic appropriateness in dif- 10 ferent types of providers of health care 11 services and health care-related services, 12 including regional collaborations among 13 health care organizations for health care 14 services and health care-related services; 15 and 16 ‘‘(v) culturally and linguistically ap- 17 propriate information for educators, practi- 18 tioners, students, and researchers. 19 ‘‘(F) TRANSLATION GLOSSARIES.—The 20 Center shall— 21 ‘‘(i) develop and publish on its website 22 translation glossaries that provide stand- 23 ardized translations of commonly used 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00106 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 107 •S 4486 IS terms and phrases utilized in documents 1 translated by the Center; and 2 ‘‘(ii) make such glossaries available— 3 ‘‘(I) free of charge; 4 ‘‘(II) in each language in which 5 the Center translates forms under 6 paragraph (2)(B); 7 ‘‘(III) in alternative formats in 8 accordance with the Americans with 9 Disabilities Act of 1990 (42 U.S.C. 10 12101 et seq.); and 11 ‘‘(IV) in paper format upon re- 12 quest. 13 ‘‘(G) INFORMATION ABOUT PROGRESS.— 14 The Center shall— 15 ‘‘(i) regularly collect and make pub- 16 licly available information about the 17 progress of entities receiving grants under 18 section 3402 regarding successful innova- 19 tions in implementing the requirements of 20 this subsection; and 21 ‘‘(ii) provide public notice in the enti- 22 ties’ communities about the availability of 23 such information. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00107 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 108 •S 4486 IS ‘‘(b) DIRECTOR.—The Center shall be headed by a 1 Director who shall be appointed by, and who shall report 2 to, the Director of the Agency for Healthcare Research 3 and Quality. 4 ‘‘(c) AVAILABILITY OF LANGUAGE ACCESS.—The Di- 5 rector of the Center shall collaborate with the Deputy As- 6 sistant Secretary for Minority Health, the Administrator 7 of the Centers for Medicare & Medicaid Services, and the 8 Administrator of the Health Resources and Services Ad- 9 ministration to notify health care providers and health 10 care organizations about the availability of language ac- 11 cess services by the Center. 12 ‘‘(d) EDUCATION.—The Secretary, directly or 13 through contract, shall undertake a national education 14 campaign to inform providers, individuals with limited 15 English proficiency, individuals with hearing or vision im- 16 pairments, health professionals, graduate schools, commu- 17 nity health centers, social service providers, and commu- 18 nity-based organizations about— 19 ‘‘(1) Federal and State laws and guidelines gov- 20 erning access to language services; 21 ‘‘(2) the value of using trained and competent 22 interpreters and the risks associated with using fam- 23 ily members, friends, minors, and untrained bilin- 24 gual staff; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00108 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 109 •S 4486 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 2023 through 2027. 7 ‘‘SEC. 3402. INNOVATIONS IN CULTURALLY AND LINGUIS- 8 TICALLY APPROPRIATE HEALTH CARE 9 GRANTS. 10 ‘‘(a) IN GENERAL.— 11 ‘‘(1) GRANTS.—The Secretary shall award 12 grants to eligible entities to enable such entities to 13 design, implement, and evaluate innovative, cost-ef- 14 fective programs to improve culturally and linguis- 15 tically appropriate access to health care services for 16 individuals with limited English proficiency and com- 17 munication disabilities. 18 ‘‘(2) COORDINATION.—In making grants under 19 this section, and in the design and implementation 20 of the program established under this section, the 21 Secretary shall coordinate with, and ensure the par- 22 ticipation of, other agencies including the Health Re- 23 sources and Services Administration, the National 24 Institute on Minority Health and Health Disparities 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00109 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 110 •S 4486 IS at the National Institutes of Health, and the Office 1 of Minority Health. 2 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 3 under subsection (a), an entity shall be— 4 ‘‘(1) a city, county, Indian Tribe, State, or sub- 5 division thereof; 6 ‘‘(2) an organization described in section 7 501(c)(3) of the Internal Revenue Code of 1986 and 8 exempt from tax under section 501(a) of such Code; 9 ‘‘(3) a community health, mental health, or 10 substance use disorder center or clinic; 11 ‘‘(4) a solo or group physician practice; 12 ‘‘(5) an integrated health care delivery system; 13 ‘‘(6) a public hospital; 14 ‘‘(7) a health care group, university, or college; 15 or 16 ‘‘(8) any other entity designated by the Sec- 17 retary. 18 ‘‘(c) APPLICATION.—An eligible entity seeking a 19 grant under this section shall prepare and submit to the 20 Secretary an application, at such time, in such manner, 21 and containing such additional information as the Sec- 22 retary may reasonably require. 23 ‘‘(d) USE OF FUNDS.—An entity shall use funds re- 24 ceived through a grant under this section to— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00110 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 111 •S 4486 IS ‘‘(1) develop, implement, and evaluate models of 1 providing competent interpretation services through 2 onsite interpretation, telephonic interpretation, or 3 video remote interpreting services; 4 ‘‘(2) implement strategies to recruit, retain, and 5 promote individuals at all levels of the organization 6 to maintain a diverse staff and leadership that can 7 promote and provide language services to patient 8 populations of the service area of the entity; 9 ‘‘(3) develop and maintain a needs assessment 10 that identifies the current demographic, cultural, 11 and epidemiological profile of the community to ac- 12 curately plan for and implement language services 13 needed in the service area of the entity; 14 ‘‘(4) develop a strategic plan to implement lan- 15 guage services; 16 ‘‘(5) develop participatory, collaborative part- 17 nerships with communities encompassing the patient 18 populations of individuals with limited English pro- 19 ficiency served by the grant to gain input in design- 20 ing and implementing language services; 21 ‘‘(6) develop and implement grievance resolu- 22 tion processes that are culturally and linguistically 23 appropriate and capable of identifying, preventing, 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00111 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 112 •S 4486 IS and resolving complaints by individuals with limited 1 English proficiency; 2 ‘‘(7) develop short-term medical and mental 3 health interpretation training courses and incentives 4 for bilingual health care staff who are asked to pro- 5 vide interpretation services in the workplace; 6 ‘‘(8) develop formal training programs, includ- 7 ing continued professional development and edu- 8 cation programs as well as supervision, for individ- 9 uals interested in becoming dedicated health care in- 10 terpreters and culturally and linguistically appro- 11 priate providers; 12 ‘‘(9) provide staff language training instruction, 13 which shall include information on the practical limi- 14 tations of such instruction for nonnative speakers; 15 ‘‘(10) develop policies that address compensa- 16 tion in salary for staff who receive training to be- 17 come either a staff interpreter or bilingual provider; 18 ‘‘(11) develop other language assistance services 19 as determined appropriate by the Secretary; 20 ‘‘(12) develop, implement, and evaluate models 21 of improving cultural competence, including cultural 22 competence programs for community health workers; 23 ‘‘(13) ensure that, consistent with the privacy 24 protections provided for under the regulations pro- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00112 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 113 •S 4486 IS mulgated under section 264(c) of the Health Insur- 1 ance Portability and Accountability Act of 1996 and 2 any applicable State privacy laws, data on the indi- 3 vidual patient or recipient’s race, ethnicity, and pri- 4 mary language are collected (and periodically up- 5 dated) in health records and integrated into the or- 6 ganization’s information management systems or 7 any similar system used to store and retrieve data; 8 and 9 ‘‘(14) ensure that culturally competent care and 10 language assistance are available to individuals with 11 limited English proficiency. 12 ‘‘(e) PRIORITY.—In awarding grants under this sec- 13 tion, the Secretary shall give priority to entities that pri- 14 marily engage in providing direct care and that have devel- 15 oped partnerships with community organizations or with 16 agencies with experience in improving language access. 17 ‘‘(f) EVALUATION.— 18 ‘‘(1) BY GRANTEES.—An entity that receives a 19 grant under this section shall submit to the Sec- 20 retary an evaluation that describes, in the manner 21 and to the extent required by the Secretary, the ac- 22 tivities carried out with funds received under the 23 grant, and how such activities improved access to 24 health care services and health care-related services 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00113 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 114 •S 4486 IS and the quality of health care for individuals with 1 limited English proficiency. Such evaluation shall be 2 collected and disseminated through the Robert T. 3 Matsui Center for Culturally and Linguistically Ap- 4 propriate Health Care established under section 5 3401. The Director of the Agency for Healthcare 6 Research and Quality shall notify grantees of the 7 availability of technical assistance for the evaluation 8 and provide such assistance upon request. 9 ‘‘(2) BY SECRETARY.—The Director of the 10 Agency for Healthcare Research and Quality shall 11 evaluate or arrange with other individuals or organi- 12 zations to evaluate projects funded under this sec- 13 tion. 14 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 15 is authorized to be appropriated to carry out this section 16 $5,000,000 for each of fiscal years 2023 through 2027. 17 ‘‘SEC. 3403. RESEARCH ON CULTURAL AND LANGUAGE COM- 18 PETENCE. 19 ‘‘(a) IN GENERAL.—The Secretary shall expand re- 20 search concerning language access in the provision of 21 health care services. 22 ‘‘(b) ELIGIBILITY.—The Secretary may conduct the 23 research described in subsection (a) or enter into contracts 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00114 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 115 •S 4486 IS with other individuals or organizations to conduct such re- 1 search. 2 ‘‘(c) USE OF FUNDS.—Research conducted under 3 this section shall be designed to do one or more of the 4 following: 5 ‘‘(1) To identify the barriers to mental and be- 6 havioral services that are faced by individuals with 7 limited English proficiency. 8 ‘‘(2) To identify health care providers’ and 9 health administrators’ knowledge and awareness of 10 the barriers to quality health care services that are 11 faced by individuals with limited English proficiency 12 and communication disabilities. 13 ‘‘(3) To identify optimal approaches for deliv- 14 ering language access. 15 ‘‘(4) To identify best practices for data collec- 16 tion, including— 17 ‘‘(A) the collection by providers of health 18 care services and health care-related services of 19 data on the race, ethnicity, and primary lan- 20 guage of recipients of such services, taking into 21 account existing research conducted by the Gov- 22 ernment or private sector; 23 ‘‘(B) the development and implementation 24 of data collection and reporting systems; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00115 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 116 •S 4486 IS ‘‘(C) effective privacy safeguards for col- 1 lected data. 2 ‘‘(5) To develop a minimum data collection set 3 for primary language. 4 ‘‘(6) To evaluate the most effective ways in 5 which the Secretary can create or coordinate, and 6 subsidize or otherwise fund, telephonic interpretation 7 services for health care providers, taking into consid- 8 eration, among other factors, the flexibility necessary 9 for such a system to accommodate variations in— 10 ‘‘(A) provider type; 11 ‘‘(B) languages needed and their frequency 12 of use; 13 ‘‘(C) type of encounter; 14 ‘‘(D) time of encounter, including whether 15 the encounter occurs during regular business 16 hours and after hours; and 17 ‘‘(E) location of encounter. 18 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 19 are authorized to be appropriated to carry out this section 20 $5,000,000 for each of fiscal years 2023 through 2027.’’. 21 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00116 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 117 •S 4486 IS SEC. 2005. PILOT PROGRAM FOR IMPROVEMENT AND DE- 1 VELOPMENT OF STATE MEDICAL INTER- 2 PRETING SERVICES. 3 (a) GRANTS AUTHORIZED.—The Secretary of Health 4 and Human Services (referred to in this section as the 5 ‘‘Secretary’’) shall award 1 grant in accordance with this 6 section to each of 3 States (to be selected by the Sec- 7 retary) to assist each such State in designing, imple- 8 menting, and evaluating a statewide program to provide 9 onsite interpreter services under the State Medicaid plan. 10 (b) GRANT PERIOD.—A grant awarded under this 11 section is authorized for the period of 3 fiscal years begin- 12 ning on October 1, 2023, and ending on September 30, 13 2026. 14 (c) PREFERENCE.—In awarding a grant under this 15 section, the Secretary shall give preference to a State— 16 (1) that has a high proportion of qualified LEP 17 enrollees, as determined by the Secretary; 18 (2) that has a large number of qualified LEP 19 enrollees, as determined by the Secretary; 20 (3) that has a high growth rate of the popu- 21 lation of individuals with limited English proficiency, 22 as determined by the Secretary; and 23 (4) that has a population of qualified LEP en- 24 rollees that is linguistically diverse, requiring inter- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00117 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 118 •S 4486 IS preter services in at least 200 non-English lan- 1 guages. 2 (d) USE OF FUNDS.—A State receiving a grant under 3 this section shall use the grant funds to— 4 (1) ensure that all health care providers in the 5 State participating in the State Medicaid plan have 6 access to onsite interpreter services, for the purpose 7 of enabling effective communication between such 8 providers and qualified LEP enrollees during the 9 furnishing of items and services and administrative 10 interactions; 11 (2) establish, expand, procure, or contract for— 12 (A) a statewide health care information 13 technology system that is designed to achieve 14 efficiencies and economies of scale with respect 15 to onsite interpreter services provided to health 16 care providers in the State participating in the 17 State Medicaid plan; and 18 (B) an entity to administer such system, 19 the duties of which shall include— 20 (i) procuring and scheduling inter- 21 preter services for qualified LEP enrollees; 22 (ii) procuring and scheduling inter- 23 preter services for individuals with limited 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00118 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 119 •S 4486 IS English proficiency seeking to enroll in the 1 State Medicaid plan; 2 (iii) ensuring that interpreters receive 3 payment for interpreter services rendered 4 under the system; and 5 (iv) consulting regularly with organi- 6 zations representing LEP consumers, in- 7 terpreters, and health care providers; and 8 (3) develop mechanisms to establish, improve, 9 and strengthen the competency of the medical inter- 10 pretation workforce that serves qualified LEP enroll- 11 ees in the State, including a national certification 12 process that is valid, credible, and vendor-neutral. 13 (e) APPLICATION.—To receive a grant under this sec- 14 tion, a State shall submit an application at such time and 15 containing such information as the Secretary may require, 16 which shall include the following: 17 (1) A description of the language access needs 18 of individuals in the State enrolled in the State Med- 19 icaid plan. 20 (2) A description of the extent to which the 21 program will— 22 (A) use the grant funds for the purposes 23 described in subsection (d); 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00119 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 120 •S 4486 IS (B) meet the health care needs of rural 1 populations of the State; and 2 (C) collect information that accurately 3 tracks the language services requested by con- 4 sumers as compared to the language services 5 provided by health care providers in the State 6 participating in the State Medicaid plan. 7 (3) A description of how the program will be 8 evaluated, including a proposal for collaboration with 9 organizations representing interpreters, consumers, 10 and individuals with limited English proficiency. 11 (f) DEFINITIONS.—In this section: 12 (1) QUALIFIED LEP ENROLLEE.—The term 13 ‘‘qualified LEP enrollee’’ means an individual— 14 (A) who is limited English proficient; and 15 (B) who is enrolled in a State Medicaid 16 plan. 17 (2) STATE.—The term ‘‘State’’ has the mean- 18 ing given the term in section 1101(a)(1) of the So- 19 cial Security Act (42 U.S.C. 1301(a)(1)), for pur- 20 poses of title XIX of such Act (42 U.S.C. 1396 et 21 seq.). 22 (3) STATE MEDICAID PLAN.—The term ‘‘State 23 Medicaid plan’’ means a State plan under title XIX 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00120 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 121 •S 4486 IS of the Social Security Act (42 U.S.C. 1396 et seq.) 1 or a waiver of such a plan. 2 (4) UNITED STATES.—The term ‘‘United 3 States’’ has the meaning given the term in section 4 1101(a)(2) of the Social Security Act (42 U.S.C. 5 1301(a)(2)), for purposes of title XIX of such Act 6 (42 U.S.C. 1396 et seq.). 7 (g) CONTINUATION PAST DEMONSTRATION.—Any 8 State receiving a grant under this section must agree to 9 directly pay for language services in Medicaid for all Med- 10 icaid providers by the end of the grant period. 11 (h) FUNDING.— 12 (1) AUTHORIZATION OF APPROPRIATIONS.— 13 There is authorized to be appropriated $5,000,000 14 to carry out this section. 15 (2) AVAILABILITY OF FUNDS.—Amounts appro- 16 priated pursuant to the authorization in paragraph 17 (1) are authorized to remain available without fiscal 18 year limitation. 19 (3) INCREASED FEDERAL FINANCIAL PARTICI- 20 PATION.—Section 1903(a)(2)(E) of the Social Secu- 21 rity Act (42 U.S.C. 1396b(a)(2)(E)) is amended by 22 inserting ‘‘(or, in the case of a State that was 23 awarded a grant under section 2005 of the Health 24 Equity and Accountability Act of 2022, 100 percent 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00121 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 122 •S 4486 IS for each quarter occurring during the grant period 1 specified in subsection (b) of such section)’’ after 2 ‘‘75 percent’’. 3 (i) LIMITATION.—No Federal funds awarded under 4 this section may be used to provide interpreter services 5 from a location outside the United States. 6 SEC. 2006. TRAINING TOMORROW’S DOCTORS FOR CUL- 7 TURALLY AND LINGUISTICALLY APPRO- 8 PRIATE CARE: GRADUATE MEDICAL EDU- 9 CATION. 10 (a) DIRECT GRADUATE MEDICAL EDUCATION.—Sec- 11 tion 1886(h)(4) of the Social Security Act (42 U.S.C. 12 1395ww(h)(4)) is amended by adding at the end the fol- 13 lowing new subparagraph: 14 ‘‘(L) TREATMENT OF CULTURALLY AND 15 LINGUISTICALLY APPROPRIATE TRAINING.—In 16 determining a hospital’s number of full-time 17 equivalent residents for purposes of this sub- 18 section, all the time that is spent by an intern 19 or resident in an approved medical residency 20 training program for education and training in 21 culturally and linguistically appropriate service 22 delivery, which shall include all medically under- 23 served populations (as defined in section 24 330(b)(3) of the Public Health Service Act), 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00122 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 123 •S 4486 IS shall be counted toward the determination of 1 full-time equivalency.’’. 2 (b) INDIRECT MEDICAL EDUCATION.—Section 3 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 4 1395ww(d)(5)(B)) is amended— 5 (1) by moving the left margin of clause (xii) 4 6 ems to the left; and 7 (2) by adding at the end the following new 8 clause: 9 ‘‘(xiii) The provisions of subparagraph (L) of 10 subsection (h)(4) shall apply under this subpara- 11 graph in the same manner as they apply under such 12 subsection.’’. 13 (c) EFFECTIVE DATE.—The amendments made by 14 subsections (a) and (b) shall apply with respect to pay- 15 ments made to hospitals on or after the date that is one 16 year after the date of the enactment of this Act. 17 SEC. 2007. FEDERAL REIMBURSEMENT FOR CULTURALLY 18 AND LINGUISTICALLY APPROPRIATE SERV- 19 ICES UNDER THE MEDICARE, MEDICAID, AND 20 STATE CHILDREN’S HEALTH INSURANCE 21 PROGRAMS. 22 (a) LANGUAGE ACCESS GRANTS FOR MEDICARE 23 PROVIDERS.— 24 (1) ESTABLISHMENT.— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00123 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 124 •S 4486 IS (A) IN GENERAL.—Not later than 6 1 months after the date of the enactment of this 2 Act, the Secretary of Health and Human Serv- 3 ices (in this subsection referred to as the ‘‘Sec- 4 retary’’), acting through the Centers for Medi- 5 care & Medicaid Services and in consultation 6 with the Center for Medicare and Medicaid In- 7 novation (as referred to in section 1115A of the 8 Social Security Act (42 U.S.C. 1315a)), shall 9 establish a demonstration program under which 10 the Secretary shall award grants to eligible 11 Medicare service providers to provide culturally 12 and linguistically appropriate services to Medi- 13 care beneficiaries who are limited English pro- 14 ficient, including beneficiaries who live in di- 15 verse and underserved communities. 16 (B) APPLICATION OF INNOVATION 17 RULES.—The demonstration project under sub- 18 paragraph (A) shall be conducted in a manner 19 that is consistent with the applicable provisions 20 of subsections (b), (c), and (d) of section 1115A 21 of the Social Security Act (42 U.S.C. 1315a). 22 (C) NUMBER OF GRANTS.—To the extent 23 practicable, the Secretary shall award not less 24 than 24 grants under this subsection. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00124 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 125 •S 4486 IS (D) GRANT PERIOD.—Except as provided 1 in paragraph (2)(D), each grant awarded under 2 this subsection shall be for a 3-year period. 3 (2) ELIGIBILITY REQUIREMENTS.—To be eligi- 4 ble for a grant under this subsection, an entity must 5 meet the following requirements: 6 (A) MEDICARE PROVIDER.—The entity 7 must be— 8 (i) a provider of services under part A 9 of title XVIII of the Social Security Act 10 (42 U.S.C. 1395c et seq.); 11 (ii) a provider of services under part 12 B of such title (42 U.S.C. 1395j et seq.); 13 (iii) a Medicare Advantage organiza- 14 tion offering a Medicare Advantage plan 15 under part C of such title (42 U.S.C. 16 1395w–21 et seq.); or 17 (iv) a PDP sponsor offering a pre- 18 scription drug plan under part D of such 19 title (42 U.S.C. 1395w–101 et seq.). 20 (B) UNDERSERVED COMMUNITIES.—The 21 entity must serve a community that, with re- 22 spect to necessary language services for improv- 23 ing access and utilization of health care among 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00125 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 126 •S 4486 IS individuals with limited English proficiency, is 1 disproportionally underserved. 2 (C) APPLICATION.—The entity must pre- 3 pare and submit to the Secretary an applica- 4 tion, at such time, in such manner, and accom- 5 panied by such additional information as the 6 Secretary may require. 7 (D) REPORTING.—In the case of a grantee 8 that received a grant under this subsection in 9 a previous year, such grantee is only eligible for 10 continued payments under a grant under this 11 subsection if the grantee met the reporting re- 12 quirements under paragraph (9) for such year. 13 If a grantee fails to meet the requirements of 14 such paragraph for the first year of a grant, the 15 Secretary may terminate the grant and solicit 16 applications from new grantees to participate in 17 the demonstration program. 18 (3) DISTRIBUTION.—To the extent feasible, the 19 Secretary shall award— 20 (A) at least 10 grants to providers of serv- 21 ices described in paragraph (2)(A)(i); 22 (B) at least 10 grants to service providers 23 described in paragraph (2)(A)(ii); 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00126 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 127 •S 4486 IS (C) at least 10 grants to organizations de- 1 scribed in paragraph (2)(A)(iii); and 2 (D) at least 10 grants to sponsors de- 3 scribed in paragraph (2)(A)(iv). 4 (4) CONSIDERATIONS IN AWARDING GRANTS.— 5 (A) VARIATION AMONG GRANTEES.—In 6 awarding grants under this subsection, the Sec- 7 retary shall select grantees to ensure the fol- 8 lowing: 9 (i) The grantees provide many dif- 10 ferent types of language services. 11 (ii) The grantees serve Medicare bene- 12 ficiaries who speak different languages, 13 and who, as a population, have differing 14 needs for language services. 15 (iii) The grantees serve Medicare 16 beneficiaries in both urban and rural set- 17 tings. 18 (iv) The grantees represent each Cen- 19 ters for Medicare & Medicaid Services re- 20 gion, as defined by the Secretary. 21 (v) The grantees serve Medicare bene- 22 ficiaries in at least two large metropolitan 23 statistical areas with racial, ethnic, sexual, 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00127 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 128 •S 4486 IS gender, disability, and economically diverse 1 populations. 2 (B) PRIORITY FOR PARTNERSHIPS WITH 3 COMMUNITY ORGANIZATIONS AND AGENCIES.— 4 In awarding grants under this subsection, the 5 Secretary shall give priority to eligible entities 6 that have a partnership with— 7 (i) a community organization; or 8 (ii) a consortium of community orga- 9 nizations, State agencies, and local agen- 10 cies; 11 that has experience in providing language serv- 12 ices. 13 (5) USE OF FUNDS FOR COMPETENT LANGUAGE 14 SERVICES.— 15 (A) IN GENERAL.—Subject to subpara- 16 graph (E), a grantee may only use grant funds 17 received under this subsection to pay for the 18 provision of competent language services to 19 Medicare beneficiaries who are individuals with 20 limited English proficiency. 21 (B) COMPETENT LANGUAGE SERVICES DE- 22 FINED.—For purposes of this subsection, the 23 term ‘‘competent language services’’ means— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00128 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 129 •S 4486 IS (i) interpreter and translation services 1 that— 2 (I) subject to the exceptions 3 under subparagraph (C)— 4 (aa) if the grantee operates 5 in a State that has statewide 6 health care interpreter standards, 7 meet the State standards cur- 8 rently in effect; or 9 (bb) if the grantee operates 10 in a State that does not have 11 statewide health care interpreter 12 standards, utilize competent in- 13 terpreters who follow the Na- 14 tional Council on Interpreting in 15 Health Care’s Code of Ethics and 16 Standards of Practice and com- 17 ply with the requirements of sec- 18 tion 1557 of the Patient Protec- 19 tion and Affordable Care Act (42 20 U.S.C. 18116) as published in 21 the Federal Register on May 18, 22 2016; and 23 (II) in the case of interpreter 24 services, are provided through— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00129 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 130 •S 4486 IS (aa) onsite interpretation; 1 (bb) telephonic interpreta- 2 tion; or 3 (cc) video interpretation; 4 and 5 (ii) the direct provision of health care 6 or health care-related services by a com- 7 petent bilingual health care provider. 8 (C) EXCEPTIONS.—The requirements of 9 subparagraph (B)(i)(I) do not apply, with re- 10 spect to interpreter and translation services and 11 a grantee— 12 (i) in the case of a Medicare bene- 13 ficiary who is limited English proficient, 14 if— 15 (I) such beneficiary has been in- 16 formed, in the beneficiary’s primary 17 language, of the availability of free in- 18 terpreter and translation services and 19 the beneficiary instead requests that a 20 family member, friend, or other per- 21 son provide such services; and 22 (II) the grantee documents such 23 request in the beneficiary’s medical 24 record; or 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00130 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 131 •S 4486 IS (ii) in the case of a medical emergency 1 where the delay directly associated with ob- 2 taining a competent interpreter or trans- 3 lation services would jeopardize the health 4 of the patient. 5 Clause (ii) shall not be construed to exempt 6 emergency rooms or similar entities that regu- 7 larly provide health care services in medical 8 emergencies to patients who are individuals 9 with limited English proficiency from any appli- 10 cable legal or regulatory requirements related to 11 providing competent interpreter and translation 12 services without undue delay. 13 (D) MEDICARE ADVANTAGE ORGANIZA- 14 TIONS AND PDP SPONSORS.—A grantee that is 15 a Medicare Advantage organization or a pre- 16 scription drug plan sponsor must provide at 17 least 50 percent of the grant funds that the 18 grantee receives under this subsection directly 19 to the entity’s network providers (including all 20 health providers and pharmacists) for the pur- 21 pose of providing support for such providers to 22 provide competent language services to Medi- 23 care beneficiaries who are individuals with lim- 24 ited English proficiency. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00131 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 132 •S 4486 IS (E) ADMINISTRATIVE AND REPORTING 1 COSTS.—A grantee may use up to 10 percent of 2 the grant funds to pay for administrative costs 3 associated with the provision of competent lan- 4 guage services and for reporting required under 5 paragraph (9). 6 (6) DETERMINATION OF AMOUNT OF GRANT 7 PAYMENTS.— 8 (A) IN GENERAL.—Payments to grantees 9 under this subsection shall be calculated based 10 on the estimated numbers of Medicare bene- 11 ficiaries who are limited English proficiency in 12 a grantee’s service area utilizing— 13 (i) data on the numbers of English 14 learners who speak English less than ‘‘very 15 well’’ from the most recently available data 16 from the Bureau of the Census or other 17 State-based study the Secretary determines 18 is likely to yield accurate data regarding 19 the number of such individuals in such 20 service area; or 21 (ii) data provided by the grantee, if 22 the grantee routinely collects data on the 23 primary language of the Medicare bene- 24 ficiaries that the grantee serves and the 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00132 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 133 •S 4486 IS Secretary determines that the data is accu- 1 rate and shows a greater number of indi- 2 viduals with limited English proficiency 3 than would be estimated using the data 4 under clause (i). 5 (B) DISCRETION OF SECRETARY.—Subject 6 to subparagraph (C), the amount of payment 7 made to a grantee under this subsection may be 8 modified annually at the discretion of the Sec- 9 retary, based on changes in the data under sub- 10 paragraph (A) with respect to the service area 11 of a grantee for the year. 12 (C) LIMITATION ON AMOUNT.—The 13 amount of a grant made under this subsection 14 to a grantee may not exceed $500,000 for the 15 period under paragraph (1)(D). 16 (7) ASSURANCES.—Grantees under this sub- 17 section shall, as a condition of receiving a grant 18 under this subsection— 19 (A) ensure that clinical and support staff 20 receive appropriate ongoing education and 21 training in linguistically appropriate service de- 22 livery; 23 (B) ensure the linguistic competence of bi- 24 lingual providers; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00133 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 134 •S 4486 IS (C) offer and provide appropriate language 1 services at no additional charge to each patient 2 who is limited English proficient for all points 3 of contact between the patient and the grantee, 4 in a timely manner during all hours of oper- 5 ation; 6 (D) notify Medicare beneficiaries of their 7 right to receive language services in their pri- 8 mary language at least annually; 9 (E) post signage in the primary languages 10 commonly used by the patient population in the 11 service area of the organization; and 12 (F) ensure that— 13 (i) primary language data are col- 14 lected for recipients of language services 15 and such data are consistent with stand- 16 ards developed under title XXXIV of the 17 Public Health Service Act, as added by 18 section 2002 of this Act, to the extent such 19 standards are available upon the initiation 20 of the demonstration program; and 21 (ii) consistent with the privacy protec- 22 tions provided under the regulations pro- 23 mulgated pursuant to section 264(c) of the 24 Health Insurance Portability and Account- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00134 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 135 •S 4486 IS ability Act of 1996 (42 U.S.C. 1320d–2 1 note), if the recipient of language services 2 is a minor or is incapacitated, primary lan- 3 guage data must also be collected on the 4 parent or legal guardian of such recipient. 5 (8) NO COST SHARING.—Medicare beneficiaries 6 who are limited English proficient shall not have to 7 pay cost sharing or co-payments for competent lan- 8 guage services provided under this demonstration 9 program. 10 (9) REPORTING REQUIREMENTS FOR GRANT- 11 EES.—Not later than the end of each calendar year, 12 a grantee that receives funds under this subsection 13 in such year shall submit to the Secretary a report 14 that includes the following information: 15 (A) The number of Medicare beneficiaries 16 to whom competent language services are pro- 17 vided, disaggregated by age and entitlement 18 basis (on the basis of age, disability, or deter- 19 mination of end stage renal disease). 20 (B) The primary languages of those Medi- 21 care beneficiaries. 22 (C) The types of language services pro- 23 vided to such beneficiaries. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00135 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 136 •S 4486 IS (D) Whether such language services were 1 provided by employees of the grantee or 2 through a contract with external contractors or 3 agencies. 4 (E) The types of interpretation services 5 provided to such beneficiaries, and the approxi- 6 mate length of time such service is provided to 7 such beneficiaries. 8 (F) The costs of providing competent lan- 9 guage services. 10 (G) An account of the training or accredi- 11 tation of bilingual staff, interpreters, and trans- 12 lators providing services funded by the grant 13 under this subsection. 14 (10) EVALUATION AND REPORT TO CON- 15 GRESS.—Not later than 1 year after the completion 16 of a 3-year grant under this subsection, the Sec- 17 retary shall conduct an evaluation of the demonstra- 18 tion program under this subsection and shall submit 19 to the Congress a report that includes the following: 20 (A) An analysis of the patient outcomes 21 and the costs of furnishing care to the Medicare 22 beneficiaries who are individuals with limited 23 English proficiency participating in the project 24 as compared to such outcomes and costs for 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00136 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 137 •S 4486 IS such Medicare beneficiaries not participating, 1 based on the data provided under paragraph (9) 2 and any other information available to the Sec- 3 retary. 4 (B) The effect of delivering language serv- 5 ices on— 6 (i) Medicare beneficiary access to care 7 and utilization of services; 8 (ii) the efficiency and cost-effective- 9 ness of health care delivery; 10 (iii) patient satisfaction with respect 11 to both health service delivery and lan- 12 guage assistance; 13 (iv) health outcomes; and 14 (v) the provision of culturally appro- 15 priate services provided to such bene- 16 ficiaries. 17 (C) The extent to which bilingual staff, in- 18 terpreters, and translators providing services 19 under such demonstration were trained or ac- 20 credited and the nature of accreditation or 21 training needed by type of provider, service, or 22 other category as determined by the Secretary 23 to ensure the provision of high-quality interpre- 24 tation, translation, or other language services to 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00137 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 138 •S 4486 IS Medicare beneficiaries if such services are ex- 1 panded pursuant to section 1115A(c) of the So- 2 cial Security Act (42 U.S.C. 1315a(c)). 3 (D) Recommendations, if any, regarding 4 the extension of such project to the entire Medi- 5 care Program, subject to the provisions of such 6 section 1115A(c). 7 (11) APPROPRIATIONS.—There is appropriated 8 to carry out this subsection, in equal parts from the 9 Federal Hospital Insurance Trust Fund under sec- 10 tion 1817 of the Social Security Act (42 U.S.C. 11 1395i) and the Federal Supplementary Medical In- 12 surance Trust Fund under section 1841 of such Act 13 (42 U.S.C. 1395t), $16,000,000 for each fiscal year 14 of the demonstration program. 15 (12) LIMITED ENGLISH PROFICIENT DE- 16 FINED.—In this subsection, the term ‘‘limited 17 English proficient’’ refers to individuals who self- 18 identify on the Census as speaking English less than 19 ‘‘very well’’. 20 (b) LANGUAGE ASSISTANCE SERVICES UNDER THE 21 MEDICARE PROGRAM.— 22 (1) INCLUSION AS RURAL HEALTH CLINIC 23 SERVICES.—Section 1861 of the Social Security Act 24 (42 U.S.C. 1395x) is amended— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00138 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 139 •S 4486 IS (A) in subsection (aa)(1)— 1 (i) in subparagraph (B), by striking 2 ‘‘and’’ at the end; 3 (ii) in subparagraph (C), by adding 4 ‘‘and’’ at the end; and 5 (iii) by inserting after subparagraph 6 (C) the following new subparagraph: 7 ‘‘(D) language assistance services as defined in 8 subsection (lll),’’; and 9 (B) by adding at the end the following new 10 subsection: 11 ‘‘Language Assistance Services and Related Terms 12 ‘‘(lll) The term ‘language assistance services’ means 13 ‘language access’ or ‘language assistance services’ (as 14 those terms are defined in section 3400 of the Public 15 Health Service Act) furnished by a ‘qualified interpreter 16 for an individual with limited English proficiency’ or a 17 ‘qualified translator’ (as those terms are defined in such 18 section 3400) to an ‘individual with limited English pro- 19 ficiency’ (as defined in such section 3400).’’. 20 (2) COVERAGE.—Section 1832(a)(2) of the So- 21 cial Security Act (42 U.S.C. 1395k(a)(2)) is amend- 22 ed— 23 (A) in subparagraph (I), by striking ‘‘and’’ 24 at the end; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00139 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 140 •S 4486 IS (B) in subparagraph (J), by striking the 1 period at the end and inserting ‘‘; and’’; and 2 (C) by adding at the end the following new 3 subparagraph: 4 ‘‘(K) language assistance services (as de- 5 fined in section 1861(lll)).’’. 6 (3) PAYMENT.—Section 1833(a) of the Social 7 Security Act (42 U.S.C. 1395l(a)) is amended— 8 (A) in paragraph (9), by striking ‘‘and’’ at 9 the end; 10 (B) in paragraph (10), by striking the pe- 11 riod at the end and inserting ‘‘; and’’; and 12 (C) by inserting after paragraph (10) the 13 following new paragraph: 14 ‘‘(11) in the case of language assistance serv- 15 ices (as defined in section 1861(lll)), 100 percent of 16 the reasonable charges for such services, as deter- 17 mined in consultation with the Medicare Payment 18 Advisory Commission.’’. 19 (4) WAIVER OF BUDGET NEUTRALITY.—For 20 the 3-year period beginning on the date of enact- 21 ment of this section, the budget neutrality provision 22 of section 1848(c)(2)(B)(ii) of the Social Security 23 Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00140 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 141 •S 4486 IS apply with respect to language assistance services 1 (as defined in section 1861(lll) of such Act). 2 (c) MEDICARE PARTS C AND D.— 3 (1) IN GENERAL.—Medicare Advantage plans 4 under part C of title XVIII of the Social Security 5 Act (42 U.S.C. 1395w–21 et seq.) and prescription 6 drug plans under part D of such title (42 U.S.C. 7 1395q–101) shall comply with title VI of the Civil 8 Rights Act of 1964 (42 U.S.C. 2000d et seq.) and 9 section 1557 of the Patient Protection and Afford- 10 able Care Act (42 U.S.C. 18116) to provide effective 11 language services to enrollees of such plans. 12 (2) MEDICARE ADVANTAGE PLANS AND PRE- 13 SCRIPTION DRUG PLANS REPORTING REQUIRE- 14 MENT.—Section 1857(e) of the Social Security Act 15 (42 U.S.C. 1395w–27(e)) is amended by adding at 16 the end the following new paragraph: 17 ‘‘(6) REPORTING REQUIREMENTS RELATING TO 18 EFFECTIVE LANGUAGE SERVICES.—A contract under 19 this part shall require a Medicare Advantage organi- 20 zation (and, through application of section 1860D– 21 12(b)(3)(D), a contract under section 1860D–12 22 shall require a PDP sponsor) to annually submit 23 (for each year of the contract) a report that contains 24 information on the internal policies and procedures 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00141 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 142 •S 4486 IS of the organization (or sponsor) related to recruit- 1 ment and retention efforts directed to workforce di- 2 versity and linguistically and culturally appropriate 3 provision of services in each of the following con- 4 texts: 5 ‘‘(A) The collection of data in a manner 6 that meets the requirements of title I of the 7 Health Equity and Accountability Act of 2022, 8 regarding the enrollee population. 9 ‘‘(B) Education of staff and contractors 10 who have routine contact with enrollees regard- 11 ing the various needs of the diverse enrollee 12 population. 13 ‘‘(C) Evaluation of the language services 14 programs and services offered by the organiza- 15 tion (or sponsor) with respect to the enrollee 16 population, such as through analysis of com- 17 plaints or satisfaction survey results. 18 ‘‘(D) Methods by which the plan provides 19 to the Secretary information regarding the eth- 20 nic diversity of the enrollee population. 21 ‘‘(E) The periodic provision of educational 22 information to plan enrollees on the language 23 services and programs offered by the organiza- 24 tion (or sponsor).’’. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00142 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 143 •S 4486 IS (d) IMPROVING LANGUAGE SERVICES IN MEDICAID 1 AND CHIP.— 2 (1) PAYMENTS TO STATES.—Section 3 1903(a)(2)(E) of the Social Security Act (42 U.S.C. 4 1396b(a)(2)(E)), as amended by section 2005(h)(3), 5 is further amended by— 6 (A) striking ‘‘75’’ and inserting ‘‘95’’; 7 (B) striking ‘‘translation or interpretation 8 services’’ and inserting ‘‘language assistance 9 services’’; and 10 (C) striking ‘‘children of families’’ and in- 11 serting ‘‘individuals’’. 12 (2) STATE PLAN REQUIREMENTS.—Section 13 1902(a)(10)(A) of the Social Security Act (42 14 U.S.C. 1396a(a)(10)(A)) is amended by striking 15 ‘‘and (30)’’ and inserting ‘‘(30), and (31)’’. 16 (3) DEFINITION OF MEDICAL ASSISTANCE.— 17 (A) IN GENERAL.—Section 1905(a) of the 18 Social Security Act (42 U.S.C. 1396d(a)) is 19 amended— 20 (i) in paragraph (30), by striking 21 ‘‘and’’ at the end; 22 (ii) by redesignating paragraph (31) 23 as paragraph (32); and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00143 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 144 •S 4486 IS (iii) by inserting after paragraph (30) 1 the following new paragraph: 2 ‘‘(31) language assistance services, as such 3 term is defined in section 1861(lll), provided in a 4 timely manner to individuals with limited English 5 proficiency as defined in section 3400 of the Public 6 Health Service Act; and’’. 7 (B) CONFORMING AMENDMENTS.— 8 (i) Section 1902(nn)(3) of the Social 9 Security Act (42 U.S.C. 1396a(nn)(3)) is 10 amended by striking ‘‘paragraph (30)’’ and 11 inserting ‘‘the last paragraph’’. 12 (ii) Section 1905(a) of the Social Se- 13 curity Act (42 U.S.C. 1396d(a)) is amend- 14 ed, in the 5th sentence, by striking ‘‘para- 15 graph (30)’’ and inserting ‘‘the last para- 16 graph’’. 17 (4) USE OF DEDUCTIONS AND COST SHAR- 18 ING.—Subsections (a)(2) and (b)(2) of section 19 1916(a)(2) of the Social Security Act (42 U.S.C. 20 1396o(a)(2)) are each amended— 21 (A) in subparagraph (G), by inserting a 22 comma after ‘‘plan’’; 23 (B) in subparagraph (H), by striking ‘‘; 24 or’’ and inserting a comma; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00144 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 145 •S 4486 IS (C) in subparagraph (I), by striking ‘‘; 1 and’’ and inserting ‘‘, or’’; and 2 (D) by adding at the end the following new 3 subparagraph: 4 ‘‘(J) language assistance services described 5 in section 1905(a)(31); and’’. 6 (5) CHIP COVERAGE REQUIREMENTS.—Section 7 2103 of the Social Security Act (42 U.S.C. 1397cc) 8 is amended— 9 (A) in subsection (a), in the matter before 10 paragraph (1), by striking ‘‘(7) and (8)’’ and 11 inserting ‘‘(7), (8), (9), (10), (11), and (12)’’; 12 (B) in subsection (c), by adding at the end 13 the following new paragraph: 14 ‘‘(12) LANGUAGE ASSISTANCE SERVICES.—The 15 child health assistance provided to a targeted low-in- 16 come child shall include coverage of language assist- 17 ance services, as such term is defined in section 18 1861(lll), provided in a timely manner to individuals 19 with limited English proficiency (as defined in sec- 20 tion 3400 of the Public Health Service Act).’’; and 21 (C) in subsection (e)(2)— 22 (i) in the heading, by striking ‘‘PRE- 23 VENTIVE’’ and inserting ‘‘CERTAIN’’; and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00145 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 146 •S 4486 IS (ii) by inserting ‘‘language assistance 1 services described in subsection (c)(12),’’ 2 before ‘‘visits described in’’. 3 (6) DEFINITION OF CHILD HEALTH ASSIST- 4 ANCE.—Section 2110(a)(27) of the Social Security 5 Act (42 U.S.C. 1397jj(a)(27)) is amended by strik- 6 ing ‘‘translation’’ and inserting ‘‘language assistance 7 services as described in section 2103(c)(12)’’. 8 (7) STATE DATA COLLECTION.—Pursuant to 9 the reporting requirement described in section 10 2107(b)(1) of the Social Security Act (42 U.S.C. 11 1397gg(b)(1)), the Secretary of Health and Human 12 Services shall require that States collect data on— 13 (A) the primary language of individuals re- 14 ceiving child health assistance under title XXI 15 of the Social Security Act (42 U.S.C. 1397aa et 16 seq.); and 17 (B) in the case of such individuals who are 18 minors or incapacitated, the primary language 19 of the individual’s parent or guardian. 20 (8) CHIP PAYMENTS TO STATES.—Section 21 2105 of the Social Security Act (42 U.S.C. 1397ee) 22 is amended— 23 (A) in subsection (a)(1)— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00146 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 147 •S 4486 IS (i) in the matter preceding subpara- 1 graph (A), by striking ‘‘75’’ and inserting 2 ‘‘95’’; and 3 (ii) in subparagraph (D)(iv), by strik- 4 ing ‘‘translation or interpretation services’’ 5 and inserting ‘‘language assistance serv- 6 ices’’; and 7 (B) in subsection (c)(2)(A), by inserting 8 before the period at the end the following: ‘‘, 9 except that expenditures pursuant to clause (iv) 10 of subparagraph (D) of such paragraph shall 11 not count towards this total’’. 12 (e) FUNDING LANGUAGE ASSISTANCE SERVICES 13 FURNISHED BY PROVIDERS OF HEALTH CARE AND 14 HEALTH CARE-RELATED SERVICES THAT SERVE HIGH 15 RATES OF UNINSURED LEP INDIVIDUALS.— 16 (1) PAYMENT OF COSTS.— 17 (A) IN GENERAL.—Subject to subpara- 18 graph (B), the Secretary of Health and Human 19 Services (referred to in this subsection as the 20 ‘‘Secretary’’) shall make payments (on a quar- 21 terly basis) directly to eligible entities to sup- 22 port the provision of language assistance serv- 23 ices to individuals with limited English pro- 24 ficiency in an amount equal to an eligible enti- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00147 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 148 •S 4486 IS ty’s eligible costs for providing such services for 1 the quarter. 2 (B) FUNDING.—Out of any funds in the 3 Treasury not otherwise appropriated, there are 4 appropriated to the Secretary such sums as 5 may be necessary for each of fiscal years 2022 6 through 2026. 7 (C) RELATION TO MEDICAID DSH.—Pay- 8 ments under this subsection shall not offset or 9 reduce payments under section 1923 of the So- 10 cial Security Act (42 U.S.C. 1396r–4), nor 11 shall payments under such section be consid- 12 ered when determining uncompensated costs as- 13 sociated with the provision of language assist- 14 ance services for the purposes of this sub- 15 section. 16 (2) METHODOLOGY FOR PAYMENT OF 17 CLAIMS.— 18 (A) IN GENERAL.—The Secretary shall es- 19 tablish a methodology to determine the average 20 per person cost of language assistance services. 21 (B) DIFFERENT ENTITIES.—In estab- 22 lishing such methodology, the Secretary may es- 23 tablish different methodologies for different 24 types of eligible entities. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00148 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 149 •S 4486 IS (C) NO INDIVIDUAL CLAIMS.—The Sec- 1 retary may not require eligible entities to sub- 2 mit individual claims for language assistance 3 services for individual patients as a requirement 4 for payment under this subsection. 5 (3) DATA COLLECTION INSTRUMENT.—For pur- 6 poses of this subsection, the Secretary shall create a 7 standard data collection instrument that is con- 8 sistent with any existing reporting requirements by 9 the Secretary or relevant accrediting organizations 10 regarding the number of individuals to whom lan- 11 guage access is provided. 12 (4) GUIDELINES.—Not later than 6 months 13 after the date of enactment of this Act, the Sec- 14 retary shall establish and distribute guidelines con- 15 cerning the implementation of this subsection. 16 (5) REPORTING REQUIREMENTS.— 17 (A) REPORT TO SECRETARY.—Entities re- 18 ceiving payment under this subsection shall pro- 19 vide the Secretary with a quarterly report on 20 how the entity used such funds. Such report 21 shall contain aggregate (and may not contain 22 individualized) data collected using the instru- 23 ment under paragraph (3) and shall otherwise 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00149 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 150 •S 4486 IS be in a form and manner determined by the 1 Secretary. 2 (B) REPORT TO CONGRESS.—Not later 3 than 2 years after the date of enactment of this 4 Act, and every 2 years thereafter, the Secretary 5 shall submit a report to Congress concerning 6 the implementation of this subsection. 7 (6) DEFINITIONS.—In this subsection: 8 (A) ELIGIBLE COSTS.—The term ‘‘eligible 9 costs’’ means, with respect to an eligible entity 10 that provides language assistance services to 11 limited English proficient individuals, the prod- 12 uct of— 13 (i) the average per person cost of lan- 14 guage assistance services, determined ac- 15 cording to the methodology devised under 16 paragraph (2); and 17 (ii) the number of individuals with 18 limited English proficiency who are pro- 19 vided language assistance services by the 20 entity and for whom no reimbursement is 21 available for such services under the 22 amendments made by subsection (a), (b), 23 (c), or (d) or by private health insurance. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00150 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 151 •S 4486 IS (B) ELIGIBLE ENTITY.—The term ‘‘eligible 1 entity’’ means an entity that— 2 (i) is a Medicaid provider that is— 3 (I) a physician; 4 (II) a hospital with a low-income 5 utilization rate (as defined in section 6 1923(b)(3) of the Social Security Act 7 (42 U.S.C. 1396r–4(b)(3))) of greater 8 than 25 percent; 9 (III) a federally qualified health 10 center (as defined in section 11 1905(l)(2)(B) of the Social Security 12 Act (42 U.S.C. 1396d(l)(2)(B))); 13 (IV) a hospice provider; or 14 (V) a palliative care provider; 15 (ii) not later than 6 months after the 16 date of the enactment of this Act, provides 17 language assistance services to not less 18 than 8 percent of the entity’s total number 19 of patients; and 20 (iii) prepares and submits an applica- 21 tion to the Secretary, at such time, in such 22 manner, and accompanied by such infor- 23 mation as the Secretary may require, to 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00151 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 152 •S 4486 IS ascertain the entity’s eligibility for funding 1 under this subsection. 2 (C) LANGUAGE ASSISTANCE SERVICES.— 3 The term ‘‘language assistance services’’ has 4 the meaning given such term in section 5 1861(lll) of the Social Security Act, as added by 6 subsection (b). 7 (f) APPLICATION OF CIVIL RIGHTS ACT OF 1964, 8 SECTION 1557 OF THE AFFORDABLE CARE ACT, AND 9 OTHER LAWS.—Nothing in this section shall be construed 10 to limit otherwise existing obligations of recipients of Fed- 11 eral financial assistance under title VI of the Civil Rights 12 Act of 1964 (42 U.S.C. 2000d et seq.), section 1557 of 13 the Affordable Care Act, or other laws that protect the 14 civil rights of individuals. 15 (g) EFFECTIVE DATE.— 16 (1) IN GENERAL.—Except as otherwise pro- 17 vided and subject to paragraph (2), the amendments 18 made by this section shall take effect on January 1, 19 2023. 20 (2) EXCEPTION IF STATE LEGISLATION RE- 21 QUIRED.—In the case of a State plan for medical as- 22 sistance under title XIX of the Social Security Act 23 (42 U.S.C. 1396 et seq.) or a State plan for child 24 health assistance under title XXI of such Act (42 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00152 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 153 •S 4486 IS U.S.C. 1397aa et seq.) which the Secretary of 1 Health and Human Services determines requires 2 State legislation (other than legislation appro- 3 priating funds) in order for the plan to meet the ad- 4 ditional requirement imposed by the amendments 5 made by this section, such State plan shall not be 6 regarded as failing to comply with the requirements 7 of such title solely on the basis of its failure to meet 8 this additional requirement before the first day of 9 the first calendar quarter beginning after the close 10 of the first regular session of the State legislature 11 that begins after the date of the enactment of this 12 Act. For purposes of the previous sentence, in the 13 case of a State that has a 2-year legislative session, 14 each year of such session shall be deemed to be a 15 separate regular session of the State legislature. 16 SEC. 2008. INCREASING UNDERSTANDING OF AND IMPROV- 17 ING HEALTH LITERACY. 18 (a) IN GENERAL.—The Secretary, in consultation 19 with the Director of the National Institute on Minority 20 Health and Health Disparities and the Deputy Assistant 21 Secretary for Minority Health, shall award grants to eligi- 22 ble entities to improve health care for patient populations 23 that have low health literacy. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00153 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 154 •S 4486 IS (b) ELIGIBILITY.—To be eligible to receive a grant 1 under subsection (a), an entity shall— 2 (1) be a hospital, health center or clinic, health 3 plan, or other health entity (including a nonprofit 4 minority health organization or association); and 5 (2) prepare and submit to the Secretary an ap- 6 plication at such time, in such manner, and con- 7 taining such information as the Secretary may rea- 8 sonably require. 9 (c) USE OF FUNDS.— 10 (1) AGENCY FOR HEALTHCARE RESEARCH AND 11 QUALITY.—A grant under subsection (a) that is 12 awarded through the Director of the Agency for 13 Healthcare Research and Quality shall be used— 14 (A) to define and increase the under- 15 standing of health literacy across all areas of 16 health care, including end of life care; 17 (B) to investigate the correlation between 18 low health literacy and health and health care; 19 (C) to clarify which aspects of health lit- 20 eracy have an effect on health outcomes; and 21 (D) for any other activity determined ap- 22 propriate by the Director. 23 (2) HEALTH RESOURCES AND SERVICES ADMIN- 24 ISTRATION.—A grant under subsection (a) that is 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00154 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 155 •S 4486 IS awarded through the Administrator of the Health 1 Resources and Services Administration shall be used 2 to conduct demonstration projects for interventions 3 for patients with low health literacy that may in- 4 clude— 5 (A) the development of new disease man- 6 agement and end of life care programs for pa- 7 tients with low health literacy; 8 (B) the tailoring of disease management 9 programs and end of life care addressing men- 10 tal, physical, oral, and behavioral health condi- 11 tions for patients with low health literacy; 12 (C) the translation of written health mate- 13 rials for patients with low health literacy; 14 (D) the identification, implementation, and 15 testing of low health literacy screening tools; 16 (E) the conduct of educational campaigns 17 for patients and providers about low health lit- 18 eracy; 19 (F) the conduct of educational campaigns 20 concerning health directed specifically at pa- 21 tients with mental disabilities, including those 22 with cognitive and intellectual disabilities, de- 23 signed to reduce the incidence of low health lit- 24 eracy among these populations, which shall 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00155 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 156 •S 4486 IS have instructional materials in the plain lan- 1 guage standards promulgated under the Plain 2 Writing Act of 2010 (5 U.S.C. 301 note) for 3 Federal agencies; and 4 (G) other activities determined appropriate 5 by the Administrator. 6 (d) DEFINITIONS.—In this section: 7 (1) LOW HEALTH LITERACY.—The term ‘‘low 8 health literacy’’ means the inability of an individual 9 to obtain, process, and understand basic health in- 10 formation and services needed to make appropriate 11 health decisions. 12 (2) SECRETARY.—The term ‘‘Secretary’’ means 13 the Secretary of Health and Human Services— 14 (A) acting through the Director of the 15 Agency for Healthcare Research and Quality, 16 with respect to grants under subsection (c)(1); 17 and 18 (B) acting through the Administrator of 19 the Health Resources and Services Administra- 20 tion with respect to grants under subsection 21 (c)(2). 22 (e) AUTHORIZATION OF APPROPRIATIONS.—There 23 are authorized to be appropriated to carry out this section 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00156 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 157 •S 4486 IS such sums as may be necessary for each of fiscal years 1 2023 through 2027. 2 SEC. 2009. REQUIREMENTS FOR HEALTH PROGRAMS OR 3 ACTIVITIES RECEIVING FEDERAL FUNDS. 4 (a) COVERED ENTITY; COVERED PROGRAM OR AC- 5 TIVITY.—In this section— 6 (1) the term ‘‘covered entity’’ has the meaning 7 given such term in section 92.4 of title 45, Code of 8 Federal Regulations, as in effect on May 18, 2016 9 (81 Fed. Reg. 31466); and 10 (2) the term ‘‘health program or activity’’ has 11 the meaning given such term in section 92.4 of title 12 45, Code of Federal Regulations, as in effect on May 13 18, 2016 (81 Fed. Reg. 31466). 14 (b) REQUIREMENTS.—A covered entity, in order to 15 ensure the right of individuals with limited English pro- 16 ficiency to receive access to high-quality health care 17 through the covered program or activity, shall— 18 (1) ensure that appropriate clinical and support 19 staff receive ongoing education and training in cul- 20 turally and linguistically appropriate service delivery 21 at least annually; 22 (2) offer and provide appropriate language as- 23 sistance services at no additional charge to each pa- 24 tient that is an individual with limited English pro- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00157 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 158 •S 4486 IS ficiency at all points of contact, in a timely manner 1 during all hours of operation; 2 (3) notify patients of their right to receive lan- 3 guage services in their primary language; and 4 (4) utilize only qualified interpreters for an in- 5 dividual with limited English proficiency or qualified 6 translators, except as provided in subsection (c). 7 (c) EXEMPTIONS.—The requirements of subsection 8 (b)(4) shall not apply as follows: 9 (1) When a patient requests the use of family, 10 friends, or other persons untrained in interpretation 11 or translation if each of the following conditions are 12 met: 13 (A) The interpreter requested by the pa- 14 tient is over the age of 18. 15 (B) The covered entity informs the patient 16 in the primary language of the patient that he 17 or she has the option of having the entity pro- 18 vide to the patient an interpreter and trans- 19 lation services without charge. 20 (C) The covered entity informs the patient 21 that the entity may not require an individual 22 with a limited English proficiency to use a fam- 23 ily member or friend as an interpreter. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00158 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 159 •S 4486 IS (D) The covered entity evaluates whether 1 the person the patient wishes to use as an in- 2 terpreter is competent. If the covered entity has 3 reason to believe that such person is not com- 4 petent as an interpreter, the entity provides its 5 own interpreter to protect the covered entity 6 from liability if the patient’s interpreter is later 7 found not competent. 8 (E) If the covered entity has reason to be- 9 lieve that there is a conflict of interest between 10 the interpreter and patient, the covered entity 11 may not use the patient’s interpreter. 12 (F) The covered entity has the patient sign 13 a waiver, witnessed by at least 1 individual not 14 related to the patient, that includes the infor- 15 mation stated in subparagraphs (A) through 16 (E) and is translated into the patient’s primary 17 language. 18 (2) When a medical emergency exists and the 19 delay directly associated with obtaining competent 20 interpreter or translation services would jeopardize 21 the health of the patient, but only until a competent 22 interpreter or translation service is available. 23 (d) RULE OF CONSTRUCTION.—Subsection (c)(2) 24 shall not be construed to mean that emergency rooms or 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00159 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 160 •S 4486 IS similar entities that regularly provide health care services 1 in medical emergencies are exempt from legal or regu- 2 latory requirements related to competent interpreter serv- 3 ices. 4 SEC. 2010. REPORT ON FEDERAL EFFORTS TO PROVIDE 5 CULTURALLY AND LINGUISTICALLY APPRO- 6 PRIATE HEALTH CARE SERVICES. 7 (a) REPORT.—Not later than 1 year after the date 8 of enactment of this Act, and annually thereafter, the Sec- 9 retary of Health and Human Services shall enter into a 10 contract with the National Academy of Medicine for the 11 preparation and publication of a report that describes 12 Federal efforts to ensure that all individuals with limited 13 English proficiency have meaningful access to health care 14 services and health care-related services that are culturally 15 and linguistically appropriate. Such report shall include— 16 (1) a description and evaluation of the activities 17 carried out under this Act; 18 (2) a description and analysis of best practices, 19 model programs, guidelines, and other effective 20 strategies for providing access to culturally and lin- 21 guistically appropriate health care services; 22 (3) recommendations on the development and 23 implementation of policies and practices by providers 24 of health care services and health care-related serv- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00160 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 161 •S 4486 IS ices for individuals with limited English proficiency, 1 including people with cognitive, hearing, vision, or 2 print impairments; 3 (4) recommend guidelines or standards for 4 health literacy and plain language, informed consent, 5 discharge instructions, and written communications, 6 and for improvement of health care access; 7 (5) a description of the effect of providing lan- 8 guage services on quality of health care and access 9 to care; and 10 (6) a description of the costs associated with or 11 savings related to the provision of language services. 12 (b) AUTHORIZATION OF APPROPRIATIONS.—There 13 are authorized to be appropriated to carry out this section 14 such sums as may be necessary for each of fiscal years 15 2023 through 2027. 16 SEC. 2011. ENGLISH INSTRUCTION FOR INDIVIDUALS WITH 17 LIMITED ENGLISH PROFICIENCY. 18 (a) GRANTS AUTHORIZED.—The Secretary of Edu- 19 cation is authorized to provide grants to eligible entities 20 for the provision of English as a second language (in this 21 section referred to as ‘‘ESL’’) instruction to individuals 22 with limited English proficiency, including health care-re- 23 lated English instruction, and shall determine, after con- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00161 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 162 •S 4486 IS sultation with appropriate stakeholders, the mechanism 1 for administering and distributing such grants. 2 (b) ELIGIBLE ENTITY.—In this section, the term ‘‘el- 3 igible entity’’ means— 4 (1) a State; or 5 (2) a community-based organization that pre- 6 dominantly employs and serves racial and ethnic mi- 7 nority groups (as defined in section 1707(g) of the 8 Public Health Service Act (42 U.S.C. 300u–6(g)). 9 (c) APPLICATION.—An eligible entity that desires to 10 receive a grant under this section shall apply by submit- 11 ting to the Secretary of Education an application at such 12 time, in such manner, and containing such information as 13 the Secretary may require. 14 (d) USE OF GRANT.—An eligible entity shall use 15 grant funds provided under this section to— 16 (1) develop and implement a plan for assuring 17 the availability of ESL instruction, free of charge, to 18 the community served by the eligible entity, that ef- 19 fectively integrates information about the nature of 20 the United States health care system, how to access 21 care, and any special language skills that may be re- 22 quired for individuals with limited English pro- 23 ficiency to access and regularly negotiate the health 24 care system effectively; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00162 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 163 •S 4486 IS (2) develop a plan for making ESL instruction 1 available free to charge to individuals with limited 2 English proficiency in the community served by the 3 eligible entity who are seeking instruction, including, 4 where appropriate, through the use of public-private 5 partnerships; and 6 (3) provide ESL instruction to individuals with 7 limited English proficiency in the community served 8 by the eligible entity. 9 (e) SUPPLEMENT, NOT SUPPLANT.—An eligible enti- 10 ty awarded a grant under this section shall use funds 11 made available under this section to supplement, and not 12 supplant, other Federal, State, and local funds that would 13 otherwise be expended to carry out activities under this 14 section. 15 (f) DUTIES OF THE SECRETARY.—The Secretary of 16 Education shall— 17 (1) collect and make publicly available annual 18 data on how much Federal, State, and local govern- 19 ments spend annually on ESL instruction; 20 (2) collect data from eligible entities awarded a 21 grant under this section to identify the unmet needs 22 of individuals with limited English proficiency for 23 appropriate ESL instruction, including— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00163 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 164 •S 4486 IS (A) the preferred written and spoken lan- 1 guage of such individuals; 2 (B) the availability of enrollment in ESL 3 instruction programs in the communities served 4 by each eligible entity awarded a grant under 5 this section, including the extent of waiting lists 6 for ESL instruction, how many programs main- 7 tain waiting lists, and, for programs that do not 8 have waiting lists, the reasons why such a list 9 is unnecessary or otherwise not maintained; 10 (C) the availability of programs to geo- 11 graphically isolated communities; 12 (D) the impact of course enrollment poli- 13 cies, including open enrollment, on the avail- 14 ability of ESL instruction; 15 (E) the number of individuals with limited 16 English proficiency and the number of individ- 17 uals enrolled in ESL instruction programs in 18 the communities served by each eligible entity 19 awarded a grant under this section; 20 (F) the effectiveness of the ESL instruc- 21 tion provided through grants awarded under 22 this section in meeting the needs of individuals 23 receiving such instruction; and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00164 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 165 •S 4486 IS (G) an assessment of the need for pro- 1 grams that integrate job training and ESL in- 2 struction, to assist individuals with limited 3 English proficiency in obtaining better jobs; 4 (3) determine the cost and most appropriate 5 methods of making ESL instruction available to all 6 individuals with limited English proficiency in the 7 United States who are seeking instruction; and 8 (4) not later than 1 year after the date of en- 9 actment of this Act, issue a report to Congress 10 that— 11 (A) assesses the information collected in 12 paragraphs (1), (2), and (3) and makes rec- 13 ommendations on steps that should be taken to 14 realize the goal of making ESL instruction 15 available to all individuals with limited English 16 proficiency in the United States who are seek- 17 ing instruction; and 18 (B) evaluates the impact of the grant pro- 19 gram authorized under this section on the ac- 20 cessibility of, and ability to effectively negotiate, 21 the health care system for individuals with lim- 22 ited English proficiency who have received ESL 23 instruction funded by a grant under this sec- 24 tion. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00165 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 166 •S 4486 IS (g) AUTHORIZATION OF APPROPRIATIONS.—There 1 are authorized to be appropriated to the Secretary of Edu- 2 cation $250,000,000 for each of fiscal years 2023 through 3 2027 to carry out this section. 4 SEC. 2012. IMPLEMENTATION. 5 (a) GENERAL PROVISIONS.— 6 (1) IMMUNITY.—A person injured by a violation 7 of this title (including an amendment made by this 8 title) by a State may bring a civil action in the ap- 9 propriate Federal court for such injury in accord- 10 ance with this section. 11 (2) REMEDIES.—In a civil action under this 12 section for a violation of this title, such remedies 13 shall be available as would be available in a civil ac- 14 tion for such violation against any party other than 15 a State. 16 (b) RULE OF CONSTRUCTION.—Nothing in this title 17 may be construed to limit otherwise existing obligations 18 of recipients of Federal financial assistance under title VI 19 of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) 20 or any other Federal statute. 21 SEC. 2013. LANGUAGE ACCESS SERVICES. 22 (a) ESSENTIAL BENEFITS.—Section 1302(b)(1) of 23 the Patient Protection and Affordable Care Act (42 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00166 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 167 •S 4486 IS U.S.C. 18022(b)(1)) is amended by adding at the end the 1 following: 2 ‘‘(K) Language access services, including 3 oral interpretation and written translations.’’. 4 (b) EMPLOYER-SPONSORED MINIMUM ESSENTIAL 5 COVERAGE.— 6 (1) IN GENERAL.—Section 36B(c)(2)(C) of the 7 Internal Revenue Code of 1986 is amended by redes- 8 ignating clauses (iii) and (iv) as clauses (iv) and (v), 9 respectively, and by inserting after clause (ii) the fol- 10 lowing new clause: 11 ‘‘(iii) COVERAGE MUST INCLUDE LAN- 12 GUAGE ACCESS AND SERVICES.—Except as 13 provided in clause (iv), an employee shall 14 not be treated as eligible for minimum es- 15 sential coverage if such coverage consists 16 of an eligible employer-sponsored plan (as 17 defined in section 5000A(f)(2)) and the 18 plan does not provide coverage for lan- 19 guage access services, including oral inter- 20 pretation and written translations.’’. 21 (2) CONFORMING AMENDMENTS.— 22 (A) Section 36B(c)(2)(C) of such Code is 23 amended by striking ‘‘clause (iii)’’ each place it 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00167 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 168 •S 4486 IS appears in clauses (i) and (ii) and inserting 1 ‘‘clause (iv)’’. 2 (B) Section 36B(c)(2)(C)(iv) of such Code, 3 as redesignated by this subsection, is amended 4 by striking ‘‘(i) and (ii)’’ and inserting ‘‘(i), (ii), 5 and (iii)’’. 6 (c) QUALITY REPORTING.—Section 2717(a)(1) of the 7 Public Health Service Act (42 U.S.C. 300gg–17(a)(1)) is 8 amended— 9 (1) by striking ‘‘and’’ at the end of subpara- 10 graph (C); 11 (2) by striking the period at the end of sub- 12 paragraph (D) and inserting ‘‘; and’’; and 13 (3) by adding at the end the following new sub- 14 paragraph: 15 ‘‘(E) reduce health disparities through the 16 provision of language access services, including 17 oral interpretation and written translations.’’. 18 (d) REGULATIONS REGARDING INTERNAL CLAIMS 19 AND APPEALS AND EXTERNAL REVIEW PROCESSES FOR 20 HEALTH PLANS AND HEALTH INSURANCE ISSUERS.— 21 The Secretary of the Treasury, the Secretary of Labor, 22 and the Secretary of Health and Human Services shall 23 amend the regulations in section 54.9815–2719(e) of title 24 26, Code of Federal Regulations, section 2590.715– 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00168 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 169 •S 4486 IS 2719(e) of title 29, Code of Federal Regulations, and sec- 1 tion 147.136(e) of title 45, Code of Federal Regulations 2 (or a successor regulation), respectively, to require group 3 health plans and health insurance issuers offering group 4 or individual health insurance coverage to which such sec- 5 tions apply— 6 (1) to provide oral interpretation services with- 7 out any threshold requirements; 8 (2) to provide in the English versions of all no- 9 tices a statement prominently displayed in not less 10 than 15 non-English languages clearly indicating 11 how to access the language services provided by the 12 plan or issuer; and 13 (3) with respect to the requirements for pro- 14 viding relevant notices in a culturally and linguis- 15 tically appropriate manner in the applicable non- 16 English languages, to apply a threshold that 5 per- 17 cent of the population, or not less than 500 individ- 18 uals, in the county is literate only in the same non- 19 English language in order for the language to be 20 considered an applicable non-English language. 21 (e) DATA COLLECTION AND REPORTING.—The Sec- 22 retary of Health and Human Services shall— 23 (1) amend the single streamlined application 24 form developed pursuant to section 1413 of the Pa- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00169 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 170 •S 4486 IS tient Protection and Affordable Care Act (42 U.S.C. 1 18083) to collect the preferred spoken and written 2 language for each household member applying for 3 coverage under a qualified health plan through an 4 Exchange under title I of such Act (42 U.S.C. 5 18001 et seq.); 6 (2) require navigators, certified application 7 counselors, and other individuals assisting with en- 8 rollment to collect and report requests for language 9 assistance; and 10 (3) require the toll-free telephone hotlines es- 11 tablished pursuant to section 1311(d)(4)(B) of the 12 Patient Protection and Affordable Care Act (42 13 U.S.C. 18031(d)(4)(B)) to submit an annual report 14 documenting the number of language assistance re- 15 quests, the types of languages requested, the range 16 and average wait time for a consumer to speak with 17 an interpreter, the number of complaints and any 18 steps the hotline, and any entity contracting with 19 the Secretary to provide language services, have 20 taken to actively address some of the consumer com- 21 plaints. 22 (f) EFFECTIVE DATE.—The amendments made by 23 this section shall not apply to plans beginning prior to the 24 date of the enactment of this Act. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00170 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 171 •S 4486 IS SEC. 2014. MEDICALLY UNDERSERVED POPULATIONS. 1 Section 330(b)(3) of the Public Health Service Act 2 (42 U.S.C. 254b(b)(3)) is amended to read as follows: 3 ‘‘(3) MEDICALLY UNDERSERVED.—The term 4 ‘medically underserved’, with respect to a popu- 5 lation, refers to— 6 ‘‘(A) the population of an urban or rural 7 area designated by the Secretary as— 8 ‘‘(i) an area with a shortage of per- 9 sonal health services; or 10 ‘‘(ii) a population group having a 11 shortage of such services; or 12 ‘‘(B) a population of individuals, not con- 13 fined to a particular urban or rural area, who 14 are designated by the Secretary as having a 15 shortage of personal health services due to a 16 specific demographic trait.’’. 17 TITLE III—HEALTH WORKFORCE 18 DIVERSITY 19 SEC. 3001. AMENDMENT TO THE PUBLIC HEALTH SERVICE 20 ACT. 21 Title XXXIV of the Public Health Service Act, as 22 added by section 2004, is amended by adding at the end 23 the following: 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00171 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 172 •S 4486 IS ‘‘Subtitle B—Diversifying the 1 Health Care Workplace 2 ‘‘SEC. 3411. NATIONAL WORKING GROUP ON WORKFORCE 3 DIVERSITY. 4 ‘‘(a) IN GENERAL.—The Secretary, acting through 5 the Bureau of Health Workforce of the Health Resources 6 and Services Administration, shall award a grant to an 7 entity determined appropriate by the Secretary for the es- 8 tablishment of a national working group on workforce di- 9 versity. 10 ‘‘(b) REPRESENTATION.—In establishing the national 11 working group under subsection (a): 12 ‘‘(1) The grantee shall ensure that the group 13 has representatives of each of the following: 14 ‘‘(A) The Health Resources and Services 15 Administration. 16 ‘‘(B) The Department of Health and 17 Human Services Data Council. 18 ‘‘(C) The Office of Minority Health of the 19 Department of Health and Human Services. 20 ‘‘(D) The Substance Abuse and Mental 21 Health Services Administration. 22 ‘‘(E) The Bureau of Labor Statistics of 23 the Department of Labor. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00172 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 173 •S 4486 IS ‘‘(F) The National Institute on Minority 1 Health and Health Disparities. 2 ‘‘(G) The Agency for Healthcare Research 3 and Quality. 4 ‘‘(H) The Institute of Medicine Study 5 Committee for the 2004 workforce diversity re- 6 port. 7 ‘‘(I) The Indian Health Service. 8 ‘‘(J) The Department of Education. 9 ‘‘(K) Minority-serving academic institu- 10 tions. 11 ‘‘(L) Consumer organizations. 12 ‘‘(M) Health professional associations, in- 13 cluding those that represent underrepresented 14 minority populations. 15 ‘‘(N) Researchers in the area of health 16 workforce. 17 ‘‘(O) Health workforce accreditation enti- 18 ties. 19 ‘‘(P) Private (including nonprofit) founda- 20 tions that have sponsored workforce diversity 21 initiatives. 22 ‘‘(Q) Local and State health departments. 23 ‘‘(R) Representatives of community mem- 24 bers to be included on admissions committees 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00173 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 174 •S 4486 IS for health profession schools pursuant to sub- 1 section (c)(9). 2 ‘‘(S) National community-based organiza- 3 tions that serve as a national intermediary to 4 their urban affiliate members and have dem- 5 onstrated capacity to train health care profes- 6 sionals. 7 ‘‘(T) The Veterans Health Administration. 8 ‘‘(U) Other entities determined appropriate 9 by the Secretary. 10 ‘‘(2) The grantee shall ensure that, in addition 11 to the representatives under paragraph (1), the 12 working group has not less than 5 health professions 13 students representing various health profession fields 14 and levels of training. 15 ‘‘(c) ACTIVITIES.—The working group established 16 under subsection (a) shall convene at least twice each year 17 to complete the following activities: 18 ‘‘(1) Review public and private health workforce 19 diversity initiatives. 20 ‘‘(2) Identify successful health workforce diver- 21 sity programs and practices. 22 ‘‘(3) Examine challenges relating to the devel- 23 opment and implementation of health workforce di- 24 versity initiatives. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00174 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 175 •S 4486 IS ‘‘(4) Draft a national strategic work plan for 1 health workforce diversity, including recommenda- 2 tions for public and private sector initiatives. 3 ‘‘(5) Develop a framework and methods for the 4 evaluation of current and future health workforce di- 5 versity initiatives. 6 ‘‘(6) Develop recommended standards for work- 7 force diversity that could be applicable to all health 8 professions programs and programs funded under 9 this Act. 10 ‘‘(7) Develop guidelines to train health profes- 11 sionals to care for a diverse population. 12 ‘‘(8) Develop a workforce data collection or 13 tracking system to identify where racial and ethnic 14 minority health professionals practice. 15 ‘‘(9) Develop a strategy for the inclusion of 16 community members on admissions committees for 17 health profession schools. 18 ‘‘(10) Help with monitoring of standards for di- 19 versity, equity, and inclusion. 20 ‘‘(11) Other activities determined appropriate 21 by the Secretary. 22 ‘‘(d) ANNUAL REPORT.—Not later than 1 year after 23 the establishment of the working group under subsection 24 (a), and annually thereafter, the working group shall pre- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00175 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 176 •S 4486 IS pare and make available to the general public for com- 1 ment, an annual report on the activities of the working 2 group. Such report shall include the recommendations of 3 the working group for improving health workforce diver- 4 sity. 5 ‘‘(e) COORDINATION WITH OTHER EFFORTS.—In 6 providing for the establishment of the working group 7 under subsection (a), the Secretary shall take such steps 8 as may be necessary to ensure that the work of the work- 9 ing group does not overlap with, or otherwise duplicate, 10 other Federal Government efforts with respect to ensuring 11 health equity in data collection in public health emer- 12 gencies. 13 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 14 are authorized to be appropriated to carry out this section 15 such sums as may be necessary for each of fiscal years 16 2023 through 2027. 17 ‘‘SEC. 3412. TECHNICAL CLEARINGHOUSE FOR HEALTH 18 WORKFORCE DIVERSITY. 19 ‘‘(a) IN GENERAL.—The Secretary, acting through 20 the Deputy Assistant Secretary for Minority Health, and 21 in collaboration with the Bureau of Health Workforce 22 within the Health Resources and Services Administration 23 and the National Institute on Minority Health and Health 24 Disparities, shall establish a technical clearinghouse on 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00176 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 177 •S 4486 IS health workforce diversity within the Office of Minority 1 Health and coordinate current and future clearinghouses 2 related to health workforce diversity. 3 ‘‘(b) INFORMATION AND SERVICES.—The clearing- 4 house established under subsection (a) shall offer the fol- 5 lowing information and services: 6 ‘‘(1) Information on the importance of health 7 workforce diversity. 8 ‘‘(2) Statistical information relating to under- 9 represented minority representation in health and al- 10 lied health professions and occupations. 11 ‘‘(3) Model health workforce diversity practices 12 and programs, including integrated models of care. 13 ‘‘(4) Admissions policies that promote health 14 workforce diversity and are in compliance with Fed- 15 eral and State laws. 16 ‘‘(5) Retainment policies that promote comple- 17 tion of health profession degrees for underserved 18 populations. 19 ‘‘(6) Lists of scholarship, loan repayment, and 20 loan cancellation grants as well as fellowship infor- 21 mation for underserved populations for health pro- 22 fessions schools. 23 ‘‘(7) Foundation and other large organizational 24 initiatives relating to health workforce diversity. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00177 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 178 •S 4486 IS ‘‘(c) CONSULTATION.—In carrying out this section, 1 the Secretary shall consult with non-Federal entities which 2 may include minority health professional associations and 3 minority sections of major health professional associations 4 to ensure the adequacy and accuracy of information. 5 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 6 are authorized to be appropriated to carry out this section 7 such sums as may be necessary for each of fiscal years 8 2023 through 2027. 9 ‘‘SEC. 3413. SUPPORT FOR INSTITUTIONS COMMITTED TO 10 WORKFORCE DIVERSITY, EQUITY, AND IN- 11 CLUSION. 12 ‘‘(a) IN GENERAL.—The Secretary, acting through 13 the Administrator of the Health Resources and Services 14 Administration and the Director of the Centers for Dis- 15 ease Control and Prevention, shall award grants to eligible 16 entities that demonstrate a commitment to health work- 17 force diversity. 18 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 19 under subsection (a), an entity shall— 20 ‘‘(1) be an educational institution or entity that 21 historically produces or trains meaningful numbers 22 of underrepresented minority health professionals, 23 including— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00178 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 179 •S 4486 IS ‘‘(A) part B institutions, as defined in sec- 1 tion 322 of the Higher Education Act of 1965; 2 ‘‘(B) historically Black professional or 3 graduate institutions eligible for grants under 4 section 326 of the Higher Education Act of 5 1965; 6 ‘‘(C) Hispanic-serving health professions 7 schools; 8 ‘‘(D) Hispanic-serving institutions, as de- 9 fined in section 502 of such Act; 10 ‘‘(E) Tribal Colleges or Universities, as de- 11 fined in section 316 of such Act; 12 ‘‘(F) Asian American and Native American 13 Pacific Islander-serving institutions, as defined 14 in section 371(c) of such Act; 15 ‘‘(G) institutions that have programs to re- 16 cruit and retain underrepresented minority 17 health professionals, in which a significant 18 number of the enrolled participants are under- 19 represented minorities; 20 ‘‘(H) health professional associations, 21 which may include underrepresented minority 22 health professional associations; and 23 ‘‘(I) institutions, including national and re- 24 gional community-based organizations with 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00179 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 180 •S 4486 IS demonstrated commitment to a diversified 1 workforce— 2 ‘‘(i) located in communities with pre- 3 dominantly underrepresented minority pop- 4 ulations; 5 ‘‘(ii) with whom partnerships have 6 been formed for the purpose of increasing 7 workforce diversity; and 8 ‘‘(iii) in which at least 20 percent of 9 the enrolled participants are underrep- 10 resented minorities; and 11 ‘‘(2) submit to the Secretary an application at 12 such time, in such manner, and containing such in- 13 formation as the Secretary may require. 14 ‘‘(c) USE OF FUNDS.—Amounts received under a 15 grant under subsection (a) shall be used to expand existing 16 workforce diversity programs, implement new workforce 17 diversity programs, or evaluate existing or new workforce 18 diversity programs, including with respect to mental 19 health care professions. Such programs shall enhance di- 20 versity by considering minority status as part of an indi- 21 vidualized consideration of qualifications. Possible activi- 22 ties may include— 23 ‘‘(1) educational outreach programs relating to 24 opportunities in the health professions; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00180 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 181 •S 4486 IS ‘‘(2) scholarship, fellowship, grant, loan repay- 1 ment, and loan cancellation programs; 2 ‘‘(3) postbaccalaureate programs; 3 ‘‘(4) academic enrichment programs, particu- 4 larly targeting those who would not be competitive 5 for health professions schools; 6 ‘‘(5) supporting workforce diversity in kinder- 7 garten through 12th grade and other health pipeline 8 programs; 9 ‘‘(6) mentoring programs; 10 ‘‘(7) internship or rotation programs involving 11 hospitals, health systems, health plans, and other 12 health entities; 13 ‘‘(8) community partnership development for 14 purposes relating to workforce diversity; or 15 ‘‘(9) leadership training. 16 ‘‘(d) REPORTS.—Not later than 1 year after receiving 17 a grant under this section, and annually for the term of 18 the grant, a grantee shall submit to the Secretary a report 19 that summarizes and evaluates all activities conducted 20 under the grant. 21 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 22 are authorized to be appropriated to carry out this section 23 such sums as may be necessary for each of fiscal years 24 2023 through 2027. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00181 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 182 •S 4486 IS ‘‘SEC. 3414. CAREER DEVELOPMENT FOR SCIENTISTS AND 1 RESEARCHERS. 2 ‘‘(a) IN GENERAL.—The Secretary, acting through 3 the Director of the National Institutes of Health, the Di- 4 rector of the Centers for Disease Control and Prevention, 5 the Commissioner of Food and Drugs, the Director of the 6 Agency for Healthcare Research and Quality, and the Ad- 7 ministrator of the Health Resources and Services Admin- 8 istration, shall award grants that expand existing opportu- 9 nities for scientists and researchers and promote the inclu- 10 sion of underrepresented minorities in the health profes- 11 sions. 12 ‘‘(b) RESEARCH FUNDING.—The head of each agency 13 listed in subsection (a) shall establish or expand existing 14 programs to provide research funding to scientists and re- 15 searchers in training. Under such programs, the head of 16 each such entity shall give priority in allocating research 17 funding to support health research in traditionally under- 18 served communities, including underrepresented minority 19 communities, and research classified as community or 20 participatory. 21 ‘‘(c) DATA COLLECTION.—The head of each agency 22 listed in subsection (a) shall collect data on the number 23 (expressed as an absolute number and a percentage) of 24 underrepresented minority and nonminority applicants 25 who receive and are denied agency funding at every stage 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00182 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 183 •S 4486 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 professions 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 are authorized to be appropriated to carry out this section 20 such sums as may be necessary for each of fiscal years 21 2023 through 2027. 22 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00183 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 184 •S 4486 IS ‘‘SEC. 3415. CAREER SUPPORT FOR NONRESEARCH HEALTH 1 PROFESSIONALS. 2 ‘‘(a) IN GENERAL.—The Secretary, acting through 3 the Director of the Centers for Disease Control and Pre- 4 vention, the Assistant Secretary for Mental Health and 5 Substance Use, the Administrator of the Health Resources 6 and Services Administration, and the Administrator of the 7 Centers for Medicare & Medicaid Services, shall establish 8 a program to award grants to universities and other insti- 9 tutions to enter into agreements with eligible individuals 10 under which— 11 ‘‘(1) the university or institution supports the 12 eligible individual’s career in a nonresearch-related 13 health and wellness profession; and 14 ‘‘(2) the eligible individual commits to per- 15 forming a period of obligated service in such a ca- 16 reer to serve, or to work on health issues affecting, 17 underserved communities, such as racial and ethnic 18 minority communities. 19 ‘‘(b) ELIGIBLE INDIVIDUALS.—To be an eligible indi- 20 vidual for purposes of subsection (a), an individual shall 21 be a student in a health professions school, a graduate 22 of such a school who is working in a health profession, 23 an individual working in a health or wellness profession 24 (including mental and behavioral health), or a faculty 25 member of such a school. 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00184 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 185 •S 4486 IS ‘‘(c) APPLICATION.—To seek a grant under this sec- 1 tion, a university or other institution shall submit to the 2 Secretary an application at such time, in such manner, 3 and containing such information as the Secretary may re- 4 quire. 5 ‘‘(d) USE OF FUNDS.—A university or other institu- 6 tion receiving a grant under this section shall use the 7 grant for agreements described in subsection (a). Such 8 agreements may— 9 ‘‘(1) support an eligible individual’s health ac- 10 tivities or projects that involve underserved commu- 11 nities, including racial and ethnic minority commu- 12 nities; 13 ‘‘(2) support an eligible individual’s health-re- 14 lated career advancement activities; 15 ‘‘(3) pay, or reimburse for payment of, student 16 loans or training or credentialing costs for eligible 17 individuals who are health professionals and are fo- 18 cused on health issues affecting underserved commu- 19 nities, including racial and ethnic minority commu- 20 nities; and 21 ‘‘(4) establish and promote leadership training 22 programs for eligible individuals to decrease health 23 disparities and to increase cultural competence with 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00185 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 186 •S 4486 IS the goal of increasing diversity in leadership posi- 1 tions. 2 ‘‘(e) DEFINITION.—In this section, the term ‘career 3 in a nonresearch-related health and wellness profession’ 4 means employment or intended employment in the field 5 of public health, health policy, health management, health 6 administration, medicine, nursing, pharmacy, psychology, 7 social work, psychiatry, other mental and behavioral 8 health, allied health, community health, social work, or 9 other fields determined appropriate by the Secretary, 10 other than in a position that involves research. 11 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 12 are authorized to be appropriated to carry out this section 13 such sums as may be necessary for each of fiscal years 14 2023 through 2027. 15 ‘‘SEC. 3416. RESEARCH ON THE EFFECT OF WORKFORCE DI- 16 VERSITY ON QUALITY. 17 ‘‘(a) IN GENERAL.—The Director of the Agency for 18 Healthcare Research and Quality (in this section referred 19 to as the ‘Director’), in collaboration with the Deputy As- 20 sistant Secretary for Minority Health and the Director of 21 the National Institute on Minority Health and Health Dis- 22 parities, shall award grants to eligible entities to expand 23 research on the link between health workforce diversity 24 and quality health care. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00186 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 187 •S 4486 IS ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 1 under subsection (a), an entity shall— 2 ‘‘(1) be a clinical, public health, or health serv- 3 ices research entity or other entity determined ap- 4 propriate by the Director; and 5 ‘‘(2) submit to the Secretary an application at 6 such time, in such manner, and containing such in- 7 formation as the Secretary may require. 8 ‘‘(c) USE OF FUNDS.—Amounts received under a 9 grant awarded under subsection (a) shall be used to sup- 10 port research that investigates the effect of health work- 11 force diversity on— 12 ‘‘(1) language access; 13 ‘‘(2) cultural competence; 14 ‘‘(3) patient satisfaction; 15 ‘‘(4) timeliness of care; 16 ‘‘(5) safety of care; 17 ‘‘(6) effectiveness of care; 18 ‘‘(7) efficiency of care; 19 ‘‘(8) patient outcomes; 20 ‘‘(9) community engagement; 21 ‘‘(10) resource allocation; 22 ‘‘(11) organizational structure; 23 ‘‘(12) compliance of care; or 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00187 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 188 •S 4486 IS ‘‘(13) other topics determined appropriate by 1 the Director. 2 ‘‘(d) PRIORITY.—In awarding grants under sub- 3 section (a), the Director shall give individualized consider- 4 ation to all relevant aspects of the applicant’s background. 5 Consideration of prior research experience involving the 6 health of underserved communities shall be such a factor. 7 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 8 are authorized to be appropriated to carry out this section 9 such sums as may be necessary for each of fiscal years 10 2023 through 2027. 11 ‘‘SEC. 3417. HEALTH DISPARITIES EDUCATION PROGRAM. 12 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 13 through the Office of Minority Health, in collaboration 14 with the National Institute on Minority Health and Health 15 Disparities, the Office for Civil Rights, the Centers for 16 Disease Control and Prevention, the Centers for Medicare 17 & Medicaid Services, the Health Resources and Services 18 Administration, and other appropriate public and private 19 entities, shall establish and coordinate a health and health 20 care disparities education program to support, develop, 21 and implement educational initiatives and outreach strate- 22 gies that inform health care professionals and the public 23 about the existence of and methods to reduce racial and 24 ethnic disparities in health and health care. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00188 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 189 •S 4486 IS ‘‘(b) ACTIVITIES.—The Secretary, through the edu- 1 cation program established under subsection (a), shall, 2 through the use of public awareness and outreach cam- 3 paigns targeting the general public and the medical com- 4 munity at large— 5 ‘‘(1) disseminate scientific evidence for the ex- 6 istence and extent of racial and ethnic disparities in 7 health care, including disparities that are not other- 8 wise attributable to known factors such as access to 9 care, patient preferences, or appropriateness of 10 intervention, as described in the 2002 report of the 11 National Academy of Medicine (formerly the ‘Insti- 12 tute of Medicine’) entitled ‘Unequal Treatment: Con- 13 fronting Racial and Ethnic Disparities in Health 14 Care’, as well as the impact of disparities related to 15 age, disability status, socioeconomic status, sex, gen- 16 der identity, and sexual orientation on racial and 17 ethnic minorities; 18 ‘‘(2) disseminate new research findings to 19 health care providers and patients to assist them in 20 understanding, reducing, and eliminating health and 21 health care disparities; 22 ‘‘(3) disseminate information about the impact 23 of linguistic and cultural barriers on health care 24 quality and the obligation of health providers who 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00189 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 190 •S 4486 IS receive Federal financial assistance to ensure that 1 individuals with limited English proficiency have ac- 2 cess to language access services; 3 ‘‘(4) disseminate information about the impor- 4 tance and legality of racial, ethnic, disability status, 5 socioeconomic status, sex, gender identity, and sex- 6 ual orientation, and primary language data collec- 7 tion, analysis, and reporting; 8 ‘‘(5) design and implement specific educational 9 initiatives to health care providers relating to health 10 and health care disparities; 11 ‘‘(6) assess the impact of the programs estab- 12 lished under this section in raising awareness of 13 health and health care disparities and providing in- 14 formation on available resources; and 15 ‘‘(7) design and implement specific educational 16 initiatives to educate the health care workforce relat- 17 ing to unconscious bias. 18 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 19 are authorized to be appropriated to carry out this section 20 such sums as may be necessary for each of fiscal years 21 2023 through 2027.’’. 22 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00190 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 191 •S 4486 IS SEC. 3002. HISPANIC-SERVING INSTITUTIONS, HISTORI- 1 CALLY BLACK COLLEGES AND UNIVERSITIES, 2 HISTORICALLY BLACK PROFESSIONAL OR 3 GRADUATE INSTITUTIONS, ASIAN AMERICAN 4 AND NATIVE AMERICAN PACIFIC ISLANDER- 5 SERVING INSTITUTIONS, TRIBAL COLLEGES, 6 REGIONAL COMMUNITY-BASED ORGANIZA- 7 TIONS, AND NATIONAL MINORITY MEDICAL 8 ASSOCIATIONS. 9 Part B of title VII of the Public Health Service Act 10 (42 U.S.C. 293 et seq.) is amended by adding at the end 11 the following: 12 ‘‘SEC. 742. HISPANIC-SERVING INSTITUTIONS, HISTORI- 13 CALLY BLACK COLLEGES AND UNIVERSITIES, 14 HISTORICALLY BLACK PROFESSIONAL OR 15 GRADUATE INSTITUTIONS, ASIAN AMERICAN 16 AND NATIVE AMERICAN PACIFIC ISLANDER- 17 SERVING INSTITUTIONS, AND TRIBAL COL- 18 LEGES. 19 ‘‘(a) IN GENERAL.—The Secretary, acting through 20 the Administrator of the Health Resources and Services 21 Administration and in consultation with the Secretary of 22 Education, shall award grants to Hispanic-serving institu- 23 tions, historically Black colleges and universities, histori- 24 cally Black professional or graduate institutions eligible 25 for grants under section 326 of the Higher Education Act 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00191 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 192 •S 4486 IS of 1965, Asian American and Native American Pacific Is- 1 lander-serving institutions, Tribal Colleges or Universities, 2 regional community-based organizations, and national mi- 3 nority medical associations, for counseling, mentoring, and 4 providing information on financial assistance to prepare 5 underrepresented minority individuals to enroll in and 6 graduate from health professional schools and to increase 7 services for underrepresented minority students includ- 8 ing— 9 ‘‘(1) mentoring with underrepresented health 10 professionals; 11 ‘‘(2) providing financial assistance information 12 for continued education and applications to health 13 professional schools; and 14 ‘‘(3) retaining existing enrolled underrep- 15 resented minority students in a health professions 16 school. 17 ‘‘(b) DEFINITIONS.—In this section: 18 ‘‘(1) ASIAN AMERICAN AND NATIVE AMERICAN 19 PACIFIC ISLANDER-SERVING INSTITUTION.—The 20 term ‘Asian American and Native American Pacific 21 Islander-serving institution’ has the meaning given 22 such term in section 320(b) of the Higher Education 23 Act of 1965. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00192 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 193 •S 4486 IS ‘‘(2) HISPANIC-SERVING INSTITUTION.—The 1 term ‘Hispanic-serving institution’ means an entity 2 that— 3 ‘‘(A) is a school or program for which 4 there is a definition under section 799B; 5 ‘‘(B) has an enrollment of full-time equiva- 6 lent students that is made up of at least 9 per- 7 cent Hispanic students; 8 ‘‘(C) has been effective in carrying out pro- 9 grams to recruit Hispanic individuals to enroll 10 in and graduate from the school; 11 ‘‘(D) has been effective in recruiting and 12 retaining Hispanic faculty members; 13 ‘‘(E) has a significant number of graduates 14 who are providing health services to medically 15 underserved populations or to individuals in 16 health professional shortage areas; and 17 ‘‘(F) is a Hispanic Center of Excellence in 18 Health Professions Education designated under 19 section 736(d)(2) of the Public Health Service 20 Act (42 U.S.C. 293(d)(2)). 21 ‘‘(3) HISTORICALLY BLACK COLLEGE AND UNI- 22 VERSITY.—The term ‘historically Black college and 23 university’ has the meaning given the term ‘part B 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00193 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 194 •S 4486 IS institution’ as defined in section 322 of the Higher 1 Education Act of 1965. 2 ‘‘(4) TRIBAL COLLEGE OR UNIVERSITY.—The 3 term ‘Tribal College or University’ has the meaning 4 given such term in section 316(b) of the Higher 5 Education Act of 1965. 6 ‘‘(c) CERTAIN LOAN REPAYMENT PROGRAMS.—In 7 carrying out the National Health Service Corps Loan Re- 8 payment Program established under subpart III of part 9 D of title III and the loan repayment program under sec- 10 tion 317F, the Secretary shall ensure, notwithstanding 11 such subpart or section, that loan repayments of not less 12 than $50,000 per year per person are awarded for repay- 13 ment of loans incurred for enrollment or participation of 14 underrepresented minority individuals in health profes- 15 sional schools and other health programs described in this 16 section. 17 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 18 are authorized to be appropriated to carry out this section 19 such sums as may be necessary for each of fiscal years 20 2023 through 2027.’’. 21 SEC. 3003. LOAN REPAYMENT PROGRAM OF CENTERS FOR 22 DISEASE CONTROL AND PREVENTION. 23 Section 317F(c)(1) of the Public Health Service Act 24 (42 U.S.C. 247b–7(c)(1)) is amended by striking 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00194 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 195 •S 4486 IS ‘‘$500,000 for fiscal year 1994, and such sums as may 1 be necessary for each of the fiscal years 1995 through 2 2002’’ and inserting ‘‘such sums as may be necessary for 3 each of fiscal years 2023 through 2027’’. 4 SEC. 3004. ALLIED HEALTH WORKFORCE DIVERSITY. 5 (a) INCREASING WORKFORCE DIVERSITY IN THE 6 PROFESSIONS OF PHYSICAL THERAPY, OCCUPATIONAL 7 THERAPY, RESPIRATORY THERAPY, AUDIOLOGY, AND 8 SPEECH-LANGUAGE PATHOLOGY.—Title VII of the Public 9 Health Service Act is amended— 10 (1) by redesignating part G (42 U.S.C. 295j et 11 seq.) as part H; and 12 (2) by inserting after part F (42 U.S.C. 295h) 13 the following new part: 14 ‘‘PART G—INCREASING WORKFORCE DIVERSITY 15 IN THE PROFESSIONS OF PHYSICAL THER- 16 APY, OCCUPATIONAL THERAPY, RES- 17 PIRATORY THERAPY, AUDIOLOGY, AND 18 SPEECH-LANGUAGE PATHOLOGY 19 ‘‘SEC. 783. SCHOLARSHIPS AND STIPENDS. 20 ‘‘(a) IN GENERAL.—The Secretary may award grants 21 and contracts to eligible entities to increase educational 22 opportunities in the professions of physical therapy, occu- 23 pational therapy, respiratory therapy, audiology, and 24 speech-language pathology for eligible individuals by— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00195 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 196 •S 4486 IS ‘‘(1) providing student scholarships or stipends, 1 including for— 2 ‘‘(A) completion of an accelerated degree 3 program; 4 ‘‘(B) completion of an associate’s, bach- 5 elor’s, master’s, or doctoral degree program; 6 and 7 ‘‘(C) entry by a diploma or associate’s de- 8 gree practitioner into a bridge or degree com- 9 pletion program; 10 ‘‘(2) providing assistance for completion of pre- 11 requisite courses or other preparation necessary for 12 acceptance for enrollment in the eligible entity; and 13 ‘‘(3) carrying out activities to increase the re- 14 tention of students in one or more programs in the 15 professions of physical therapy, occupational ther- 16 apy, respiratory therapy, audiology, and speech-lan- 17 guage pathology. 18 ‘‘(b) CONSIDERATION OF RECOMMENDATIONS.—In 19 carrying out subsection (a), the Secretary shall take into 20 consideration the recommendations of national organiza- 21 tions representing the professions of physical therapy, oc- 22 cupational therapy, respiratory therapy, audiology, and 23 speech-language pathology, including the American Phys- 24 ical Therapy Association, the American Occupational 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00196 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 197 •S 4486 IS Therapy Association, the American Speech-Language- 1 Hearing Association, the American Association for Res- 2 piratory Care, the American Academy of Audiology, and 3 the Academy of Doctors of Audiology. 4 ‘‘(c) REQUIRED INFORMATION AND CONDITIONS FOR 5 AWARD RECIPIENTS.— 6 ‘‘(1) IN GENERAL.—The Secretary may require 7 recipients of awards under this section to report to 8 the Secretary concerning the annual admission, re- 9 tention, and graduation rates for eligible individuals 10 in programs of the recipient leading to a degree in 11 any of the professions of physical therapy, occupa- 12 tional therapy, respiratory therapy, audiology, and 13 speech-language pathology. 14 ‘‘(2) FALLING RATES.—If any of the rates re- 15 ported by a recipient under paragraph (1) fall below 16 the average for such recipient over the 2 years pre- 17 ceding the year covered by the report, the recipient 18 shall provide the Secretary with plans for imme- 19 diately improving such rates. 20 ‘‘(3) INELIGIBILITY.—A recipient described in 21 paragraph (2) shall be ineligible for continued fund- 22 ing under this section if the plan of the recipient 23 fails to improve the rates within the 1-year period 24 beginning on the date such plan is implemented. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00197 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 198 •S 4486 IS ‘‘(d) DEFINITIONS.—In this section: 1 ‘‘(1) ELIGIBLE ENTITIES.—The term ‘eligible 2 entity’ means an accredited education program that 3 is carrying out a program for recruiting and retain- 4 ing students underrepresented in the professions of 5 physical therapy, occupational therapy, respiratory 6 therapy, audiology, and speech-language pathology 7 (including racial or ethnic minorities, or students 8 from disadvantaged backgrounds). 9 ‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 10 individual’ means an individual who— 11 ‘‘(A) is a member of a class of persons who 12 are underrepresented in the professions of phys- 13 ical therapy, occupational therapy, respiratory 14 therapy, audiology, and speech-language pathol- 15 ogy, including individuals who are— 16 ‘‘(i) racial or ethnic minorities; 17 ‘‘(ii) from disadvantaged backgrounds; 18 or 19 ‘‘(iii) individuals with a disability (as 20 defined in section 3(1) of the Americans 21 with Disabilities Act of 1990), or who have 22 an individualized education program (as 23 defined in section 602 of the Individuals 24 with Disabilities Education Act), are cov- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00198 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 199 •S 4486 IS ered under section 504 of the Rehabilita- 1 tion Act of 1973, or have other documenta- 2 tion establishing the student’s disability 3 (as such term is defined in section 3(1) of 4 the Americans with Disabilities Act of 5 1990); 6 ‘‘(B) has a financial need for a scholarship 7 or stipend; and 8 ‘‘(C) is enrolled (or accepted for enroll- 9 ment) at an audiology, speech-language pathol- 10 ogy, respiratory therapy, physical therapy, or 11 occupational therapy program as a full-time 12 student at an eligible entity. 13 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 14 is authorized to be appropriated to carry out this section 15 $8,000,000 for the first fiscal year commencing after the 16 date of enactment of the Health Equity and Accountability 17 Act of 2022 and each of the 4 succeeding fiscal years.’’. 18 (b) ELIGIBILITY CLARIFICATION REGARDING STU- 19 DENTS SUPPORTED THROUGH MENTAL AND BEHAV- 20 IORAL HEALTH EDUCATION AND TRAINING GRANTS.— 21 Section 756(a)(1) of the Public Health Service Act (42 22 U.S.C. 294e–1(a)(1)) is amended by inserting after ‘‘occu- 23 pational therapy’’ the following: ‘‘(which may include mas- 24 ter’s and doctoral level programs)’’. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00199 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 200 •S 4486 IS SEC. 3005. COOPERATIVE AGREEMENTS FOR ONLINE DE- 1 GREE PROGRAMS AT SCHOOLS OF PUBLIC 2 HEALTH AND SCHOOLS OF ALLIED HEALTH. 3 Part D of title VII of the Public Health Service Act 4 (42 U.S.C. 294 et seq.) is amended by inserting after sec- 5 tion 755 of such Act (42 U.S.C. 294e) the following: 6 ‘‘SEC. 755A. COOPERATIVE AGREEMENTS FOR ONLINE DE- 7 GREE PROGRAMS. 8 ‘‘(a) COOPERATIVE AGREEMENTS.—The Secretary, 9 acting through the Administrator of the Health Resources 10 and Services Administration, in consultation with the Di- 11 rector of the Centers for Disease Control and Prevention, 12 the Director of the Agency for Healthcare Research and 13 Quality, and the Deputy Assistant Secretary for Minority 14 Health, shall enter into cooperative agreements with 15 schools of public health and schools of allied health to de- 16 sign and implement online degree programs. 17 ‘‘(b) PRIORITY.—In entering into cooperative agree- 18 ments under this section, the Secretary shall give priority 19 to any school of public health or school of allied health 20 that has an established track record of serving medically 21 underserved communities. 22 ‘‘(c) REQUIREMENTS.—As a condition of entering 23 into a cooperative agreement with the Secretary under this 24 section, a school of public health or school of allied health 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00200 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 201 •S 4486 IS shall agree to design and implement an online degree pro- 1 gram that meets the following restrictions: 2 ‘‘(1) Enrollment of individuals who have ob- 3 tained a secondary school diploma or its recognized 4 equivalent. 5 ‘‘(2) Maintaining a significant enrollment of 6 underrepresented minority or disadvantaged stu- 7 dents. 8 ‘‘(3) Achieving a high completion rate of en- 9 rolled underrepresented minority or disadvantaged 10 students. 11 ‘‘(d) PERIOD OF COOPERATIVE AGREEMENTS.—The 12 period during which payments are made through a cooper- 13 ative agreement entered into under this section may not 14 exceed 3 years. 15 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 16 are authorized to be appropriated to carry out this section 17 such sums as may be necessary for each of fiscal years 18 2023 through 2027.’’. 19 SEC. 3006. NATIONAL HEALTH CARE WORKFORCE COMMIS- 20 SION. 21 (a) SENSE OF CONGRESS.—It is the sense of Con- 22 gress that the National Health Care Workforce Commis- 23 sion established by section 5101 of the Patient Protection 24 and Affordable Care Act (42 U.S.C. 294q) should, in car- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00201 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 202 •S 4486 IS rying out its assigned duties under that section, give at- 1 tention to the needs of racial and ethnic minorities, indi- 2 viduals with lower socioeconomic status, individuals with 3 mental, developmental, and physical disabilities, lesbian, 4 gay, bisexual, transgender, queer, and questioning popu- 5 lations, and individuals who are members of multiple mi- 6 nority or special population groups. 7 (b) REAUTHORIZATION.—Section 5101(h)(2) of the 8 Patient Protection and Affordable Care Act (42 U.S.C. 9 294q(h)(2)) is amended by striking ‘‘such sums as may 10 be necessary’’ and inserting ‘‘$3,000,000 for each of fiscal 11 years 2023 through 2025’’. 12 SEC. 3007. SCHOLARSHIP AND FELLOWSHIP PROGRAMS. 13 Subtitle B of title XXXIV of the Public Health Serv- 14 ice Act, as added by section 3001, is further amended by 15 inserting after section 3417 the following: 16 ‘‘SEC. 3418. DAVID SATCHER PUBLIC HEALTH AND HEALTH 17 SERVICES CORPS. 18 ‘‘(a) IN GENERAL.—The Director of the Centers for 19 Disease Control and Prevention, in collaboration with the 20 Administrator of the Health Resources and Services Ad- 21 ministration and the Deputy Assistant Secretary for Mi- 22 nority Health, shall award grants to eligible entities to in- 23 crease awareness among secondary and postsecondary stu- 24 dents of career opportunities in the health professions. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00202 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 203 •S 4486 IS ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 1 under subsection (a), an entity shall— 2 ‘‘(1) be a clinical, public health, or health serv- 3 ices organization, community-based or nonprofit en- 4 tity, or other entity determined appropriate by the 5 Director of the Centers for Disease Control and Pre- 6 vention; 7 ‘‘(2) serve a health professional shortage area, 8 as determined by the Secretary; 9 ‘‘(3) work with students, including those from 10 racial and ethnic minority backgrounds, that have 11 expressed an interest in the health professions; and 12 ‘‘(4) submit to the Secretary an application at 13 such time, in such manner, and containing such in- 14 formation as the Secretary may require. 15 ‘‘(c) USE OF FUNDS.—Grant awards under sub- 16 section (a) shall be used to support internships that will 17 increase awareness among students of non-research-based, 18 career opportunities in the following health professions: 19 ‘‘(1) Medicine. 20 ‘‘(2) Nursing. 21 ‘‘(3) Public health. 22 ‘‘(4) Pharmacy. 23 ‘‘(5) Health administration and management. 24 ‘‘(6) Health policy. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00203 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 204 •S 4486 IS ‘‘(7) Psychology. 1 ‘‘(8) Dentistry. 2 ‘‘(9) International health. 3 ‘‘(10) Social work. 4 ‘‘(11) Allied health. 5 ‘‘(12) Psychiatry. 6 ‘‘(13) Hospice care. 7 ‘‘(14) Community health, patient navigation, 8 and peer support. 9 ‘‘(15) Other professions determined appropriate 10 by the Director of the Centers for Disease Control 11 and Prevention. 12 ‘‘(d) PRIORITY.—In awarding grants under sub- 13 section (a), the Director of the Centers for Disease Con- 14 trol and Prevention shall give priority to those entities 15 that— 16 ‘‘(1) serve a high proportion of individuals from 17 disadvantaged backgrounds; 18 ‘‘(2) have experience in health disparity elimi- 19 nation programs; 20 ‘‘(3) facilitate the entry of disadvantaged indi- 21 viduals into institutions of higher education; and 22 ‘‘(4) provide counseling or other services de- 23 signed to assist disadvantaged individuals in success- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00204 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 205 •S 4486 IS fully completing their education at the postsecondary 1 level. 2 ‘‘(e) STIPENDS.— 3 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 4 an entity receiving a grant under this section may 5 use the funds made available through such grant to 6 award stipends for educational and living expenses 7 to students participating in the internship supported 8 by the grant. 9 ‘‘(2) LIMITATIONS.—A stipend awarded under 10 paragraph (1) to an individual— 11 ‘‘(A) may not be provided for a period that 12 exceeds 6 months; and 13 ‘‘(B) may not exceed $20 per day for an 14 individual (notwithstanding any other provision 15 of law regarding the amount of a stipend). 16 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 17 are authorized to be appropriated to carry out this section 18 such sums as may be necessary for each of fiscal years 19 2023 through 2027. 20 ‘‘SEC. 3419. LOUIS STOKES PUBLIC HEALTH SCHOLARS 21 PROGRAM. 22 ‘‘(a) IN GENERAL.—The Director of the Centers for 23 Disease Control and Prevention, in collaboration with the 24 Deputy Assistant Secretary for Minority Health, shall 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00205 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 206 •S 4486 IS award scholarships to eligible individuals under subsection 1 (b) who seek a career in public health. 2 ‘‘(b) ELIGIBILITY.—To be eligible to receive a schol- 3 arship under subsection (a), an individual shall— 4 ‘‘(1) have interest, knowledge, or skill in public 5 health research or public health practice, or other 6 health professions as determined appropriate by the 7 Director of the Centers for Disease Control and Pre- 8 vention; 9 ‘‘(2) reside in a health professional shortage 10 area as determined by the Secretary; 11 ‘‘(3) demonstrate promise for becoming a leader 12 in public health; 13 ‘‘(4) secure admission to a 4-year institution of 14 higher education; and 15 ‘‘(5) submit to the Secretary an application at 16 such time, in such manner, and containing such in- 17 formation as the Secretary may require. 18 ‘‘(c) USE OF FUNDS.—Amounts received under an 19 award under subsection (a) shall be used to support oppor- 20 tunities for students to become public health professionals. 21 ‘‘(d) PRIORITY.—In awarding grants under sub- 22 section (a), the Director shall give priority to those stu- 23 dents that— 24 ‘‘(1) are from disadvantaged backgrounds; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00206 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 207 •S 4486 IS ‘‘(2) have secured admissions to a minority- 1 serving institution; and 2 ‘‘(3) have identified a health professional as a 3 mentor at their school or institution and an aca- 4 demic advisor to assist in the completion of their 5 baccalaureate degree. 6 ‘‘(e) SCHOLARSHIPS.—The Secretary may approve 7 payment of scholarships under this section for such indi- 8 viduals for any period of education in student under- 9 graduate tenure, except that such a scholarship may not 10 be provided to an individual for more than 4 years, and 11 such a scholarship may not exceed $10,000 per academic 12 year for an individual (notwithstanding any other provi- 13 sion of law regarding the amount of a scholarship). 14 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 15 are authorized to be appropriated to carry out this section 16 such sums as may be necessary for each of fiscal years 17 2023 through 2027. 18 ‘‘SEC. 3420. PATSY MINK HEALTH AND GENDER RESEARCH 19 FELLOWSHIP PROGRAM. 20 ‘‘(a) IN GENERAL.—The Director of the Centers for 21 Disease Control and Prevention, in collaboration with the 22 Deputy Assistant Secretary for Minority Health, the As- 23 sistant Secretary for Mental Health and Substance Use, 24 and the Director of the Indian Health Service, shall award 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00207 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 208 •S 4486 IS research fellowships to eligible individuals under sub- 1 section (b) to conduct research that will examine gender 2 and health disparities and to pursue a career in the health 3 professions. 4 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow- 5 ship under subsection (a), an individual shall— 6 ‘‘(1) have experience in health research or pub- 7 lic health practice; 8 ‘‘(2) reside in a health professional shortage 9 area designated by the Secretary under section 332; 10 ‘‘(3) have expressed an interest in the health 11 professions; 12 ‘‘(4) demonstrate promise for becoming a leader 13 in the field of women’s sexual and reproductive 14 health, including family planning; 15 ‘‘(5) secure admission to a health professions 16 school or graduate program with an emphasis in 17 gender studies; and 18 ‘‘(6) submit to the Secretary an application at 19 such time, in such manner, and containing such in- 20 formation as the Secretary may require. 21 ‘‘(c) USE OF FUNDS.—A fellowship awarded under 22 subsection (a) to an eligible individual under subsection 23 (b) shall be used to support an opportunity for the indi- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00208 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 209 •S 4486 IS vidual to become a researcher and advance the research 1 base on the intersection between gender and health. 2 ‘‘(d) PRIORITY.—In awarding fellowships under sub- 3 section (a), the Director of the Centers for Disease Con- 4 trol and Prevention shall give priority to those applicants 5 that— 6 ‘‘(1) are from disadvantaged backgrounds; and 7 ‘‘(2) have identified a mentor and academic ad- 8 visor who will assist in the completion of their grad- 9 uate or professional degree and have secured a re- 10 search assistant position with a researcher working 11 in the area of gender and health. 12 ‘‘(e) FELLOWSHIPS.—The Director of the Centers for 13 Disease Control and Prevention may approve fellowships 14 for individuals under this section for any period of edu- 15 cation in the student’s graduate or health profession ten- 16 ure, except that such a fellowship may not be provided 17 to an individual for more than 3 years, and such a fellow- 18 ship may not exceed $18,000 per academic year for an 19 individual (notwithstanding any other provision of law re- 20 garding the amount of a fellowship). 21 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 22 are authorized to be appropriated to carry out this section 23 such sums as may be necessary for each of fiscal years 24 2023 through 2027. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00209 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 210 •S 4486 IS ‘‘SEC. 3421. PAUL DAVID WELLSTONE INTERNATIONAL 1 HEALTH FELLOWSHIP PROGRAM. 2 ‘‘(a) IN GENERAL.—The Director of the Agency for 3 Healthcare Research and Quality, in collaboration with 4 the Deputy Assistant Secretary for Minority Health, shall 5 award research fellowships to eligible individuals under 6 subsection (b) to advance their understanding of inter- 7 national health. 8 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow- 9 ship under subsection (a), an individual shall— 10 ‘‘(1) have educational experience in the field of 11 international health; 12 ‘‘(2) reside in a health professional shortage 13 area as determined by the Secretary; 14 ‘‘(3) demonstrate promise for becoming a leader 15 in the field of international health; 16 ‘‘(4) be in the fourth year of a 4-year institu- 17 tion of higher education or a recent graduate of a 18 4-year institution of higher education; and 19 ‘‘(5) submit to the Secretary an application at 20 such time, in such manner, and containing such in- 21 formation as the Secretary may require. 22 ‘‘(c) USE OF FUNDS.—A fellowship awarded under 23 subsection (a) to an eligible individual under subsection 24 (b) shall be used to support an opportunity for the indi- 25 vidual to become a health professional and to advance the 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00210 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 211 •S 4486 IS knowledge of the individual about international issues re- 1 lating to health care access and quality. 2 ‘‘(d) PRIORITY.—In awarding fellowships under sub- 3 section (a), the Director of the Agency for Healthcare Re- 4 search and Quality shall give priority to eligible individuals 5 under subsection (b) that— 6 ‘‘(1) are from a disadvantaged background; and 7 ‘‘(2) have identified a mentor at a health pro- 8 fessions school or institution, an academic advisor to 9 assist in the completion of their graduate or profes- 10 sional degree, and an advisor from an international 11 health non-governmental organization, private volun- 12 teer organization, or other international institution 13 or program that focuses on increasing health care 14 access and quality for residents in developing coun- 15 tries. 16 ‘‘(e) FELLOWSHIPS.—A fellowship awarded under 17 this section may not— 18 ‘‘(1) be provided to an eligible individual for 19 more than a period of 6 months; 20 ‘‘(2) be awarded to a graduate of a 4-year insti- 21 tution of higher education that has not been enrolled 22 in such institution for more than 1 year; or 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00211 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 212 •S 4486 IS ‘‘(3) exceed $4,000 per academic year (notwith- 1 standing any other provision of law regarding the 2 amount of a fellowship). 3 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 4 are authorized to be appropriated to carry out this section 5 such sums as may be necessary for each of fiscal years 6 2023 through 2027. 7 ‘‘SEC. 3422. EDWARD R. ROYBAL HEALTH SCHOLAR PRO- 8 GRAM. 9 ‘‘(a) IN GENERAL.—The Director of the Agency for 10 Healthcare Research and Quality, the Administrator of 11 the Centers for Medicare & Medicaid Services, and the Ad- 12 ministrator of the Health Resources and Services Admin- 13 istration, in collaboration with the Deputy Assistant Sec- 14 retary for Minority Health, shall award grants to eligible 15 entities under subsection (b) to expose entering graduate 16 students to the health professions. 17 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 18 under subsection (a), an entity shall— 19 ‘‘(1) be a clinical, public health, or health serv- 20 ices organization, community-based, academic, or 21 nonprofit entity, or other entity determined appro- 22 priate by the Director of the Agency for Healthcare 23 Research and Quality; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00212 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 213 •S 4486 IS ‘‘(2) serve in a health professional shortage 1 area designated by the Secretary under section 332; 2 ‘‘(3) work with students obtaining a degree in 3 the health professions; and 4 ‘‘(4) submit to the Secretary an application at 5 such time, in such manner, and containing such in- 6 formation as the Secretary may require. 7 ‘‘(c) USE OF FUNDS.—Amounts received under a 8 grant awarded under subsection (a) shall be used to sup- 9 port opportunities that expose students to non-research- 10 based health professions, including— 11 ‘‘(1) public health policy; 12 ‘‘(2) health care and pharmaceutical policy; 13 ‘‘(3) health care administration and manage- 14 ment; 15 ‘‘(4) health economics; and 16 ‘‘(5) other professions determined appropriate 17 by the Director of the Agency for Healthcare Re- 18 search and Quality, the Administrator of the Centers 19 for Medicare & Medicaid Services, or the Adminis- 20 trator of the Health Resources and Services Admin- 21 istration. 22 ‘‘(d) PRIORITY.—In awarding grants under sub- 23 section (a), the Director of the Agency for Healthcare Re- 24 search and Quality, the Administrator of the Centers for 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00213 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 214 •S 4486 IS Medicare & Medicaid Services, and the Administrator of 1 the Health Resources and Services Administration, in col- 2 laboration with the Deputy Assistant Secretary for Minor- 3 ity Health, shall give priority to entities that— 4 ‘‘(1) have experience with health disparity elimi- 5 nation programs; 6 ‘‘(2) facilitate training in the fields described in 7 subsection (c); and 8 ‘‘(3) provide counseling or other services de- 9 signed to assist students in successfully completing 10 their education at the postsecondary level. 11 ‘‘(e) STIPENDS.— 12 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 13 an entity receiving a grant under this section may 14 use the funds made available through such grant to 15 award stipends for educational and living expenses 16 to students participating in the opportunities sup- 17 ported by the grant. 18 ‘‘(2) LIMITATIONS.—A stipend awarded under 19 paragraph (1) to an individual— 20 ‘‘(A) may not be provided for a period that 21 exceeds 2 months; and 22 ‘‘(B) may not exceed $100 per day (not- 23 withstanding any other provision of law regard- 24 ing the amount of a stipend). 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00214 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 215 •S 4486 IS ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 1 are authorized to be appropriated to carry out this section 2 such sums as may be necessary for each of fiscal years 3 2023 through 2027. 4 ‘‘SEC. 3423. LEADERSHIP FELLOWSHIP PROGRAMS. 5 ‘‘(a) IN GENERAL.—The Secretary shall award 6 grants to national minority medical or health professional 7 associations to develop leadership fellowship programs for 8 underrepresented health professionals in order to— 9 ‘‘(1) assist such professionals in becoming fu- 10 ture leaders in public health and health care delivery 11 institutions; and 12 ‘‘(2) increase diversity in decision-making posi- 13 tions that can improve the health of underserved 14 communities. 15 ‘‘(b) USE OF FUNDS.—A leadership fellowship pro- 16 gram supported under this section shall— 17 ‘‘(1) focus on training mid-career physicians 18 and health care executives who have documented 19 leadership experience and a commitment to public 20 health services in underserved communities; and 21 ‘‘(2) support Federal public health policy and 22 budget programs, and priorities that impact health 23 equity, through activities such as didactic lectures 24 and leader site visits. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00215 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 216 •S 4486 IS ‘‘(c) PERIOD OF GRANTS.—The period during which 1 payments are made under a grant awarded under sub- 2 section (a) may not exceed 3 years. 3 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 4 are authorized to be appropriated to carry out this section 5 such sums as may be necessary for each of fiscal years 6 2023 through 2027.’’. 7 SEC. 3008. MCNAIR POSTBACCALAUREATE ACHIEVEMENT 8 PROGRAM. 9 Section 402E of the Higher Education Act of 1965 10 (20 U.S.C. 1070a–15) is amended by striking subsection 11 (g) and inserting the following: 12 ‘‘(g) COLLABORATION IN HEALTH PROFESSION DI- 13 VERSITY TRAINING PROGRAMS.—The Secretary shall co- 14 ordinate with the Secretary of Health and Human Serv- 15 ices to ensure that there is collaboration between the goals 16 of the program under this section and programs of the 17 Health Resources and Services Administration that pro- 18 mote health workforce diversity. The Secretary of Edu- 19 cation shall take such measures as may be necessary to 20 encourage students participating in projects assisted 21 under this section to consider health profession careers. 22 ‘‘(h) FUNDING.—From amounts appropriated pursu- 23 ant to the authority of section 402A(g), the Secretary 24 shall, to the extent practicable, allocate funds for projects 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00216 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 217 •S 4486 IS authorized by this section in an amount that is not less 1 than $31,000,000 for each of the fiscal years 2023 2 through 2027.’’. 3 SEC. 3009. RULES FOR DETERMINATION OF FULL-TIME 4 EQUIVALENT RESIDENTS FOR COST-REPORT- 5 ING PERIODS. 6 (a) DGME DETERMINATIONS.—Section 1886(h)(4) 7 of the Social Security Act (42 U.S.C. 1395ww(h)(4)), as 8 amended by section 2006(a), is amended— 9 (1) in subparagraph (E), by striking ‘‘Subject 10 to subparagraphs (J) and (K), such rules’’ and in- 11 serting ‘‘Subject to subparagraphs (J), (K), and 12 (M), such rules’’; 13 (2) in subparagraph (J), by striking ‘‘Such 14 rules’’ and inserting ‘‘Subject to subparagraph (M), 15 such rules’’; 16 (3) in subparagraph (K), by striking ‘‘In deter- 17 mining’’ and inserting ‘‘Subject to subparagraph 18 (M), in determining’’; and 19 (4) by adding at the end the following new sub- 20 paragraph: 21 ‘‘(M) TREATMENT OF CERTAIN RESIDENTS 22 AND INTERNS.—For purposes of cost-reporting 23 periods beginning on or after October 1, 2022, 24 in determining the hospital’s number of full- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00217 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 218 •S 4486 IS time equivalent residents for purposes of this 1 paragraph, all time spent by an intern or resi- 2 dent in an approved medical residency training 3 program shall be counted toward the determina- 4 tion of full-time equivalency if the hospital— 5 ‘‘(i) is recognized as a subsection (d) 6 hospital; 7 ‘‘(ii) is recognized as a subsection (d) 8 Puerto Rico hospital; 9 ‘‘(iii) is reimbursed under a reim- 10 bursement system authorized under section 11 1814(b)(3); or 12 ‘‘(iv) is a provider-based hospital out- 13 patient department.’’. 14 (b) IME DETERMINATIONS.—Section 15 1886(d)(5)(B)(xi) of the Social Security Act (42 U.S.C. 16 1395ww(d)(5)(B)(xi)) is amended— 17 (1) in subclause (II), by striking ‘‘In deter- 18 mining’’ and inserting ‘‘Subject to subclause (IV), in 19 determining’’; 20 (2) in subclause (III), by striking ‘‘In deter- 21 mining’’ and inserting ‘‘Subject to subclause (IV), in 22 determining’’; and 23 (3) by inserting after subclause (III) the fol- 24 lowing new subclause: 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00218 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 219 •S 4486 IS ‘‘(IV) For purposes of cost-reporting peri- 1 ods beginning on or after October 1, 2022, the 2 provisions of subparagraph (M) of subsection 3 (h)(4) shall apply under this subparagraph in 4 the same manner as they apply under such sub- 5 section.’’. 6 SEC. 3010. DEVELOPING AND IMPLEMENTING STRATEGIES 7 FOR LOCAL HEALTH EQUITY. 8 (a) GRANTS.—The Secretary of Health and Human 9 Services, acting jointly with the Secretary of Education 10 and the Secretary of Labor, shall make grants to an eligi- 11 ble institution of higher education for the purposes of— 12 (1) in accordance with subsection (b), devel- 13 oping capacity— 14 (A) to build an evidence base for successful 15 strategies for increasing local health equity; and 16 (B) to serve as national models of driving 17 local health equity; and 18 (2) in accordance with subsection (c), devel- 19 oping a strategic partnership with the community in 20 which the institution is located. 21 (b) DEVELOPING CAPACITY FOR INCREASING LOCAL 22 HEALTH EQUITY.—As a condition on receipt of a grant 23 under subsection (a), an institution of higher education 24 shall agree to use such grant to build an evidence base 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00219 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 220 •S 4486 IS for successful strategies for increasing local health equity, 1 and to serve as a national model of driving local health 2 equity, by supporting— 3 (1) resources to strengthen institutional metrics 4 and capacity to execute institution-wide health work- 5 force goals that can serve as models for increasing 6 health equity in communities across the United 7 States; 8 (2) collaborations among a cohort of institu- 9 tions in implementing systemic change, partnership 10 development, and programmatic efforts supportive of 11 health equity goals across disciplines and popu- 12 lations; and 13 (3) enhanced or newly developed data systems 14 and research infrastructure capable of informing 15 current and future workforce efforts and building a 16 foundation for a broader research agenda targeting 17 urban health disparities. 18 (c) STRATEGIC PARTNERSHIPS.—As a condition on 19 receipt of a grant under subsection (a), an institution of 20 higher education shall agree to use the grant to develop 21 a strategic partnership with the community in which such 22 institution is located for the purposes of— 23 (1) strengthening connections between such in- 24 stitution and the community— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00220 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 221 •S 4486 IS (A) to improve evaluation of, and address, 1 the health and health workforce needs of such 2 community; and 3 (B) to engage such community in health 4 workforce development; 5 (2) developing, enhancing, or accelerating inno- 6 vative undergraduate and graduate programs in the 7 biomedical sciences and health professions; and 8 (3) strengthening pipeline programs in the bio- 9 medical sciences and health professions, including by 10 developing partnerships between institutions of high- 11 er education and elementary schools and secondary 12 schools to recruit the next generation of health pro- 13 fessionals earlier in the pipeline to a health care ca- 14 reer. 15 (d) ELIGIBLE INSTITUTION OF HIGHER EDUCATION 16 DEFINED.—For purposes of this section, an ‘‘eligible in- 17 stitution of higher education’’ includes— 18 (1) a program authorized under section 317(a) 19 of the Higher Education Act of 1965 (20 U.S.C. 20 1059d(a)); or 21 (2) a professional or graduate institution de- 22 scribed in section 326 of such Act (20 U.S.C. 23 1063b). 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00221 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 222 •S 4486 IS (e) AUTHORIZATION OF APPROPRIATIONS.—There 1 are authorized to be appropriated to carry out this section 2 such sums as may be necessary for each of fiscal years 3 2023 through 2027. 4 SEC. 3011. HEALTH PROFESSIONS WORKFORCE FUND. 5 (a) ESTABLISHMENT.—There is established in the 6 Health Resources and Services Administration of the De- 7 partment of Health and Human Services a Health Profes- 8 sions Workforce Fund to provide for expanded and sus- 9 tained national investment in the health professions and 10 nursing workforce development programs under title VII 11 and title VIII of the Public Health Service Act (42 U.S.C. 12 292 et seq.; 42 U.S.C. 296 et seq.). 13 (b) FUNDING.— 14 (1) IN GENERAL.—There is authorized to be 15 appropriated, and there is appropriated, out of any 16 monies in the Treasury not otherwise appropriated, 17 to the Health Professions Workforce Fund— 18 (A) $392,000,000 for fiscal year 2023; 19 (B) $412,000,000 for fiscal year 2024; 20 (C) $432,000,000 for fiscal year 2025; 21 (D) $454,000,000 for fiscal year 2026; 22 (E) $476,000,000 for fiscal year 2027; 23 (F) $500,000,000 for fiscal year 2028; 24 (G) $525,000,000 for fiscal year 2029; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00222 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 223 •S 4486 IS (H) $552,000,000 for fiscal year 2030. 1 (2) HEALTH PROFESSIONS EDUCATION PRO- 2 GRAMS.—For the purpose of carrying out health 3 professions education programs authorized under 4 title VII of the Public Health Service Act (42 U.S.C. 5 292 et seq.), in addition to any other amounts au- 6 thorized to be appropriated for such purpose, there 7 is authorized to be appropriated out of any monies 8 in the Health Professions Workforce Fund, the fol- 9 lowing: 10 (A) $265,000,000 for fiscal year 2023. 11 (B) $278,000,000 for fiscal year 2024. 12 (C) $292,000,000 for fiscal year 2025. 13 (D) $307,000,000 for fiscal year 2026. 14 (E) $322,000,000 for fiscal year 2027. 15 (F) $338,000,000 for fiscal year 2028. 16 (G) $355,000,000 for fiscal year 2029. 17 (H) $373,000,000 for fiscal year 2030. 18 (3) NURSING WORKFORCE DEVELOPMENT PRO- 19 GRAMS.—For the purpose of carrying out nursing 20 workforce development programs authorized under 21 title VIII of the Public Health Service Act (42 22 U.S.C. 296 et seq.), in addition to any other 23 amounts authorized to be appropriated for such pur- 24 pose, there is authorized to be appropriated out of 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00223 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 224 •S 4486 IS any monies in the Health Professions Workforce 1 Fund, the following: 2 (A) $127,000,000 for fiscal year 2023. 3 (B) $134,000,000 for fiscal year 2024. 4 (C) $140,000,000 for fiscal year 2025. 5 (D) $147,000,000 for fiscal year 2026. 6 (E) $154,000,000 for fiscal year 2027. 7 (F) $162,000,000 for fiscal year 2028. 8 (G) $170,000,000 for fiscal year 2029. 9 (H) $179,000,000 for fiscal year 2030. 10 SEC. 3012. FUTURE ADVANCEMENT OF ACADEMIC NURS- 11 ING. 12 (a) SUPPORT FOR NURSING EDUCATION AND THE 13 FUTURE NURSING WORKFORCE.—Part D of title VIII of 14 the Public Health Service Act (42 U.S.C. 296p et seq.) 15 is amended by adding at the end the following: 16 ‘‘SEC. 832. NURSING EDUCATION ENHANCEMENT AND MOD- 17 ERNIZATION GRANTS IN UNDERSERVED 18 AREAS. 19 ‘‘(a) IN GENERAL.—The Secretary, acting through 20 the Administrator of the Health Resources and Services 21 Administration, may award grants to schools of nursing 22 for— 23 ‘‘(1) increasing the number of faculty and stu- 24 dents at such schools in order to enhance the pre- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00224 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 225 •S 4486 IS paredness of the United States for, and the ability 1 of the United States to address and quickly respond 2 to, public health emergencies declared under section 3 319 and pandemics; or 4 ‘‘(2) the enhancement and modernization of 5 nursing education programs. 6 ‘‘(b) PRIORITY.—In selecting grant recipients under 7 this section, the Secretary shall give priority to schools of 8 nursing that— 9 ‘‘(1) are located in a medically underserved 10 community; 11 ‘‘(2) are located in a health professional short- 12 age area as defined under section 332(a); or 13 ‘‘(3) are institutions of higher education listed 14 under section 371(a) of the Higher Education Act of 15 1965. 16 ‘‘(c) CONSIDERATION.—In awarding grants under 17 this section, the Secretary, to the extent practicable, may 18 ensure equitable distribution of awards among the geo- 19 graphic regions of the United States. 20 ‘‘(d) USE OF FUNDS.—A school of nursing that re- 21 ceives a grant under this section may use the funds award- 22 ed through such grant for activities that include— 23 ‘‘(1) enhancing enrollment and retention of stu- 24 dents at such school, with a priority for students 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00225 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 226 •S 4486 IS from disadvantaged backgrounds (including racial or 1 ethnic groups underrepresented in the nursing work- 2 force), individuals from rural and underserved areas, 3 low-income individuals, and first generation college 4 students (as defined in section 402A(h)(3) of the 5 Higher Education Act of 1965); 6 ‘‘(2) creating, supporting, or modernizing edu- 7 cational programs and curriculum at such school; 8 ‘‘(3) retaining current faculty, and hiring new 9 faculty, with an emphasis on faculty from racial or 10 ethnic groups who are underrepresented in the nurs- 11 ing workforce; 12 ‘‘(4) modernizing infrastructure at such school, 13 including audiovisual or other equipment, personal 14 protective equipment, simulation and augmented re- 15 ality resources, telehealth technologies, and virtual 16 and physical laboratories; 17 ‘‘(5) partnering with a health care facility, 18 nurse-managed health clinic, community health cen- 19 ter, or other facility that provides health care in 20 order to provide educational opportunities for the 21 purpose of establishing or expanding clinical edu- 22 cation; 23 ‘‘(6) enhancing and expanding nursing pro- 24 grams that prepare nurse researchers and scientists; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00226 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 227 •S 4486 IS ‘‘(7) establishing nurse-led intradisciplinary and 1 interprofessional educational partnerships; and 2 ‘‘(8) other activities that the Secretary deter- 3 mines further the development, improvement, and 4 expansion of schools of nursing. 5 ‘‘(e) REPORTS FROM ENTITIES.—Each school of 6 nursing awarded a grant under this section shall submit 7 an annual report to the Secretary on the activities con- 8 ducted under such grant, and other information as the 9 Secretary may require. 10 ‘‘(f) REPORT TO CONGRESS.—Not later than 5 years 11 after the date of the enactment of this section, the Sec- 12 retary shall submit to the Committee on Health, Edu- 13 cation, Labor, and Pensions of the Senate and the Com- 14 mittee on Energy and Commerce of the House of Rep- 15 resentatives a report that provides a summary of the ac- 16 tivities and outcomes associated with grants made under 17 this section. Such report shall include— 18 ‘‘(1) a list of schools of nursing receiving grants 19 under this section, including the primary geographic 20 location of any school of nursing that was improved 21 or expanded through such a grant; 22 ‘‘(2) the total number of students who are en- 23 rolled at or who have graduated from any school of 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00227 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 228 •S 4486 IS nursing that was improved or expanded through a 1 grant under this section, which such statistic shall— 2 ‘‘(A) to the extent such information is 3 available, be deidentified and disaggregated by 4 race, ethnicity, age, sex, geographic region, dis- 5 ability status, and other relevant factors; and 6 ‘‘(B) include an indication of the number 7 of such students who are from racial or ethnic 8 groups underrepresented in the nursing work- 9 force, such students who are from rural or un- 10 derserved areas, such students who are low-in- 11 come students, and such students who are first 12 generation college students (as defined in sec- 13 tion 402A(h)(3) of the Higher Education Act of 14 1965); 15 ‘‘(3) to the extent such information is available, 16 the effects of the grants awarded under this section 17 on retaining and hiring of faculty, including any in- 18 crease in diverse faculty, the number of clinical edu- 19 cation partnerships, the modernization of nursing 20 education infrastructure, and other ways this section 21 helps address and quickly respond to public health 22 emergencies and pandemics; 23 ‘‘(4) recommendations for improving the grants 24 awarded under this section; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00228 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 229 •S 4486 IS ‘‘(5) any other considerations as the Secretary 1 determines appropriate. 2 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—To 3 carry out this section, there is authorized to be appro- 4 priated $1,000,000,000, to remain available until ex- 5 pended.’’. 6 (b) STRENGTHENING NURSE EDUCATION.—The 7 heading of part D of title VIII of the Public Health Serv- 8 ice Act (42 U.S.C. 296p et seq.) is amended by striking 9 ‘‘BASIC’’. 10 SEC. 3013. FINDINGS; SENSE OF CONGRESS RELATING TO 11 GRADUATE MEDICAL EDUCATION. 12 (a) FINDINGS.—Congress finds the following: 13 (1) Projections by the Association of American 14 Medical Colleges and other expert entities, such as 15 the Health Resources and Services Administration, 16 have indicated a nationwide shortage of up to 17 121,900 physicians, split evenly between primary 18 care and specialists, by 2032. 19 (2) Primarily due to the growing and aging 20 population, over the next decade, physician demand 21 is expected to grow up to 17 percent. 22 (3) The United States Census Bureau estimates 23 that the United States population will grow from 24 321,000,000 in 2015 to 347,000,000 in 2025. Fur- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00229 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 230 •S 4486 IS ther, the number of Medicare beneficiaries is esti- 1 mated to increase from 47,800,000 in 2015 to ap- 2 proximately 66,000,000 in 2025. 3 (4) Approximately 36 percent of practicing phy- 4 sicians are over the age of 55 and are likely to retire 5 within the next decade. 6 (5) A nationwide physician shortage will result 7 in many individuals in the United States waiting 8 longer and traveling farther for health care; seeking 9 nonemergent care in emergency departments; and 10 delaying treatment until the health care needs of 11 such individuals become more serious, complex, and 12 costly. 13 (6) Changing demographics (such as an aging 14 population), new health care delivery models (such 15 as medical homes), and other factors (such as dis- 16 aster preparedness) are contributing to a shortage of 17 both generalist and specialist physicians. 18 (7) These shortages will have the most severe 19 impact on vulnerable and underserved populations, 20 including racial and ethnic minorities and the ap- 21 proximately 20 percent of people in the United 22 States who live in rural or inner-city locations des- 23 ignated as health professional shortage areas. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00230 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 231 •S 4486 IS (8) The health care utilization equity model of 1 the Association of American Medical Colleges esti- 2 mates that if racial and ethnic minorities and indi- 3 viduals from rural areas utilized health care in a 4 similar way to their Caucasian counterparts living in 5 metropolitan areas, the physician shortage would re- 6 quire an additional 96,000 physicians. 7 (9) To address the physician shortage in rural 8 and medically underserved areas, medical education 9 and training need to be accessible to underrep- 10 resented minorities (including individuals who are 11 African American, Hispanic, Native American, or 12 Native Hawaiian), and need to increase pathway 13 programs for such underrepresented minorities who 14 make up less than 12 percent of individuals enrolled 15 in graduate medical education and for international 16 students who make up 25 percent of individuals en- 17 rolled in graduate medical education. Immigration 18 pathways like student, exchange-visitor, and employ- 19 ment visas, and programs like the National Interest 20 Waiver and Conrad State 30 J–1 Visa Waiver, help 21 improve health access across the United States. 22 (10) United States medical school enrollment 23 was expected to grow by 30 percent from 2018 to 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00231 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 232 •S 4486 IS 2019 to help reduce the shortage of quality physi- 1 cians in the United States. 2 (11) An increase in United States medical 3 school graduates must be accompanied by an in- 4 crease of 4,000 graduate medical education training 5 positions each year. 6 (12) Graduate medical education programs and 7 teaching hospitals provide venues in which the next 8 generation of physicians learns to work collabo- 9 ratively with other physicians and health profes- 10 sionals, adopt more efficient care delivery models 11 (such as care coordination and medical homes), in- 12 corporate health information technology and elec- 13 tronic health records in every aspect of their work, 14 apply new methods of assuring quality and safety, 15 and participate in groundbreaking clinical and public 16 health research. 17 (13) The Medicare program under title XVIII 18 of the Social Security Act (42 U.S.C. 1395 et seq.) 19 (having more beneficiaries than any other health 20 care program), supports its ‘‘fair share’’ of the costs 21 associated with graduate medical education. 22 (14) In general, the level of support of graduate 23 medical education by the Medicare program has 24 been capped since 1997 and has not been increased 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00232 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 233 •S 4486 IS to support the expansion of graduate medical edu- 1 cation programs needed to avert the projected physi- 2 cian shortage or to accommodate the increase in 3 United States medical school graduates. 4 (b) SENSE OF CONGRESS.—It is the sense of Con- 5 gress that eliminating the limit of the number of residency 6 positions that receive some level of Medicare support 7 under section 1886(h) of the Social Security Act (42 8 U.S.C. 1395ww(h)), also referred to as the Medical grad- 9 uate medical education cap, is critical to— 10 (1) ensuring an appropriate supply of physi- 11 cians to meet the health care needs in the United 12 States; 13 (2) facilitating equitable access for all who seek 14 health care; 15 (3) increasing the racial and ethnic diversity of 16 physicians in the United States; and 17 (4) mitigating disparities in health and health 18 care. 19 SEC. 3014. CAREER SUPPORT FOR SKILLED, INTERNATION- 20 ALLY EDUCATED HEALTH PROFESSIONALS. 21 (a) FINDINGS.—Congress finds the following: 22 (1) According to a 2018 study, the State and 23 local public health workforce has shrunk by more 24 than 50,000 individuals since the beginning of the 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00233 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 234 •S 4486 IS 2008 Great Recession, and almost one quarter of in- 1 dividuals comprising the governmental public health 2 workforce plan to leave or retire in the coming years. 3 (2) Shortages are projected for other health 4 professions, including within the fields of nursing 5 (500,000 by 2025), dentistry (15,000 by 2025), 6 pharmacy (38,000 by 2030), mental and behavioral 7 health (236,880 by 2025), and primary care (46,000 8 by 2025). 9 (3) A nationwide health workforce shortage will 10 result in serious health threats and more severe and 11 costly health care needs, due to, in part, a delayed 12 response to food-borne outbreaks, emerging infec- 13 tious diseases, natural disasters, fewer cancer 14 screenings, and delayed treatment. 15 (4) Vulnerable and underserved populations and 16 health professional shortage areas will be most se- 17 verely impacted by the health workforce shortage. 18 (5) According to the Migration Policy Institute, 19 more than 2,000,000 college-educated immigrants in 20 the United States today are unemployed or under- 21 employed in low- or semi-skilled jobs that fail to 22 draw on their education and expertise. 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00234 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 235 •S 4486 IS (6) Approximately 2 out of every 5 internation- 1 ally educated immigrants are unemployed or under- 2 employed. 3 (7) According to the Drexel University Center 4 for Labor Markets and Policy, underemployment for 5 internationally educated immigrant women is 28 per- 6 cent higher than for their male counterparts. 7 (8) According to the Drexel University Center 8 for Labor Markets and Policy, the mean annual 9 earnings of underemployed immigrants were 10 $32,000, or 43 percent less than United States-born 11 college graduates employed in the college labor mar- 12 ket. 13 (9) According to Upwardly Global and the Wel- 14 come Back Initiative, with proper guidance and sup- 15 port, underemployed skilled immigrants typically in- 16 crease their income by 215 percent to 900 percent. 17 (10) According to the Brookings Institution and 18 the Partnership for a New American Economy, im- 19 migrants working in the health workforce are, on av- 20 erage, better educated than United States-born 21 workers in the health workforce. 22 (b) GRANTS TO ELIGIBLE ENTITIES.— 23 (1) AUTHORITY TO PROVIDE GRANTS.—The 24 Secretary of Health and Human Services acting 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00235 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 236 •S 4486 IS through the Bureau of Health Workforce within the 1 Health Resources and Services Administration, the 2 National Institute on Minority Health and Health 3 Disparities, or the Office of Minority Health (in this 4 section referred to as the ‘‘Secretary’’) may award 5 grants to eligible entities under paragraph (2) to 6 carry out activities described in subsection (c). 7 (2) ELIGIBILITY.—To be eligible to receive a 8 grant under this section, an entity shall— 9 (A) be a clinical, public health, or health 10 services organization, a community-based or 11 nonprofit entity, an academic institution, a 12 faith-based organization, a State, county, or 13 local government, an area health education cen- 14 ter, or another entity determined appropriate by 15 the Secretary; and 16 (B) submit to the Secretary an application 17 at such time, in such manner, and containing 18 such information as the Secretary may require. 19 (c) AUTHORIZED ACTIVITIES.—A grant awarded 20 under this section shall be used— 21 (1) to provide services to assist unemployed and 22 underemployed skilled immigrants, residing in the 23 United States, who have legal, permanent work au- 24 thorization and who are internationally educated 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00236 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 237 •S 4486 IS health professionals, enter into the health workforce 1 of the United States with employment matching 2 their health professional skills and education, and 3 advance in employment to positions that better 4 match their health professional education and exper- 5 tise; 6 (2) to provide training opportunities to reduce 7 barriers to entry and advancement in the health 8 workforce for skilled, internationally educated immi- 9 grants; 10 (3) to educate employers regarding the abilities 11 and capacities of internationally educated health 12 professionals; 13 (4) to assist in the evaluation of foreign creden- 14 tials; 15 (5) to support preceptorships for international 16 medical graduates in hospital primary care training; 17 and 18 (6) to facilitate access to contextualized and ac- 19 celerated courses on English as a second language. 20 SEC. 3015. STUDY AND REPORT ON STRATEGIES FOR IN- 21 CREASING DIVERSITY. 22 (a) STUDY.—The Comptroller General of the United 23 States shall conduct a study on strategies for increasing 24 the diversity of the health professional workforce. Such 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00237 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 238 •S 4486 IS study shall include an analysis of strategies for increasing 1 the number of health professionals from rural, lower in- 2 come, and underrepresented minority communities, includ- 3 ing which strategies are most effective for achieving such 4 goal. 5 (b) REPORT.—Not later than 2 years after the date 6 of enactment of this Act, the Comptroller General shall 7 submit to Congress a report on the study conducted under 8 subsection (a), together with recommendations for such 9 legislation and administrative action as the Comptroller 10 General determines appropriate. 11 SEC. 3016. CONRAD STATE 30 PROGRAM; PHYSICIAN RETEN- 12 TION. 13 (a) CONRAD STATE 30 PROGRAM EXTENSION.—Sec- 14 tion 220(c) of the Immigration and Nationality Technical 15 Corrections Act of 1994 (Public Law 103–416; 8 U.S.C. 16 1182 note) is amended by striking ‘‘September 30, 2015’’ 17 and inserting ‘‘September 30, 2022’’. 18 (b) RETAINING PHYSICIANS WHO HAVE PRACTICED 19 IN MEDICALLY UNDERSERVED COMMUNITIES.—Section 20 201(b)(1) of the Immigration and Nationality Act (8 21 U.S.C. 1151(b)(1)) is amended by adding at the end the 22 following: 23 ‘‘(F)(i) Alien physicians who have com- 24 pleted service requirements for a national inter- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00238 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 239 •S 4486 IS est waiver requested under section 1 203(b)(2)(B)(ii), including— 2 ‘‘(I) alien physicians who completed 3 such service before the date of the enact- 4 ment of the Health Equity and Account- 5 ability Act of 2022; and 6 ‘‘(II) the spouse or children of an 7 alien physician described in subclause (I). 8 ‘‘(ii) Nothing in this subparagraph may be 9 construed— 10 ‘‘(I) to prevent the filing of a petition 11 with the Secretary of Homeland Security 12 for classification under section 204(a) or 13 the filing of an application for adjustment 14 of status under section 245 by an alien 15 physician described in clause (i) before the 16 date on which such alien physician com- 17 pletes the service described in section 18 214(l) or worked full-time as a physician 19 for an aggregate of 5 years at the location 20 identified in the waiver of the 2-year for- 21 eign residence requirement under section 22 214(l) or in an area or areas designated by 23 the Secretary of Health and Human Serv- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00239 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 240 •S 4486 IS ices as having a shortage of health care 1 professionals; or 2 ‘‘(II) to permit the Secretary of 3 Homeland Security to grant a petition or 4 application described in subclause (I) until 5 the alien has satisfied all of the require- 6 ments of the waiver received under section 7 214(l).’’. 8 (c) EMPLOYMENT PROTECTIONS FOR PHYSICIANS.— 9 (1) EXCEPTIONS TO 2-YEAR FOREIGN RESI- 10 DENCY REQUIREMENT.—Section 214(l)(1) of the 11 Immigration and Nationality Act (8 U.S.C. 12 1184(l)(1)) is amended— 13 (A) in the matter preceding subparagraph 14 (A), by striking ‘‘Attorney General shall not’’ 15 and inserting ‘‘Secretary of Homeland Security 16 may not’’; 17 (B) in subparagraph (A), by striking ‘‘Di- 18 rector of the United States Information Agen- 19 cy’’ and inserting ‘‘Secretary of State’’; 20 (C) in subparagraph (B), by inserting ‘‘, 21 except as provided in paragraphs (7) and (8)’’ 22 before the semicolon at the end; 23 (D) in subparagraph (C), by amending 24 clauses (i) and (ii) to read as follows: 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00240 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 241 •S 4486 IS ‘‘(i) the alien demonstrates a bona 1 fide offer of full-time employment at a 2 health facility or health care organization, 3 which employment has been determined by 4 the Secretary of Homeland Security to be 5 in the public interest; and 6 ‘‘(ii) the alien— 7 ‘‘(I) has accepted employment 8 with the health facility or health care 9 organization in a geographic area or 10 areas which are designated by the 11 Secretary of Health and Human Serv- 12 ices as having a shortage of health 13 care professionals; 14 ‘‘(II) begins employment by the 15 later of the date that is— 16 ‘‘(aa) 120 days after receiv- 17 ing such waiver; 18 ‘‘(bb) 120 days after com- 19 pleting graduate medical edu- 20 cation or training under a pro- 21 gram approved pursuant to sec- 22 tion 212(j)(1); or 23 ‘‘(cc) 120 days after receiv- 24 ing nonimmigrant status or em- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00241 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 242 •S 4486 IS ployment authorization, if the 1 alien or the alien’s employer peti- 2 tions for such nonimmigrant sta- 3 tus or employment authorization 4 not later than 120 days after the 5 date on which the alien completes 6 his or her graduate medical edu- 7 cation or training under a pro- 8 gram approved pursuant to sec- 9 tion 212(j)(1); and 10 ‘‘(III) agrees to continue to work 11 for a total of not less than 3 years in 12 the status authorized for such employ- 13 ment under this subsection, except as 14 provided in paragraph (8); and’’; and 15 (E) in subparagraph (D), in the matter 16 preceding clause (i), by inserting ‘‘, subject to 17 paragraph (8),’’ before ‘‘in the case’’. 18 (2) ALLOWABLE VISA STATUS FOR PHYSICIANS 19 FULFILLING WAIVER REQUIREMENTS IN MEDICALLY 20 UNDERSERVED AREAS.—Section 214(l)(2)(A) of 21 such Act (8 U.S.C. 1184(l)(2)(A)) is amended to 22 read as follows: 23 ‘‘(A) Upon the request of an interested 24 Federal agency or an interested State agency 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00242 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 243 •S 4486 IS for recommendation of a waiver under this sec- 1 tion by a physician who is maintaining valid 2 nonimmigrant status under section 3 101(a)(15)(J) and received a favorable rec- 4 ommendation by the Secretary of State, the 5 Secretary of Homeland Security may change 6 the status of such physician to any status au- 7 thorized for employment under this Act. The 8 numerical limitations set forth in subsection 9 (g)(1)(A) shall not apply to any alien whose 10 status is changed under this subparagraph.’’. 11 (3) VIOLATION OF AGREEMENTS.—Section 12 214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is 13 amended by inserting ‘‘substantial requirement of 14 an’’ before ‘‘agreement entered into’’. 15 (4) PHYSICIAN EMPLOYMENT IN UNDERSERVED 16 AREAS.—Section 214(l) of such Act (8 U.S.C. 17 1184(l)), as amended by this section, is further 18 amended by adding at the end the following: 19 ‘‘(4)(A) If an interested State agency denies the 20 application for a waiver under paragraph (1)(B) 21 from a physician pursuing graduate medical edu- 22 cation or training pursuant to section 101(a)(15)(J) 23 because the State has requested the maximum num- 24 ber of waivers permitted for that fiscal year, the 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00243 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 244 •S 4486 IS physician’s nonimmigrant status shall be extended 1 for up to 6 months if the physician agrees to seek 2 a waiver under this subsection (except for paragraph 3 (1)(D)(ii)) to work for an employer described in 4 paragraph (1)(C) in a State that has not yet re- 5 quested the maximum number of waivers. 6 ‘‘(B) A physician described in subparagraph (A) 7 may only work for the employer referred to in sub- 8 paragraph (A) during the period beginning on the 9 date on which a new waiver application is filed with 10 such State and ending on the earlier of— 11 ‘‘(i) the date on which the Secretary of 12 Homeland Security denies such waiver; or 13 ‘‘(ii) the date on which the Secretary ap- 14 proves an application for change of status 15 under paragraph (2)(A) pursuant to the ap- 16 proval of such waiver.’’. 17 (5) CONTRACT REQUIREMENTS.—Section 214(l) 18 of such Act, as amended by this section, is further 19 amended by adding at the end the following: 20 ‘‘(5) An alien granted a waiver under para- 21 graph (1)(C) shall enter into an employment agree- 22 ment with the contracting health facility or health 23 care organization that— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00244 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 245 •S 4486 IS ‘‘(A) specifies the maximum number of on- 1 call hours per week (which may be a monthly 2 average) that the alien will be expected to be 3 available and the compensation the alien will re- 4 ceive for on-call time; 5 ‘‘(B) specifies— 6 ‘‘(i) whether the contracting facility or 7 organization will pay the alien’s mal- 8 practice insurance premiums; 9 ‘‘(ii) whether the employer will provide 10 malpractice insurance; and 11 ‘‘(iii) the amount of such insurance 12 that will be provided; 13 ‘‘(C) describes all of the work locations 14 that the alien will work including a statement 15 that the contracting facility or organization will 16 not add additional work locations without the 17 approval of the Federal agency or State agency 18 that requested the waiver; and 19 ‘‘(D) does not include a non-compete provi- 20 sion. 21 ‘‘(6) An alien granted a waiver under this sub- 22 section whose employment relationship with a health 23 facility or health care organization terminates under 24 paragraph (1)(C)(ii) during the 3-year service period 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00245 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 246 •S 4486 IS required under paragraph (1) shall be considered to 1 be maintaining lawful status in an authorized period 2 of stay during the 120-day period referred to in 3 items (aa) and (bb) of subclause (III) of paragraph 4 (1)(C)(ii) or the 45-day period referred to in sub- 5 clause (III)(cc) of such paragraph.’’. 6 (6) RECAPTURING WAIVER SLOTS LOST TO 7 OTHER STATES.—Section 214(l) of such Act, as 8 amended by this section, is further amended by add- 9 ing at the end the following: 10 ‘‘(7) If a recipient of a waiver under this sub- 11 section terminates the recipient’s employment with a 12 health facility or health care organization pursuant 13 to paragraph (1)(C)(ii), including termination of em- 14 ployment because of circumstances described in 15 paragraph (1)(C)(ii)(III), and accepts new employ- 16 ment with such a facility or organization in a dif- 17 ferent State, the State from which the alien is de- 18 parting may be accorded an additional waiver by the 19 Secretary of State for use in the fiscal year in which 20 the alien’s employment was terminated.’’. 21 (7) EXCEPTION TO 3-YEAR WORK REQUIRE- 22 MENT.—Section 214(l) of such Act, as amended by 23 this section, is further amended by adding at the 24 end the following: 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00246 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 247 •S 4486 IS ‘‘(8) The 3-year work requirement set forth in 1 subparagraphs (C) and (D) of paragraph (1) shall 2 not apply if— 3 ‘‘(A)(i) the Secretary of Homeland Secu- 4 rity determines that extenuating circumstances, 5 including violations by the employer of the em- 6 ployment agreement with the alien or of labor 7 and employment laws, exist that justify a lesser 8 period of employment at such facility or organi- 9 zation; and 10 ‘‘(ii) not later than 120 days after the em- 11 ployment termination date (unless the Secretary 12 determines that extenuating circumstances 13 would justify an extension), the alien dem- 14 onstrates another bona fide offer of employment 15 at a health facility or health care organization 16 in a geographic area or areas which are des- 17 ignated by the Secretary of Health and Human 18 Services as having a shortage of health care 19 professionals, for the remainder of such 3-year 20 period; 21 ‘‘(B)(i) the interested State agency that re- 22 quested the waiver attests that extenuating cir- 23 cumstances, including violations by the em- 24 ployer of the employment agreement with the 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00247 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 248 •S 4486 IS alien or of labor and employment laws, exist 1 that justify a lesser period of employment at 2 such facility or organization; and 3 ‘‘(ii) the alien demonstrates, not later than 4 120 days after the employment termination 5 date (unless the Secretary determines that ex- 6 tenuating circumstances would justify an exten- 7 sion), another bona fide offer of employment at 8 a health facility or health care organization in 9 a geographic area or areas which are designated 10 by the Secretary of Health and Human Services 11 as having a shortage of health care profes- 12 sionals, for the remainder of such 3-year period; 13 or 14 ‘‘(C) the alien— 15 ‘‘(i) elects not to pursue a determina- 16 tion of extenuating circumstances pursuant 17 to subparagraph (A) or (B); 18 ‘‘(ii) terminates the alien’s employ- 19 ment relationship with the health facility 20 or health care organization at which the 21 alien was employed; 22 ‘‘(iii) not later than 45 days after the 23 employment termination date, dem- 24 onstrates another bona fide offer of em- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00248 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 249 •S 4486 IS ployment at a health facility or health care 1 organization in a geographic area or areas, 2 in the State that requested the alien’s 3 waiver, which are designated by the Sec- 4 retary of Health and Human Services as 5 having a shortage of health care profes- 6 sionals; and 7 ‘‘(iv) agrees to be employed for the re- 8 mainder of such 3-year period, and 1 addi- 9 tional year for each termination under 10 clause (ii).’’. 11 (d) ALLOTMENT OF CONRAD STATE 30 WAIVERS.— 12 (1) IN GENERAL.—Section 214(l) of the Immi- 13 gration and Nationality Act (8 U.S.C. 1184(l)), as 14 amended by subsection (c), is further amended by 15 adding at the end the following: 16 ‘‘(9)(A)(i) All States shall be allotted 35 waivers 17 under paragraph (1)(B) for each fiscal year if 90 percent 18 of the waivers available to the States receiving at least 19 5 waivers were used in the previous fiscal year. 20 ‘‘(ii) When an allotment occurs under clause (i), all 21 States shall be allotted an additional 5 waivers under 22 paragraph (1)(B) for each subsequent fiscal year if 90 23 percent of the waivers available to the States receiving at 24 least 5 waivers were used in the previous fiscal year. If 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00249 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 250 •S 4486 IS the States are allotted 45 or more waivers for a fiscal year, 1 the States will only receive an additional increase of 5 2 waivers the following fiscal year if 95 percent of the waiv- 3 ers available to the States receiving at least 1 waiver were 4 used in the previous fiscal year. 5 ‘‘(B) Any increase in allotments under subparagraph 6 (A) shall be maintained indefinitely, unless in a fiscal year 7 the total number of such waivers granted is 5 percent 8 lower than in the last year in which there was an increase 9 in the number of waivers allotted pursuant to this para- 10 graph. In such case— 11 ‘‘(i) the number of waivers allotted beginning in 12 the next fiscal year shall be decreased by 5 for all 13 States; and 14 ‘‘(ii) each additional 5 percent decrease in such 15 waivers granted from the last year in which there 16 was an increase in the allotment, shall result in an 17 additional decrease of 5 waivers allotted for all 18 States, provided that the number of waivers allotted 19 for all States shall not drop below 30.’’. 20 (2) ACADEMIC MEDICAL CENTERS.—Section 21 214(l)(1)(D) of such Act, as amended by subsection 22 (c)(1)(E), is further amended— 23 (A) in clause (ii), by striking ‘‘and’’ at the 24 end; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00250 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 251 •S 4486 IS (B) in clause (iii), by striking the period at 1 the end and inserting ‘‘; and’’; and 2 (C) by adding at the end the following: 3 ‘‘(iv) in the case of a request by an inter- 4 ested State agency— 5 ‘‘(I) the head of such agency deter- 6 mines that the alien is to practice medicine 7 in, or be on the faculty of a residency pro- 8 gram at, an academic medical center (as 9 defined in section 411.355(e)(2) of title 42, 10 Code of Federal Regulations), without re- 11 gard to whether such facility is located 12 within an area designated by the Secretary 13 of Health and Human Services as having 14 a shortage of health care professionals; and 15 ‘‘(II) the head of such agency deter- 16 mines that— 17 ‘‘(aa) the alien physician’s work 18 is in the public interest; and 19 ‘‘(bb) subject to paragraph (6), 20 the grant of such waiver would not 21 cause the number of the waivers 22 granted on behalf of aliens for such 23 State for a fiscal year to exceed 3, 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00251 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 252 •S 4486 IS within the limitation under subpara- 1 graph (B).’’. 2 (e) AMENDMENTS TO THE PROCEDURES, DEFINI- 3 TIONS, AND OTHER PROVISIONS RELATED TO PHYSICIAN 4 IMMIGRATION.— 5 (1) DUAL INTENT FOR PHYSICIANS SEEKING 6 GRADUATE MEDICAL TRAINING.—Section 214(b) of 7 the Immigration and Nationality Act (8 U.S.C. 8 1184(b)) is amended by striking ‘‘and other than a 9 nonimmigrant described in any provision of section 10 101(a)(15)(H)(i) except subclause (b1) of such sec- 11 tion)’’ and inserting ‘‘a nonimmigrant described in 12 any provision of section 101(a)(15)(H)(i) (except 13 subclause (b1) of such section), and an alien coming 14 to the United States to receive graduate medical 15 education or training as described in section 212(j) 16 or to take examinations required to receive graduate 17 medical education or training as described in section 18 212(j))’’. 19 (2) PHYSICIAN NATIONAL INTEREST WAIVER 20 CLARIFICATIONS.— 21 (A) PRACTICE AND GEOGRAPHIC AREA.— 22 Section 203(b)(2)(B)(ii)(I) of the Immigration 23 and Nationality Act (8 U.S.C. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00252 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 253 •S 4486 IS 1153(b)(2)(B)(ii)(I)) is amended by striking 1 items (aa) and (bb) and inserting the following: 2 ‘‘(aa) the alien physician agrees to 3 work on a full-time basis practicing pri- 4 mary care, specialty medicine, or a com- 5 bination thereof, in an area or areas des- 6 ignated by the Secretary of Health and 7 Human Services as having a shortage of 8 health care professionals, or at a health 9 care facility under the jurisdiction of the 10 Secretary of Veterans Affairs; or 11 ‘‘(bb) the alien physician is pursuing 12 such waiver based upon service at a facility 13 or facilities that serve patients who reside 14 in a geographic area or areas designated 15 by the Secretary of Health and Human 16 Services as having a shortage of health 17 care professionals (without regard to 18 whether such facility or facilities are lo- 19 cated within such an area) and a Federal 20 agency, or a local, county, regional, or 21 State department of public health deter- 22 mines the alien physician’s work was or 23 will be in the public interest.’’. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00253 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 254 •S 4486 IS (B) FIVE-YEAR SERVICE REQUIREMENT.— 1 Section 203(b)(2)(B)(ii) of such Act is amend- 2 ed— 3 (i) by moving subclauses (II), (III), 4 and (IV) 4 ems to the left; and 5 (ii) in subclause (II)— 6 (I) by inserting ‘‘(aa)’’ after 7 ‘‘(II)’’; and 8 (II) by adding at the end the fol- 9 lowing: 10 ‘‘(bb) The 5-year service requirement 11 described in item (aa) shall begin on the 12 date on which the alien physician begins 13 work in the shortage area in any legal sta- 14 tus and not on the date on which an immi- 15 grant visa petition is filed or approved. 16 Such service shall be aggregated without 17 regard to when such service began and 18 without regard to whether such service 19 began during or in conjunction with a 20 course of graduate medical education. 21 ‘‘(cc) An alien physician shall not be 22 required to submit an employment contract 23 with a term exceeding the balance of the 5- 24 year commitment yet to be served or an 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00254 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 255 •S 4486 IS employment contract dated within a min- 1 imum time period before filing a visa peti- 2 tion under this subsection. 3 ‘‘(dd) An alien physician shall not be 4 required to file additional immigrant visa 5 petitions upon a change of work location 6 from the location approved in the original 7 national interest immigrant petition.’’. 8 (3) TECHNICAL CLARIFICATION REGARDING AD- 9 VANCED DEGREE FOR PHYSICIANS.—Section 10 203(b)(2)(A) of such Act is amended by adding at 11 the end the following: ‘‘An alien physician holding a 12 foreign medical degree that has been deemed suffi- 13 cient for acceptance by an accredited United States 14 medical residency or fellowship program shall be 15 considered a member of the professions holding an 16 advanced degree or its equivalent for purposes of 17 this paragraph.’’. 18 (4) SHORT-TERM WORK AUTHORIZATION FOR 19 PHYSICIANS COMPLETING THEIR RESIDENCIES.— 20 (A) IN GENERAL.—A physician completing 21 graduate medical education or training de- 22 scribed in section 212(j) of the Immigration 23 and Nationality Act (8 U.S.C. 1182(j)) as a 24 nonimmigrant described in section 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00255 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 256 •S 4486 IS 101(a)(15)(H)(i) of such Act (8 U.S.C. 1 1101(a)(15)(H)(i))— 2 (i) shall have such nonimmigrant sta- 3 tus automatically extended until October 1 4 of the fiscal year for which a petition for 5 a continuation of such nonimmigrant sta- 6 tus has been submitted in a timely manner 7 and the employment start date for the ben- 8 eficiary of such petition is October 1 of 9 that fiscal year; and 10 (ii) shall be authorized to be employed 11 incident to status during the period be- 12 tween the filing of such petition and Octo- 13 ber 1 of such fiscal year. 14 (B) TERMINATION.—The status and em- 15 ployment authorization of a physician described 16 in subparagraph (A) shall terminate on the date 17 that is 30 days after the date on which a peti- 18 tion described in clause (i)(I) is rejected, denied 19 or revoked. 20 (C) AUTOMATIC EXTENSION.—The status 21 and employment authorization of a physician 22 described in subparagraph (A) will automati- 23 cally extend to October 1 of the next fiscal year 24 if all of the visas described in section 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00256 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 257 •S 4486 IS 101(a)(15)(H)(i) of the Immigration and Na- 1 tionality Act (8 U.S.C. 1101(a)(15)(H)(i)) that 2 were authorized to be issued for the fiscal year 3 have been issued. 4 (5) APPLICABILITY OF SECTION 212(e) TO 5 SPOUSES AND CHILDREN OF J–1 EXCHANGE VISI- 6 TORS.—A spouse or child of an exchange visitor de- 7 scribed in section 101(a)(15)(J) of the Immigration 8 and Nationality Act (8 U.S.C. 1101(a)(15)(J)) shall 9 not be subject to the requirements under section 10 212(e) of such Act (8 U.S.C. 1182(e)). 11 SEC. 3017. NATIONAL HISPANIC NURSES DAY. 12 (a) FINDINGS.—Congress finds the following: 13 (1) A special group of nurses in the Nation are 14 the Hispanic nurses. 15 (2) Hispanic nurses provide culturally and eth- 16 nically competent care and are educated to be sen- 17 sitive to regional and community customs of persons 18 needing care. 19 (3) Hispanic nurses are well-positioned to pro- 20 vide leadership to eliminate health care disparities 21 that exist in the Nation. 22 (4) Since 1975, the National Association of 23 Hispanic Nurses (NAHN) has represented Hispanic 24 nurses (RNs/LPNs) in the United States and is the 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00257 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 258 •S 4486 IS only nursing organization for Hispanic nurses whose 1 mission is to advance the health in Hispanic commu- 2 nities and to lead, promote, and advocate for edu- 3 cational, professional, and leadership opportunities 4 for Hispanic nurses. 5 (5) Since September is the month that has been 6 set aside to honor the contributions of Hispanics, it 7 is only fitting that Hispanic nurses be recognized 8 and honored during this time for their outstanding 9 contributions to their community and country. 10 (6) The designation of an observation day will 11 help to raise awareness of the accomplishments of 12 Hispanic nurses and pave the way for the important 13 work that they must continue to carry out. 14 (7) Each February, the National Association of 15 Hispanic Nurses convenes nearly 100 nursing lead- 16 ers from academia, research, education, and practice 17 in the District of Columbia for a day on Capitol Hill 18 promoting legislation that improves the health of 19 Hispanic communities. 20 (8) Hispanic nurses are strong allies to Con- 21 gress as they help inform, educate, and work closely 22 with legislators to improve the education, retention, 23 recruitment, and practice of all nurses and, more 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00258 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 259 •S 4486 IS importantly, the health and safety of the patients for 1 whom they provide care. 2 (9) Hispanic nurses add needed diversity to the 3 nursing profession, and these nurses have engaged 4 in numerous ways to support communities and the 5 needs of an overlooked, under resourced, and under- 6 served population being severely impacted by 7 COVID–19. 8 (b) SENSE OF CONGRESS.—The Congress— 9 (1) supports the goals and ideals, and the des- 10 ignation, of National Hispanic Nurses Day, as pro- 11 posed by the National Association of Hispanic 12 Nurses; 13 (2) recognizes the significant contributions of 14 Hispanic nurses to the health care system of the 15 United States; and 16 (3) encourages the people of the United States 17 to observe National Hispanic Nurses Day with ap- 18 propriate recognition, ceremonies, activities, and pro- 19 grams to demonstrate the importance of Hispanic 20 nurses to the everyday lives of patients and the com- 21 munities they serve. 22 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00259 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 260 •S 4486 IS SEC. 3018. EXPANDING MEDICAL EDUCATION. 1 Subpart II of part C of title VII of the Public Health 2 Service Act (42 U.S.C. 293m et seq.) is amended by add- 3 ing at the end the following: 4 ‘‘SEC. 749C. GRANTS FOR SCHOOLS OF MEDICINE AND 5 SCHOOLS OF OSTEOPATHIC MEDICINE IN UN- 6 DERSERVED AREAS. 7 ‘‘(a) IN GENERAL.—The Secretary, acting through 8 the Administrator of the Health Resources and Services 9 Administration, may award grants to institutions of high- 10 er education (including consortiums of such institutions) 11 for the establishment, improvement, or expansion of a 12 school of medicine or osteopathic medicine, or a branch 13 campus of a school of medicine or osteopathic medicine. 14 ‘‘(b) PRIORITY.—In selecting grant recipients under 15 this section, the Secretary shall give priority to any insti- 16 tution of higher education (or consortium of such institu- 17 tions) that— 18 ‘‘(1) proposes to use the grant for the establish- 19 ment of a school of medicine or osteopathic medi- 20 cine, or a branch campus of a school of medicine or 21 osteopathic medicine, in an area— 22 ‘‘(A) in which no other such school is 23 based; and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00260 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 261 •S 4486 IS ‘‘(B) that is a medically underserved com- 1 munity or a health professional shortage area; 2 or 3 ‘‘(2) is an institution described in section 4 371(a) of the Higher Education Act of 1965. 5 ‘‘(c) CONSIDERATIONS.—In awarding grants under 6 this section, the Secretary, to the extent practicable, may 7 ensure equitable distribution of awards among the geo- 8 graphical regions of the United States. 9 ‘‘(d) USE OF FUNDS.—An institution of higher edu- 10 cation (or a consortium of such institutions)— 11 ‘‘(1) shall use grant amounts received under 12 this section to— 13 ‘‘(A) recruit, enroll, and retain students, 14 including individuals who are from disadvan- 15 taged backgrounds (including racial and ethnic 16 groups underrepresented among medical stu- 17 dents and health professions), individuals from 18 rural and underserved areas, low-income indi- 19 viduals, and first generation college students, at 20 a school of medicine or osteopathic medicine or 21 branch campus of a school of medicine or osteo- 22 pathic medicine; and 23 ‘‘(B) develop, implement, and expand cur- 24 riculum that emphasizes care for rural and un- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00261 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 262 •S 4486 IS derserved populations, including accessible and 1 culturally and linguistically appropriate care 2 and services, at such school or branch campus; 3 and 4 ‘‘(2) may use grant amounts received under this 5 section to— 6 ‘‘(A) plan and construct— 7 ‘‘(i) a school of medicine or osteo- 8 pathic medicine in an area in which no 9 other such school is based; or 10 ‘‘(ii) a branch campus of a school of 11 medicine or osteopathic medicine in an 12 area in which no other such school is 13 based; 14 ‘‘(B) plan, develop, and meet criteria for 15 accreditation for a school of medicine or osteo- 16 pathic medicine or branch campus of a school 17 of medicine or osteopathic medicine; 18 ‘‘(C) hire faculty, including faculty from 19 racial and ethnic groups who are underrep- 20 resented among the medical and other health 21 professions, and other staff to serve at such a 22 school or branch campus; 23 ‘‘(D) support educational programs at such 24 a school or branch campus; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00262 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 263 •S 4486 IS ‘‘(E) modernize and expand infrastructure 1 at such a school or branch campus; and 2 ‘‘(F) support other activities that the Sec- 3 retary determines further the establishment, 4 improvement, or expansion of a school of medi- 5 cine or osteopathic medicine or branch campus 6 of a school of medicine or osteopathic medicine. 7 ‘‘(e) APPLICATION.—To be eligible to receive a grant 8 under subsection (a), an institution of higher education 9 (or a consortium of such institutions), shall submit an ap- 10 plication to the Secretary at such time, in such manner, 11 and containing such information as the Secretary may re- 12 quire, including a description of the institution’s or con- 13 sortium’s planned activities described in subsection (d). 14 ‘‘(f) REPORTING.— 15 ‘‘(1) REPORTS FROM ENTITIES.—Each institu- 16 tion of higher education, or consortium of such insti- 17 tutions, awarded a grant under this section shall 18 submit an annual report to the Secretary on the ac- 19 tivities conducted under such grant, and other infor- 20 mation as the Secretary may require. 21 ‘‘(2) REPORT TO CONGRESS.—Not later than 5 22 years after the date of enactment of this section and 23 every 5 years thereafter, the Secretary shall submit 24 to the Committee on Health, Education, Labor, and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00263 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 264 •S 4486 IS Pensions of the Senate and the Committee on En- 1 ergy and Commerce of the House of Representatives 2 a report that provides a summary of the activities 3 and outcomes associated with grants made under 4 this section. Such reports shall include— 5 ‘‘(A) a list of awardees, including their pri- 6 mary geographic location, and location of any 7 school of medicine or osteopathic medicine, or a 8 branch campus of a school of medicine or osteo- 9 pathic medicine that was established, improved, 10 or expanded under a grant awarded under this 11 section; 12 ‘‘(B) the total number of students (includ- 13 ing the number of students from racial and eth- 14 nic groups underrepresented among medical 15 students and health professions, low-income 16 students, and first generation college students) 17 who— 18 ‘‘(i) are enrolled at or who have grad- 19 uated from any school of medicine or os- 20 teopathic medicine, or a branch campus of 21 a school of medicine or osteopathic medi- 22 cine, that was established, improved, or ex- 23 panded under a grant awarded under this 24 section, deidentified and disaggregated by 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00264 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 265 •S 4486 IS race, ethnicity, age, sex, geographic region, 1 disability status, and other relevant fac- 2 tors, to the extent such information is 3 available; and 4 ‘‘(ii) subsequently participate in an 5 accredited internship or medical residency 6 program upon graduation from any school 7 of medicine or osteopathic medicine, or a 8 branch campus of a school of medicine or 9 osteopathic medicine, that was established, 10 improved, or expanded under a grant 11 awarded under this section, deidentified 12 and disaggregated by race, ethnicity, age, 13 sex, geographic region, disability status, 14 medical specialty pursued, and other rel- 15 evant factors, to the extent such informa- 16 tion is available; 17 ‘‘(C) the effects of the grants awarded 18 under this section on the health care provider 19 workforce, including any impact on demo- 20 graphic representation disaggregated by race, 21 ethnicity, and sex, and the fields or specialties 22 pursued by students who have graduated from 23 any school of medicine or osteopathic medicine, 24 or a branch campus of a school of medicine or 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00265 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 266 •S 4486 IS osteopathic medicine, that was established, im- 1 proved, or expanded under a grant awarded 2 under this section; 3 ‘‘(D) the effects of the grants awarded 4 under this section on health care access in un- 5 derserved areas, including medically under- 6 served communities and health professional 7 shortage areas; and 8 ‘‘(E) recommendations for improving the 9 grants awarded under this section, and any 10 other considerations as the Secretary deter- 11 mines appropriate. 12 ‘‘(3) PUBLIC AVAILABILITY.—The Secretary 13 shall make reports submitted under paragraph (2) 14 publicly available on the internet website of the De- 15 partment of Health and Human Services. 16 ‘‘(g) DEFINITIONS.—In this section: 17 ‘‘(1) BRANCH CAMPUS.— 18 ‘‘(A) IN GENERAL.—The term ‘branch 19 campus’, with respect to a school of medicine or 20 osteopathic medicine, means an additional loca- 21 tion of such school that is geographically apart 22 and independent of the main campus, at which 23 the school offers at least 50 percent of the pro- 24 gram leading to a degree of doctor of medicine 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00266 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 267 •S 4486 IS or doctor of osteopathy that is offered at the 1 main campus. 2 ‘‘(B) INDEPENDENCE FROM MAIN CAM- 3 PUS.—For purposes of subparagraph (A), the 4 location of a school described in such subpara- 5 graph shall be considered to be independent of 6 the main campus described in such subpara- 7 graph if the location— 8 ‘‘(i) is permanent in nature; 9 ‘‘(ii) offers courses in educational pro- 10 grams leading to a degree, certificate, or 11 other recognized educational credential; 12 ‘‘(iii) has its own faculty and adminis- 13 trative or supervisory organization; and 14 ‘‘(iv) has its own budgetary and hiring 15 authority. 16 ‘‘(2) FIRST GENERATION COLLEGE STUDENT.— 17 The term ‘first generation college student’ has the 18 meaning given such term in section 402A(h)(3) of 19 the Higher Education Act of 1965. 20 ‘‘(3) HEALTH PROFESSIONAL SHORTAGE 21 AREA.—The term ‘health professional shortage area’ 22 has the meaning given such term in section 332(a). 23 ‘‘(4) INSTITUTION OF HIGHER EDUCATION.— 24 The term ‘institution of higher education’ has the 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00267 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 268 •S 4486 IS meaning given such term in section 101 of the High- 1 er Education Act of 1965. 2 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—To 3 carry out this section, there is authorized to be appro- 4 priated $1,000,000,000, to remain available until ex- 5 pended.’’. 6 TITLE IV—IMPROVING HEALTH 7 CARE ACCESS AND QUALITY 8 SEC. 4000. DEFINITION. 9 In this title and the amendments made by this title, 10 the term ‘‘health care’’ includes all health care needed 11 throughout the life cycle and the end of life. 12 Subtitle A—Reducing Barriers to 13 Accessing Care 14 SEC. 4001. PROTECTING PROTECTED AREAS. 15 Section 287 of the Immigration and Nationality Act 16 (8 U.S.C. 1357) is amended— 17 (1) by striking ‘‘Service’’ each place such term 18 appears and inserting ‘‘Department of Homeland 19 Security’’; 20 (2) by striking ‘‘Attorney General’’ each place 21 such term appears and inserting ‘‘Secretary of 22 Homeland Security’’; 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00268 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 269 •S 4486 IS (3) in subsection (f)(1), by striking ‘‘Commis- 1 sioner’’ and inserting ‘‘Director of U.S. Citizenship 2 and Immigration Services’’; 3 (4) in subsection (h)— 4 (A) by striking ‘‘of the Immigration and 5 Nationality Act’’; and 6 (B) by striking ‘‘of such Act’’; and 7 (5) by adding at the end the following: 8 ‘‘(i)(1) In this subsection: 9 ‘‘(A) The term ‘appropriate congressional com- 10 mittees’ means— 11 ‘‘(i) the Committee on Homeland Security 12 and Governmental Affairs of the Senate; 13 ‘‘(ii) the Committee on the Judiciary of the 14 Senate; 15 ‘‘(iii) the Committee on Homeland Security 16 of the House of Representatives; and 17 ‘‘(iv) the Committee on the Judiciary of 18 the House of Representatives. 19 ‘‘(B) The term ‘enforcement action’— 20 ‘‘(i) means an apprehension, arrest, inspec- 21 tion interview, request for identification, search, 22 seizure, service of charging documents or sub- 23 poenas, or surveillance for the purposes of im- 24 migration enforcement; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00269 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 270 •S 4486 IS ‘‘(ii) includes an enforcement action at, or 1 focused on, a protected area that is part of a 2 joint case led by another law enforcement agen- 3 cy. 4 ‘‘(C) The term ‘exigent circumstances’ means a 5 situation involving— 6 ‘‘(i) the imminent risk of death, violence, 7 or physical harm to any person or property, in- 8 cluding a situation implicating terrorism or the 9 national security of the United States; 10 ‘‘(ii) the immediate arrest or pursuit of a 11 dangerous felon, terrorist suspect, or other indi- 12 vidual presenting an imminent danger; or 13 ‘‘(iii) the imminent risk of destruction of 14 evidence that is material to an ongoing criminal 15 case. 16 ‘‘(D) The term ‘protected area’ includes all of 17 the physical space located within 1,000 feet of— 18 ‘‘(i) any medical treatment or mental 19 health care facility, including any hospital, doc- 20 tor’s office, health clinic, alcohol or drug pre- 21 vention, counseling, or treatment facilities, sy- 22 ringe exchange services, vaccination, treatment, 23 or testing sites, emergent or urgent care facil- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00270 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 271 •S 4486 IS ity, sites that serve pregnant individuals, or 1 community health centers; 2 ‘‘(ii) any public or private school, including 3 any known and licensed day care facility, pre- 4 school, sites of early childhood programs, pri- 5 mary school, secondary school, postsecondary 6 school (including colleges and universities), or 7 other institution of learning (including voca- 8 tional or trade schools); 9 ‘‘(iii) any scholastic or education-related 10 activity or event or before or after school pro- 11 gram, including field trips and interscholastic 12 events; 13 ‘‘(iv) any school bus or school bus stop; 14 ‘‘(v) places where children gather such as 15 a playground, recreation center, library, foster 16 care facility, or group home for children; 17 ‘‘(vi) any physical structure of an organiza- 18 tion or subdivision of government that— 19 ‘‘(I) assists children, pregnant women, 20 victims of crime or abuse, or individuals 21 with significant mental or physical disabil- 22 ities; 23 ‘‘(II) provides social services and as- 24 sistance, including homeless shelters, com- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00271 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 272 •S 4486 IS munity-based organizations, facilities that 1 serve disabled persons, drug or alcohol 2 counseling and treatment facilities, food 3 banks or food pantries, and other places 4 providing emergency and disaster services 5 or assistance with food and nutrition, 6 housing affordability and income or other 7 services funded by State or local govern- 8 ment, charitable giving, the Special Sup- 9 plemental Nutrition Program for Women, 10 Infants, and Children (WIC), Supple- 11 mental Nutrition Assistance Program 12 (SNAP), Temporary Assistance for Needy 13 Families (TANF), Social Security, or the 14 United States Housing Act; or 15 ‘‘(III) provides hospice, palliative, or 16 other available end-of-life care services to 17 terminally ill persons; 18 ‘‘(vii) any church, synagogue, mosque, or 19 other place of worship or religious study, in- 20 cluding buildings rented for the purpose of reli- 21 gious services, retreats, counseling, workshops, 22 instruction, and education; 23 ‘‘(viii) any Federal, State, or local court- 24 house, including the office of an individual’s 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00272 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 273 •S 4486 IS legal counsel or representative, and a probation, 1 parole, or supervised release office; 2 ‘‘(ix) the site of a funeral, grave-side cere- 3 mony, rosary, wedding, or other religious cere- 4 mony or observance; 5 ‘‘(x) any public demonstration, such as a 6 march, rally, or parade; 7 ‘‘(xi) any domestic violence shelter, rape 8 crisis center, child advocacy center, supervised 9 visitation center, family justice center, or victim 10 services provider; 11 ‘‘(xii) congressional district offices; 12 ‘‘(xiii) indoor and outdoor premises of de- 13 partments of motor vehicles; 14 ‘‘(xiv) a place where disaster or emergency 15 response and relief is provided, including evacu- 16 ation routes, places where shelter or emergency 17 supplies, food, or water are distributed, or 18 places where registration for disaster-relief as- 19 sistance or family reunification is underway; or 20 ‘‘(xv) any other location specified by the 21 Secretary of Homeland Security for purposes of 22 this subsection. 23 ‘‘(E) The term ‘prior approval’ means— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00273 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 274 •S 4486 IS ‘‘(i) in the case of officers and agents of 1 U.S. Immigration and Customs Enforcement, 2 prior written approval to carry out an enforce- 3 ment action involving a specific individual or in- 4 dividuals authorized by— 5 ‘‘(I) the Assistant Director of Oper- 6 ations, Homeland Security Investigations; 7 ‘‘(II) the Executive Associate Direc- 8 tor, Homeland Security Investigations; 9 ‘‘(III) the Assistant Director for Field 10 Operations, Enforcement and Removal Op- 11 erations; or 12 ‘‘(IV) the Executive Associate Direc- 13 tor for Field Operations, Enforcement and 14 Removal Operations; 15 ‘‘(ii) in the case of officers and agents of 16 U.S. Customs and Border Protection, prior 17 written approval to carry out an enforcement 18 action involving a specific individual or individ- 19 uals authorized by— 20 ‘‘(I) a Chief Patrol Agent; 21 ‘‘(II) the Director of Field Operations; 22 ‘‘(III) the Director of Air and Marine 23 Operations; or 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00274 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 275 •S 4486 IS ‘‘(IV) the Internal Affairs Special 1 Agent in Charge; and 2 ‘‘(iii) in the case of other Federal, State, 3 or local law enforcement officers, to carry out 4 an enforcement action involving a specific indi- 5 vidual or individuals authorized by— 6 ‘‘(I) the head of the Federal agency 7 carrying out the enforcement action; or 8 ‘‘(II) the head of the State or local 9 law enforcement agency carrying out the 10 enforcement action. 11 ‘‘(2)(A) An enforcement action may not take place 12 at, or be focused on, a protected area unless— 13 ‘‘(i) the action involves exigent circumstances; 14 and 15 ‘‘(ii) prior approval for the enforcement action 16 was obtained. 17 ‘‘(B) If an enforcement action is initiated pursuant 18 to subparagraph (A) and the exigent circumstances per- 19 mitting the enforcement action cease, the enforcement ac- 20 tion shall be discontinued until such exigent circumstances 21 reemerge. 22 ‘‘(C) If an enforcement action is carried out in viola- 23 tion of this subsection— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00275 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 276 •S 4486 IS ‘‘(i) no information resulting from the enforce- 1 ment action may be entered into the record or re- 2 ceived into evidence in a removal proceeding result- 3 ing from the enforcement action; and 4 ‘‘(ii) the noncitizen who is the subject of such 5 removal proceeding may file a motion for the imme- 6 diate termination of the removal proceeding. 7 ‘‘(3)(A) This subsection shall apply to any enforce- 8 ment action by officers or agents of the Department of 9 Homeland Security, including— 10 ‘‘(i) officers or agents of U.S. Immigration and 11 Customs Enforcement; 12 ‘‘(ii) officers or agents of U.S. Customs and 13 Border Protection; and 14 ‘‘(iii) any individual designated to perform im- 15 migration enforcement functions pursuant to sub- 16 section (g). 17 ‘‘(B) While carrying out an enforcement action at a 18 protected area, officers and agents referred to in subpara- 19 graph (A) shall make every effort— 20 ‘‘(i) to limit the time spent at the protected 21 area; 22 ‘‘(ii) to limit the enforcement action at the pro- 23 tected area to the person or persons for whom prior 24 approval was obtained; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00276 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 277 •S 4486 IS ‘‘(iii) to conduct themselves discreetly. 1 ‘‘(C) If, while carrying out an enforcement action 2 that is not initiated at or focused on a protected area, 3 officers or agents are led to a protected area, and no exi- 4 gent circumstance and prior approval with respect to the 5 protected area, such officers or agents shall— 6 ‘‘(i) cease before taking any further enforce- 7 ment action; 8 ‘‘(ii) conduct themselves in a discreet manner; 9 ‘‘(iii) maintain surveillance on an individual; 10 and 11 ‘‘(iv) immediately consult their supervisor in 12 order to determine whether such enforcement action 13 should be discontinued. 14 ‘‘(D) The limitations under this paragraph shall not 15 apply to the transportation of an individual apprehended 16 at or near a land or sea border to a hospital or health 17 care provider for the purpose of providing medical care 18 to such individual. 19 ‘‘(4)(A) Each official specified in subparagraph (B) 20 shall ensure that the employees under his or her super- 21 vision receive annual training on compliance with— 22 ‘‘(i) the requirements under this subsection with 23 respect to enforcement actions at or focused on pro- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00277 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 278 •S 4486 IS tected areas and enforcement actions that lead offi- 1 cers or agents to a protected area; and 2 ‘‘(ii) the requirements under section 239 of this 3 Act and section 384 of the Illegal Immigration Re- 4 form and Immigrant Responsibility Act of 1996 (8 5 U.S.C. 1367). 6 ‘‘(B) The officials specified in this subparagraph 7 are— 8 ‘‘(i) the Chief Counsel of each Field Office of 9 U.S. Immigration and Customs Enforcement; 10 ‘‘(ii) each Field Office Director of U.S. Immi- 11 gration and Customs Enforcement; 12 ‘‘(iii) each Special Agent in Charge of U.S. Im- 13 migration and Customs Enforcement; 14 ‘‘(iv) each Chief Patrol Agent of U.S. Customs 15 and Border Protection; 16 ‘‘(v) the Director of Field Operations of U.S. 17 Customs and Border Protection; 18 ‘‘(vi) the Director of Air and Marine Operations 19 of U.S. Customs and Border Protection; 20 ‘‘(vii) the Internal Affairs Special Agent in 21 Charge of U.S. Customs and Border Protection; and 22 ‘‘(viii) the chief law enforcement officer of each 23 State or local law enforcement agency that enters 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00278 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 279 •S 4486 IS into a written agreement with the Department of 1 Homeland Security pursuant to subsection (g). 2 ‘‘(5) Not later than 180 days after the date of the 3 enactment of the Health Equity and Accountability Act 4 of 2022, the Secretary of Homeland Security shall modify 5 the Notice to Appear form (I–862)— 6 ‘‘(A) to provide the subject of an enforcement 7 action with information, written in plain language, 8 summarizing the restrictions against enforcement 9 actions at protected areas set forth in this sub- 10 section and the remedies available to the individual 11 if such action violates such restrictions; 12 ‘‘(B) to ensure that the information described 13 in subparagraph (A) is accessible to an individual 14 with limited English proficiency; and 15 ‘‘(C) to ensure that a subject of an enforcement 16 action is not permitted to verify that the officers or 17 agents that carried out such action complied with 18 the restrictions set forth in this subsection. 19 ‘‘(6)(A) The Director of U.S. Immigration and Cus- 20 toms Enforcement and the Commissioner of U.S. Customs 21 and Border Protection shall each submit an annual report 22 to the appropriate congressional committees that includes 23 the information set forth in subparagraph (B) with respect 24 to the respective agency. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00279 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 280 •S 4486 IS ‘‘(B) Each report submitted under subparagraph (A) 1 shall include, with respect to the submitting agency during 2 the reporting period— 3 ‘‘(i) the number of enforcement actions that 4 were carried out at, or focused on, a protected area; 5 ‘‘(ii) the number of enforcement actions in 6 which officers or agents were subsequently led to a 7 protected area; and 8 ‘‘(iii) for each enforcement action described in 9 clause (i) or (ii)— 10 ‘‘(I) the date on which it occurred; 11 ‘‘(II) the specific site, city, county, and 12 State in which it occurred; 13 ‘‘(III) whether the site was a protected 14 area and, if so— 15 ‘‘(aa) identification of the protected 16 area; 17 ‘‘(bb) each reason why the enforce- 18 ment action was taken there; 19 ‘‘(cc) where the enforcement action 20 was taken without prior approval, certifi- 21 cation that notification to headquarters of 22 a submitting agency was provided after the 23 enforcement action took place; and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00280 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 281 •S 4486 IS ‘‘(dd) a report of what occurred dur- 1 ing and immediately after the enforcement 2 action; 3 ‘‘(IV) the components of the agency in- 4 volved in the enforcement action; 5 ‘‘(V) a description of the enforcement ac- 6 tion, including the nature of the criminal activ- 7 ity of its intended target; 8 ‘‘(VI) the number of individuals, if any, ar- 9 rested or taken into custody; 10 ‘‘(VII) the number of collateral arrests, if 11 any, and the reasons for each such arrest; 12 ‘‘(VIII) a certification whether the location 13 administrator of a protected area was contacted 14 before, during, or after the enforcement action; 15 and 16 ‘‘(IX) the percentage of all of the staff 17 members and supervisors reporting to the offi- 18 cials listed in paragraph (4)(B) who completed 19 the training required under paragraph (4)(A). 20 ‘‘(7) Nothing in the subsection may be construed— 21 ‘‘(A) to affect the authority of Federal, State, 22 or local law enforcement agencies— 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00281 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 282 •S 4486 IS ‘‘(i) to enforce generally applicable Federal 1 or State criminal laws unrelated to immigra- 2 tion; or 3 ‘‘(ii) to protect residents from imminent 4 threats to public safety; or 5 ‘‘(B) to limit or override the protections pro- 6 vided in— 7 ‘‘(i) section 239; or 8 ‘‘(ii) section 384 of the Illegal Immigration 9 Reform and Immigrant Responsibility Act of 10 1996 (8 U.S.C. 1367).’’. 11 SEC. 4002. REPEAL OF REQUIREMENT FOR DOCUMENTA- 12 TION EVIDENCING CITIZENSHIP OR NATION- 13 ALITY UNDER THE MEDICAID PROGRAM. 14 (a) REPEAL.—Subsections (i)(22) and (x) of section 15 1903 of the Social Security Act (42 U.S.C. 1396b) are 16 each repealed. 17 (b) CONFORMING AMENDMENTS.— 18 (1) STATE PAYMENTS FOR MEDICAL ASSIST- 19 ANCE.—Section 1902 of the Social Security Act (42 20 U.S.C. 1396a) is amended— 21 (A) by amending paragraph (46) of sub- 22 section (a) to read as follows: 23 ‘‘(46) provide that information is requested and 24 exchanged for purposes of income and eligibility 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00282 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 283 •S 4486 IS verification in accordance with a State system which 1 meets the requirements of section 1137 of this 2 Act;’’; 3 (B) in subsection (e)(13)(A)(i)— 4 (i) in the matter preceding subclause 5 (I), by striking ‘‘sections 1902(a)(46)(B) 6 and 1137(d)’’ and inserting ‘‘section 7 1137(d)’’; and 8 (ii) in subclause (IV), by striking 9 ‘‘1902(a)(46)(B) or’’; and 10 (C) by striking subsection (ee). 11 (2) REPEAL.—Subsection (c) of section 6036 of 12 the Deficit Reduction Act of 2005 (42 U.S.C. 1396b 13 note) is repealed. 14 (c) EFFECTIVE DATE.—The amendments made by 15 this section shall take effect on the date of enactment of 16 this Act. 17 SEC. 4003. AVAILABILITY OF BASIC ASSISTANCE TO LAW- 18 FULLY PRESENT NONCITIZENS. 19 (a) ELIMINATION OF ARBITRARY ELIGIBILITY RE- 20 STRICTIONS.— 21 (1) IN GENERAL.—Sections 402, 403, 411, 412, 22 421, and 422 of the Personal Responsibility and 23 Work Opportunity Reconciliation Act of 1996 (8 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00283 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 284 •S 4486 IS U.S.C. 1612, 1613, 1621, 1622, 1631, and 1632) 1 are repealed. 2 (2) CONFORMING AMENDMENTS.—Title IV of 3 the Personal Responsibility and Work Opportunity 4 Reconciliation Act of 1996 (8 U.S.C. 1601 et seq.) 5 is amended— 6 (A) in section 401(b)(5) of (8 U.S.C. 7 1611(b)(5)), by striking ‘‘the program defined 8 in section 402(a)(3)(A) (relating to the supple- 9 mental security income program)’’ and inserting 10 ‘‘the Supplemental Security Income Program 11 under title XVI of the Social Security Act (42 12 U.S.C. 1381 et seq.)’’; 13 (B) in section 404(a) (8 U.S.C. 1614(a)), 14 by striking ‘‘, 402, or 403’’; 15 (C) in section 413 (8 U.S.C. 1625)— 16 (i) by striking ‘‘A State’’ and insert- 17 ing the following: 18 ‘‘(a) STATE OR LOCAL PUBLIC BENEFIT DE- 19 FINED.—In this section, except as provided in paragraphs 20 (2) and (3), the term ‘State or local public benefit’— 21 ‘‘(1) means— 22 ‘‘(A) any grant, contract, loan, professional 23 license, or commercial license provided by an 24 agency of a State or local government or by ap- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00284 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 285 •S 4486 IS propriated funds of a State or local govern- 1 ment; and 2 ‘‘(B) any retirement, welfare, health, dis- 3 ability, public or assisted housing, postsec- 4 ondary education, food assistance, unemploy- 5 ment benefit, or any other similar benefit for 6 which payments or assistance are provided to 7 an individual, household, or family eligibility 8 unit by an agency of a State or local govern- 9 ment or by appropriated funds of a State or 10 local government; 11 ‘‘(2) shall not apply— 12 ‘‘(A) to any contract, professional license, 13 or commercial license for a nonimmigrant 14 whose visa for entry is related to such employ- 15 ment in the United States, or to a citizen of a 16 freely associated state, if section 141 of the ap- 17 plicable compact of free association approved in 18 Public Law 99–239 or 99–658 (or a successor 19 provision) is in effect; 20 ‘‘(B) with respect to benefits for an alien 21 who as a work authorized nonimmigrant or as 22 an alien lawfully admitted for permanent resi- 23 dence under the Immigration and Nationality 24 Act qualified for such benefits and for whom 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00285 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 286 •S 4486 IS the United States under reciprocal treaty agree- 1 ments is required to pay benefits, as determined 2 by the Secretary of State, after consultation 3 with the Attorney General; or 4 ‘‘(C) to the issuance of a professional li- 5 cense to, or the renewal of a professional license 6 by, a foreign national not physically present in 7 the United States; and 8 ‘‘(3) does not include any Federal public ben- 9 efit. 10 ‘‘(b) PROOF OF ELIGIBILITY REQUIREMENT.—A 11 State’’; and 12 (ii) in subsection (b), as so des- 13 ignated, by striking ‘‘(as defined in section 14 411(c))’’; 15 (D) in section 432(d) (8 U.S.C. 1642(d)), 16 by striking ‘‘(as defined in section 411(c))’’ and 17 inserting ‘‘(as defined in section 413(a))’’; 18 (E) in section 435 (8 U.S.C. 1645), by 19 striking ‘‘(as provided under section 403)’’; and 20 (F) in section 436 (8 U.S.C. 1646)— 21 (i) by striking ‘‘the food stamp pro- 22 gram (as defined in section 402(a)(3)(B))’’ 23 and inserting ‘‘the supplemental nutrition 24 assistance program established under the 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00286 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 287 •S 4486 IS Food and Nutrition Act of 2008 (7 U.S.C. 1 2011 et seq.)’’; and 2 (ii) by striking ‘‘the supplemental se- 3 curity income program (as defined in sec- 4 tion 402(a)(3)(A))’’ and inserting ‘‘the 5 Supplemental Security Income Program 6 under title XVI of the Social Security Act 7 (42 U.S.C. 1381 et seq.)’’. 8 (b) QUALIFIED NONCITIZENS.—Title IV of the Per- 9 sonal Responsibility and Work Opportunity Reconciliation 10 Act of 1996 (8 U.S.C. 1601 et seq.) is amended— 11 (1) in the title heading, by striking 12 ‘‘ALIENS’’ and inserting ‘‘NONCITIZENS’’; 13 (2) in section 401, in the section heading— 14 (A) by striking ‘‘QUALIFIED ALIENS’’ 15 and inserting ‘‘QUALIFIED NONCITIZENS’’; 16 and 17 (B) by striking ‘‘ALIENS’’ and inserting 18 ‘‘NONCITIZENS’’; 19 (3) by striking ‘‘qualified alien’’ each place it 20 appears and inserting ‘‘qualified noncitizen’’; 21 (4) by striking ‘‘qualified aliens’’ each place it 22 appears and inserting ‘‘qualified noncitizens’’; 23 (5) by striking ‘‘qualified alien’s’’ each place it 24 appears and inserting ‘‘qualified noncitizen’s’’; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00287 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 288 •S 4486 IS (6) by striking ‘‘an alien’’ each place that it ap- 1 pears and inserting ‘‘a noncitizen’’; 2 (7) by striking ‘‘alien’’ each place it appears 3 and inserting ‘‘noncitizen’’; 4 (8) by striking ‘‘aliens’’ each place it appears 5 and inserting ‘‘noncitizens’’; and 6 (9) by striking ‘‘alien’s’’ each place it appears 7 and inserting ‘‘noncitizen’s’’. 8 (c) ACCESS TO BASIC SERVICES FOR LAWFULLY RE- 9 SIDING NONCITIZENS.—Section 431 of the Personal Re- 10 sponsibility and Work Opportunity Reconciliation Act of 11 1996 (8 U.S.C. 1641) is amended— 12 (1) in subsection (b)— 13 (A) in the subsection heading, by striking 14 ‘‘QUALIFIED ALIEN’’ and inserting ‘‘QUALIFIED 15 NONCITIZEN’’; and 16 (B) in the matter preceding paragraph (1), 17 by striking ‘‘benefit’’ and all that follows 18 through the period at the end of the subsection 19 and inserting ‘‘benefit, is lawfully present in the 20 United States.’’; 21 (2) in subsection (c)— 22 (A) in the subsection heading, by striking 23 ‘‘ALIENS AS QUALIFIED ALIENS’’ and inserting 24 ‘‘NONCITIZENS AS QUALIFIED NONCITIZENS’’; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00288 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 289 •S 4486 IS (B) in paragraph (3)(B), by striking ‘‘; or’’ 1 and inserting a semicolon; 2 (C) in paragraph (4), by striking the pe- 3 riod at the end and inserting ‘‘; or’’; and 4 (D) by inserting after paragraph (4) the 5 following: 6 ‘‘(5) a noncitizen— 7 ‘‘(A) in a category that was treated as law- 8 fully present for purposes of section 1101 of the 9 Patient Protection and Affordable Care Act of 10 2010 (42 U.S.C. 18001); 11 ‘‘(B) who met the requirements of section 12 402(a)(2)(D) of the Personal Responsibility and 13 Work Opportunity Reconciliation Act of 1996 14 (8 U.S.C. 1612(a)(2)(D)) on or before January 15 1, 2023; 16 ‘‘(C) who is granted special immigrant ju- 17 venile status as described by section 18 101(a)(27)(J) of the Immigration and Nation- 19 ality Act (8 U.S.C. 1101(a)(27)(J)); 20 ‘‘(D) who has a pending, bona fide applica- 21 tion for nonimmigrant status under section 22 101(a)(15)(U) of the Immigration and Nation- 23 ality Act (8 U.S.C. 1101(a)(15)(U)); 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00289 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 290 •S 4486 IS ‘‘(E) who was granted relief under the De- 1 ferred Action for Childhood Arrivals program; 2 or 3 ‘‘(F) any other person who is not a citizen 4 of the United States but who resides in a State 5 or territory of the United States and is feder- 6 ally authorized to be present in the United 7 States.’’; and 8 (3) by adding at the end the following: 9 ‘‘(d) NONCITIZEN.—In this title, the term ‘noncit- 10 izen’ means any individual who is not a citizen of the 11 United States.’’. 12 (d) CHILD NUTRITION PROGRAMS.—Section 742 of 13 the Personal Responsibility and Work Opportunity Rec- 14 onciliation Act of 1996 (8 U.S.C. 1615) is amended— 15 (1) in subsection (a)— 16 (A) in the subsection heading, by striking 17 ‘‘SCHOOL LUNCH AND BREAKFAST PROGRAMS’’ 18 and inserting ‘‘CHILD NUTRITION PROGRAMS’’; 19 (B) by striking ‘‘the school lunch pro- 20 gram’’ and inserting ‘‘any program’’; and 21 (C) by striking ‘‘the school breakfast pro- 22 gram under section 4 of the’’ and inserting 23 ‘‘any program under the’’; and 24 (2) in subsection (b)(1)— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00290 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 291 •S 4486 IS (A) by striking ‘‘Nothing in this Act shall 1 prohibit or require a State to provide to an in- 2 dividual who is not a citizen or a qualified alien, 3 as defined in section 431(b),’’ and inserting ‘‘A 4 State shall not deny’’; and 5 (B) by striking ‘‘paragraph (2)’’ and in- 6 serting ‘‘paragraph (2) on the basis of an indi- 7 vidual’s citizenship or citizenship, alienage, or 8 immigration status’’. 9 (e) EXCLUSION OF MEDICAL ASSISTANCE EXPENDI- 10 TURES FOR CITIZENS OF FREELY ASSOCIATED STATES.— 11 Section 1108(h) of the Social Security Act (42 U.S.C. 12 1308(h)) is amended— 13 (1) by striking ‘‘Expenditures’’ and inserting: 14 ‘‘(1) IN GENERAL.—Expenditures’’; and 15 (2) by adding at the end the following: 16 ‘‘(2) MEDICAID PROGRAMS.—With respect to 17 eligibility for benefits for a State plan approved 18 under title XIX, other than medical assistance de- 19 scribed in section 401(b)(1)(A), paragraph (1) shall 20 not apply to any individual who lawfully resides in 21 1 of the 50 States or the District of Columbia in ac- 22 cordance with the Compacts of Free Association be- 23 tween the Government of the United States and the 24 Governments of the Federated States of Micronesia, 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00291 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 292 •S 4486 IS the Republic of the Marshall Islands, and the Re- 1 public of Palau and shall not apply, at the option of 2 the Governor of Puerto Rico, the Virgin Islands, 3 Guam, the Northern Mariana Islands, or American 4 Samoa as communicated to the Secretary of Health 5 and Human Services in writing, to any individual 6 who lawfully resides in the respective territory in ac- 7 cordance with such Compacts.’’. 8 (f) CHILD HEALTH INSURANCE PROGRAM.—Section 9 2107(e)(1) of the Social Security Act (42 U.S.C. 10 1397gg(e)(1)) is amended by striking subparagraph (O). 11 (g) CONFORMING AMENDMENTS.— 12 (1) SUPPLEMENTAL FOOD ASSISTANCE PRO- 13 GRAM.—The Food and Nutrition Act of 2008 (7 14 U.S.C. 2011 et seq.) is amended— 15 (A) in section 5 (7 U.S.C. 2014)— 16 (i) in subsection (d)— 17 (I) in paragraph (1), by striking 18 ‘‘law)’’ and all that follows through 19 the semicolon at the end and inserting 20 ‘‘law);’’; and 21 (II) in paragraph (10), by strik- 22 ing ‘‘subsection (k)’’ and inserting 23 ‘‘subsection (j)’’; 24 (ii) by striking subsection (i); 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00292 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 293 •S 4486 IS (iii) in subsection (j), by striking 1 ‘‘subsections (a) through (i)’’ and inserting 2 ‘‘subsections (a) through (h)’’; and 3 (iv) by redesignating subsections (j) 4 through (n) as subsection (i) through (m), 5 respectively; 6 (B) in section 6 (7 U.S.C. 2015)— 7 (i) in subsection (f)(2)(B), by striking 8 ‘‘an alien lawfully admitted for permanent’’ 9 and all that follows through the end of the 10 subsection and inserting ‘‘a noncitizen law- 11 fully present in the United States.’’; and 12 (ii) in subsection (s)(2), by striking 13 ‘‘(i), (k), (l), (m), and (n)’’ and inserting 14 ‘‘(j), (k), (l), and (m)’’; and 15 (C) in section 11(e)(2)(B)(v)(II) (7 U.S.C. 16 2020(e)(2)(B)(v)(II)), by striking ‘‘aliens’’ and 17 inserting ‘‘noncitizens’’. 18 (2) MEDICAID.—Section 1903(v) of the Social 19 Security Act (42 U.S.C. 1396b(v)) is amended— 20 (A) in paragraph (1)— 21 (i) by striking ‘‘paragraphs (2) and 22 (4)’’ and inserting ‘‘paragraph (2)’’; and 23 (ii) by striking ‘‘admitted for’’ and all 24 that follows through the end of the para- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00293 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 294 •S 4486 IS graph and inserting ‘‘present in the United 1 States.’’; and 2 (B) by striking paragraph (4). 3 (3) HOUSING ASSISTANCE.—Section 214(a) of 4 the Housing and Community Development Act of 5 1980 (42 U.S.C. 1436a(a)) is amended— 6 (A) in paragraph (6), by striking ‘‘; or’’ 7 and inserting a semicolon; 8 (B) in paragraph (7), by striking the pe- 9 riod at the end and inserting ‘‘; or’’; and 10 (C) by adding at the end the following: 11 ‘‘(8) a qualified noncitizen (as defined in sec- 12 tion 431 of the Personal Responsibility and Work 13 Opportunity Reconciliation Act of 1996 (8 U.S.C. 14 1641));’’. 15 (4) ASSISTANCE NOT TREATED AS DEBT AB- 16 SENT FRAUD.—Section 213A of the Immigration 17 and Nationality Act (8 U.S.C. 1183a) is amended— 18 (A) in subsection (a)(3)— 19 (i) in subparagraph (A), by striking 20 ‘‘(as provided under section 403 of the 21 Personal Responsibility and Work Oppor- 22 tunity Reconciliation Act of 1996)’’; and 23 (ii) in subparagraph (B), in the un- 24 designated matter following clause (ii), by 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00294 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 295 •S 4486 IS striking ‘‘(as provided under section 403 of 1 the Personal Responsibility and Work Op- 2 portunity Reconciliation Act of 1996)’’; 3 and 4 (B) in subsection (b)(1)(A), by striking 5 ‘‘benefit,’’ and inserting ‘‘benefit by fraud,’’; 6 and 7 (C) in subsection (d)(2)(B), by striking ‘‘, 8 403(c)(2), or 411(b)’’. 9 (5) REPORT.—Section 565 of the Illegal Immi- 10 gration Reform and Immigrant Responsibility Act of 11 1996 (8 U.S.C. 1371) is amended— 12 (A) by striking paragraph (2); and 13 (B) by redesignating paragraph (3) as 14 paragraph (2). 15 (h) PRESERVING ACCESS TO HEALTH CARE.—Sec- 16 tion 36B(c)(1)(B) of the Internal Revenue Code of 1986 17 is amended to read as follows: 18 ‘‘(B) SPECIAL RULE FOR CERTAIN INDI- 19 VIDUALS LAWFULLY PRESENT IN THE UNITED 20 STATES.—If— 21 ‘‘(i) a taxpayer has a household in- 22 come which is not greater than 100 per- 23 cent of an amount equal to the poverty line 24 for a family of the size involved, 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00295 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 296 •S 4486 IS ‘‘(ii) the taxpayer is a non-citizen law- 1 fully present in the United States, 2 ‘‘(iii) the taxpayer is ineligible for 3 minimum essential coverage under section 4 5000A(f)(1)(A)(ii), and 5 ‘‘(iv) under the Medicaid eligibility 6 criteria for non-citizens in effect on De- 7 cember 26, 2020, the taxpayer would be 8 ineligible for such minimum essential cov- 9 erage by reason of the taxpayer’s immigra- 10 tion status, 11 the taxpayer shall, for purposes of the credit 12 under this section, be treated as an applicable 13 taxpayer with a household income which is 14 equal to 100 percent of the poverty line for a 15 family of the size involved.’’. 16 (i) FEDERAL AGENCY GUIDANCE.—Not later than 17 180 days after the date of the enactment of this Act, each 18 Federal agency, as applicable, shall issue guidance with 19 respect to implementing the amendments made by this 20 section. 21 (j) EFFECTIVE DATE.—The amendments made by 22 this section shall take effect on the date of enactment of 23 this Act. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00296 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 297 •S 4486 IS SEC. 4004. IMPROVE AFFORDABILITY AND REDUCE PRE- 1 MIUM COSTS OF HEALTH INSURANCE FOR 2 CONSUMERS. 3 (a) IN GENERAL.—Section 36B(b)(3)(A) of the In- 4 ternal Revenue Code of 1986 is amended to read as fol- 5 lows: 6 ‘‘(A) APPLICABLE PERCENTAGE.—The ap- 7 plicable percentage for any taxable year shall be 8 the percentage such that the applicable percent- 9 age for any taxpayer whose household income is 10 within an income tier specified in the following 11 table shall increase, on a sliding scale in a lin- 12 ear manner, from the initial premium percent- 13 age to the final premium percentage specified in 14 such table for such income tier: 15 ‘‘In the case of household income (expressed as a percent of poverty line) within the following in- come tier: The initial premium percentage is— The final premium percentage is— Up to 150 percent .................................................. 0.0 0.0 150 percent up to 200 percent ............................... 0.0 3.0 200 percent up to 250 percent ............................... 3.0 4.0 250 percent up to 300 percent ............................... 4.0 6.0 300 percent up to 400 percent ............................... 6.0 8.5 400 percent and higher .......................................... 8.5 8.5.’’. (b) CONFORMING AMENDMENT.—Section 16 36B(c)(1)(A) of the Internal Revenue Code of 1986 is 17 amended by striking ‘‘but does not exceed 400 percent’’. 18 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00297 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 298 •S 4486 IS (c) EFFECTIVE DATE.—The amendments made by 1 this section shall apply to taxable years beginning after 2 December 31, 2021. 3 SEC. 4005. REMOVING CITIZENSHIP AND IMMIGRATION 4 BARRIERS TO ACCESS TO AFFORDABLE 5 HEALTH CARE UNDER THE ACA. 6 (a) IN GENERAL.— 7 (1) PREMIUM TAX CREDITS.—Section 36B of 8 the Internal Revenue Code of 1986 is amended— 9 (A) in subsection (c)(1)(B), as amended by 10 section 4003(h)— 11 (i) by amending the heading to read 12 as follows: ‘‘SPECIAL RULE FOR CERTAIN 13 INDIVIDUALS INELIGIBLE FOR MEDICAID 14 DUE TO STATUS’’; and 15 (ii) by amending clause (ii) to read as 16 follows: 17 ‘‘(ii) the taxpayer is a noncitizen who 18 is not eligible for the Medicaid program 19 under title XIX of the Social Security Act 20 by reason of the individual’s immigration 21 status,’’; and 22 (B) by striking subsection (e). 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00298 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 299 •S 4486 IS (2) COST-SHARING REDUCTIONS.—Section 1402 1 of the Patient Protection and Affordable Care Act 2 (42 U.S.C. 18071) is amended— 3 (A) by striking subsection (e); and 4 (B) by redesignating subsections (f) and 5 (g) as subsections (e) and (f), respectively. 6 (3) BASIC HEALTH PROGRAM ELIGIBILITY.— 7 Section 1331(e)(1)(B) of the Patient Protection and 8 Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is 9 amended by striking ‘‘lawfully present in the United 10 States,’’. 11 (4) RESTRICTIONS ON FEDERAL PAYMENTS.— 12 Section 1412 of the Patient Protection and Afford- 13 able Care Act (42 U.S.C. 18082) is amended— 14 (A) by striking subsection (d); and 15 (B) by redesignating subsection (e) as sub- 16 section (d). 17 (5) REQUIREMENT TO MAINTAIN MINIMUM ES- 18 SENTIAL COVERAGE.—Section 5000A(d) of the In- 19 ternal Revenue Code of 1986 is amended— 20 (A) by striking paragraph (3); and 21 (B) by redesignating paragraph (4) as 22 paragraph (3). 23 (b) CONFORMING AMENDMENTS.— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00299 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 300 •S 4486 IS (1) ESTABLISHMENT OF PROGRAM.—Section 1 1411(a) of the Patient Protection and Affordable 2 Care Act (42 U.S.C. 18081(a)) is amended— 3 (A) by striking paragraph (1); and 4 (B) by redesignating paragraphs (2), (3), 5 and (4) as paragraphs (1), (2), and (3), respec- 6 tively. 7 (2) QUALIFIED INDIVIDUALS.—Section 1312(f) 8 of the Patient Protection and Affordable Care Act 9 (42 U.S.C. 18032(f)) is amended— 10 (A) in the heading, by striking ‘‘; ACCESS 11 LIMITED TO CITIZENS AND LAWFUL RESI- 12 DENTS’’; and 13 (B) by striking paragraph (3). 14 (c) EFFECTIVE DATE.—The amendments made by 15 this section shall apply to years, plan years, and taxable 16 years, as applicable, beginning after December 31, 2022. 17 SEC. 4006. REMOVING BARRIERS TO ACCESS TO AFFORD- 18 ABLE HEALTH CARE FOR LAWFULLY RESID- 19 ING IMMIGRANTS UNDER MEDICAID AND 20 CHIP. 21 (a) MEDICAID.—Section 1903(v) of the Social Secu- 22 rity Act (42 U.S.C. 1396b(v)(4)), as amended by section 23 4003(g)(2), is amended by adding at the end the following: 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00300 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 301 •S 4486 IS ‘‘(4) COVERAGE OF LAWFULLY RESIDING IMMI- 1 GRANTS.— 2 ‘‘(A) IN GENERAL.—Notwithstanding title 3 IV of the Personal Responsibility and Work Op- 4 portunity Reconciliation Act of 1996, a State 5 shall provide medical assistance under this title 6 to individuals who are lawfully residing in the 7 United States (including individuals described 8 in paragraph (1), battered individuals described 9 in section 431(c) of such Act, and individuals 10 with an approved or pending application for de- 11 ferred action or other federally authorized pres- 12 ence), if they otherwise meet the eligibility re- 13 quirements for medical assistance under the 14 State plan approved under this title (other than 15 the requirement of the receipt of aid or assist- 16 ance under title IV, supplemental security in- 17 come benefits under title XVI, or a State sup- 18 plementary payment). 19 ‘‘(B) TREATMENT OF MEDICAL ASSIST- 20 ANCE PROVIDED TO LAWFULLY RESIDING IMMI- 21 GRANTS.—No debt shall accrue under an affi- 22 davit of support against any sponsor of an indi- 23 vidual provided medical assistance under sub- 24 paragraph (A) on the basis of provision of as- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00301 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 302 •S 4486 IS sistance to such individual and the cost of such 1 assistance shall not be considered as an unreim- 2 bursed cost. 3 ‘‘(C) VERIFICATION REQUIREMENT.—As 4 part of the State’s ongoing eligibility redeter- 5 mination requirements and procedures for an 6 individual provided medical assistance as a re- 7 sult of the application of subparagraph (A), a 8 State shall verify that the individual continues 9 to lawfully reside or be lawfully present in the 10 United States using the documentation pre- 11 sented to the State by the individual on initial 12 enrollment. If the State cannot successfully 13 verify that the individual is lawfully residing or 14 present in the United States in this manner, it 15 shall require that the individual provide the 16 State with further documentation or other evi- 17 dence to verify that the individual is lawfully re- 18 siding or present in the United States.’’. 19 (b) CHIP.—Section 2107(e)(1) of the Social Security 20 Act (42 U.S.C. 1397gg(e)(1)), as amended by section 21 4003(f), is amended by inserting after subparagraph (N) 22 the following new subparagraph: 23 ‘‘(O) Paragraph (4) of section 1903(v) (re- 24 lating to lawfully residing individuals).’’. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00302 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 303 •S 4486 IS (c) EFFECTIVE DATE.— 1 (1) IN GENERAL.—Except as provided in para- 2 graph (2), the amendments made by this section 3 shall take effect on the date of enactment of this Act 4 and shall apply to services furnished on or after the 5 date that is 90 days after such date of enactment. 6 (2) EXCEPTION IF STATE LEGISLATION RE- 7 QUIRED.—In the case of a State plan for medical as- 8 sistance under title XIX, or a State child health plan 9 under title XXI, of the Social Security Act which the 10 Secretary of Health and Human Services determines 11 requires State legislation (other than legislation ap- 12 propriating funds) in order for the plan to meet the 13 additional requirements imposed by the amendments 14 made by this section, the respective State plan shall 15 not be regarded as failing to comply with the re- 16 quirements of such title solely on the basis of its 17 failure to meet these additional requirements before 18 the first day of the first calendar quarter beginning 19 after the close of the first regular session of the 20 State legislature that begins after the date of enact- 21 ment of this Act. For purposes of the previous sen- 22 tence, in the case of a State that has a 2-year legis- 23 lative session, each year of such session shall be 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00303 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 304 •S 4486 IS deemed to be a separate regular session of the State 1 legislature. 2 (d) PRESERVING COVERAGE.— 3 (1) IN GENERAL.—Nothing in this section, in- 4 cluding the amendments made by this section, shall 5 prevent lawfully present noncitizens who are ineli- 6 gible for full benefits under the Medicaid program 7 under title XIX of the Social Security Act from se- 8 curing a credit for which such lawfully present non- 9 citizens would be eligible under section 36B(c)(1)(B) 10 of the Internal Revenue Code of 1986 and under the 11 Medicaid provisions for lawfully present noncitizens, 12 as in effect on the date prior to the date of enact- 13 ment of this Act. 14 (2) DEFINITION.—For purposes of paragraph 15 (1), the term ‘‘full benefits’’ means, with respect to 16 an individual and State, medical assistance for all 17 services covered under the State plan under title 18 XIX of the Social Security Act that is not less in 19 amount, duration, or scope, or is determined by the 20 Secretary of Health and Human Services to be sub- 21 stantially equivalent to the medical assistance avail- 22 able for an individual described in section 23 1902(a)(10)(A)(i) of the Social Security Act (42 24 U.S.C. 1396a(a)(10)(A)(i)). 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00304 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 305 •S 4486 IS SEC. 4007. CONSISTENCY IN HEALTH INSURANCE COV- 1 ERAGE FOR INDIVIDUALS WITH FEDERALLY 2 AUTHORIZED PRESENCE, INCLUDING DE- 3 FERRED ACTION. 4 (a) IN GENERAL.—For purposes of eligibility under 5 any of the provisions described in subsection (b), all indi- 6 viduals granted lawful presence in the United States shall 7 be considered to be lawfully present in the United States. 8 (b) PROVISIONS DESCRIBED.—The provisions de- 9 scribed in this subsection are the following: 10 (1) EXCHANGE ELIGIBILITY.—Section 1311 of 11 the Patient Protection and Affordable Care Act (42 12 U.S.C. 18031). 13 (2) REDUCED COST-SHARING ELIGIBILITY.— 14 Section 1402 of the Patient Protection and Afford- 15 able Care Act (42 U.S.C. 18071). 16 (3) PREMIUM SUBSIDY ELIGIBILITY.—Section 17 36B of the Internal Revenue Code of 1986. 18 (4) MEDICAID AND CHIP ELIGIBILITY.—Titles 19 XIX and XXI of the Social Security Act (42 U.S.C. 20 1396 et seq.; 1397aa et seq.), including under sec- 21 tion 1903(v) of such Act (42 U.S.C. 1396b(v)). 22 (c) EFFECTIVE DATE.— 23 (1) IN GENERAL.—Subsection (a) shall take ef- 24 fect on the date of enactment of this Act. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00305 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 306 •S 4486 IS (2) TRANSITION THROUGH SPECIAL ENROLL- 1 MENT PERIOD.—In the case of an individual de- 2 scribed in subsection (a) who, before the first day of 3 the first annual open enrollment period under sub- 4 paragraph (B) of section 1311(c)(6) of the Patient 5 Protection and Affordable Care Act (42 U.S.C. 6 18031(c)(6)) beginning after the date of enactment 7 of this Act, is granted lawful presence in the United 8 States and who, as a result of such subsection, 9 qualifies for a subsidy under a provision described in 10 paragraph (2) or (3) of subsection (b), the Secretary 11 of Health and Human Services shall establish a spe- 12 cial enrollment period under subparagraph (C) of 13 such section 1311(c)(6) during which such individual 14 may enroll in qualified health plans through Ex- 15 changes under title I of the Patient Protection and 16 Affordable Care Act (42 U.S.C. 18001 note et seq.) 17 and qualify for such a subsidy. For such an indi- 18 vidual who has been granted federally authorized 19 presence in the United States as of the date of en- 20 actment of this Act, such special enrollment period 21 shall begin not later than 90 days after such date 22 of enactment. Nothing in this paragraph shall be 23 construed as affecting the authority of the Secretary 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00306 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 307 •S 4486 IS to establish additional special enrollment periods 1 under such subparagraph (C). 2 SEC. 4008. STUDY ON THE UNINSURED. 3 (a) IN GENERAL.—The Secretary of Health and 4 Human Services (in this section referred to as the ‘‘Sec- 5 retary’’) shall— 6 (1) conduct a study, in accordance with the 7 standards under section 3101 of the Public Health 8 Service Act (42 U.S.C. 300kk), on the demographic 9 characteristics of the population of individuals who 10 do not have health insurance coverage or oral health 11 coverage; and 12 (2) predict, based on such study, the demo- 13 graphic characteristics of the population of individ- 14 uals who would remain without health insurance cov- 15 erage after the end of any annual open enrollment 16 or any special enrollment period or upon enactment 17 and implementation of any legislative changes to the 18 Patient Protection and Affordable Care Act (Public 19 Law 111–148) that affect the number of persons eli- 20 gible for coverage. 21 (b) REPORTING REQUIREMENTS.— 22 (1) IN GENERAL.—Not later than 12 months 23 after the date of the enactment of this Act, the Sec- 24 retary shall submit to the Congress the results of 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00307 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 308 •S 4486 IS the study under subsection (a)(1) and the prediction 1 made under subsection (a)(2). 2 (2) REPORTING OF DEMOGRAPHIC CHARACTER- 3 ISTICS.—The Secretary shall— 4 (A) report the demographic characteristics 5 under paragraphs (1) and (2) of subsection (a) 6 on the basis of racial and ethnic group (as de- 7 fined in section 1707(g)(1) of the Public Health 8 Service Act), and stratify the reporting on each 9 racial and ethnic group by other demographic 10 characteristics that can impact access to health 11 insurance coverage, such as sexual orientation, 12 gender identity, primary language, disability 13 status, sex, socioeconomic status, age group, 14 citizenship, and immigration status, in a man- 15 ner consistent with title I of this Act, including 16 the amendments made by such title; and 17 (B) not use such report, or any informa- 18 tion gathered in preparing such report— 19 (i) to engage in or anticipate any de- 20 portation or immigration related enforce- 21 ment action by any entity, including the 22 Department of Homeland Security; or 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00308 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 309 •S 4486 IS (ii) for the exploitation of, or discrimi- 1 nation against, communities of color or the 2 LGBTQ+ population. 3 SEC. 4009. MEDICAID FALLBACK COVERAGE PROGRAM FOR 4 LOW-INCOME ADULTS IN NON-EXPANSION 5 STATES. 6 (a) IN GENERAL.—As soon as possible after the date 7 of enactment of this Act the Secretary of Health and 8 Human Services (in this section referred to as the ‘‘Sec- 9 retary’’) shall— 10 (1) directly or by contract, establish a program 11 that offers eligible individuals the opportunity to en- 12 roll in health benefits coverage that meets the re- 13 quirements described in subsection (c) and any re- 14 quirements applicable to such coverage pursuant to 15 subsection (d); and 16 (2) ensure that such program is administered 17 consistent with the requirements of section 18 431.10(c)(2) of title 42, Code of Federal Regula- 19 tions. 20 (b) DEFINITION OF ELIGIBLE INDIVIDUAL.—In this 21 section, the term ‘‘eligible individual’’ means an individual 22 who— 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00309 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 310 •S 4486 IS (1) is described in section 1 1902(a)(10)(A)(i)(VIII) of the Social Security Act 2 (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)); 3 (2) resides in a State that— 4 (A) does not expend amounts for medical 5 assistance under title XIX of the Social Secu- 6 rity Act (42 U.S.C. 1396 et seq.) for all individ- 7 uals described in such section; and 8 (B) did not expend amounts for medical 9 assistance under such title for all such individ- 10 uals as of the date of enactment of this Act; 11 and 12 (3) would not be eligible for medical assistance 13 under such State’s plan for medical assistance under 14 title XIX of the Social Security Act (42 U.S.C. 1396 15 et seq.), or a waiver of such plan, as such plan or 16 waiver was in effect on such date. 17 (c) HEALTH BENEFITS COVERAGE REQUIRE- 18 MENTS.—The requirements described in this subsection 19 with respect to health benefits coverage are the following: 20 (1) ESSENTIAL HEALTH BENEFITS.—At a min- 21 imum, the coverage meets the minimum standards 22 required under paragraph (5) of section 1937(b) of 23 the Social Security Act (42 U.S.C. 1396u–7(b)) for 24 benchmark coverage described in paragraph (1) of 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00310 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 311 •S 4486 IS such section or benchmark equivalent coverage de- 1 scribed in paragraph (2) of such section. 2 (2) PREMIUMS AND COST-SHARING.—No pre- 3 miums are imposed for the coverage, and deduct- 4 ibles, cost-sharing, or similar charges may only be 5 imposed in accordance with the requirements im- 6 posed on State Medicaid plans under section 1916 of 7 the Social Security Act (42 U.S.C. 1396o). 8 (d) APPLICATION OF REQUIREMENTS AND PROVI- 9 SIONS OF TITLE XIX OF THE SOCIAL SECURITY ACT.— 10 The Secretary shall specify that— 11 (1) any requirement applicable to the furnishing 12 of medical assistance under title XIX of the Social 13 Security Act (42 U.S.C. 1396 et seq.) by States that 14 have elected to make medical assistance available to 15 individuals described in section 16 1902(a)(10)(A)(i)(VIII) of such title (42 U.S.C. 17 1396a(a)(10)(A)(i)(VIII)) that does not conflict with 18 the requirements specified in subsection (c) applies 19 to the program established under this section; and 20 (2) other provisions of such title apply to such 21 program. 22 (e) NO STATE MANDATE.—Nothing in this section 23 shall be construed as requiring a State to make expendi- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00311 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 312 •S 4486 IS tures related to the program established under this section 1 and the Secretary shall not impose any such requirement. 2 (f) FUNDING.—There are appropriated to the Sec- 3 retary for each fiscal year beginning with fiscal year 2022 4 from any funds in the Treasury not otherwise appro- 5 priated, such sums as are necessary to carry out this sec- 6 tion. 7 SEC. 4010. INCREASE AND EXTENSION OF TEMPORARY EN- 8 HANCED FMAP FOR STATES WHICH BEGIN TO 9 EXPEND AMOUNTS FOR CERTAIN MANDA- 10 TORY INDIVIDUALS. 11 (a) IN GENERAL.—Section 1905(ii)(1) of the Social 12 Security Act (42 U.S.C. 1396d(ii)(1)) is amended— 13 (1) by striking ‘‘8-quarter period’’ and inserting 14 ‘‘40-quarter period’’; and 15 (2) by striking ‘‘5 percentage points’’ and in- 16 serting ‘‘10 percentage points’’. 17 (b) EFFECTIVE DATE.—The amendments made by 18 this section shall take effect as if included in the enact- 19 ment of section 9814 of the American Rescue Plan Act 20 of 2021 (Public Law 117–2). 21 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00312 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 313 •S 4486 IS Subtitle B—Improvement of 1 Coverage 2 SEC. 4101. 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 pre- 8 ceding paragraph (1), by striking ‘‘subsections 9 (g) and (h)’’ and inserting ‘‘subsections (g), 10 (h), and (i)’’; 11 (B) in subsection (g)(2), in the matter pre- 12 ceding subparagraph (A), by inserting ‘‘sub- 13 section (i) and’’ after ‘‘subject to’’; and 14 (C) by adding at the end the following new 15 subsection: 16 ‘‘(i) SUNSET OF MEDICAID FUNDING LIMITATIONS 17 FOR PUERTO RICO, THE VIRGIN ISLANDS, GUAM, THE 18 NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA.— 19 Subsections (f) and (g) shall not apply to Puerto Rico, 20 the Virgin Islands, Guam, the Northern Mariana Islands, 21 and American Samoa beginning with fiscal year 2024.’’. 22 (2) CONFORMING AMENDMENTS.— 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00313 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 314 •S 4486 IS (A) Section 1902(j) of the Social Security 1 Act (42 U.S.C. 1396a(j)) is amended by strik- 2 ing ‘‘, the limitation in section 1108(f),,’’. 3 (B) Section 1903(u) of the Social Security 4 Act (42 U.S.C. 1396b(u)) is amended by strik- 5 ing paragraph (4). 6 (3) EFFECTIVE DATE.—The amendments made 7 by this section shall apply beginning with fiscal year 8 2024. 9 (b) ELIMINATION OF SPECIFIC FEDERAL MEDICAL 10 ASSISTANCE PERCENTAGE (FMAP) LIMITATION FOR 11 TERRITORIES.—Section 1905(b) of the Social Security 12 Act (42 U.S.C. 1396d(b)) is amended, in clause (2), by 13 inserting ‘‘for fiscal years before fiscal year 2024’’ after 14 ‘‘American Samoa’’. 15 (c) PERMITTING MEDICAID DSH ALLOTMENTS FOR 16 TERRITORIES.—Section 1923(f) of the Social Security Act 17 (42 U.S.C. 1396r–4(f)) is amended— 18 (1) in paragraph (6), by adding at the end the 19 following new subparagraph: 20 ‘‘(C) TERRITORIES.— 21 ‘‘(i) FISCAL YEAR 2023.—For fiscal 22 year 2023, the DSH allotment for Puerto 23 Rico, the Virgin Islands, Guam, the North- 24 ern Mariana Islands, and American Samoa 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00314 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 315 •S 4486 IS shall bear the same ratio to $300,000,000 1 as the ratio of the number of individuals 2 who are low-income or uninsured and re- 3 siding in such respective territory (as esti- 4 mated from time to time by the Secretary) 5 bears to the sums of the number of such 6 individuals residing in all of the territories. 7 ‘‘(ii) SUBSEQUENT FISCAL YEAR.— 8 For each subsequent fiscal year, the DSH 9 allotment for each such territory is subject 10 to an increase in accordance with para- 11 graph (3).’’; and 12 (2) in paragraph (9), by inserting before the pe- 13 riod at the end the following: ‘‘, and includes, begin- 14 ning with fiscal year 2023, Puerto Rico, the Virgin 15 Islands, Guam, the Northern Mariana Islands, and 16 American Samoa’’. 17 SEC. 4102. EXTENSION OF THE SUPPLEMENTAL SECURITY 18 INCOME PROGRAM TO PUERTO RICO, THE 19 UNITED STATES VIRGIN ISLANDS, GUAM, AND 20 AMERICAN SAMOA. 21 (a) IN GENERAL.—Section 303 of the Social Security 22 Amendments of 1972 (86 Stat. 1484) is amended by strik- 23 ing subsection (b). 24 (b) CONFORMING AMENDMENTS.— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00315 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 316 •S 4486 IS (1) DEFINITION OF STATE.—Section 1 1101(a)(1) of the Social Security Act (42 U.S.C. 2 1301(a)(1)) is amended by striking the 5th sentence 3 and inserting the following: ‘‘Such term when used 4 in title XVI includes Puerto Rico, the United States 5 Virgin Islands, Guam, and American Samoa.’’. 6 (2) ELIMINATION OF LIMIT ON TOTAL PAY- 7 MENTS TO THE TERRITORIES.—Section 1108 of 8 such Act (42 U.S.C. 1308) is amended— 9 (A) in the section heading, by striking ‘‘; 10 LIMITATION ON TOTAL PAYMENTS’’; 11 (B) by striking subsection (a); and 12 (C) in subsection (c), by striking para- 13 graphs (2) and (4) and redesignating para- 14 graphs (3) and (5) as paragraphs (2) and (4), 15 respectively. 16 (3) UNITED STATES NATIONALS TREATED THE 17 SAME AS CITIZENS.—Section 1614(a)(1)(B) of such 18 Act (42 U.S.C. 1382c(a)(1)(B)) is amended— 19 (A) in clause (i)(I), by inserting ‘‘or na- 20 tional,’’ after ‘‘citizen’’; 21 (B) in clause (i)(II), by adding ‘‘; or’’ at 22 the end; and 23 (C) in clause (ii), by inserting ‘‘or na- 24 tional’’ after ‘‘citizen’’. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00316 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 317 •S 4486 IS (4) TERRITORIES INCLUDED IN GEOGRAPHIC 1 MEANING OF UNITED STATES.—Section 1614(e) of 2 such Act (42 U.S.C. 1382c(e)) is amended by strik- 3 ing ‘‘and the District of Columbia’’ and inserting ‘‘, 4 the District of Columbia, Puerto Rico, the United 5 States Virgin Islands, Guam, and American 6 Samoa’’. 7 (c) WAIVER AUTHORITY.—The Commissioner of So- 8 cial Security may waive or modify any statutory require- 9 ment relating to the provision of benefits under the Sup- 10 plemental Security Income Program under title XVI of the 11 Social Security Act in Puerto Rico, the United States Vir- 12 gin Islands, Guam, or American Samoa, to the extent that 13 the Commissioner deems it necessary in order to adapt 14 the program to the needs of the territory involved. 15 (d) EFFECTIVE DATE.—This section and the amend- 16 ments made by this section shall take effect on the 1st 17 day of the 1st Federal fiscal year that begins 1 year or 18 more after the date of the enactment of this Act. 19 SEC. 4103. 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 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00317 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 318 •S 4486 IS (1) in the last sentence, by inserting ‘‘, and be- 1 fore January 1, 2023’’ after ‘‘prior to such date)’’; 2 and 3 (2) by adding at the end the following new sen- 4 tence: ‘‘Effective for items and services furnished on 5 or after January 1, 2023 (with respect to periods 6 beginning on or after the date that is 42 months 7 prior to such date), clauses (i) and (ii) shall be ap- 8 plied by substituting ‘42-month’ for ‘12-month’ each 9 place it appears.’’. 10 (b) EFFECTIVE DATE.—The amendments made by 11 this section shall take effect on the date of enactment of 12 this Act. For purposes of determining an individual’s sta- 13 tus under section 1862(b)(1)(C) of the Social Security Act 14 (42 U.S.C. 1395y(b)(1)(C)), as amended by subsection 15 (a), an individual who is within the coordinating period 16 as of the date of enactment of this Act shall have that 17 period extended to the full 42 months described in the last 18 sentence of such section, as added by the amendment 19 made by subsection (a)(2). 20 SEC. 4104. INDIAN DEFINED IN TITLE I OF THE PATIENT 21 PROTECTION AND AFFORDABLE CARE ACT. 22 (a) DEFINITION OF INDIAN.—Section 1304 of the 23 Patient Protection and Affordable Care Act (42 U.S.C. 24 18024) is amended by adding at the end the following: 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00318 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 319 •S 4486 IS ‘‘(f) INDIAN.—In this title: 1 ‘‘(1) IN GENERAL.—The term ‘Indian’ means— 2 ‘‘(A) an Indian, a California Indian, or an 3 Urban Indian (as those terms are defined in 4 section 4 of the Indian Health Care Improve- 5 ment Act (25 U.S.C. 1603)); or 6 ‘‘(B) an individual who is of Indian de- 7 scent and a member of an Indian community 8 served by a local facility or program of the In- 9 dian Health Service. 10 ‘‘(2) INCLUSIONS.—The term ‘Indian’ includes 11 the following individuals: 12 ‘‘(A) A member of a federally recognized 13 Indian Tribe. 14 ‘‘(B) A resident of an urban center who 15 meets 1 or more of the following criteria: 16 ‘‘(i) A member of 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 2022 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 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00319 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 320 •S 4486 IS ‘‘(ii) An Eskimo or Aleut or other 1 Alaska Native. 2 ‘‘(iii) An individual who is determined 3 to be an Indian under regulations promul- 4 gated by the Secretary. 5 ‘‘(C) An individual who is considered by 6 the Secretary of the Interior to be an Indian for 7 any purpose. 8 ‘‘(D) An individual who is considered by 9 the Secretary to be an Indian for purposes of 10 eligibility for services provided by the Indian 11 Health Service, including as a California In- 12 dian, Eskimo, Aleut, or other Alaska Native.’’. 13 (b) CONFORMING AMENDMENTS.— 14 (1) AFFORDABLE CHOICES OF HEALTH BEN- 15 EFIT PLANS.—Section 1311(c)(6)(D) of the Patient 16 Protection and Affordable Care Act (42 U.S.C. 17 18031(c)(6)(D)) is amended by striking ‘‘(as defined 18 in section 4 of the Indian Health Care Improvement 19 Act)’’. 20 (2) REDUCED COST-SHARING FOR INDIVIDUALS 21 ENROLLING IN QUALIFIED HEALTH PLANS.—Section 22 1402(d) of the Patient Protection and Affordable 23 Care Act (42 U.S.C. 18071(d)) is amended— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00320 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 321 •S 4486 IS (A) in paragraph (1), in the matter pre- 1 ceding subparagraph (A), by striking ‘‘(as de- 2 fined in section 4(d) of the Indian Self-Deter- 3 mination and Education Assistance Act (25 4 U.S.C. 450b(d)))’’; and 5 (B) in paragraph (2), in the matter pre- 6 ceding subparagraph (A), by striking ‘‘(as so 7 defined)’’. 8 (3) EXEMPTION FROM PENALTY FOR NOT 9 MAINTAINING MINIMUM ESSENTIAL COVERAGE.— 10 Section 5000A(e) of the Internal Revenue Code of 11 1986 is amended by striking paragraph (3) and in- 12 serting the following: 13 ‘‘(3) INDIANS.—Any applicable individual who 14 is an Indian (as defined in section 1304(f) of the 15 Patient Protection and Affordable Care Act).’’. 16 (c) EFFECTIVE DATE OF IRC AMENDMENT.—The 17 amendment made by subsection (b)(3) shall apply to tax- 18 able years beginning after the date of the enactment of 19 this Act. 20 SEC. 4105. REMOVING MEDICARE BARRIER TO HEALTH 21 CARE. 22 (a) PART A.—Section 1818(a)(3)(B) of the Social 23 Security Act (42 U.S.C. 1395i–2(a)(3)(B)) is amended by 24 striking ‘‘an alien’’ and all that follows through ‘‘under 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00321 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 322 •S 4486 IS this section’’ and inserting ‘‘an individual who is lawfully 1 present in the United States’’. 2 (b) PART B.—Section 1836(a)(2)(B) of the Social 3 Security Act (42 U.S.C. 1395o(a)(2)(B)) is amended by 4 striking ‘‘an alien’’ and all that follows through ‘‘under 5 this part’’ and inserting ‘‘an individual who is lawfully 6 present in the United States’’. 7 SEC. 4106. LOWERING MEDICARE PREMIUMS AND PRE- 8 SCRIPTION DRUG COSTS. 9 (a) MEDICARE COST ASSISTANCE PROGRAM.— 10 (1) IN GENERAL.—Title XVIII of the Social Se- 11 curity Act (42 U.S.C. 1395 et seq.) is amended by 12 adding at the end the following new section: 13 ‘‘SEC. 1899C. MEDICARE COST ASSISTANCE PROGRAM. 14 ‘‘(a) IN GENERAL.—Effective beginning January 1, 15 2023, in the case of a Medicare Cost Assistance Program 16 eligible individual (as defined in subsection (b)(1)), the 17 Secretary shall provide Medicare cost assistance for the 18 following costs incurred with respect to the individual: 19 ‘‘(1) Premiums under section 1818. 20 ‘‘(2) Premiums under section 1839. 21 ‘‘(3) Coinsurance under this title (including co- 22 insurance described in section 1813). 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00322 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 323 •S 4486 IS ‘‘(4) Deductibles established under this title (in- 1 cluding those described in section 1813 and section 2 1833(b)). 3 ‘‘(5) The difference between the amount that is 4 paid under section 1833(a) and the amount that 5 would be paid under such section if any reference to 6 a percent less than 100 percent therein were deemed 7 a reference to ‘100 percent’. 8 ‘‘(b) DETERMINATION OF ELIGIBILITY.— 9 ‘‘(1) MEDICARE COST ASSISTANCE PROGRAM 10 ELIGIBLE INDIVIDUAL DEFINED.—The term ‘Medi- 11 care Cost Assistance Program eligible individual’ 12 means an individual who— 13 ‘‘(A) is eligible for, and is receiving, med- 14 ical assistance for the payment of medicare 15 cost-sharing under a State Medicaid program 16 pursuant to clause (i), (iii), or (iv) of section 17 1902(a)(10)(E) as of December 31, 2022; or 18 ‘‘(B)(i) is entitled to hospital insurance 19 benefits under part A (including an individual 20 entitled to such benefits pursuant to an enroll- 21 ment under section 1818); and 22 ‘‘(ii) has income at or below 200 percent of 23 the poverty line applicable to a family of the 24 size involved. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00323 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 324 •S 4486 IS ‘‘(2) JOINT DETERMINATION BY COMMISSIONER 1 OF SOCIAL SECURITY FOR LIS AND MEDICARE COST 2 ASSISTANCE.— 3 ‘‘(A) IN GENERAL.—The determination of 4 whether an individual is a Medicare Cost As- 5 sistance Program eligible individual shall be de- 6 termined by the Commissioner of Social Secu- 7 rity jointly with the determination of whether 8 an individual is a subsidy eligible individual de- 9 scribed in section 1860D–14(a)(3). Such deter- 10 mination shall be made with respect to eligi- 11 bility for Medicare cost assistance under this 12 section and premium and cost-sharing subsidies 13 under section 1860D–14 upon application of an 14 individual for a determination with respect to 15 eligibility for either such assistance or such sub- 16 sidies. There are authorized to be appropriated 17 to the Social Security Administration such 18 sums as may be necessary for the determination 19 of eligibility under this paragraph. 20 ‘‘(B) EFFECTIVE PERIOD.—Determina- 21 tions under this paragraph with respect to eligi- 22 bility for each of such assistance or such sub- 23 sidies shall be effective beginning with the 24 month in which the individual applies for a de- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00324 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 325 •S 4486 IS termination described in subparagraph (A) and 1 shall remain in effect until such time as the 2 Secretary determines the individual is no longer 3 eligible as determined under subparagraph 4 (C)(ii). 5 ‘‘(C) REDETERMINATIONS.—With respect 6 to eligibility determinations under this para- 7 graph— 8 ‘‘(i) redeterminations shall be made at 9 the same time with respect to eligibility for 10 Medicare cost assistance under this section 11 and cost-sharing subsidies under section 12 1860D–14, but not more frequently than 13 once every 12 months; 14 ‘‘(ii) a redetermination shall automati- 15 cally determine that an individual remains 16 eligible for such assistance or subsidies un- 17 less— 18 ‘‘(I) the Commissioner has infor- 19 mation indicating that the individual’s 20 circumstances have changed such that 21 the individual is no longer eligible for 22 such assistance or subsidies; 23 ‘‘(II) the Commissioner sends no- 24 tice to the individual regarding such 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00325 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 326 •S 4486 IS information that requests a response 1 either confirming or correcting such 2 information; and 3 ‘‘(III) the individual either con- 4 firms such information or fails to pro- 5 vide documentation indicating that 6 such circumstances have not changed 7 within 60 days of receiving the notice 8 described in subclause (II); 9 ‘‘(iii) the Commissioner shall establish 10 procedures for appeals of such determina- 11 tions that are similar to the procedures de- 12 scribed in the third sentence of section 13 1631(c)(1)(A); and 14 ‘‘(iv) judicial review of the final deci- 15 sion of the Commissioner made after a 16 hearing shall be available to the same ex- 17 tent, and with the same limitations, as pro- 18 vided in subsections (g) and (h) of section 19 205. 20 ‘‘(D) TREATMENT OF MEDICAID BENE- 21 FICIARIES.—The Secretary shall provide that 22 individuals who are full-benefit dual eligible in- 23 dividuals (as defined in section 1935(c)(6)) or 24 who are recipients of supplemental security in- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00326 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 327 •S 4486 IS come benefits under title XVI shall be treated 1 as a Medicare Cost Assistance Program eligible 2 individual and, in the case of such individual 3 who is a part D eligible individual, a subsidy el- 4 igible individual described in section 1860D– 5 14(a)(3). 6 ‘‘(E) SIMPLIFIED APPLICATION FORM.— 7 ‘‘(i) IN GENERAL.—The Secretary 8 shall develop and distribute a simplified 9 application form for use by individuals in 10 applying for Medicare cost assistance 11 under this section and premium and cost- 12 sharing subsidies under section 1860D–14. 13 Such form shall be easily readable based 14 on culturally fluid language for all demo- 15 graphics beyond just the various languages 16 offered. An audio version, digital version, 17 and photo-voice option should also be pro- 18 vided for all learners. The Secretary shall 19 provide for the translation of such applica- 20 tion form into at least the 10 languages 21 (other than English) that are most often 22 used by individuals applying for hospital 23 insurance benefits under section 226 or 24 226A and shall make the translated forms 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00327 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 328 •S 4486 IS available to the Commissioner of Social Se- 1 curity. 2 ‘‘(ii) CONSULTATION.—In developing 3 the form under clause (i), the Secretary 4 shall consult with beneficiary groups. 5 ‘‘(3) INCOME DETERMINATIONS.—For purposes 6 of applying this section— 7 ‘‘(A) in the case of an individual who is 8 not treated as a Medicare Cost Assistance Pro- 9 gram eligible individual or a subsidy eligible in- 10 dividual under paragraph (2)(D), income shall 11 be determined in the manner described under 12 section 1612 for purposes of the supplemental 13 security income program, except that support 14 and maintenance furnished in kind shall not be 15 counted as income; and 16 ‘‘(B) the term ‘poverty line’ has the mean- 17 ing given such term in section 673(2) of the 18 Community Services Block Grant Act (42 19 U.S.C. 9902(2)), including any revision re- 20 quired by such section. 21 ‘‘(c) BENEFICIARY PROTECTIONS.— 22 ‘‘(1) IN GENERAL.—In the case in which the 23 payment for Medicare cost assistance for a Medicare 24 Cost Assistance Program eligible individual with re- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00328 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 329 •S 4486 IS spect to an item or service is reduced or eliminated, 1 the individual shall not have any legal liability to 2 make payment to a provider of services (as defined 3 in section 1861(u)) or supplier (as defined in section 4 1861(d)) or to an organization described in section 5 1903(m)(1)(A) for the service, and any lawful sanc- 6 tion that may be imposed upon a provider of services 7 or supplier or such an organization for excess 8 charges under this title or title XIX shall apply to 9 the imposition of any charge imposed upon the indi- 10 vidual in such case. 11 ‘‘(2) CLARIFICATION.—This paragraph shall 12 not be construed as preventing payment of any 13 medicare cost assistance by a medicare supplemental 14 policy or an employer retiree health plan on behalf 15 of an individual. 16 ‘‘(d) ADMINISTRATION.— 17 ‘‘(1) IN GENERAL.—The Secretary shall estab- 18 lish procedures for the administration of the pro- 19 gram under this section. 20 ‘‘(2) FUNDING.—For purposes of carrying out 21 this section, the Secretary shall make payments from 22 the Federal Hospital Insurance Trust Fund under 23 section 1817 and the Federal Supplementary Med- 24 ical Insurance Trust Fund under section 1841, in 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00329 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 330 •S 4486 IS such proportion as the Secretary determines appro- 1 priate, of such amounts as the Secretary determines 2 necessary to provide Medicare cost assistance under 3 this section. 4 ‘‘(e) REFERENCES TO MEDICARE COST-SHARING.— 5 Effective beginning January 1, 2023, any reference to 6 medicare cost-sharing described in section 1905(p) shall 7 be deemed a reference to Medicare cost assistance under 8 this section. 9 ‘‘(f) OUTREACH EFFORTS.—For provisions relating 10 to outreach efforts to increase awareness of the availability 11 of Medicare cost assistance, see section 1144.’’. 12 (2) SPECIAL ENROLLMENT PERIOD.— 13 (A) NO PREMIUM PENALTY.—Section 14 1839(b) of the Social Security Act (42 U.S.C. 15 1395r(b)) is amended, in the last sentence, by 16 inserting the following before the period: ‘‘or, 17 effective beginning January 1, 2023, for indi- 18 viduals who are Medicare Cost Assistance Pro- 19 gram eligible individuals (as defined in section 20 1899B(b)(1)).’’. 21 (B) SPECIAL ENROLLMENT PERIOD.—Sec- 22 tion 1837 of the Social Security Act (42 U.S.C. 23 1395p) is amended by adding at the end the 24 following new subsection: 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00330 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 331 •S 4486 IS ‘‘(p) SPECIAL ENROLLMENT PERIOD FOR MEDICARE 1 COST ASSISTANCE PROGRAM ELIGIBLE INDIVIDUAL.— 2 ‘‘(1) IN GENERAL.—Effective beginning Janu- 3 ary 1, 2023, the Secretary shall establish special en- 4 rollment periods for Medicare Cost Assistance Pro- 5 gram eligible individuals (as defined in section 6 1899C(b)(1)). 7 ‘‘(2) COVERAGE PERIOD.—In the case of an in- 8 dividual who enrolls during the special enrollment 9 period provided under paragraph (1), the coverage 10 period under this part shall— 11 ‘‘(A) begin on the first day of the first 12 month in which the individual applies for a de- 13 termination under section 1899C(b)(2)(A); and 14 ‘‘(B) remain in effect until such time as 15 the Secretary determines the individual is no 16 longer eligible as determined under section 17 1899C(b)(2)(C)(ii).’’. 18 (C) CONFORMING SUNSET OF STATE 19 AGREEMENTS RELATING TO ENROLLMENT OF 20 QUALIFIED MEDICARE BENEFICIARIES.— 21 (i) PART A.—Section 1818(g) of the 22 Social Security Act (42 U.S.C. 1395i–2(g)) 23 is amended by adding at the end the fol- 24 lowing new paragraph: 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00331 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 332 •S 4486 IS ‘‘(3) SUNSET.—This subsection shall not apply on or 1 after January 1, 2023.’’. 2 (ii) PART B.—Section 1843(h) of the 3 Social Security Act (42 U.S.C. 1395v(h)) 4 is amended by adding at the end the fol- 5 lowing new paragraph: 6 ‘‘(3) SUNSET WITH RESPECT TO QUALIFIED MEDI- 7 CARE BENEFICIARIES.—This subsection shall not apply 8 with respect to qualified medicare beneficiaries on or after 9 January 1, 2023.’’. 10 (3) PUBLIC AWARENESS CAMPAIGN.—Section 11 1144 of the Social Security Act (42 U.S.C. 1320b– 12 14) is amended by adding at the end the following 13 new subsection: 14 ‘‘(d) PUBLIC AWARENESS CAMPAIGN.— 15 ‘‘(1) IN GENERAL.—The Commissioner shall 16 conduct a public awareness campaign to educate 17 Medicare beneficiaries on the availability of Medicare 18 cost assistance for low-income individuals under sec- 19 tion 1899B. 20 ‘‘(2) COORDINATION.—In carrying out the pub- 21 lic awareness campaign under paragraph (1), the 22 Commissioner shall coordinate with State health in- 23 surance assistance programs described in subsection 24 (a)(1)(A) of section 119 of the Medicare Improve- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00332 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 333 •S 4486 IS ments for Patients and Providers Act of 2008 (42 1 U.S.C. 1395b–3 note), the Administrator of the Ad- 2 ministration for Community Living, and the Admin- 3 istrator of the Centers for Medicare & Medicaid 4 Services. 5 ‘‘(3) FUNDING.—There is appropriated to the 6 Commissioner, out of any funds in the Treasury not 7 otherwise appropriated, $10,000,000 for each of fis- 8 cal years 2023 through 2025, to provide grants to 9 State health insurance assistance programs to carry 10 out outreach and education activities under the pub- 11 lic awareness campaign pursuant to this sub- 12 section.’’. 13 (b) MOVING MEDICARE COST-SHARING BENEFITS 14 FROM MEDICAID TO MEDICARE.— 15 (1) ENDING MOST MEDICARE COST-SHARING 16 BENEFITS UNDER MEDICAID.—Section 1902(a)(10) 17 of the Social Security Act (42 U.S.C. 1396a(a)(10)) 18 is amended— 19 (A) by inserting ‘‘for calendar quarters be- 20 ginning before January 1, 2023,’’ before ‘‘for 21 making’’ each place it appears in clauses (i), 22 (iii), and (iv) of subparagraph (E); and 23 (B) in the matter following subparagraph 24 (G)— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00333 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 334 •S 4486 IS (i) by inserting ‘‘furnished during cal- 1 endar quarters beginning before January 2 1, 2023’’ after ‘‘(described in section 3 1905(p)(3))’’; 4 (ii) by striking ‘‘(XV)’’ and inserting 5 ‘‘, (XV)’’; 6 (iii) by striking ‘‘and (XVIII)’’ and in- 7 serting ‘‘, (XVIII)’’; 8 (iv) by striking ‘‘and (XIX)’’ and in- 9 serting ‘‘(XIX)’’; and 10 (v) by inserting ‘‘, and (XX) no med- 11 ical assistance for medicare cost-sharing, 12 other than medical assistance for medicare 13 cost-sharing for qualified disabled and 14 working individuals described in section 15 1905(s), shall be made available after Jan- 16 uary 1, 2023’’ before the semicolon at the 17 end. 18 (2) CONFORMING AMENDMENTS.— 19 (A) TITLE XIX.— 20 (i) Section 1903(i) of such Act (42 21 U.S.C. 1396b(i)), as amended by section 22 4002, is amended— 23 (I) in paragraph (26), by striking 24 ‘‘or’’ at the end; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00334 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 335 •S 4486 IS (II) in paragraph (27), by strik- 1 ing the period at the end and insert- 2 ing ‘‘; or’’; and 3 (III) by inserting after paragraph 4 (27) the following new paragraph: 5 ‘‘(28) with respect to any amount expended for 6 medical assistance for medicare cost-sharing (other 7 than medical assistance for medicare cost-sharing 8 for qualified disabled and working individuals de- 9 scribed in section 1905(s)) furnished during cal- 10 endar quarters beginning on or after January 1, 11 2023.’’. 12 (ii) Section 1905(a) of such Act (42 13 U.S.C. 1396d(a)) is amended, in the first 14 sentence, by inserting ‘‘furnished during 15 calendar quarters beginning before Janu- 16 ary 1, 2023’’ after ‘‘medicare cost-shar- 17 ing’’. 18 (iii) Section 1933(g) of such Act (42 19 U.S.C. 1396u–3(g)) is amended— 20 (I) in paragraph (2)(Q), by strik- 21 ing ‘‘paragraph (4), for each subse- 22 quent year’’ and inserting ‘‘para- 23 graphs (4) and (5), for each subse- 24 quent year before 2023’’; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00335 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 336 •S 4486 IS (II) by adding at the end the fol- 1 lowing: 2 ‘‘(5) SUNSET.—No individual shall be selected 3 to be a qualifying individual for any calendar year 4 or period under this section beginning on or after 5 January 1, 2023, and no State allocation shall be 6 made for any fiscal year or period under this section 7 beginning on or after January 1, 2023.’’. 8 (iv) Section 1935(a) of such Act (42 9 U.S.C. 1396u–5(a)) is amended— 10 (I) in paragraph (2)(A), by strik- 11 ing ‘‘make determinations’’ and in- 12 serting ‘‘prior to January 1, 2023, 13 make determinations’’; and 14 (II) in paragraph (3), by insert- 15 ing ‘‘prior to January 1, 2023,’’ be- 16 fore ‘‘the State shall’’. 17 (c) ENHANCING PRESCRIPTION DRUG AFFORD- 18 ABILITY BY EXPANDING ACCESS TO ASSISTANCE WITH 19 OUT-OF-POCKET COSTS UNDER MEDICARE PART D FOR 20 LOW-INCOME SENIORS AND INDIVIDUALS WITH DISABIL- 21 ITIES.— 22 (1) EXPANDING ACCESS.—Section 1860D–14 of 23 the Social Security Act (42 U.S.C. 1395w–114) is 24 amended— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00336 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 337 •S 4486 IS (A) in subsection (a)— 1 (i) in the subsection heading, by strik- 2 ing ‘‘150 PERCENT’’ and inserting ‘‘200 3 PERCENT’’; 4 (ii) in paragraph (1)— 5 (I) in the paragraph heading, by 6 striking ‘‘135 PERCENT’’ and inserting 7 ‘‘200 PERCENT’’; and 8 (II) in the matter preceding sub- 9 paragraph (A)— 10 (aa) by striking ‘‘135 per- 11 cent’’ and inserting ‘‘200 per- 12 cent’’; and 13 (bb) by striking ‘‘and who 14 meets the resources requirement 15 described in paragraph (3)(D) or 16 who is covered under this para- 17 graph under paragraph 18 (3)(B)(i)’’ and inserting ‘‘or who 19 is covered under this paragraph 20 under paragraph (3)(B)(v)’’; 21 (iii) by striking paragraph (2); 22 (iv) in paragraph (3)— 23 (I) in subparagraph (A)— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00337 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 338 •S 4486 IS (aa) in clause (i), by adding 1 ‘‘and’’ at the end; 2 (bb) in clause (ii)— 3 (AA) by striking ‘‘150 4 percent’’ and inserting ‘‘200 5 percent’’; and 6 (BB) by striking ‘‘; 7 and’’ at the end and insert- 8 ing a period; and 9 (cc) by striking clause (iii); 10 (II) by striking subparagraphs 11 (B) and (C) and inserting the fol- 12 lowing: 13 ‘‘(B) DETERMINATIONS.—For provisions 14 relating to joint determinations with respect to 15 eligibility for Medicare cost assistance under 16 section 1899C and premium and cost-sharing 17 subsidies under this section, see section 18 1899C(b)(2). 19 ‘‘(C) INCOME DETERMINATIONS.—For pur- 20 poses of applying this section— 21 ‘‘(i) in the case of an individual who 22 is not treated as a Medicare cost-sharing 23 assistance eligible individual and a subsidy 24 eligible individual under section 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00338 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 339 •S 4486 IS 1899C(b)(2)(D), income shall be deter- 1 mined in the manner described under sec- 2 tion 1612 for purposes of the supplemental 3 security income program, except that sup- 4 port and maintenance furnished in kind 5 shall not be counted as income; and 6 ‘‘(ii) the term ‘poverty line’ has the 7 meaning given such term in section 673(2) 8 of the Community Services Block Grant 9 Act (42 U.S.C. 9902(2)), including any re- 10 vision required by such section.’’; and 11 (III) by striking subparagraphs 12 (D), (E), and (G); and 13 (v) in paragraph (4), by striking sub- 14 paragraph (B); and 15 (B) in subsection (c)(1), in the second sen- 16 tence, by striking ‘‘subsections (a)(1)(D) and 17 (a)(2)(E)’’ and inserting ‘‘subsection 18 (a)(1)(D)’’. 19 (2) TREATMENT OF REDUCTION OF COST-SHAR- 20 ING FOR INDIVIDUALS RECEIVING HOME AND COM- 21 MUNITY-BASED SERVICES.—Section 1860D– 22 14(a)(1)(D)(i) of the Social Security Act (42 U.S.C. 23 1395w–114(a)(1)(D)(i)) is amended— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00339 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 340 •S 4486 IS (A) by striking ‘‘who would be such an in- 1 stitutionalized individual or couple, if the full- 2 benefit dual eligible individual were not’’; and 3 (B) by striking ‘‘or subsection (c) or (d) of 4 section 1915 or under a State plan amendment 5 under subsection (i) of such section’’ and in- 6 serting ‘‘, section 1115A, section 1915, or 7 under a State plan amendment’’. 8 (3) EFFECTIVE DATE.—The amendments made 9 by this subsection shall apply to plan year 2023 and 10 subsequent plan years. 11 SEC. 4107. REDUCING COST-SHARING, ALIGNING INCOME 12 AND RESOURCE ELIGIBILITY TESTS, SIMPLI- 13 FYING ENROLLMENT, AND OTHER PROGRAM 14 IMPROVEMENTS FOR LOW-INCOME BENE- 15 FICIARIES. 16 (a) INCREASE IN INCOME ELIGIBILITY TO 135 PER- 17 CENT OF FPL FOR QUALIFIED MEDICARE BENE- 18 FICIARIES.— 19 (1) IN GENERAL.—Section 1905(p)(2)(A) of the 20 Social Security Act (42 U.S.C. 1396d(p)(2)(A)) is 21 amended by striking ‘‘shall be at least the percent 22 provided under subparagraph (B) (but not more 23 than 100 percent) of the official poverty line’’ and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00340 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 341 •S 4486 IS all that follows through the period at the end and 1 inserting the following: ‘‘shall be— 2 ‘‘(i) before January 1, 2023, at least 3 the percent provided under subparagraph 4 (B) (but not more than 100 percent) of 5 the official poverty line (as defined by the 6 Office of Management and Budget, and re- 7 vised annually in accordance with section 8 673(2) of the Omnibus Budget Reconcili- 9 ation Act of 1981) applicable to a family 10 of the size involved; and 11 ‘‘(ii) on or after January 1, 2023, 12 equal to 135 percent of the official poverty 13 line (as so defined and revised) applicable 14 to a family of the size involved.’’. 15 (2) NOT COUNTING IN-KIND SUPPORT AND 16 MAINTENANCE AS INCOME.—Section 1905(p)(2)(D) 17 of the Social Security Act (42 U.S.C. 18 1396d(p)(2)(D)) is amended by adding at the end 19 the following new clause: 20 ‘‘(iii) In determining income under this sub- 21 section, support and maintenance furnished in kind 22 shall not be counted as income.’’. 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00341 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 342 •S 4486 IS (b) INCREASE IN INCOME ELIGIBILITY TO 200 PER- 1 CENT OF FPL FOR SPECIFIED LOW-INCOME MEDICARE 2 BENEFICIARIES.— 3 (1) ELIGIBILITY OF INDIVIDUALS WITH IN- 4 COMES BELOW 150 PERCENT OF FPL.—Section 5 1902(a)(10)(E) of the Social Security Act (42 6 U.S.C. 1396a(a)(10)(E)) is amended— 7 (A) by adding ‘‘and’’ at the end of clause 8 (ii); 9 (B) in clause (iii)— 10 (i) by striking ‘‘and 120 percent in 11 1995 and years thereafter’’ and inserting 12 ‘‘120 percent in 1995 and years thereafter 13 before 2023, and 200 percent in 2023 and 14 years thereafter’’; and 15 (ii) by striking ‘‘and’’ at the end; and 16 (C) by striking clause (iv). 17 (2) REFERENCES.—Section 1905(p)(1) of the 18 Social Security Act (42 U.S.C. 1396d(p)(1)) is 19 amended by adding at and below subparagraph (C) 20 the following flush sentence: 21 ‘‘The term ‘specified low-income medicare beneficiary’ 22 means an individual described in section 23 1902(a)(10)(E)(iii).’’. 24 (3) CONFORMING AMENDMENTS.— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00342 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 343 •S 4486 IS (A) The first sentence of section 1905(b) 1 of such Act (42 U.S.C. 1396d(b)) is amended 2 by striking ‘‘and section 1933(d)’’. 3 (B) Section 1933 of such Act (42 U.S.C. 4 1396u–3) is repealed. 5 (c) 100 PERCENT FMAP.—Section 1905 of the So- 6 cial Security Act (42 U.S.C. 1396d) is amended by adding 7 at the end the following new subsection: 8 ‘‘(jj) INCREASED FMAP FOR EXPANDED MEDICARE 9 COST-SHARING POPULATIONS.— 10 ‘‘(1) IN GENERAL.—Notwithstanding subsection 11 (b), with respect to expenditures described in para- 12 graph (2) the Federal medical assistance percentage 13 shall be equal to 100 percent. 14 ‘‘(2) EXPENDITURES DESCRIBED.—The expend- 15 itures described in this paragraph are expenditures 16 made on or after January 1, 2023, for medical as- 17 sistance for medicare cost-sharing provided to any 18 individual under clause (i), (ii), or (iii) of section 19 1902(a)(10)(E) who would not have been eligible for 20 medicare cost-sharing under any such clause under 21 the income or resource eligibility standards in effect 22 on October 1, 2018.’’. 23 (d) CONSOLIDATION OF LOW-INCOME SUBSIDY RE- 24 SOURCE ELIGIBILITY TESTS.— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00343 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 344 •S 4486 IS (1) IN GENERAL.—Section 1860D–14(a)(3) of 1 the Social Security Act (42 U.S.C. 1395w– 2 114(a)(3)) is amended— 3 (A) by striking subparagraph (D); 4 (B) by redesignating subparagraphs (E) 5 through (G) as subparagraphs (D) through (F), 6 respectively; and 7 (C) in the heading of subparagraph (D), as 8 so redesignated, by striking ‘‘ALTERNATIVE’’. 9 (2) CLARIFICATION OF CERTAIN RULES RELAT- 10 ING TO INCOME AND RESOURCE DETERMINA- 11 TIONS.—Section 1860D–14(a)(3) of the Social Secu- 12 rity Act (42 U.S.C. 1395w–114(a)(3)), as amended 13 by paragraph (1), is amended by striking subpara- 14 graph (F) and inserting the following new subpara- 15 graphs: 16 ‘‘(F) RESOURCE EXCLUSIONS.—In deter- 17 mining the resources of an individual (and the 18 eligible spouse of the individual, if any) under 19 section 1613 for purposes of subparagraph 20 (D)— 21 ‘‘(i) no part of the value of any life in- 22 surance policy shall be taken into account; 23 ‘‘(ii) no part of the value of any vehi- 24 cle shall be taken into account; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00344 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 345 •S 4486 IS ‘‘(iii) there shall be excluded an 1 amount equal to $1,500 each with respect 2 to any individual or eligible spouse of an 3 individual who attests that some of the re- 4 sources of such individual or spouse will be 5 used to meet the burial and related ex- 6 penses of such individual or spouse; and 7 ‘‘(iv) no balance in, or benefits re- 8 ceived under, an employee pension benefit 9 plan (as defined in section 3 of the Em- 10 ployee Retirement Income Security Act of 11 1974) shall be taken into account. 12 ‘‘(G) FAMILY SIZE.—In determining the 13 size of the family of an individual for purposes 14 of determining the income eligibility of such in- 15 dividual under this section, an individual’s fam- 16 ily shall consist of— 17 ‘‘(i) the individual; 18 ‘‘(ii) the individual’s spouse who lives 19 in the same household as the individual (if 20 any); and 21 ‘‘(iii) any other individuals who— 22 ‘‘(I) are related to the individual 23 whose income eligibility is in question 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00345 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 346 •S 4486 IS or such individual’s spouse who lives 1 in the same household; 2 ‘‘(II) are living in the same 3 household as such individual; and 4 ‘‘(III) are dependent on such in- 5 dividual or such individual’s spouse 6 who is living in the same household 7 for at least one-half of their financial 8 support.’’. 9 (3) CONFORMING AMENDMENTS.—Section 10 1860D–14(a) of the Social Security Act (42 U.S.C. 11 1395w–114(a)) is amended— 12 (A) in paragraph (1), in the matter pre- 13 ceding subparagraph (A), by inserting ‘‘(as de- 14 termined under paragraph (3)(G))’’ after ‘‘fam- 15 ily of the size involved’’; and 16 (B) in paragraph (3), as amended by para- 17 graphs (1) and (2)— 18 (i) in subparagraph (A), in the matter 19 preceding clause (i), by striking ‘‘subpara- 20 graph (F)’’ and inserting ‘‘subparagraph 21 (E)’’; 22 (ii) in subparagraph (A)(ii), by insert- 23 ing ‘‘(as determined under subparagraph 24 (G))’’ after ‘‘family of the size involved’’; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00346 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 347 •S 4486 IS (iii) in subparagraph (A)(iii), by strik- 1 ing ‘‘or (E)’’; 2 (iv) in subparagraph (B)(v), in the 3 matter preceding subclause (I), by striking 4 ‘‘subparagraph (F)’’ and inserting ‘‘sub- 5 paragraph (E)’’; and 6 (v) in subparagraph (D)(i), in the 7 matter preceding subclause (I), by striking 8 ‘‘subject to the life insurance policy exclu- 9 sion provided under subparagraph (G)’’ 10 and inserting ‘‘subject to the resource ex- 11 clusions provided under subparagraph 12 (F)’’. 13 (e) ALIGNMENT OF LOW-INCOME SUBSIDY AND 14 MEDICARE SAVINGS PROGRAM INCOME AND RESOURCE 15 ELIGIBILITY TESTS.— 16 (1) APPLICATION OF MEDICAID SPOUSAL IM- 17 POVERISHMENT RESOURCE ALLOWANCE TO MSP AND 18 LIS RESOURCE ELIGIBILITY.—Section 1905(p)(1)(C) 19 of the Social Security Act (42 U.S.C. 20 1396d(p)(1)(C)) is amended to read as follows: 21 ‘‘(C) whose resources (as determined under sec- 22 tion 1613 for purposes of the supplemental security 23 income program subject to the resource exclusions 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00347 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 348 •S 4486 IS under subparagraph (G) of section 1860D–14(a)(3)) 1 do not exceed— 2 ‘‘(i) in the case of an individual with a 3 spouse, an amount equal to the sum of the first 4 amount specified in subsection (f)(2)(A)(i) of 5 section 1924 (as adjusted under subsection (g) 6 of such section) and the amount specified in 7 subsection (f)(2)(A)(ii)(II) of such section (as 8 so adjusted); or 9 ‘‘(ii) in the case of an individual who does 10 not have a spouse, an amount equal to 1⁄2 of 11 the amount described in clause (i).’’. 12 (2) APPLICATION TO QDWIS.—Section 13 1905(s)(3) of the Social Security Act (42 U.S.C. 14 1396d(s)(3)) is amended to read as follows: 15 ‘‘(3) whose resources (as determined under sec- 16 tion 1613 for purposes of the supplemental security 17 income program subject to the resource exclusions 18 under subparagraph (G) of section 1860D–14(a)(3)) 19 do not exceed— 20 ‘‘(A) in the case of an individual with a 21 spouse, the amount in effect for the year under 22 clause (i) of subsection (p)(1)(C); and 23 ‘‘(B) in the case of an individual who does 24 not have a spouse, the amount in effect for the 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00348 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 349 •S 4486 IS year under clause (ii) of subsection (p)(1)(C); 1 and’’. 2 (3) APPLICATION TO LIS.—Clause (i) of section 3 1860D–14(a)(3)(D) of the Social Security Act (42 4 U.S.C. 1395w–114(a)(3)(D)), as redesignated and 5 amended by subsection (d)(1), is amended to read as 6 follows: 7 ‘‘(i) IN GENERAL.—The resources re- 8 quirement of this subparagraph is that an 9 individual’s resources (as determined under 10 section 1613 for purposes of the supple- 11 mental security income program subject to 12 the resource exclusions provided under 13 subparagraph (G)) do not exceed the 14 amount in effect for the year under section 15 1905(p)(1)(C)(ii).’’. 16 (f) ENROLLMENT SIMPLIFICATIONS.— 17 (1) APPLICATION OF 3-MONTH RETROACTIVE 18 ELIGIBILITY TO QMBS.— 19 (A) IN GENERAL.—Section 1902(e)(8) of 20 the Social Security Act (42 U.S.C. 1396a(e)(8)) 21 is amended by striking ‘‘after the end of the 22 month in which the determination first occurs’’ 23 and inserting ‘‘in or after the third month be- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00349 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 350 •S 4486 IS fore the month in which the individual makes 1 application for assistance’’. 2 (B) PROCESS FOR SUBMITTING CLAIMS 3 DURING RETROACTIVE ELIGIBILITY PERIOD.— 4 Section 1902(e)(8) of the Social Security Act 5 (42 U.S.C. 1396a(e)(8)) is further amended by 6 adding at the end the following: ‘‘The Secretary 7 shall provide for a process under which claims 8 for medical assistance under the State plan may 9 be submitted for services furnished to such an 10 individual during such 3-month period before 11 the month in which the individual made appli- 12 cation for assistance.’’. 13 (C) CONFORMING AMENDMENT.—Section 14 1905(a) of the Social Security Act (42 U.S.C. 15 1396d(a)) is amended, in the matter preceding 16 paragraph (1), by striking ‘‘or, in the case of 17 medicare cost-sharing with respect to a quali- 18 fied medicare beneficiary described in sub- 19 section (p)(1), if provided after the month in 20 which the individual becomes such a bene- 21 ficiary’’. 22 (2) STATE OPTION FOR 12-MONTH CONTINUOUS 23 ELIGIBILITY FOR SLMBS AND QWDIS.—Section 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00350 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 351 •S 4486 IS 1902(e)(12) of the Social Security Act (42 U.S.C. 1 1396a(e)(12)) is amended— 2 (A) by redesignating subparagraphs (A) 3 and (B) as clauses (i) and (ii), respectively; 4 (B) by inserting ‘‘(A)’’ after ‘‘(12)’’; and 5 (C) by adding at the end the following: 6 ‘‘(B) At the option of the State, the plan may provide 7 that an individual who is determined to be eligible for ben- 8 efits under a State plan approved under this title under 9 any of the following eligibility categories, or who is rede- 10 termined to be eligible for such benefits under any of such 11 categories, shall be considered to meet the eligibility re- 12 quirements met on the date of application and shall re- 13 main eligible for those benefits until the end of the 12- 14 month period following the date of the determination or 15 redetermination of eligibility, except that a State may pro- 16 vide for such determinations more frequently, but not 17 more frequently than once every 6 months for an indi- 18 vidual: 19 ‘‘(i) A specified low-income medicare beneficiary 20 described in subsection (a)(10)(E)(iii) of this section 21 who is determined eligible for medicare cost-sharing 22 described in section 1905(p)(3)(A)(ii). 23 ‘‘(ii) A qualified disabled and working indi- 24 vidual described in section 1905(s) who is deter- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00351 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 352 •S 4486 IS mined eligible for medicare cost-sharing described in 1 section 1905(p)(3)(A)(i).’’. 2 (3) STATE OPTION TO USE EXPRESS LANE ELI- 3 GIBILITY FOR THE MEDICARE SAVINGS PROGRAM.— 4 Section 1902(e)(13)(A) of the Social Security Act 5 (42 U.S.C. 1396a(e)(13)(A)) is amended by adding 6 at the end the following new clause: 7 ‘‘(iii) STATE OPTION TO EXTEND EXPRESS 8 LANE ELIGIBILITY TO OTHER POPULATIONS.— 9 ‘‘(I) IN GENERAL.—At the option of 10 the State, the State may apply the provi- 11 sions of this paragraph with respect to de- 12 termining eligibility under this title for an 13 eligible individual (as defined in subclause 14 (II)). In applying this paragraph in the 15 case of a State making such an option, any 16 reference in this paragraph to a child with 17 respect to this title (other than a reference 18 to child health assistance) shall be deemed 19 to be a reference to an eligible individual. 20 ‘‘(II) ELIGIBLE INDIVIDUAL DE- 21 FINED.—In this clause, the term ‘eligible 22 individual’ means any of the following: 23 ‘‘(aa) A qualified medicare bene- 24 ficiary described in section 1905(p)(1) 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00352 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 353 •S 4486 IS for purposes of determining eligibility 1 for medicare cost-sharing (as defined 2 in section 1905(p)(3)). 3 ‘‘(bb) A specified low-income 4 medicare beneficiary described in sub- 5 section (a)(10)(E)(iii) of this section 6 for purposes of determining eligibility 7 for medicare cost-sharing described in 8 section 1905(p)(3)(A)(ii). 9 ‘‘(cc) A qualified disabled and 10 working individual described in sec- 11 tion 1905(s) for purposes of deter- 12 mining eligibility for medicare cost- 13 sharing described in section 14 1905(p)(3)(A)(i).’’. 15 (g) MEDICAID TREATMENT OF CERTAIN MEDICARE 16 PROVIDERS.—Section 1902(n) of the Social Security Act 17 (42 U.S.C. 1396a(n)) is amended by adding at the end 18 the following new paragraph: 19 ‘‘(4) A State plan shall not deny a claim from a pro- 20 vider or supplier with respect to medicare cost-sharing de- 21 scribed in subparagraph (B), (C), or (D) of section 22 1905(p)(3) for an item or service which is eligible for pay- 23 ment under title XVIII on the basis that the provider or 24 supplier does not have a provider agreement in effect 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00353 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 354 •S 4486 IS under this title or does not otherwise serve all individuals 1 entitled to medical assistance under this title. The State 2 shall create a mechanism through which providers or sup- 3 pliers that do not otherwise have provider agreements with 4 the State can bill the State for medicare cost-sharing for 5 qualified medicare beneficiaries.’’. 6 (h) ELIGIBILITY FOR OTHER PROGRAMS.—Section 7 1905(p) of the Social Security Act (42 U.S.C. 1396d(p)) 8 is amended by adding at the end the following new para- 9 graph: 10 ‘‘(7) Notwithstanding any other provision of law, any 11 medical assistance for some or all medicare cost-sharing 12 under this title shall not be considered income or resources 13 in determining eligibility for, or the amount of assistance 14 or benefits provided under, any other public benefit pro- 15 vided under Federal law or the law of any State or polit- 16 ical subdivision thereof.’’. 17 (i) TREATMENT OF QUALIFIED MEDICARE BENE- 18 FICIARIES, SPECIFIED LOW-INCOME MEDICARE BENE- 19 FICIARIES, AND OTHER DUAL ELIGIBLES AS MEDICARE 20 BENEFICIARIES.—Section 1862 of the Social Security Act 21 (42 U.S.C. 1395y) is amended by adding at the end the 22 following new subsection: 23 ‘‘(p) TREATMENT OF QUALIFIED MEDICARE BENE- 24 FICIARIES (QMBS), SPECIFIED LOW-INCOME MEDICARE 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00354 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 355 •S 4486 IS BENEFICIARIES (SLMBS), AND OTHER DUAL ELIGI- 1 BLES.—Nothing in this title shall be construed as author- 2 izing a provider of services or supplier to discriminate 3 (through a private contractual arrangement or otherwise) 4 against an individual who is otherwise entitled to services 5 under this title on the basis that the individual is a quali- 6 fied medicare beneficiary (as defined in section 7 1905(p)(1)), a specified low-income medicare beneficiary, 8 or is otherwise eligible for medical assistance for medicare 9 cost-sharing or other benefits under title XIX.’’. 10 (j) ADDITIONAL FUNDING FOR STATE HEALTH IN- 11 SURANCE ASSISTANCE PROGRAMS.— 12 (1) GRANTS.— 13 (A) IN GENERAL.—The Secretary of 14 Health and Human Services (in this subsection 15 referred to as the ‘‘Secretary’’) shall use 16 amounts made available under subparagraph 17 (B) to make grants to States for State health 18 insurance assistance programs receiving assist- 19 ance under section 4360 of the Omnibus Budg- 20 et Reconciliation Act of 1990. 21 (B) FUNDING.—For purposes of making 22 grants under this subsection, the Secretary 23 shall provide for the transfer, from the Federal 24 Hospital Insurance Trust Fund under section 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00355 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 356 •S 4486 IS 1817 of the Social Security Act (42 U.S.C. 1 1395i) and the Federal Supplementary Medical 2 Insurance Trust Fund under section 1841 of 3 such Act (42 U.S.C. 1395t), in the same pro- 4 portion as the Secretary determines under sec- 5 tion 1853(f) of such Act (42 U.S.C. 1395w– 6 23(f)), of $50,000,000 to the Centers for Medi- 7 care & Medicaid Services Program Management 8 Account for each of the fiscal years 2024 9 through 2028, to remain available until ex- 10 pended. 11 (2) AMOUNT OF GRANTS.—The amount of a 12 grant to a State under this subsection from the total 13 amount made available under paragraph (1) shall be 14 equal to the sum of the amount allocated to the 15 State under paragraph (3)(A) and the amount allo- 16 cated to the State under subparagraph (3)(B). 17 (3) ALLOCATION TO STATES.— 18 (A) ALLOCATION BASED ON PERCENTAGE 19 OF LOW-INCOME BENEFICIARIES.—The amount 20 allocated to a State under this subparagraph 21 from 2⁄3 of the total amount made available 22 under paragraph (1) shall be based on the num- 23 ber of individuals who meet the requirement 24 under subsection (a)(3)(A)(ii) of section 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00356 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 357 •S 4486 IS 1860D–14 of the Social Security Act (42 1 U.S.C. 1395w–114) but who have not enrolled 2 to receive a subsidy under such section 1860D– 3 14 relative to the total number of individuals 4 who meet the requirement under such sub- 5 section (a)(3)(A)(ii) in each State, as estimated 6 by the Secretary. 7 (B) ALLOCATION BASED ON PERCENTAGE 8 OF RURAL BENEFICIARIES.—The amount allo- 9 cated to a State under this subparagraph from 10 1⁄3 of the total amount made available under 11 paragraph (1) shall be based on the number of 12 part D eligible individuals (as defined in section 13 1860D–1(a)(3)(A) of such Act (42 U.S.C. 14 1395w–101(a)(3)(A))) residing in a rural area 15 relative to the total number of such individuals 16 in each State, as estimated by the Secretary. 17 (4) PORTION OF GRANT BASED ON PERCENT- 18 AGE OF LOW-INCOME BENEFICIARIES TO BE USED 19 TO PROVIDE OUTREACH TO INDIVIDUALS WHO MAY 20 BE SUBSIDY ELIGIBLE INDIVIDUALS OR ELIGIBLE 21 FOR THE MEDICARE SAVINGS PROGRAM.—Each 22 grant awarded under this subsection with respect to 23 amounts allocated under paragraph (3)(A) shall be 24 used to provide outreach to individuals who may be 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00357 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 358 •S 4486 IS subsidy eligible individuals (as defined in section 1 1860D–14(a)(3)(A) of the Social Security Act (42 2 U.S.C. 1395w–114(a)(3)(A))) or eligible for the pro- 3 gram of medical assistance for payment of the cost 4 of medicare cost-sharing under the Medicaid pro- 5 gram pursuant to sections 1902(a)(10)(E) and 1933 6 of such Act (42 U.S.C. 1396a(a)(10)(E), 1396u–3). 7 (k) EFFECTIVE DATE.— 8 (1) IN GENERAL.—Except as provided in para- 9 graph (2), the amendments and repeal made by this 10 section take effect on January 1, 2023, and, with re- 11 spect to title XIX of the Social Security Act, apply 12 to calendar quarters beginning on or after January 13 1, 2023. 14 (2) EXCEPTION FOR STATE LEGISLATION.—In 15 the case of a State plan for medical assistance under 16 title XIX of the Social Security Act which the Sec- 17 retary of Health and Human Services determines re- 18 quires State legislation (other than legislation appro- 19 priating funds) in order for the plan to meet the ad- 20 ditional requirements imposed by the amendments 21 and repeal made by this section, the State plan shall 22 not be regarded as failing to comply with the re- 23 quirements of such title solely on the basis of its 24 failure to meet these additional requirements before 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00358 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 359 •S 4486 IS the first day of the first calendar quarter beginning 1 after the close of the first regular session of the 2 State legislature that begins after the date of the en- 3 actment of this Act. For purposes of the previous 4 sentence, in the case of a State that has a 2-year 5 legislative session, each year of such session shall be 6 deemed to be a separate regular session of the State 7 legislature. 8 SEC. 4108. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 9 PROVIDED BY URBAN INDIAN ORGANIZA- 10 TIONS. 11 (a) IN GENERAL.—The third sentence of section 12 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) 13 is amended by striking ‘‘for the 8 fiscal year quarters be- 14 ginning with the first fiscal year quarter beginning after 15 the date of the enactment of the American Rescue Plan 16 Act of 2021,’’ and inserting ‘‘and’’. 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 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00359 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 360 •S 4486 IS SEC. 4109. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 1 PROVIDED TO A NATIVE HAWAIIAN THROUGH 2 A FEDERALLY QUALIFIED HEALTH CENTER 3 OR A NATIVE HAWAIIAN HEALTH CARE SYS- 4 TEM UNDER THE MEDICAID PROGRAM. 5 (a) IN GENERAL.—The third sentence of section 6 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) 7 is amended by striking ‘‘, for such 8 fiscal year quarters’’. 8 (b) EFFECTIVE DATE.—The amendment made by 9 this section shall apply to medical assistance provided on 10 or after the date of enactment of this Act. 11 SEC. 4110. REPEAL OF REQUIREMENT FOR ESTATE RECOV- 12 ERY UNDER THE MEDICAID PROGRAM. 13 Section 1917 of the Social Security Act (42 U.S.C. 14 1396p) is amended— 15 (1) in subsection (a)— 16 (A) by amending paragraph (1) to read as 17 follows: 18 ‘‘(1) No lien may be imposed against the prop- 19 erty of any individual prior to his death on account 20 of medical assistance paid or to be paid on his behalf 21 under the State plan, except pursuant to the judg- 22 ment of a court on account of benefits incorrectly 23 paid on behalf of such individual.’’; 24 (B) by striking paragraph (2); 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00360 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 361 •S 4486 IS (C) in paragraph (3), by striking ‘‘(1)(B)’’ 1 and inserting ‘‘(1)’’; and 2 (D) by redesignating paragraph (3) as 3 paragraph (2); and 4 (2) by amending subsection (b) to read as fol- 5 lows: 6 ‘‘(b) ADJUSTMENT OR RECOVERY OF MEDICAL AS- 7 SISTANCE CORRECTLY PAID UNDER A STATE PLAN.—No 8 adjustment or recovery of any medical assistance correctly 9 paid on behalf of an individual under the State plan may 10 be made.’’. 11 SEC. 4111. ALLOW FOR SUSPENSION OF MEDICARE BENE- 12 FITS AND PREMIUM LIABILITY FOR INDIVID- 13 UALS WHO ARE INCARCERATED AND PRO- 14 VIDE A SPECIAL ENROLLMENT PERIOD 15 AROUND THE DATE OF RELEASE. 16 (a) SPECIAL ENROLLMENT PERIOD FOR INDIVID- 17 UALS INCARCERATED AT TIME OF MEDICARE ELIGI- 18 BILITY.—Section 1837(i) of the Social Security Act (42 19 U.S.C. 1395p(i)) is amended by adding at the end the fol- 20 lowing new paragraph: 21 ‘‘(5)(A) In the case of an individual who— 22 ‘‘(i) at the time the individual first satis- 23 fies paragraph (1) or (2) of section 1836(a), is 24 incarcerated; or 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00361 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 362 •S 4486 IS ‘‘(ii) has elected not to enroll (or to be 1 deemed enrolled) under this section during the 2 individual’s initial enrollment period; 3 there shall be a special enrollment period de- 4 scribed in subparagraph (B). 5 ‘‘(B) The special enrollment period re- 6 ferred to in subparagraph (A) is the 6-month 7 period beginning on the first day after which 8 the individual is no longer incarcerated.’’. 9 (b) PREMIUM AMOUNT.—Section 1839(a) of the So- 10 cial Security Act (42 U.S.C. 1395r(a)) is amended— 11 (1) in paragraph (1), in the second sentence, by 12 striking ‘‘or (7)’’ and inserting ‘‘(7) or (8)’’; and 13 (2) by adding at the end the following new 14 paragraph: 15 ‘‘(8) In the case of an individual whose coverage pe- 16 riod includes months in which by reason of custody under 17 penal authority coverage is excluded pursuant to section 18 1862(a)(3), the premium amount for such months such 19 individual is in custody under penal authority shall be 20 zero.’’. 21 (c) CONFORMING AMENDMENT.—Section 1818(d)(5) 22 of the Social Security Act (42 U.S.C. 1395i–2(d)(5)) is 23 amended by adding at the end the following: 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00362 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 363 •S 4486 IS ‘‘(D) In the case of an individual who is a 1 person who is excluded from coverage pursuant 2 to section 1862(a)(3) by reason of custody 3 under penal authority, the amount of the 4 monthly premium for such individual shall be 5 zero for any month in which such individual is 6 in custody under penal authority.’’. 7 SEC. 4112. FEDERAL EMPLOYEE HEALTH BENEFIT PLANS. 8 (a) COVERAGE OF PREGNANCY.—The Director of the 9 Office of Personnel Management shall issue such regula- 10 tions as are necessary to ensure that pregnancy is consid- 11 ered a change in family status and a qualifying life event 12 for an individual who is eligible to enroll, but is not en- 13 rolled, in a health benefits plan under chapter 89 of title 14 5, United States Code. 15 (b) EFFECTIVE DATE.—The requirement in para- 16 graph (1) shall apply with respect to any contract entered 17 into under section 8902 of such title beginning 12 months 18 after the date of enactment of this Act. 19 SEC. 4113. CONTINUATION OF MEDICAID INCOME ELIGI- 20 BILITY STANDARD FOR PREGNANT INDIVID- 21 UALS AND INFANTS. 22 Section 1902(l)(2)(A) of the Social Security Act (42 23 U.S.C. 1396a(l)(2)(A)) is amended— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00363 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 364 •S 4486 IS (1) in clause (i), by striking ‘‘and not more 1 than 185 percent’’; 2 (2) in clause (ii)— 3 (A) in subclause (I), by striking ‘‘and’’ 4 after the comma; 5 (B) in subclause (II), by striking the pe- 6 riod at the end and inserting ‘‘, and’’; and 7 (C) by adding at the end the following: 8 ‘‘(III) January 1, 2023, is the 9 percentage provided under clause 10 (v).’’; and 11 (3) by adding at the end the following new 12 clause: 13 ‘‘(v) The percentage provided under 14 clause (ii) for medical assistance provided 15 on or after January 1, 2023, with respect 16 to individuals described in subparagraph 17 (A) or (B) of paragraph (1) shall not be 18 less than— 19 ‘‘(I) the percentage specified for 20 such individuals by the State in an 21 amendment to its State plan (whether 22 approved or not) as of January 1, 23 2014; or 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00364 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 365 •S 4486 IS ‘‘(II) if no such percentage is 1 specified as of January 1, 2014, the 2 percentage established for such indi- 3 viduals under the State’s authorizing 4 legislation or provided for under the 5 State’s appropriations as of that 6 date.’’. 7 Subtitle C—Expansion of Access 8 PART 1—GENERAL PROVISIONS 9 SEC. 4201. AMENDMENT TO THE PUBLIC HEALTH SERVICE 10 ACT. 11 Title XXXIV of the Public Health Service Act, as 12 amended by titles I, II, and III of this Act, is further 13 amended by inserting after subtitle B the following: 14 ‘‘Subtitle D—Reconstruction and 15 Improvement Grants for Public 16 Health Care Facilities Serving 17 Pacific Islanders and the Insu- 18 lar Areas 19 ‘‘SEC. 3441. GRANT SUPPORT FOR QUALITY IMPROVEMENT 20 INITIATIVES. 21 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 22 with the Administrator of the Health Resources and Serv- 23 ices Administration, the Director of the Agency for 24 Healthcare Research and Quality, and the Administrator 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00365 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 366 •S 4486 IS of the Centers for Medicare & Medicaid Services, shall 1 award grants to eligible entities for the conduct of dem- 2 onstration projects to improve the quality of and access 3 to health care. 4 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 5 under subsection (a), an entity shall— 6 ‘‘(1) be a health center, hospital, health plan, 7 health system, community clinic, hospice or palliative 8 care provider, or other health entity determined ap- 9 propriate by the Secretary— 10 ‘‘(A) that, by legal mandate or explicitly 11 adopted mission, provides patients with access 12 to services regardless of their ability to pay; 13 ‘‘(B) that provides care or treatment for a 14 substantial number of patients who are unin- 15 sured, are receiving assistance under a State 16 plan under title XIX of the Social Security Act 17 (or under a waiver of such plan), or are mem- 18 bers of vulnerable populations, as determined 19 by the Secretary; and 20 ‘‘(C)(i) with respect to which, not less than 21 50 percent of the entity’s patient population is 22 made up of racial and ethnic minority groups 23 (as defined in section 1707(g)(1)); or 24 ‘‘(ii) that— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00366 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 367 •S 4486 IS ‘‘(I) serves a disproportionate percent- 1 age of local patients who are from a racial 2 and ethnic minority group, or has a patient 3 population at least 50 percent of which is 4 composed of individuals with limited 5 English proficiency; and 6 ‘‘(II) provides an assurance that 7 amounts received under the grant will be 8 used only to support quality improvement 9 activities in the racial and ethnic minority 10 population served; and 11 ‘‘(2) prepare and submit to the Secretary an 12 application at such time, in such manner, and con- 13 taining such information as the Secretary may re- 14 quire. 15 ‘‘(c) PRIORITY.—In awarding grants under sub- 16 section (a), the Secretary shall give priority to eligible enti- 17 ties that— 18 ‘‘(1) demonstrate an intent to operate as part 19 of a health care partnership, network, collaborative, 20 coalition, or alliance where each member entity con- 21 tributes to the design, implementation, and evalua- 22 tion of the proposed intervention; or 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00367 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 368 •S 4486 IS ‘‘(2) intend to use funds to carry out system- 1 wide changes with respect to health care quality im- 2 provement, including— 3 ‘‘(A) improved systems for data collection 4 and reporting; 5 ‘‘(B) innovative collaborative or similar 6 processes; 7 ‘‘(C) group programs with behavioral or 8 self-management interventions; 9 ‘‘(D) case management services; 10 ‘‘(E) physician or patient reminder sys- 11 tems; 12 ‘‘(F) educational interventions; 13 ‘‘(G) comprehensive and patient-centric 14 health care; 15 ‘‘(H) creation and distribution of education 16 materials on available health care options; or 17 ‘‘(I) other activities determined appropriate 18 by the Secretary. 19 ‘‘(d) USE OF FUNDS.—An entity shall use amounts 20 received under a grant under subsection (a) to support 21 the implementation and evaluation of health care quality 22 improvement activities or minority health and health care 23 disparity reduction activities that include— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00368 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 369 •S 4486 IS ‘‘(1) with respect to health care systems, activi- 1 ties relating to improving— 2 ‘‘(A) patient safety; 3 ‘‘(B) timeliness of care; 4 ‘‘(C) effectiveness of care; 5 ‘‘(D) efficiency of care; 6 ‘‘(E) patient centeredness; 7 ‘‘(F) health information technology; 8 ‘‘(G) accessibility and availability of infor- 9 mation on health care; 10 ‘‘(H) comprehensiveness of health care; 11 and 12 ‘‘(I) patient involvement and choice in 13 health care; and 14 ‘‘(2) with respect to patients, activities relating 15 to— 16 ‘‘(A) staying healthy; 17 ‘‘(B) getting well, mentally and physically; 18 ‘‘(C) living effectively with illness or dis- 19 ability; 20 ‘‘(D) preparing for end of life and ensuring 21 that end-of-life care is accessible and available, 22 as well as coping with end-of-life issues; and 23 ‘‘(E) shared decision making. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00369 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 370 •S 4486 IS ‘‘(e) COMMON DATA SYSTEMS.—The Secretary shall 1 provide financial and other technical assistance to grant- 2 ees under this section for the development of common data 3 systems. 4 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 5 are authorized to be appropriated to carry out this section 6 such sums as may be necessary for each of fiscal years 7 2023 through 2030. 8 ‘‘SEC. 3442. CENTERS OF EXCELLENCE. 9 ‘‘(a) IN GENERAL.—The Secretary, acting through 10 the Administrator of the Health Resources and Services 11 Administration, shall designate centers of excellence at 12 public hospitals, and other health systems serving large 13 numbers of minority patients, that— 14 ‘‘(1) meet the requirements of section 15 3441(b)(1); 16 ‘‘(2) demonstrate excellence in providing care to 17 minority populations; and 18 ‘‘(3) demonstrate excellence in reducing dispari- 19 ties in health and health care. 20 ‘‘(b) REQUIREMENTS.—A hospital or health system 21 that serves as a center of excellence under subsection (a) 22 shall— 23 ‘‘(1) design, implement, and evaluate programs 24 and policies relating to the delivery of care in ra- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00370 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 371 •S 4486 IS cially, ethnically, and linguistically diverse popu- 1 lations; 2 ‘‘(2) provide training and technical assistance 3 to other hospitals and health systems relating to the 4 provision of high-quality health care to minority pop- 5 ulations; and 6 ‘‘(3) develop activities for graduate or con- 7 tinuing medical education that institutionalize a 8 focus on cultural competence training for health care 9 providers. 10 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 11 are authorized to be appropriated to carry out this section, 12 such sums as may be necessary for each of fiscal years 13 2023 through 2030. 14 ‘‘SEC. 3443. RECONSTRUCTION AND IMPROVEMENT GRANTS 15 FOR PUBLIC HEALTH CARE FACILITIES SERV- 16 ING PACIFIC ISLANDERS AND THE INSULAR 17 AREAS. 18 ‘‘(a) IN GENERAL.—The Secretary shall provide di- 19 rect financial assistance to designated health care pro- 20 viders and community health centers in American Samoa, 21 Guam, the Commonwealth of the Northern Mariana Is- 22 lands, the United States Virgin Islands, Puerto Rico, and 23 Hawaii for the purposes of reconstructing and improving 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00371 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 372 •S 4486 IS health care facilities and services in a culturally competent 1 and sustainable manner. 2 ‘‘(b) ELIGIBILITY.—To be eligible to receive direct fi- 3 nancial assistance under subsection (a), an entity shall be 4 a public health facility or community health center located 5 in American Samoa, Guam, the Commonwealth of the 6 Northern Mariana Islands, the United States Virgin Is- 7 lands, Puerto Rico, or Hawaii that— 8 ‘‘(1) is owned or operated by— 9 ‘‘(A) the Government of American Samoa, 10 Guam, the Commonwealth of the Northern 11 Mariana Islands, the United States Virgin Is- 12 lands, Puerto Rico, or Hawaii or a unit of local 13 government; or 14 ‘‘(B) a nonprofit organization; and 15 ‘‘(2)(A) provides care or treatment for a sub- 16 stantial number of patients who are uninsured, are 17 receiving assistance under title XVIII of the Social 18 Security Act or under a State plan under title XIX 19 of such Act (or under a waiver of such plan), or are 20 members of a vulnerable population, as determined 21 by the Secretary; or 22 ‘‘(B) serves a disproportionate percentage of 23 local patients that are from a racial and ethnic mi- 24 nority group. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00372 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 373 •S 4486 IS ‘‘(c) REPORT.—Not later than 180 days after the 1 date of enactment of this title and annually thereafter, the 2 Secretary shall submit to the Congress and the President 3 a report that includes an assessment of health resources 4 and facilities serving populations in American Samoa, 5 Guam, the Commonwealth of the Northern Mariana Is- 6 lands, the United States Virgin Islands, Puerto Rico, and 7 Hawaii. In preparing such report, the Secretary shall— 8 ‘‘(1) consult with and obtain information on all 9 health care facilities needs from the entities receiv- 10 ing direct financial assistance under subsection (a); 11 ‘‘(2) include all amounts of Federal assistance 12 received by each such entity in the preceding fiscal 13 year; 14 ‘‘(3) review the total unmet needs of health care 15 facilities serving American Samoa, Guam, the Com- 16 monwealth of the Northern Mariana Islands, the 17 United States Virgin Islands, Puerto Rico, and Ha- 18 waii, including needs for renovation and expansion 19 of existing facilities; 20 ‘‘(4) include a strategic plan for addressing the 21 needs of each such population identified in the re- 22 port; and 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00373 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 374 •S 4486 IS ‘‘(5) evaluate the effectiveness of the care pro- 1 vided by measuring patient outcomes and cost meas- 2 ures. 3 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 4 are authorized to be appropriated such sums as necessary 5 to carry out this section.’’. 6 SEC. 4202. BORDER HEALTH GRANTS. 7 (a) DEFINITIONS.—In this section: 8 (1) BORDER AREA.—The term ‘‘border area’’ 9 means the United States-Mexico Border Area, as de- 10 fined in section 8 of the United States-Mexico Bor- 11 der Health Commission Act (22 U.S.C. 290n–6). 12 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti- 13 ty’’ means an entity that is located in the border 14 area and is any of the following: 15 (A) A State, local government, or Tribal 16 government. 17 (B) A public institution of higher edu- 18 cation. 19 (C) A nonprofit health organization. 20 (D) A community health center. 21 (E) A community clinic that is a health 22 center receiving assistance under section 330 of 23 the Public Health Service Act (42 U.S.C. 24 254b). 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00374 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 375 •S 4486 IS (F) A nonprofit organization serving immi- 1 grants. 2 (b) AUTHORIZATION.—From funds appropriated pur- 3 suant to subsection (f), the Secretary of Health and 4 Human Services (in this section referred to as the ‘‘Sec- 5 retary’’), acting through the United States members of the 6 United States-Mexico Border Health Commission, shall 7 award grants to eligible entities to address priorities and 8 recommendations to improve the health of border area 9 residents that are established by— 10 (1) the United States members of the United 11 States-Mexico Border Health Commission; 12 (2) the State border health offices; and 13 (3) the Secretary. 14 (c) APPLICATION.—An eligible entity that desires a 15 grant under subsection (b) shall submit an application to 16 the Secretary at such time, in such manner, and con- 17 taining such information as the Secretary may require and 18 demonstrating the entity’s capacity to provide culturally 19 and linguistically appropriate services to border area resi- 20 dents. 21 (d) USE OF FUNDS.—An eligible entity that receives 22 a grant under subsection (b) shall use the grant funds 23 for— 24 (1) programs relating to— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00375 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 376 •S 4486 IS (A) maternal and child health; 1 (B) primary care and preventative health; 2 (C) public health and public health infra- 3 structure; 4 (D) musculoskeletal health and obesity; 5 (E) health education and promotion; 6 (F) oral health; 7 (G) mental and behavioral health; 8 (H) substance use disorders; 9 (I) health conditions that have a high prev- 10 alence in the border area; 11 (J) medical and health services research; 12 (K) workforce training and development; 13 (L) community health workers, patient 14 navigators, and promotores; 15 (M) health care infrastructure problems in 16 the border area (including planning and con- 17 struction grants); 18 (N) health disparities in the border area; 19 (O) environmental health; 20 (P) outreach and enrollment services with 21 respect to Federal programs (including pro- 22 grams authorized under titles XIX and XXI of 23 the Social Security Act (42 U.S.C. 1396 et seq.; 24 42 U.S.C. 1397aa et seq.)); 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00376 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 377 •S 4486 IS (Q) end-of-life care; and 1 (R) addressing social determinants of 2 health; and 3 (2) other programs determined appropriate by 4 the Secretary. 5 (e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro- 6 vided to an eligible entity awarded a grant under sub- 7 section (b) shall be used to supplement and not supplant 8 other funds available to the eligible entity to carry out the 9 activities described in subsection (d). 10 (f) AUTHORIZATION OF APPROPRIATIONS.—There 11 are authorized to be appropriated to carry out this section, 12 $200,000,000 for fiscal year 2024, and such sums as may 13 be necessary for each succeeding fiscal year. 14 SEC. 4203. CRITICAL ACCESS HOSPITAL IMPROVEMENTS. 15 (a) ELIMINATION OF ISOLATION TEST FOR COST- 16 BASED AMBULANCE REIMBURSEMENT.— 17 (1) IN GENERAL.—Section 1834(l)(8) of the 18 Social Security Act (42 U.S.C. 1395m(l)(8)) is 19 amended— 20 (A) in subparagraph (B)— 21 (i) by striking ‘‘owned and’’; and 22 (ii) by inserting ‘‘(including when 23 such services are provided by the entity 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00377 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 378 •S 4486 IS under an arrangement with the hospital)’’ 1 after ‘‘hospital’’; and 2 (B) by striking the comma at the end of 3 subparagraph (B) and all that follows and in- 4 serting a period. 5 (2) EFFECTIVE DATE.—The amendments made 6 by this subsection shall apply to services furnished 7 on or after January 1, 2023. 8 (b) PROVISION OF A MORE FLEXIBLE ALTERNATIVE 9 TO THE CAH DESIGNATION 25 INPATIENT BED LIMIT 10 REQUIREMENT.— 11 (1) IN GENERAL.—Section 1820(c)(2) of the 12 Social Security Act (42 U.S.C. 1395i–4(c)(2)) is 13 amended— 14 (A) in subparagraph (B)(iii), by striking 15 ‘‘provides not more than’’ and inserting ‘‘sub- 16 ject to subparagraph (F), provides not more 17 than’’; and 18 (B) by adding at the end the following new 19 subparagraph: 20 ‘‘(F) ALTERNATIVE TO 25 INPATIENT BED 21 LIMIT REQUIREMENT.— 22 ‘‘(i) IN GENERAL.—A State may elect 23 to treat a facility, with respect to the des- 24 ignation of the facility for a cost reporting 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00378 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 379 •S 4486 IS period, as satisfying the requirement of 1 subparagraph (B)(iii) relating to a max- 2 imum number of acute care inpatient beds 3 if the facility elects, in accordance with a 4 method specified by the Secretary and be- 5 fore the beginning of the cost reporting pe- 6 riod, to meet the requirement under clause 7 (ii). 8 ‘‘(ii) ALTERNATE REQUIREMENT.— 9 The requirement under this clause, with 10 respect to a facility and a cost reporting 11 period, is that the total number of inpa- 12 tient bed days described in subparagraph 13 (B)(iii) during such period will not exceed 14 7,300. For purposes of this subparagraph, 15 an individual who is an inpatient in a bed 16 in the facility for a single day shall be 17 counted as one inpatient bed day. 18 ‘‘(iii) WITHDRAWAL OF ELECTION.— 19 The option described in clause (i) shall not 20 apply to a facility for a cost reporting pe- 21 riod if the facility (for any two consecutive 22 cost reporting periods during the previous 23 5 cost-reporting periods) was treated under 24 such option and had a total number of in- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00379 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 380 •S 4486 IS patient bed days for each of such two cost 1 reporting periods that exceeded the num- 2 ber specified in such clause.’’. 3 (2) EFFECTIVE DATE.—The amendments made 4 by paragraph (1) shall apply to cost reporting peri- 5 ods beginning on or after the date of the enactment 6 of this Act. 7 SEC. 4204. MEDICARE REMOTE MONITORING PILOT 8 PROJECTS. 9 (a) PILOT PROJECTS.— 10 (1) IN GENERAL.—Not later than 9 months 11 after the date of enactment of this Act, the Sec- 12 retary of Health and Human Services (in this sec- 13 tion referred to as the ‘‘Secretary’’) shall conduct 14 pilot projects under title XVIII of the Social Secu- 15 rity Act (42 U.S.C. 1395 et seq.) for the purpose of 16 providing incentives to home health agencies to uti- 17 lize home monitoring and communications tech- 18 nologies that— 19 (A) enhance health and health care out- 20 comes for Medicare beneficiaries; and 21 (B) reduce expenditures under such title. 22 (2) SITE REQUIREMENTS.— 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00380 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 381 •S 4486 IS (A) URBAN AND RURAL.—The Secretary 1 shall conduct the pilot projects under this sec- 2 tion in both urban and rural areas. 3 (B) SITE IN A SMALL STATE.—The Sec- 4 retary shall conduct at least 3 of the pilot 5 projects in a State with a population of less 6 than 1,000,000. 7 (3) DEFINITION OF HOME HEALTH AGENCY.— 8 In this section, the term ‘‘home health agency’’ has 9 the meaning given that term in section 1861(o) of 10 the Social Security Act (42 U.S.C. 1395x(o)). 11 (b) MEDICARE BENEFICIARIES WITHIN THE SCOPE 12 OF PROJECTS.—The Secretary shall specify the criteria 13 for identifying those Medicare beneficiaries who shall be 14 considered within the scope of the pilot projects under this 15 section for purposes of the application of subsection (c) 16 and for the assessment of the effectiveness of the home 17 health agency in achieving the objectives of this section. 18 Such criteria may provide for the inclusion in the projects 19 of Medicare beneficiaries who begin receiving home health 20 services under title XVIII of the Social Security Act (42 21 U.S.C. 1395 et seq.) after the date of the implementation 22 of the projects. 23 (c) INCENTIVES.— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00381 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 382 •S 4486 IS (1) PERFORMANCE TARGETS.—The Secretary 1 shall establish for each home health agency partici- 2 pating in a pilot project under this section a per- 3 formance target using one of the following meth- 4 odologies, as determined appropriate by the Sec- 5 retary: 6 (A) ADJUSTED HISTORICAL PERFORMANCE 7 TARGET.—The Secretary shall establish for the 8 agency— 9 (i) a base expenditure amount equal 10 to the average total payments made to the 11 agency under parts A and B of title XVIII 12 of the Social Security Act (42 U.S.C. 1395 13 et seq.) for Medicare beneficiaries deter- 14 mined to be within the scope of the pilot 15 project in a base period determined by the 16 Secretary; and 17 (ii) an annual per capita expenditure 18 target for such beneficiaries, reflecting the 19 base expenditure amount adjusted for risk 20 and adjusted growth rates. 21 (B) COMPARATIVE PERFORMANCE TAR- 22 GET.—The Secretary shall establish for the 23 agency a comparative performance target equal 24 to the average total payments under such parts 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00382 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 383 •S 4486 IS A and B during the pilot project for comparable 1 individuals in the same geographic area that 2 are not determined to be within the scope of the 3 pilot project. 4 (2) INCENTIVE.—Subject to paragraph (3), the 5 Secretary shall pay to each participating home care 6 agency an incentive payment for each year under the 7 pilot project equal to a portion of the Medicare sav- 8 ings realized for such year relative to the perform- 9 ance target under paragraph (1). 10 (3) LIMITATION ON EXPENDITURES.—The Sec- 11 retary shall limit incentive payments under this sec- 12 tion in order to ensure that the aggregate expendi- 13 tures under title XVIII of the Social Security Act 14 (42 U.S.C. 1395 et seq.) (including incentive pay- 15 ments under this subsection) do not exceed the 16 amount that the Secretary estimates would have 17 been expended if the pilot projects under this section 18 had not been implemented. 19 (d) WAIVER AUTHORITY.—The Secretary may waive 20 such provisions of titles XI and XVIII of the Social Secu- 21 rity Act (42 U.S.C. 1301 et seq.; 42 U.S.C. 1395 et seq.) 22 as the Secretary determines to be appropriate for the con- 23 duct of the pilot projects under this section. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00383 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 384 •S 4486 IS (e) REPORT TO CONGRESS.—Not later than 5 years 1 after the date that the first pilot project under this section 2 is implemented, the Secretary shall submit to Congress a 3 report on the pilot projects. Such report shall contain a 4 detailed description of issues related to the expansion of 5 the projects under subsection (f) and recommendations for 6 such legislation and administrative actions as the Sec- 7 retary considers appropriate. 8 (f) EXPANSION.—If the Secretary determines that 9 any of the pilot projects under this section enhance health 10 outcomes for Medicare beneficiaries and reduce expendi- 11 tures under title XVIII of the Social Security Act (42 12 U.S.C. 1395 et seq.), the Secretary may initiate com- 13 parable projects in additional areas. 14 (g) INCENTIVE PAYMENTS HAVE NO EFFECT ON 15 OTHER MEDICARE PAYMENTS TO AGENCIES.—An incen- 16 tive payment under this section— 17 (1) shall be in addition to the payments that a 18 home health agency would otherwise receive under 19 title XVIII of the Social Security Act for the provi- 20 sion of home health services; and 21 (2) shall have no effect on the amount of such 22 payments. 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00384 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 385 •S 4486 IS SEC. 4205. COMMUNITY HEALTH CENTER COLLABORATIVE 1 ACCESS EXPANSION. 2 Section 330(r)(4) of the Public Health Service Act 3 (42 U.S.C. 254b(r)(4)) is amended— 4 (1) in subparagraph (A), by striking ‘‘primary 5 health care services’’ each place it appears and in- 6 serting ‘‘primary health care and other mental, den- 7 tal, and physical health services’’; and 8 (2) in subparagraph (B)— 9 (A) in clause (i), by striking ‘‘and’’ at the 10 end; 11 (B) in clause (ii), by striking the period at 12 the end and inserting ‘‘; and’’; and 13 (C) by adding at the end the following: 14 ‘‘(iii) in the case of a rural health 15 clinic described in such subparagraph— 16 ‘‘(I) that such clinic provides, to 17 the extent possible, enabling services, 18 such as transportation and language 19 assistance (including translation and 20 interpretation); and 21 ‘‘(II) that the primary health 22 care and other services described in 23 such subparagraph are subject to full 24 reimbursement according to the pro- 25 spective payment system for Federally 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00385 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 386 •S 4486 IS qualified health center services under 1 section 1834(o) of the Social Security 2 Act.’’. 3 SEC. 4206. FACILITATING THE PROVISION OF TELEHEALTH 4 SERVICES ACROSS STATE LINES. 5 (a) IN GENERAL.—For purposes of expediting the 6 provision of telehealth services, for which payment is made 7 under the Medicare Program, across State lines, the Sec- 8 retary of Health and Human Services shall, in consulta- 9 tion with representatives of States, physicians, health care 10 practitioners, and patient advocates, encourage and facili- 11 tate the adoption of provisions allowing for multistate 12 practitioner practice across State lines. 13 (b) DEFINITIONS.—In subsection (a): 14 (1) TELEHEALTH SERVICE.—The term ‘‘tele- 15 health service’’ has the meaning given that term in 16 subparagraph (F) of section 1834(m)(4) of the So- 17 cial Security Act (42 U.S.C. 1395m(m)(4)). 18 (2) PHYSICIAN, PRACTITIONER.—The terms 19 ‘‘physician’’ and ‘‘practitioner’’ have the meaning 20 given those terms in subparagraphs (D) and (E), re- 21 spectively, of section 1834(m)(4) of the Social Secu- 22 rity Act (42 U.S.C. 1395m(m)(4)). 23 (3) MEDICARE PROGRAM.—The term ‘‘Medicare 24 Program’’ means the program of health insurance 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00386 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 387 •S 4486 IS administered by the Secretary of Health and Human 1 Services under title XVIII of the Social Security Act 2 (42 U.S.C. 1395 et seq.). 3 SEC. 4207. SCORING OF PREVENTIVE HEALTH SAVINGS. 4 Section 202 of the Congressional Budget and Im- 5 poundment Control Act of 1974 (2 U.S.C. 602) is amend- 6 ed by adding at the end the following: 7 ‘‘(h) SCORING OF PREVENTIVE HEALTH SAVINGS.— 8 ‘‘(1) DETERMINATION BY THE DIRECTOR.— 9 Upon a request by the chairman or ranking minority 10 member of the Committee on the Budget of the Sen- 11 ate, or by the chairman or ranking minority member 12 of the Committee on the Budget of the House of 13 Representatives, the Director shall determine if a 14 proposed measure would result in reductions in 15 budget outlays in budgetary outyears through the 16 use of preventive health and preventive health serv- 17 ices. 18 ‘‘(2) PROJECTIONS.—If the Director determines 19 that a measure would result in substantial reduc- 20 tions in budget outlays as described in paragraph 21 (1), the Director— 22 ‘‘(A) shall include, in any projection pre- 23 pared by the Director, a description and esti- 24 mate of the reductions in budget outlays in the 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00387 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 388 •S 4486 IS budgetary outyears and a description of the 1 basis for such conclusions; and 2 ‘‘(B) may prepare a budget projection that 3 includes some or all of the budgetary outyears, 4 notwithstanding the time periods for projections 5 described in subsection (e) and sections 308, 6 402, and 424. 7 ‘‘(3) DEFINITIONS.—As used in this sub- 8 section— 9 ‘‘(A) the term ‘budgetary outyears’ means 10 the 2 consecutive 10-fiscal-year periods begin- 11 ning with the first fiscal year that is 10 years 12 after the budget year provided for in the most 13 recently agreed to concurrent resolution on the 14 budget; and 15 ‘‘(B) the term ‘preventive health’ means an 16 action that focuses on the health of the public, 17 individuals, and defined populations in order to 18 protect, promote, and maintain health, wellness, 19 and functional ability, and prevent disease, dis- 20 ability, and premature death that is dem- 21 onstrated by credible and publicly available epi- 22 demiological projection models, incorporating 23 clinical trials or observational studies in hu- 24 mans, to avoid future health care costs.’’. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00388 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 389 •S 4486 IS SEC. 4208. SENSE OF CONGRESS ON MAINTENANCE OF EF- 1 FORT PROVISIONS REGARDING CHILDREN’S 2 HEALTH. 3 It is the sense of the Congress that— 4 (1) the maintenance of effort provisions added 5 to sections 1902 and 2105(d) of the Social Security 6 Act (42 U.S.C. 1396a; 42 U.S.C. 1397ee(d)) by sec- 7 tions 2001(b) and 2101(b) of the Patient Protection 8 and Affordable Care Act were intended to maintain 9 the eligibility standards for the Medicaid program 10 under title XIX of the Social Security Act (42 11 U.S.C. 1396 et seq.) and Children’s Health Insur- 12 ance Program under title XXI of such Act (42 13 U.S.C. 1397aa et seq.) to protect vulnerable and dis- 14 abled adults, children, and senior citizens, many of 15 whom are also members of communities of color; 16 (2) the maintenance of effort provisions for 17 children’s coverage have been extended by the Con- 18 gress through September 30, 2027; 19 (3) the maintenance of effort provisions ensure 20 the continued success of the Medicaid program and 21 Children’s Health Insurance Program and were in- 22 tended to specifically protect vulnerable and disabled 23 children, many of whom are also members of com- 24 munities of color; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00389 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 390 •S 4486 IS (4) the maintenance of effort provisions must 1 be strictly enforced and proposals to weaken or 2 waive the maintenance of effort provisions must not 3 be considered. 4 SEC. 4209. PROTECTION OF THE HHS OFFICES OF MINOR- 5 ITY HEALTH. 6 (a) IN GENERAL.—Pursuant to section 1707A of the 7 Public Health Service Act (42 U.S.C. 300u–6a), the Of- 8 fices of Minority Health established within the Centers for 9 Disease Control and Prevention, the Health Resources 10 and Services Administration, the Substance Abuse and 11 Mental Health Services Administration, the Agency for 12 Healthcare Research and Quality, the Food and Drug Ad- 13 ministration, and the Centers for Medicare & Medicaid 14 Services, are offices that, regardless of change in the 15 structure of the Department of Health and Human Serv- 16 ices, shall report to the Secretary of Health and Human 17 Services. 18 (b) SENSE OF CONGRESS.—It is the sense of the 19 Congress that the Offices of Minority Health referred to 20 in subsection (a) play a critical role in addressing health 21 disparities and should be adequately funded and given a 22 prominent role in evaluating and establishing health poli- 23 cies and programs. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00390 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 391 •S 4486 IS SEC. 4210. OFFICE OF MINORITY HEALTH IN VETERANS 1 HEALTH ADMINISTRATION OF DEPARTMENT 2 OF VETERANS AFFAIRS. 3 (a) ESTABLISHMENT AND FUNCTIONS.—Subchapter 4 I of chapter 73 of title 38, United States Code, is amended 5 by inserting after section 7308 the following new section: 6 ‘‘§ 7308A. Office of Minority Health 7 ‘‘(a) ESTABLISHMENT.—There is established in the 8 Department within the Office of the Under Secretary for 9 Health an office to be known as the ‘Office of Minority 10 Health’ (in this section referred to as the ‘Office’). 11 ‘‘(b) HEAD.—The Director of the Office of Minority 12 Health shall be the head of the Office. The Director of 13 the Office of Minority Health shall be appointed by the 14 Under Secretary for Health from among individuals quali- 15 fied to perform the duties of the position. 16 ‘‘(c) FUNCTIONS.—The functions of the Office are as 17 follows: 18 ‘‘(1) To establish short-range and long-range 19 goals and objectives and coordinate all other activi- 20 ties within the Veterans Health Administration that 21 relate to disease prevention, health promotion, health 22 care services delivery, health and health care edu- 23 cation, health care quality, and health care research 24 concerning veterans who are members of a racial or 25 ethnic minority group. 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00391 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 392 •S 4486 IS ‘‘(2) To support research, demonstrations, and 1 evaluations to test new and innovative models for 2 the discharge of activities described in paragraph 3 (1). 4 ‘‘(3) To increase knowledge and understanding 5 of health risk factors for veterans who are members 6 of a racial or ethnic minority group. 7 ‘‘(4) To develop mechanisms that support bet- 8 ter health care information dissemination, education, 9 prevention, and services delivery to veterans from 10 disadvantaged backgrounds, including veterans who 11 are members of a racial or ethnic minority group. 12 ‘‘(5) To enter into contracts or agreements with 13 appropriate public and nonprofit private entities to 14 develop and carry out programs to provide bilingual 15 or interpretive services to assist veterans who are 16 members of a racial or ethnic minority group and 17 who lack proficiency in speaking the English lan- 18 guage in accessing and receiving health care services 19 through the Veterans Health Administration. 20 ‘‘(6) To carry out programs to improve access 21 to health care services through the Veterans Health 22 Administration for veterans with limited proficiency 23 in speaking the English language, including the de- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00392 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 393 •S 4486 IS velopment and evaluation of demonstration and pilot 1 projects for that purpose. 2 ‘‘(7) To advise the Under Secretary for Health 3 on matters relating to the development, implementa- 4 tion, and evaluation of health professions education 5 in decreasing disparities in health care outcomes be- 6 tween veterans who are members of a racial or eth- 7 nic minority group and other veterans, including cul- 8 tural competency as a method of eliminating such 9 health disparities. 10 ‘‘(8) To perform such other functions and du- 11 ties as the Secretary or the Under Secretary for 12 Health considers appropriate. 13 ‘‘(d) DEFINITIONS.—In this section: 14 ‘‘(1) The term ‘racial or ethnic minority group’ 15 means any of the following: 16 ‘‘(A) American Indians (including Alaska 17 Natives, Eskimos, and Aleuts). 18 ‘‘(B) Asian Americans. 19 ‘‘(C) Native Hawaiians and Pacific Island- 20 ers. 21 ‘‘(D) Blacks. 22 ‘‘(E) Hispanics. 23 ‘‘(2) The term ‘Hispanic’ means individuals 24 whose origin is from Mexico, Puerto Rico, Cuba, 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00393 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 394 •S 4486 IS Central or South America, or any other Spanish- 1 speaking country.’’. 2 (b) CLERICAL AMENDMENT.—The table of sections 3 at the beginning of such subchapter is amended by insert- 4 ing after the item relating to section 7308 the following 5 new item: 6 ‘‘7308A. Office of Minority Health.’’. SEC. 4211. STUDY OF DSH PAYMENTS TO ENSURE HOSPITAL 7 ACCESS FOR LOW-INCOME PATIENTS. 8 (a) IN GENERAL.—Not later than January 1, 2023, 9 the Comptroller General of the United States shall con- 10 duct a study on how amendments made by the Patient 11 Protection and Affordable Care Act (Public Law 111– 12 148) and the Health Care and Education Reconciliation 13 Act of 2010 (Public Law 111–152) to titles XVIII and 14 XIX of the Social Security Act (42 U.S.C. 1395 et seq.; 15 42 U.S.C. 1396 et seq.) relating to disproportionate share 16 hospital adjustment payments under Medicare and Med- 17 icaid (and subsequent amendments made with respect to 18 such payments) affect the timely access to health care 19 services for low-income patients. Such study shall— 20 (1) evaluate and examine whether States elect- 21 ing to make medical assistance available under sec- 22 tion 1902(a)(10)(A)(i)(VIII) of the Social Security 23 Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)) (including 24 States making such an election through a waiver of 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00394 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 395 •S 4486 IS the State plan) to individuals described in such sec- 1 tion mitigate the need for payments to dispropor- 2 tionate share hospitals under section 1886(d)(5)(F) 3 of the Social Security Act (42 U.S.C. 4 1395ww(d)(5)(F)) and section 1923 of such Act (42 5 U.S.C. 1396r–4), including the impact of such 6 States electing to make medical assistance available 7 to such individuals on— 8 (A) the number of individuals in the 9 United States who are without health insurance 10 and the distribution of such individuals in rela- 11 tion to areas primarily served by dispropor- 12 tionate share hospitals; and 13 (B) the low-income utilization rate of such 14 hospitals and the resulting fiscal sustainability 15 of such hospitals; 16 (2) evaluate the appropriate level and distribu- 17 tion of such payments among such disproportionate 18 share hospitals for purposes of— 19 (A) sufficiently accounting for the level of 20 uncompensated care provided by such hospitals 21 to low-income patients; and 22 (B) providing timely access to health care 23 services for individuals in medically underserved 24 areas; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00395 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 396 •S 4486 IS (3) assess, with respect to such disproportionate 1 share hospitals— 2 (A) the role played by such hospitals in 3 providing critical access to emergency, inpa- 4 tient, and outpatient health services, including 5 end-of-life services, as well as the location of 6 such hospitals in relation to medically under- 7 served areas; and 8 (B) the extent to which such hospitals sat- 9 isfy the requirements established for charitable 10 hospital organizations under section 501(r) of 11 the Internal Revenue Code of 1986 with respect 12 to community health needs assessments, finan- 13 cial assistance policy requirements, limitations 14 on charges, and billing and collection require- 15 ments. 16 (b) REPORTS.— 17 (1) REPORT TO CONGRESS.—Not later than 18 180 days after the date on which the study under 19 subsection (a) is completed, the Comptroller General 20 of the United States shall submit to the Committee 21 on Energy and Commerce of the House of Rep- 22 resentatives and the Committee on Finance of the 23 Senate a report that contains— 24 (A) the results of the study; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00396 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 397 •S 4486 IS (B) recommendations to Congress for any 1 legislative changes to the payments to dis- 2 proportionate share hospitals under section 3 1886(d)(5)(F) of the Social Security Act (42 4 U.S.C. 1395ww(d)(5)(F)) and section 1923 of 5 such Act (42 U.S.C. 1396r–4) that are needed 6 to ensure access to health services for low-in- 7 come patients that— 8 (i) are based on the number of indi- 9 viduals without health insurance, the 10 amount of uncompensated care provided by 11 such hospitals, and the impact of reduced 12 payment levels on low-income communities; 13 and 14 (ii) takes into account any reports 15 submitted by the Secretary of the Treas- 16 ury, in consultation with the Secretary of 17 Health and Human Services, to congres- 18 sional committees regarding the costs in- 19 curred by charitable hospital organizations 20 for charity care, bad debt, nonreimbursed 21 expenses for services provided to individ- 22 uals under the Medicare program under 23 title XVIII of the Social Security Act and 24 the Medicaid program under title XIX of 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00397 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 398 •S 4486 IS such Act, and any community benefit ac- 1 tivities provided by such organizations. 2 (2) REPORT TO THE SECRETARY OF HEALTH 3 AND HUMAN SERVICES.—Not later than 180 days 4 after the date on which the study under subsection 5 (a) is completed, the Comptroller General of the 6 United States shall submit to the Secretary of 7 Health and Human Services a report that con- 8 tains— 9 (A) the results of the study; and 10 (B) any recommendations for purposes of 11 assisting in the development of the methodology 12 for the adjustment of payments to dispropor- 13 tionate share hospitals, as required under sec- 14 tion 1886(r) of the Social Security Act (42 15 U.S.C. 1395ww(r)) and the reduction of such 16 payments under section 1923(f)(7) of such Act 17 (42 U.S.C. 1396r–4(f)(7)), taking into account 18 the reports referred to in paragraph (1)(B)(ii). 19 SEC. 4212. REAUTHORIZATION OF PROGRAMS UNDER THE 20 NATIVE HAWAIIAN HEALTH CARE IMPROVE- 21 MENT ACT. 22 (a) NATIVE HAWAIIAN HEALTH CARE SYSTEMS.— 23 Section 6(h)(1) of the Native Hawaiian Health Care Im- 24 provement Act (42 U.S.C. 11705(h)(1)) is amended by 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00398 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 399 •S 4486 IS striking ‘‘may be necessary for fiscal years 1993 through 1 2019’’ and inserting ‘‘are necessary’’. 2 (b) ADMINISTRATIVE GRANT FOR PAPA OLA 3 LOKAHI.—Section 7(b) of the Native Hawaiian Health 4 Care Improvement Act (42 U.S.C. 11706(b)) is amended 5 by striking ‘‘may be necessary for fiscal years 1993 6 through 2019’’ and inserting ‘‘are necessary’’. 7 (c) NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.— 8 Section 10(c) of the Native Hawaiian Health Care Im- 9 provement Act (42 U.S.C. 11709(c)) is amended by strik- 10 ing ‘‘may be necessary for fiscal years 1993 through 11 2019’’ and inserting ‘‘are necessary’’. 12 PART 2—RURAL 13 SEC. 4221. ESTABLISHMENT OF RURAL COMMUNITY HOS- 14 PITAL (RCH) PROGRAM. 15 (a) IN GENERAL.—Section 1861 of the Social Secu- 16 rity Act (42 U.S.C. 1395x), as amended by section 17 2007(b)(1), is amended by adding at the end of the fol- 18 lowing new subsection: 19 ‘‘Rural Community Hospital; Rural Community Hospital 20 Services 21 ‘‘(mmm)(1) The term ‘rural community hospital’ 22 means a hospital (as defined in subsection (e)) that— 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00399 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 400 •S 4486 IS ‘‘(A) is located in a rural area (as defined in 1 section 1886(d)(2)(D)) or treated as being so lo- 2 cated pursuant to section 1886(d)(8)(E); 3 ‘‘(B) subject to paragraph (2), has less than 51 4 acute care inpatient beds, as reported in its most re- 5 cent cost report; 6 ‘‘(C) makes available 24-hour emergency care 7 services; 8 ‘‘(D) subject to paragraph (3), has a provider 9 agreement in effect with the Secretary and is open 10 to the public as of January 1, 2010; and 11 ‘‘(E) applies to the Secretary for such designa- 12 tion. 13 ‘‘(2) For purposes of paragraph (1)(B), beds in a 14 psychiatric or rehabilitation unit of the hospital which is 15 a distinct part of the hospital shall not be counted. 16 ‘‘(3) Paragraph (1)(D) shall not be construed to pro- 17 hibit any of the following from qualifying as a rural com- 18 munity hospital: 19 ‘‘(A) A replacement facility (as defined by the 20 Secretary in regulations in effect on January 1, 21 2012) with the same service area (as defined by the 22 Secretary in regulations in effect on such date). 23 ‘‘(B) A facility obtaining a new provider num- 24 ber pursuant to a change of ownership. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00400 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 401 •S 4486 IS ‘‘(C) A facility which has a binding written 1 agreement with an outside, unrelated party for the 2 construction, reconstruction, lease, rental, or financ- 3 ing of a building as of January 1, 2012. 4 ‘‘(4) Nothing in this subsection shall be construed as 5 prohibiting a critical access hospital from qualifying as a 6 rural community hospital if the critical access hospital 7 meets the conditions otherwise applicable to hospitals 8 under subsection (e) and section 1866. 9 ‘‘(5) Nothing in this subsection shall be construed as 10 prohibiting a rural community hospital participating in 11 the demonstration program under section 410A of the 12 Medicare Prescription Drug, Improvement, and Mod- 13 ernization Act of 2003 (Public Law 108–173; 117 Stat. 14 2313) from qualifying as a rural community hospital if 15 the rural community hospital meets the conditions other- 16 wise applicable to hospitals under subsection (e) and sec- 17 tion 1866.’’. 18 (b) PAYMENT.— 19 (1) INPATIENT HOSPITAL SERVICES.—Section 20 1814 of the Social Security Act (42 U.S.C. 1395f) 21 is amended by adding at the end the following new 22 subsection: 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00401 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 402 •S 4486 IS ‘‘Payment for Inpatient Services Furnished in Rural 1 Community Hospitals 2 ‘‘(m) The amount of payment under this part for in- 3 patient hospital services furnished in a rural community 4 hospital, other than such services furnished in a psy- 5 chiatric or rehabilitation unit of the hospital which is a 6 distinct part, is, at the election of the hospital in the appli- 7 cation referred to in section 1861(mmm)(1)(E)— 8 ‘‘(1) 101 percent of the reasonable costs of pro- 9 viding such services, without regard to the amount 10 of the customary or other charge, or 11 ‘‘(2) the amount of payment provided for under 12 the prospective payment system for inpatient hos- 13 pital services under section 1886(d).’’. 14 (2) OUTPATIENT SERVICES.—Section 1834 of 15 the Social Security Act (42 U.S.C. 1395m) is 16 amended by adding at the end the following new 17 subsection: 18 ‘‘(z) PAYMENT FOR OUTPATIENT SERVICES FUR- 19 NISHED IN RURAL COMMUNITY HOSPITALS.—The 20 amount of payment under this part for outpatient services 21 furnished in a rural community hospital is, at the election 22 of the hospital in the application referred to in section 23 1861(mmm)(1)(E)— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00402 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 403 •S 4486 IS ‘‘(1) 101 percent of the reasonable costs of pro- 1 viding such services, without regard to the amount 2 of the customary or other charge and any limitation 3 under section 1861(v)(1)(U), or 4 ‘‘(2) the amount of payment provided for under 5 the prospective payment system for covered OPD 6 services under section 1833(t).’’. 7 (3) EXEMPTION FROM 30-PERCENT REDUCTION 8 IN REIMBURSEMENT FOR BAD DEBT.—Section 9 1861(v)(1)(T) of the Social Security Act (42 U.S.C. 10 1395x(v)(1)(T)) is amended by inserting ‘‘(other 11 than for a rural community hospital)’’ after ‘‘In de- 12 termining such reasonable costs for hospitals’’. 13 (c) BENEFICIARY COST-SHARING FOR OUTPATIENT 14 SERVICES.—Section 1834(z) of the Social Security Act (as 15 added by subsection (b)(2)) is amended— 16 (1) by redesignating paragraphs (1) and (2) as 17 subparagraphs (A) and (B), respectively; 18 (2) by inserting ‘‘(1)’’ after ‘‘(z)’’; and 19 (3) by adding at the end the following: 20 ‘‘(2) The amounts of beneficiary cost-sharing for out- 21 patient services furnished in a rural community hospital 22 under this part shall be as follows: 23 ‘‘(A) For items and services that would have 24 been paid under section 1833(t) if furnished by a 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00403 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 404 •S 4486 IS hospital, the amount of cost-sharing determined 1 under paragraph (8) of such section. 2 ‘‘(B) For items and services that would have 3 been paid under section 1833(h) if furnished by a 4 provider of services or supplier, no cost-sharing shall 5 apply. 6 ‘‘(C) For all other items and services, the 7 amount of cost-sharing that would apply to the item 8 or service under the methodology that would be used 9 to determine payment for such item or service if pro- 10 vided by a physician, provider of services, or sup- 11 plier, as the case may be.’’. 12 (d) CONFORMING AMENDMENTS.— 13 (1) PART A PAYMENT.—Section 1814(b) of the 14 Social Security Act (42 U.S.C. 1395f(b)) is amended 15 in the matter preceding paragraph (1) by inserting 16 ‘‘other than inpatient hospital services furnished by 17 a rural community hospital,’’ after ‘‘critical access 18 hospital services,’’. 19 (2) PART B PAYMENT.—Section 1833(a) of the 20 Social Security Act (42 U.S.C. 1395l(a)), as amend- 21 ed by section 207(b)(3), is amended— 22 (A) by striking ‘‘and’’ at the end of para- 23 graph (9); 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00404 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 405 •S 4486 IS (B) by striking the period at the end of 1 paragraph (10) and inserting ‘‘; and’’; and 2 (C) by adding at the end the following: 3 ‘‘(11) in the case of outpatient services fur- 4 nished by a rural community hospital, the amounts 5 described in section 1834(z).’’. 6 (3) TECHNICAL AMENDMENTS.— 7 (A) CONSULTATION WITH STATE AGEN- 8 CIES.—Section 1863 of the Social Security Act 9 (42 U.S.C. 1395z) is amended by striking ‘‘and 10 (dd)(2)’’ and inserting ‘‘(dd)(2), and 11 (mmm)(1)’’. 12 (B) PROVIDER AGREEMENTS.—Section 13 1866(a)(2)(A) of the Social Security Act (42 14 U.S.C. 1395cc(a)(2)(A)) is amended by insert- 15 ing ‘‘section 1834(z)(2),’’ after ‘‘section 16 1833(b),’’. 17 (e) EFFECTIVE DATE.—The amendments made by 18 this section shall apply to items and services furnished on 19 or after October 1, 2022. 20 SEC. 4222. RURAL HEALTH QUALITY ADVISORY COMMIS- 21 SION AND DEMONSTRATION PROJECTS. 22 (a) RURAL HEALTH QUALITY ADVISORY COMMIS- 23 SION.— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00405 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 406 •S 4486 IS (1) ESTABLISHMENT.—Not later than 6 1 months after the date of the enactment of this sec- 2 tion, the Secretary of Health and Human Services 3 (in this section referred to as the ‘‘Secretary’’) shall 4 establish a commission to be known as the Rural 5 Health Quality Advisory Commission (in this section 6 referred to as the ‘‘Commission’’). 7 (2) DUTIES OF COMMISSION.— 8 (A) NATIONAL PLAN.—The Commission 9 shall develop, coordinate, and facilitate imple- 10 mentation of a national plan for rural health 11 quality improvement. The national plan shall— 12 (i) identify objectives for rural health 13 quality improvement; 14 (ii) identify strategies to eliminate 15 known gaps in rural health system capacity 16 and improve rural health quality; and 17 (iii) provide recommendations for 18 Federal programs to identify opportunities 19 for strengthening and aligning policies and 20 programs to improve rural health quality. 21 (B) DEMONSTRATION PROJECTS.—The 22 Commission shall design demonstration projects 23 to recommend to the Secretary to test alter- 24 native models for rural health quality improve- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00406 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 407 •S 4486 IS ment, including with respect to both personal 1 and population health. 2 (C) MONITORING.—The Commission shall 3 monitor progress toward the objectives identi- 4 fied pursuant to subparagraph (A)(i). 5 (3) MEMBERSHIP.— 6 (A) NUMBER.—The Commission shall be 7 composed of 11 members appointed by the Sec- 8 retary. 9 (B) SELECTION.—The Secretary shall se- 10 lect the members of the Commission from 11 among individuals with significant rural health 12 care and health care quality expertise, including 13 expertise in clinical health care, health care 14 quality research, end-of-life care, population or 15 public health, or purchaser organizations. 16 (4) CONTRACTING AUTHORITY.—Subject to the 17 availability of funds, the Commission may enter into 18 contracts and make other arrangements, as may be 19 necessary to carry out the duties described in para- 20 graph (2). 21 (5) STAFF.—Upon the request of the Commis- 22 sion, the Secretary may detail, on a reimbursable 23 basis, any of the personnel of the Office of Rural 24 Health Policy of the Health Resources and Services 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00407 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 408 •S 4486 IS Administration, the Agency for Healthcare Research 1 and Quality, or the Centers for Medicare & Medicaid 2 Services to the Commission to assist in carrying out 3 this subsection. 4 (6) REPORTS TO CONGRESS.—Not later than 1 5 year after the establishment of the Commission, and 6 annually thereafter, the Commission shall submit a 7 report to the Congress on rural health quality. Each 8 such report shall include the following: 9 (A) An inventory of relevant programs and 10 recommendations for improved coordination and 11 integration of policy and programs. 12 (B) An assessment of achievement of the 13 objectives identified in the national plan devel- 14 oped under paragraph (2) and recommenda- 15 tions for realizing such objectives. 16 (C) Recommendations on Federal legisla- 17 tion, regulations, or administrative policies to 18 enhance rural health quality and outcomes. 19 (b) RURAL HEALTH QUALITY DEMONSTRATION 20 PROJECTS.— 21 (1) IN GENERAL.—Not later than 270 days 22 after the date of the enactment of this section, the 23 Secretary, in consultation with the Rural Health 24 Quality Advisory Commission, the Office of Rural 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00408 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 409 •S 4486 IS Health Policy of the Health Resources and Services 1 Administration, the Agency for Healthcare Research 2 and Quality, and the Centers for Medicare & Med- 3 icaid Services, shall make grants to eligible entities 4 for a total of 5 demonstration projects to implement 5 and evaluate methods for improving the quality of 6 health care in rural communities. Each such dem- 7 onstration project shall include— 8 (A) alternative community models that— 9 (i) will achieve greater integration of 10 personal and population health services; 11 and 12 (ii) address safety, effectiveness, 13 patient- or community-centeredness, timeli- 14 ness, efficiency, and equity (the 6 aims 15 identified by the National Academy of 16 Medicine (formerly known as the ‘‘Institute 17 of Medicine’’) in its report entitled ‘‘Cross- 18 ing the Quality Chasm: A New Health Sys- 19 tem for the 21st Century’’ released on 20 March 1, 2001); 21 (B) innovative approaches to the financing 22 and delivery of health care services to achieve 23 rural health quality and accessibility goals for 24 patients; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00409 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 410 •S 4486 IS (C) development of quality improvement 1 support structures to assist rural health sys- 2 tems and professionals in the provision of 3 health care (such as workforce support struc- 4 tures, quality monitoring and reporting, clinical 5 care protocols, and information technology ap- 6 plications). 7 (2) ELIGIBLE ENTITIES.—In this subsection, 8 the term ‘‘eligible entity’’ means a consortium 9 that— 10 (A) shall include— 11 (i) at least one health care provider or 12 health care delivery system located in a 13 rural area; and 14 (ii) at least one organization rep- 15 resenting multiple community stakeholders; 16 and 17 (B) may include other partners such as 18 rural research centers. 19 (3) CONSULTATION.—In developing the pro- 20 gram for awarding grants under this subsection, the 21 Secretary shall consult with the Administrator of the 22 Agency for Healthcare Research and Quality, rural 23 health care providers, rural health care researchers, 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00410 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 411 •S 4486 IS and private and nonprofit groups (including national 1 associations) which are undertaking similar efforts. 2 (4) EXPEDITED WAIVERS.—The Secretary shall 3 expedite the processing of any waiver that— 4 (A) is authorized under title XVIII or XIX 5 of the Social Security Act (42 U.S.C. 1395 et 6 seq.; 42 U.S.C. 1396 et seq.); and 7 (B) is necessary to carry out a demonstra- 8 tion project under this subsection. 9 (5) DEMONSTRATION PROJECT SITES.—The 10 Secretary shall ensure that the 5 demonstration 11 projects funded under this subsection are conducted 12 at a variety of sites representing the diversity of 13 rural communities in the United States. 14 (6) DURATION.—Each demonstration project 15 under this subsection shall be for a period of 4 16 years. 17 (7) INDEPENDENT EVALUATION.—The Sec- 18 retary shall enter into an arrangement with an enti- 19 ty that has experience working directly with rural 20 health systems for the conduct of an independent 21 evaluation of the program carried out under this 22 subsection. 23 (8) REPORT.—Not later than 1 year after the 24 conclusion of all of the demonstration projects fund- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00411 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 412 •S 4486 IS ed under this subsection, the Secretary shall submit 1 a report to the Congress on the results of such 2 projects. The report shall include— 3 (A) an evaluation of patient access to care, 4 patient outcomes, and an analysis of the cost- 5 effectiveness of each such project; and 6 (B) recommendations on Federal legisla- 7 tion, regulations, or administrative policies to 8 enhance rural health quality and outcomes. 9 (c) APPROPRIATION.— 10 (1) IN GENERAL.—Out of funds in the Treas- 11 ury not otherwise appropriated, there are appro- 12 priated to the Secretary to carry out this section 13 $30,000,000 for the period of fiscal years 2023 14 through 2027. 15 (2) AVAILABILITY.— 16 (A) IN GENERAL.—Funds appropriated 17 under paragraph (1) shall remain available for 18 expenditure through fiscal year 2027. 19 (B) REPORT.—For purposes of carrying 20 out subsection (b)(8), funds appropriated under 21 paragraph (1) shall remain available for ex- 22 penditure through fiscal year 2028. 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00412 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 413 •S 4486 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. 4223. 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 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00413 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 414 •S 4486 IS ‘‘(2) under subsection (c), to provide for the 1 planning and implementation of integrated health 2 care networks in rural areas; 3 ‘‘(3) under subsection (d), to assist rural com- 4 munities in the Delta Region to reduce health dis- 5 parities and to promote and enhance health system 6 development; and 7 ‘‘(4) under subsection (e), to provide for the 8 planning and implementation of small rural health 9 care provider quality improvement activities. 10 ‘‘(b) RURAL HEALTH CARE SERVICES OUTREACH 11 GRANTS.— 12 ‘‘(1) GRANTS.—The Director of the Office of 13 Rural Health Policy of the Health Resources and 14 Services Administration (referred to in this section 15 as the ‘Director’) may award grants to eligible enti- 16 ties to promote rural health care services outreach 17 by expanding the delivery of health care services to 18 include new and enhanced services in rural areas. 19 The Director may award the grants for periods of 20 not more than 3 years. 21 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 22 grant under this subsection for a project, an enti- 23 ty— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00414 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 415 •S 4486 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 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00415 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 416 •S 4486 IS ‘‘(A) a description of the project that the 1 eligible entity will carry out using the funds 2 provided under the grant; 3 ‘‘(B) a description of the manner in which 4 the project funded under the grant will meet 5 the health care needs of rural populations in 6 the local community or region to be served; 7 ‘‘(C) a plan for quantifying how health 8 care needs will be met through identification of 9 the target population and benchmarks of service 10 delivery or health status, such as— 11 ‘‘(i) quantifiable measurements of 12 health and health care status improvement 13 for projects focusing on health promotion; 14 or 15 ‘‘(ii) benchmarks of increased access 16 to primary and end-of-life care, including 17 tracking factors such as the number and 18 type of primary and end-of-life care visits, 19 identification of a medical home, or other 20 general measures of such access; 21 ‘‘(D) a description of how the local com- 22 munity or region to be served will be involved 23 in the development and ongoing operations of 24 the project; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00416 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 417 •S 4486 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 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00417 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 418 •S 4486 IS ‘‘(iii) implement health information 1 technology to achieve efficiencies, reduce 2 medical errors, and improve quality; 3 ‘‘(iv) coordinate care and manage 4 chronic and terminal illness; and 5 ‘‘(v) strengthen the rural health care 6 system as a whole and across all facets of 7 the health care delivery system, including 8 end-of-life care, in such a manner as to 9 show a quantifiable return on investment 10 to the participants in the network. 11 ‘‘(B) GRANT PERIODS.—The Director may 12 award such a rural health network development 13 grant— 14 ‘‘(i) for a period of 3 years for imple- 15 mentation activities; or 16 ‘‘(ii) for a period of 1 year for plan- 17 ning activities to assist in the initial devel- 18 opment of an integrated health care net- 19 work, if the proposed participants in the 20 network do not have a history of collabo- 21 rative efforts and a 3-year grant would be 22 inappropriate. 23 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 24 grant under this subsection, an entity— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00418 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 419 •S 4486 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 network composed 10 of participants— 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 (other than a 1- 17 year grant for planning activities) for the same 18 or a similar project. 19 ‘‘(3) APPLICATIONS.—To be eligible to receive a 20 grant under this subsection, an eligible entity, in 21 consultation with the appropriate State office of 22 rural health or another appropriate State entity, 23 shall prepare and submit to the Director an applica- 24 tion at such time, in such manner, and containing 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00419 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 420 •S 4486 IS such information as the Director may require, in- 1 cluding— 2 ‘‘(A) a description of the project that the 3 eligible entity will carry out using the funds 4 provided under the grant; 5 ‘‘(B) an explanation of the reasons why 6 Federal assistance is required to carry out the 7 project; 8 ‘‘(C) a description of— 9 ‘‘(i) the history of collaborative activi- 10 ties carried out by the participants in the 11 network; 12 ‘‘(ii) the degree to which the partici- 13 pants are ready to integrate their func- 14 tions; and 15 ‘‘(iii) how the local community or re- 16 gion to be served will benefit from and be 17 involved in the activities carried out by the 18 network; 19 ‘‘(D) a description of how the local com- 20 munity or region to be served will experience in- 21 creased access to quality health care services 22 across the continuum of care as a result of the 23 integration activities carried out by the net- 24 work, including a description of— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00420 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 421 •S 4486 IS ‘‘(i) return on investment for the com- 1 munity and the network members; and 2 ‘‘(ii) other quantifiable performance 3 measures that show the benefit of the net- 4 work activities; 5 ‘‘(E) a plan for sustaining the project after 6 Federal support for the project has ended; 7 ‘‘(F) a description of how the project will 8 be evaluated; 9 ‘‘(G) the administrative capacity to submit 10 annual performance data electronically as speci- 11 fied by the Director; and 12 ‘‘(H) other such information as the Direc- 13 tor determines to be appropriate. 14 ‘‘(d) DELTA RURAL DISPARITIES AND HEALTH SYS- 15 TEMS DEVELOPMENT GRANTS.— 16 ‘‘(1) GRANTS.—The Director may award grants 17 to eligible entities to support reduction of health dis- 18 parities, improve access to health care, and enhance 19 rural health system development in the Delta Re- 20 gion. 21 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 22 grant under this subsection, an entity shall be a 23 rural public or rural nonprofit private entity, a facil- 24 ity that qualifies as a rural health clinic under title 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00421 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 422 •S 4486 IS XVIII of the Social Security Act, a public or non- 1 profit entity existing exclusively to provide services 2 to migrant and seasonal farm workers in rural 3 areas, or a Tribal government whose grant-funded 4 activities will be conducted within federally recog- 5 nized Tribal areas. 6 ‘‘(3) APPLICATIONS.—To be eligible to receive a 7 grant under this subsection, an eligible entity shall 8 prepare and submit to the Director an application at 9 such time, in such manner, and containing such in- 10 formation as the Director may require, including— 11 ‘‘(A) a description of the project that the 12 eligible entity will carry out using the funds 13 provided under the grant; 14 ‘‘(B) an explanation of the reasons why 15 Federal assistance is required to carry out the 16 project; 17 ‘‘(C) a description of the manner in which 18 the project funded under the grant will meet 19 the health care needs of the Delta Region; 20 ‘‘(D) a description of how the local com- 21 munity or region to be served will experience in- 22 creased access to quality health care services as 23 a result of the activities carried out by the enti- 24 ty; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00422 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 423 •S 4486 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 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00423 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 424 •S 4486 IS ‘‘(2) ELIGIBILITY.—To be eligible for a grant 1 under this subsection, an entity— 2 ‘‘(A) shall be— 3 ‘‘(i) a rural public or rural nonprofit 4 private health care provider or provider of 5 health care services, such as a rural health 6 clinic; or 7 ‘‘(ii) another rural provider or net- 8 work of small rural providers identified by 9 the Director as a key source of local care; 10 and 11 ‘‘(B) shall not previously have received a 12 grant under this subsection for the same or a 13 similar project. 14 ‘‘(3) PREFERENCE.—In awarding grants under 15 this subsection, the Director shall give preference to 16 facilities that qualify as rural health clinics under 17 title XVIII of the Social Security Act. 18 ‘‘(4) APPLICATIONS.—To be eligible to receive a 19 grant under this subsection, an eligible entity shall 20 prepare and submit to the Director an application at 21 such time, in such manner, and containing such in- 22 formation as the Director may require, including— 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00424 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 425 •S 4486 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 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00425 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 426 •S 4486 IS ‘‘(1) PROHIBITED USES OF FUNDS.—An entity 1 that receives a grant under this section may not use 2 funds provided through the grant— 3 ‘‘(A) to build or acquire real property; or 4 ‘‘(B) for construction. 5 ‘‘(2) COORDINATION WITH OTHER AGENCIES.— 6 The Director shall coordinate activities carried out 7 under grant programs described in this section, to 8 the extent practicable, with Federal and State agen- 9 cies and nonprofit organizations that are operating 10 similar grant programs, to maximize the effect of 11 public dollars in funding meritorious proposals. 12 ‘‘(g) REPORT.—Not later than September 30, 2024, 13 the Secretary shall prepare and submit to the appropriate 14 committees of Congress a report on the progress and ac- 15 complishments of the grant programs described in sub- 16 sections (b), (c), (d), and (e). 17 ‘‘(h) DEFINITION OF DELTA REGION.—In this sec- 18 tion, the term ‘Delta Region’ has the meaning given to 19 the term ‘region’ in section 382A of the Consolidated 20 Farm and Rural Development Act (7 U.S.C. 2009aa). 21 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There 22 are authorized to be appropriated to carry out this section 23 such sums as may be necessary for each of fiscal years 24 2024 through 2027.’’. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00426 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 427 •S 4486 IS PART 3—INDIAN COMMUNITIES 1 SEC. 4231. ASSISTANT SECRETARY OF THE INDIAN HEALTH 2 SERVICE. 3 (a) REFERENCES.—Any reference in a law, regula- 4 tion, document, paper, or other record of the United 5 States to the Director of the Indian Health Service shall 6 be deemed to be a reference to the Assistant Secretary 7 of the Indian Health Service. 8 (b) EXECUTIVE SCHEDULE.—Section 5315 of title 5, 9 United States Code, is amended, in the matter relating 10 to the Assistant Secretaries of Health and Human Serv- 11 ices, by striking ‘‘(6)’’ and inserting ‘‘(7), 1 of whom shall 12 be the Assistant Secretary of the Indian Health Service’’. 13 (c) CONFORMING AMENDMENT.—Section 5316 of 14 title 5, United States Code, is amended by striking ‘‘Direc- 15 tor, Indian Health Service, Department of Health and 16 Human Services.’’. 17 SEC. 4232. EXTENSION OF FULL FEDERAL MEDICAL ASSIST- 18 ANCE PERCENTAGE TO INDIAN HEALTH 19 CARE PROVIDERS. 20 Section 1905 of the Social Security Act (42 U.S.C. 21 1396d) is amended— 22 (1) in subsection (a), by amending paragraph 23 (9) to read as follows: 24 ‘‘(9) clinic services furnished by or under the 25 direction of a physician, without regard to whether 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00427 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 428 •S 4486 IS the clinic itself is administered by a physician, in- 1 cluding— 2 ‘‘(A) such services furnished outside the 3 clinic by clinic personnel to an eligible indi- 4 vidual who does not reside in a permanent 5 dwelling or does not have a fixed home or mail- 6 ing address; and 7 ‘‘(B) such services furnished outside the 8 clinic by any Indian Health Service facility, a 9 health program or facility operated by a tribe or 10 tribal organization under the Indian Self-Deter- 11 mination Act (Public Law 93–638), or an 12 urban Indian organization receiving funds 13 under title V of the Indian Health Care Im- 14 provement Act;’’; and 15 (2) in subsection (b), by inserting after ‘‘Papa 16 Ola Lokahi under section 8 of such Act’’ the fol- 17 lowing: ‘‘; the Federal medical assistance percentage 18 shall also be 100 per centum with respect to 19 amounts expended as medical assistance for services 20 which are received by an Indian Health Service facil- 21 ity, a health program or facility operated by a tribe 22 or tribal organization under the Indian Self-Deter- 23 mination Act (Public Law 93–638), or an urban In- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00428 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 429 •S 4486 IS dian organization receiving funds under title V of 1 the Indian Health Care Improvement Act’’. 2 SEC. 4233. CONFERRING WITH URBAN INDIAN ORGANIZA- 3 TIONS. 4 Section 514 of the Indian Health Care Improvement 5 Act (25 U.S.C. 1660d) is amended by striking subsection 6 (b) and inserting the following: 7 ‘‘(b) REQUIREMENT.—The Secretary shall ensure 8 that the Service and other agencies and offices of the De- 9 partment and the Department of Veterans Affairs confer, 10 to the maximum extent practicable, with urban Indian or- 11 ganizations in carrying out— 12 ‘‘(1) this Act; and 13 ‘‘(2) other provisions of law relating to Indian 14 health care.’’. 15 PART 4—PROVIDERS 16 SEC. 4241. AVAILABILITY OF NON-ENGLISH LANGUAGE 17 SPEAKING PROVIDERS. 18 (a) IN GENERAL.—Section 1311(c)(1)(B) of the Pa- 19 tient Protection and Affordable Care Act (42 U.S.C. 20 18031(c)(1)(B)) is amended by inserting before the semi- 21 colon the following: ‘‘and the ability of such provider to 22 provide care in a language other than English either 23 through the provider speaking such language or by the 24 provider having a qualified interpreter for an individual 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00429 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 430 •S 4486 IS with limited English proficiency (as defined in section 1 3400 of such Act) who speaks such language available 2 during office hours’’. 3 (b) EFFECTIVE DATE.—The amendment made by 4 subsection (a) shall not apply to any plan beginning on 5 or prior to the date that is 1 year after the date of the 6 enactment of this Act. 7 SEC. 4242. ACCESS TO ESSENTIAL COMMUNITY PROVIDERS. 8 (a) ESSENTIAL COMMUNITY PROVIDERS.—Section 9 1311(c)(1)(C) of the Patient Protection and Affordable 10 Care Act (42 U.S.C. 18031(c)(1)(C)) is amended— 11 (1) by inserting ‘‘(i)’’ after ‘‘(C)’’; and 12 (2) by adding at the end the following new 13 clauses: 14 ‘‘(ii) not later than January 1, 2023, in- 15 crease the percentage of essential community 16 providers as described in clause (i) included in 17 its network by 10 percent annually (based on 18 the level in the plan for 2016) until 90 percent 19 of all federally qualified health centers and 75 20 percent of all other such essential community 21 providers in the contract service area are in-net- 22 work; and 23 ‘‘(iii) include at least one essential commu- 24 nity provider in each of the essential community 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00430 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 431 •S 4486 IS provider categories described in section 1 156.235(a)(2)(ii)(B) of title 45, Code of Fed- 2 eral Regulations (as in effect on the date of en- 3 actment of the Health Equity and Account- 4 ability Act of 2022), in each county in the serv- 5 ice area, where available;’’. 6 (b) REPORTING REQUIREMENTS.—Section 7 1311(e)(3) of the Patient Protection and Affordable Care 8 Act (42 U.S.C. 18031(e)(3)) is amended by adding at the 9 end the following new subparagraph: 10 ‘‘(E) DATA ON ESSENTIAL COMMUNITY 11 PROVIDERS.—The Secretary shall require quali- 12 fied health plans to submit annually to the Sec- 13 retary data on the percentage of essential com- 14 munity providers as described in clause (ii) of 15 subsection (c)(1)(C), by county, that contract 16 with each qualified health plan offered in that 17 county and the percentage of such essential 18 community providers, by category as described 19 in clause (iii) of such subsection, that contract 20 with each qualified health plan offered in that 21 county. Such data shall be made available to 22 the general public.’’. 23 (c) ESSENTIAL COMMUNITY PROVIDER PROVISIONS 24 APPLIED UNDER MEDICARE AND MEDICAID.— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00431 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 432 •S 4486 IS (1) MEDICARE.—Section 1852(d)(1) of the So- 1 cial Security Act (42 U.S.C. 1395w–22(d)(1)) is 2 amended— 3 (A) by striking ‘‘and’’ at the end of sub- 4 paragraph (D); 5 (B) by striking the period at the end of 6 subparagraph (E) and inserting ‘‘; and’’; and 7 (C) by adding at the end the following new 8 subparagraph: 9 ‘‘(F) the plan meets the requirements of 10 clauses (ii) and (iii) of section 1311(c)(1)(C) of 11 the Patient Protection and Affordable Care Act 12 (relating to inclusion in networks of essential 13 community providers).’’. 14 (2) MEDICAID.—Section 1932(b)(5) of the So- 15 cial Security Act (42 U.S.C. 1396u–2(b)(5)) is 16 amended— 17 (A) by striking ‘‘and’’ at the end of sub- 18 paragraph (A); 19 (B) by striking the period at the end of 20 subparagraph (B) and inserting ‘‘; and’’; and 21 (C) by adding at the end the following new 22 subparagraph: 23 ‘‘(C) meets the requirements of clauses (ii) 24 and (iii) of section 1311(c)(1)(C) of the Patient 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00432 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 433 •S 4486 IS Protection and Affordable Care Act (relating to 1 inclusion in networks of essential community 2 providers) with respect to services offered in the 3 service area involved.’’. 4 SEC. 4243. PROVIDER NETWORK ADEQUACY IN COMMU- 5 NITIES OF COLOR. 6 (a) IN GENERAL.—Section 1311(c)(1)(B) of the Pa- 7 tient Protection and Affordable Care Act (42 U.S.C. 8 18031(c)(1)(B)), as amended by section 4241(a), is fur- 9 ther amended— 10 (1) by inserting ‘‘(i)’’ after ‘‘(B)’’; and 11 (2) by adding at the end the following new 12 clauses: 13 ‘‘(ii) meet such network adequacy stand- 14 ards as the Secretary may establish with regard 15 to— 16 ‘‘(I) appointment wait time; 17 ‘‘(II) travel time and distance to 18 health care provider facilities and providers 19 by public and private transit; 20 ‘‘(III) hours of operation to accommo- 21 date individuals who cannot come to pro- 22 vider appointments during standard busi- 23 ness hours; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00433 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 434 •S 4486 IS ‘‘(IV) availability of health care op- 1 tions for patients; and 2 ‘‘(V) other network adequacy stand- 3 ards to ensure that care through these 4 plans is accessible to diverse communities, 5 including individuals with limited English 6 proficiency as defined in section 3400 of 7 such Act; and 8 ‘‘(iii) provide coverage for services for en- 9 rollees through out-of-network providers at no 10 additional cost to the enrollees in cases where 11 in-network providers are unable to comply with 12 the standards established under subclause (III) 13 or (IV) of clause (ii) for such services and the 14 out-of-network providers can deliver such serv- 15 ices in compliance with such standards;’’. 16 (b) EFFECTIVE DATE.—The amendments made by 17 subsection (a) shall not apply to plans beginning on or 18 prior to the date that is 1 year after the date of the enact- 19 ment of the Health Equity and Accountability Act of 20 2022. 21 PART 5—DENTAL 22 SEC. 4251. IMPROVING ACCESS TO DENTAL CARE. 23 (a) REPORTS TO CONGRESS.— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00434 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 435 •S 4486 IS (1) GAO REPORTS.—Not later than 1 year 1 after the date of the enactment of this Act, the 2 Comptroller General of the United States shall sub- 3 mit to Congress— 4 (A) a report on the Alaska Dental Health 5 Aide Therapists program and the Dental Ther- 6 apist and Advanced Dental Therapist programs 7 in Minnesota, to assess the effectiveness of den- 8 tal therapists in— 9 (i) improving access to timely dental 10 care among communities of color; 11 (ii) providing high-quality care; 12 (iii) providing culturally competent 13 care; and 14 (iv) providing accessible care to people 15 with disabilities; 16 (B) a report on State variations in the use 17 of dental hygienists and the effectiveness of ex- 18 panding the scope of practice for dental hygien- 19 ists in— 20 (i) improving access to timely dental 21 care among communities of color; 22 (ii) providing high-quality care; 23 (iii) providing culturally competent 24 care; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00435 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 436 •S 4486 IS (iv) providing accessible care to people 1 with disabilities; and 2 (C) a report on the use of telehealth serv- 3 ices to enhance services provided by dental hy- 4 gienists and therapists, including recommenda- 5 tions for any modifications to the Medicare pro- 6 gram under title XVIII of the Social Security 7 Act (42 U.S.C. 1395 et seq.) and the Medicaid 8 program under title XIX of such Act (42 9 U.S.C. 1396 et seq.) to better provide for tele- 10 health consultations in conjunction with thera- 11 pists’ and hygienists’ care. 12 (2) HRSA REPORT ON DENTAL SHORTAGE 13 AREAS.—Not later than 1 year after the date of the 14 enactment of this Act, the Secretary of Health and 15 Human Services, acting through the Administrator 16 of the Health Resources and Services Administra- 17 tion, shall submit to Congress a report which details 18 geographic dental access shortages and the pre- 19 paredness of dental providers to offer culturally and 20 linguistically appropriate, affordable, accessible, and 21 timely services. 22 (b) EXPANSION OF DENTAL HEALTH AID THERA- 23 PISTS IN TRIBAL AND URBAN INDIAN COMMUNITIES.— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00436 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 437 •S 4486 IS Section 119 of the Indian Health Care Improvement Act 1 (25 U.S.C. 1616l) is amended— 2 (1) in subsection (d)— 3 (A) by striking paragraph (2) and insert- 4 ing the following: 5 ‘‘(2) REQUIREMENT; EXCLUSION.—Subject to 6 paragraphs (3) and (4), in establishing a national 7 program under paragraph (1), the Secretary— 8 ‘‘(A) shall not reduce the amounts pro- 9 vided for the Community Health Aide Program 10 described in subsections (a) and (b); 11 ‘‘(B) shall exclude dental health aide thera- 12 pist services from services covered under such 13 Program; and 14 ‘‘(C) shall include urban Indian organiza- 15 tions.’’; and 16 (B) in paragraph (3), by striking ‘‘or tribal 17 organization’’ each place it appears and insert- 18 ing ‘‘, tribal organization, or urban Indian orga- 19 nization’’; and 20 (2) in subsection (e), by striking ‘‘or a tribal or- 21 ganization’’ and inserting ‘‘a tribal organization, or 22 an urban Indian organization’’. 23 (c) COVERAGE OF DENTAL SERVICES UNDER THE 24 MEDICARE PROGRAM.— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00437 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 438 •S 4486 IS (1) COVERAGE.—Section 1861(s)(2) of the So- 1 cial Security Act (42 U.S.C. 1395x(s)(2)) is amend- 2 ed— 3 (A) in subparagraph (GG), by striking 4 ‘‘and’’ at the end; 5 (B) in subparagraph (HH), by striking the 6 period at the end and inserting ‘‘; and’’; and 7 (C) by adding at the end the following new 8 subparagraph: 9 ‘‘(II) dental and oral health services (as defined 10 in subsection (nnn));’’. 11 (2) DENTAL AND ORAL HEALTH SERVICES DE- 12 FINED.—Section 1861 of the Social Security Act (42 13 U.S.C. 1395x), as amended by sections 2007(b) and 14 4221(a), is amended by adding at the end the fol- 15 lowing new subsection: 16 ‘‘Dental and Oral Health Services 17 ‘‘(nnn)(1) The term ‘dental and oral health services’ 18 means services (as defined by the Secretary) that are nec- 19 essary to prevent disease and promote oral health, restore 20 oral structures to health and function, and treat emer- 21 gency conditions, including— 22 ‘‘(A) routine diagnostic and preventive care 23 such as dental cleanings, exams, and x-rays; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00438 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 439 •S 4486 IS ‘‘(B) basic dental services such as fillings and 1 extractions; 2 ‘‘(C) major dental services such as root canals, 3 crowns, and dentures; 4 ‘‘(D) emergency dental care; and 5 ‘‘(E) other necessary services related to dental 6 and oral health (as defined by the Secretary). 7 ‘‘(2) For purposes of paragraph (1), such term shall 8 include mobile and portable oral health services (as de- 9 fined by the Secretary) that— 10 ‘‘(A) are provided for the purpose of over- 11 coming mobility, transportation, and access barriers 12 for individuals; and 13 ‘‘(B) satisfy the standards and certification re- 14 quirements established under section 1902(a)(82)(B) 15 for the State in which the services are provided.’’. 16 (3) PAYMENT AND COINSURANCE.—Section 17 1833(a)(1) of the Social Security Act (42 U.S.C. 18 1395l(a)(1)) is amended— 19 (A) by striking ‘‘and’’ before ‘‘(DD)’’; and 20 (B) by inserting before the semicolon at 21 the end the following: ‘‘and (EE) with respect 22 to dental and oral health services (as defined in 23 section 1861(nnn)), the amount paid shall be 24 (i) in the case of such services that are preven- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00439 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 440 •S 4486 IS tive, 100 percent of the lesser of the actual 1 charge for the services or the amount deter- 2 mined under the payment basis determined 3 under section 1848, and (ii) in the case of all 4 other such services, 80 percent of the lesser of 5 the actual charge for the services or the amount 6 determined under the payment basis determined 7 under section 1848’’. 8 (4) PAYMENT UNDER PHYSICIAN FEE SCHED- 9 ULE.—Section 1848(j)(3) of the Social Security Act 10 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 11 ‘‘, (2)(II),’’ after ‘‘(including administration of the 12 health risk assessment)’’. 13 (5) DENTURES.—Section 1861(s)(8) of the So- 14 cial Security Act (42 U.S.C. 1395x(s)(8)) is amend- 15 ed— 16 (A) by striking ‘‘(other than dental)’’ and 17 inserting ‘‘(including dentures)’’; and 18 (B) by striking ‘‘internal body’’. 19 (6) REPEAL OF GROUND FOR EXCLUSION.— 20 Section 1862(a) of the Social Security Act (42 21 U.S.C. 1395y) is amended by striking paragraph 22 (12). 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00440 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 441 •S 4486 IS (7) EFFECTIVE DATE.—The amendments made 1 by this section shall apply to services furnished on 2 or after January 1, 2023. 3 (d) REQUIRING COVERAGE OF DENTAL SERVICES 4 FOR ADULTS UNDER THE MEDICAID PROGRAM.— 5 (1) MANDATORY COVERAGE.— 6 (A) IN GENERAL.— 7 (i) REQUIREMENT.—Section 8 1902(a)(10)(A) of the Social Security Act 9 (42 U.S.C. 1396a(a)(10)(A)) is amended 10 by inserting ‘‘, (10)’’ after ‘‘(5)’’. 11 (ii) EFFECTIVE DATE.—The amend- 12 ment made by clause (i) shall apply with 13 respect to medical assistance furnished in 14 calendar quarters beginning on or after the 15 date that is 1 year after the date of the en- 16 actment of this Act. 17 (B) BENCHMARK COVERAGE.—Section 18 1937(b)(5) of the Social Security Act (42 19 U.S.C. 1396u–7(b)(5)) is amended by striking 20 the period and inserting ‘‘, and, beginning with 21 the first quarter beginning on or after the date 22 of the enactment of the Health Equity and Ac- 23 countability Act of 2022, coverage of dental and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00441 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 442 •S 4486 IS oral health services (as defined in section 1 1905(kk)).’’. 2 (2) DEFINITION OF SERVICES.—Section 1905 3 of the Social Security Act (42 U.S.C. 1396d), as 4 amended by section 4107, is further amended— 5 (A) in subsection (a)(10), by striking ‘‘den- 6 tal services’’ and inserting ‘‘dental and oral 7 health services (as defined in subsection 8 (kk)(1))’’; and 9 (B) by adding at the end the following new 10 subsection: 11 ‘‘(kk) DENTAL AND ORAL HEALTH SERVICES.—(1) 12 For purposes of this title, the term ‘dental and oral health 13 services’ means services necessary to prevent disease and 14 promote oral health, restore oral structures to health and 15 function, reduce oral pain, and treat emergency oral condi- 16 tions. Such term includes the services specified in para- 17 graph (2). 18 ‘‘(2) For purposes of paragraph (1), the services 19 specified in this paragraph are the following: 20 ‘‘(A) Routine diagnostic and preventive care 21 (such as dental cleanings, exams, and x-rays). 22 ‘‘(B) Basic dental services (such as fillings and 23 extractions) and major dental services (such as root 24 canals, crowns, and dentures). 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00442 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 443 •S 4486 IS ‘‘(C) Emergency dental care. 1 ‘‘(D) Temporomandibular (TMD) and orofacial 2 pain disorder treatment. 3 ‘‘(E) Other necessary services related to dental 4 and oral health (as specified by the Secretary).’’. 5 ‘‘(3) For purposes of paragraph (1), such term shall 6 not include dental care or services provided to individuals 7 under the age of 21 under subsection (r)(3).’’. 8 (3) CONFORMING AMENDMENTS.— 9 (A) STATE PLAN REQUIREMENTS.—Section 10 1902(a) of the Social Security Act (42 U.S.C. 11 1396a(a)) is amended— 12 (i) in paragraph (10)(A), in the mat- 13 ter preceding clause (i), by inserting 14 ‘‘(10),’’ after ‘‘(5),’’; 15 (ii) in paragraph (86), by striking 16 ‘‘and’’ at the end; 17 (iii) in paragraph (87), by striking the 18 period at the end and inserting ‘‘; and’’; 19 and 20 (iv) by inserting after paragraph (87) 21 the following: 22 ‘‘(88) provide for— 23 ‘‘(A) informing, in writing, all individuals 24 who have been determined to be eligible for 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00443 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 444 •S 4486 IS medical assistance of the availability of dental 1 and oral health services (as defined in section 2 1905(kk)); 3 ‘‘(B) conducting targeted outreach to preg- 4 nant women who have been determined to be el- 5 igible for medical assistance about the avail- 6 ability of medical assistance for such dental 7 services and the importance of receiving dental 8 care while pregnant; and 9 ‘‘(C) establishing and maintaining stand- 10 ards for and certification of mobile and portable 11 oral health services (as described in section 12 1905(r)(3)(C)).’’. 13 (B) DEFINITION OF MEDICAL ASSIST- 14 ANCE.—Section 1905(a)(12) of the Social Secu- 15 rity Act (42 U.S.C. 1396d(a)(12)) is amended 16 by striking ‘‘, dentures,’’. 17 (4) MOBILE AND PORTABLE ORAL HEALTH 18 SERVICES UNDER EPSDT.—Section 1905(r)(3) of the 19 Social Security Act (42 U.S.C. 1396d(r)(3)) is 20 amended— 21 (A) in subparagraph (A)(ii), by striking ‘‘; 22 and’’ and inserting a semicolon; 23 (B) in subparagraph (B), by striking the 24 period at the end and inserting ‘‘; and’’; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00444 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 445 •S 4486 IS (C) by adding at the end the following new 1 subparagraph: 2 ‘‘(C) which shall include mobile and port- 3 able oral health services (as defined by the Sec- 4 retary) that— 5 ‘‘(i) are provided for the purpose of 6 overcoming mobility, transportation, or ac- 7 cess barriers for children; and 8 ‘‘(ii) satisfy the standards and certifi- 9 cation requirements established under sec- 10 tion 1902(a)(88)(C) for the State in which 11 the services are provided.’’. 12 (5) ENHANCED FMAP; MAINTENANCE OF EF- 13 FORT.— 14 (A) MEDICAID.—Section 1905 of the So- 15 cial Security Act (42 U.S.C. 1396d), as amend- 16 ed by paragraph (2), is further amended— 17 (i) in subsection (b), by striking ‘‘and 18 (ii)’’ and inserting ‘‘(ii), and (ll)’’; and 19 (ii) by adding at the end of the fol- 20 lowing new subsection: 21 ‘‘(ll) INCREASED FMAP FOR EXPENDITURES FOR 22 DENTAL AND ORAL HEALTH SERVICES.— 23 ‘‘(1) IN GENERAL.—The Federal medical assist- 24 ance percentage with respect to amounts expended 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00445 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 446 •S 4486 IS by such State for medical assistance consisting of 1 dental and oral health services (as defined in sub- 2 section (kk)) furnished during the first calendar 3 quarter beginning on or after the date that is 1 year 4 after the date of the enactment of this subsection or 5 during any subsequent quarter) to individuals 21 6 years of age or older shall be equal to, in the case 7 of such services furnished— 8 ‘‘(A) during the 3-year period beginning on 9 the first day of such first calendar year, 100 10 percent; 11 ‘‘(B) during the 1-year period immediately 12 following the period described in subparagraph 13 (A), 95 percent; 14 ‘‘(C) during each subsequent 1-year period 15 (through the third such subsequent period), the 16 percentage specified under this paragraph for 17 the preceding 1-year period, reduced by 5 per- 18 centage points; and 19 ‘‘(D) during any quarter beginning after 20 the 7-year period beginning on the first day de- 21 scribed in subparagraph (A), 80 percent. 22 ‘‘(2) NO REDUCTION IN FMAP.—Paragraph (1) 23 shall not apply with respect to amounts expended by 24 a State if the Federal medical assistance percentage 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00446 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 447 •S 4486 IS otherwise applicable to such amounts without appli- 1 cation of such paragraph would be higher than such 2 percentage available to such amounts with applica- 3 tion of such paragraph.’’. 4 (6) EXCLUSION OF AMOUNTS ATTRIBUTABLE 5 TO INCREASED FMAP FROM TERRITORIAL CAPS.— 6 Section 1108 of the Social Security Act (42 U.S.C. 7 1308), as amended by section 4101(a), is amend- 8 ed— 9 (A) in subsection (f), in the matter pre- 10 ceding paragraph (1), by striking ‘‘subsections 11 (g), (h), and (i)’’; and 12 (B) by adding at the end the following: 13 ‘‘(j) EXCLUSION FROM CAPS OF AMOUNTS ATTRIB- 14 UTABLE TO INCREASED FMAP FOR COVERAGE OF DEN- 15 TAL AND ORAL SERVICES.—Any payment made to a terri- 16 tory for expenditures for medical assistance that are sub- 17 ject to an increase in the Federal medical assistance per- 18 centage applicable to such expenditures under section 19 1905(ll) shall not be taken into account for purposes of 20 applying payment limits under subsections (f) and (g) to 21 the extent that such payment exceeds the amount of the 22 payment that would have been made to the territory for 23 such expenditures without regard to such section.’’. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00447 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 448 •S 4486 IS (e) ORAL HEALTH SERVICES AS AN ESSENTIAL 1 HEALTH BENEFIT.—Section 1302(b) of the Patient Pro- 2 tection and Affordable Care Act (42 U.S.C. 18022(b)), as 3 amended by section 2013(a), is further amended— 4 (1) in paragraph (1)— 5 (A) in subparagraph (J), by striking ‘‘oral 6 and’’; and 7 (B) by adding at the end the following: 8 ‘‘(K) Oral health services for children and 9 adults.’’; and 10 (2) by adding at the end the following: 11 ‘‘(6) ORAL HEALTH SERVICES.—For purposes 12 of paragraph (1)(K), the term ‘oral health services’ 13 means services (as defined by the Secretary) that 14 are necessary to prevent any oral disease and pro- 15 mote oral health, restore oral structures to health 16 and function, and treat emergency oral conditions.’’. 17 (f) DEMONSTRATION PROGRAM ON TRAINING AND 18 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 19 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR 20 VETERANS IN RURAL AND OTHER UNDERSERVED COM- 21 MUNITIES.— 22 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 23 The Secretary of Veterans Affairs may carry out a 24 demonstration program to establish programs to 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00448 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 449 •S 4486 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 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00449 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 450 •S 4486 IS (g) DEMONSTRATION PROGRAM ON TRAINING AND 1 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 2 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR 3 MEMBERS OF THE ARMED FORCES AND DEPENDENTS 4 LACKING READY ACCESS TO SUCH SERVICES.— 5 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 6 The Secretary of Defense may carry out a dem- 7 onstration program to establish programs to train 8 and employ alternative dental health care providers 9 in order to increase access to dental health care 10 services for members of the Armed Forces and their 11 dependents who lack ready access to such services, 12 including the following: 13 (A) Members and dependents who reside in 14 rural areas or areas otherwise underserved by 15 dental health care providers. 16 (B) Members of a reserve component of 17 the Armed Forces in active status who are po- 18 tentially deployable. 19 (2) TELEHEALTH.—For purposes of alternative 20 dental health care providers and other dental care 21 providers who are licensed to provide clinical care, 22 dental services provided under the demonstration 23 program under this subsection may be administered 24 by such providers through telehealth-enabled collabo- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00450 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 451 •S 4486 IS ration and supervision when appropriate and fea- 1 sible. 2 (3) DEFINITIONS.—In this subsection: 3 (A) ACTIVE STATUS.—The term ‘‘active 4 status’’ has the meaning given that term in sec- 5 tion 101(d) of title 10, United States Code. 6 (B) ALTERNATIVE DENTAL HEALTH CARE 7 PROVIDERS.—The term ‘‘alternative dental 8 health care providers’’ has the meaning given 9 that term in section 340G–1(a)(2) of the Public 10 Health Service Act (42 U.S.C. 256g–1(a)(2)). 11 (4) AUTHORIZATION OF APPROPRIATIONS.— 12 There are authorized to be appropriated such sums 13 as are necessary to carry out the demonstration pro- 14 gram under this subsection. 15 (h) DEMONSTRATION PROGRAM ON TRAINING AND 16 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 17 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR 18 PRISONERS WITHIN THE CUSTODY OF THE BUREAU OF 19 PRISONS.— 20 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 21 The Attorney General, acting through the Director 22 of the Bureau of Prisons, may carry out a dem- 23 onstration program to establish programs to train 24 and employ alternative dental health care providers 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00451 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 452 •S 4486 IS in order to increase access to dental health services 1 for prisoners within the custody of the Bureau of 2 Prisons. 3 (2) TELEHEALTH.—For purposes of alternative 4 dental health care providers and other dental care 5 providers who are licensed to provide clinical care, 6 dental services provided under the demonstration 7 program under this subsection may be administered 8 by such providers through telehealth-enabled collabo- 9 ration and supervision when appropriate and fea- 10 sible. 11 (3) ALTERNATIVE DENTAL HEALTH CARE PRO- 12 VIDERS DEFINED.—In this subsection, the term ‘‘al- 13 ternative dental health care providers’’ has the 14 meaning given that term in section 340G–1(a)(2) of 15 the Public Health Service Act (42 U.S.C. 256g– 16 1(a)(2)). 17 (4) AUTHORIZATION OF APPROPRIATIONS.— 18 There are authorized to be appropriated such sums 19 as are necessary to carry out the demonstration pro- 20 gram under this subsection. 21 (i) DEMONSTRATION PROGRAM ON TRAINING AND 22 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 23 PROVIDERS FOR DENTAL HEALTH CARE SERVICES 24 UNDER THE INDIAN HEALTH SERVICE.— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00452 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 453 •S 4486 IS (1) DEMONSTRATION PROGRAM AUTHORIZED.— 1 The Secretary of Health and Human Services, act- 2 ing through the Indian Health Service, may carry 3 out a demonstration program to establish programs 4 to train and employ alternative dental health care 5 providers in order to help eliminate oral health dis- 6 parities and increase access to dental services 7 through health programs operated by the Indian 8 Health Service, Indian tribes, tribal organizations, 9 and Urban Indian organizations. 10 (2) TELEHEALTH.—For purposes of alternative 11 dental health care providers and other dental care 12 providers who are licensed to provide clinical care, 13 dental services provided under the demonstration 14 program under this subsection may be administered 15 by such providers through telehealth-enabled collabo- 16 ration and supervision when appropriate and fea- 17 sible. 18 (3) DEFINITIONS.—In this subsection: 19 (A) ALTERNATIVE DENTAL HEALTH CARE 20 PROVIDERS DEFINED.—The term ‘‘alternative 21 dental health care providers’’ has the meaning 22 given that term in section 340G–1(a)(2) of the 23 Public Health Service Act (42 U.S.C. 256g– 24 1(a)(2)). 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00453 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 454 •S 4486 IS (B) INDIAN HEALTH CARE IMPROVEMENT 1 ACT.—The terms ‘‘Indian tribe’’, ‘‘tribal organi- 2 zation’’, and ‘‘Urban Indian organization’’ have 3 the meaning given the terms in section 4 of the 4 Indian Health Care Improvement Act (25 5 U.S.C. 1603). 6 (4) AUTHORIZATION OF APPROPRIATIONS.— 7 There are authorized to be appropriated such sums 8 as are necessary to carry out the demonstration pro- 9 gram under this subsection. 10 SEC. 4252. ORAL HEALTH LITERACY AND AWARENESS CAM- 11 PAIGN. 12 The Public Health Service Act is amended by insert- 13 ing after section 340G–1 of such Act (42 U.S.C. 256g– 14 1) the following: 15 ‘‘SEC. 340G–2. ORAL HEALTH LITERACY AND AWARENESS. 16 ‘‘(a) CAMPAIGN.—The Secretary, acting through the 17 Administrator of the Health Resources and Services Ad- 18 ministration, shall establish a public education campaign 19 (referred to in this subsection as the ‘campaign’) across 20 all relevant programs of the Health Resources and Serv- 21 ices Administration (including the health center program, 22 oral health workforce programs, maternal and child health 23 programs, the Ryan White HIV/AIDS Program, and rural 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00454 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 455 •S 4486 IS health programs) to increase oral health literacy and 1 awareness. 2 ‘‘(b) STRATEGIES.—In carrying out the campaign, 3 the Secretary shall identify oral health literacy and aware- 4 ness strategies that are evidence based and focused on oral 5 health care education, including education on prevention 6 of oral disease such as early childhood and other caries, 7 periodontal disease, and oral cancer. 8 ‘‘(c) FOCUS.—The Secretary shall design the cam- 9 paign to communicate directly with specific populations, 10 including children, pregnant women, parents, the elderly, 11 individuals with disabilities, and ethnic and racial minority 12 populations, including Indians, Alaska Natives, and Na- 13 tive Hawaiians, in a culturally and linguistically appro- 14 priate manner. 15 ‘‘(d) OUTCOMES.—In carrying out the campaign, the 16 Secretary shall include a process for measuring outcomes 17 and effectiveness. 18 ‘‘(e) REPORT TO CONGRESS.—Not later than 3 years 19 after the date of enactment of this section, the Secretary 20 shall submit to the Committee on Energy and Commerce 21 of the House of Representatives and the Committee on 22 Health, Education, Labor, and Pensions of the Senate a 23 report on the outcomes and effectiveness of the campaign. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00455 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 456 •S 4486 IS ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To 1 carry out this section, there is authorized to be appro- 2 priated $750,000 for each of fiscal years 2023 through 3 2027.’’. 4 Subtitle D—Advancing Health Eq- 5 uity Through Payment and De- 6 livery Reform 7 SEC. 4301. SENSE OF CONGRESS. 8 It is the sense of Congress that— 9 (1) the sustainability of the health care system 10 in the United States hinges on restructuring how 11 health care is paid for, shifting away from paying 12 for the volume of services provided to the value the 13 services provide; 14 (2) high value care is care that provides higher 15 quality care more efficiently, achieving greater 16 health improvement and better health outcomes at 17 lower cost (per patient and overall); 18 (3) a high value health care system must deliver 19 timely, accessible, well-coordinated, high-quality, cul- 20 turally centered, and language-appropriate care to 21 everyone; 22 (4) eliminating health and health care dispari- 23 ties and achieving health equity must be central to 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00456 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 457 •S 4486 IS and required in efforts to achieve a high value health 1 care system; 2 (5) eliminating such disparities and achieving 3 such equity will require tailored interventions and 4 targeted investments to address inequities in health 5 and health care to make sure that health care deliv- 6 ery and payment efforts are responsive to and inclu- 7 sive of the needs of communities of color and other 8 communities experiencing disparities; and 9 (6) new models of value-based payment and 10 care delivery should prioritize primary care and con- 11 sider the holistic needs of and other factors with re- 12 spect to the patient population, including with re- 13 spect to behavioral health, oral health, end-of-life 14 care, history of adverse childhood experiences and 15 adverse community environments, social deter- 16 minants of health, social risk factors, unmet social 17 needs, and the burden of intergenerational racial 18 and other inequities. 19 SEC. 4302. CENTERS FOR MEDICARE & MEDICAID SERVICES 20 REPORTING AND VALUE-BASED PROGRAMS. 21 (a) ADVANCING HEALTH EQUITY IN REPORTING AND 22 VALUE-BASED PAYMENT PROGRAMS.— 23 (1) IN GENERAL.—The Administrator of the 24 Centers for Medicare & Medicaid Services (in this 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00457 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 458 •S 4486 IS section referred to as the ‘‘Administrator’’) shall re- 1 quire that a clinician or other professional partici- 2 pating in any pay-for-reporting or value-based pay- 3 ment program stratify clinical quality measures by 4 disparity variables, including race, ethnicity, sex, pri- 5 mary language, disability status, sexual orientation, 6 gender identity, and socioeconomic status. A clini- 7 cian or other professional may use existing demo- 8 graphic data collection fields in certified electronic 9 health record technology (as defined in section 10 1848(o)(4) of the Social Security Act (42 U.S.C. 11 1395w–4(o)(4))) to carry out such data stratifica- 12 tion under the preceding sentence. Such stratified 13 data will assist clinicians and other professionals in 14 the identification of disparities obscured in aggre- 15 gated data and assist with the provision of interven- 16 tions that target reducing those disparities. 17 (2) CLINICIAN.—In assessing performance in 18 any value-based payment program, the Adminis- 19 trator shall incorporate a clinician or other profes- 20 sional’s performance in reducing disparities across 21 race, ethnicity, sex, primary language, disability sta- 22 tus, sexual orientation, gender identity, and socio- 23 economic status. Linking performance payments to 24 the reduction of health care disparities across such 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00458 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 459 •S 4486 IS variables will assist in holding clinicians and other 1 professionals accountable for providing quality care 2 that can lead to decreased health inequities. 3 (3) REQUIREMENT OF ADOPTION OF CERT.—All 4 entities, clinicians, or other professionals partici- 5 pating in the Quality Payment Program of the Cen- 6 ters for Medicare & Medicaid Services shall be re- 7 quired to adopt 2015 certified electronic health 8 record technology (as so defined) as a condition of 9 participating in such program. 10 (b) QUALITY IMPROVEMENT ACTIVITIES.—The Ad- 11 ministrator, upon yearly review of the Quality Payment 12 Program, shall add quality improvement activities that im- 13 plement the Culturally and Linguistically Accessible 14 Standards (CLAS) as Improvement Activities under the 15 Quality Payment Program. 16 SEC. 4303. DEVELOPMENT AND TESTING OF DISPARITY RE- 17 DUCING DELIVERY AND PAYMENT MODELS. 18 (a) IN GENERAL.—The Center for Medicare and 19 Medicaid Innovation established under section 1115A of 20 the Social Security Act (42 U.S.C. 1315a) (in this section 21 referred to as the ‘‘CMI’’) shall establish a dedicated fund 22 to identify, test, evaluate, and scale delivery and payment 23 models under the applicable titles (as defined in subsection 24 (a)(4)(B) of such section) that target health disparities 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00459 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 460 •S 4486 IS among racial and ethnic minorities, including models that 1 support high-value nonmedical services that address so- 2 cially determined barriers to health in all stages of the 3 life cycle through end-of-life, including English proficiency 4 status, low health and health care literacy, lack of access 5 to health care planning, including end-of-life care plan- 6 ning, case management, transportation, enrollment assist- 7 ance needs, stable and affordable housing, utility assist- 8 ance, employment and career development, and nutrition 9 and food security which will help to reduce disparities and 10 impact the overall cost of care. 11 (b) AMENDMENT TO SOCIAL SECURITY ACT.—The 12 second sentence of section 1115A(a)(1) of the Social Secu- 13 rity Act (42 U.S.C. 1315a(a)(1)) is amended by inserting 14 ‘‘and improve health equity’’ after ‘‘expenditures’’. 15 (c) PILOT PROGRAMS.—The CMI shall prioritize the 16 testing of models under such section 1115A that include 17 partnerships with entities, including community-based or- 18 ganizations or other nonprofit entities, to help address so- 19 cially determined barriers to health and health care. 20 (d) ALTERNATIVES.—Any model tested by the CMI 21 under such 1115A shall include measures to assess and 22 track the impact of the model on health disparities, using 23 existing measures such as the Healthcare Disparities and 24 Cultural Competency Measures endorsed by the entity 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00460 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 461 •S 4486 IS with a contract under section 1890(a) of the Social Secu- 1 rity Act (42 U.S.C. 1395aaa(a)), and stratified by race, 2 ethnicity, English proficiency, gender identity, sexual ori- 3 entation, and disability status. 4 SEC. 4304. DIVERSITY IN CENTERS FOR MEDICARE AND 5 MEDICAID CONSULTATION. 6 (a) IN GENERAL.—In carrying out the duties under 7 this section, the CMI shall consult representatives of rel- 8 evant Federal agencies, and clinical and analytical experts 9 with expertise in medicine and health care management, 10 specifically such experts with expertise in— 11 (1) the health care needs of minority, rural, and 12 underserved populations; and 13 (2) the financial needs of safety net, commu- 14 nity-based, rural, and critical access providers, in- 15 cluding federally qualified health centers. 16 (b) OPEN DOOR FORUMS.—The CMI shall use open 17 door forums or other mechanisms to seek external feed- 18 back from interested parties and incorporate that feedback 19 into the development of models. 20 SEC. 4305. SUPPORTING SAFETY NET AND COMMUNITY- 21 BASED PROVIDERS TO COMPETE IN VALUE- 22 BASED PAYMENT SYSTEMS. 23 (a) IN GENERAL.—Any pay-for-performance or alter- 24 native payment model that is developed and tested by the 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00461 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 462 •S 4486 IS Center for Medicare and Medicaid Innovation established 1 under section 1115A of the Social Security Act (42 U.S.C. 2 1315a), or any other agency of the Department of Health 3 and Human Services with respect to the programs under 4 titles XVIII, XIX, or XXI of such Act, shall be assessed 5 for potential impact on safety net, community-based, and 6 critical access providers, including Federally qualified 7 health centers. 8 (b) NEW MODELS.—The rollout of any such models 9 shall include training and additional up front resources for 10 community-based and safety net providers to enable those 11 providers to participate in the model. 12 Subtitle E—Health Empowerment 13 Zones 14 SEC. 4401. DESIGNATION OF HEALTH EMPOWERMENT 15 ZONES. 16 (a) IN GENERAL.—The Secretary may, at the request 17 of an eligible community partnership described in sub- 18 section (b)(1), designate an eligible area described in sub- 19 section (b)(2) as a health empowerment zone for the pur- 20 pose of eligibility for a grant under section 4402. 21 (b) ELIGIBILITY CRITERIA.— 22 (1) ELIGIBLE COMMUNITY PARTNERSHIP.—A 23 community partnership is eligible to submit a re- 24 quest under this section if the partnership— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00462 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 463 •S 4486 IS (A) demonstrates widespread public sup- 1 port from key individuals and entities in the eli- 2 gible area, including members of the target 3 community, State and local governments, non- 4 profit organizations including national and re- 5 gional intermediaries with demonstrated capac- 6 ity to serve low-income urban communities, and 7 community and industry leaders, for designa- 8 tion of the eligible area as a health empower- 9 ment zone; and 10 (B) includes representatives of— 11 (i) a broad cross-section of stake- 12 holders and residents from communities in 13 the eligible area experiencing dispropor- 14 tionate disparities in health status and 15 health care; and 16 (ii) organizations, facilities, and insti- 17 tutions that have a history of working 18 within and serving such communities. 19 (2) ELIGIBLE AREA.—An area is eligible to be 20 designated as a health empowerment zone under this 21 section if one or more communities in the area expe- 22 rience disproportionate disparities in health status 23 and health care. In determining whether a commu- 24 nity experiences such disparities, the Secretary shall 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00463 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 464 •S 4486 IS consider data collected by the Department of Health 1 and Human Services focusing on the following areas: 2 (A) Access to affordable, high-quality 3 health care services. 4 (B) The prevalence of disproportionate 5 rates of certain illnesses or diseases including 6 the following: 7 (i) Arthritis, osteoporosis, chronic 8 back conditions, and other musculoskeletal 9 diseases. 10 (ii) Cancer. 11 (iii) Chronic kidney disease. 12 (iv) Diabetes. 13 (v) Injury (intentional and uninten- 14 tional). 15 (vi) Violence (intimate and non- 16 intimate). 17 (vii) Maternal and paternal illnesses 18 and diseases. 19 (viii) Infant mortality. 20 (ix) Mental illness and other disabil- 21 ities. 22 (x) Substance use disorder treatment 23 and prevention, including underage drink- 24 ing. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00464 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 465 •S 4486 IS (xi) Nutrition, obesity, and overweight 1 conditions. 2 (xii) Heart disease. 3 (xiii) Hypertension. 4 (xiv) Cerebrovascular disease or 5 stroke. 6 (xv) Tuberculosis. 7 (xvi) HIV/AIDS and other sexually 8 transmitted infections. 9 (xvii) Viral hepatitis. 10 (xviii) Asthma. 11 (xix) Tooth decay and other oral 12 health issues. 13 (C) Within the community, the historical 14 and persistent presence of conditions that have 15 been found to contribute to health disparities 16 including any such conditions respecting any of 17 the following: 18 (i) Poverty. 19 (ii) Educational status and the quality 20 of community schools. 21 (iii) Income. 22 (iv) Access to high-quality affordable 23 health care. 24 (v) Work and work environment. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00465 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 466 •S 4486 IS (vi) Environmental conditions in the 1 community, including with respect to clean 2 water, clean air, and the presence or ab- 3 sence of pollutants. 4 (vii) Language and English pro- 5 ficiency. 6 (viii) Access to affordable healthy 7 food. 8 (ix) Access to ethnically and culturally 9 diverse health and human service providers 10 and practitioners. 11 (x) Access to culturally and linguis- 12 tically competent health and human serv- 13 ices and health and human service pro- 14 viders. 15 (xi) Health-supporting infrastructure. 16 (xii) Health insurance that is ade- 17 quate and affordable. 18 (xiii) Race, racism, and bigotry (con- 19 scious and unconscious). 20 (xiv) Sexual orientation. 21 (xv) Health and health care literacy. 22 (xvi) Place of residence (such as 23 urban areas, rural areas, and reservations 24 of Indian Tribes). 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00466 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 467 •S 4486 IS (xvii) Stress. 1 (c) PROCEDURE.— 2 (1) REQUEST.—A request under subsection (a) 3 shall— 4 (A) describe the bounds of the area to be 5 designated as a health empowerment zone and 6 the process used to select those bounds; 7 (B) demonstrate that the partnership sub- 8 mitting the request is an eligible community 9 partnership described in subsection (b)(1); 10 (C) demonstrate that the area is an eligible 11 area described in subsection (b)(2); 12 (D) include a comprehensive assessment of 13 disparities in health status and health care ex- 14 perience by one or more communities in the 15 area; 16 (E) set forth— 17 (i) a vision and a set of values for the 18 area; and 19 (ii) a comprehensive and holistic set of 20 goals to be achieved in the area through 21 designation as a health empowerment zone; 22 and 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00467 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 468 •S 4486 IS (F) include a strategic plan and an action 1 plan for achieving the goals described in sub- 2 paragraph (E)(ii). 3 (2) APPROVAL.—Not later than 60 days after 4 the receipt of a request for designation of an area 5 as a health empowerment zone under this section, 6 the Secretary shall approve or disapprove the re- 7 quest. 8 (d) MINIMUM NUMBER.—The Secretary— 9 (1) shall designate not more than 110 health 10 empowerment zones under this section; and 11 (2) of such zones designated under paragraph 12 (1), shall designate at least one health empowerment 13 zone in each of the several States, the District of 14 Columbia, and each territory or possession of the 15 United States. 16 SEC. 4402. ASSISTANCE TO THOSE SEEKING DESIGNATION. 17 At the request of any organization or entity seeking 18 to submit a request under section 4401(a), the Secretary 19 shall provide technical assistance, and may award a grant, 20 to assist such organization or entity— 21 (1) to form an eligible community partnership 22 described in section 4401(b)(1); 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00468 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 469 •S 4486 IS (2) to complete a health assessment, including 1 an assessment of health disparities under section 2 4401(c)(1)(D); or 3 (3) to prepare and submit a request, including 4 a strategic plan, in accordance with section 4401. 5 SEC. 4403. BENEFITS OF DESIGNATION. 6 (a) PRIORITY.—In awarding a grant under sub- 7 section (b), a Federal official shall give priority to any ap- 8 plicant that— 9 (1) meets the eligibility criteria for the grant; 10 (2) proposes to use the grant for activities in a 11 health empowerment zone; and 12 (3) demonstrates that such activities will di- 13 rectly and significantly further the goals of the stra- 14 tegic plan approved for such zone under section 15 4401. 16 (b) GRANTS FOR INITIAL IMPLEMENTATION OF 17 STRATEGIC PLAN.— 18 (1) IN GENERAL.—Upon designating an eligible 19 area as a health empowerment zone at the request 20 of an eligible community partnership, the Secretary 21 shall, subject to the availability of appropriations, 22 make a grant to the community partnership for im- 23 plementation of the strategic plan for such zone. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00469 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 470 •S 4486 IS (2) GRANT PERIOD.—A grant under paragraph 1 (1) for a health empowerment zone shall be for a pe- 2 riod of 2 years and may be renewed, except that the 3 total period of grants under paragraph (1) for such 4 zone may not exceed 10 years. 5 (3) LIMITATION.—In awarding grants under 6 this subsection, the Secretary shall not give less pri- 7 ority to an applicant or reduce the amount of a 8 grant because the Secretary rendered technical as- 9 sistance or made a grant to the same applicant 10 under section 4401. 11 (4) REPORTING.—The Secretary shall establish 12 metrics for measuring the progress of grantees 13 under this subsection and, based on such metrics, 14 require each such grantee to report to the Secretary 15 not less than every 6 months on the progress in im- 16 plementing the strategic plan for the health em- 17 powerment zone. 18 SEC. 4404. DEFINITION OF SECRETARY. 19 In this subtitle, the term ‘‘Secretary’’ means the Sec- 20 retary of Health and Human Services, acting through the 21 Administrator of the Health Resources and Services Ad- 22 ministration and the Deputy Assistant Secretary for Mi- 23 nority Health, and in cooperation with the Director of the 24 Office of Community Services and the Director of the Na- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00470 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 471 •S 4486 IS tional Institute on Minority Health and Health Dispari- 1 ties. 2 SEC. 4405. AUTHORIZATION OF APPROPRIATIONS. 3 To carry out this subtitle, there is authorized to be 4 appropriated $100,000,000 for fiscal year 2023. 5 Subtitle F—Equitable Health Care 6 for All 7 SEC. 4501. FINDINGS. 8 Congress finds the following: 9 (1) In 1966, Dr. Martin Luther King, Jr., said 10 ‘‘Of all the forms of inequality, injustice in health 11 care is the most shocking and inhuman because it 12 often results in physical death.’’. 13 (2) Inequity in health care remains a persistent 14 and devastating reality for many communities, and, 15 in particular, communities of color. 16 (3) The provision of inequitable health care has 17 complex causes, many stemming from systemic in- 18 equality in access to health care, housing, nutrition, 19 economic opportunity, education, and other factors. 20 (4) Health care outcomes for Black commu- 21 nities in particular lag far behind those of the popu- 22 lation as a whole. 23 (5) Dr. Anthony Fauci, Director of the Na- 24 tional Institute of Allergy and Infectious Diseases, 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00471 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 472 •S 4486 IS said on April 7, 2020, the coronavirus outbreak is 1 ‘‘shining a bright light’’ on ‘‘unacceptable’’ health 2 disparities in the Black community. 3 (6) A contributing factor in health disparities is 4 explicit and implicit bias in the delivery of health 5 care, resulting in inferior care and poorer outcomes 6 for some patients on the basis of factors that include 7 race, national origin, sex (including sexual orienta- 8 tion or gender identity), disability, age, and religion. 9 (7) The National Academy of Medicine (for- 10 merly known as the ‘‘Institute of Medicine’’) issued 11 a report in 2002 titled ‘‘Unequal Treatment’’, find- 12 ing that racial and ethnic minorities receive lower- 13 quality health care than Whites do, even when insur- 14 ance status, income, age, and severity of condition is 15 comparable. 16 (8) Just as Congress has sought to eliminate 17 bias, both explicit and implicit, in employment, hous- 18 ing, and other parts of our society, the elimination 19 of bias and the legacy of structural racism in health 20 care is of paramount importance. 21 SEC. 4502. DATA COLLECTION AND REPORTING. 22 (a) REQUIRED REPORTING.— 23 (1) IN GENERAL.—The Secretary of Health and 24 Human Services, in consultation with the Director 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00472 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 473 •S 4486 IS for Civil Rights and Health Equity, the Director of 1 the National Institutes of Health, the Administrator 2 of the Centers for Medicare & Medicaid Services, the 3 Director of the Agency for Healthcare Research and 4 Quality, the Deputy Assistant Secretary for Minority 5 Health, and the Director of the Centers for Disease 6 Control and Prevention, shall by regulation require 7 all health care providers and facilities that are re- 8 quired under other provisions of law to report data 9 on specific health outcomes to the Department of 10 Health and Human Services in aggregate form, to 11 disaggregate such data by demographic characteris- 12 tics, including by race, national origin, sex (including 13 sexual orientation and gender identity), disability, 14 and age, as well as any other factor that the Sec- 15 retary of Health and Human Services determines 16 would be useful for determining a pattern of provi- 17 sion of inequitable health care. 18 (2) PROPOSED REGULATIONS.—Not later than 19 90 days after the date of enactment of this Act, the 20 Secretary of Health and Human Services shall issue 21 proposed regulations to carry out paragraph (1). 22 (b) REPOSITORY.—The Secretary of Health and 23 Human Services shall— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00473 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 474 •S 4486 IS (1) not later than 1 year after the date of en- 1 actment of this Act, establish a repository of the 2 disaggregated data reported pursuant to subsection 3 (a); 4 (2) subject to paragraph (3), make the data in 5 such repository publicly available; and 6 (3) ensure that such repository does not contain 7 any data that is individually identifiable. 8 SEC. 4503. REQUIRING EQUITABLE HEALTH CARE IN THE 9 HOSPITAL VALUE-BASED PURCHASING PRO- 10 GRAM. 11 (a) EQUITABLE HEALTH CARE AS VALUE MEASURE- 12 MENT.—Section 1886(b)(3)(B)(viii) of the Social Security 13 Act (42 U.S.C. 1395ww(b)(3)(B)(viii)) is amended by 14 adding at the end the following new subclause: 15 ‘‘(XIII)(aa) Effective for payments beginning with 16 fiscal year 2024, in expanding the number of measures 17 under subclause (III), the Secretary shall adopt measures 18 that relate to equitable health care furnished by hospitals 19 in inpatient settings. 20 ‘‘(bb) In carrying out this subclause, the Secretary 21 shall solicit input and recommendations from individuals 22 and groups representing communities of color and other 23 protected classes and ensure measures adopted pursuant 24 to this subclause account for social determinants of health, 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00474 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 475 •S 4486 IS as defined in section 4506(e)(10) of the Health Equity 1 and Accountability Act of 2022. 2 ‘‘(cc) For purposes of this subclause, the term ‘equi- 3 table health care’ refers to the principle that high-quality 4 care should be provided to all individuals and health care 5 treatment and services should not vary on account of the 6 real or perceived race, national origin, sex (including sex- 7 ual orientation and gender identity), disability, or age of 8 an individual, as well as any other factor that the Sec- 9 retary determines would be useful for determining a pat- 10 tern of provision of inequitable health care.’’. 11 (b) INCLUSION OF EQUITABLE HEALTH CARE MEAS- 12 URES.—Section 1886(o)(2)(B) of the Social Security Act 13 (42 U.S.C. 1395ww(o)(2)(B)) is amended by adding at the 14 end the following new clause: 15 ‘‘(iv) INCLUSION OF EQUITABLE 16 HEALTH CARE MEASURES.—Beginning in 17 fiscal year 2024, measures selected under 18 subparagraph (A) shall include the equi- 19 table health care measures described in 20 subsection (b)(3)(B)(viii)(XIII).’’. 21 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00475 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 476 •S 4486 IS SEC. 4504. PROVISION OF INEQUITABLE HEALTH CARE AS A 1 BASIS FOR PERMISSIVE EXCLUSION FROM 2 MEDICARE AND STATE HEALTH CARE PRO- 3 GRAMS. 4 Section 1128(b) of the Social Security Act (42 U.S.C. 5 1320a–7(b)) is amended by adding at the end the fol- 6 lowing new paragraph: 7 ‘‘(18) PROVISION OF INEQUITABLE HEALTH 8 CARE.— 9 ‘‘(A) IN GENERAL.—Subject to subpara- 10 graph (B), any health care provider that the 11 Secretary determines has engaged in a pattern 12 of providing inequitable health care (as defined 13 in section 4506(e)(7) of the Health Equity and 14 Accountability Act of 2022) on the basis of 15 race, national origin, sex (including sexual ori- 16 entation and gender identity), disability, or age 17 of an individual. 18 ‘‘(B) EXCEPTION.—For purposes of car- 19 rying out subparagraph (A), the Secretary shall 20 not exclude any health care provider from par- 21 ticipation in the Medicare program under title 22 XVIII of the Social Security Act or the Med- 23 icaid program under title XIX of such Act if 24 the exclusion of such health care provider would 25 result in increased difficulty in access to health 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00476 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 477 •S 4486 IS care services for underserved or low-income 1 communities.’’. 2 SEC. 4505. OFFICE FOR CIVIL RIGHTS AND HEALTH EQUITY 3 OF THE DEPARTMENT OF HEALTH AND 4 HUMAN SERVICES. 5 (a) NAME OF OFFICE.—Beginning on the date of en- 6 actment of this Act, the Office for Civil Rights of the De- 7 partment of Health and Human Services shall be known 8 as the ‘‘Office for Civil Rights and Health Equity’’ of the 9 Department of Health and Human Services. Any ref- 10 erence to the Office for Civil Rights of the Department 11 of Health and Human Services in any law, regulation, 12 map, document, record, or other paper of the United 13 States shall be deemed to be a reference to the Office for 14 Civil Rights and Health Equity. 15 (b) HEAD OF OFFICE.—The head of the Office for 16 Civil Rights and Health Equity shall be the Director for 17 Civil Rights and Health Equity, to be appointed by the 18 President. Any reference to the Director of the Office for 19 Civil Rights of the Department of Health and Human 20 Services in any law, regulation, map, document, record, 21 or other paper of the United States shall be deemed to 22 be a reference to the Director for Civil Rights and Health 23 Equity. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00477 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 478 •S 4486 IS SEC. 4506. PROHIBITING DISCRIMINATION IN HEALTH 1 CARE. 2 (a) PROHIBITING DISCRIMINATION.— 3 (1) IN GENERAL.—No health care provider 4 may, on the basis, in whole or in part, of race, sex 5 (including sexual orientation and gender identity), 6 disability, age, or religion, subject an individual to 7 the provision of inequitable health care. 8 (2) NOTICE OF PATIENT RIGHTS.—The Sec- 9 retary shall provide to each patient a notice of a pa- 10 tient’s rights under this section. 11 (b) ADMINISTRATIVE COMPLAINT AND CONCILIATION 12 PROCESS.— 13 (1) COMPLAINTS AND ANSWERS.— 14 (A) IN GENERAL.—An aggrieved person 15 may, not later than 1 year after an alleged vio- 16 lation of subsection (a) has occurred or con- 17 cluded, file a complaint with the Director alleg- 18 ing provision of inequitable health care by a 19 provider described in subsection (a). 20 (B) COMPLAINT.—A complaint submitted 21 pursuant to subparagraph (A) shall be in writ- 22 ing and shall contain such information and be 23 in such form as the Director requires. 24 (C) OATH OR AFFIRMATION.—The com- 25 plaint and any answer made under this sub- 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00478 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 479 •S 4486 IS section shall be made under oath or affirmation, 1 and may be reasonably and fairly modified at 2 any time. 3 (2) RESPONSE TO COMPLAINTS.— 4 (A) IN GENERAL.—Upon the filing of a 5 complaint under this subsection, the following 6 procedures shall apply: 7 (i) COMPLAINANT NOTICE.—The Di- 8 rector shall serve notice upon the com- 9 plainant acknowledging receipt of such fil- 10 ing and advising the complainant of the 11 time limits and procedures provided under 12 this section. 13 (ii) RESPONDENT NOTICE.—The Di- 14 rector shall, not later than 30 days after 15 receipt of such filing— 16 (I) serve on the respondent a no- 17 tice of the complaint, together with a 18 copy of the original complaint; and 19 (II) advise the respondent of the 20 procedural rights and obligations of 21 respondents under this section. 22 (iii) ANSWER.—The respondent may 23 file, not later than 60 days after receipt of 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00479 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 480 •S 4486 IS the notice from the Director, an answer to 1 such complaint. 2 (iv) INVESTIGATIVE DUTIES.—The Di- 3 rector shall— 4 (I) make an investigation of the 5 alleged provision of inequitable health 6 care; and 7 (II) complete such investigation 8 within 180 days (unless it is impracti- 9 cable to complete such investigation 10 within 180 days) after the filing of 11 the complaint. 12 (B) INVESTIGATIONS.— 13 (i) PATTERN OR PRACTICE.—In the 14 course of investigating the complaint, the 15 Director may seek records of care provided 16 to patients other than the complainant if 17 necessary to demonstrate or disprove an 18 allegation of provision of inequitable health 19 care or to determine whether there is a 20 pattern or practice of such care. 21 (ii) ACCOUNTING FOR SOCIAL DETER- 22 MINANTS OF HEALTH.—In investigating 23 the complaint and reaching a determina- 24 tion on the validity of the complaint, the 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00480 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 481 •S 4486 IS Director shall account for social deter- 1 minants of health and the effect of such 2 social determinants on health care out- 3 comes. 4 (iii) INABILITY TO COMPLETE INVES- 5 TIGATION.—If the Director is unable to 6 complete (or finds it is impracticable to 7 complete) the investigation within 180 8 days after the filing of the complaint (or, 9 if the Secretary takes further action under 10 paragraph (6)(B) with respect to a com- 11 plaint, within 180 days after the com- 12 mencement of such further action), the Di- 13 rector shall notify the complainant and re- 14 spondent in writing of the reasons in- 15 volved. 16 (iv) REPORT TO STATE LICENSING 17 AUTHORITIES.—On concluding each inves- 18 tigation under this subparagraph, the Di- 19 rector shall provide to the appropriate 20 State licensing authorities information 21 specifying the results of the investigation. 22 (C) REPORT.— 23 (i) FINAL REPORT.—On completing 24 each investigation under this paragraph, 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00481 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 482 •S 4486 IS the Director shall prepare a final investiga- 1 tive report. 2 (ii) MODIFICATION OF REPORT.—A 3 final report under this subparagraph may 4 be modified if additional evidence is later 5 discovered. 6 (3) CONCILIATION.— 7 (A) IN GENERAL.—During the period be- 8 ginning on the date on which a complaint is 9 filed under this subsection and ending on the 10 date of final disposition of such complaint (in- 11 cluding during an investigation under para- 12 graph (2)(B)), the Director shall, to the extent 13 feasible, engage in conciliation with respect to 14 such complaint. 15 (B) CONCILIATION AGREEMENT.—A con- 16 ciliation agreement arising out of such concilia- 17 tion shall be an agreement between the re- 18 spondent and the complainant, and shall be 19 subject to approval by the Director. 20 (C) RIGHTS PROTECTED.—The Director 21 shall approve a conciliation agreement only if 22 the agreement protects the rights of the com- 23 plainant and other persons similarly situated. 24 (D) PUBLICLY AVAILABLE AGREEMENT.— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00482 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 483 •S 4486 IS (i) IN GENERAL.—Subject to clause 1 (ii), the Secretary shall make available to 2 the public a copy of a conciliation agree- 3 ment entered into pursuant to this sub- 4 section unless the complainant and re- 5 spondent otherwise agree, and the Sec- 6 retary determines, that disclosure is not re- 7 quired to further the purposes of this sub- 8 section. 9 (ii) LIMITATION.—A conciliation 10 agreement that is made available to the 11 public pursuant to clause (i) may not dis- 12 close individually identifiable health infor- 13 mation. 14 (4) FAILURE TO COMPLY WITH CONCILIATION 15 AGREEMENT.—Whenever the Director has reason- 16 able cause to believe that a respondent has breached 17 a conciliation agreement, the Director shall refer the 18 matter to the Attorney General to consider filing a 19 civil action to enforce such agreement. 20 (5) WRITTEN CONSENT FOR DISCLOSURE OF 21 INFORMATION.—Nothing said or done in the course 22 of conciliation under this subsection may be made 23 public, or used as evidence in a subsequent pro- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00483 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 484 •S 4486 IS ceeding under this subsection, without the written 1 consent of the parties to the conciliation. 2 (6) PROMPT JUDICIAL ACTION.— 3 (A) IN GENERAL.—If the Director deter- 4 mines at any time following the filing of a com- 5 plaint under this subsection that prompt judi- 6 cial action is necessary to carry out the pur- 7 poses of this subsection, the Director may rec- 8 ommend that the Attorney General promptly 9 commence a civil action under subsection (d). 10 (B) IMMEDIATE SUIT.—If the Director de- 11 termines at any time following the filing of a 12 complaint under this subsection that the public 13 interest would be served by allowing the com- 14 plainant to bring a civil action under subsection 15 (c) in a State or Federal court immediately, the 16 Director shall certify that the administrative 17 process has concluded and that the complainant 18 may file such a suit immediately. 19 (7) ANNUAL REPORT.—Not later than 1 year 20 after the date of enactment of this Act, and annually 21 thereafter, the Director shall make publicly available 22 a report detailing the activities of the Office for Civil 23 Rights and Health Equity under this subsection, in- 24 cluding— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00484 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 485 •S 4486 IS (A) the number of complaints filed and the 1 basis on which the complaints were filed; 2 (B) the number of investigations under- 3 taken as a result of such complaints; and 4 (C) the disposition of all such investiga- 5 tions. 6 (c) ENFORCEMENT BY PRIVATE PERSONS.— 7 (1) IN GENERAL.— 8 (A) CIVIL ACTION.— 9 (i) IN SUIT.—A complainant under 10 subsection (b) may commence a civil action 11 to obtain appropriate relief with respect to 12 an alleged violation of subsection (a), or 13 for breach of a conciliation agreement 14 under subsection (b), in an appropriate 15 district court of the United States or State 16 court— 17 (I) not sooner than the earliest 18 of— 19 (aa) the date a conciliation 20 agreement is reached under sub- 21 section (b); 22 (bb) the date of a final dis- 23 position of a complaint under 24 subsection (b); or 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00485 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 486 •S 4486 IS (cc) 180 days after the first 1 day of the alleged violation; and 2 (II) not later than 2 years after 3 the final day of the alleged violation. 4 (ii) STATUTE OF LIMITATIONS.—The 5 computation of such 2-year period shall 6 not include any time during which an ad- 7 ministrative proceeding (including inves- 8 tigation or conciliation) under subsection 9 (b) was pending with respect to a com- 10 plaint under such subsection. 11 (B) BARRING SUIT.—If the Director has 12 obtained a conciliation agreement under sub- 13 section (b) regarding an alleged violation of 14 subsection (a), no action may be filed under 15 this paragraph by the complainant involved 16 with respect to the alleged violation except for 17 the purpose of enforcing the terms of such an 18 agreement. 19 (2) RELIEF WHICH MAY BE GRANTED.— 20 (A) IN GENERAL.—In a civil action under 21 paragraph (1), if the court finds that a viola- 22 tion of subsection (a) or breach of a conciliation 23 agreement has occurred, the court may award 24 to the plaintiff actual and punitive damages, 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00486 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 487 •S 4486 IS and may grant as relief, as the court deter- 1 mines to be appropriate, any permanent or tem- 2 porary injunction, temporary restraining order, 3 or other order (including an order enjoining the 4 defendant from engaging in a practice violating 5 subsection (a) or ordering such affirmative ac- 6 tion as may be appropriate). 7 (B) FEES AND COSTS.—In a civil action 8 under paragraph (1), the court, in its discre- 9 tion, may allow the prevailing party, other than 10 the United States, a reasonable attorney’s fee 11 and costs. The United States shall be liable for 12 such fees and costs to the same extent as a pri- 13 vate person. 14 (3) INTERVENTION BY ATTORNEY GENERAL.— 15 Upon timely application, the Attorney General may 16 intervene in a civil action under paragraph (1), if 17 the Attorney General certifies that the case is of 18 general public importance. 19 (d) ENFORCEMENT BY THE ATTORNEY GENERAL.— 20 (1) COMMENCEMENT OF ACTIONS.— 21 (A) PATTERN OR PRACTICE CASES.—The 22 Attorney General may commence a civil action 23 in any appropriate district court of the United 24 States if the Attorney General has reasonable 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00487 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 488 •S 4486 IS cause to believe that any health care provider 1 covered by subsection (a)— 2 (i) is engaged in a pattern or practice 3 that violates such subsection; or 4 (ii) is engaged in a violation of such 5 subsection that raises an issue of signifi- 6 cant public importance. 7 (B) CASES BY REFERRAL.—The Director 8 may determine, based on a pattern of com- 9 plaints, a pattern of violations, a review of data 10 reported by a health care provider covered by 11 subsection (a), or any other means, that there 12 is reasonable cause to believe a health care pro- 13 vider is engaged in a pattern or practice that 14 violates subsection (a). If the Director makes 15 such a determination, the Director shall refer 16 the related findings to the Attorney General. If 17 the Attorney General finds that such reasonable 18 cause exists, the Attorney General may com- 19 mence a civil action in any appropriate district 20 court of the United States. 21 (2) ENFORCEMENT OF SUBPOENAS.—The At- 22 torney General, on behalf of the Director, or another 23 party at whose request a subpoena is issued under 24 this subsection, may enforce such subpoena in ap- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00488 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 489 •S 4486 IS propriate proceedings in the district court of the 1 United States for the district in which the person to 2 whom the subpoena was addressed resides, was 3 served, or transacts business. 4 (3) RELIEF WHICH MAY BE GRANTED IN CIVIL 5 ACTIONS.— 6 (A) IN GENERAL.—In a civil action under 7 paragraph (1), the court— 8 (i) may award such preventive relief, 9 including a permanent or temporary in- 10 junction, temporary restraining order, or 11 other order against the person responsible 12 for a violation of subsection (a) as is nec- 13 essary to assure the full enjoyment of the 14 rights granted by this subsection; 15 (ii) may award such other relief as the 16 court determines to be appropriate, includ- 17 ing monetary damages, to aggrieved per- 18 sons; and 19 (iii) may, to vindicate the public inter- 20 est, assess punitive damages against the 21 respondent— 22 (I) in an amount not exceeding 23 $500,000, for a first violation; and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00489 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 490 •S 4486 IS (II) in an amount not exceeding 1 $1,000,000, for any subsequent viola- 2 tion. 3 (B) FEES AND COSTS.—In a civil action 4 under this subsection, the court, in its discre- 5 tion, may allow the prevailing party, other than 6 the United States, a reasonable attorney’s fee 7 and costs. The United States shall be liable for 8 such fees and costs to the extent provided by 9 section 2412 of title 28, United States Code. 10 (4) INTERVENTION IN CIVIL ACTIONS.—Upon 11 timely application, any person may intervene in a 12 civil action commenced by the Attorney General 13 under paragraphs (1) and (2) if the action involves 14 an alleged violation of subsection (a) with respect to 15 which such person is an aggrieved person (including 16 a person who is a complainant under subsection (b)) 17 or a conciliation agreement to which such person is 18 a party. 19 (e) DEFINITIONS.—In this section: 20 (1) AGGRIEVED PERSON.—The term ‘‘aggrieved 21 person’’ means— 22 (A) a person who believes that the person 23 was or will be injured in violation of subsection 24 (a); or 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00490 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 491 •S 4486 IS (B) the personal representative or estate of 1 a deceased person who was injured in violation 2 of subsection (a). 3 (2) DIRECTOR.—The term ‘‘Director’’ means 4 the Director for Civil Rights and Health Equity of 5 the Department of Health and Human Services. 6 (3) DISABILITY.—The term ‘‘disability’’ has the 7 meaning given such term in section 3 of the Ameri- 8 cans with Disabilities Act of 1990 (42 U.S.C. 9 12102). 10 (4) CONCILIATION.—The term ‘‘conciliation’’ 11 means the attempted resolution of issues raised by 12 a complaint, or by the investigation of such com- 13 plaint, through informal negotiations involving the 14 complainant, the respondent, and the Secretary. 15 (5) CONCILIATION AGREEMENT.—The term 16 ‘‘conciliation agreement’’ means a written agreement 17 setting forth the resolution of the issues in concilia- 18 tion. 19 (6) INDIVIDUALLY IDENTIFIABLE HEALTH IN- 20 FORMATION.—The term ‘‘individually identifiable 21 health information’’ means any information, includ- 22 ing demographic information collected from an indi- 23 vidual— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00491 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 492 •S 4486 IS (A) that is created or received by a health 1 care provider covered by subsection (a), health 2 plan, employer, or health care clearinghouse; 3 (B) that relates to the past, present, or fu- 4 ture physical or mental health or condition of, 5 the provision of health care to, or the past, 6 present, or future payment for the provision of 7 health care to, the individual; and 8 (C)(i) that identifies the individual; or 9 (ii) with respect to which there is a reason- 10 able basis to believe that the information can be 11 used to identify the individual. 12 (7) PROVISION OF INEQUITABLE HEALTH 13 CARE.—The term ‘‘provision of inequitable health 14 care’’ means the provision of any health care service, 15 by a health care provider in a manner that— 16 (A) fails to meet a high-quality care stand- 17 ard, meaning the health care provider fails to— 18 (i) avoid harm to patients as a result 19 of the health services that are intended to 20 help the patient; 21 (ii) provide health services based on 22 scientific knowledge to all and to all pa- 23 tients who benefit; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00492 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 493 •S 4486 IS (iii) refrain from providing services to 1 patients not likely to benefit; 2 (iv) provide care that is responsive to 3 patient preferences, needs, and values; and 4 (v) avoids waits or delays in care; and 5 (B) is discriminatory in intent or effect 6 based at least in part on a basis specified in 7 subsection (a). 8 (8) RESPONDENT.—The term ‘‘respondent’’ 9 means the person or other entity accused in a com- 10 plaint of a violation of subsection (a). 11 (9) SECRETARY.—The term ‘‘Secretary’’ means 12 the Secretary of Health and Human Services. 13 (10) SOCIAL DETERMINANTS OF HEALTH.—The 14 term ‘‘social determinants of health’’ means condi- 15 tions in the environments in which individuals live, 16 work, attend school, and worship, that affect a wide 17 range of health, functioning, and quality-of-life out- 18 comes and risks. 19 (f) RULE OF CONSTRUCTION.—Nothing in this sec- 20 tion shall be construed as repealing or limiting the effect 21 of title VI of the Civil Rights Act of 1964 (42 U.S.C. 22 2000d et seq.), section 1557 of the Patient Protection and 23 Affordable Care Act (42 U.S.C. 18116), section 504 of 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00493 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 494 •S 4486 IS the Rehabilitation Act of 1973 (29 U.S.C. 794), or the 1 Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.). 2 SEC. 4507. FEDERAL HEALTH EQUITY COMMISSION. 3 (a) ESTABLISHMENT OF COMMISSION.— 4 (1) IN GENERAL.—There is established the 5 Federal Health Equity Commission (in this section 6 referred to as the ‘‘Commission’’). 7 (2) MEMBERSHIP.— 8 (A) IN GENERAL.—The Commission shall 9 be composed of— 10 (i) 8 voting members appointed under 11 subparagraph (B); and 12 (ii) the nonvoting, ex officio members 13 listed in subparagraph (C). 14 (B) VOTING MEMBERS.—Not more than 4 15 of the members described in subparagraph 16 (A)(i) shall at any one time be of the same po- 17 litical party. Such members shall have recog- 18 nized expertise in and personal experience with 19 racial and ethnic health inequities, health care 20 needs of vulnerable and marginalized popu- 21 lations, and health equity as a vehicle for im- 22 proving health status and health outcomes. 23 Such members shall be appointed to the Com- 24 mission as follows: 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00494 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 495 •S 4486 IS (i) 4 members of the Commission 1 shall be appointed by the President. 2 (ii) 2 members of the Commission 3 shall be appointed by the President pro 4 tempore of the Senate, upon the rec- 5 ommendations of the majority leader and 6 the minority leader of the Senate. Each 7 member appointed to the Commission 8 under this clause shall be appointed from 9 a different political party. 10 (iii) 2 members of the Commission 11 shall be appointed by the Speaker of the 12 House of Representatives upon the rec- 13 ommendations of the majority leader and 14 the minority leader of the House of Rep- 15 resentatives. Each member appointed to 16 the Commission under this clause shall be 17 appointed from a different political party. 18 (C) EX OFFICIO MEMBER.—The Commis- 19 sion shall have the following nonvoting, ex offi- 20 cio members: 21 (i) The Director for Civil Rights and 22 Health Equity of the Department of 23 Health and Human Services. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00495 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 496 •S 4486 IS (ii) The Deputy Assistant Secretary 1 for Minority Health of the Department of 2 Health and Human Services. 3 (iii) The Director of the National In- 4 stitute on Minority Health and Health Dis- 5 parities. 6 (iv) The Chairperson of the Advisory 7 Committee on Minority Health established 8 under section 1707(c) of the Public Health 9 Service Act (42 U.S.C. 300u–6(c)). 10 (3) TERMS.—The term of office of each mem- 11 ber appointed under paragraph (2)(B) of the Com- 12 mission shall be 6 years. 13 (4) CHAIRPERSON; VICE CHAIRPERSON.— 14 (A) CHAIRPERSON.—The President shall, 15 with the concurrence of a majority of the mem- 16 bers of the Commission appointed under para- 17 graph (2)(B), designate a Chairperson from 18 among the members of the Commission ap- 19 pointed under such paragraph. 20 (B) VICE CHAIRPERSON.— 21 (i) DESIGNATION.—The Speaker of 22 the House of Representatives shall, in con- 23 sultation with the majority leaders and the 24 minority leaders of the Senate and the 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00496 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 497 •S 4486 IS House of Representatives and with the 1 concurrence of a majority of the members 2 of the Commission appointed under para- 3 graph (2)(B), designate a Vice Chairperson 4 from among the members of the Commis- 5 sion appointed under such paragraph. The 6 Vice Chairperson may not be a member of 7 the same political party as the Chair- 8 person. 9 (ii) DUTY.—The Vice Chairperson 10 shall act in place of the Chairperson in the 11 absence of the Chairperson. 12 (5) REMOVAL OF MEMBERS.—The President 13 may remove a member of the Commission only for 14 neglect of duty or malfeasance in office. 15 (6) QUORUM.—A majority of members of the 16 Commission appointed under paragraph (2)(B) shall 17 constitute a quorum of the Commission, but a lesser 18 number of members may hold hearings. 19 (b) DUTIES OF THE COMMISSION.— 20 (1) IN GENERAL.—The Commission shall— 21 (A) monitor and report on the implementa- 22 tion of this Act; and 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00497 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 498 •S 4486 IS (B) investigate, monitor, and report on 1 progress towards health equity and the elimi- 2 nation of health disparities. 3 (2) ANNUAL REPORT.—The Commission 4 shall— 5 (A) submit to the President and Congress 6 at least one report annually on health equity 7 and health disparities; and 8 (B) include in such report— 9 (i) a description of actions taken by 10 the Department of Health and Human 11 Services and any other Federal agency re- 12 lated to health equity or health disparities; 13 and 14 (ii) recommendations on ensuring eq- 15 uitable health care and eliminating health 16 disparities. 17 (c) POWERS.— 18 (1) HEARINGS.— 19 (A) IN GENERAL.—The Commission or, at 20 the direction of the Commission, any sub- 21 committee or member of the Commission, may, 22 for the purpose of carrying out this section, as 23 the Commission or the subcommittee or mem- 24 ber considers advisable— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00498 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 499 •S 4486 IS (i) hold such hearings, meet and act 1 at such times and places, take such testi- 2 mony, receive such evidence, and admin- 3 ister such oaths; and 4 (ii) require, by subpoena or otherwise, 5 the attendance and testimony of such wit- 6 nesses and the production of such books, 7 records, correspondence, memoranda, pa- 8 pers, documents, tapes, and materials. 9 (B) LIMITATION ON HEARINGS.—The 10 Commission may hold a hearing under subpara- 11 graph (A)(i) only if the hearing is approved— 12 (i) by a majority of the members of 13 the Commission appointed under sub- 14 section (a)(2)(B); or 15 (ii) by a majority of such members 16 present at a meeting when a quorum is 17 present. 18 (2) ISSUANCE AND ENFORCEMENT OF SUB- 19 POENAS.— 20 (A) ISSUANCE.—A subpoena issued under 21 paragraph (1) shall— 22 (i) bear the signature of the Chair- 23 person of the Commission; and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00499 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 500 •S 4486 IS (ii) be served by any person or class 1 of persons designated by the Chairperson 2 for that purpose. 3 (B) ENFORCEMENT.—In the case of contu- 4 macy or failure to obey a subpoena issued 5 under paragraph (1), the United States district 6 court for the district in which the subpoenaed 7 person resides, is served, or may be found may 8 issue an order requiring the person to appear at 9 any designated place to testify or to produce 10 documentary or other evidence. 11 (C) NONCOMPLIANCE.—Any failure to 12 obey the order of the court may be punished by 13 the court as a contempt of court. 14 (3) WITNESS ALLOWANCES AND FEES.— 15 (A) IN GENERAL.—Section 1821 of title 16 28, United States Code, shall apply to a witness 17 requested or subpoenaed to appear at a hearing 18 of the Commission. 19 (B) EXPENSES.—The per diem and mile- 20 age allowances for a witness shall be paid from 21 funds available to pay the expenses of the Com- 22 mission. 23 (4) POSTAL SERVICES.—The Commission may 24 use the United States mails in the same manner and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00500 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 501 •S 4486 IS under the same conditions as other agencies of the 1 Federal Government. 2 (5) GIFTS.—The Commission may accept, use, 3 and dispose of gifts or donations of services or prop- 4 erty. 5 (d) ADMINISTRATIVE PROVISIONS.— 6 (1) STAFF.— 7 (A) DIRECTOR.—There shall be a full-time 8 staff director for the Commission who shall— 9 (i) serve as the administrative head of 10 the Commission; and 11 (ii) be appointed by the Chairperson 12 with the concurrence of the Vice Chair- 13 person. 14 (B) OTHER PERSONNEL.—The Commis- 15 sion may— 16 (i) appoint such other personnel as it 17 considers advisable, subject to the provi- 18 sions of title 5, United States Code, gov- 19 erning appointments in the competitive 20 service, and the provisions of chapter 51 21 and subchapter III of chapter 53 of that 22 title relating to classification and General 23 Schedule pay rates; and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00501 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 502 •S 4486 IS (ii) may procure temporary and inter- 1 mittent services under section 3109(b) of 2 title 5, United States Code, at rates for in- 3 dividuals not in excess of the daily equiva- 4 lent paid for positions at the maximum 5 rate for GS–15 of the General Schedule 6 under section 5332 of title 5, United 7 States Code. 8 (2) COMPENSATION OF MEMBERS.— 9 (A) NON-FEDERAL EMPLOYEES.—Each 10 member of the Commission who is not an offi- 11 cer or employee of the Federal Government 12 shall be compensated at a rate equal to the 13 daily equivalent of the annual rate of basic pay 14 prescribed for level IV of the Executive Sched- 15 ule under section 5315 of title 5, United States 16 Code, for each day (including travel time) dur- 17 ing which the member is engaged in the per- 18 formance of the duties of the Commission. 19 (B) FEDERAL EMPLOYEES.—Each member 20 of the Commission who is an officer or em- 21 ployee of the Federal Government shall serve 22 without compensation in addition to the com- 23 pensation received for the services of the mem- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00502 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 503 •S 4486 IS ber as an office or employee of the Federal 1 Government. 2 (C) TRAVEL EXPENSES.—A member of the 3 Commission shall be allowed travel expenses, in- 4 cluding per diem in lieu of subsistence, at rates 5 authorized for an employee of an agency under 6 subchapter I of chapter 57 of title 5, United 7 States Code, while away from the home or reg- 8 ular place of business of the member in the per- 9 formance of the duties of the Commission. 10 (3) COOPERATION.—The Commission may se- 11 cure directly from any Federal department or agency 12 such information as the Commission considers nec- 13 essary to carry out this Act. Upon request of the 14 Chairman of the Commission, the head of such de- 15 partment or agency shall furnish such information to 16 the Commission. 17 (e) PERMANENT COMMISSION.—Section 14 of the 18 Federal Advisory Committee Act (5 U.S.C. App.) shall not 19 apply to the Commission. 20 (f) AUTHORIZATION OF APPROPRIATIONS.—There 21 are authorized to be appropriated for fiscal year 2022 and 22 each fiscal year thereafter such sums as may be necessary 23 to carry out the duties of the Commission. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00503 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 504 •S 4486 IS SEC. 4508. GRANTS FOR HOSPITALS TO PROMOTE EQUI- 1 TABLE HEALTH CARE AND OUTCOMES. 2 (a) IN GENERAL.—Not later than 180 days after the 3 date of the enactment of this Act, the Secretary of Health 4 and Human Services (in this section referred to as the 5 ‘‘Secretary’’) shall award grants to hospitals to promote 6 equitable health care treatment and services, and reduce 7 disparities in care and outcomes. 8 (b) CONSULTATION.—In establishing the criteria for 9 grants under this section and evaluating applications for 10 such grants, the Secretary shall consult with the Director 11 for Civil Rights and Health Equity of the Department of 12 Health and Human Services. 13 (c) USE OF FUNDS.—A hospital shall use funds re- 14 ceived from a grant under this section to establish or ex- 15 pand programs to provide equitable health care to all pa- 16 tients and to ensure equitable health care outcomes. Such 17 uses may include— 18 (1) providing explicit and implicit bias training 19 to medical providers and staff; 20 (2) providing translation or interpretation serv- 21 ices for patients; 22 (3) recruiting and training a diverse workforce; 23 (4) tracking data related to care and outcomes; 24 and 25 (5) training on cultural sensitivity. 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00504 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 505 •S 4486 IS (d) PRIORITY.—In awarding grants under this sec- 1 tion, the Secretary shall give priority to hospitals that 2 have received disproportionate share hospital payments 3 under section 1886(r) of the Social Security Act (42 4 U.S.C. 1395ww(r)) or section 1923 of such Act (42 U.S.C. 5 1396r–4) with respect to fiscal year 2021. 6 (e) SUPPLEMENT, NOT SUPPLANT.—Grants awarded 7 under this section shall be used to supplement, not sup- 8 plant, any nongovernment efforts, or other Federal, State, 9 or local funds provided to a recipient. 10 (f) EQUITABLE HEALTH CARE DEFINED.—The term 11 ‘‘equitable health care’’ has the meaning given such term 12 in section 1886(b)(3)(B)(viii)(XIII)(cc) of the Social Secu- 13 rity Act (42 U.S.C. 1395ww(b)(3)(B)(viii)(XIII)(cc)), as 14 added by section 4503(a). 15 (g) AUTHORIZATION OF APPROPRIATIONS.—To carry 16 out this section, there are authorized to be appropriated 17 such sums as may be necessary for each of fiscal years 18 2022 through 2027. 19 Subtitle G—Investing in Equity 20 SEC. 4601. DEFINITIONS. 21 In this subtitle: 22 (1) ADVISORY COUNCIL.—The term ‘‘Advisory 23 Council’’ means the Pay for Equity Council con- 24 vened under section 4603. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00505 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 506 •S 4486 IS (2) SECRETARY.—The term ‘‘Secretary’’ means 1 the Secretary of Health and Human Services. 2 (3) STRATEGY.—The term ‘‘Strategy’’ means 3 the Pay for Equity Strategy set forth under section 4 4602. 5 SEC. 4602. STRATEGY TO INCENTIVIZE HEALTH EQUITY. 6 (a) IN GENERAL.—The Secretary, in consultation 7 with the heads of other appropriate Federal agencies, shall 8 develop jointly with the Advisory Council and submit to 9 the Committee on Finance of the Senate and the Com- 10 mittee on Energy and Commerce and the Committee on 11 Ways and Means of the House of Representatives, and 12 make publicly available on the internet website of the De- 13 partment of Health and Human Services, a Pay for Eq- 14 uity Strategy. 15 (b) CONTENTS.—The Strategy shall establish goals 16 for Federal programs, including those authorized under ti- 17 tles XVIII and XIX of the Social Security Act, to 18 incentivize health equity, which may include at least— 19 (1) incorporating measures of equity into all 20 payment models by 2025; 21 (2) tying a percentage of reimbursement in 22 value-based payment models to equity measure per- 23 formance by 2028; and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00506 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 507 •S 4486 IS (3) increasing the number of safety net pro- 1 viders participating in value-based payment by a set 2 percentage by 2030. 3 (c) DUTIES OF THE SECRETARY.—The Secretary, in 4 carrying out subsection (a), shall oversee the following: 5 (1) Collecting and making publicly available in- 6 formation submitted by the Advisory Council. 7 (2) Coordinating and assessing existing Federal 8 Government programs and activities to assess capac- 9 ity to meet equity goals. 10 (3) Providing technical assistance, as appro- 11 priate, such as disseminating identified best prac- 12 tices and information sharing based on reports de- 13 veloped as a result of this subtitle. 14 (d) INITIAL STRATEGY; UPDATES.—The Secretary 15 shall— 16 (1) not later than 18 months after the date of 17 enactment of this Act, develop, publish, and submit 18 to the Committee on Finance of the Senate and the 19 Committee on Energy and Commerce and the Com- 20 mittee on Ways and Means of the House of Rep- 21 resentatives the strategy outlined in subsection (a); 22 and 23 (2) biennially update, publish, and submit to 24 Congress an updated strategy to— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00507 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 508 •S 4486 IS (A) reflect new developments, challenges, 1 opportunities, and solutions; and 2 (B) review progress and, based on the re- 3 sults of such review, recommend priority actions 4 for improving the implementation of such rec- 5 ommendations, as appropriate. 6 (e) PROCESS FOR PUBLIC INPUT.—The Secretary 7 shall establish a process for public input to inform the de- 8 velopment of, and updates to, the Strategy, including a 9 process for the public to submit recommendations to the 10 Advisory Council and an opportunity for public comment 11 on the proposed Strategy. 12 SEC. 4603. PAY FOR EQUITY ADVISORY COUNCIL. 13 (a) CONVENING.—The Secretary shall convene a Pay 14 for Equity Advisory Council to advise and provide rec- 15 ommendations, including identified best practices, to the 16 Secretary on the Pay for Equity Strategy. 17 (b) MEMBERSHIP.— 18 (1) IN GENERAL.—The members of the Advi- 19 sory Council shall consist of— 20 (A) the appointed members under para- 21 graph (2); and 22 (B) the Federal members under paragraph 23 (3). 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00508 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 509 •S 4486 IS (2) APPOINTED MEMBERS.—In addition to the 1 Federal members under paragraph (3), the Sec- 2 retary shall appoint not more than 15 voting mem- 3 bers of the Advisory Council who are not representa- 4 tives of Federal departments or agencies and who 5 shall include at least 1 representative of each of the 6 following: 7 (A) Beneficiaries of Medicare and Med- 8 icaid. 9 (B) Safety net health care providers. 10 (C) Value-based payment experts. 11 (D) Other members with expertise and 12 lived experience the Secretary deems appro- 13 priate. 14 (3) FEDERAL MEMBERS.—The Federal mem- 15 bers of the Advisory Council, who shall be nonvoting 16 members, shall consist of the following: 17 (A) The Administrator of the Centers for 18 Medicare & Medicaid Services (or the Adminis- 19 trator’s designee). 20 (B) The Administrator of the Health Re- 21 sources and Services Administration. 22 (4) DIVERSE REPRESENTATION.—The Sec- 23 retary shall ensure that the membership of the Advi- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00509 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 510 •S 4486 IS sory Council reflects the diversity of individuals im- 1 pacted by Federal health payment programs. 2 (c) MEETINGS.—The Advisory Council shall meet 3 quarterly during the 1-year period beginning on the date 4 of enactment of this Act and at least 3 times during each 5 year thereafter. Meetings of the Advisory Council shall be 6 open to the public. 7 TITLE V—IMPROVING HEALTH 8 OUTCOMES FOR WOMEN, 9 CHILDREN, AND FAMILIES 10 Subtitle A—In General 11 SEC. 5001. GRANTS TO PROMOTE HEALTH FOR UNDER- 12 SERVED COMMUNITIES. 13 Part Q of title III of the Public Health Service Act 14 (42 U.S.C. 280h et seq.) is amended by adding at the end 15 the following: 16 ‘‘SEC. 399Z–3. GRANTS TO PROMOTE HEALTH FOR UNDER- 17 SERVED COMMUNITIES. 18 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col- 19 laboration with the Administrator of the Health Resources 20 and Services Administration and other Federal officials 21 determined appropriate by the Secretary, is authorized to 22 award grants to eligible entities— 23 ‘‘(1) to promote health for medically under- 24 served communities, with preference given to 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00510 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 511 •S 4486 IS projects that benefit racial and ethnic minority 1 women, racial and ethnic minority children, adoles- 2 cents, and lesbian, gay, bisexual, transgender, queer, 3 nonbinary, gender-nonconforming, or questioning 4 communities; and 5 ‘‘(2) to strengthen health outreach initiatives in 6 medically underserved communities, including lin- 7 guistically isolated populations. 8 ‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 9 subsection (a) may be used to support the activities of 10 community health workers, including such activities— 11 ‘‘(1) to educate and provide outreach regarding 12 enrollment in health insurance including the State 13 Children’s Health Insurance Program under title 14 XXI of the Social Security Act, Medicare under title 15 XVIII of such Act, and Medicaid under title XIX of 16 such Act; 17 ‘‘(2) to educate and provide outreach in a com- 18 munity setting regarding health problems prevalent 19 among medically underserved communities, and es- 20 pecially among racial and ethnic minority women, 21 racial and ethnic minority children, adolescents, and 22 lesbian, gay, bisexual, transgender, queer, nonbinary, 23 gender-nonconforming, or questioning communities; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00511 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 512 •S 4486 IS ‘‘(3) to educate and provide experiential learn- 1 ing opportunities and target risk factors and healthy 2 behaviors that impede or contribute to achieving 3 positive health outcomes, including— 4 ‘‘(A) healthy nutrition; 5 ‘‘(B) physical activity; 6 ‘‘(C) overweight or obesity; 7 ‘‘(D) tobacco use, including the use of e- 8 cigarettes and vaping; 9 ‘‘(E) alcohol and substance use; 10 ‘‘(F) injury and violence; 11 ‘‘(G) sexual health; 12 ‘‘(H) mental health; 13 ‘‘(I) musculoskeletal health and arthritis; 14 ‘‘(J) prenatal and postnatal care; 15 ‘‘(K) dental and oral health; 16 ‘‘(L) understanding informed consent; 17 ‘‘(M) stigma; and 18 ‘‘(N) environmental hazards; 19 ‘‘(4) to promote community wellness and aware- 20 ness; and 21 ‘‘(5) to educate and refer target populations to 22 appropriate health care agencies and community- 23 based programs and organizations in order to in- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00512 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 513 •S 4486 IS crease access to quality health care services, includ- 1 ing preventive health services. 2 ‘‘(c) APPLICATION.— 3 ‘‘(1) IN GENERAL.—Each eligible entity that 4 desires to receive a grant under subsection (a) shall 5 submit an application to the Secretary, at such time, 6 in such manner, and accompanied by such additional 7 information as the Secretary may require. 8 ‘‘(2) CONTENTS.—Each application submitted 9 pursuant to paragraph (1) shall— 10 ‘‘(A) describe the activities for which as- 11 sistance under this section is sought; 12 ‘‘(B) contain an assurance that, with re- 13 spect to each community health worker pro- 14 gram receiving funds under the grant awarded, 15 such program provides in-language training and 16 supervision to community health workers to en- 17 able such workers to provide authorized pro- 18 gram activities in (at least) the most commonly 19 used languages within a particular geographic 20 region; 21 ‘‘(C) contain an assurance that the appli- 22 cant will evaluate the effectiveness of commu- 23 nity health worker programs receiving funds 24 under the grant; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00513 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 514 •S 4486 IS ‘‘(D) contain an assurance that each com- 1 munity health worker program receiving funds 2 under the grant will provide culturally com- 3 petent services in the linguistic context most 4 appropriate for the individuals served by the 5 program; 6 ‘‘(E) contain a plan to document and dis- 7 seminate project descriptions and results to 8 other States and organizations as identified by 9 the Secretary; and 10 ‘‘(F) describe plans to enhance the capac- 11 ity of individuals to utilize health services and 12 health-related social services under Federal, 13 State, and local programs by— 14 ‘‘(i) assisting individuals in estab- 15 lishing eligibility under the programs and 16 in receiving the services or other benefits 17 of the programs; and 18 ‘‘(ii) providing other services, as the 19 Secretary determines to be appropriate, 20 which may include transportation and 21 translation services. 22 ‘‘(d) PRIORITY.—In awarding grants under sub- 23 section (a), the Secretary shall give priority to those appli- 24 cants— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00514 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 515 •S 4486 IS ‘‘(1) who propose to target geographic areas 1 that— 2 ‘‘(A)(i) have a high percentage of residents 3 who are uninsured or underinsured (if the tar- 4 geted geographic area is located in a State that 5 has elected to make medical assistance available 6 under section 1902(a)(10)(A)(i)(VIII) of the 7 Social Security Act to individuals described in 8 such section); 9 ‘‘(ii) have a high percentage of under- 10 insured residents in a particular geographic 11 area (if the targeted geographic area is located 12 in a State that has not so elected); or 13 ‘‘(iii) have a high number of households ex- 14 periencing extreme poverty; and 15 ‘‘(B) have a high percentage of families for 16 whom English is not their primary language or 17 including smaller limited English-proficient 18 communities within the region that are not oth- 19 erwise reached by linguistically appropriate 20 health services; 21 ‘‘(2) with experience in providing health or 22 health-related social services to individuals who are 23 underserved with respect to such services; and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00515 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 516 •S 4486 IS ‘‘(3) with documented community activity and 1 experience with community health workers. 2 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU- 3 TIONS.—The Secretary shall encourage community health 4 worker programs receiving funds under this section to col- 5 laborate with academic institutions, including minority- 6 serving institutions. Nothing in this section shall be con- 7 strued to require such collaboration. 8 ‘‘(f) QUALITY ASSURANCE AND COST-EFFECTIVE- 9 NESS.—The Secretary shall establish guidelines for ensur- 10 ing the quality of the training and supervision of commu- 11 nity health workers under the programs funded under this 12 section and for ensuring the cost-effectiveness of such pro- 13 grams. 14 ‘‘(g) MONITORING.—The Secretary shall monitor 15 community health worker programs identified in approved 16 applications and shall determine whether such programs 17 are in compliance with the guidelines established under 18 subsection (f). 19 ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 20 provide technical assistance to community health worker 21 programs identified in approved applications with respect 22 to planning, developing, and operating programs under the 23 grant. 24 ‘‘(i) REPORT TO CONGRESS.— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00516 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 517 •S 4486 IS ‘‘(1) IN GENERAL.—Not later than 4 years 1 after the date on which the Secretary first awards 2 grants under subsection (a), the Secretary shall sub- 3 mit to Congress a report regarding the grant 4 project. 5 ‘‘(2) CONTENTS.—The report required under 6 paragraph (1) shall include the following: 7 ‘‘(A) A description of the programs for 8 which grant funds were used. 9 ‘‘(B) The number of individuals served. 10 ‘‘(C) An evaluation of— 11 ‘‘(i) the effectiveness of these pro- 12 grams; 13 ‘‘(ii) the cost of these programs; and 14 ‘‘(iii) the impact of these programs on 15 the health outcomes of the community resi- 16 dents. 17 ‘‘(D) Recommendations for sustaining the 18 community health worker programs developed 19 or assisted under this section. 20 ‘‘(E) Recommendations regarding training 21 to enhance career opportunities for community 22 health workers. 23 ‘‘(j) DEFINITIONS.—In this section: 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00517 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 518 •S 4486 IS ‘‘(1) COMMUNITY HEALTH WORKER.—The term 1 ‘community health worker’ means an individual who 2 promotes health or nutrition within the community 3 in which the individual resides— 4 ‘‘(A) by serving as a liaison between com- 5 munities and health care agencies; 6 ‘‘(B) by providing guidance and social as- 7 sistance to community residents; 8 ‘‘(C) by enhancing community residents’ 9 ability to effectively communicate with health 10 care providers; 11 ‘‘(D) by providing culturally and linguis- 12 tically appropriate health or nutrition edu- 13 cation; 14 ‘‘(E) by advocating for individual and com- 15 munity health, including dental, oral, mental, 16 and environmental health, or nutrition needs; 17 ‘‘(F) by taking into consideration the 18 needs of the communities served, including the 19 prevalence rates of risk factors that impede 20 achieving positive healthy outcomes among 21 pregnant, birthing, and postpartum people and 22 children, especially among racial and ethnic mi- 23 nority pregnant, birthing, and postpartum peo- 24 ple and children; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00518 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 519 •S 4486 IS ‘‘(G) by providing referral and followup 1 services. 2 ‘‘(2) COMMUNITY SETTING.—The term ‘commu- 3 nity setting’ means a home or a community organi- 4 zation that serves a population. 5 ‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en- 6 tity’ means— 7 ‘‘(A) a unit of State, territorial, local, or 8 Tribal government (including a federally recog- 9 nized Tribe or Alaska Native village); or 10 ‘‘(B) a community-based organization. 11 ‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 12 The term ‘medically underserved community’ means 13 a community— 14 ‘‘(A) that has a substantial number of in- 15 dividuals who are members of a medically un- 16 derserved population, as defined by section 17 330(b)(3); 18 ‘‘(B) a significant portion of which is a 19 health professional shortage area as designated 20 under section 332; and 21 ‘‘(C) that includes populations that are lin- 22 guistically isolated, such as geographic areas 23 with a shortage of health professionals able to 24 provide linguistically appropriate services. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00519 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 520 •S 4486 IS ‘‘(5) SUPPORT.—The term ‘support’ means the 1 provision of training, supervision, and materials 2 needed to effectively deliver the services described in 3 subsection (b), reimbursement for services, and 4 other benefits. 5 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 6 are authorized to be appropriated to carry out this section 7 $15,000,000 for each of fiscal years 2023 through 2027.’’. 8 Subtitle B—Pregnancy Screening 9 SEC. 5101. PREGNANCY INTENTION SCREENING INITIATIVE 10 DEMONSTRATION PROGRAM. 11 Part P of title III of the Public Health Service Act 12 (42 U.S.C. 280g et seq.) is amended by adding at the end 13 the following: 14 ‘‘SEC. 399V–7. PREGNANCY INTENTION SCREENING INITIA- 15 TIVE DEMONSTRATION PROGRAM. 16 ‘‘(a) PROGRAM ESTABLISHMENT.—The Secretary, 17 acting through the Director of the Centers for Disease 18 Control and Prevention, shall establish a demonstration 19 program to facilitate the clinical adoption of pregnancy in- 20 tention screening initiatives by health care and social serv- 21 ices providers. 22 ‘‘(b) GRANTS.—The Secretary may carry out the 23 demonstration program through awarding grants to eligi- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00520 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 521 •S 4486 IS ble entities to implement pregnancy intention screening 1 initiatives, collect data, and evaluate such initiatives. 2 ‘‘(c) ELIGIBLE ENTITIES.—To be eligible to seek a 3 grant under this section, an entity shall— 4 ‘‘(1) provide non-directive, comprehensive, 5 medically accurate information; and 6 ‘‘(2) be a community-based organization, vol- 7 untary health organization, public health depart- 8 ment, community health center, or other interested 9 public or private primary, behavioral, or other health 10 care or social service provider or organization. 11 ‘‘(d) PREGNANCY INTENTION SCREENING INITIA- 12 TIVE.—For purposes of this section, the term ‘pregnancy 13 intention screening initiative’ means any initiative by an 14 eligible entity to routinely screen people with respect to 15 their pregnancy intentions and goals to either prevent un- 16 intended pregnancies or improve the likelihood of healthy 17 pregnancies, in order to better provide health care that 18 meets the contraceptive or pre-pregnancy needs and goals 19 of such people. 20 ‘‘(e) EVALUATION.— 21 ‘‘(1) IN GENERAL.—The Secretary, acting 22 through the Director of the Centers for Disease 23 Control and Prevention, shall, by grant or contract, 24 and after consultation as described in paragraph (2), 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00521 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 522 •S 4486 IS conduct an evaluation of the demonstration pro- 1 gram, with respect to pregnancy intention screening 2 initiatives, conducted under this section. Such eval- 3 uation shall include: 4 ‘‘(A) Assessment of the implementation of 5 pregnancy intention screening protocols among 6 a diverse group of patients and providers, in- 7 cluding collecting data on the experiences and 8 outcomes for diverse patient populations in a 9 variety of clinical settings. 10 ‘‘(B) Analysis of outcome measures that 11 will facilitate effective and widespread adoption 12 of such protocols by health care providers for 13 inquiring about and responding to pregnancy 14 goals of people with both contraceptive and pre- 15 pregnancy care. 16 ‘‘(C) Consideration of health inequities 17 among the population served. 18 ‘‘(D) Assessment of the equitable and vol- 19 untary application of such initiatives to minor- 20 ity and medically underserved communities. 21 ‘‘(E) Assessment of the training, capacity, 22 and ongoing technical assistance needed for 23 providers to effectively implement such preg- 24 nancy intention screening protocols. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00522 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 523 •S 4486 IS ‘‘(F) Assessment of whether referral sys- 1 tems for selected protocols follow evidence-based 2 standards that ensure access to comprehensive 3 health services and appropriate follow-up care. 4 ‘‘(G) Measuring through rigorous methods 5 the effect of such initiatives on key health out- 6 comes. 7 ‘‘(2) CONSULTATION WITH INDEPENDENT, EX- 8 PERT ADVISORY PANEL.—In conducting the evalua- 9 tion under paragraph (1), the Director of the Cen- 10 ters for Disease Control and Prevention shall consult 11 with physicians, physician assistants, advanced prac- 12 tice registered nurses, nurse midwives, and other 13 health care providers who specialize in women’s 14 health, and other experts in public health, clinical 15 practice, program evaluation, and research. 16 ‘‘(3) REPORT.—Not later than one year after 17 the last day of the demonstration program under 18 this section, the Director of the Centers for Disease 19 Control and Prevention shall— 20 ‘‘(A) submit to Congress a report on the 21 results of the evaluation conducted under para- 22 graph (1); and 23 ‘‘(B) make the report publicly available. 24 ‘‘(f) FUNDING.— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00523 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 524 •S 4486 IS ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 1 To carry out this section, there is authorized to be 2 appropriated $10,000,000 for each of fiscal years 3 2023 through 2027. 4 ‘‘(2) LIMITATION.—Not more than 20 percent 5 of funds appropriated to carry out this section pur- 6 suant to paragraph (1) for a fiscal year may be used 7 for purposes of the evaluation under subsection 8 (e).’’. 9 SEC. 5102. BIRTH DEFECTS PREVENTION, RISK REDUCTION, 10 AND AWARENESS. 11 (a) IN GENERAL.—The Secretary shall establish and 12 implement a birth defects prevention and public awareness 13 program, consisting of the activities described in sub- 14 sections (c) and (d). 15 (b) DEFINITIONS.—In this section: 16 (1) MATERNAL.—The term ‘‘maternal’’ refers 17 to people who are pregnant or breastfeeding. 18 (2) PREGNANCY AND BREASTFEEDING INFOR- 19 MATION SERVICES.—The term ‘‘pregnancy and 20 breastfeeding information services’’ includes only— 21 (A) information services to provide accu- 22 rate, evidence-based, clinical information re- 23 garding maternal exposures during pregnancy 24 or breastfeeding that may be associated with 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00524 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 525 •S 4486 IS birth defects, health risks to a breastfed infant, 1 or other health risks, such as exposures to 2 medications, chemicals, infections, foodborne 3 pathogens, illnesses, nutrition, lifestyle, or 4 climate- and weather-related factors; 5 (B) the provision of accurate, evidence- 6 based information weighing risks of exposures 7 during breastfeeding against the benefits of 8 breastfeeding; and 9 (C) the provision of information described 10 in subparagraph (A) or (B) through counselors, 11 websites, fact sheets, telephonic or electronic 12 communication, community outreach efforts, or 13 other appropriate means. 14 (3) SECRETARY.—The term ‘‘Secretary’’ means 15 the Secretary of Health and Human Services, acting 16 through the Director of the Centers for Disease 17 Control and Prevention. 18 (c) NATIONWIDE MEDIA CAMPAIGN.—In carrying out 19 subsection (a), the Secretary shall conduct or support a 20 nationwide media campaign to increase awareness among 21 health care providers and at-risk populations about preg- 22 nancy and breastfeeding information services. 23 (d) GRANTS FOR PREGNANCY AND BREASTFEEDING 24 INFORMATION SERVICES.— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00525 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 526 •S 4486 IS (1) IN GENERAL.—In carrying out subsection 1 (a), the Secretary shall award grants to State or re- 2 gional agencies or organizations for any of the fol- 3 lowing: 4 (A) INFORMATION SERVICES.—The provi- 5 sion of, or campaigns to increase awareness 6 about, pregnancy and breastfeeding information 7 services. 8 (B) SURVEILLANCE AND RESEARCH.—The 9 conduct or support of— 10 (i) surveillance of or research on— 11 (I) maternal exposures and ma- 12 ternal health conditions that may in- 13 fluence the risk of birth defects, pre- 14 maturity, or other adverse pregnancy 15 outcomes; and 16 (II) maternal exposures that may 17 influence health risks to a breastfed 18 infant; or 19 (ii) networking to facilitate surveil- 20 lance or research described in this sub- 21 paragraph. 22 (2) PREFERENCE FOR CERTAIN STATES.—The 23 Secretary, in making any grant under this sub- 24 section, shall give preference to States, otherwise 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00526 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 527 •S 4486 IS equally qualified, that have pregnancy and 1 breastfeeding information services in place. 2 (3) MATCHING FUNDS.—The Secretary may 3 only award a grant under this subsection to a State 4 or regional agency or organization that agrees, with 5 respect to the costs to be incurred in carrying out 6 the grant activities, to make available (directly or 7 through donations from public or private entities) 8 non-Federal funds toward such costs in an amount 9 equal to not less than 25 percent of the amount of 10 the grant. 11 (4) COORDINATION.—The Secretary shall en- 12 sure that activities funded through a grant under 13 this subsection are coordinated, to the maximum ex- 14 tent practicable, with other birth defects prevention 15 and environmental health activities of the Federal 16 Government, including with respect to pediatric envi- 17 ronmental health specialty units and children’s envi- 18 ronmental health centers. 19 (e) EVALUATION.—The Secretary shall provide for an 20 evaluation of pregnancy and breastfeeding information 21 services carried out by States to identify efficient and ef- 22 fective models of— 23 (1) providing information; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00527 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 528 •S 4486 IS (2) raising awareness and increasing knowledge 1 about birth defects prevention measures and tar- 2 geting education to at-risk groups; 3 (3) modifying risk behaviors; or 4 (4) other outcome measures as determined ap- 5 propriate by the Secretary. 6 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 7 out this section, there are authorized to be appropriated— 8 (1) $5,000,000 for fiscal year 2023; 9 (2) $6,000,000 for fiscal year 2024; 10 (3) $7,000,000 for fiscal year 2025; 11 (4) $8,000,000 for fiscal year 2026; and 12 (5) $9,000,000 for fiscal year 2027. 13 Subtitle C—Pregnancy-Related 14 Care 15 SEC. 5201. MOTHERS AND OFFSPRING MORTALITY AND 16 MORBIDITY AWARENESS. 17 (a) IMPROVING FEDERAL EFFORTS WITH RESPECT 18 TO PREVENTION OF MATERNAL MORTALITY.— 19 (1) TECHNICAL ASSISTANCE FOR STATES WITH 20 RESPECT TO REPORTING MATERNAL MORTALITY.— 21 Not later than one year after the date of enactment 22 of this Act, the Director of the Centers for Disease 23 Control and Prevention (referred to in this section 24 as the ‘‘Director’’), in consultation with the Admin- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00528 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 529 •S 4486 IS istrator of the Health Resources and Services Ad- 1 ministration, shall provide technical assistance to 2 States that elect to report comprehensive data on 3 maternal mortality and factors relating to such mor- 4 tality (including oral and mental health), intimate 5 partner violence, and breastfeeding health informa- 6 tion, for the purpose of encouraging uniformity in 7 the reporting of such data and to encourage the 8 sharing of such data among the respective States. 9 (2) BEST PRACTICES RELATING TO PREVEN- 10 TION OF MATERNAL MORTALITY.— 11 (A) IN GENERAL.—Not later than one year 12 after the date of enactment of this Act— 13 (i) the Director, in consultation with 14 relevant patient and provider groups, shall 15 issue best practices to State maternal mor- 16 tality review committees on how best to 17 identify and review maternal mortality 18 cases, taking into account any data made 19 available by States relating to maternal 20 mortality, including data on oral, mental, 21 and breastfeeding health, and utilization of 22 any emergency services; and 23 (ii) the Director, working in collabora- 24 tion with the Health Resources and Serv- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00529 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 530 •S 4486 IS ices Administration, shall issue best prac- 1 tices to hospitals, State professional society 2 groups, and perinatal quality collaboratives 3 on how best to prevent maternal mortality. 4 (B) AUTHORIZATION OF APPROPRIA- 5 TIONS.—For purposes of carrying out this 6 paragraph, there is authorized to be appro- 7 priated $5,000,000 for each of fiscal years 8 2023 through 2027. 9 (3) ALLIANCE FOR INNOVATION ON MATERNAL 10 HEALTH GRANT PROGRAM.— 11 (A) IN GENERAL.—Not later than one year 12 after the date of enactment of this Act, the Sec- 13 retary of Health and Human Services, acting 14 through the Associate Administrator of the Ma- 15 ternal and Child Health Bureau of the Health 16 Resources and Services Administration (re- 17 ferred to in this paragraph as the ‘‘Secretary’’), 18 shall establish a grant program to be known as 19 the Alliance for Innovation on Maternal Health 20 Grant Program (referred to in this subsection 21 as ‘‘AIM’’) under which the Secretary shall 22 award grants to eligible entities for the purpose 23 of— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00530 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 531 •S 4486 IS (i) directing widespread adoption and 1 implementation of maternal safety bundles 2 through collaborative State-based teams; 3 and 4 (ii) collecting and analyzing process, 5 structure, and outcome data to drive con- 6 tinuous improvement in the implementa- 7 tion of such safety bundles by such State- 8 based teams with the ultimate goal of 9 eliminating preventable maternal mortality 10 and severe maternal morbidity in the 11 United States. 12 (B) ELIGIBLE ENTITIES.—In order to be 13 eligible for a grant under subparagraph (A), an 14 entity shall— 15 (i) submit to the Secretary an applica- 16 tion at such time, in such manner, and 17 containing such information as the Sec- 18 retary may require; and 19 (ii) demonstrate in such application 20 that the entity is an interdisciplinary, 21 multi-stakeholder, national organization 22 with a national data-driven maternal safety 23 and quality improvement initiative based 24 on implementation approaches that have 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00531 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 532 •S 4486 IS been proven to improve maternal safety 1 and outcomes in the United States. 2 (C) USE OF FUNDS.—An eligible entity 3 that receives a grant under subparagraph (A) 4 shall use such grant funds— 5 (i) to develop and implement, through 6 a robust, multi-stakeholder process, mater- 7 nal safety bundles to assist States, 8 perinatal quality collaboratives, and health 9 care systems in aligning national, State, 10 and hospital-level quality improvement ef- 11 forts to improve maternal health outcomes, 12 specifically the reduction of maternal mor- 13 tality and severe maternal morbidity; 14 (ii) to ensure, in developing and im- 15 plementing maternal safety bundles under 16 clause (i), that such maternal safety bun- 17 dles— 18 (I) satisfy the quality improve- 19 ment needs of a State, perinatal qual- 20 ity collaborative, or health care system 21 by factoring in the results and find- 22 ings of relevant data reviews, such as 23 reviews conducted by a State maternal 24 mortality review committee; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00532 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 533 •S 4486 IS (II) address topics which may in- 1 clude— 2 (aa) information on evi- 3 dence-based practices to improve 4 the quality and safety of mater- 5 nal health care in hospitals and 6 other health care settings of a 7 State or health care system, in- 8 cluding by addressing topics com- 9 monly associated with health 10 complications or risks related to 11 prenatal care, labor care, birth- 12 ing, and postpartum care; 13 (bb) best practices for im- 14 proving maternal health care 15 based on data findings and re- 16 views conducted by a State ma- 17 ternal mortality review committee 18 that address topics of relevance 19 to common complications or 20 health risks related to prenatal 21 care, labor care, birthing, and 22 postpartum care; 23 (cc) information on address- 24 ing determinants of health that 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00533 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 534 •S 4486 IS impact maternal health outcomes 1 for people before, during, and 2 after pregnancy; 3 (dd) obstetric hemorrhage; 4 (ee) obstetric and 5 postpartum care for people with 6 substance use disorders, includ- 7 ing opioid use disorder; 8 (ff) maternal cardiovascular 9 system; 10 (gg) maternal mental health; 11 (hh) postpartum care basics 12 for maternal safety; 13 (ii) reduction of peripartum 14 racial and ethnic inequities; 15 (jj) reduction of primary ce- 16 sarean birth; 17 (kk) severe hypertension in 18 pregnancy; 19 (ll) severe maternal mor- 20 bidity reviews; 21 (mm) support after a severe 22 maternal morbidity event; 23 (nn) thromboembolism; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00534 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 535 •S 4486 IS (oo) optimization of support 1 for breastfeeding; 2 (pp) maternal oral health; 3 and 4 (qq) intimate partner vio- 5 lence; and 6 (iii) to provide ongoing technical as- 7 sistance at the national and State levels to 8 support implementation of maternal safety 9 bundles under clause (i). 10 (D) MATERNAL SAFETY BUNDLE DE- 11 FINED.—For purposes of this paragraph, the 12 term ‘‘maternal safety bundle’’ means standard- 13 ized, evidence-informed processes for maternal 14 health care. 15 (E) AUTHORIZATION OF APPROPRIA- 16 TIONS.—For purposes of carrying out this 17 paragraph, there is authorized to be appro- 18 priated $10,000,000 for each of fiscal years 19 2023 through 2027. 20 (4) FUNDING FOR STATE-BASED PERINATAL 21 QUALITY COLLABORATIVES DEVELOPMENT AND SUS- 22 TAINABILITY.— 23 (A) IN GENERAL.—Not later than one year 24 after the date of enactment of this Act, the Sec- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00535 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 536 •S 4486 IS retary of Health and Human Services (referred 1 to in this paragraph as the ‘‘Secretary’’), acting 2 through the Division of Reproductive Health of 3 the Centers for Disease Control and Prevention, 4 shall establish a grant program to be known as 5 the State-Based Perinatal Quality Collaborative 6 grant program under which the Secretary 7 awards grants to eligible entities for the pur- 8 pose of development and sustainability of 9 perinatal quality collaboratives in every State, 10 the District of Columbia, and eligible terri- 11 tories, in order to measurably improve perinatal 12 care and perinatal health outcomes for preg- 13 nant and postpartum people and their infants. 14 (B) GRANT AMOUNTS.—Grants awarded 15 under this paragraph shall be in amounts not to 16 exceed $250,000 per year, for the duration of 17 the grant period. 18 (C) STATE-BASED PERINATAL QUALITY 19 COLLABORATIVE DEFINED.—For purposes of 20 this paragraph, the term ‘‘State-based perinatal 21 quality collaborative’’ means a network of teams 22 that— 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00536 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 537 •S 4486 IS (i) is multidisciplinary in nature and 1 includes the full range of perinatal and 2 maternity care providers; 3 (ii) works to improve measurable out- 4 comes for maternal and infant health by 5 advancing evidence-informed clinical prac- 6 tices using quality improvement principles; 7 (iii) works with hospital-based or out- 8 patient facility-based clinical teams, ex- 9 perts, and stakeholders, including patients 10 and families, to spread best practices and 11 optimize resources to improve perinatal 12 care and outcomes; 13 (iv) employs strategies that include 14 the use of the collaborative learning model 15 to provide opportunities for hospitals and 16 clinical teams to collaborate on improve- 17 ment strategies, rapid-response data to 18 provide timely feedback to hospital and 19 other clinical teams to track progress, and 20 quality improvement science to provide 21 support and coaching to hospital and clin- 22 ical teams; 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00537 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 538 •S 4486 IS (v) has the goal of improving popu- 1 lation-level outcomes in maternal and in- 2 fant health; and 3 (vi) has the goal of improving out- 4 comes of all birthing people, through the 5 coordination, integration, and collaboration 6 across birth settings. 7 (D) AUTHORIZATION OF APPROPRIA- 8 TIONS.—For purposes of carrying out this 9 paragraph, there is authorized to be appro- 10 priated $14,000,000 per year for each of fiscal 11 years 2023 through 2027. 12 (5) EXPANSION OF MEDICAID AND CHIP COV- 13 ERAGE FOR PREGNANT AND POSTPARTUM PEO- 14 PLE.— 15 (A) REQUIRING COVERAGE OF ORAL 16 HEALTH SERVICES FOR PREGNANT AND 17 POSTPARTUM PEOPLE.— 18 (i) MEDICAID.—Section 1905 of the 19 Social Security Act (42 U.S.C. 1396d), as 20 previously amended by this Act, is amend- 21 ed— 22 (I) in subsection (a)(4), by in- 23 serting ‘‘; and (G) oral health services 24 for pregnant and postpartum people 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00538 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 539 •S 4486 IS (as defined in subsection (mm))’’ be- 1 fore the semicolon at the end; and 2 (II) by adding at the end the fol- 3 lowing new subsection: 4 ‘‘(mm) ORAL HEALTH SERVICES FOR PREGNANT 5 AND POSTPARTUM PEOPLE.— 6 ‘‘(1) IN GENERAL.—For purposes of this title, 7 the term ‘oral health services for pregnant and 8 postpartum people’ means dental services necessary 9 to prevent disease and promote oral health, restore 10 oral structures to health and function, and treat 11 emergency conditions that are furnished to a person 12 during pregnancy (or during the 1-year period be- 13 ginning on the last day of the pregnancy). 14 ‘‘(2) COVERAGE REQUIREMENTS.—To satisfy 15 the requirement to provide oral health services for 16 pregnant and postpartum people, a State shall pro- 17 vide coverage for preventive, diagnostic, periodontal, 18 and restorative care consistent with recommenda- 19 tions for perinatal oral health care and dental care 20 during pregnancy from the American Academy of 21 Pediatric Dentistry and the American College of Ob- 22 stetricians and Gynecologists.’’. 23 (ii) CHIP.—Section 2103(c)(6)(A) of 24 the Social Security Act (42 U.S.C. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00539 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 540 •S 4486 IS 1397cc(c)(6)(A)) is amended by inserting 1 ‘‘or a targeted low-income pregnant per- 2 son’’ after ‘‘targeted low-income child’’. 3 (B) EXTENDING MEDICAID COVERAGE FOR 4 PREGNANT AND POSTPARTUM PEOPLE.—Sec- 5 tion 1902 of the Social Security Act (42 U.S.C. 6 1396a) is amended— 7 (i) in subsection (e)— 8 (I) in paragraph (5)— 9 (aa) by inserting ‘‘(including 10 oral health services for pregnant 11 and postpartum people (as de- 12 fined in section 1905(mm)))’’ 13 after ‘‘postpartum medical assist- 14 ance under the plan’’; and 15 (bb) by striking ‘‘60-day’’ 16 and inserting ‘‘1-year’’; and 17 (II) in paragraph (6), by striking 18 ‘‘60-day’’ and inserting ‘‘1-year’’; and 19 (ii) in subsection (l)(1)(A), by striking 20 ‘‘60-day’’ and inserting ‘‘1-year’’. 21 (C) EXTENDING CHIP COVERAGE FOR 22 PREGNANT AND POSTPARTUM PEOPLE.—Sec- 23 tion 2112(d)(2)(A) of the Social Security Act 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00540 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 541 •S 4486 IS (42 U.S.C. 1397ll(d)(2)(A)) is amended by 1 striking ‘‘60-day’’ and inserting ‘‘1-year’’. 2 (D) CONFORMING AMENDMENTS.— 3 (i) Section 1902(e)(16) of the Social 4 Security Act (42 U.S.C. 1396a(e)(16)) is 5 amended— 6 (I) in subparagraph (A), by strik- 7 ing ‘‘may provide’’ and all that follows 8 through the period and inserting the 9 following: ‘‘may provide that the State 10 will provide the medical assistance de- 11 scribed in subparagraph (B) to an in- 12 dividual who, while pregnant, is eligi- 13 ble for and has received medical as- 14 sistance under the State plan ap- 15 proved under this title (or a waiver of 16 such plan), including during a period 17 of retroactive eligibility under sub- 18 section (a)(34) and through the end 19 of the month in which the 1-year pe- 20 riod beginning on the last day of the 21 individual’s pregnancy ends.’’; and 22 (II) in subparagraph (B), by 23 striking ‘‘12-month’’ each place it ap- 24 pears and inserting ‘‘1-year’’. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00541 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 542 •S 4486 IS (ii) Section 1905(a) of the Social Se- 1 curity Act (42 U.S.C. 1396d(a)) is amend- 2 ed, in the fifth sentence, by striking ‘‘60- 3 day’’ and inserting ‘‘1-year’’. 4 (E) MAINTENANCE OF EFFORT.— 5 (i) MEDICAID.—Section 1902(l) of the 6 Social Security Act (42 U.S.C. 1396a(l)) is 7 amended by adding at the end the fol- 8 lowing new paragraph: 9 ‘‘(5) During the period that begins on the date of 10 enactment of this paragraph and ends on the date that 11 is 5 years after such date of enactment, as a condition 12 for receiving any Federal payments under section 1903(a) 13 for calendar quarters occurring during such period, a 14 State shall not have in effect, with respect to people who 15 are eligible for medical assistance under the State plan 16 or under a waiver of such plan on the basis of being preg- 17 nant or having been pregnant, eligibility standards, meth- 18 odologies, or procedures under the State plan or waiver 19 that are more restrictive than the eligibility standards, 20 methodologies, or procedures, respectively, under such 21 plan or waiver that are in effect on the date of enactment 22 of this paragraph.’’. 23 (ii) CHIP.—Section 2105(d) of the 24 Social Security Act (42 U.S.C. 1397ee(d)) 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00542 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 543 •S 4486 IS is amended by adding at the end the fol- 1 lowing new paragraph: 2 ‘‘(4) ELIGIBILITY STANDARDS FOR TARGETED 3 LOW-INCOME PREGNANT PEOPLE.—During the pe- 4 riod that begins on the date of enactment of this 5 paragraph and ends on the date that is five years 6 after such date of enactment, as a condition of re- 7 ceiving payments under subsection (a) and section 8 1903(a), a State that elects to provide assistance to 9 people on the basis of being pregnant (including 10 pregnancy-related assistance provided to targeted 11 low-income pregnant people (as defined in section 12 2112(d)), pregnancy-related assistance provided to 13 people who are eligible for such assistance through 14 application of section 1902(v)(4)(A) under section 15 2107(e)(1), or any other assistance under the State 16 child health plan (or a waiver of such plan) which 17 is provided to people on the basis of being pregnant) 18 shall not have in effect, with respect to such people, 19 eligibility standards, methodologies, or procedures 20 under such plan (or waiver) that are more restrictive 21 than the eligibility standards, methodologies, or pro- 22 cedures, respectively, under such plan (or waiver) 23 that are in effect on the date of enactment of this 24 paragraph.’’. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00543 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 544 •S 4486 IS (F) INFORMATION ON BENEFITS.—The 1 Secretary of Health and Human Services shall 2 make publicly available on the internet website 3 of the Department of Health and Human Serv- 4 ices, information regarding benefits available to 5 pregnant and postpartum people and under the 6 Medicaid program and the Children’s Health 7 Insurance Program, including information on— 8 (i) benefits that States are required to 9 provide to pregnant and postpartum people 10 under such programs; 11 (ii) optional benefits that States may 12 provide to pregnant and postpartum people 13 under such programs; and 14 (iii) the availability of different kinds 15 of benefits for pregnant and postpartum 16 people, including oral health and mental 17 health benefits, under such programs. 18 (G) FEDERAL FUNDING FOR COST OF EX- 19 TENDED MEDICAID AND CHIP COVERAGE FOR 20 POSTPARTUM PEOPLE.— 21 (i) MEDICAID.—Section 1905 of the 22 Social Security Act (42 U.S.C. 1396d), as 23 previously amended by this Act, is further 24 amended— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00544 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 545 •S 4486 IS (I) in subsection (b), by striking 1 ‘‘and (ll)’’ and inserting ‘‘(ll), and 2 (nn)’’; and 3 (II) by adding at the end the fol- 4 lowing: 5 ‘‘(nn) INCREASED FMAP FOR EXTENDED MEDICAL 6 ASSISTANCE FOR POSTPARTUM PEOPLE.—Notwith- 7 standing subsection (b), the Federal medical assistance 8 percentage for a State, with respect to amounts expended 9 by such State for medical assistance for a person who is 10 eligible for such assistance on the basis of being pregnant 11 or having been pregnant that is provided during the 305- 12 day period that begins on the 60th day after the last day 13 of their pregnancy (including any such assistance provided 14 during the month in which such period ends), shall be 15 equal to— 16 ‘‘(1) 100 percent for the first 20 calendar quar- 17 ters during which this subsection is in effect; and 18 ‘‘(2) 90 percent for calendar quarters there- 19 after.’’. 20 (ii) CHIP.—Section 2105(c) of the 21 Social Security Act (42 U.S.C. 1397ee(c)) 22 is amended by adding at the end the fol- 23 lowing new paragraph: 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00545 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 546 •S 4486 IS ‘‘(13) ENHANCED PAYMENT FOR EXTENDED 1 ASSISTANCE PROVIDED TO PREGNANT PEOPLE.— 2 Notwithstanding subsection (b), the enhanced 3 FMAP, with respect to payments under subsection 4 (a) for expenditures under the State child health 5 plan (or a waiver of such plan) for assistance pro- 6 vided under the plan (or waiver) to a person who is 7 eligible for such assistance on the basis of being 8 pregnant (including pregnancy-related assistance 9 provided to a targeted low-income pregnant person 10 (as defined in section 2112(d)), pregnancy-related 11 assistance provided to a person who is eligible for 12 such assistance through application of section 13 1902(v)(4)(A) under section 2107(e)(1), or any 14 other assistance under the plan (or waiver) provided 15 to a person who is eligible for such assistance on the 16 basis of being pregnant) during the 305-day period 17 that begins on the 60th day after the last day of her 18 pregnancy (including any such assistance provided 19 during the month in which such period ends), shall 20 be equal to— 21 ‘‘(A) 100 percent for the first 20 calendar 22 quarters during which this paragraph is in ef- 23 fect; and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00546 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 547 •S 4486 IS ‘‘(B) 90 percent for calendar quarters 1 thereafter.’’. 2 (H) GUIDANCE ON STATE OPTIONS FOR 3 MEDICAID COVERAGE OF DOULA SERVICES.— 4 Not later than 1 year after the date of the en- 5 actment of this Act, the Secretary of Health 6 and Human Services, acting through the Ad- 7 ministrator of the Centers for Medicare & Med- 8 icaid Services, shall issue guidance for the 9 States concerning options for Medicaid coverage 10 and payment for support services provided by 11 doulas. 12 (I) EFFECTIVE DATE.— 13 (i) IN GENERAL.—Subject to clause 14 (ii), the amendments made by this para- 15 graph shall take effect on the first day of 16 the first calendar quarter that begins on or 17 after the date that is one year after the 18 date of enactment of this Act. 19 (ii) EXCEPTION FOR STATE LEGISLA- 20 TION.—In the case of a State plan under 21 title XIX of the Social Security Act or a 22 State child health plan under title XXI of 23 such Act that the Secretary of Health and 24 Human Services determines requires State 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00547 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 548 •S 4486 IS legislation in order for the respective plan 1 to meet any requirement imposed by 2 amendments made by this paragraph, the 3 respective plan shall not be regarded as 4 failing to comply with the requirements of 5 such title solely on the basis of its failure 6 to meet such an additional requirement be- 7 fore the first day of the first calendar 8 quarter beginning after the close of the 9 first regular session of the State legislature 10 that begins after the date of enactment of 11 this Act. For purposes of the previous sen- 12 tence, in the case of a State that has a 2- 13 year legislative session, each year of the 14 session shall be considered to be a separate 15 regular session of the State legislature. 16 (6) REGIONAL CENTERS OF EXCELLENCE.— 17 Part P of title III of the Public Health Service Act 18 (42 U.S.C. 280g et seq.), as amended by section 19 5101, is further amended by adding at the end the 20 following new section: 21 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00548 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 549 •S 4486 IS ‘‘SEC. 399V–8. REGIONAL CENTERS OF EXCELLENCE AD- 1 DRESSING IMPLICIT BIAS AND CULTURAL 2 COMPETENCY IN PATIENT-PROVIDER INTER- 3 ACTIONS EDUCATION. 4 ‘‘(a) IN GENERAL.—Not later than one year after the 5 date of enactment of this section, the Secretary, in con- 6 sultation with such other agency heads as the Secretary 7 determines appropriate, shall award cooperative agree- 8 ments for the establishment or support of regional centers 9 of excellence addressing implicit bias, cultural competency, 10 and respectful care practices in patient-provider inter- 11 actions education for the purpose of enhancing and im- 12 proving how health care professionals are educated in im- 13 plicit bias and delivering culturally competent health care. 14 ‘‘(b) ELIGIBILITY.—To be eligible to receive a cooper- 15 ative agreement under subsection (a), an entity shall— 16 ‘‘(1) be a public or other nonprofit entity speci- 17 fied by the Secretary that provides educational and 18 training opportunities for students and health care 19 professionals, which may be a health system, teach- 20 ing hospital, community health center, medical 21 school, school of public health, school of nursing, 22 dental school, social work school, school of profes- 23 sional psychology, or any other health professional 24 school or program at an institution of higher edu- 25 cation (as defined in section 101 of the Higher Edu- 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00549 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 550 •S 4486 IS cation Act of 1965) focused on the prevention, treat- 1 ment, or recovery of health conditions that con- 2 tribute to maternal mortality and the prevention of 3 maternal mortality and severe maternal morbidity; 4 ‘‘(2) demonstrate community engagement and 5 participation, such as through partnerships with 6 home visiting and case management programs; 7 ‘‘(3) demonstrate engagement with groups en- 8 gaged in the implementation of health care profes- 9 sional training in implicit bias and delivering cul- 10 turally competent care, such as departments of pub- 11 lic health, perinatal quality collaboratives, hospital 12 systems, and health care professional groups, in 13 order to obtain input on resources needed for effec- 14 tive implementation strategies; and 15 ‘‘(4) provide to the Secretary such information, 16 at such time and in such manner, as the Secretary 17 may require. 18 ‘‘(c) DIVERSITY.—In awarding a cooperative agree- 19 ment under subsection (a), the Secretary shall take into 20 account any regional differences among eligible entities 21 and make an effort to ensure geographic diversity among 22 award recipients. 23 ‘‘(d) DISSEMINATION OF INFORMATION.— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00550 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 551 •S 4486 IS ‘‘(1) PUBLIC AVAILABILITY.—The Secretary 1 shall make publicly available on the internet website 2 of the Department of Health and Human Services 3 information submitted to the Secretary under sub- 4 section (b)(4). 5 ‘‘(2) EVALUATION.—The Secretary shall evalu- 6 ate each regional center of excellence established or 7 supported pursuant to subsection (a) and dissemi- 8 nate the findings resulting from each such evalua- 9 tion to the appropriate public and private entities. 10 ‘‘(3) DISTRIBUTION.—The Secretary shall share 11 evaluations and overall findings with State depart- 12 ments of health and other relevant State level offices 13 to inform State and local best practices. 14 ‘‘(e) MATERNAL MORTALITY DEFINED.—In this sec- 15 tion, the term ‘maternal mortality’ means death of a per- 16 son that occurs during pregnancy or within the one-year 17 period following the end of such pregnancy. 18 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—For 19 purposes of carrying out this section, there is authorized 20 to be appropriated $5,000,000 for each of fiscal years 21 2023 through 2027.’’. 22 (7) SPECIAL SUPPLEMENTAL NUTRITION PRO- 23 GRAM FOR PEOPLE, INFANTS, AND CHILDREN.—Sec- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00551 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 552 •S 4486 IS tion 17(d)(3)(A)(ii) of the Child Nutrition Act of 1 1966 (42 U.S.C. 1786(d)(3)(A)(ii)) is amended— 2 (A) by striking the clause designation and 3 heading and all that follows through ‘‘A State’’ 4 and inserting the following: 5 ‘‘(ii) PREGNANT AND POSTPARTUM 6 PEOPLE.— 7 ‘‘(I) BREASTFEEDING PEOPLE.— 8 A State’’; 9 (B) in subclause (I) (as so designated), by 10 striking ‘‘1 year’’ and all that follows through 11 ‘‘earlier’’ and inserting ‘‘2 years postpartum’’; 12 and 13 (C) by adding at the end the following: 14 ‘‘(II) POSTPARTUM PEOPLE.—A 15 State may elect to certify a 16 postpartum person for a period of 2 17 years.’’. 18 (8) DEFINITIONS.—In this subsection: 19 (A) MATERNAL MORTALITY.—The term 20 ‘‘maternal mortality’’ means death of a person 21 that occurs during pregnancy or within the one- 22 year period following the end of such preg- 23 nancy. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00552 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 553 •S 4486 IS (B) PREGNANCY RELATED DEATH.—The 1 term ‘‘pregnancy related death’’ includes the 2 death of a person during pregnancy or within 3 one year of the end of pregnancy from a preg- 4 nancy complication, a chain of events initiated 5 by pregnancy, or the aggravation of an unre- 6 lated condition by the physiologic effects of 7 pregnancy. 8 (C) SEVERE MATERNAL MORBIDITY.—The 9 term ‘‘severe maternal morbidity’’ includes un- 10 expected outcomes of labor and delivery that re- 11 sult in significant short-term or long-term con- 12 sequences to a person’s health. 13 (b) INCREASE IN TAX ON CERTAIN TOBACCO PROD- 14 UCTS AND IMPOSITION OF TAX ON NICOTINE.— 15 (1) INCREASING TAX ON CIGARETTES.— 16 (A) SMALL CIGARETTES.—Section 17 5701(b)(1) of the Internal Revenue Code of 18 1986 is amended by striking ‘‘$50.33’’ and in- 19 serting ‘‘$100.66’’. 20 (B) LARGE CIGARETTES.—Section 21 5701(b)(2) of such Code is amended by striking 22 ‘‘$105.69’’ and inserting ‘‘$211.39’’. 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00553 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 554 •S 4486 IS (2) TAX PARITY FOR SMALL CIGARS.—Section 1 5701(a)(1) of such Code is amended by striking 2 ‘‘$50.33’’ and inserting ‘‘$100.66’’. 3 (3) TAX PARITY FOR LARGE CIGARS.—Section 4 5701(a)(2) of such Code is amended by striking 5 ‘‘52.75 percent’’ and all that follows through the pe- 6 riod and inserting ‘‘$49.56 per pound and a propor- 7 tionate tax at the like rate on all fractional parts of 8 a pound but not less than 10.06 cents per cigar.’’. 9 (4) TAX PARITY FOR SMOKELESS TOBACCO.— 10 (A) Section 5701(e) of such Code is 11 amended— 12 (i) in paragraph (1), by striking 13 ‘‘$1.51’’ and inserting ‘‘$26.84’’, 14 (ii) in paragraph (2), by striking 15 ‘‘50.33 cents’’ and inserting ‘‘$10.70’’, and 16 (iii) by adding at the end the fol- 17 lowing new paragraph: 18 ‘‘(3) SMOKELESS TOBACCO SOLD IN DISCRETE 19 SINGLE-USE UNITS.—On discrete single-use units, 20 $100 per thousand.’’. 21 (B) Section 5702(m) of such Code is 22 amended— 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00554 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 555 •S 4486 IS (i) in paragraph (1), by striking ‘‘or 1 chewing tobacco’’ and inserting ‘‘, chewing 2 tobacco, or discrete single-use unit’’, 3 (ii) in paragraphs (2) and (3), by in- 4 serting ‘‘and that is not a discrete single- 5 use unit’’ before the period at the end of 6 each such paragraph, and 7 (iii) by adding at the end the fol- 8 lowing new paragraph: 9 ‘‘(4) DISCRETE SINGLE-USE UNIT.—The term 10 ‘discrete single-use unit’ means any product con- 11 taining tobacco that— 12 ‘‘(A) is not intended to be smoked, and 13 ‘‘(B) is in the form of a lozenge, tablet, 14 pill, pouch, dissolvable strip, or other discrete 15 single-use or single-dose unit.’’. 16 (5) TAX PARITY FOR PIPE TOBACCO.—Section 17 5701(f) of such Code is amended by striking 18 ‘‘$2.8311 cents’’ and inserting ‘‘$49.56’’. 19 (6) TAX PARITY FOR ROLL-YOUR-OWN TO- 20 BACCO.—Section 5701(g) of such Code is amended 21 by striking ‘‘$24.78’’ and inserting ‘‘$49.56’’. 22 (7) TAX PARITY FOR ROLL-YOUR-OWN TOBACCO 23 AND CERTAIN PROCESSED TOBACCO.—Section 24 5702(o) of such Code is amended by inserting ‘‘, 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00555 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 556 •S 4486 IS and includes processed tobacco that is removed for 1 delivery or delivered to a person other than a person 2 with a permit provided under section 5713, but does 3 not include removals of processed tobacco for expor- 4 tation’’ after ‘‘wrappers thereof’’. 5 (8) IMPOSITION OF TAX ON NICOTINE FOR USE 6 IN VAPING, ETC.— 7 (A) IN GENERAL.—Section 5701 of such 8 Code is amended by redesignating subsection 9 (h) as subsection (i) and by inserting after sub- 10 section (g) the following new subsection: 11 ‘‘(h) NICOTINE.—On taxable nicotine, manufactured 12 in or imported into the United States, there shall be im- 13 posed a tax equal to the dollar amount specified in section 14 5701(b)(1) per 1,810 milligrams of nicotine (and a pro- 15 portionate tax at the like rate on any fractional part there- 16 of).’’. 17 (B) TAXABLE NICOTINE.—Section 5702 of 18 such Code is amended by adding at the end the 19 following new subsection: 20 ‘‘(q) TAXABLE NICOTINE.— 21 ‘‘(1) IN GENERAL.—Except as otherwise pro- 22 vided in this subsection, the term ‘taxable nicotine’ 23 means any nicotine which has been extracted, con- 24 centrated, or synthesized. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00556 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 557 •S 4486 IS ‘‘(2) EXCEPTION FOR PRODUCTS APPROVED BY 1 FOOD AND DRUG ADMINISTRATION.—Such term 2 shall not include any nicotine if the manufacturer or 3 importer thereof demonstrates to the satisfaction of 4 the Secretary of Health and Human Services that 5 such nicotine will be used in— 6 ‘‘(A) a drug— 7 ‘‘(i) that is approved under section 8 505 of the Federal Food, Drug, and Cos- 9 metic Act or licensed under section 351 of 10 the Public Health Service Act, or 11 ‘‘(ii) for which an investigational use 12 exemption has been authorized under sec- 13 tion 505(i) of the Federal Food, Drug, and 14 Cosmetic Act or under section 351(a) of 15 the Public Health Service Act, or 16 ‘‘(B) a combination product (as described 17 in section 503(g) of the Federal Food, Drug, 18 and Cosmetic Act), the constituent parts of 19 which were approved or cleared under section 20 505, 510(k), or 515 of such Act. 21 ‘‘(3) COORDINATION WITH TAXATION OF OTHER 22 TOBACCO PRODUCTS.—Tobacco products meeting 23 the definition of cigars, cigarettes, smokeless to- 24 bacco, pipe tobacco, and roll-your-own tobacco in 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00557 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 558 •S 4486 IS this section shall be classified and taxed as such de- 1 spite any concentration of the nicotine inherent in 2 those products or any addition of nicotine to those 3 products during the manufacturing process. 4 ‘‘(4) REGULATIONS.—The Secretary shall pre- 5 scribe such regulations or other guidance as is nec- 6 essary or appropriate to carry out the purposes of 7 this subsection, including regulations or other guid- 8 ance for coordinating the taxation of tobacco prod- 9 ucts and taxable nicotine to protect revenue and pre- 10 vent double taxation.’’. 11 (C) TAXABLE NICOTINE TREATED AS A TO- 12 BACCO PRODUCT.—Section 5702(c) of such 13 Code is amended by striking ‘‘and roll-your-own 14 tobacco’’ and inserting ‘‘roll-your-own tobacco, 15 and taxable nicotine’’. 16 (D) MANUFACTURER OF TAXABLE NICO- 17 TINE.—Section 5702 of such Code, as amended 18 by subparagraph (B), is amended by adding at 19 the end the following new subsection: 20 ‘‘(r) MANUFACTURER OF TAXABLE NICOTINE.— 21 ‘‘(1) IN GENERAL.—Any person who extracts, 22 concentrates, or synthesizes nicotine shall be treated 23 as a manufacturer of taxable nicotine (and as manu- 24 facturing such taxable nicotine). 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00558 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 559 •S 4486 IS ‘‘(2) APPLICATION OF RULES RELATED TO 1 MANUFACTURERS OF TOBACCO PRODUCTS.—Any 2 reference to a manufacturer of tobacco products, or 3 to manufacturing tobacco products, shall be treated 4 as including a reference to a manufacturer of tax- 5 able nicotine, or to manufacturing taxable nicotine, 6 respectively.’’. 7 (9) REPEAL OF SPECIAL RULES FOR DETER- 8 MINING PRICE OF CIGARS.—Section 5702 of such 9 Code is amended by striking subsection (l). 10 (10) FLOOR STOCKS TAXES.— 11 (A) IMPOSITION OF TAX.—On covered to- 12 bacco products, and cigarette papers and tubes, 13 manufactured in or imported into the United 14 States which are removed before the tax in- 15 crease date and held on such date for sale by 16 any person, there is hereby imposed a tax in an 17 amount equal to the excess of— 18 (i) the tax which would be imposed 19 under section 5701 of the Internal Rev- 20 enue Code of 1986 on the article if the ar- 21 ticle had been removed on such date, over 22 (ii) the prior tax (if any) imposed 23 under section 5701 of such Code on such 24 article. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00559 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 560 •S 4486 IS (B) COVERED TOBACCO PRODUCTS.—For 1 purposes of this paragraph, the term ‘‘covered 2 tobacco products’’ means any tobacco product 3 other than— 4 (i) cigars described in section 5 5701(a)(2) of the Internal Revenue Code 6 of 1986, 7 (ii) discrete single-use units (as de- 8 fined in section 5702(m)(4) of such Code, 9 as amended by this subsection), and 10 (iii) taxable nicotine (as defined in 11 section 5702(q) of such Code, as amended 12 by this subsection). 13 (C) CREDIT AGAINST TAX.—Each person 14 shall be allowed as a credit against the taxes 15 imposed by subparagraph (A) an amount equal 16 to the lesser of $1,000 or the amount of such 17 taxes. For purposes of the preceding sentence, 18 all persons treated as a single employer under 19 subsection (b), (c), (m), or (o) of section 414 of 20 the Internal Revenue Code of 1986 shall be 21 treated as 1 person for purposes of this sub- 22 paragraph. 23 (D) LIABILITY FOR TAX AND METHOD OF 24 PAYMENT.— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00560 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 561 •S 4486 IS (i) LIABILITY FOR TAX.—The person 1 referred to in subparagraph (A) shall be 2 liable for the tax imposed by such subpara- 3 graph. 4 (ii) METHOD OF PAYMENT.—The tax 5 imposed by subparagraph (A) shall be paid 6 in such manner as the Secretary may pro- 7 vide. 8 (E) ARTICLES IN FOREIGN TRADE 9 ZONES.— 10 (i) IN GENERAL.—Notwithstanding 11 the Act of June 18, 1934 (commonly 12 known as the Foreign Trade Zone Act, 48 13 Stat. 998, 19 U.S.C. 81a et seq.) or any 14 other provision of law, any covered tobacco 15 products, or cigarette papers and tubes, 16 which are located in a foreign trade zone 17 on the tax increase date, shall be subject 18 to the tax imposed by subparagraph (A) 19 if— 20 (I) internal revenue taxes have 21 been determined, or customs duties 22 liquidated, with respect to such article 23 before such date pursuant to a re- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00561 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 562 •S 4486 IS quest made under the 1st proviso of 1 section 3(a) of such Act, or 2 (II) such article is held on such 3 date under the supervision of an offi- 4 cer of the United States Customs and 5 Border Protection of the Department 6 of Homeland Security pursuant to the 7 2d proviso of such section 3(a). 8 (F) TAX INCREASE DATE.—For purposes 9 of this paragraph, the term ‘‘tax increase date’’ 10 means the first day of the first calendar quarter 11 described in paragraph (11)(A). 12 (G) CERTAIN OTHER DEFINITIONS.— 13 Terms used in this paragraph which are also 14 used in section 5702 of the Internal Revenue 15 Code of 1986 shall have the same meaning as 16 when used in such section. 17 (11) EFFECTIVE DATE.— 18 (A) IN GENERAL.—Except as otherwise 19 provided in this paragraph, the amendments 20 made by this subsection shall apply to articles 21 removed in calendar quarters beginning after 22 the date of the enactment of this Act. 23 (B) DELAYED EFFECTIVE DATE FOR CER- 24 TAIN PRODUCTS.—The amendments made by 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00562 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 563 •S 4486 IS paragraphs (3), (4)(A)(iii), (4)(B), and (8) 1 shall apply to articles removed in calendar 2 quarters beginning after the date which is 180 3 days after the date of the enactment of this 4 Act. 5 (12) TRANSITION RULE FOR PERMIT AND BOND 6 REQUIREMENTS.—A person which is lawfully en- 7 gaged in business as a manufacturer or importer of 8 taxable nicotine (within the meaning of subchapter 9 A of chapter 52 of the Internal Revenue Code of 10 1986, as amended by this subsection) on the date of 11 the enactment of this Act, first becomes subject to 12 the requirements of subchapter B of chapter 52 of 13 such Code by reason of the amendments made by 14 this subsection, and submits an application under 15 such subchapter B to engage in such business not 16 later than 90 days after the date of the enactment 17 of this Act, shall not be denied the right to carry on 18 such business by reason of such requirements before 19 final action on such application. 20 SEC. 5202. MOMMIES. 21 (a) GAO STUDY AND REPORT.— 22 (1) IN GENERAL.—Not later than 1 year after 23 the date of the enactment of this Act, the Comp- 24 troller General of the United States shall submit to 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00563 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 564 •S 4486 IS Congress a report on the gaps in coverage with re- 1 spect to— 2 (A) pregnant individuals enrolled under a 3 State plan (or waiver of such plan) under title 4 XIX of the Social Security Act (42 U.S.C. 1396 5 et seq.) and the Children’s Health Insurance 6 Program under title XXI of the Social Security 7 Act (42 U.S.C. 1397aa et seq.); and 8 (B) postpartum individuals enrolled under 9 a State plan (or waiver of such plan) under title 10 XIX of the Social Security Act (42 U.S.C. 1396 11 et seq.) and the Children’s Health Insurance 12 Program under title XXI of the Social Security 13 Act (42 U.S.C. 1397aa et seq.) who received as- 14 sistance under either such program during their 15 pregnancy. 16 (2) CONTENT OF REPORT.—The report re- 17 quired under this paragraph shall include the fol- 18 lowing: 19 (A) Information about the abilities and 20 successes of State Medicaid agencies in deter- 21 mining whether pregnant and postpartum indi- 22 viduals are eligible under another insurance af- 23 fordability program, and in transitioning any 24 such individuals who are so eligible to coverage 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00564 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 565 •S 4486 IS under such a program at the end of their period 1 of eligibility for medical assistance, pursuant to 2 section 435.1200 of the title 42, Code of Fed- 3 eral Regulations (as in effect on September 1, 4 2018). 5 (B) Information on factors contributing to 6 gaps in coverage that disproportionately impact 7 underserved populations, including low-income 8 individuals, Black, Indigenous, and other indi- 9 viduals of color, individuals who reside in a 10 health professional shortage area (as defined in 11 section 332(a)(1)(A) of the Public Health Serv- 12 ice Act (42 U.S.C. 254e(a)(1)(A))) or individ- 13 uals who are members of a medically under- 14 served population (as defined by section 15 330(b)(3) of such Act (42 U.S.C. 16 254b(b)(3)(A))). 17 (C) Recommendations for addressing and 18 reducing such gaps in coverage. 19 (D) Such other information as the Comp- 20 troller General deems necessary. 21 (3) DATA DISAGGREGATION.—To the greatest 22 extent possible, the Comptroller General shall 23 disaggregate data presented in the report, including 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00565 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 566 •S 4486 IS by age, gender identity, race, ethnicity, income level, 1 and other demographic factors. 2 (b) MATERNITY CARE HOME DEMONSTRATION 3 PROJECT.—Title XIX of the Social Security Act (42 4 U.S.C. 1396 et seq.) is amended by inserting the following 5 new section after section 1947: 6 ‘‘SEC. 1948. MATERNITY CARE HOME DEMONSTRATION 7 PROJECT. 8 ‘‘(a) IN GENERAL.—Not later than 1 year after the 9 date of the enactment of this section, the Secretary shall 10 establish a demonstration project (in this section referred 11 to as the ‘demonstration project’) under which the Sec- 12 retary shall provide grants to States to enter into arrange- 13 ments with eligible entities to implement or expand a ma- 14 ternity care home model for eligible individuals. 15 ‘‘(b) GOALS OF DEMONSTRATION PROJECT.—The 16 goals of the demonstration project are the following: 17 ‘‘(1) To improve— 18 ‘‘(A) maternity and infant care outcomes; 19 ‘‘(B) birth equity; 20 ‘‘(C) health equity for— 21 ‘‘(i) Black, Indigenous, and other peo- 22 ple of color; 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00566 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 567 •S 4486 IS ‘‘(ii) lesbian, gay, bisexual, 1 transgender, queer, non-binary, and gender 2 nonconfirming individuals; 3 ‘‘(iii) people with disabilities; and 4 ‘‘(iv) other underserved populations; 5 ‘‘(D) communication by maternity, infant 6 care, and social services providers; 7 ‘‘(E) integration of perinatal support serv- 8 ices, including community health workers, 9 doulas, social workers, public health nurses, 10 peer lactation counselors, lactation consultants, 11 childbirth educators, peer mental health work- 12 ers, and others, into health care entities and or- 13 ganizations; 14 ‘‘(F) care coordination between maternity, 15 infant care, oral health services, and social serv- 16 ices providers within the community; 17 ‘‘(G) the quality and safety of maternity 18 and infant care; 19 ‘‘(H) the experience of individuals receiv- 20 ing maternity care, including by increasing the 21 ability of an individual to develop and follow 22 their own birthing plans; and 23 ‘‘(I) access to adequate prenatal and 24 postpartum care, including— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00567 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 568 •S 4486 IS ‘‘(i) prenatal care that is initiated in 1 a timely manner; 2 ‘‘(ii) not fewer than 5 post-pregnancy 3 visits to a maternity care provider; and 4 ‘‘(iii) interpregnancy care. 5 ‘‘(2) To provide coordinated, evidence-based, re- 6 spectful, culturally and linguistically appropriate, 7 and person-centered maternity care management. 8 ‘‘(3) To decrease— 9 ‘‘(A) severe and preventable maternal mor- 10 bidity and maternal mortality; 11 ‘‘(B) overall health care spending; 12 ‘‘(C) unnecessary emergency department 13 visits; 14 ‘‘(D) inequities in maternal and infant care 15 outcomes, including racial, economic, disability, 16 gender-based, and geographical inequities; 17 ‘‘(E) racial, gender, economic, and other 18 discrimination among health care professionals; 19 ‘‘(F) racism, discrimination, disrespect, 20 and abuse in maternity care settings; 21 ‘‘(G) the rate of cesarean deliveries for 22 low-risk pregnancies; 23 ‘‘(H) the rate of pre-term births and in- 24 fants born with low birth weight; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00568 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 569 •S 4486 IS ‘‘(I) the rate of avoidable maternal and 1 newborn hospitalizations and admissions to in- 2 tensive care units. 3 ‘‘(c) CONSULTATION.—In designing and imple- 4 menting the demonstration project the Secretary shall 5 consult with stakeholders, including— 6 ‘‘(1) States; 7 ‘‘(2) organizations representing relevant health 8 care professionals, including oral health services pro- 9 fessionals; 10 ‘‘(3) organizations, particularly reproductive 11 justice and birth justice organizations led by people 12 of color, that represent consumers of maternal 13 health care, including consumers of maternal health 14 care who are disproportionately impacted by poor 15 maternal health outcomes; 16 ‘‘(4) representatives with experience imple- 17 menting other maternity care home models, includ- 18 ing representatives from the Center for Medicare 19 and Medicaid Innovation; 20 ‘‘(5) community-based health care professionals, 21 including doulas, lactation consultants, and other 22 stakeholders; 23 ‘‘(6) experts in promoting health equity and 24 combating racial bias in health care settings; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00569 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 570 •S 4486 IS ‘‘(7) Black, Indigenous, and other maternal 1 health care consumers of color who have experienced 2 severe maternal morbidity. 3 ‘‘(d) APPLICATION AND SELECTION OF STATES.— 4 ‘‘(1) IN GENERAL.—A State seeking to partici- 5 pate in the demonstration project shall submit an 6 application to the Secretary at such time and in 7 such manner as the Secretary shall require. 8 ‘‘(2) SELECTION OF STATES.— 9 ‘‘(A) IN GENERAL.—The Secretary shall 10 select at least 10 States to participate in the 11 demonstration project. 12 ‘‘(B) SELECTION REQUIREMENTS.—In se- 13 lecting States to participate in the demonstra- 14 tion project, the Secretary shall— 15 ‘‘(i) ensure that there is geographic 16 and regional diversity in the areas in which 17 activities will be carried out under the 18 project; 19 ‘‘(ii) ensure that States with signifi- 20 cant inequities in maternal and infant 21 health outcomes, including severe maternal 22 morbidity, and other inequities based on 23 race, income, or access to maternity care, 24 are included; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00570 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 571 •S 4486 IS ‘‘(iii) ensure that at least 1 territory 1 is included. 2 ‘‘(e) GRANTS.— 3 ‘‘(1) IN GENERAL.—From amounts appro- 4 priated under subsection (l), the Secretary shall 5 award 1 grant for each year of the demonstration 6 project to each State that is selected to participate 7 in the demonstration project. 8 ‘‘(2) USE OF GRANT FUNDS.—A State may use 9 funds received under this section to— 10 ‘‘(A) award grants or make payments to 11 eligible entities as part of an arrangement de- 12 scribed in subsection (f)(2); 13 ‘‘(B) provide financial incentives to health 14 care professionals, including community-based 15 health care workers and community-based 16 doulas, who participate in the State’s maternity 17 care home model; 18 ‘‘(C) provide adequate training for health 19 care professionals, including community-based 20 health care workers, doulas, and care coordina- 21 tors, who participate in the State’s maternity 22 care home model, which may include training 23 for cultural humility and antiracism, racial bias, 24 health equity, reproductive and birth justice, 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00571 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 572 •S 4486 IS trauma-informed care, home visiting skills, and 1 respectful communication and listening skills, 2 particularly in regards to maternal health; 3 ‘‘(D) pay for personnel and administrative 4 expenses associated with designing, imple- 5 menting, and operating the State’s maternity 6 care home model; 7 ‘‘(E) pay for items and services that are 8 furnished under the State’s maternity care 9 home model and for which payment is otherwise 10 unavailable under this title; 11 ‘‘(F) pay for services and materials to en- 12 sure culturally and linguistically appropriate 13 communication, including— 14 ‘‘(i) language services such as inter- 15 preters and translation of written mate- 16 rials; and 17 ‘‘(ii) development of culturally and lin- 18 guistically appropriate materials; and aux- 19 iliary aids and services; and 20 ‘‘(G) pay for other costs related to the 21 State’s maternity care home model, as deter- 22 mined by the Secretary. 23 ‘‘(3) GRANT FOR NATIONAL INDEPENDENT 24 EVALUATOR.— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00572 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 573 •S 4486 IS ‘‘(A) IN GENERAL.—From the amounts 1 appropriated under subsection (l), prior to 2 awarding any grants under paragraph (1), the 3 Secretary shall enter into a contract with a na- 4 tional external entity to create a single, uniform 5 process to— 6 ‘‘(i) ensure that States that receive 7 grants under paragraph (1) comply with 8 the requirements of this section; and 9 ‘‘(ii) evaluate the outcomes of the 10 demonstration project in each participating 11 State. 12 ‘‘(B) ANNUAL REPORT.—The contract de- 13 scribed in subparagraph (A) shall require the 14 national external entity to submit to the Sec- 15 retary— 16 ‘‘(i) a yearly evaluation report for 17 each year of the demonstration project; 18 and 19 ‘‘(ii) a final impact report after the 20 demonstration project has concluded. 21 ‘‘(C) SECRETARY’S AUTHORITY.—Nothing 22 in this paragraph shall prevent the Secretary 23 from making a determination that a State is 24 not in compliance with the requirements of this 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00573 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 574 •S 4486 IS section without the national external entity 1 making such a determination. 2 ‘‘(f) PARTNERSHIP WITH ELIGIBLE ENTITIES.— 3 ‘‘(1) IN GENERAL.—As a condition of receiving 4 a grant under this section, a State shall enter into 5 an arrangement with one or more eligible entities 6 that meets the requirements of paragraph (2). 7 ‘‘(2) ARRANGEMENTS WITH ELIGIBLE ENTI- 8 TIES.—Under an arrangement between a State and 9 an eligible entity under this subsection, the eligible 10 entity shall perform the following functions, with re- 11 spect to eligible individuals enrolled with the entity 12 under the State’s maternity care home model— 13 ‘‘(A) provide culturally and linguistically 14 appropriate congruent care, which may include 15 prenatal care, family planning services, medical 16 care, mental and behavioral care, postpartum 17 care, and oral health services to such eligible in- 18 dividuals through a team of health care profes- 19 sionals, which may include obstetrician-gyne- 20 cologists, maternal-fetal medicine specialists, 21 family physicians, primary care providers, oral 22 health providers, physician assistants, advanced 23 practice registered nurses such as nurse practi- 24 tioners and certified nurse midwives, certified 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00574 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 575 •S 4486 IS midwives, certified professional midwives, phys- 1 ical therapists, social workers, traditional and 2 community-based doulas, lactation consultants, 3 childbirth educators, community health workers, 4 peer mental health supporters, and other health 5 care professionals; 6 ‘‘(B) conduct a risk assessment of each 7 such eligible individual to determine if their 8 pregnancy is high or low risk, and establish a 9 tailored pregnancy care plan, which takes into 10 consideration the individual’s own preferences 11 and pregnancy care and birthing plans and de- 12 termines the appropriate support services to re- 13 duce the individual’s medical, social, and envi- 14 ronmental risk factors, for each such eligible in- 15 dividual based on the results of such risk as- 16 sessment; 17 ‘‘(C) assign each such eligible individual to 18 a culturally and linguistically appropriate care 19 coordinator, which may be a nurse, social work- 20 er, traditional or community-based doula, com- 21 munity health worker, midwife, or other health 22 care provider, who is responsible for ensuring 23 that such eligible individual receives the nec- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00575 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 576 •S 4486 IS essary medical care and connections to essential 1 support services; 2 ‘‘(D) provide, or arrange for the provision 3 of, essential support services, such as services 4 that address— 5 ‘‘(i) food access, nutrition, and exer- 6 cise; 7 ‘‘(ii) smoking cessation; 8 ‘‘(iii) substance use disorder and ad- 9 diction treatment; 10 ‘‘(iv) anxiety, depression, trauma, and 11 other mental and behavioral health issues; 12 ‘‘(v) breastfeeding, chestfeeding, or 13 other infant feeding options supports, initi- 14 ation, continuation, and duration; 15 ‘‘(vi) stable, affordable, safe, and 16 healthy housing; 17 ‘‘(vii) transportation; 18 ‘‘(viii) intimate partner violence; 19 ‘‘(ix) community and police violence; 20 ‘‘(x) home visiting services; 21 ‘‘(xi) childbirth and newborn care edu- 22 cation; 23 ‘‘(xii) oral health education; 24 ‘‘(xiii) continuous labor support; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00576 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 577 •S 4486 IS ‘‘(xiv) group prenatal care; 1 ‘‘(xv) family planning and contracep- 2 tive care and supplies; and 3 ‘‘(xvi) affordable child care; 4 ‘‘(E) as appropriate, facilitate connections 5 to a usual primary care provider, which may be 6 a reproductive health care provider; 7 ‘‘(F) refer to guidelines and opinions of 8 medical associations when determining whether 9 an elective delivery should be performed on an 10 eligible individual before 39 weeks of gestation; 11 ‘‘(G) provide such eligible individual with 12 evidence-based and culturally and linguistically 13 appropriate education and resources to identify 14 potential warning signs of pregnancy and 15 postpartum complications and when and how to 16 obtain medical attention; 17 ‘‘(H) provide, or arrange for the provision 18 of, culturally and linguistically appropriate 19 pregnancy and postpartum health services, in- 20 cluding family planning counseling and services, 21 to eligible individuals; 22 ‘‘(I) track and report postpartum health 23 and birth outcomes of such eligible individuals 24 and their children; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00577 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 578 •S 4486 IS ‘‘(J) ensure that care is person-centered, 1 culturally and linguistically appropriate, and 2 patient-led, including by engaging eligible indi- 3 viduals in their own care, including through 4 communication and education; and 5 ‘‘(K) ensure adequate training for appro- 6 priately serving the population of individuals el- 7 igible for medical assistance under the State 8 plan (or waiver of such plan), including through 9 reproductive justice, birth justice, birth equity, 10 and anti-racist frameworks, home visiting skills, 11 and knowledge of social services. 12 ‘‘(g) TERM OF DEMONSTRATION PROJECT.—The 13 Secretary shall conduct the demonstration project for a 14 period of 5 years. 15 ‘‘(h) REPORT.—Not later than 18 months after the 16 date of the enactment of this section and annually there- 17 after for each year of the demonstration project term, the 18 Secretary shall submit a report to Congress on the results 19 of the demonstration project, including— 20 ‘‘(1) the results of the final report of the na- 21 tional external entity required under subsection 22 (e)(3)(B)(ii); and 23 ‘‘(2) recommendations on whether the model 24 studied in the demonstration project should be con- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00578 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 579 •S 4486 IS tinued or more widely adopted, including by private 1 health plans. 2 ‘‘(i) WAIVER AUTHORITY.—To the extent that the 3 Secretary determines necessary in order to carry out the 4 demonstration project, the Secretary may waive section 5 1902(a)(1) (relating to statewideness) and section 6 1902(a)(10)(B) (relating to comparability). 7 ‘‘(j) TECHNICAL ASSISTANCE.—The Secretary shall 8 establish a process to provide technical assistance to 9 States that are awarded grants under this section and to 10 eligible entities and other providers participating in a 11 State maternity care home model funded by such a grant. 12 ‘‘(k) DEFINITIONS.—In this section: 13 ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en- 14 tity’ means an entity or organization that provides 15 medically accurate, comprehensive maternity services 16 to individuals who are eligible for medical assistance 17 under a State plan under this title or a waiver of 18 such a plan, and may include: 19 ‘‘(A) A freestanding birth center. 20 ‘‘(B) An entity or organization receiving 21 assistance under section 330 of the Public 22 Health Service Act. 23 ‘‘(C) A federally qualified health center. 24 ‘‘(D) A rural health clinic. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00579 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 580 •S 4486 IS ‘‘(E) A health facility operated by an In- 1 dian tribe or tribal organization (as those terms 2 are defined in section 4 of the Indian Health 3 Care Improvement Act). 4 ‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 5 individual’ means a pregnant individual or a for- 6 merly pregnant individual during the 1-year period 7 beginning on the last day of the pregnancy, or such 8 longer period beginning on such day as a State may 9 elect, who is— 10 ‘‘(A) enrolled in a State plan under this 11 title, a waiver of such a plan, or a State child 12 health plan under title XXI; and 13 ‘‘(B) a patient of an eligible entity which 14 has entered into an arrangement with a State 15 under subsection (g). 16 ‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—There 17 are authorized to be appropriated to the Secretary, for 18 each of fiscal years 2023 through 2030, such sums as may 19 be necessary to carry out this section.’’. 20 (c) REAPPLICATION OF MEDICARE PAYMENT RATE 21 FLOOR TO PRIMARY CARE SERVICES FURNISHED UNDER 22 MEDICAID AND INCLUSION OF ADDITIONAL PRO- 23 VIDERS.— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00580 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 581 •S 4486 IS (1) REAPPLICATION OF PAYMENT FLOOR; ADDI- 1 TIONAL PROVIDERS.— 2 (A) IN GENERAL.—Section 1902(a)(13) of 3 the Social Security Act (42 U.S.C. 4 1396a(a)(13)) is amended— 5 (i) in subparagraph (B), by striking ‘‘; 6 and’’ and inserting a semicolon; 7 (ii) in subparagraph (C), by striking 8 the semicolon and inserting ‘‘; and’’; and 9 (iii) by adding at the end the fol- 10 lowing new subparagraph: 11 ‘‘(D) payment for primary care services (as 12 defined in subsection (jj)(1)) furnished in the 13 period that begins on the first day of the first 14 month that begins after the date of enactment 15 of this subparagraph by a provider described in 16 subsection (jj)(2)— 17 ‘‘(i) at a rate that is not less than 100 18 percent of the payment rate that applies to 19 such services and the provider of such 20 services under part B of title XVIII (or, if 21 greater, the payment rate that would be 22 applicable under such part if the conver- 23 sion factor under section 1848(d) for the 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00581 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 582 •S 4486 IS year were the conversion factor under such 1 section for 2009); 2 ‘‘(ii) in the case of items and services 3 that are not items and services provided 4 under such part, at a rate to be established 5 by the Secretary; and 6 ‘‘(iii) in the case of items and services 7 that are furnished in rural areas (as de- 8 fined in section 1886(d)(2)(D)), health 9 professional shortage areas (as defined in 10 section 332(a)(1)(A) of the Public Health 11 Service Act (42 U.S.C. 254e(a)(1)(A))), or 12 medically underserved areas (according to 13 a designation under section 330(b)(3)(A) 14 of the Public Health Service Act (42 15 U.S.C. 254b(b)(3)(A))), at the rate other- 16 wise applicable to such items or services 17 under clause (i) or (ii) increased, at the 18 Secretary’s discretion, by not more than 25 19 percent;’’. 20 (B) CONFORMING AMENDMENTS.— 21 (i) Section 1902(a)(13)(C) of the So- 22 cial Security Act (42 U.S.C. 23 1396a(a)(13)(C)) is amended by striking 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00582 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 583 •S 4486 IS ‘‘subsection (jj)’’ and inserting ‘‘subsection 1 (jj)(1)’’. 2 (ii) Section 1905(dd) of the Social Se- 3 curity Act (42 U.S.C. 1396d(dd)) is 4 amended— 5 (I) by striking ‘‘Notwith- 6 standing’’ and inserting the following: 7 ‘‘(1) IN GENERAL.—Notwithstanding’’; 8 (II) by striking ‘‘section 9 1902(a)(13)(C)’’ and inserting ‘‘sub- 10 paragraph (C) of section 11 1902(a)(13)’’; 12 (III) by inserting ‘‘or for services 13 described in subparagraph (D) of sec- 14 tion 1902(a)(13) furnished during an 15 additional period specified in para- 16 graph (2),’’ after ‘‘2015,’’; 17 (IV) by striking ‘‘under such sec- 18 tion’’ and inserting ‘‘under subpara- 19 graph (C) or (D) of section 20 1902(a)(13), as applicable’’; and 21 (V) by adding at the end the fol- 22 lowing: 23 ‘‘(2) ADDITIONAL PERIODS.—For purposes of 24 paragraph (1), the following are additional periods: 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00583 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 584 •S 4486 IS ‘‘(A) The period that begins on the first 1 day of the first month that begins after the 2 date of enactment of this paragraph.’’. 3 (2) IMPROVED TARGETING OF PRIMARY 4 CARE.—Section 1902(jj) of the Social Security Act 5 (42 U.S.C. 1396a(jj)) is amended— 6 (A) by redesignating paragraphs (1) and 7 (2) as clauses (i) and (ii), respectively, and re- 8 aligning the left margins accordingly; 9 (B) by striking ‘‘For purposes of sub- 10 section (a)(13)(C)’’ and inserting the following: 11 ‘‘(1) IN GENERAL.— 12 ‘‘(A) DEFINITION.—For purposes of sub- 13 paragraphs (C) and (D) of subsection (a)(13)’’; 14 and 15 (C) by inserting after clause (ii) (as so re- 16 designated) the following: 17 ‘‘(B) EXCLUSIONS.—Such term does not 18 include any services described in subparagraph 19 (A) or (B) of paragraph (1) if such services are 20 provided in an emergency department of a hos- 21 pital. 22 ‘‘(2) ADDITIONAL PROVIDERS.—For purposes 23 of subparagraph (D) of subsection (a)(13), a pro- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00584 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 585 •S 4486 IS vider described in this paragraph is any of the fol- 1 lowing: 2 ‘‘(A) A physician with a primary specialty 3 designation of family medicine, general internal 4 medicine, or pediatric medicine, or obstetrics 5 and gynecology. 6 ‘‘(B) An advanced practice clinician, as de- 7 fined by the Secretary, that works under the 8 supervision of— 9 ‘‘(i) a physician that satisfies the cri- 10 teria specified in subparagraph (A); 11 ‘‘(ii) a nurse practitioner or a physi- 12 cian assistant (as such terms are defined 13 in section 1861(aa)(5)(A)) who is working 14 in accordance with State law; or 15 ‘‘(iii) or a certified nurse-midwife (as 16 defined in section 1861(gg)) or a certified 17 professional midwife who is working in ac- 18 cordance with State law. 19 ‘‘(C) A rural health clinic, federally quali- 20 fied health center, health center that receives 21 funding under title X of the Public Health 22 Service Act, or other health clinic that receives 23 reimbursement on a fee schedule applicable to 24 a physician. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00585 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 586 •S 4486 IS ‘‘(D) An advanced practice clinician super- 1 vised by a physician described in subparagraph 2 (A), another advanced practice clinician, or a 3 certified nurse-midwife. 4 ‘‘(E) A midwife who is working in accord- 5 ance with State law.’’. 6 (3) ENSURING PAYMENT BY MANAGED CARE 7 ENTITIES.— 8 (A) IN GENERAL.—Section 1903(m)(2)(A) 9 of the Social Security Act (42 U.S.C. 10 1396b(m)(2)(A)) is amended— 11 (i) in clause (xii), by striking ‘‘and’’ 12 after the semicolon; 13 (ii) by realigning the left margin of 14 clause (xiii) so as to align with the left 15 margin of clause (xii) and by striking the 16 period at the end of clause (xiii) and in- 17 serting ‘‘; and’’; and 18 (iii) by inserting after clause (xiii) the 19 following: 20 ‘‘(xiv) such contract provides that (I) payments 21 to providers specified in section 1902(a)(13)(D) for 22 primary care services (as defined in section 1902(jj)) 23 that are furnished during a year or period (as speci- 24 fied in section 1902(a)(13)(D) and section 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00586 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 587 •S 4486 IS 1905(dd)) are at least equal to the amounts set 1 forth and required by the Secretary by regulation; 2 (II) the entity shall, upon request, provide docu- 3 mentation to the State, sufficient to enable the State 4 and the Secretary to ensure compliance with sub- 5 clause (I); and (III) the Secretary shall approve pay- 6 ments described in subclause (I) that are furnished 7 through an agreed upon capitation, partial capita- 8 tion, or other value-based payment arrangement if 9 the capitation, partial capitation, or other value- 10 based payment arrangement is based on a reason- 11 able methodology and the entity provides docu- 12 mentation to the State sufficient to enable the State 13 and the Secretary to ensure compliance with sub- 14 clause (I).’’. 15 (B) CONFORMING AMENDMENT.—Section 16 1932(f) of the Social Security Act (42 U.S.C. 17 1396u–2(f)) is amended— 18 (i) by striking ‘‘section 19 1902(a)(13)(C)’’ and inserting ‘‘sub- 20 sections (C) and (D) of section 21 1902(a)(13)’’; and 22 (ii) by inserting ‘‘, and clause (xiv) of 23 section 1903(m)(2)(A)’’ before the period. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00587 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 588 •S 4486 IS (d) MACPAC REPORT AND CMS GUIDANCE ON IN- 1 CREASING ACCESS TO DOULA SERVICES FOR MEDICAID 2 BENEFICIARIES.— 3 (1) MACPAC REPORT.— 4 (A) IN GENERAL.—Not later than 1 year 5 after the date of the enactment of this Act, the 6 Medicaid and CHIP Payment and Access Com- 7 mission (referred to in this subsection as 8 ‘‘MACPAC’’) shall publish a report on the cov- 9 erage of doula services under State Medicaid 10 programs, which shall at a minimum include 11 the following: 12 (i) Information about coverage for 13 doula services under State Medicaid pro- 14 grams that currently provide coverage for 15 such care, including the type of doula serv- 16 ices offered (such as prenatal, labor and 17 delivery, postpartum support, and also 18 community-based and traditional doula 19 services). 20 (ii) An analysis of barriers to covering 21 doula services under State Medicaid pro- 22 grams. 23 (iii) An identification of effective 24 strategies to increase the use of doula serv- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00588 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 589 •S 4486 IS ices in order to provide better care and 1 achieve better maternal and infant health 2 outcomes, including strategies that States 3 may use to recruit, train, and certify a di- 4 verse doula workforce, particularly from 5 underserved communities, communities of 6 color, and communities facing linguistic or 7 cultural barriers. 8 (iv) Recommendations for legislative 9 and administrative actions to increase ac- 10 cess to doula services in State Medicaid 11 programs, including actions that ensure 12 doulas may earn a living wage that ac- 13 counts for their time and costs associated 14 with providing care and community-based 15 doula program administration and oper- 16 ation. 17 (B) STAKEHOLDER CONSULTATION.—In 18 developing the report required under subpara- 19 graph (A), MACPAC shall consult with relevant 20 stakeholders, including— 21 (i) States; 22 (ii) organizations, especially reproduc- 23 tive justice and birth justice organizations 24 led by people of color, representing con- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00589 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 590 •S 4486 IS sumers of maternal health care, including 1 those that are disproportionately impacted 2 by poor maternal health outcomes; 3 (iii) organizations and individuals rep- 4 resenting doulas, including community- 5 based doula programs and those who serve 6 underserved communities, including com- 7 munities of color, and communities facing 8 linguistic or cultural barriers; 9 (iv) organizations representing health 10 care providers; and 11 (v) Black, Indigenous, and other ma- 12 ternal health care consumers of color who 13 have experienced severe maternal mor- 14 bidity. 15 (2) CMS GUIDANCE.— 16 (A) IN GENERAL.—Not later than 1 year 17 after the date that MACPAC publishes the re- 18 port required under paragraph (1)(A), the Ad- 19 ministrator of the Centers for Medicare & Med- 20 icaid Services shall issue guidance to States on 21 increasing access to doula services under Med- 22 icaid. Such guidance shall at a minimum in- 23 clude— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00590 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 591 •S 4486 IS (i) options for States to provide med- 1 ical assistance for doula services under 2 State Medicaid programs; 3 (ii) best practices for ensuring that 4 doulas, including community-based doulas, 5 receive reimbursement for doula services 6 provided under a State Medicaid program, 7 at a level that allows doulas to earn a liv- 8 ing wage that accounts for their time and 9 costs associated with providing care and 10 community-based doula program adminis- 11 tration; and 12 (iii) best practices for increasing ac- 13 cess to doula services, including services 14 provided by community-based doulas, 15 under State Medicaid programs. 16 (B) STAKEHOLDER CONSULTATION.—In 17 developing the guidance required under sub- 18 paragraph (A), the Administrator of the Cen- 19 ters for Medicare & Medicaid Services shall con- 20 sult with MACPAC and other relevant stake- 21 holders, including— 22 (i) State Medicaid officials; 23 (ii) organizations representing con- 24 sumers of maternal health care, including 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00591 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 592 •S 4486 IS those that are disproportionately impacted 1 by poor maternal health outcomes; 2 (iii) organizations representing doulas, 3 including community-based doulas and 4 those who serve underserved communities, 5 such as communities of color and commu- 6 nities facing linguistic or cultural barriers; 7 and 8 (iv) organizations representing med- 9 ical professionals. 10 (e) GAO REPORT ON STATE MEDICAID PROGRAMS’ 11 USE OF TELEHEALTH TO INCREASE ACCESS TO MATER- 12 NITY CARE.—Not later than 1 year after the date of the 13 enactment of this Act, the Comptroller General of the 14 United States shall submit a report to Congress on State 15 Medicaid programs’ use of telehealth to increase access to 16 maternity care. Such report shall include the following: 17 (1) The number of State Medicaid programs 18 that utilize telehealth that increases access to mater- 19 nity care. 20 (2) With respect to State Medicaid programs 21 that utilize telehealth that increases access to mater- 22 nity care, information about— 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00592 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 593 •S 4486 IS (A) common characteristics of such pro- 1 grams’ approaches to utilizing telehealth that 2 increases access to maternity care; 3 (B) differences in States’ approaches to 4 utilizing telehealth to improve access to mater- 5 nity care, and the resulting differences in State 6 maternal health outcomes, as determined by 7 factors described in subsection (C); and 8 (C) when compared to patients who receive 9 maternity care in person, what is known 10 about— 11 (i) the demographic characteristics, 12 such as race, ethnicity, sex, sexual orienta- 13 tion, gender identity, disability status, age, 14 and preferred language of the individuals 15 enrolled in such programs who use tele- 16 health to access maternity care; 17 (ii) health outcomes for such individ- 18 uals, including frequency of mortality and 19 severe morbidity, as compared to individ- 20 uals with similar characteristics who did 21 not use telehealth to access maternity care; 22 (iii) the services provided to individ- 23 uals through telehealth, including family 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00593 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 594 •S 4486 IS planning services, mental health care serv- 1 ices, and oral health services; 2 (iv) the devices and equipment pro- 3 vided to individuals for remote patient 4 monitoring and telehealth, including blood 5 pressure monitors and blood glucose mon- 6 itors; 7 (v) the quality of maternity care pro- 8 vided through telehealth, including whether 9 maternity care provided through telehealth 10 is culturally and linguistically appropriate; 11 (vi) the level of patient satisfaction 12 with maternity care provided through tele- 13 health to individuals enrolled in State Med- 14 icaid programs; 15 (vii) the impact of utilizing telehealth 16 to increase access to maternity care on 17 spending, cost savings, access to care, and 18 utilization of care under State Medicaid 19 programs; and 20 (viii) the accessibility and effectiveness 21 of telehealth for maternity care during the 22 COVID–19 pandemic. 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00594 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 595 •S 4486 IS (3) An identification and analysis of the bar- 1 riers to using telehealth to increase access to mater- 2 nity care under State Medicaid programs. 3 (4) Recommendations for such legislative and 4 administrative actions related to increasing access to 5 telehealth maternity services under Medicaid as the 6 Comptroller General deems appropriate. 7 SEC. 5203. JUSTICE FOR INCARCERATED MOMS. 8 (a) SENSE OF CONGRESS.—It is the sense of Con- 9 gress that— 10 (1) the respect and proper care that birthing 11 people deserve is inclusive; and 12 (2) regardless of race, ethnicity, gender iden- 13 tity, sexual orientation, religion, marital status, fa- 14 milial status, socioeconomic status, immigration sta- 15 tus, incarceration status, or disability, all deserve 16 dignity. 17 (b) ENDING THE SHACKLING OF PREGNANT INDI- 18 VIDUALS.— 19 (1) IN GENERAL.—For each fiscal year that be- 20 gins on or after the date that is 180 days after the 21 date of enactment of this Act, for each State that 22 receives a grant under subpart 1 of part E of title 23 I of the Omnibus Crime Control and Safe Streets 24 Act of 1968 (34 U.S.C. 10151 et seq.) (commonly 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00595 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 596 •S 4486 IS referred to as the ‘‘Edward Byrne Memorial Justice 1 Assistance Grant Program’’) and that does not have 2 in effect throughout the State for such fiscal year 3 laws restricting the use of restraints on pregnant in- 4 dividuals in correctional facilities that provide rights, 5 procedures, requirements, effects, and penalties that 6 are substantially similar to those set forth in section 7 4322 of title 18, United States Code, the amount of 8 such grant that would otherwise be allocated to such 9 State under such subpart for the fiscal year shall be 10 decreased by 25 percent. 11 (2) REALLOCATION.—Amounts not allocated to 12 a State for failure to comply with paragraph (1) 13 shall be reallocated in accordance with subpart 1 of 14 part E of title I of the Omnibus Crime Control and 15 Safe Streets Act of 1968 (34 U.S.C. 10151 et seq.) 16 to States that have complied with such paragraph. 17 (c) CREATING MODEL PROGRAMS FOR THE CARE OF 18 INCARCERATED INDIVIDUALS IN THE PRENATAL AND 19 POSTPARTUM PERIODS.— 20 (1) IN GENERAL.—Not later than 1 year after 21 the date of enactment of this Act, the Attorney Gen- 22 eral, acting through the Director of the Bureau of 23 Prisons (in this subsection referred to as the ‘‘Direc- 24 tor’’), shall establish, in not fewer than 6 Bureau of 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00596 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 597 •S 4486 IS Prisons facilities, programs to optimize maternal 1 health outcomes for pregnant and postpartum indi- 2 viduals incarcerated in such facilities. The Attorney 3 General shall establish such programs in consulta- 4 tion with stakeholders such as— 5 (A) Federal Public Defenders and Execu- 6 tive Directors of Community Defender Organi- 7 zations; 8 (B) relevant community-based organiza- 9 tions, particularly organizations that represent 10 incarcerated and formerly incarcerated individ- 11 uals and organizations that seek to improve ma- 12 ternal health outcomes for pregnant and 13 postpartum individuals from racial and ethnic 14 minority groups; 15 (C) relevant organizations representing pa- 16 tients, with a particular focus on patients from 17 racial and ethnic minority groups; 18 (D) organizations representing maternity 19 care providers and maternal health care edu- 20 cation programs; 21 (E) perinatal health workers; and 22 (F) researchers and policy experts in fields 23 related to maternal health care for incarcerated 24 individuals. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00597 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 598 •S 4486 IS (2) START DATE.—Each facility selected under 1 paragraph (1) shall begin the programs to optimize 2 maternal health outcomes for pregnant and 3 postpartum individuals incarcerated in such facilities 4 not later than 18 months after the date of enact- 5 ment of this Act. 6 (3) FACILITY PRIORITY.—In carrying out para- 7 graph (1), the Director, in consultation with the 8 stakeholders described in paragraph (1), shall give 9 priority to a facility based on— 10 (A) the number of pregnant and 11 postpartum individuals incarcerated in such fa- 12 cility and, among such individuals, the number 13 of pregnant and postpartum individuals from 14 racial and ethnic minority groups; and 15 (B) the extent to which the leaders of such 16 facility have demonstrated a commitment to de- 17 veloping exemplary programs for pregnant and 18 postpartum individuals incarcerated in such fa- 19 cility. 20 (4) PROGRAM DURATION.—The programs es- 21 tablished under this subsection shall be carried out 22 for a 5-year period. 23 (5) PROGRAMS.—Bureau of Prisons facilities 24 selected by the Director shall establish programs for 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00598 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 599 •S 4486 IS pregnant and postpartum incarcerated individuals, 1 and such programs may— 2 (A) provide access to perinatal health 3 workers from pregnancy through the 4 postpartum period; 5 (B) provide access to healthy foods and 6 counseling on nutrition, recommended activity 7 levels, and safety measures throughout preg- 8 nancy; 9 (C) train correctional officers to ensure 10 that pregnant incarcerated individuals receive 11 safe and respectful treatment; 12 (D) train medical personnel to ensure that 13 pregnant incarcerated individuals receive trau- 14 ma-informed, culturally congruent care that 15 promotes the health and safety of the pregnant 16 individuals; 17 (E) provide counseling and treatment for 18 individuals who have suffered from— 19 (i) diagnosed mental or behavioral 20 health conditions, including trauma and 21 substance use disorders; 22 (ii) trauma or violence, including do- 23 mestic violence; 24 (iii) human immunodeficiency virus; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00599 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 600 •S 4486 IS (iv) sexual abuse; 1 (v) pregnancy or infant loss; or 2 (vi) chronic conditions; 3 (F) provide evidence-based pregnancy and 4 childbirth education, parenting support, and 5 other relevant forms of health literacy; 6 (G) provide clinical education opportunities 7 to maternity care providers in training to ex- 8 pand pathways into maternal health care ca- 9 reers serving incarcerated individuals; 10 (H) offer opportunities for postpartum in- 11 dividuals to maintain contact with the individ- 12 ual’s newborn child to promote bonding, includ- 13 ing enhanced visitation policies, access to prison 14 nursery programs, or breastfeeding support; 15 (I) provide reentry assistance, particularly 16 to— 17 (i) ensure access to health insurance 18 coverage and transfer of health records to 19 community providers if an incarcerated in- 20 dividual exits the criminal justice system 21 during such individual’s pregnancy or in 22 the postpartum period; and 23 (ii) connect individuals exiting the 24 criminal justice system during pregnancy 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00600 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 601 •S 4486 IS or in the postpartum period to community- 1 based resources, such as referrals to health 2 care providers, substance use disorder 3 treatments, and social services that ad- 4 dress social determinants of maternal 5 health; or 6 (J) establish partnerships with local public 7 entities, private community entities, community- 8 based organizations, Indian Tribes and tribal 9 organizations (as such terms are defined in sec- 10 tion 4 of the Indian Self-Determination and 11 Education Assistance Act (25 U.S.C. 5304)), 12 and urban Indian organizations (as such term 13 is defined in section 4 of the Indian Health 14 Care Improvement Act (25 U.S.C. 1603)) to es- 15 tablish or expand pretrial diversion programs as 16 an alternative to incarceration for pregnant and 17 postpartum individuals, including— 18 (i) evidence-based childbirth education 19 or parenting classes; 20 (ii) prenatal health coordination; 21 (iii) family and individual counseling; 22 (iv) evidence-based screenings, edu- 23 cation, and, as needed, treatment for men- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00601 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 602 •S 4486 IS tal and behavioral health conditions, in- 1 cluding drug and alcohol treatments; 2 (v) family case management services; 3 (vi) domestic violence education and 4 prevention; 5 (vii) physical and sexual abuse coun- 6 seling; and 7 (viii) programs to address social de- 8 terminants of health such as employment, 9 housing, education, transportation, and nu- 10 trition. 11 (6) IMPLEMENTATION AND REPORTING.—A fa- 12 cility selected under paragraph (1) shall be respon- 13 sible for— 14 (A) implementing programs, which may in- 15 clude the programs described in paragraph (5); 16 and 17 (B) not later than 3 years after the date 18 of enactment of this Act, and not later than 6 19 years after the date of enactment of this Act, 20 reporting results of the programs to the Direc- 21 tor, including information describing— 22 (i) relevant quantitative indicators of 23 success in improving the standard of care 24 and health outcomes for pregnant and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00602 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 603 •S 4486 IS postpartum incarcerated individuals in the 1 facility, including data stratified by race, 2 ethnicity, sex, gender, age, geography, dis- 3 ability status, the category of the criminal 4 charge against such individual, rates of 5 pregnancy-related deaths, pregnancy-asso- 6 ciated deaths, cases of infant mortality and 7 morbidity, rates of pre-term births and 8 low-birthweight births, cases of severe ma- 9 ternal morbidity, cases of violence against 10 pregnant or postpartum individuals, diag- 11 noses of maternal mental or behavioral 12 health conditions, and other such informa- 13 tion as appropriate; 14 (ii) relevant qualitative and quan- 15 titative evaluations from pregnant and 16 postpartum incarcerated individuals who 17 participated in such programs, including 18 measures of patient-reported experience of 19 care; and 20 (iii) strategies to sustain such pro- 21 grams after fiscal year 2028 and expand 22 such programs to other facilities. 23 (7) REPORT.—Not later than 6 years after the 24 date of enactment of this Act, the Director shall 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00603 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 604 •S 4486 IS submit to the Attorney General and Congress a re- 1 port describing the results of the programs carried 2 out under this subsection. 3 (8) OVERSIGHT.—Not later than 1 year after 4 the date of enactment of this Act, the Attorney Gen- 5 eral shall award a contract to an independent orga- 6 nization or independent organizations to conduct 7 oversight of the programs described in paragraph 8 (5). 9 (9) AUTHORIZATION OF APPROPRIATIONS.— 10 There is authorized to be appropriated to carry out 11 this subsection $10,000,000 for each of fiscal years 12 2024 through 2028. 13 (d) GRANT PROGRAM TO IMPROVE MATERNAL 14 HEALTH OUTCOMES FOR INDIVIDUALS IN STATE AND 15 LOCAL CORRECTIONAL FACILITIES.— 16 (1) ESTABLISHMENT.—Not later than 1 year 17 after the date of enactment of this Act, the Attorney 18 General, acting through the Director of the Bureau 19 of Justice Assistance (in this subsection referred to 20 as the ‘‘Director’’), shall award Justice for Incarcer- 21 ated Moms grants to States to establish or expand 22 programs in State and local correctional facilities for 23 pregnant and postpartum incarcerated individuals. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00604 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 605 •S 4486 IS The Attorney General shall award such grants in 1 consultation with stakeholders such as— 2 (A) Federal Public Defenders and Execu- 3 tive Directors of Community Defender Organi- 4 zations; 5 (B) relevant community-based organiza- 6 tions, particularly organizations that represent 7 incarcerated and formerly incarcerated individ- 8 uals and organizations that seek to improve ma- 9 ternal health outcomes for pregnant and 10 postpartum individuals from racial and ethnic 11 minority groups; 12 (C) relevant organizations representing pa- 13 tients, with a particular focus on patients from 14 racial and ethnic minority groups; 15 (D) organizations representing maternity 16 care providers and maternal health care edu- 17 cation programs; 18 (E) perinatal health workers; and 19 (F) researchers and policy experts in fields 20 related to maternal health care for incarcerated 21 individuals. 22 (2) APPLICATIONS.—Each State desiring a 23 grant under this subsection shall submit to the Di- 24 rector an application at such time, in such manner, 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00605 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 606 •S 4486 IS and containing such information as the Director 1 may require. 2 (3) USE OF FUNDS.—A State that is awarded 3 a grant under this subsection shall use such grant 4 to establish or expand programs for pregnant and 5 postpartum incarcerated individuals, and such pro- 6 grams may— 7 (A) provide access to perinatal health 8 workers from pregnancy through the 9 postpartum period; 10 (B) provide access to healthy foods and 11 counseling on nutrition, recommended activity 12 levels, and safety measures throughout preg- 13 nancy; 14 (C) train correctional officers to ensure 15 that pregnant incarcerated individuals receive 16 safe and respectful treatment; 17 (D) train medical personnel to ensure that 18 pregnant incarcerated individuals receive trau- 19 ma-informed, culturally congruent care that 20 promotes the health and safety of the pregnant 21 individuals; 22 (E) provide counseling and treatment for 23 individuals who have suffered from— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00606 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 607 •S 4486 IS (i) diagnosed mental or behavioral 1 health conditions, including trauma and 2 substance use disorders; 3 (ii) trauma or violence, including do- 4 mestic violence; 5 (iii) human immunodeficiency virus; 6 (iv) sexual abuse; 7 (v) pregnancy or infant loss; or 8 (vi) chronic conditions; 9 (F) provide evidence-based pregnancy and 10 childbirth education, parenting support, and 11 other relevant forms of health literacy; 12 (G) provide clinical education opportunities 13 to maternity care providers in training to ex- 14 pand pathways into maternal health care ca- 15 reers serving incarcerated individuals; 16 (H) offer opportunities for postpartum in- 17 dividuals to maintain contact with the individ- 18 ual’s newborn child to promote bonding, includ- 19 ing enhanced visitation policies, access to prison 20 nursery programs, or breastfeeding support; 21 (I) provide reentry assistance, particularly 22 to— 23 (i) ensure access to health insurance 24 coverage and transfer of health records to 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00607 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 608 •S 4486 IS community providers if an incarcerated in- 1 dividual exits the criminal justice system 2 during such individual’s pregnancy or in 3 the postpartum period; and 4 (ii) connect individuals exiting the 5 criminal justice system during pregnancy 6 or in the postpartum period to community- 7 based resources, such as referrals to health 8 care providers, substance use disorder 9 treatments, and social services that ad- 10 dress social determinants of maternal 11 health; or 12 (J) establish partnerships with local public 13 entities, private community entities, community- 14 based organizations, Indian Tribes and tribal 15 organizations (as such terms are defined in sec- 16 tion 4 of the Indian Self-Determination and 17 Education Assistance Act (25 U.S.C. 5304)), 18 and urban Indian organizations (as such term 19 is defined in section 4 of the Indian Health 20 Care Improvement Act (25 U.S.C. 1603)) to es- 21 tablish or expand pretrial diversion programs as 22 an alternative to incarceration for pregnant and 23 postpartum individuals, including— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00608 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 609 •S 4486 IS (i) evidence-based childbirth education 1 or parenting classes; 2 (ii) prenatal health coordination; 3 (iii) family and individual counseling; 4 (iv) evidence-based screenings, edu- 5 cation, and, as needed, treatment for men- 6 tal and behavioral health conditions, in- 7 cluding drug and alcohol treatments; 8 (v) family case management services; 9 (vi) domestic violence education and 10 prevention; 11 (vii) physical and sexual abuse coun- 12 seling; and 13 (viii) programs to address social de- 14 terminants of health such as employment, 15 housing, education, transportation, and nu- 16 trition. 17 (4) PRIORITY.—In awarding grants under this 18 subsection, the Director shall give priority to appli- 19 cants based on— 20 (A) the number of pregnant and 21 postpartum individuals incarcerated in the 22 State and, among such individuals, the number 23 of pregnant and postpartum individuals from 24 racial and ethnic minority groups; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00609 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 610 •S 4486 IS (B) the extent to which the State has dem- 1 onstrated a commitment to developing exem- 2 plary programs for pregnant and postpartum 3 individuals incarcerated in the correctional fa- 4 cilities in such State. 5 (5) GRANT DURATION.—A grant awarded under 6 this subsection shall be for a 5-year period. 7 (6) IMPLEMENTING AND REPORTING.—A State 8 that receives a grant under this subsection shall be 9 responsible for— 10 (A) implementing the program funded by 11 the grant; and 12 (B) not later than 3 years after the date 13 of enactment of this Act, and not later than 6 14 years after the date of enactment of this Act, 15 reporting results of such program to the Attor- 16 ney General, including information describing— 17 (i) relevant quantitative indicators of 18 the program’s success in improving the 19 standard of care and health outcomes for 20 pregnant and postpartum incarcerated in- 21 dividuals in the facility, including data 22 stratified by race, ethnicity, sex, gender, 23 age, geography, disability status, category 24 of the criminal charge against such indi- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00610 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 611 •S 4486 IS vidual, incidence rates of pregnancy-related 1 deaths, pregnancy-associated deaths, cases 2 of infant mortality and morbidity, rates of 3 pre-term births and low-birthweight births, 4 cases of severe maternal morbidity, cases 5 of violence against pregnant or postpartum 6 individuals, diagnoses of maternal mental 7 or behavioral health conditions, and other 8 such information as appropriate; 9 (ii) relevant qualitative and quan- 10 titative evaluations from pregnant and 11 postpartum incarcerated individuals who 12 participated in such programs, including 13 measures of patient-reported experience of 14 care; and 15 (iii) strategies to sustain such pro- 16 grams beyond the duration of the grant 17 and expand such programs to other facili- 18 ties. 19 (7) REPORT.—Not later than 6 years after the 20 date of enactment of this Act, the Attorney General 21 shall submit to Congress a report describing the re- 22 sults of programs carried out using grants under 23 this subsection. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00611 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 612 •S 4486 IS (8) OVERSIGHT.—Not later than 1 year after 1 the date of enactment of this Act, the Attorney Gen- 2 eral shall award a contract to an independent orga- 3 nization or independent organizations to conduct 4 oversight of the programs described in paragraph 5 (3). 6 (9) AUTHORIZATION OF APPROPRIATIONS.— 7 There is authorized to be appropriated to carry out 8 this subsection $10,000,000 for each of fiscal years 9 2024 through 2028. 10 (e) GAO REPORT.— 11 (1) IN GENERAL.—Not later than 2 years after 12 the date of enactment of this Act, the Comptroller 13 General of the United States shall submit to Con- 14 gress a report on adverse maternal and infant health 15 outcomes among incarcerated individuals and infants 16 born to such individuals, with a particular focus on 17 racial and ethnic inequities in maternal and infant 18 health outcomes for incarcerated individuals. 19 (2) CONTENTS OF REPORT.—The report de- 20 scribed in this subsection shall include— 21 (A) to the extent practicable— 22 (i) the number of pregnant individuals 23 who are incarcerated in Bureau of Prisons 24 facilities; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00612 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 613 •S 4486 IS (ii) the number of incarcerated indi- 1 viduals, including those incarcerated in 2 Federal, State, and local correctional facili- 3 ties, who have experienced a pregnancy-re- 4 lated death, pregnancy-associated death, or 5 the death of an infant in the most recent 6 10 years of available data; 7 (iii) the number of cases of severe ma- 8 ternal morbidity among incarcerated indi- 9 viduals, including those incarcerated in 10 Federal, State, and local correctional facili- 11 ties, in the most recent 10 years of avail- 12 able data; 13 (iv) the number of pre-term and low- 14 birthweight births of infants born to incar- 15 cerated individuals, including those incar- 16 cerated in Federal, State, and local correc- 17 tional facilities, in the most recent 10 18 years of available data; and 19 (v) statistics on the racial and ethnic 20 inequities in maternal and infant health 21 outcomes and severe maternal morbidity 22 rates among incarcerated individuals, in- 23 cluding those incarcerated in Federal, 24 State, and local correctional facilities; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00613 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 614 •S 4486 IS (B) in the case that the Comptroller Gen- 1 eral of the United States is unable to determine 2 the information required in clauses (i) through 3 (v) of subparagraph (A), an assessment of the 4 barriers to determining such information and 5 recommendations for improvements in tracking 6 maternal health outcomes among incarcerated 7 individuals, including those incarcerated in Fed- 8 eral, State, and local correctional facilities; 9 (C) a discussion of causes of adverse ma- 10 ternal health outcomes that are unique to incar- 11 cerated individuals, including those incarcerated 12 in Federal, State, and local correctional facili- 13 ties; 14 (D) a discussion of causes of adverse ma- 15 ternal health outcomes and severe maternal 16 morbidity that are unique to incarcerated indi- 17 viduals from racial and ethnic minority groups; 18 (E) recommendations to reduce maternal 19 mortality and severe maternal morbidity among 20 incarcerated individuals and to address racial 21 and ethnic inequities in maternal health out- 22 comes for incarcerated individuals in Bureau of 23 Prisons facilities and State and local correc- 24 tional facilities; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00614 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 615 •S 4486 IS (F) such other information as may be ap- 1 propriate to reduce the occurrence of adverse 2 maternal health outcomes among incarcerated 3 individuals and to address racial and ethnic in- 4 equities in maternal health outcomes for such 5 individuals. 6 (f) MACPAC REPORT.— 7 (1) IN GENERAL.—Not later than 2 years after 8 the date of enactment of this section, the Medicaid 9 and CHIP Payment and Access Commission (re- 10 ferred to in this subsection as ‘‘MACPAC’’) shall 11 publish a report on the implications of pregnant and 12 postpartum incarcerated individuals being ineligible 13 for medical assistance under a State plan under title 14 XIX of the Social Security Act (42 U.S.C. 1396 et 15 seq.) that contains the information described in 16 paragraph (2). 17 (2) INFORMATION DESCRIBED.—For purposes 18 of paragraph (1), the information described in this 19 paragraph includes— 20 (A) information on the effect of ineligibility 21 for medical assistance under a State plan under 22 title XIX of the Social Security Act (42 U.S.C. 23 1396 et seq.) on maternal health outcomes for 24 pregnant and postpartum incarcerated individ- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00615 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 616 •S 4486 IS uals, concentrating on the effects of such ineli- 1 gibility for pregnant and postpartum individuals 2 from racial and ethnic minority groups; and 3 (B) the potential implications on maternal 4 health outcomes resulting from suspending eli- 5 gibility for medical assistance under a State 6 plan under such title of such Act when a preg- 7 nant or postpartum individual is incarcerated. 8 (g) DEFINITIONS.—In this section: 9 (1) CULTURALLY CONGRUENT.—The term ‘‘cul- 10 turally congruent’’ means that the care, maternity 11 care, health care services, provider, or non-clinical 12 support made available is in agreement with the pre- 13 ferred cultural values, beliefs, worldview, language, 14 and practices of the health care consumer and other 15 stakeholders. 16 (2) MATERNITY CARE PROVIDER.—The term 17 ‘‘maternity care provider’’ means a health care pro- 18 vider who— 19 (A) is a physician, physician assistant, 20 midwife who meets at a minimum the inter- 21 national definition of the midwife and global 22 standards for midwifery education as estab- 23 lished by the International Confederation of 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00616 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 617 •S 4486 IS Midwives, nurse practitioner, or clinical nurse 1 specialist; and 2 (B) has a focus on maternal or perinatal 3 health. 4 (3) MATERNAL MORTALITY.—The term ‘‘mater- 5 nal mortality’’ means a death occurring during or 6 within a one-year period after pregnancy that is 7 caused by pregnancy-related or childbirth complica- 8 tions, including a suicide, overdose, or other death 9 resulting from a mental health or substance use dis- 10 order attributed to or aggravated by pregnancy-re- 11 lated or childbirth complications. 12 (4) PERINATAL HEALTH WORKER.—The term 13 ‘‘perinatal health worker’’ means a doula, commu- 14 nity health worker, peer supporter, breastfeeding 15 and lactation educator or counselor, nutritionist or 16 dietitian, childbirth educator, social worker, home 17 visitor, language interpreter, or navigator. 18 (5) POSTPARTUM AND POSTPARTUM PERIOD.— 19 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 20 refer to the 1-year period beginning on the last day 21 of the pregnancy of an individual. 22 (6) PREGNANCY-ASSOCIATED DEATH.—The 23 term ‘‘pregnancy-associated death’’ means a death of 24 a pregnant or postpartum individual, by any cause, 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00617 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 618 •S 4486 IS that occurs during, or within 1 year following, the 1 individual’s pregnancy, regardless of the outcome, 2 duration, or site of the pregnancy. 3 (7) PREGNANCY-RELATED DEATH.—The term 4 ‘‘pregnancy-related death’’ means a death of a preg- 5 nant or postpartum individual that occurs during, or 6 within 1 year following, the individual’s pregnancy, 7 from a pregnancy complication, a chain of events 8 initiated by pregnancy, or the aggravation of an un- 9 related condition by the physiologic effects of preg- 10 nancy. 11 (8) RACIAL AND ETHNIC MINORITY GROUP.— 12 The term ‘‘racial and ethnic minority group’’ has the 13 meaning given such term in section 1707(g)(1) of 14 the Public Health Service Act (42 U.S.C. 300u– 15 6(g)(1)). 16 (9) SEVERE MATERNAL MORBIDITY.—The term 17 ‘‘severe maternal morbidity’’ means a health condi- 18 tion, including mental health conditions and sub- 19 stance use disorders, attributed to or aggravated by 20 pregnancy or childbirth that results in significant 21 short-term or long-term consequences to the health 22 of the individual who was pregnant. 23 (10) SOCIAL DETERMINANTS OF MATERNAL 24 HEALTH.—The term ‘‘social determinants of mater- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00618 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 619 •S 4486 IS nal health’’ means non-clinical factors that impact 1 maternal health outcomes, including— 2 (A) economic factors, which may include 3 poverty, employment, food security, support for 4 and access to lactation and other infant feeding 5 options, housing stability, and related factors; 6 (B) neighborhood factors, which may in- 7 clude quality of housing, access to transpor- 8 tation, access to child care, availability of 9 healthy foods and nutrition counseling, avail- 10 ability of clean water, air and water quality, 11 ambient temperatures, neighborhood crime and 12 violence, access to broadband, and related fac- 13 tors; 14 (C) social and community factors, which 15 may include systemic racism, gender discrimi- 16 nation or discrimination based on other pro- 17 tected classes, workplace conditions, incarcer- 18 ation, and related factors; 19 (D) household factors, which may include 20 ability to conduct lead testing and abatement, 21 car seat installation, indoor air temperatures, 22 and related factors; 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00619 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 620 •S 4486 IS (E) education access and quality factors, 1 which may include educational attainment, lan- 2 guage and literacy, and related factors; and 3 (F) health care access factors, including 4 health insurance coverage, access to culturally 5 congruent health care services, providers, and 6 non-clinical support, access to home visiting 7 services, access to wellness and stress manage- 8 ment programs, health literacy, access to tele- 9 health and items required to receive telehealth 10 services, and related factors. 11 (11) STATE.—The term ‘‘State’’ means any 12 State of the United States, the District of Columbia, 13 or any territory or possession of the United States. 14 SEC. 5204. IMPACT TO SAVE MOMS ACT. 15 (a) PERINATAL CARE ALTERNATIVE PAYMENT 16 MODEL DEMONSTRATION PROJECT.— 17 (1) IN GENERAL.—For the period of fiscal 18 years 2023 through 2027, the Secretary of Health 19 and Human Services (referred to in this subsection 20 as the ‘‘Secretary’’), acting through the Adminis- 21 trator of the Centers for Medicare & Medicaid Serv- 22 ices, shall establish and implement, in accordance 23 with the requirements of this subsection, a dem- 24 onstration project, to be known as the Perinatal 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00620 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 621 •S 4486 IS Care Alternative Payment Model Demonstration 1 Project (referred to in this subsection as the ‘‘Dem- 2 onstration Project’’), for purposes of allowing States 3 to test payment models under their State plans 4 under title XIX of the Social Security Act (42 5 U.S.C. 1396 et seq.) and State child health plans 6 under title XXI of such Act (42 U.S.C. 1397aa et 7 seq.) with respect to maternity care provided to 8 pregnant and postpartum individuals enrolled in 9 such State plans and State child health plans. 10 (2) COORDINATION.—In establishing the Dem- 11 onstration Project, the Secretary shall coordinate 12 with stakeholders such as— 13 (A) State Medicaid programs; 14 (B) relevant organizations representing 15 maternal health care providers; 16 (C) relevant organizations representing pa- 17 tients, with a particular focus on individuals 18 from demographic groups with disproportionate 19 rates of adverse maternal health outcomes; 20 (D) relevant community-based organiza- 21 tions, particularly organizations that seek to 22 improve maternal health outcomes for individ- 23 uals from demographic groups with dispropor- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00621 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 622 •S 4486 IS tionate rates of adverse maternal health out- 1 comes; 2 (E) non-clinical perinatal health workers 3 such as doulas, community health workers, peer 4 supporters, certified lactation consultants, nu- 5 tritionists and dieticians, social workers, home 6 visitors, and navigators; 7 (F) relevant health insurance issuers; 8 (G) hospitals, health systems, freestanding 9 birth centers (as such term is defined in para- 10 graph (3)(B) of section 1905(l) of the Social 11 Security Act (42 U.S.C. 1396d(l))), Federally- 12 qualified health centers (as such term is defined 13 in paragraph (2)(B) of such section), and rural 14 health clinics (as such term is defined in section 15 1861(aa) of such Act (42 U.S.C. 1395x(aa))); 16 (H) researchers and policy experts in fields 17 related to maternity care payment models; and 18 (I) any other stakeholders as the Secretary 19 determines appropriate, with a particular focus 20 on stakeholders from demographic groups with 21 disproportionate rates of adverse maternal 22 health outcomes. 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00622 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 623 •S 4486 IS (3) CONSIDERATIONS.—In establishing the 1 Demonstration Project, the Secretary shall consider 2 each of the following: 3 (A) Findings from any evaluations of the 4 Strong Start for Mothers and Newborns initia- 5 tive carried out by the Centers for Medicare & 6 Medicaid Services, the Health Resources and 7 Services Administration, and the Administra- 8 tion on Children and Families. 9 (B) Any alternative payment model that— 10 (i) is designed to improve maternal 11 health outcomes for racial and ethnic 12 groups with disproportionate rates of ad- 13 verse maternal health outcomes; 14 (ii) includes methods for stratifying 15 patients by pregnancy risk level and, as 16 appropriate, adjusting payments under 17 such model to take into account pregnancy 18 risk level; 19 (iii) establishes evidence-based quality 20 metrics for such payments; 21 (iv) includes consideration of non-hos- 22 pital birth settings such as freestanding 23 birth centers (as so defined); 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00623 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 624 •S 4486 IS (v) includes consideration of social de- 1 terminants of health that are relevant to 2 maternal health outcomes such as housing, 3 transportation, nutrition, and other non- 4 clinical factors that influence maternal 5 health outcomes; or 6 (vi) includes diverse maternity care 7 teams that include— 8 (I) maternity care providers, in- 9 cluding obstetrician-gynecologists, 10 family physicians, physician assist- 11 ants, midwives who meet, at a min- 12 imum, the international definition of 13 the term ‘‘midwife’’ and global stand- 14 ards for midwifery education (as es- 15 tablished by the International Confed- 16 eration of Midwives), and nurse prac- 17 titioners— 18 (aa) from racially, eth- 19 nically, and professionally diverse 20 backgrounds; 21 (bb) with experience prac- 22 ticing in racially and ethnically 23 diverse communities; or 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00624 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 625 •S 4486 IS (cc) who have undergone 1 trainings on racism, implicit bias, 2 and explicit bias; and 3 (II) non-clinical perinatal health 4 workers such as doulas, community 5 health workers, peer supporters, cer- 6 tified lactation consultants, nutrition- 7 ists and dieticians, social workers, 8 home visitors, and navigators. 9 (4) ELIGIBILITY.—To be eligible to participate 10 in the Demonstration Project, a State shall submit 11 an application to the Secretary at such time, in such 12 manner, and containing such information as the Sec- 13 retary may require. 14 (5) EVALUATION.—The Secretary shall conduct 15 an evaluation of the Demonstration Project to deter- 16 mine the impact of the Demonstration Project on— 17 (A) maternal health outcomes, with data 18 stratified by race, ethnicity, socioeconomic indi- 19 cators, and any other factors as the Secretary 20 determines appropriate; 21 (B) spending on maternity care by States 22 participating in the Demonstration Project; 23 (C) to the extent practicable, subjective 24 measures of patient experience; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00625 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 626 •S 4486 IS (D) any other areas of assessment that the 1 Secretary determines relevant. 2 (6) REPORT.—Not later than one year after the 3 completion or termination date of the Demonstration 4 Project, the Secretary shall submit to the Committee 5 on Energy and Commerce, the Committee on Ways 6 and Means, and the Committee on Education and 7 Labor of the House of Representatives and the Com- 8 mittee on Finance and the Committee on Health, 9 Education, Labor, and Pensions of the Senate, and 10 make publicly available, a report containing— 11 (A) the results of any evaluation conducted 12 under paragraph (5); and 13 (B) a recommendation regarding whether 14 the Demonstration Project should be continued 15 after fiscal year 2026 and expanded on a na- 16 tional basis. 17 (7) AUTHORIZATION OF APPROPRIATIONS.— 18 There are authorized to be appropriated such sums 19 as are necessary to carry out this subsection. 20 (8) DEFINITIONS.—In this subsection: 21 (A) ALTERNATIVE PAYMENT MODEL.—The 22 term ‘‘alternative payment model’’ has the 23 meaning given such term in section 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00626 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 627 •S 4486 IS 1833(z)(3)(C) of the Social Security Act (42 1 U.S.C. 1395l(z)(3)(C)). 2 (B) PERINATAL.—The term ‘‘perinatal’’ 3 means the period beginning on the day a person 4 becomes pregnant and ending on the last day of 5 the 1-year period beginning on the last day of 6 such person’s pregnancy. 7 (b) MACPAC REPORT.— 8 (1) IN GENERAL.—Not later than two years 9 after the date of the enactment of this section, the 10 Medicaid and CHIP Payment and Access Commis- 11 sion shall publish a report on issues relating to the 12 continuity of coverage under State plans under title 13 XIX of the Social Security Act (42 U.S.C. 1396 et 14 seq.) and State child health plans under title XXI of 15 such Act (42 U.S.C. 1397aa et seq.) for pregnant 16 and postpartum individuals. Such report shall, at a 17 minimum, include the following: 18 (A) An assessment of any existing policies 19 under such State plans and such State child 20 health plans regarding presumptive eligibility 21 for pregnant individuals while their application 22 for enrollment in such a State plan or such a 23 State child health plan is being processed. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00627 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 628 •S 4486 IS (B) An assessment of any existing policies 1 under such State plans and such State child 2 health plans regarding measures to ensure con- 3 tinuity of coverage under such a State plan or 4 such a State child health plan for pregnant and 5 postpartum individuals, including such individ- 6 uals who need to change their health insurance 7 coverage during their pregnancy or the 8 postpartum period following their pregnancy. 9 (C) An assessment of any existing policies 10 under such State plans and such State child 11 health plans regarding measures to automati- 12 cally reenroll individuals who are eligible to en- 13 roll under such a State plan or such a State 14 child health plan as a parent. 15 (D) If determined appropriate by the Com- 16 mission, any recommendations for the Depart- 17 ment of Health and Human Services, or such 18 State plans and such State child health plans, 19 to ensure continuity of coverage under such a 20 State plan or such a State child health plan for 21 pregnant and postpartum people. 22 (2) POSTPARTUM DEFINED.—In this sub- 23 section, the term ‘‘postpartum’’ means the 1-year 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00628 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 629 •S 4486 IS period beginning on the last day of a person’s preg- 1 nancy. 2 SEC. 5205. PROTECTING MOMS AND BABIES AGAINST CLI- 3 MATE CHANGE. 4 (a) GRANT PROGRAM TO PROTECT VULNERABLE 5 MOTHERS AND BABIES FROM CLIMATE CHANGE 6 RISKS.— 7 (1) IN GENERAL.—Not later than 180 days 8 after the date of the enactment of this section, the 9 Secretary of Health and Human Services (in this 10 section referred to as the ‘‘Secretary’’) shall estab- 11 lish a grant program (in this subsection referred to 12 as the ‘‘Program’’) to protect vulnerable individuals 13 from risks associated with climate change. 14 (2) GRANT AUTHORITY.—In carrying out the 15 Program, the Secretary may award, on a competitive 16 basis, grants to 10 covered entities. 17 (3) APPLICATIONS.—To be eligible for a grant 18 under the Program, a covered entity shall submit to 19 the Secretary an application at such time, in such 20 form, and containing such information as the Sec- 21 retary may require, which shall include, at a min- 22 imum, a description of the following: 23 (A) Plans for the use of grant funds 24 awarded under the Program and how patients 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00629 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 630 •S 4486 IS and stakeholder organizations were involved in 1 the development of such plans. 2 (B) How such grant funds will be targeted 3 to geographic areas that have disproportionately 4 high levels of risks associated with climate 5 change for vulnerable individuals. 6 (C) How such grant funds will be used to 7 address racial and ethnic inequities in— 8 (i) adverse maternal and infant health 9 outcomes; and 10 (ii) exposure to risks associated with 11 climate change for vulnerable individuals. 12 (D) Strategies to prevent an initiative as- 13 sisted with such grant funds from causing— 14 (i) adverse environmental impacts; 15 (ii) displacement of residents and 16 businesses; 17 (iii) rent and housing price increases; 18 or 19 (iv) disproportionate adverse impacts 20 on racial and ethnic minority groups and 21 other underserved populations. 22 (4) SELECTION OF GRANT RECIPIENTS.— 23 (A) TIMING.—Not later than 270 days 24 after the date of the enactment of this Act, the 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00630 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 631 •S 4486 IS Secretary shall select the recipients of grants 1 under the Program. 2 (B) CONSULTATION.—In selecting covered 3 entities for grants under the Program, the Sec- 4 retary shall consult with— 5 (i) representatives of stakeholder or- 6 ganizations; 7 (ii) the Administrator of the Environ- 8 mental Protection Agency; 9 (iii) the Administrator of the National 10 Oceanic and Atmospheric Administration; 11 and 12 (iv) from the Department of Health 13 and Human Services— 14 (I) the Deputy Assistant Sec- 15 retary for Minority Health; 16 (II) the Administrator of the 17 Centers for Medicare & Medicaid 18 Services; 19 (III) the Administrator of the 20 Health Resources and Services Ad- 21 ministration; 22 (IV) the Director of the National 23 Institutes of Health; and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00631 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 632 •S 4486 IS (V) the Director of the Centers 1 for Disease Control and Prevention. 2 (C) PRIORITY.—In selecting a covered en- 3 tity to be awarded a grant under the Program, 4 the Secretary shall give priority to covered enti- 5 ties that serve a county— 6 (i) designated, or located in an area 7 designated, as a nonattainment area pur- 8 suant to section 107 of the Clean Air Act 9 (42 U.S.C. 7407) for any air pollutant for 10 which air quality criteria have been issued 11 under section 108(a) of such Act (42 12 U.S.C. 7408(a)); 13 (ii) with a level of vulnerability of 14 moderate-to-high or higher, according to 15 the Social Vulnerability Index of the Cen- 16 ters for Disease Control and Prevention; or 17 (iii) with temperatures that pose a 18 risk to human health, as determined by the 19 Secretary, in consultation with the Admin- 20 istrator of the National Oceanic and At- 21 mospheric Administration and the Chair of 22 the United States Global Change Research 23 Program, based on the best available 24 science. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00632 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 633 •S 4486 IS (D) LIMITATION.—A recipient of grant 1 funds under the Program may not use such 2 grant funds to serve a county that is served by 3 any other recipient of a grant under the Pro- 4 gram. 5 (5) USE OF FUNDS.—A covered entity awarded 6 grant funds under the Program may only use such 7 grant funds for the following: 8 (A) Initiatives to identify risks associated 9 with climate change for vulnerable individuals 10 and to provide services and support to such in- 11 dividuals that address such risks, which may in- 12 clude— 13 (i) training for health care providers, 14 doulas, and other employees in hospitals, 15 birth centers, midwifery practices, and 16 other health care practices that provide 17 prenatal or labor and delivery services to 18 vulnerable individuals on the identification 19 of, and patient counseling relating to, risks 20 associated with climate change for vulner- 21 able individuals; 22 (ii) hiring, training, or providing re- 23 sources to community health workers and 24 perinatal health workers who can help 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00633 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 634 •S 4486 IS identify risks associated with climate 1 change for vulnerable individuals, provide 2 patient counseling about such risks, and 3 carry out the distribution of relevant serv- 4 ices and support; 5 (iii) enhancing the monitoring of risks 6 associated with climate change for vulner- 7 able individuals, including by— 8 (I) collecting data on such risks 9 in specific census tracts, neighbor- 10 hoods, or other geographic areas; and 11 (II) sharing such data with local 12 health care providers, doulas, and 13 other employees in hospitals, birth 14 centers, midwifery practices, and 15 other health care practices that pro- 16 vide prenatal or labor and delivery 17 services to local vulnerable individuals; 18 and 19 (iv) providing vulnerable individuals— 20 (I) air conditioning units, resi- 21 dential weatherization support, filtra- 22 tion systems, household appliances, or 23 related items; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00634 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 635 •S 4486 IS (II) direct financial assistance; 1 and 2 (III) services and support, in- 3 cluding housing and transportation 4 assistance, to prepare for or recover 5 from extreme weather events, which 6 may include floods, hurricanes, 7 wildfires, droughts, and related 8 events. 9 (B) Initiatives to mitigate levels of and ex- 10 posure to risks associated with climate change 11 for vulnerable individuals, which shall be based 12 on the best available science and which may in- 13 clude initiatives to— 14 (i) develop, maintain, or expand urban 15 or community forestry initiatives and tree 16 canopy coverage initiatives; 17 (ii) improve infrastructure, including 18 buildings and paved surfaces; 19 (iii) develop or improve community 20 outreach networks to provide culturally 21 and linguistically appropriate information 22 and notifications about risks associated 23 with climate change for vulnerable individ- 24 uals; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00635 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 636 •S 4486 IS (iv) provide enhanced services to ra- 1 cial and ethnic minority groups and other 2 underserved populations. 3 (6) LENGTH OF AWARD.—A grant under this 4 subsection shall be disbursed over 4 fiscal years. 5 (7) TECHNICAL ASSISTANCE.—The Secretary 6 shall provide technical assistance to a covered entity 7 awarded a grant under the Program to support the 8 development, implementation, and evaluation of ac- 9 tivities funded with such grant. 10 (8) REPORTS TO SECRETARY.— 11 (A) ANNUAL REPORT.—For each fiscal 12 year during which a covered entity is disbursed 13 grant funds under the Program, such covered 14 entity shall submit to the Secretary a report 15 that summarizes the activities carried out by 16 such covered entity with such grant funds dur- 17 ing such fiscal year, which shall include a de- 18 scription of the following: 19 (i) The involvement of stakeholder or- 20 ganizations in the implementation of initia- 21 tives assisted with such grant funds. 22 (ii) Relevant health and environmental 23 data, disaggregated, to the extent prac- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00636 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 637 •S 4486 IS ticable, by race, ethnicity, gender, and 1 pregnancy status. 2 (iii) Qualitative feedback received 3 from vulnerable individuals with respect to 4 initiatives assisted with such grant funds. 5 (iv) Criteria used in selecting the geo- 6 graphic areas assisted with such grant 7 funds. 8 (v) Efforts to address racial and eth- 9 nic inequities in adverse maternal and in- 10 fant health outcomes and in exposure to 11 risks associated with climate change for 12 vulnerable individuals. 13 (vi) Any negative and unintended im- 14 pacts of initiatives assisted with such grant 15 funds, including— 16 (I) adverse environmental im- 17 pacts; 18 (II) displacement of residents 19 and businesses; 20 (III) rent and housing price in- 21 creases; and 22 (IV) disproportionate adverse im- 23 pacts on racial and ethnic minority 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00637 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 638 •S 4486 IS groups and other underserved popu- 1 lations. 2 (vii) How the covered entity will ad- 3 dress and prevent any impacts described in 4 clause (vi). 5 (B) PUBLICATION.—Not later than 30 6 days after the date on which a report is sub- 7 mitted under subparagraph (A), the Secretary 8 shall publish such report on a public website of 9 the Department of Health and Human Services. 10 (9) REPORT TO CONGRESS.—Not later than the 11 date that is 5 years after the date on which the Pro- 12 gram is established, the Secretary shall submit to 13 Congress and publish on a public website of the De- 14 partment of Health and Human Services a report on 15 the results of the Program, including the following: 16 (A) Summaries of the annual reports sub- 17 mitted under paragraph (8). 18 (B) Evaluations of the initiatives assisted 19 with grant funds under the Program. 20 (C) An assessment of the effectiveness of 21 the Program in— 22 (i) identifying risks associated with 23 climate change for vulnerable individuals; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00638 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 639 •S 4486 IS (ii) providing services and support to 1 such individuals; 2 (iii) mitigating levels of and exposure 3 to such risks; and 4 (iv) addressing racial and ethnic in- 5 equities in adverse maternal and infant 6 health outcomes and in exposure to such 7 risks. 8 (D) A description of how the Program 9 could be expanded, including— 10 (i) monitoring efforts or data collec- 11 tion that would be required to identify 12 areas with high levels of risks associated 13 with climate change for vulnerable individ- 14 uals; 15 (ii) how such areas could be identified 16 using the strategy developed under sub- 17 section (d); and 18 (iii) recommendations for additional 19 funding. 20 (10) COVERED ENTITY DEFINED.—In this sub- 21 section, the term ‘‘covered entity’’ means a consor- 22 tium of organizations serving a county that— 23 (A) shall include a community-based orga- 24 nization; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00639 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 640 •S 4486 IS (B) may include— 1 (i) another stakeholder organization; 2 (ii) the government of such county; 3 (iii) the governments of one or more 4 municipalities within such county; 5 (iv) a State or local public health de- 6 partment or emergency management agen- 7 cy; 8 (v) a local health care practice, which 9 may include a licensed and accredited hos- 10 pital, birth center, midwifery practice, or 11 other health care practice that provides 12 prenatal or labor and delivery services to 13 vulnerable individuals; 14 (vi) an Indian tribe or tribal organiza- 15 tion (as such terms are defined in section 16 4 of the Indian Self-Determination and 17 Education Assistance Act (25 U.S.C. 18 5304)); 19 (vii) an Urban Indian organization (as 20 defined in section 4 of the Indian Health 21 Care Improvement Act (25 U.S.C. 1603)); 22 and 23 (viii) an institution of higher edu- 24 cation. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00640 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 641 •S 4486 IS (11) AUTHORIZATION OF APPROPRIATIONS.— 1 There is authorized to be appropriated to carry out 2 this subsection $100,000,000 for fiscal years 2023 3 through 2026. 4 (b) GRANT PROGRAM FOR EDUCATION AND TRAIN- 5 ING AT HEALTH PROFESSION SCHOOLS.— 6 (1) IN GENERAL.—Not later than 1 year after 7 the date of the enactment of this Act, the Secretary 8 shall establish a grant program (in this subsection 9 referred to as the ‘‘Program’’) to provide funds to 10 health profession schools to support the development 11 and integration of education and training programs 12 for identifying and addressing risks associated with 13 climate change for vulnerable individuals. 14 (2) GRANT AUTHORITY.—In carrying out the 15 Program, the Secretary may award, on a competitive 16 basis, grants to health profession schools. 17 (3) APPLICATION.—To be eligible for a grant 18 under the Program, a health profession school shall 19 submit to the Secretary an application at such time, 20 in such form, and containing such information as 21 the Secretary may require, which shall include, at a 22 minimum, a description of the following: 23 (A) How such health profession school will 24 engage with vulnerable individuals, and stake- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00641 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 642 •S 4486 IS holder organizations representing such individ- 1 uals, in developing and implementing the edu- 2 cation and training programs supported by 3 grant funds awarded under the Program. 4 (B) How such health profession school will 5 ensure that such education and training pro- 6 grams will address racial and ethnic inequities 7 in exposure to, and the effects of, risks associ- 8 ated with climate change for vulnerable individ- 9 uals. 10 (4) USE OF FUNDS.—A health profession school 11 awarded a grant under the Program shall use the 12 grant funds to develop, and integrate into the cur- 13 riculum and continuing education of such health 14 profession school, education and training on each of 15 the following: 16 (A) Identifying risks associated with cli- 17 mate change for vulnerable individuals and indi- 18 viduals with the intent to become pregnant. 19 (B) How risks associated with climate 20 change affect vulnerable individuals and individ- 21 uals with the intent to become pregnant. 22 (C) Racial and ethnic inequities in expo- 23 sure to, and the effects of, risks associated with 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00642 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 643 •S 4486 IS climate change for vulnerable individuals and 1 individuals with the intent to become pregnant. 2 (D) Patient counseling and mitigation 3 strategies relating to risks associated with cli- 4 mate change for vulnerable individuals. 5 (E) Relevant services and support for vul- 6 nerable individuals relating to risks associated 7 with climate change and strategies for ensuring 8 vulnerable individuals have access to such serv- 9 ices and support. 10 (F) Implicit and explicit bias, racism, and 11 discrimination. 12 (G) Related topics identified by such 13 health profession school based on the engage- 14 ment of such health profession school with vul- 15 nerable individuals and stakeholder organiza- 16 tions representing such individuals. 17 (5) PARTNERSHIPS.—In carrying out activities 18 with grant funds, a health profession school awarded 19 a grant under the Program may partner with one or 20 more of the following: 21 (A) A State or local public health depart- 22 ment. 23 (B) A health care professional membership 24 organization. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00643 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 644 •S 4486 IS (C) A stakeholder organization. 1 (D) A health profession school. 2 (E) An institution of higher education. 3 (6) REPORTS TO SECRETARY.— 4 (A) ANNUAL REPORT.—For each fiscal 5 year during which a health profession school is 6 disbursed grant funds under the Program, such 7 health profession school shall submit to the Sec- 8 retary a report that describes the activities car- 9 ried out with such grant funds during such fis- 10 cal year. 11 (B) FINAL REPORT.—Not later than the 12 date that is 1 year after the end of the last fis- 13 cal year during which a health profession school 14 is disbursed grant funds under the Program, 15 the health profession school shall submit to the 16 Secretary a final report that summarizes the 17 activities carried out with such grant funds. 18 (7) REPORT TO CONGRESS.—Not later than the 19 date that is 6 years after the date on which the Pro- 20 gram is established, the Secretary shall submit to 21 Congress and publish on a public website of the De- 22 partment of Health and Human Services a report 23 that includes the following: 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00644 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 645 •S 4486 IS (A) A summary of the reports submitted 1 under paragraph (6). 2 (B) Recommendations to improve edu- 3 cation and training programs at health profes- 4 sion schools with respect to identifying and ad- 5 dressing risks associated with climate change 6 for vulnerable individuals. 7 (8) HEALTH PROFESSION SCHOOL DEFINED.— 8 In this subsection, the term ‘‘health profession 9 school’’ means an accredited— 10 (A) medical school; 11 (B) school of nursing; 12 (C) midwifery program; 13 (D) physician assistant education program; 14 (E) teaching hospital; 15 (F) residency or fellowship program; or 16 (G) other school or program determined 17 appropriate by the Secretary. 18 (9) AUTHORIZATION OF APPROPRIATIONS.— 19 There is authorized to be appropriated to carry out 20 this subsection $5,000,000 for fiscal years 2023 21 through 2026. 22 (c) NIH CONSORTIUM ON BIRTH AND CLIMATE 23 CHANGE RESEARCH.— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00645 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 646 •S 4486 IS (1) ESTABLISHMENT.—Not later than 1 year 1 after the date of the enactment of this Act, the Di- 2 rector of the National Institutes of Health (in this 3 subsection referred to as the ‘‘Director of NIH’’) 4 shall establish the Consortium on Birth and Climate 5 Change Research (in this subsection referred to as 6 the ‘‘Consortium’’). 7 (2) DUTIES.— 8 (A) IN GENERAL.—The Consortium shall 9 coordinate, across the institutes, centers, and 10 offices of the National Institutes of Health, re- 11 search on the risks associated with climate 12 change for vulnerable individuals. 13 (B) REQUIRED ACTIVITIES.—In carrying 14 out subparagraph (A), the Consortium shall— 15 (i) establish research priorities, in- 16 cluding by prioritizing research that— 17 (I) identifies the risks associated 18 with climate change for vulnerable in- 19 dividuals with a particular focus on 20 inequities in such risks among racial 21 and ethnic minority groups and other 22 underserved populations; and 23 (II) identifies strategies to reduce 24 levels of, and exposure to, such risks, 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00646 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 647 •S 4486 IS with a particular focus on risks 1 among racial and ethnic minority 2 groups and other underserved popu- 3 lations; 4 (ii) identify gaps in available data re- 5 lated to such risks; 6 (iii) identify gaps in, and opportuni- 7 ties for, research collaborations; 8 (iv) identify funding opportunities for 9 community-based organizations and re- 10 searchers from racially, ethnically, and 11 geographically diverse backgrounds; and 12 (v) publish annual reports on the 13 work and findings of the Consortium on a 14 public website of the National Institutes of 15 Health. 16 (3) MEMBERSHIP.—The Director of NIH shall 17 appoint to the Consortium representatives of such 18 institutes, centers, and offices of the National Insti- 19 tutes of Health as the Director of NIH considers ap- 20 propriate, including, at a minimum, representatives 21 of— 22 (A) the National Institute of Environ- 23 mental Health Sciences; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00647 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 648 •S 4486 IS (B) the National Institute on Minority 1 Health and Health Disparities; 2 (C) the Eunice Kennedy Shriver National 3 Institute of Child Health and Human Develop- 4 ment; 5 (D) the National Institute of Nursing Re- 6 search; and 7 (E) the Office of Research on Women’s 8 Health. 9 (4) CHAIRPERSON.—The Chairperson of the 10 Consortium shall be designated by the Director of 11 NIH and selected from among the representatives 12 appointed under paragraph (3). 13 (5) CONSULTATION.—In carrying out the duties 14 described in paragraph (2), the Consortium shall 15 consult with— 16 (A) the heads of relevant Federal agencies, 17 including— 18 (i) the Environmental Protection 19 Agency; 20 (ii) the National Oceanic and Atmos- 21 pheric Administration; 22 (iii) the Occupational Safety and 23 Health Administration; and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00648 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 649 •S 4486 IS (iv) from the Department of Health 1 and Human Services— 2 (I) the Office of Minority Health 3 in the Office of the Secretary; 4 (II) the Centers for Medicare & 5 Medicaid Services; 6 (III) the Health Resources and 7 Services Administration; 8 (IV) the Centers for Disease 9 Control and Prevention; 10 (V) the Indian Health Service; 11 and 12 (VI) the Administration for Chil- 13 dren and Families; and 14 (B) representatives of— 15 (i) stakeholder organizations; 16 (ii) health care providers and profes- 17 sional membership organizations with ex- 18 pertise in maternal health or environ- 19 mental justice; 20 (iii) State and local public health de- 21 partments; 22 (iv) licensed and accredited hospitals, 23 birth centers, midwifery practices, or other 24 health care practices that provide prenatal 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00649 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 650 •S 4486 IS or labor and delivery services to vulnerable 1 individuals; and 2 (v) institutions of higher education, 3 including such institutions that are minor- 4 ity-serving institutions or have expertise in 5 maternal health or environmental justice. 6 (d) STRATEGY FOR IDENTIFYING CLIMATE CHANGE 7 RISK ZONES FOR VULNERABLE MOTHERS AND BABIES.— 8 (1) IN GENERAL.—The Secretary, acting 9 through the Director of the Centers for Disease 10 Control and Prevention, shall develop a strategy (in 11 this subsection referred to as the ‘‘Strategy’’) for 12 designating areas that the Secretary determines to 13 have a high risk of adverse maternal and infant 14 health outcomes among vulnerable individuals as a 15 result of risks associated with climate change. 16 (2) STRATEGY REQUIREMENTS.— 17 (A) IN GENERAL.—In developing the 18 Strategy, the Secretary shall establish a process 19 to identify areas where vulnerable individuals 20 are exposed to a high risk of adverse maternal 21 and infant health outcomes as a result of risks 22 associated with climate change in conjunction 23 with other factors that can impact such health 24 outcomes, including— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00650 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 651 •S 4486 IS (i) the incidence of diseases associated 1 with air pollution, extreme heat, and other 2 environmental factors; 3 (ii) the availability and accessibility of 4 maternal and infant health care providers; 5 (iii) English-language proficiency 6 among people of reproductive age; 7 (iv) the health insurance status of 8 people of reproductive age; 9 (v) the number of people of reproduc- 10 tive age who are members of racial or eth- 11 nic groups with disproportionately high 12 rates of adverse maternal and infant 13 health outcomes; 14 (vi) the socioeconomic status of people 15 of reproductive age, including with respect 16 to— 17 (I) poverty; 18 (II) unemployment; 19 (III) household income; and 20 (IV) educational attainment; and 21 (vii) access to quality housing, trans- 22 portation, and nutrition. 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00651 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 652 •S 4486 IS (B) RESOURCES.—In developing the Strat- 1 egy, the Secretary shall identify, and incor- 2 porate a description of, the following: 3 (i) Existing mapping tools or Federal 4 programs that identify— 5 (I) risks associated with climate 6 change for vulnerable individuals; and 7 (II) other factors that can influ- 8 ence maternal and infant health out- 9 comes, including the factors described 10 in subparagraph (A). 11 (ii) Environmental, health, socio- 12 economic, and demographic data relevant 13 to identifying risks associated with climate 14 change for vulnerable individuals. 15 (iii) Existing monitoring networks 16 that collect data described in clause (ii), 17 and any gaps in such networks. 18 (iv) Federal, State, and local stake- 19 holders involved in maintaining monitoring 20 networks identified under clause (iii), and 21 how such stakeholders are coordinating 22 their monitoring efforts. 23 (v) Additional monitoring networks, 24 and enhancements to existing monitoring 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00652 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 653 •S 4486 IS networks, that would be required to ad- 1 dress gaps identified under clause (iii), in- 2 cluding at the subcounty and census tract 3 level. 4 (vi) Funding amounts required to es- 5 tablish the monitoring networks identified 6 under clause (v) and recommendations for 7 Federal, State, and local coordination with 8 respect to such networks. 9 (vii) Potential uses for data collected 10 and generated as a result of the Strategy, 11 including how such data may be used in 12 determining recipients of grants under the 13 program established by subsection (a) or 14 other similar programs. 15 (viii) Other information the Secretary 16 considers relevant for the development of 17 the Strategy. 18 (3) COORDINATION AND CONSULTATION.—In 19 developing the Strategy, the Secretary shall— 20 (A) coordinate with the Administrator of 21 the Environmental Protection Agency and the 22 Administrator of the National Oceanic and At- 23 mospheric Administration; and 24 (B) consult with— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00653 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 654 •S 4486 IS (i) stakeholder organizations; 1 (ii) health care providers and profes- 2 sional membership organizations with ex- 3 pertise in maternal health or environ- 4 mental justice; 5 (iii) State and local public health de- 6 partments; 7 (iv) licensed and accredited hospitals, 8 birth centers, midwifery practices, or other 9 health care providers that provide prenatal 10 or labor and delivery services to vulnerable 11 individuals; and 12 (v) institutions of higher education, 13 including such institutions that are minor- 14 ity-serving institutions or have expertise in 15 maternal health or environmental justice. 16 (4) NOTICE AND COMMENT.—At least 240 days 17 before the date on which the Strategy is published 18 in accordance with paragraph (5), the Secretary 19 shall provide— 20 (A) notice of the Strategy on a public 21 website of the Department of Health and 22 Human Services; and 23 (B) an opportunity for public comment of 24 at least 90 days. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00654 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 655 •S 4486 IS (5) PUBLICATION.—Not later than 18 months 1 after the date of the enactment of this Act, the Sec- 2 retary shall publish on a public website of the De- 3 partment of Health and Human Services— 4 (A) the Strategy; 5 (B) the public comments received under 6 paragraph (4); and 7 (C) the responses of the Secretary to such 8 public comments. 9 (e) DEFINITIONS.—In this section, the following defi- 10 nitions apply: 11 (1) ADVERSE MATERNAL AND INFANT HEALTH 12 OUTCOMES.—The term ‘‘adverse maternal and in- 13 fant health outcomes’’ includes the outcomes of pre- 14 term birth, low birth weight, stillbirth, infant or ma- 15 ternal mortality, and severe maternal morbidity. 16 (2) INSTITUTION OF HIGHER EDUCATION.—The 17 term ‘‘institution of higher education’’ has the 18 meaning given such term in section 101 of the High- 19 er Education Act of 1965 (20 U.S.C. 1001). 20 (3) MINORITY-SERVING INSTITUTION.—The 21 term ‘‘minority-serving institution’’ means an entity 22 specified in any of paragraphs (1) through (7) of 23 section 371(a) of the Higher Education Act of 1965 24 (20 U.S.C. 1067q(a)). 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00655 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 656 •S 4486 IS (4) RACIAL AND ETHNIC MINORITY GROUP.— 1 The term ‘‘racial and ethnic minority group’’ has the 2 meaning given such term in section 1707(g) of the 3 Public Health Service Act (42 U.S.C. 300u–6(g)). 4 (5) RISKS ASSOCIATED WITH CLIMATE 5 CHANGE.—The term ‘‘risks associated with climate 6 change’’ includes risks associated with extreme heat, 7 air pollution, extreme weather events, and other en- 8 vironmental issues associated with climate change 9 that can result in adverse maternal and infant 10 health outcomes. 11 (6) STAKEHOLDER ORGANIZATION.—The term 12 ‘‘stakeholder organization’’ means— 13 (A) a community-based organization with 14 expertise in providing assistance to vulnerable 15 individuals; 16 (B) a nonprofit organization with expertise 17 in maternal or infant health or environmental 18 justice; and 19 (C) a patient advocacy organization rep- 20 resenting vulnerable individuals. 21 (7) VULNERABLE INDIVIDUAL.—The term ‘‘vul- 22 nerable individual’’ means— 23 (A) an individual who is pregnant; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00656 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 657 •S 4486 IS (B) an individual who was pregnant during 1 any portion of the preceding 1-year period; and 2 (C) an individual under 3 years of age. 3 SEC. 5206. TECH TO SAVE MOMS. 4 (a) DEFINITIONS.—In this section: 5 (1) POSTPARTUM AND POSTPARTUM PERIOD.— 6 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 7 refer to the 1-year period beginning on the last day 8 of the pregnancy of an individual. 9 (2) RACIAL AND ETHNIC MINORITY GROUP.— 10 The term ‘‘racial and ethnic minority group’’ has the 11 meaning given such term in section 1707(g)(1) of 12 the Public Health Service Act (42 U.S.C. 300u– 13 6(g)(1)). 14 (3) SEVERE MATERNAL MORBIDITY.—The term 15 ‘‘severe maternal morbidity’’ means a health condi- 16 tion, including mental health conditions and sub- 17 stance use disorders, attributed to or aggravated by 18 pregnancy or childbirth that results in significant 19 short-term or long-term consequences to the health 20 of the individual who was pregnant. 21 (4) SOCIAL DETERMINANTS OF MATERNAL 22 HEALTH.—The term ‘‘social determinants of mater- 23 nal health’’ means non-clinical factors that impact 24 maternal health outcomes, including— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00657 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 658 •S 4486 IS (A) economic factors, which may include 1 poverty, employment, food security, support for 2 and access to lactation and other infant feeding 3 options, housing stability, and related factors; 4 (B) neighborhood factors, which may in- 5 clude quality of housing, access to transpor- 6 tation, access to child care, availability of 7 healthy foods and nutrition counseling, avail- 8 ability of clean water, air and water quality, 9 ambient temperatures, neighborhood crime and 10 violence, access to broadband, and related fac- 11 tors; 12 (C) social and community factors, which 13 may include systemic racism, gender discrimi- 14 nation or discrimination based on other pro- 15 tected classes, workplace conditions, incarcer- 16 ation, and related factors; 17 (D) household factors, which may include 18 ability to conduct lead testing and abatement, 19 car seat installation, indoor air temperatures, 20 and related factors; 21 (E) education access and quality factors, 22 which may include educational attainment, lan- 23 guage and literacy, and related factors; and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00658 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 659 •S 4486 IS (F) health care access factors, including 1 health insurance coverage, access to culturally 2 congruent health care services, providers, and 3 non-clinical support, access to home visiting 4 services, access to wellness and stress manage- 5 ment programs, health literacy, access to tele- 6 health and items required to receive telehealth 7 services, and related factors. 8 (b) INTEGRATED TELEHEALTH MODELS IN MATER- 9 NITY CARE SERVICES.— 10 (1) IN GENERAL.—Section 1115A(b)(2)(B) of 11 the Social Security Act (42 U.S.C. 1315a(b)(2)(B)) 12 is amended by adding at the end the following: 13 ‘‘(xxviii) Focusing on title XIX, pro- 14 viding for the adoption of and use of tele- 15 health tools that allow for screening, moni- 16 toring, and management of common health 17 complications with respect to an individual 18 receiving medical assistance during such 19 individual’s pregnancy and for not more 20 than a 1-year period beginning on the last 21 day of the pregnancy.’’. 22 (2) EFFECTIVE DATE.—The amendment made 23 by paragraph (1) shall take effect 1 year after the 24 date of the enactment of this section. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00659 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 660 •S 4486 IS (c) GRANTS TO EXPAND THE USE OF TECHNOLOGY- 1 ENABLED COLLABORATIVE LEARNING AND CAPACITY 2 MODELS FOR PREGNANT AND POSTPARTUM INDIVID- 3 UALS.—Title III of the Public Health Service Act is 4 amended by inserting after section 330N (42 U.S.C. 5 254c–20) the following new section: 6 ‘‘SEC. 330N–1. EXPANDING CAPACITY FOR MATERNAL 7 HEALTH OUTCOMES. 8 ‘‘(a) ESTABLISHMENT.—Beginning not later than 1 9 year after the date of enactment of this section, the Sec- 10 retary shall award grants to eligible entities to evaluate, 11 develop, and expand the use of technology-enabled collabo- 12 rative learning and capacity building models and improve 13 maternal health outcomes— 14 ‘‘(1) in health professional shortage areas; 15 ‘‘(2) in areas with high rates of maternal mor- 16 tality and severe maternal morbidity; 17 ‘‘(3) in areas with significant racial and ethnic 18 inequities in maternal health outcomes; and 19 ‘‘(4) for medically underserved populations and 20 American Indians and Alaska Natives, including In- 21 dian Tribes, Tribal organizations, and Urban Indian 22 organizations. 23 ‘‘(b) USE OF FUNDS.— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00660 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 661 •S 4486 IS ‘‘(1) REQUIRED USES.—Recipients of grants 1 under this section shall use the grants to— 2 ‘‘(A) train maternal health care providers, 3 students, and other similar professionals 4 through models that include— 5 ‘‘(i) methods to increase safety and 6 health care quality; 7 ‘‘(ii) training to increase awareness of, 8 and eliminate implicit bias, racism, and 9 discrimination in, the provision of health 10 care; 11 ‘‘(iii) best practices in screening for 12 and, as needed, evaluating and treating 13 maternal mental health conditions and 14 substance use disorders; 15 ‘‘(iv) training on best practices in ma- 16 ternity care for pregnant and postpartum 17 individuals during the COVID–19 public 18 health emergency or future public health 19 emergencies; 20 ‘‘(v) methods to screen for social de- 21 terminants of maternal health risks in the 22 prenatal and postpartum periods; and 23 ‘‘(vi) the use of remote patient moni- 24 toring tools for pregnancy-related com- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00661 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 662 •S 4486 IS plications described in section 1 1115A(b)(2)(B)(xxviii) of the Social Secu- 2 rity Act; 3 ‘‘(B) evaluate and collect information on 4 the effect of such models on— 5 ‘‘(i) access to, and quality of, care; 6 ‘‘(ii) outcomes with respect to the 7 health of an individual; and 8 ‘‘(iii) the experience of individuals who 9 receive pregnancy-related health care; 10 ‘‘(C) develop qualitative and quantitative 11 measures to identify best practices for the ex- 12 pansion and use of such models; 13 ‘‘(D) study the effect of such models on 14 patient outcomes and maternity care providers; 15 and 16 ‘‘(E) conduct any other activity, as deter- 17 mined by the Secretary. 18 ‘‘(2) PERMISSIBLE USES.—Recipients of grants 19 under this section may use grants to support— 20 ‘‘(A) the use and expansion of technology- 21 enabled collaborative learning and capacity 22 building models, including hardware and soft- 23 ware that— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00662 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 663 •S 4486 IS ‘‘(i) enable distance learning and tech- 1 nical support; and 2 ‘‘(ii) support the secure exchange of 3 electronic health information; and 4 ‘‘(B) maternity care providers, students, 5 and other similar professionals in the provision 6 of maternity care through such models. 7 ‘‘(c) APPLICATION.— 8 ‘‘(1) IN GENERAL.—An eligible entity seeking a 9 grant under subsection (a) shall submit to the Sec- 10 retary an application, at such time, in such manner, 11 and containing such information as the Secretary 12 may require. 13 ‘‘(2) ASSURANCE.—An application under para- 14 graph (1) shall include an assurance that such entity 15 shall collect information on, and assess the effect of, 16 the use of technology-enabled collaborative learning 17 and capacity building models, including with respect 18 to— 19 ‘‘(A) maternal health outcomes; 20 ‘‘(B) access to maternal health care serv- 21 ices; 22 ‘‘(C) quality of maternal health care; and 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00663 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 664 •S 4486 IS ‘‘(D) retention of maternity care providers 1 serving areas and populations described in sub- 2 section (a). 3 ‘‘(d) LIMITATIONS.— 4 ‘‘(1) NUMBER.—The Secretary may not award 5 more than 1 grant under this section to an eligible 6 entity. 7 ‘‘(2) DURATION.—A grant awarded under this 8 section shall be for a 5-year period. 9 ‘‘(e) ACCESS TO BROADBAND.—In administering 10 grants under this section, the Secretary may coordinate 11 with other agencies to ensure that funding opportunities 12 are available to support access to reliable, high-speed 13 internet for grantees. 14 ‘‘(f) TECHNICAL ASSISTANCE.—The Secretary shall 15 provide (either directly or by contract) technical assistance 16 to eligible entities, including recipients of grants under 17 subsection (a), on the development, use, and sustainability 18 of technology-enabled collaborative learning and capacity 19 building models to expand access to maternal health care 20 services provided by such entities, including— 21 ‘‘(1) in health professional shortage areas; 22 ‘‘(2) in areas with high rates of maternal mor- 23 tality and severe maternal morbidity or significant 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00664 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 665 •S 4486 IS racial and ethnic inequities in maternal health out- 1 comes; and 2 ‘‘(3) for medically underserved populations or 3 American Indians and Alaska Natives. 4 ‘‘(g) RESEARCH AND EVALUATION.—The Secretary, 5 in consultation with experts, shall develop a strategic plan 6 to research and evaluate the evidence for such models. 7 ‘‘(h) REPORTING.— 8 ‘‘(1) ELIGIBLE ENTITIES.—An eligible entity 9 that receives a grant under subsection (a) shall sub- 10 mit to the Secretary a report, at such time, in such 11 manner, and containing such information as the Sec- 12 retary may require. 13 ‘‘(2) SECRETARY.—Not later than 4 years after 14 the date of enactment of this section, the Secretary 15 shall submit to the Congress, and make available on 16 the website of the Department of Health and 17 Human Services, a report that includes— 18 ‘‘(A) a description of grants awarded 19 under subsection (a) and the purpose and 20 amounts of such grants; 21 ‘‘(B) a summary of— 22 ‘‘(i) the evaluations conducted under 23 subsection (b)(1)(B); 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00665 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 666 •S 4486 IS ‘‘(ii) any technical assistance provided 1 under subsection (f); and 2 ‘‘(iii) the activities conducted under 3 subsection (a); and 4 ‘‘(C) a description of any significant find- 5 ings with respect to— 6 ‘‘(i) patient outcomes; and 7 ‘‘(ii) best practices for expanding, 8 using, or evaluating technology-enabled col- 9 laborative learning and capacity building 10 models. 11 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 12 authorized to be appropriated to carry out this section, 13 $6,000,000 for each of fiscal years 2023 through 2027. 14 ‘‘(j) DEFINITIONS.—In this section: 15 ‘‘(1) ELIGIBLE ENTITY.— 16 ‘‘(A) IN GENERAL.—The term ‘eligible en- 17 tity’ means an entity that provides, or supports 18 the provision of, maternal health care services 19 or other evidence-based services for pregnant 20 and postpartum individuals— 21 ‘‘(i) in health professional shortage 22 areas; 23 ‘‘(ii) in areas with high rates of ad- 24 verse maternal health outcomes or signifi- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00666 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 667 •S 4486 IS cant racial and ethnic inequities in mater- 1 nal health outcomes; or 2 ‘‘(iii) who are— 3 ‘‘(I) members of medically under- 4 served populations; or 5 ‘‘(II) American Indians and Alas- 6 ka Natives, including Indian Tribes, 7 Tribal organizations, and Urban In- 8 dian organizations. 9 ‘‘(B) INCLUSIONS.—An eligible entity may 10 include entities that lead, or are capable of 11 leading, a technology-enabled collaborative 12 learning and capacity building model. 13 ‘‘(2) HEALTH PROFESSIONAL SHORTAGE 14 AREA.—The term ‘health professional shortage area’ 15 means a health professional shortage area des- 16 ignated under section 332. 17 ‘‘(3) INDIAN TRIBE.—The term ‘Indian Tribe’ 18 has the meaning given such term in section 4 of the 19 Indian Self-Determination and Education Assistance 20 Act. 21 ‘‘(4) MATERNAL MORTALITY.—The term ‘ma- 22 ternal mortality’ means a death occurring during or 23 within the 1-year period after pregnancy caused by 24 pregnancy-related or childbirth complications, in- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00667 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 668 •S 4486 IS cluding a suicide, overdose, or other death resulting 1 from a mental health or substance use disorder at- 2 tributed to or aggravated by pregnancy or childbirth 3 complications. 4 ‘‘(5) MEDICALLY UNDERSERVED POPU- 5 LATION.—The term ‘medically underserved popu- 6 lation’ has the meaning given such term in section 7 330(b)(3). 8 ‘‘(6) POSTPARTUM.—The term ‘postpartum’ 9 means the 1-year period beginning on the last date 10 of an individual’s pregnancy. 11 ‘‘(7) SEVERE MATERNAL MORBIDITY.—The 12 term ‘severe maternal morbidity’ means a health 13 condition, including a mental health or substance 14 use disorder, attributed to or aggravated by preg- 15 nancy or childbirth that results in significant short- 16 term or long-term consequences to the health of the 17 individual who was pregnant. 18 ‘‘(8) TECHNOLOGY-ENABLED COLLABORATIVE 19 LEARNING AND CAPACITY BUILDING MODEL.—The 20 term ‘technology-enabled collaborative learning and 21 capacity building model’ means a distance health 22 education model that connects health care profes- 23 sionals, and other specialists, through simultaneous 24 interactive videoconferencing for the purpose of fa- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00668 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 669 •S 4486 IS cilitating case-based learning, disseminating best 1 practices, and evaluating outcomes in the context of 2 maternal health care. 3 ‘‘(9) TRIBAL ORGANIZATION.—The term ‘Tribal 4 organization’ has the meaning given such term in 5 section 4 of the Indian Self-Determination and Edu- 6 cation Assistance Act. 7 ‘‘(10) URBAN INDIAN ORGANIZATION.—The 8 term ‘Urban Indian organization’ has the meaning 9 given such term in section 4 of the Indian Health 10 Care Improvement Act.’’. 11 (d) GRANTS TO PROMOTE EQUITY IN MATERNAL 12 HEALTH OUTCOMES THROUGH DIGITAL TOOLS.— 13 (1) IN GENERAL.—Beginning not later than 1 14 year after the date of the enactment of this Act, the 15 Secretary of Health and Human Services shall make 16 grants to eligible entities to reduce racial and ethnic 17 inequities in maternal health outcomes by increasing 18 access to digital tools related to maternal health 19 care. 20 (2) APPLICATIONS.—To be eligible to receive a 21 grant under this subsection, an eligible entity shall 22 submit to the Secretary an application at such time, 23 in such manner, and containing such information as 24 the Secretary may require. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00669 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 670 •S 4486 IS (3) PRIORITIZATION.—In awarding grants 1 under this subsection, the Secretary shall prioritize 2 an eligible entity— 3 (A) in an area with high rates of adverse 4 maternal health outcomes or significant racial 5 and ethnic inequities in maternal health out- 6 comes; 7 (B) in a health professional shortage area 8 designated under section 332 of the Public 9 Health Service Act (42 U.S.C. 254e); and 10 (C) that promotes technology that address- 11 es racial and ethnic inequities in maternal 12 health outcomes. 13 (4) LIMITATIONS.— 14 (A) NUMBER.—The Secretary may award 15 not more than 1 grant under this subsection to 16 an eligible entity. 17 (B) DURATION.—A grant awarded under 18 this subsection shall be for a 5-year period. 19 (5) TECHNICAL ASSISTANCE.—The Secretary 20 shall provide technical assistance to an eligible entity 21 on the development, use, evaluation, and post-grant 22 sustainability of digital tools for purposes of pro- 23 moting equity in maternal health outcomes. 24 (6) REPORTING.— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00670 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 671 •S 4486 IS (A) ELIGIBLE ENTITIES.—An eligible enti- 1 ty that receives a grant under paragraph (1) 2 shall submit to the Secretary a report, at such 3 time, in such manner, and containing such in- 4 formation as the Secretary may require. 5 (B) SECRETARY.—Not later than 4 years 6 after the date of the enactment of this Act, the 7 Secretary shall submit to Congress a report 8 that includes— 9 (i) an evaluation on the effectiveness 10 of grants awarded under this subsection to 11 improve health outcomes for pregnant and 12 postpartum individuals from racial and 13 ethnic minority groups; 14 (ii) recommendations on new grant 15 programs that promote the use of tech- 16 nology to improve such maternal health 17 outcomes; and 18 (iii) recommendations with respect 19 to— 20 (I) technology-based privacy and 21 security safeguards in maternal health 22 care; 23 (II) reimbursement rates for ma- 24 ternal telehealth services; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00671 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 672 •S 4486 IS (III) the use of digital tools to 1 analyze large data sets to identify po- 2 tential pregnancy-related complica- 3 tions; 4 (IV) barriers that prevent mater- 5 nity care providers from providing 6 telehealth services across States; 7 (V) the use of consumer digital 8 tools such as mobile phone applica- 9 tions, patient portals, and wearable 10 technologies to improve maternal 11 health outcomes; 12 (VI) barriers that prevent access 13 to telehealth services, including a lack 14 of access to reliable, high-speed inter- 15 net or electronic devices; 16 (VII) barriers to data sharing be- 17 tween the Special Supplemental Nu- 18 trition Program for Women, Infants, 19 and Children program and maternity 20 care providers, and recommendations 21 for addressing such barriers; and 22 (VIII) lessons learned from ex- 23 panded access to telehealth related to 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00672 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 673 •S 4486 IS maternity care during the COVID–19 1 public health emergency. 2 (7) AUTHORIZATION OF APPROPRIATIONS.— 3 There is authorized to be appropriated to carry out 4 this subsection $6,000,000 for each of fiscal years 5 2023 through 2027. 6 (e) REPORT ON THE USE OF TECHNOLOGY IN MA- 7 TERNITY CARE.— 8 (1) IN GENERAL.—Not later than 60 days after 9 the date of enactment of this Act, the Secretary of 10 Health and Human Services shall enter into an 11 agreement with the National Academies of Sciences, 12 Engineering, and Medicine (referred to in this sec- 13 tion as the ‘‘National Academies’’) under which the 14 National Academies shall conduct a study on the use 15 of technology and patient monitoring devices in ma- 16 ternity care. 17 (2) CONTENT.—The agreement entered into 18 pursuant to paragraph (1) shall provide for the 19 study of the following: 20 (A) The use of innovative technology (in- 21 cluding artificial intelligence) in maternal 22 health care, including the extent to which such 23 technology has affected racial or ethnic biases 24 in maternal health care. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00673 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 674 •S 4486 IS (B) The use of patient monitoring devices 1 (including pulse oximeter devices) in maternal 2 health care, including the extent to which such 3 devices have affected racial or ethnic biases in 4 maternal health care. 5 (C) Best practices for reducing and pre- 6 venting racial or ethnic biases in the use of in- 7 novative technology and patient monitoring de- 8 vices in maternity care. 9 (D) Best practices in the use of innovative 10 technology and patient monitoring devices for 11 pregnant and postpartum individuals from ra- 12 cial and ethnic minority groups. 13 (E) Best practices with respect to privacy 14 and security safeguards in such use. 15 (3) REPORT.—Not later than 24 months after 16 the date of enactment of this Act, the National 17 Academies shall complete the study under this sub- 18 section, and transmit a report of the results of such 19 study to Congress. 20 SEC. 5207. SOCIAL DETERMINANTS FOR MOMS. 21 (a) TASK FORCE TO DEVELOP A STRATEGY TO AD- 22 DRESS SOCIAL DETERMINANTS OF MATERNAL 23 HEALTH.— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00674 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 675 •S 4486 IS (1) IN GENERAL.—The Secretary of Health and 1 Human Services shall convene a task force (in this 2 subsection referred to as the ‘‘Task Force’’) to de- 3 velop a strategy to coordinate efforts between Fed- 4 eral agencies to address social determinants of ma- 5 ternal health with respect to pregnant and 6 postpartum individuals. 7 (2) EX OFFICIO MEMBERS.—The ex officio 8 members of the Task Force shall consist of the fol- 9 lowing: 10 (A) The Secretary of Health and Human 11 Services (or a designee thereof). 12 (B) The Secretary of Housing and Urban 13 Development (or a designee thereof). 14 (C) The Secretary of Transportation (or a 15 designee thereof). 16 (D) The Secretary of Agriculture (or a 17 designee thereof). 18 (E) The Secretary of Labor (or a designee 19 thereof). 20 (F) The Administrator of the Environ- 21 mental Protection Agency (or a designee there- 22 of). 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00675 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 676 •S 4486 IS (G) The Assistant Secretary for the Ad- 1 ministration for Children and Families (or a 2 designee thereof). 3 (H) The Administrator of the Centers for 4 Medicare & Medicaid Services (or a designee 5 thereof). 6 (I) The Director of the Indian Health 7 Service (or a designee thereof). 8 (J) The Director of the National Institutes 9 of Health (or a designee thereof). 10 (K) The Administrator of the Health Re- 11 sources and Services Administration (or a des- 12 ignee thereof). 13 (L) The Deputy Assistant Secretary for 14 Minority Health of the Department of Health 15 and Human Services (or a designee thereof). 16 (M) The Deputy Assistant Secretary for 17 Women’s Health of the Department of Health 18 and Human Services (or a designee thereof). 19 (N) The Director of the Centers for Dis- 20 ease Control and Prevention (or a designee 21 thereof). 22 (O) The Director of the Office on Violence 23 Against Women of the Department of Justice 24 (or a designee thereof). 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00676 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 677 •S 4486 IS (3) APPOINTED MEMBERS.—In addition to the 1 ex officio members of the Task Force, the Secretary 2 of Health and Human Services shall appoint the fol- 3 lowing members of the Task Force: 4 (A) At least two representatives of pa- 5 tients, to include— 6 (i) a representative of patients who 7 have suffered from severe maternal mor- 8 bidity; or 9 (ii) a representative of patients who is 10 a family member of an individual who suf- 11 fered a pregnancy-related death. 12 (B) At least two leaders of community- 13 based organizations that address maternal mor- 14 tality and severe maternal morbidity with a spe- 15 cific focus on racial and ethnic inequities. In 16 appointing such leaders under this subpara- 17 graph, the Secretary of Health and Human 18 Services shall give priority to individuals who 19 are leaders of organizations led by individuals 20 from racial and ethnic minority groups. 21 (C) At least two perinatal health workers. 22 (D) A professionally diverse panel of ma- 23 ternity care providers. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00677 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 678 •S 4486 IS (4) CHAIR.—The Secretary of Health and 1 Human Services shall select the chair of the Task 2 Force from among the members of the Task Force. 3 (5) REPORT.—Not later than 2 years after the 4 date of the enactment of this Act, the Task Force 5 shall submit to Congress a report on— 6 (A) the strategy developed under para- 7 graph (1); 8 (B) recommendations on funding amounts 9 with respect to implementing such strategy; and 10 (C) recommendations for how to expand 11 coverage of social services to address social de- 12 terminants of maternal health under Medicaid 13 managed care organizations and State Medicaid 14 programs. 15 (6) TERMINATION.—Section 14 of the Federal 16 Advisory Committee Act (5 U.S.C. App.) shall not 17 apply to the Task Force with respect to termination. 18 (b) HOUSING FOR MOMS GRANT PROGRAM.— 19 (1) DEFINITIONS.—In this subsection: 20 (A) ELIGIBLE ENTITY.—The term ‘‘eligible 21 entity’’ means— 22 (i) a community-based organization; 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00678 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 679 •S 4486 IS (ii) a State or local governmental enti- 1 ty, including a State or local public health 2 department; 3 (iii) an Indian tribe or Tribal organi- 4 zation (as such terms are defined in sec- 5 tion 4 of the Indian Self-Determination 6 and Education Assistance Act (25 U.S.C. 7 5304)); or 8 (iv) an Urban Indian organization (as 9 such term is defined in section 4 of the In- 10 dian Health Care Improvement Act (25 11 U.S.C. 1603)). 12 (B) SECRETARY.—The term ‘‘Secretary’’ 13 means the Secretary of Housing and Urban De- 14 velopment. 15 (2) ESTABLISHMENT.—The Secretary shall es- 16 tablish a Housing for Moms grant program to make 17 grants to eligible entities to increase access to safe, 18 stable, affordable, and adequate housing for preg- 19 nant and postpartum individuals and their families. 20 (3) APPLICATION.—To be eligible to receive a 21 grant under this subsection, an eligible entity shall 22 submit to the Secretary an application at such time, 23 in such manner, and containing such information as 24 the Secretary may provide. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00679 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 680 •S 4486 IS (4) PRIORITY.—In awarding grants under this 1 subsection, the Secretary shall give priority to an eli- 2 gible entity that— 3 (A) is a community-based organization or 4 will partner with a community-based organiza- 5 tion to implement initiatives to increase access 6 to safe, stable, affordable, and adequate hous- 7 ing for pregnant and postpartum individuals 8 and their families; 9 (B) is operating in an area with high rates 10 of adverse maternal health outcomes or signifi- 11 cant racial or ethnic inequities in maternal 12 health outcomes, to the extent such data are 13 available; and 14 (C) is operating in an area with a high 15 poverty rate or a significant number of individ- 16 uals who lack consistent access to safe, stable, 17 affordable, and adequate housing. 18 (5) USE OF FUNDS.—An eligible entity that re- 19 ceives a grant under this subsection shall use funds 20 from the grant for the purposes of— 21 (A) identifying and conducting outreach to 22 pregnant and postpartum individuals who are 23 low-income and lack consistent access to safe, 24 stable, affordable, and adequate housing; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00680 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 681 •S 4486 IS (B) providing safe, stable, affordable, and 1 adequate housing options to such individuals; 2 (C) connecting such individuals with local 3 organizations offering safe, stable, affordable, 4 and adequate housing options; 5 (D) providing application assistance to 6 such individuals seeking to enroll in programs 7 offering safe, stable, affordable, and adequate 8 housing options; 9 (E) providing direct financial assistance to 10 such individuals for the purposes of maintaining 11 safe, stable, and adequate housing for the dura- 12 tion of the individual’s pregnancy and 13 postpartum periods; and 14 (F) working with relevant stakeholders to 15 ensure that local housing and homeless shelter 16 infrastructure is supportive to pregnant and 17 postpartum individuals, including through— 18 (i) health-promoting housing codes; 19 (ii) enforcement of housing codes; 20 (iii) proactive rental inspection pro- 21 grams; 22 (iv) code enforcement officer training; 23 and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00681 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 682 •S 4486 IS (v) partnerships between regional of- 1 fices of the Department of Housing and 2 Urban Development and community-based 3 organizations to ensure housing laws are 4 understood and violations are discovered. 5 (6) REPORTING.— 6 (A) ELIGIBLE ENTITIES.—The Secretary 7 shall require each eligible entity receiving a 8 grant under this subsection to annually submit 9 to the Secretary and make publicly available a 10 report on the status of activities conducted 11 using the grant. 12 (B) SECRETARY.—Not later than the end 13 of each fiscal year in which grants are made 14 under this subsection, the Secretary shall sub- 15 mit to Congress and make publicly available a 16 report that— 17 (i) summarizes the reports received 18 under subparagraph (A); 19 (ii) evaluates the effectiveness of 20 grants awarded under this subsection in 21 increasing access to safe, stable, afford- 22 able, and adequate housing for pregnant 23 and postpartum individuals and their fami- 24 lies; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00682 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 683 •S 4486 IS (iii) makes recommendations with re- 1 spect to ensuring activities described in 2 paragraph (5) continue after grant 3 amounts made available under this sub- 4 section are expended. 5 (7) AUTHORIZATION OF APPROPRIATIONS.— 6 There is authorized to be appropriated to carry out 7 this subsection $10,000,000 for fiscal year 2023, 8 which shall remain available until expended. 9 (c) DEPARTMENT OF TRANSPORTATION.— 10 (1) REPORT.—Not later than 1 year after the 11 date of enactment of this Act, the Secretary of 12 Transportation shall submit to Congress and make 13 publicly available a report containing— 14 (A) an assessment of transportation bar- 15 riers preventing individuals from attending pre- 16 natal and postpartum appointments, accessing 17 maternal health care services, or accessing serv- 18 ices and resources related to social deter- 19 minants of maternal health; 20 (B) recommendations on how to overcome 21 the barriers assessed under subparagraph (A); 22 and 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00683 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 684 •S 4486 IS (C) an assessment of transportation safety 1 risks for pregnant individuals and recommenda- 2 tions on how to mitigate those risks. 3 (2) CONSIDERATIONS.—In carrying out para- 4 graph (1), the Secretary of Transportation shall give 5 special consideration to solutions for— 6 (A) pregnant and postpartum individuals 7 living in a health professional shortage area 8 designated under section 332 of the Public 9 Health Service Act (42 U.S.C. 254e); 10 (B) pregnant and postpartum individuals 11 living in areas with high maternal mortality or 12 severe morbidity rates or significant racial or 13 ethnic inequities in maternal health outcomes; 14 and 15 (C) pregnant and postpartum individuals 16 with a disability that impacts mobility. 17 (d) DEPARTMENT OF AGRICULTURE.— 18 (1) SPECIAL SUPPLEMENTAL NUTRITION PRO- 19 GRAM FOR WOMEN, INFANTS, AND CHILDREN.— 20 (A) EXTENSION OF POSTPARTUM PE- 21 RIOD.—Section 17(b)(10) of the Child Nutri- 22 tion Act of 1966 (42 U.S.C. 1786(b)(10)) is 23 amended by striking ‘‘six’’ and inserting ‘‘24’’. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00684 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 685 •S 4486 IS (B) REPORT.—Not later than 2 years after 1 the date of enactment of this Act, the Secretary 2 shall submit to Congress a report that evaluates 3 the effect of the amendment made by subpara- 4 graph (A) on— 5 (i) maternal and infant health out- 6 comes, including racial and ethnic inequi- 7 ties with respect to those outcomes; 8 (ii) breastfeeding rates among 9 postpartum individuals; 10 (iii) qualitative evaluations of family 11 experiences under the special supplemental 12 nutrition program for women, infants, and 13 children established under section 17 of 14 the Child Nutrition Act of 1966 (42 15 U.S.C. 1786); and 16 (iv) other relevant information as de- 17 termined by the Secretary. 18 (2) GRANT PROGRAM FOR HEALTHY FOOD AND 19 CLEAN WATER FOR PREGNANT AND POSTPARTUM 20 INDIVIDUALS.— 21 (A) IN GENERAL.—The Secretary shall es- 22 tablish a program (referred to in this paragraph 23 as the ‘‘program’’) to award grants, on a com- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00685 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 686 •S 4486 IS petitive basis, to eligible entities to carry out 1 the activities described in subparagraph (D). 2 (B) APPLICATION.—To be eligible for a 3 grant under the program, an eligible entity 4 shall submit to the Secretary an application at 5 such time, in such manner, and containing such 6 information as the Secretary determines appro- 7 priate. 8 (C) PRIORITY.—In awarding grants under 9 the program, the Secretary shall give priority to 10 an eligible entity that— 11 (i) is, or will partner with, an eligible 12 entity described in paragraph (3)(A)(i); 13 and 14 (ii) is operating in an area with a high 15 rate of— 16 (I) adverse maternal health out- 17 comes; or 18 (II) significant racial or ethnic 19 inequities in maternal health out- 20 comes. 21 (D) USE OF FUNDS.—An eligible entity 22 shall use a grant awarded under the program to 23 deliver healthy food, infant formula, clean 24 water, or diapers to pregnant and postpartum 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00686 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 687 •S 4486 IS individuals located in areas that are food 1 deserts, as determined by the Secretary using 2 data from the Food Access Research Atlas of 3 the Department of Agriculture. 4 (E) REPORTS.— 5 (i) ELIGIBLE ENTITIES.—Not later 6 than 1 year after the date on which an eli- 7 gible entity receives a grant under the pro- 8 gram, and annually thereafter, the eligible 9 entity shall submit to the Secretary a re- 10 port on the status of activities conducted 11 using the grant, which shall contain such 12 information as the Secretary may require. 13 (ii) SECRETARY.— 14 (I) IN GENERAL.—Not later than 15 2 years after the date on which the 16 first grant is awarded under the pro- 17 gram, the Secretary shall submit to 18 Congress a report that includes— 19 (aa) a summary of the re- 20 ports submitted by eligible enti- 21 ties under clause (i); 22 (bb) an assessment of the 23 extent to which food distributed 24 using grants awarded under the 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00687 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 688 •S 4486 IS program was purchased from 1 local and regional food systems; 2 (cc) an evaluation of the ef- 3 fect of the program on maternal 4 and infant health outcomes, in- 5 cluding racial and ethnic inequi- 6 ties with respect to those out- 7 comes; and 8 (dd) recommendations with 9 respect to ensuring the activities 10 described in subparagraph (D) 11 continue after the grant period 12 funding those activities expires. 13 (II) PUBLICATION.—The Sec- 14 retary shall make the report sub- 15 mitted under subclause (I) publicly 16 available on the website of the De- 17 partment of Agriculture. 18 (F) AUTHORIZATION OF APPROPRIA- 19 TIONS.—There is authorized to be appropriated 20 to carry out the program $5,000,000 for the 21 period of fiscal years 2022 through 2024. 22 (3) DEFINITIONS.—In this subsection: 23 (A) ELIGIBLE ENTITY.—The term ‘‘eligible 24 entity’’ means— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00688 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 689 •S 4486 IS (i) a community-based organization; 1 (ii) a State or local governmental enti- 2 ty, including a State or local public health 3 department; 4 (iii) an Indian Tribe or Tribal organi- 5 zation (as those terms are defined in sec- 6 tion 4 of the Indian Self-Determination 7 and Education Assistance Act (25 U.S.C. 8 5304)); and 9 (iv) an Urban Indian organization (as 10 defined in section 4 of the Indian Health 11 Care Improvement Act (25 U.S.C. 1603)). 12 (B) SECRETARY.—The term ‘‘Secretary’’ 13 means the Secretary of Agriculture. 14 (e) ENVIRONMENTAL STUDY THROUGH NATIONAL 15 ACADEMIES.— 16 (1) IN GENERAL.—Not later than 60 days after 17 the date of enactment of this Act, the Administrator 18 of the Environmental Protection Agency shall seek 19 to enter into an agreement with the National Acad- 20 emies of Sciences, Engineering, and Medicine (re- 21 ferred to in this subsection as the ‘‘National Acad- 22 emies’’) under which the National Academies agree 23 to conduct a study on the impacts of, with respect 24 to maternal and infant health incomes, water and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00689 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 690 •S 4486 IS air quality, exposure to extreme temperatures, envi- 1 ronmental chemicals, environmental risks in the 2 workplace and the home, and pollution levels. 3 (2) STUDY REQUIREMENTS.—The agreement 4 under paragraph (1) shall direct the National Acad- 5 emies to make recommendations for— 6 (A) improving environmental conditions to 7 improve maternal and infant health outcomes; 8 and 9 (B) reducing or eliminating racial and eth- 10 nic inequities in those outcomes. 11 (3) REPORT.—The agreement under paragraph 12 (1) shall direct the National Academies to complete 13 the study under this subsection, and submit to Con- 14 gress and make publicly available a report on the re- 15 sults of the study, not later than 1 year after the 16 date of enactment of this Act. 17 (f) CHILD CARE ACCESS.— 18 (1) GRANT PROGRAM.—The Secretary of 19 Health and Human Services (in this subsection re- 20 ferred to as the ‘‘Secretary’’) shall award grants to 21 eligible organizations to carry out programs to pro- 22 vide pregnant and postpartum individuals with free 23 and accessible drop-in child care services during pre- 24 natal and postpartum appointments. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00690 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 691 •S 4486 IS (2) APPLICATION.—To be eligible to receive a 1 grant under this subsection, an eligible entity shall 2 submit to the Secretary an application at such time, 3 in such manner, and containing such information as 4 the Secretary may require. 5 (3) ELIGIBLE ORGANIZATIONS.— 6 (A) ELIGIBILITY.—To be eligible to receive 7 a grant under this subsection, an organization 8 shall be an organization that— 9 (i) provides child care services; and 10 (ii) can carry out a program providing 11 pregnant and postpartum individuals with 12 free and accessible drop-in child care serv- 13 ices during prenatal and postpartum ap- 14 pointments. 15 (B) PRIORITIZATION.—In selecting grant 16 recipients under this subsection, the Secretary 17 shall give priority to eligible organizations that 18 operate in an area that has, to the extent data 19 with respect to such an area are available— 20 (i) high rates of adverse maternal 21 health outcomes; or 22 (ii) significant racial or ethnic inequi- 23 ties in maternal health outcomes. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00691 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 692 •S 4486 IS (4) TIMING.—The Secretary shall commence 1 the grant program under paragraph (1) not later 2 than 1 year after the date of enactment of this Act. 3 (5) REPORTING.— 4 (A) GRANTEES.—Each recipient of a grant 5 under this subsection shall annually submit to 6 the Secretary and make publicly available a re- 7 port on the status of activities conducted using 8 the grant. Each such report shall include— 9 (i) an analysis of the effect of the 10 funded program on prenatal and 11 postpartum appointment attendance rates; 12 (ii) summaries of qualitative assess- 13 ments of the funded program from— 14 (I) pregnant and postpartum in- 15 dividuals participating in the pro- 16 gram; and 17 (II) the families of such individ- 18 uals; and 19 (iii) such additional information as 20 the Secretary may require. 21 (B) SECRETARY.—Not later than the end 22 of fiscal year 2024, the Secretary shall submit 23 to the Congress, and make publicly available, a 24 report containing each of the following: 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00692 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 693 •S 4486 IS (i) A summary of the reports received 1 under subparagraph (A). 2 (ii) An assessment of the effects, if 3 any, of the funded programs on maternal 4 health outcomes, with a specific focus on 5 racial and ethnic inequities in such out- 6 comes. 7 (iii) A description of actions the Sec- 8 retary can take to ensure that pregnant 9 and postpartum individuals eligible for 10 medical assistance under a State plan 11 under title XIX of the Social Security Act 12 (42 U.S.C. 1936 et seq.) have access to 13 free and accessible drop-in child care serv- 14 ices during prenatal and postpartum ap- 15 pointments, including identification of the 16 funding necessary to carry out such ac- 17 tions. 18 (6) DROP-IN CHILD CARE SERVICES DE- 19 FINED.—In this subsection, the term ‘‘drop-in child 20 care services’’ means child care (including early 21 childhood education) services that are— 22 (A) delivered at a facility that meets the 23 requirements of all applicable laws and regula- 24 tions of the State or local government in which 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00693 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 694 •S 4486 IS it is located, including the requirements for li- 1 censing of the facility as a child care facility; 2 and 3 (B) provided in single encounters without 4 requiring full-time enrollment of a person in a 5 child care program. 6 (7) AUTHORIZATION OF APPROPRIATIONS.—To 7 carry out this subsection, there is authorized to be 8 appropriated $5,000,000 for the period of fiscal 9 years 2023 through 2025. 10 (g) GRANTS TO LOCAL ENTITIES ADDRESSING SO- 11 CIAL DETERMINANTS OF MATERNAL HEALTH.— 12 (1) IN GENERAL.—The Secretary of Health and 13 Human Services (in this subsection referred to as 14 the ‘‘Secretary’’) shall award grants to eligible enti- 15 ties to— 16 (A) address social determinants of mater- 17 nal health for pregnant and postpartum individ- 18 uals; and 19 (B) eliminate racial and ethnic inequities 20 in maternal health outcomes. 21 (2) APPLICATION.—To be eligible to receive a 22 grant under this subsection an eligible entity shall 23 submit to the Secretary an application at such time, 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00694 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 695 •S 4486 IS in such manner, and containing such information as 1 the Secretary may provide. 2 (3) PRIORITIZATION.—In awarding grants 3 under paragraph (1), the Secretary shall give pri- 4 ority to an eligible entity that— 5 (A) is a community-based organization, or 6 will partner with a community-based organiza- 7 tion to carry out the activities under paragraph 8 (4); 9 (B) is operating in an area with high rates 10 of adverse maternal health outcomes or signifi- 11 cant racial or ethnic inequities in maternal 12 health outcomes; and 13 (C) is operating in an area with a high 14 poverty rate. 15 (4) ACTIVITIES.—An eligible entity that re- 16 ceives a grant under this subsection may use funds 17 received through the grant to— 18 (A) hire and retain staff; 19 (B) develop and distribute a list of avail- 20 able resources with respect to social service pro- 21 grams in a community; 22 (C) establish a resource center that pro- 23 vides multiple social service programs in a sin- 24 gle location; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00695 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 696 •S 4486 IS (D) offer programs and resources in the 1 communities in which the respective eligible en- 2 tities are located to address social determinants 3 of health for pregnant and postpartum individ- 4 uals; and 5 (E) consult with such pregnant and 6 postpartum individuals to conduct an assess- 7 ment of the activities under this paragraph. 8 (5) TECHNICAL ASSISTANCE.—The Secretary 9 shall provide to grant recipients under this sub- 10 section technical assistance to plan for sustaining 11 programs to address social determinants of maternal 12 health among pregnant and postpartum individuals 13 after the period of the grant. 14 (6) REPORTING.— 15 (A) GRANTEES.—Not later than 1 year 16 after the date on which an eligible entity first 17 receives a grant under this subsection, and an- 18 nually thereafter, an eligible entity shall submit 19 to the Secretary, and make publicly available, a 20 report on the status of activities conducted 21 using the grant. Each such report shall include 22 data on the effects of such activities, 23 disaggregated by race, ethnicity, gender, and 24 other relevant factors. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00696 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 697 •S 4486 IS (B) SECRETARY.—Not later than the end 1 of fiscal year 2026, the Secretary shall submit 2 to Congress a report that includes— 3 (i) a summary of the reports received 4 under subparagraph (A); and 5 (ii) recommendations for— 6 (I) improving maternal health 7 outcomes; and 8 (II) reducing or eliminating ra- 9 cial and ethnic inequities in maternal 10 health outcomes. 11 (7) AUTHORIZATION OF APPROPRIATIONS.— 12 There is authorized to be appropriated to carry out 13 this subsection $15,000,000 for each of fiscal years 14 2023 through 2027. 15 (h) DEFINITIONS.—In this section: 16 (1) CULTURALLY CONGRUENT.—The term ‘‘cul- 17 turally congruent’’, with respect to care or maternity 18 care provided to a health care consumer, means care 19 that is in agreement with the preferred cultural val- 20 ues, beliefs, worldview, language, and practices of 21 the health care consumer and other relevant stake- 22 holders. 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00697 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 698 •S 4486 IS (2) MATERNITY CARE PROVIDER.—The term 1 ‘‘maternity care provider’’ means a health care pro- 2 vider who— 3 (A) is a physician, physician assistant, 4 midwife who meets at a minimum the inter- 5 national definition of the midwife and global 6 standards for midwifery education as estab- 7 lished by the International Confederation of 8 Midwives, nurse practitioner, or clinical nurse 9 specialist; and 10 (B) has a focus on maternal or perinatal 11 health. 12 (3) MATERNAL MORTALITY.—The term ‘‘mater- 13 nal mortality’’ means a death occurring during or 14 within a one-year period after pregnancy, caused by 15 pregnancy-related or childbirth complications, in- 16 cluding a suicide, overdose, or other death resulting 17 from a mental health or substance use disorder at- 18 tributed to or aggravated by pregnancy-related or 19 childbirth complications. 20 (4) PERINATAL HEALTH WORKER.—The term 21 ‘‘perinatal health worker’’ means a doula, commu- 22 nity health worker, peer supporter, breastfeeding 23 and lactation educator or counselor, nutritionist or 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00698 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 699 •S 4486 IS dietitian, childbirth educator, social worker, home 1 visitor, language interpreter, or navigator. 2 (5) POSTPARTUM AND POSTPARTUM PERIOD.— 3 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 4 refer to the 1-year period beginning on the last day 5 of the pregnancy of an individual. 6 (6) RACIAL AND ETHNIC MINORITY GROUP.— 7 The term ‘‘racial and ethnic minority group’’ has the 8 meaning given such term in section 1707(g)(1) of 9 the Public Health Service Act (42 U.S.C. 300u– 10 6(g)(1)). 11 (7) SEVERE MATERNAL MORBIDITY.—The term 12 ‘‘severe maternal morbidity’’ means a health condi- 13 tion, including mental health conditions and sub- 14 stance use disorders, attributed to or aggravated by 15 pregnancy or childbirth that results in significant 16 short-term or long-term consequences to the health 17 of the individual who was pregnant. 18 (8) SOCIAL DETERMINANTS OF MATERNAL 19 HEALTH DEFINED.—The term ‘‘social determinants 20 of maternal health’’ means non-clinical factors that 21 impact maternal health outcomes, including— 22 (A) economic factors, which may include 23 poverty, employment, food security, support for 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00699 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 700 •S 4486 IS and access to lactation and other infant feeding 1 options, housing stability, and related factors; 2 (B) neighborhood factors, which may in- 3 clude quality of housing, access to transpor- 4 tation, access to child care, availability of 5 healthy foods and nutrition counseling, avail- 6 ability of clean water, air and water quality, 7 ambient temperatures, neighborhood crime and 8 violence, access to broadband, and related fac- 9 tors; 10 (C) social and community factors, which 11 may include systemic racism, gender discrimi- 12 nation or discrimination based on other pro- 13 tected classes, workplace conditions, incarcer- 14 ation, and related factors; 15 (D) household factors, which may include 16 ability to conduct lead testing and abatement, 17 car seat installation, indoor air temperatures, 18 and related factors; 19 (E) education access and quality factors, 20 which may include educational attainment, lan- 21 guage and literacy, and related factors; and 22 (F) health care access factors, including 23 health insurance coverage, access to culturally 24 congruent health care services, providers, and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00700 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 701 •S 4486 IS non-clinical support, access to home visiting 1 services, access to wellness and stress manage- 2 ment programs, health literacy, access to tele- 3 health and items required to receive telehealth 4 services, and related factors. 5 SEC. 5208. DATA TO SAVE MOMS. 6 (a) SHORT TITLE.—This section may be cited as the 7 ‘‘Data To Save Moms Act’’. 8 (b) FUNDING FOR MATERNAL MORTALITY REVIEW 9 COMMITTEES TO PROMOTE REPRESENTATIVE COMMU- 10 NITY ENGAGEMENT.— 11 (1) IN GENERAL.—Section 317K(d) of the Pub- 12 lic Health Service Act (42 U.S.C. 247b–12(d)) is 13 amended by adding at the end the following: 14 ‘‘(9) GRANTS TO PROMOTE REPRESENTATIVE 15 COMMUNITY ENGAGEMENT IN MATERNAL MOR- 16 TALITY REVIEW COMMITTEES.— 17 ‘‘(A) IN GENERAL.—The Secretary may, 18 using funds made available pursuant to sub- 19 paragraph (C), provide assistance to an applica- 20 ble maternal mortality review committee of a 21 State, Indian tribe, tribal organization, or 22 Urban Indian organization (as such term is de- 23 fined in section 4 of the Indian Health Care 24 Improvement Act (25 U.S.C. 1603))— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00701 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 702 •S 4486 IS ‘‘(i) to select for inclusion in the mem- 1 bership of such a committee community 2 members from the State, Indian tribe, trib- 3 al organization, or Urban Indian organiza- 4 tion by— 5 ‘‘(I) prioritizing community mem- 6 bers who can increase the diversity of 7 the committee’s membership with re- 8 spect to race and ethnicity, location, 9 and professional background, includ- 10 ing members with non-clinical experi- 11 ences; and 12 ‘‘(II) to the extent applicable, 13 using funds reserved under subsection 14 (f), to address barriers to maternal 15 mortality review committee participa- 16 tion for community members, includ- 17 ing through providing required train- 18 ing, reducing transportation barriers, 19 providing compensation, and providing 20 other supports as may be necessary; 21 ‘‘(ii) to establish initiatives to conduct 22 outreach and community engagement ef- 23 forts within communities throughout the 24 State or Indian tribe to seek input from 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00702 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 703 •S 4486 IS community members on the work of such 1 maternal mortality review committee, with 2 a particular focus on outreach to people 3 who are members of minority groups; and 4 ‘‘(iii) to release public reports assess- 5 ing— 6 ‘‘(I) the pregnancy-related death 7 and pregnancy-associated death review 8 processes of the maternal mortality 9 review committee, with a particular 10 focus on the maternal mortality re- 11 view committee’s sensitivity to the 12 unique circumstances of pregnant and 13 postpartum individuals from racial 14 and ethnic minority groups (as such 15 term is defined in section 1707(g)(1)) 16 who have suffered pregnancy-related 17 deaths; and 18 ‘‘(II) the impact of the use of 19 funds made available pursuant to 20 paragraph (C) on increasing the diver- 21 sity of the maternal mortality review 22 committee membership and promoting 23 community engagement efforts 24 throughout the State or Indian tribe. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00703 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 704 •S 4486 IS ‘‘(B) TECHNICAL ASSISTANCE.—The Sec- 1 retary shall provide (either directly through the 2 Department of Health and Human Services or 3 by contract) technical assistance to any mater- 4 nal mortality review committee receiving a 5 grant under this paragraph on best practices 6 for increasing the diversity of the maternal 7 mortality review committee’s membership and 8 for conducting effective community engagement 9 throughout the State or Indian tribe. 10 ‘‘(C) AUTHORIZATION OF APPROPRIA- 11 TIONS.—In addition to any funds made avail- 12 able under subsection (f), there are authorized 13 to be appropriated to carry out this paragraph 14 $10,000,000 for each of fiscal years 2023 15 through 2027.’’. 16 (2) RESERVATION OF FUNDS.—Section 317K(f) 17 of the Public Health Service Act (42 U.S.C. 247b– 18 12(f)) is amended by adding at the end the fol- 19 lowing: ‘‘Of the amount made available under the 20 preceding sentence for a fiscal year, not less than 21 $1,500,000 shall be reserved for grants awarded 22 under subsection (d)(9) to Indian tribes, tribal orga- 23 nizations, or Urban Indian organizations (as those 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00704 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 705 •S 4486 IS terms are defined in section 4 of the Indian Health 1 Care Improvement Act (25 U.S.C. 1603)).’’. 2 (c) DATA COLLECTION AND REVIEW.—Section 3 317K(d)(3)(A)(i) of the Public Health Service Act (42 4 U.S.C. 247b–12(d)(3)(A)(i)) is amended— 5 (1) by redesignating subclauses (II) and (III) 6 as subclauses (V) and (VI), respectively; and 7 (2) by inserting after subclause (I) the fol- 8 lowing: 9 ‘‘(II) to the extent practicable, 10 reviewing cases of severe maternal 11 morbidity, according to the most up- 12 to-date indicators; 13 ‘‘(III) to the extent practicable, 14 reviewing deaths during pregnancy or 15 up to 1 year after the end of a preg- 16 nancy from suicide, overdose, or other 17 death from a mental health condition 18 or substance use disorder attributed 19 to, or aggravated by, pregnancy or 20 childbirth complications; 21 ‘‘(IV) to the extent practicable, 22 consulting with local community-based 23 organizations representing pregnant 24 and postpartum individuals from de- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00705 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 706 •S 4486 IS mographic groups disproportionately 1 impacted by poor maternal health out- 2 comes to ensure that, in addition to 3 clinical factors, non-clinical factors 4 that might have contributed to a preg- 5 nancy-related death are appropriately 6 considered;’’. 7 (d) REVIEW OF MATERNAL HEALTH DATA COLLEC- 8 TION PROCESSES AND QUALITY MEASURES.— 9 (1) IN GENERAL.—The Secretary of Health and 10 Human Services, acting through the Administrator 11 for the Centers for Medicare & Medicaid Services 12 and the Director of the Agency for Healthcare Re- 13 search and Quality, shall consult with relevant stake- 14 holders— 15 (A) to review existing maternal health data 16 collection processes and quality measures; and 17 (B) to make recommendations to improve 18 such processes and measures, including topics 19 described under paragraph (3). 20 (2) COLLABORATION.—In carrying out this sub- 21 section, the Secretary shall consult with a diverse 22 group of maternal health stakeholders, which may 23 include— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00706 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 707 •S 4486 IS (A) pregnant and postpartum individuals 1 and their family members, and nonprofit orga- 2 nizations representing such individuals, with a 3 particular focus on patients from racial and 4 ethnic minority groups; 5 (B) community-based organizations that 6 provide support for pregnant and postpartum 7 individuals, with a particular focus on patients 8 from racial and ethnic minority groups; 9 (C) membership organizations for mater- 10 nity care providers; 11 (D) organizations representing perinatal 12 health workers; 13 (E) organizations that focus on maternal 14 mental or behavioral health; 15 (F) organizations that focus on intimate 16 partner violence; 17 (G) institutions of higher education, with a 18 particular focus on minority-serving institu- 19 tions; 20 (H) licensed and accredited hospitals, birth 21 centers, midwifery practices, or other medical 22 practices that provide maternal health care 23 services to pregnant and postpartum patients; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00707 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 708 •S 4486 IS (I) relevant State and local public agencies, 1 including State maternal mortality review com- 2 mittees; and 3 (J) the National Quality Forum, or such 4 other standard-setting organizations specified 5 by the Secretary. 6 (3) TOPICS.—The review of maternal health 7 data collection processes and recommendations to 8 improve such processes and measures required under 9 paragraph (1) shall assess all available relevant in- 10 formation, including information from State-level 11 sources, and shall consider at least the following: 12 (A) Current State and Tribal practices for 13 maternal health, maternal mortality, and severe 14 maternal morbidity data collection and dissemi- 15 nation, including consideration of— 16 (i) the timeliness of processes for 17 amending a death certificate when new in- 18 formation pertaining to the death becomes 19 available to reflect whether the death was 20 a pregnancy-related death; 21 (ii) relevant data collected with elec- 22 tronic health records, including data on 23 race, ethnicity, socioeconomic status, insur- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00708 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 709 •S 4486 IS ance type, and other relevant demographic 1 information; 2 (iii) maternal health data collected 3 and publicly reported by hospitals, health 4 systems, midwifery practices, and birth 5 centers; 6 (iv) the barriers preventing States 7 from correlating maternal outcome data 8 with race and ethnicity data; 9 (v) processes for determining the 10 cause of a pregnancy-associated death in 11 States that do not have a maternal mor- 12 tality review committee; 13 (vi) whether maternal mortality review 14 committees include multidisciplinary and 15 diverse membership (as described in sec- 16 tion 317K(d)(1)(A) of the Public Health 17 Service Act (42 U.S.C. 247b– 18 12(d)(1)(A))); 19 (vii) whether members of maternal 20 mortality review committees participate in 21 trainings on bias, racism, or discrimina- 22 tion, and the quality of such trainings; 23 (viii) the extent to which States have 24 implemented systematic processes of listen- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00709 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 710 •S 4486 IS ing to the stories of pregnant and 1 postpartum individuals and their family 2 members, with a particular focus on preg- 3 nant and postpartum individuals from ra- 4 cial and ethnic minority groups and their 5 family members, to fully understand the 6 causes of, and inform potential solutions 7 to, the maternal mortality and severe ma- 8 ternal morbidity crisis within their respec- 9 tive States; 10 (ix) the extent to which maternal mor- 11 tality review committees are considering 12 social determinants of maternal health 13 when examining the causes of pregnancy- 14 associated and pregnancy-related deaths; 15 (x) the extent to which maternal mor- 16 tality review committees are making ac- 17 tionable recommendations based on their 18 reviews of adverse maternal health out- 19 comes and the extent to which such rec- 20 ommendations are being implemented by 21 appropriate stakeholders; 22 (xi) the legal and administrative bar- 23 riers preventing the collection, collation, 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00710 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 711 •S 4486 IS and dissemination of State maternity care 1 data; 2 (xii) the effectiveness of data collec- 3 tion and reporting processes in separating 4 pregnancy-associated deaths from preg- 5 nancy-related deaths; and 6 (xiii) the current Federal, State, local, 7 and Tribal funding support for the activi- 8 ties referred to in clauses (i) through (xii). 9 (B) Whether the funding support referred 10 to in subparagraph (A)(xiii) is adequate for 11 States to carry out optimal data collection and 12 dissemination processes with respect to mater- 13 nal health, maternal mortality, and severe ma- 14 ternal morbidity. 15 (C) Current quality measures for mater- 16 nity care, including prenatal measures, labor 17 and delivery measures, and postpartum meas- 18 ures, including topics such as— 19 (i) effective quality measures for ma- 20 ternity care used by hospitals, health sys- 21 tems, midwifery practices, birth centers, 22 health plans, and other relevant entities; 23 (ii) the sufficiency of current outcome 24 measures used to evaluate maternity care 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00711 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 712 •S 4486 IS for driving improved care, experiences, and 1 outcomes in maternity care payment and 2 delivery system models; 3 (iii) maternal health quality measures 4 that other countries effectively use; 5 (iv) validated measures that have been 6 used for research purposes that could be 7 tested, refined, and submitted for national 8 endorsement; 9 (v) barriers preventing maternity care 10 providers and insurers from implementing 11 quality measures that are aligned with best 12 practices; 13 (vi) the frequency with which mater- 14 nity care quality measures are reviewed 15 and revised; 16 (vii) the strengths and weaknesses of 17 the Prenatal and Postpartum Care meas- 18 ures of the Health Plan Employer Data 19 and Information Set measures established 20 by the National Committee for Quality As- 21 surance; 22 (viii) the strengths and weaknesses of 23 maternity care quality measures under the 24 Medicaid program under title XIX of the 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00712 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 713 •S 4486 IS Social Security Act (42 U.S.C. 1396 et 1 seq.) and the Children’s Health Insurance 2 Program under title XXI of such Act (42 3 U.S.C. 1397aa et seq.), including the ex- 4 tent to which States voluntarily report rel- 5 evant measures; 6 (ix) the extent to which maternity 7 care quality measures are informed by pa- 8 tient experiences that include measures of 9 patient-reported experience of care; 10 (x) the current processes for collecting 11 stratified data on the race and ethnicity of 12 pregnant and postpartum individuals in 13 hospitals, health systems, midwifery prac- 14 tices, and birth centers, and for incor- 15 porating such racially and ethnically strati- 16 fied data in maternity care quality meas- 17 ures; 18 (xi) the extent to which maternity 19 care quality measures account for the 20 unique experiences of pregnant and 21 postpartum individuals from racial and 22 ethnic minority groups; and 23 (xii) the extent to which hospitals, 24 health systems, midwifery practices, and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00713 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 714 •S 4486 IS birth centers are implementing existing 1 maternity care quality measures. 2 (D) Recommendations on authorizing addi- 3 tional funds and providing additional technical 4 assistance to improve maternal mortality review 5 committees and State and Tribal maternal 6 health data collection and reporting processes. 7 (E) Recommendations for new authorities 8 that may be granted to maternal mortality re- 9 view committees to be able to— 10 (i) access records from other Federal 11 and State agencies and departments that 12 may be necessary to identify causes of 13 pregnancy-associated and pregnancy-re- 14 lated deaths that are unique to pregnant 15 and postpartum individuals from specific 16 populations, such as veterans and individ- 17 uals who are incarcerated; and 18 (ii) work with relevant experts who 19 are not members of the maternal mortality 20 review committee to assist in the review of 21 pregnancy-associated deaths of pregnant 22 and postpartum individuals from specific 23 populations, such as veterans and individ- 24 uals who are incarcerated. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00714 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 715 •S 4486 IS (F) Recommendations to improve and 1 standardize current quality measures for mater- 2 nity care, with a particular focus on racial and 3 ethnic inequities in maternal health outcomes. 4 (G) Recommendations to improve the co- 5 ordination by the Department of Health and 6 Human Services of the efforts undertaken by 7 the agencies and organizations within the De- 8 partment related to maternal health data and 9 quality measures. 10 (4) REPORT.—Not later than 1 year after the 11 date of the enactment of this Act, the Secretary 12 shall submit to the Congress, and make publicly 13 available, a report on the results of the review of 14 maternal health data collection processes and quality 15 measures and recommendations to improve such 16 processes and measures required under paragraph 17 (1). 18 (5) DEFINITIONS.—In this subsection: 19 (A) MATERNAL MORTALITY REVIEW COM- 20 MITTEE.—The term ‘‘maternal mortality review 21 committee’’ means a maternal mortality review 22 committee duly authorized by a State and re- 23 ceiving funding under section 317K(a)(2)(D) of 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00715 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 716 •S 4486 IS the Public Health Service Act (42 U.S.C. 247b– 1 12(a)(2)(D)). 2 (B) PREGNANCY-ASSOCIATED DEATH.— 3 The term ‘‘pregnancy-associated’’, with respect 4 to a death, means a death of a pregnant or 5 postpartum individual, by any cause, that oc- 6 curs during, or within 1 year following, the in- 7 dividual’s pregnancy, regardless of the outcome, 8 duration, or site of the pregnancy. 9 (C) PREGNANCY-RELATED DEATH.—The 10 term ‘‘pregnancy-related’’, with respect to a 11 death, means a death of a pregnant or 12 postpartum individual that occurs during, or 13 within 1 year following, the individual’s preg- 14 nancy, from a pregnancy complication, a chain 15 of events initiated by pregnancy, or the aggra- 16 vation of an unrelated condition by the physio- 17 logic effects of pregnancy. 18 (6) AUTHORIZATION OF APPROPRIATIONS.— 19 There are authorized to be appropriated such sums 20 as may be necessary to carry out this subsection for 21 each of fiscal years 2023 through 2027. 22 (e) INDIAN HEALTH SERVICE STUDY ON MATERNAL 23 MORTALITY AND SEVERE MATERNAL MORBIDITY.— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00716 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 717 •S 4486 IS (1) IN GENERAL.—The Director of the Indian 1 Health Service (referred to in this subsection as the 2 ‘‘Director’’) shall, in coordination with entities de- 3 scribed in paragraph (2)— 4 (A) not later than 90 days after the date 5 of enactment of this Act, enter into a contract 6 with an independent research organization or 7 Tribal Epidemiology Center to conduct a com- 8 prehensive study on maternal mortality and se- 9 vere maternal morbidity in the populations of 10 American Indian and Alaska Native individuals; 11 and 12 (B) not later than 3 years after the date 13 of the enactment of this Act, submit to Con- 14 gress a report on such study that contains rec- 15 ommendations for policies and practices that 16 can be adopted to improve maternal health out- 17 comes for pregnant and postpartum American 18 Indian and Alaska Native individuals. 19 (2) PARTICIPATING ENTITIES.—The entities de- 20 scribed in this paragraph shall consist of 12 mem- 21 bers, selected by the Director from among individ- 22 uals nominated by Indian Tribes and Tribal organi- 23 zations (as such terms are defined in section 4 of 24 the Indian Self-Determination and Education Assist- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00717 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 718 •S 4486 IS ance Act (25 U.S.C. 5304)), and Urban Indian or- 1 ganizations (as such term is defined in section 4 of 2 the Indian Health Care Improvement Act (25 U.S.C. 3 1603)). In selecting such members, the Director 4 shall ensure that each of the 12 service areas of the 5 Indian Health Service is represented. 6 (3) CONTENTS OF STUDY.—The study con- 7 ducted pursuant to paragraph (1) shall— 8 (A) examine the causes of maternal mor- 9 tality and severe maternal morbidity that are 10 unique to American Indian and Alaska Native 11 individuals; 12 (B) include a systematic process of listen- 13 ing to the stories of American Indian and Alas- 14 ka Native pregnant and postpartum individuals 15 to fully understand the causes of, and inform 16 potential solutions to, the maternal mortality 17 and severe maternal morbidity crisis within 18 their respective communities; 19 (C) distinguish between the causes of, 20 landscape of maternity care at, and rec- 21 ommendations to improve maternal health out- 22 comes within, the different settings in which 23 American Indian and Alaska Native pregnant 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00718 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 719 •S 4486 IS and postpartum individuals receive maternity 1 care, such as— 2 (i) facilities operated by the Indian 3 Health Service; 4 (ii) an Indian health program oper- 5 ated by an Indian Tribe or Tribal organi- 6 zation pursuant to a contract, grant, coop- 7 erative agreement, or compact with the In- 8 dian Health Service pursuant to the Indian 9 Self-Determination Act; and 10 (iii) an Urban Indian health program 11 operated by an Urban Indian organization 12 pursuant to a grant or contract with the 13 Indian Health Service pursuant to title V 14 of the Indian Health Care Improvement 15 Act; 16 (D) review processes for coordinating pro- 17 grams of the Indian Health Service with social 18 services provided through other programs ad- 19 ministered by the Secretary of Health and 20 Human Services (other than the Medicare pro- 21 gram under title XVIII of the Social Security 22 Act (42 U.S.C. 1395 et seq.), the Medicaid pro- 23 gram under title XIX of such Act (42 U.S.C. 24 1396 et seq.), and the Children’s Health Insur- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00719 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 720 •S 4486 IS ance Program under title XXI of such Act (42 1 U.S.C. 1397aa et seq.)); 2 (E) review current data collection and 3 quality measurement processes and practices; 4 (F) assess causes and frequency of mater- 5 nal mental health conditions and substance use 6 disorders; 7 (G) consider social determinants of health, 8 including poverty, lack of health insurance, un- 9 employment, sexual violence, and environmental 10 conditions in Tribal areas; 11 (H) consider the role that historical mis- 12 treatment of American Indian and Alaska Na- 13 tive people has played in causing currently high 14 rates of maternal mortality and severe maternal 15 morbidity; 16 (I) consider how current funding of the In- 17 dian Health Service affects the ability of the 18 Service to deliver quality maternity care; 19 (J) consider the extent to which the deliv- 20 ery of maternity care services is culturally ap- 21 propriate for American Indian and Alaska Na- 22 tive pregnant and postpartum individuals; 23 (K) make recommendations to reduce 24 misclassification of American Indian and Alaska 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00720 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 721 •S 4486 IS Native pregnant and postpartum individuals, 1 including consideration of best practices in 2 training for maternal mortality review com- 3 mittee members to be able to correctly classify 4 American Indian and Alaska Native individuals; 5 and 6 (L) make recommendations informed by 7 the stories shared by American Indian and 8 Alaska Native pregnant and postpartum indi- 9 viduals pursuant to subparagraph (B) to im- 10 prove maternal health outcomes for such indi- 11 viduals. 12 (4) REPORT.—The agreement entered into 13 under paragraph (1) with an independent research 14 organization or Tribal Epidemiology Center shall re- 15 quire that the organization or center transmit to 16 Congress a report on the results of the study con- 17 ducted pursuant to that agreement not later than 36 18 months after the date of the enactment of this Act. 19 (5) AUTHORIZATION OF APPROPRIATIONS.— 20 There is authorized to be appropriated to carry out 21 this subsection $2,000,000 for each of fiscal years 22 2023 through 2025. 23 (f) GRANTS TO MINORITY-SERVING INSTITUTIONS 24 TO STUDY MATERNAL MORTALITY, SEVERE MATERNAL 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00721 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 722 •S 4486 IS MORBIDITY, AND OTHER ADVERSE MATERNAL HEALTH 1 OUTCOMES.— 2 (1) IN GENERAL.—The Secretary of Health and 3 Human Services shall establish a program under 4 which the Secretary shall award grants to research 5 centers, health professions schools and programs, 6 and other entities at minority-serving institutions to 7 study specific aspects of the maternal health crisis 8 among pregnant and postpartum individuals from 9 racial and ethnic minority groups. Such research 10 may— 11 (A) include the development and imple- 12 mentation of systematic processes of listening 13 to the stories of pregnant and postpartum indi- 14 viduals from racial and ethnic minority groups, 15 and perinatal health workers supporting such 16 individuals, to fully understand the causes of, 17 and inform potential solutions to, the maternal 18 mortality and severe maternal morbidity crisis 19 within their respective communities; 20 (B) assess the potential causes of relatively 21 low rates of maternal mortality among Hispanic 22 individuals, including potential racial 23 misclassification and other data collection and 24 reporting issues that might be misrepresenting 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00722 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 723 •S 4486 IS maternal mortality rates among Hispanic indi- 1 viduals in the United States; and 2 (C) assess differences in rates of adverse 3 maternal health outcomes among subgroups 4 identifying as Hispanic. 5 (2) APPLICATION.—To be eligible to receive a 6 grant under paragraph (1), an entity described in 7 such paragraph shall submit to the Secretary an ap- 8 plication at such time, in such manner, and con- 9 taining such information as the Secretary may re- 10 quire. 11 (3) TECHNICAL ASSISTANCE.—The Secretary 12 may use not more than 10 percent of the funds 13 made available under paragraph (7)— 14 (A) to conduct outreach to minority-serv- 15 ing institutions to raise awareness of the avail- 16 ability of grants under paragraph (1); 17 (B) to provide technical assistance in the 18 application process for such a grant; and 19 (C) to promote capacity building, as need- 20 ed to enable entities described in such para- 21 graph to submit such an application. 22 (4) REPORTING REQUIREMENT.—Each entity 23 awarded a grant under this subsection shall periodi- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00723 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 724 •S 4486 IS cally submit to the Secretary a report on the status 1 of activities conducted using the grant. 2 (5) EVALUATION.—Beginning one year after 3 the date on which the first grant is awarded under 4 this subsection, the Secretary shall submit to Con- 5 gress an annual report summarizing the findings of 6 research conducted using funds made available 7 under this subsection. 8 (6) MINORITY-SERVING INSTITUTIONS DE- 9 FINED.—In this subsection, the term ‘‘minority-serv- 10 ing institution’’ means an eligible institution de- 11 scribed in section 371(a) of the Higher Education 12 Act of 1965 (20 U.S.C. 1067q(a)). 13 (7) AUTHORIZATION OF APPROPRIATIONS.— 14 There are authorized to be appropriated to carry out 15 this subsection $10,000,000 for each of fiscal years 16 2023 through 2027. 17 (g) DEFINITIONS.—In this section: 18 (1) CULTURALLY CONGRUENT.—The term ‘‘cul- 19 turally congruent’’, with respect to care or maternity 20 care, means care that is in agreement with the pre- 21 ferred cultural values, beliefs, worldview, language, 22 and practices of the health care consumer and other 23 stakeholders. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00724 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 725 •S 4486 IS (2) MATERNITY CARE PROVIDER.—The term 1 ‘‘maternity care provider’’ means a health care pro- 2 vider who— 3 (A) is a physician, physician assistant, 4 midwife who meets at a minimum the inter- 5 national definition of the midwife and global 6 standards for midwifery education as estab- 7 lished by the International Confederation of 8 Midwives, nurse practitioner, or clinical nurse 9 specialist; and 10 (B) has a focus on maternal or perinatal 11 health. 12 (3) MATERNAL MORTALITY.—The term ‘‘mater- 13 nal mortality’’ means a death occurring during or 14 within a one-year period after pregnancy, caused by 15 pregnancy-related or childbirth complications, in- 16 cluding a suicide, overdose, or other death resulting 17 from a mental health or substance use disorder at- 18 tributed to or aggravated by pregnancy-related or 19 childbirth complications. 20 (4) PERINATAL HEALTH WORKER.—The term 21 ‘‘perinatal health worker’’ means a doula, commu- 22 nity health worker, peer supporter, breastfeeding 23 and lactation educator or counselor, nutritionist or 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00725 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 726 •S 4486 IS dietitian, childbirth educator, social worker, home 1 visitor, language interpreter, or navigator. 2 (5) POSTPARTUM AND POSTPARTUM PERIOD.— 3 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 4 refer to the 1-year period beginning on the last day 5 of the pregnancy of an individual. 6 (6) PREGNANCY-ASSOCIATED DEATH.—The 7 term ‘‘pregnancy-associated death’’ means a death of 8 a pregnant or postpartum individual, by any cause, 9 that occurs during, or within 1 year following, the 10 individual’s pregnancy, regardless of the outcome, 11 duration, or site of the pregnancy. 12 (7) PREGNANCY-RELATED DEATH.—The term 13 ‘‘pregnancy-related death’’ means a death of a preg- 14 nant or postpartum individual that occurs during, or 15 within 1 year following, the individual’s pregnancy, 16 from a pregnancy complication, a chain of events 17 initiated by pregnancy, or the aggravation of an un- 18 related condition by the physiologic effects of preg- 19 nancy. 20 (8) RACIAL AND ETHNIC MINORITY GROUP.— 21 The term ‘‘racial and ethnic minority group’’ has the 22 meaning given such term in section 1707(g)(1) of 23 the Public Health Service Act (42 U.S.C. 300u– 24 6(g)(1)). 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00726 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 727 •S 4486 IS (9) SEVERE MATERNAL MORBIDITY.—The term 1 ‘‘severe maternal morbidity’’ means a health condi- 2 tion, including mental health conditions and sub- 3 stance use disorders, attributed to or aggravated by 4 pregnancy or childbirth that results in significant 5 short-term or long-term consequences to the health 6 of the individual who was pregnant. 7 (10) SOCIAL DETERMINANTS OF MATERNAL 8 HEALTH DEFINED.—The term ‘‘social determinants 9 of maternal health’’ means non-clinical factors that 10 impact maternal health outcomes, including— 11 (A) economic factors, which may include 12 poverty, employment, food security, support for 13 and access to lactation and other infant feeding 14 options, housing stability, and related factors; 15 (B) neighborhood factors, which may in- 16 clude quality of housing, access to transpor- 17 tation, access to child care, availability of 18 healthy foods and nutrition counseling, avail- 19 ability of clean water, air and water quality, 20 ambient temperatures, neighborhood crime and 21 violence, access to broadband, and related fac- 22 tors; 23 (C) social and community factors, which 24 may include systemic racism, gender discrimi- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00727 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 728 •S 4486 IS nation or discrimination based on other pro- 1 tected classes, workplace conditions, incarcer- 2 ation, and related factors; 3 (D) household factors, which may include 4 ability to conduct lead testing and abatement, 5 car seat installation, indoor air temperatures, 6 and related factors; 7 (E) education access and quality factors, 8 which may include educational attainment, lan- 9 guage and literacy, and related factors; and 10 (F) health care access factors, including 11 health insurance coverage, access to culturally 12 congruent health care services, providers, and 13 non-clinical support, access to home visiting 14 services, access to wellness and stress manage- 15 ment programs, health literacy, access to tele- 16 health and items required to receive telehealth 17 services, and related factors. 18 SEC. 5209. KIRA JOHNSON ACT. 19 (a) INVESTMENTS IN COMMUNITY-BASED ORGANIZA- 20 TIONS TO IMPROVE BLACK MATERNAL HEALTH OUT- 21 COMES.— 22 (1) AWARDS.—Following the 1-year period de- 23 scribed in paragraph (3), the Secretary of Health 24 and Human Services (in this subsection referred to 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00728 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 729 •S 4486 IS as the ‘‘Secretary’’) shall award grants to eligible 1 entities to establish or expand programs to prevent 2 maternal mortality and severe maternal morbidity 3 among Black pregnant and postpartum individuals. 4 (2) ELIGIBILITY.—To be eligible to seek a 5 grant under this subsection, an entity shall be a 6 community-based organization offering programs 7 and resources aligned with evidence-based practices 8 for improving maternal health outcomes for Black 9 pregnant and postpartum individuals. 10 (3) OUTREACH AND TECHNICAL ASSISTANCE 11 PERIOD.—During the 1-year period beginning on the 12 date of enactment of this Act, the Secretary shall— 13 (A) conduct outreach to encourage eligible 14 entities to apply for grants under this sub- 15 section; and 16 (B) provide technical assistance to eligible 17 entities on best practices for applying for grants 18 under this subsection. 19 (4) SPECIAL CONSIDERATION.— 20 (A) OUTREACH.—In conducting outreach 21 under paragraph (3), the Secretary shall give 22 special consideration to eligible entities that— 23 (i) are based in, and provide support 24 for, communities with high rates of adverse 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00729 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 730 •S 4486 IS maternal health outcomes or significant ra- 1 cial and ethnic inequities in maternal 2 health outcomes, to the extent such data 3 are available; 4 (ii) are led by Black people; and 5 (iii) offer programs and resources that 6 are aligned with evidence-based practices 7 for improving maternal health outcomes 8 for Black pregnant and postpartum indi- 9 viduals. 10 (B) AWARDS.—In awarding grants under 11 this subsection, the Secretary shall give special 12 consideration to eligible entities that— 13 (i) are described in clauses (i), (ii), 14 and (iii) of subparagraph (A); 15 (ii) offer programs and resources de- 16 signed in consultation with and intended 17 for Black pregnant and postpartum indi- 18 viduals; and 19 (iii) offer programs and resources in 20 the communities in which the respective el- 21 igible entities are located that— 22 (I) promote maternal mental 23 health and maternal substance use 24 disorder treatments and supports that 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00730 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 731 •S 4486 IS are aligned with evidence-based prac- 1 tices for improving maternal mental 2 and behavioral health outcomes for 3 Black pregnant and postpartum indi- 4 viduals; 5 (II) address social determinants 6 of maternal health for pregnant and 7 postpartum individuals; 8 (III) promote evidence-based 9 health literacy and pregnancy, child- 10 birth, and parenting education for 11 pregnant and postpartum individuals; 12 (IV) provide support from 13 perinatal health workers to pregnant 14 and postpartum individuals; 15 (V) provide culturally congruent 16 training to perinatal health workers; 17 (VI) conduct or support research 18 on maternal health issues dispropor- 19 tionately impacting Black pregnant 20 and postpartum individuals; 21 (VII) provide support to family 22 members of individuals who suffered a 23 pregnancy-associated death or preg- 24 nancy-related death; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00731 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 732 •S 4486 IS (VIII) operate midwifery prac- 1 tices that provide culturally congruent 2 maternal health care and support, in- 3 cluding for the purposes of— 4 (aa) supporting additional 5 education, training, and certifi- 6 cation programs, including sup- 7 port for distance learning; 8 (bb) providing financial sup- 9 port to current and future mid- 10 wives to address education costs, 11 debts, and other needs; 12 (cc) clinical site investments; 13 (dd) supporting preceptor 14 development trainings; 15 (ee) expanding the mid- 16 wifery practice; or 17 (ff) related needs identified 18 by the midwifery practice and de- 19 scribed in the practice’s applica- 20 tion; or 21 (IX) have developed other pro- 22 grams and resources that address 23 community-specific needs for pregnant 24 and postpartum individuals and are 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00732 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 733 •S 4486 IS aligned with evidence-based practices 1 for improving maternal health out- 2 comes for Black pregnant and 3 postpartum individuals. 4 (5) TECHNICAL ASSISTANCE.—The Secretary 5 shall provide to grant recipients under this sub- 6 section technical assistance on— 7 (A) capacity building to establish or ex- 8 pand programs to prevent adverse maternal 9 health outcomes among Black pregnant and 10 postpartum individuals; 11 (B) best practices in data collection, meas- 12 urement, evaluation, and reporting; and 13 (C) planning for sustaining programs to 14 prevent maternal mortality and severe maternal 15 morbidity among Black pregnant and 16 postpartum individuals after the period of the 17 grant. 18 (6) EVALUATION.—Not later than the end of 19 fiscal year 2026, the Secretary shall submit to the 20 Congress an evaluation of the grant program under 21 this subsection that— 22 (A) assesses the effectiveness of outreach 23 efforts during the application process in diversi- 24 fying the pool of grant recipients; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00733 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 734 •S 4486 IS (B) makes recommendations for future 1 outreach efforts to diversify the pool of grant 2 recipients for Department of Health and 3 Human Services grant programs and funding 4 opportunities related to maternal health; 5 (C) assesses the effectiveness of programs 6 funded by grants under this subsection in im- 7 proving maternal health outcomes for Black 8 pregnant and postpartum individuals, to the ex- 9 tent practicable; and 10 (D) makes recommendations for future 11 Department of Health and Human Services 12 grant programs and funding opportunities that 13 deliver funding to community-based organiza- 14 tions that provide programs and resources that 15 are aligned with evidence-based practices for 16 improving maternal health outcomes for Black 17 pregnant and postpartum individuals. 18 (7) AUTHORIZATION OF APPROPRIATIONS.—To 19 carry out this subsection, there is authorized to be 20 appropriated $10,000,000 for each of fiscal years 21 2023 through 2027. 22 (b) INVESTMENTS IN COMMUNITY-BASED ORGANIZA- 23 TIONS TO IMPROVE MATERNAL HEALTH OUTCOMES IN 24 UNDERSERVED COMMUNITIES.— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00734 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 735 •S 4486 IS (1) AWARDS.—Following the 1-year period de- 1 scribed in paragraph (3), the Secretary of Health 2 and Human Services (in this subsection referred to 3 as the ‘‘Secretary’’) shall award grants to eligible 4 entities to establish or expand programs to prevent 5 maternal mortality and severe maternal morbidity 6 among underserved groups. 7 (2) ELIGIBILITY.—To be eligible to seek a 8 grant under this subsection, an entity shall be a 9 community-based organization offering programs 10 and resources aligned with evidence-based practices 11 for improving maternal health outcomes for preg- 12 nant and postpartum individuals. 13 (3) OUTREACH AND TECHNICAL ASSISTANCE 14 PERIOD.—During the 1-year period beginning on the 15 date of enactment of this Act, the Secretary shall— 16 (A) conduct outreach to encourage eligible 17 entities to apply for grants under this sub- 18 section; and 19 (B) provide technical assistance to eligible 20 entities on best practices for applying for grants 21 under this subsection. 22 (4) SPECIAL CONSIDERATION.— 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00735 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 736 •S 4486 IS (A) OUTREACH.—In conducting outreach 1 under paragraph (3), the Secretary shall give 2 special consideration to eligible entities that— 3 (i) are based in, and provide support 4 for, communities with high rates of adverse 5 maternal health outcomes or significant ra- 6 cial and ethnic inequities in maternal 7 health outcomes, to the extent such data 8 are available; 9 (ii) are led by individuals from ra- 10 cially, ethnically, and geographically di- 11 verse backgrounds; and 12 (iii) offer programs and resources that 13 are aligned with evidence-based practices 14 for improving maternal health outcomes 15 for pregnant and postpartum individuals. 16 (B) AWARDS.—In awarding grants under 17 this subsection, the Secretary shall give special 18 consideration to eligible entities that— 19 (i) are described in clauses (i), (ii), 20 and (iii) of subparagraph (A); 21 (ii) offer programs and resources de- 22 signed in consultation with and intended 23 for pregnant and postpartum individuals 24 from underserved groups; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00736 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 737 •S 4486 IS (iii) offer programs and resources in 1 the communities in which the respective el- 2 igible entities are located that— 3 (I) promote maternal mental 4 health and maternal substance use 5 disorder treatments and support that 6 are aligned with evidence-based prac- 7 tices for improving maternal mental 8 and behavioral health outcomes for 9 pregnant and postpartum individuals; 10 (II) address social determinants 11 of maternal health for pregnant and 12 postpartum individuals; 13 (III) promote evidence-based 14 health literacy and pregnancy, child- 15 birth, and parenting education for 16 pregnant and postpartum individuals; 17 (IV) provide support from 18 perinatal health workers to pregnant 19 and postpartum individuals; 20 (V) provide culturally congruent 21 training to perinatal health workers; 22 (VI) conduct or support research 23 on maternal health outcomes and in- 24 equities; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00737 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 738 •S 4486 IS (VII) provide support to family 1 members of individuals who suffered a 2 pregnancy-associated death or preg- 3 nancy-related death; or 4 (VIII) operate midwifery prac- 5 tices that provide culturally congruent 6 maternal health care and support, in- 7 cluding for the purposes of— 8 (aa) supporting additional 9 education, training, and certifi- 10 cation programs, including sup- 11 port for distance learning; 12 (bb) providing financial sup- 13 port to current and future mid- 14 wives to address education costs, 15 debts, and other needs; 16 (cc) clinical site investments; 17 (dd) supporting preceptor 18 development trainings; 19 (ee) expanding the mid- 20 wifery practice; or 21 (ff) related needs identified 22 by the midwifery practice and de- 23 scribed in the practice’s applica- 24 tion; or 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00738 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 739 •S 4486 IS (iv) have developed other programs 1 and resources that address community-spe- 2 cific needs for pregnant and postpartum 3 individuals and are aligned with evidence- 4 based practices for improving maternal 5 health outcomes for pregnant and 6 postpartum individuals. 7 (5) TECHNICAL ASSISTANCE.—The Secretary 8 shall provide to grant recipients under this sub- 9 section technical assistance on— 10 (A) capacity building to establish or ex- 11 pand programs to prevent adverse maternal 12 health outcomes among pregnant and 13 postpartum individuals from underserved 14 groups; 15 (B) best practices in data collection, meas- 16 urement, evaluation, and reporting; and 17 (C) planning for sustaining programs to 18 prevent maternal mortality and severe maternal 19 morbidity among pregnant and postpartum in- 20 dividuals from underserved groups after the pe- 21 riod of the grant. 22 (6) EVALUATION.—Not later than the end of 23 fiscal year 2026, the Secretary shall submit to the 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00739 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 740 •S 4486 IS Congress an evaluation of the grant program under 1 this subsection that— 2 (A) assesses the effectiveness of outreach 3 efforts during the application process in diversi- 4 fying the pool of grant recipients; 5 (B) makes recommendations for future 6 outreach efforts to diversify the pool of grant 7 recipients for Department of Health and 8 Human Services grant programs and funding 9 opportunities related to maternal health; 10 (C) assesses the effectiveness of programs 11 funded by grants under this subsection in im- 12 proving maternal health outcomes for pregnant 13 and postpartum individuals from underserved 14 groups, to the extent practicable; and 15 (D) makes recommendations for future 16 Department of Health and Human Services 17 grant programs and funding opportunities that 18 deliver funding to community-based organiza- 19 tions that provide programs and resources that 20 are aligned with evidence-based practices for 21 improving maternal health outcomes for preg- 22 nant and postpartum individuals. 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00740 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 741 •S 4486 IS (7) DEFINITION.—In this subsection, the term 1 ‘‘underserved groups’’ refers to pregnant and 2 postpartum individuals— 3 (A) from racial and ethnic minority 4 groups; 5 (B) whose household income is equal to or 6 less than 150 percent of the Federal poverty 7 line; 8 (C) who live in health professional shortage 9 areas (as such term is defined in section 332 of 10 the Public Health Service Act (42 U.S.C. 11 254e)); 12 (D) who live in counties with no hospital 13 offering obstetric care, no birth center, and no 14 obstetric provider; or 15 (E) who live in counties with a level of vul- 16 nerability of moderate-to-high or higher, accord- 17 ing to the Social Vulnerability Index of the Cen- 18 ters for Disease Control and Prevention. 19 (8) AUTHORIZATION OF APPROPRIATIONS.—To 20 carry out this subsection, there is authorized to be 21 appropriated $10,000,000 for each of fiscal years 22 2023 through 2027. 23 (c) RESPECTFUL MATERNITY CARE TRAINING FOR 24 ALL EMPLOYEES IN MATERNITY CARE SETTINGS.—Part 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00741 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 742 •S 4486 IS B of title VII of the Public Health Service Act (42 U.S.C. 1 293 et seq.), as amended by section 3002, is further 2 amended by adding at the end the following new section: 3 ‘‘SEC. 743. RESPECTFUL MATERNITY CARE TRAINING FOR 4 ALL EMPLOYEES IN MATERNITY CARE SET- 5 TINGS. 6 ‘‘(a) GRANTS.—The Secretary shall award grants for 7 programs to reduce and prevent bias, racism, and dis- 8 crimination in maternity care settings and to advance re- 9 spectful, culturally congruent, trauma-informed care. 10 ‘‘(b) SPECIAL CONSIDERATION.—In awarding grants 11 under subsection (a), the Secretary shall give special con- 12 sideration to applications for programs that would— 13 ‘‘(1) apply to all maternity care providers and 14 any employees who interact with pregnant and 15 postpartum individuals in the provider setting, in- 16 cluding front desk employees, sonographers, sched- 17 ulers, health care professionals, hospital or health 18 system administrators, security staff, and other em- 19 ployees; 20 ‘‘(2) emphasize periodic, as opposed to one- 21 time, trainings for all birthing professionals and em- 22 ployees described in paragraph (1); 23 ‘‘(3) address implicit bias, racism, and cultural 24 humility; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00742 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 743 •S 4486 IS ‘‘(4) be delivered in ongoing education settings 1 for providers maintaining their licenses, with a pref- 2 erence for trainings that provide continuing edu- 3 cation units; 4 ‘‘(5) include trauma-informed care best prac- 5 tices and an emphasis on shared decision making be- 6 tween providers and patients; 7 ‘‘(6) include antiracism training and programs; 8 ‘‘(7) be delivered in undergraduate programs 9 that funnel into health professions schools; 10 ‘‘(8) be delivered in settings that apply to pro- 11 viders of the special supplemental nutrition program 12 for women, infants, and children under section 17 of 13 the Child Nutrition Act of 1966; 14 ‘‘(9) integrate bias training in obstetric emer- 15 gency simulation trainings or related trainings; 16 ‘‘(10) include training for emergency depart- 17 ment employees and emergency medical technicians 18 on recognizing warning signs for severe pregnancy- 19 related complications; 20 ‘‘(11) offer training to all maternity care pro- 21 viders on the value of racially, ethnically, and profes- 22 sionally diverse maternity care teams to provide cul- 23 turally congruent care; or 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00743 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 744 •S 4486 IS ‘‘(12) be based on one or more programs de- 1 signed by a historically Black college or university or 2 other minority-serving institution. 3 ‘‘(c) APPLICATION.—To seek a grant under sub- 4 section (a), an entity shall submit an application at such 5 time, in such manner, and containing such information as 6 the Secretary may require. 7 ‘‘(d) REPORTING TO SECRETARY.—Each recipient of 8 a grant under this section shall annually submit to the 9 Secretary a report on the status of activities conducted 10 using the grant, including, as applicable, a description of 11 the impact of training provided through the grant on pa- 12 tient outcomes and patient experience for pregnant and 13 postpartum individuals from racial and ethnic minority 14 groups and their families. 15 ‘‘(e) DISSEMINATION OF FINDINGS.—Based on the 16 annual reports submitted pursuant to subsection (d), the 17 Secretary— 18 ‘‘(1) shall produce an annual report on the find- 19 ings resulting from programs funded through this 20 section; 21 ‘‘(2) shall disseminate such report to all recipi- 22 ents of grants under this section and to the public; 23 and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00744 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 745 •S 4486 IS ‘‘(3) may include in such report findings on 1 best practices for improving patient outcomes and 2 patient experience for pregnant and postpartum in- 3 dividuals from racial and ethnic minority groups and 4 their families in maternity care settings. 5 ‘‘(f) DEFINITIONS.—In this section: 6 ‘‘(1) The term ‘postpartum’ means the one-year 7 period beginning on the last day of an individual’s 8 pregnancy. 9 ‘‘(2) The term ‘culturally congruent’ means in 10 agreement with the preferred cultural values, beliefs, 11 world view, language, and practices of the health 12 care consumer and other stakeholders. 13 ‘‘(3) The term ‘maternity care provider’ means 14 a health care provider who— 15 ‘‘(A) is a physician, physician assistant, 16 midwife who meets at a minimum the inter- 17 national definition of the midwife and global 18 standards for midwifery education as estab- 19 lished by the International Confederation of 20 Midwives, nurse practitioner, or clinical nurse 21 specialist; and 22 ‘‘(B) has a focus on maternal or perinatal 23 health. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00745 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 746 •S 4486 IS ‘‘(4) The term ‘racial and ethnic minority 1 group’ has the meaning given such term in section 2 1707(g)(1). 3 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—To 4 carry out this section, there is authorized to be appro- 5 priated $5,000,000 for each of fiscal years 2023 through 6 2027.’’. 7 (d) STUDY ON REDUCING AND PREVENTING BIAS, 8 RACISM, AND DISCRIMINATION IN MATERNITY CARE SET- 9 TINGS.— 10 (1) IN GENERAL.—The Secretary of Health and 11 Human Services shall seek to enter into an agree- 12 ment, not later than 90 days after the date of enact- 13 ment of this Act, with the National Academies of 14 Sciences, Engineering, and Medicine (referred to in 15 this subsection as the ‘‘National Academies’’) under 16 which the National Academies agree to— 17 (A) conduct a study on the design and im- 18 plementation of programs to reduce and prevent 19 bias, racism, and discrimination in maternity 20 care settings and to advance respectful, cul- 21 turally congruent, trauma-informed care; and 22 (B) not later than 24 months after the 23 date of the enactment of this Act— 24 (i) complete the study; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00746 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 747 •S 4486 IS (ii) transmit a report on the results of 1 the study to the Congress. 2 (2) POSSIBLE TOPICS.—The agreement entered 3 into pursuant to paragraph (1) may provide for the 4 study of any of the following: 5 (A) The development of a scorecard or 6 other evaluation standards for programs de- 7 signed to reduce and prevent bias, racism, and 8 discrimination in maternity care settings to as- 9 sess the effectiveness of such programs in im- 10 proving patient outcomes and patient experi- 11 ence for pregnant and postpartum individuals 12 from racial and ethnic minority groups and 13 their families. 14 (B) Determination of the types and fre- 15 quency of training to reduce and prevent bias, 16 racism, and discrimination in maternity care 17 settings that are demonstrated to improve pa- 18 tient outcomes or patient experience for preg- 19 nant and postpartum individuals from racial 20 and ethnic minority groups and their families. 21 (e) RESPECTFUL MATERNITY CARE COMPLIANCE 22 PROGRAM.— 23 (1) IN GENERAL.—The Secretary of Health and 24 Human Services (referred to in this subsection as 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00747 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 748 •S 4486 IS the ‘‘Secretary’’) shall award grants to accredited 1 hospitals, health systems, and other maternity care 2 settings to establish as an integral part of quality 3 implementation initiatives within one or more hos- 4 pitals or other birth settings a respectful maternity 5 care compliance program. 6 (2) PROGRAM REQUIREMENTS.—A respectful 7 maternity care compliance program funded through 8 a grant under this subsection shall— 9 (A) institutionalize mechanisms to allow 10 patients receiving maternity care services, the 11 families of such patients, or perinatal health 12 workers supporting such patients to report in- 13 stances of racism or evidence of bias on the 14 basis of race, ethnicity, or another protected 15 class; 16 (B) institutionalize response mechanisms 17 through which representatives of the program 18 can directly follow up with the patient, if pos- 19 sible, and the patient’s family in a timely man- 20 ner; 21 (C) prepare, and make publicly available, a 22 hospital- or health system-wide strategy to re- 23 duce bias on the basis of race, ethnicity, or an- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00748 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 749 •S 4486 IS other protected class in the delivery of mater- 1 nity care that includes— 2 (i) information on the training pro- 3 grams to reduce and prevent bias, racism, 4 and discrimination on the basis of race, 5 ethnicity, or another protected class for all 6 employees in maternity care settings; 7 (ii) information on the number of 8 cases reported to the compliance program; 9 and 10 (iii) the development of methods to 11 routinely assess the extent to which bias, 12 racism, or discrimination on the basis of 13 race, ethnicity, or another protected class 14 are present in the delivery of maternity 15 care to patients from racial and ethnic mi- 16 nority groups; 17 (D) develop mechanisms to routinely col- 18 lect and publicly report hospital-level data re- 19 lated to patient-reported experience of care; and 20 (E) provide annual reports to the Sec- 21 retary with information about each case re- 22 ported to the compliance program over the 23 course of the year containing such information 24 as the Secretary may require, such as— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00749 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 750 •S 4486 IS (i) de-identified demographic informa- 1 tion on the patient in the case, such as 2 race, ethnicity, gender identity, and pri- 3 mary language; 4 (ii) the content of the report from the 5 patient or the family of the patient to the 6 compliance program; 7 (iii) the response from the compliance 8 program; and 9 (iv) to the extent applicable, institu- 10 tional changes made as a result of the 11 case. 12 (3) SECRETARY REQUIREMENTS.— 13 (A) PROCESSES.—Not later than 180 days 14 after the date of the enactment of this Act, the 15 Secretary shall establish processes for— 16 (i) disseminating best practices for es- 17 tablishing and implementing a respectful 18 maternity care compliance program within 19 a hospital or other birth setting; 20 (ii) promoting coordination and col- 21 laboration between hospitals, health sys- 22 tems, and other maternity care delivery 23 settings on the establishment and imple- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00750 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 751 •S 4486 IS mentation of respectful maternity care 1 compliance programs; and 2 (iii) evaluating the effectiveness of re- 3 spectful maternity care compliance pro- 4 grams on maternal health outcomes and 5 patient and family experiences, especially 6 for patients from racial and ethnic minor- 7 ity groups and their families. 8 (B) STUDY.— 9 (i) IN GENERAL.—Not later than 2 10 years after the date of the enactment of 11 this Act, the Secretary shall, through a 12 contract with an independent research or- 13 ganization, conduct a study on strategies 14 to address— 15 (I) racism or bias on the basis of 16 race, ethnicity, or another protected 17 class in the delivery of maternity care 18 services; and 19 (II) successful implementation of 20 respectful care initiatives. 21 (ii) COMPONENTS OF STUDY.—The 22 study shall include the following: 23 (I) An assessment of the reports 24 submitted to the Secretary from the 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00751 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 752 •S 4486 IS respectful maternity care compliance 1 programs pursuant to paragraph 2 (2)(E). 3 (II) Based on such assessment, 4 recommendations for potential ac- 5 countability mechanisms related to 6 cases of racism or bias on the basis of 7 race, ethnicity, or another protected 8 class in the delivery of maternity care 9 services at hospitals and other birth 10 settings. Such recommendations shall 11 take into consideration medical and 12 non-medical factors that contribute to 13 adverse patient experiences and ma- 14 ternal health outcomes. 15 (iii) REPORT.—The Secretary shall 16 submit to the Congress, and make publicly 17 available, a report on the results of the 18 study under this subparagraph. 19 (4) AUTHORIZATION OF APPROPRIATIONS.—To 20 carry out this subsection, there is authorized to be 21 appropriated such sums as may be necessary for fis- 22 cal years 2023 through 2028. 23 (f) GAO REPORT.— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00752 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 753 •S 4486 IS (1) IN GENERAL.—Not later than 2 years after 1 the date of enactment of this Act and annually 2 thereafter, the Comptroller General of the United 3 States shall submit to the Congress, and make pub- 4 licly available, a report on the establishment of re- 5 spectful maternity care compliance programs within 6 hospitals, health systems, and other maternity care 7 settings. 8 (2) MATTERS INCLUDED.—The report under 9 paragraph (1) shall include the following: 10 (A) Information regarding the extent to 11 which hospitals, health systems, and other ma- 12 ternity care settings have elected to establish 13 respectful maternity care compliance programs, 14 including— 15 (i) which hospitals and other birth 16 settings elect to establish compliance pro- 17 grams and when such programs are estab- 18 lished; 19 (ii) to the extent practicable, impacts 20 of the establishment of such programs on 21 maternal health outcomes and patient and 22 family experiences in the hospitals and 23 other birth settings that have established 24 such programs, especially for patients from 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00753 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 754 •S 4486 IS racial and ethnic minority groups and their 1 families; 2 (iii) information on geographic areas, 3 and types of hospitals or other birth set- 4 tings, where respectful maternity care com- 5 pliance programs are not being established 6 and information on factors contributing to 7 decisions to not establish such programs; 8 and 9 (iv) recommendations for establishing 10 respectful maternity care compliance pro- 11 grams in geographic areas, and types of 12 hospitals or other birth settings, where 13 such programs are not being established. 14 (B) Whether the funding made available to 15 carry out this subsection has been sufficient 16 and, if applicable, recommendations for addi- 17 tional appropriations to carry out this sub- 18 section. 19 (C) Such other information as the Comp- 20 troller General determines appropriate. 21 (g) DEFINITIONS.—In this section: 22 (1) CULTURALLY CONGRUENT.—The term ‘‘cul- 23 turally congruent’’, with respect to care or maternity 24 care, means care that is in agreement with the pre- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00754 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 755 •S 4486 IS ferred cultural values, beliefs, worldview, language, 1 and practices of the health care consumer and other 2 stakeholders. 3 (2) MATERNITY CARE PROVIDER.—The term 4 ‘‘maternity care provider’’ means a health care pro- 5 vider who— 6 (A) is a physician, physician assistant, 7 midwife who meets at a minimum the inter- 8 national definition of the midwife and global 9 standards for midwifery education as estab- 10 lished by the International Confederation of 11 Midwives, nurse practitioner, or clinical nurse 12 specialist; and 13 (B) has a focus on maternal or perinatal 14 health. 15 (3) MATERNAL MORTALITY.—The term ‘‘mater- 16 nal mortality’’ means a death occurring during or 17 within a one-year period after pregnancy, caused by 18 pregnancy-related or childbirth complications, in- 19 cluding a suicide, overdose, or other death resulting 20 from a mental health or substance use disorder at- 21 tributed to or aggravated by pregnancy-related or 22 childbirth complications. 23 (4) PERINATAL HEALTH WORKER.—The term 24 ‘‘perinatal health worker’’ means a doula, commu- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00755 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 756 •S 4486 IS nity health worker, peer supporter, breastfeeding 1 and lactation educator or counselor, nutritionist or 2 dietitian, childbirth educator, social worker, home 3 visitor, language interpreter, or navigator. 4 (5) POSTPARTUM AND POSTPARTUM PERIOD.— 5 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 6 refer to the 1-year period beginning on the last day 7 of the pregnancy of an individual. 8 (6) PREGNANCY-ASSOCIATED DEATH.—The 9 term ‘‘pregnancy-associated death’’ means a death of 10 a pregnant or postpartum individual, by any cause, 11 that occurs during, or within 1 year following, the 12 individual’s pregnancy, regardless of the outcome, 13 duration, or site of the pregnancy. 14 (7) PREGNANCY-RELATED DEATH.—The term 15 ‘‘pregnancy-related death’’ means a death of a preg- 16 nant or postpartum individual that occurs during, or 17 within 1 year following, the individual’s pregnancy, 18 from a pregnancy complication, a chain of events 19 initiated by pregnancy, or the aggravation of an un- 20 related condition by the physiologic effects of preg- 21 nancy. 22 (8) RACIAL AND ETHNIC MINORITY GROUP.— 23 The term ‘‘racial and ethnic minority group’’ has the 24 meaning given such term in section 1707(g)(1) of 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00756 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 757 •S 4486 IS the Public Health Service Act (42 U.S.C. 300u– 1 6(g)(1)). 2 (9) SEVERE MATERNAL MORBIDITY.—The term 3 ‘‘severe maternal morbidity’’ means a health condi- 4 tion, including mental health conditions and sub- 5 stance use disorders, attributed to or aggravated by 6 pregnancy or childbirth that results in significant 7 short-term or long-term consequences to the health 8 of the individual who was pregnant. 9 (10) SOCIAL DETERMINANTS OF MATERNAL 10 HEALTH DEFINED.—The term ‘‘social determinants 11 of maternal health’’ means non-clinical factors that 12 impact maternal health outcomes, including— 13 (A) economic factors, which may include 14 poverty, employment, food security, support for 15 and access to lactation and other infant feeding 16 options, housing stability, and related factors; 17 (B) neighborhood factors, which may in- 18 clude quality of housing, access to transpor- 19 tation, access to child care, availability of 20 healthy foods and nutrition counseling, avail- 21 ability of clean water, air and water quality, 22 ambient temperatures, neighborhood crime and 23 violence, access to broadband, and related fac- 24 tors; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00757 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 758 •S 4486 IS (C) social and community factors, which 1 may include systemic racism, gender discrimi- 2 nation or discrimination based on other pro- 3 tected classes, workplace conditions, incarcer- 4 ation, and related factors; 5 (D) household factors, which may include 6 ability to conduct lead testing and abatement, 7 car seat installation, indoor air temperatures, 8 and related factors; 9 (E) education access and quality factors, 10 which may include educational attainment, lan- 11 guage and literacy, and related factors; and 12 (F) health care access factors, including 13 health insurance coverage, access to culturally 14 congruent health care services, providers, and 15 non-clinical support, access to home visiting 16 services, access to wellness and stress manage- 17 ment programs, health literacy, access to tele- 18 health and items required to receive telehealth 19 services, and related factors. 20 SEC. 5210. MOMS MATTER. 21 (a) MATERNAL MENTAL HEALTH EQUITY GRANT 22 PROGRAM.— 23 (1) IN GENERAL.—The Secretary of Health and 24 Human Services, acting through the Assistant Sec- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00758 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 759 •S 4486 IS retary for Mental Health and Substance Use, shall 1 establish a program to award grants to eligible enti- 2 ties to address maternal mental health conditions 3 and substance use disorders with respect to preg- 4 nant and postpartum individuals, with a focus on ra- 5 cial and ethnic minority groups. 6 (2) APPLICATION.—To be eligible to receive a 7 grant under this subsection, an eligible entity shall 8 submit to the Secretary an application at such time, 9 in such manner, and containing such information as 10 the Secretary may provide, including how such entity 11 will use funds for activities described in paragraph 12 (4) that are culturally congruent. 13 (3) PRIORITY.—In awarding grants under this 14 subsection, the Secretary shall give priority to an eli- 15 gible entity that— 16 (A) is, or will partner with, a community- 17 based organization to address maternal mental 18 health conditions and substance use disorders 19 described in paragraph (1); 20 (B) is operating in an area with high rates 21 of— 22 (i) adverse maternal health outcomes; 23 or 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00759 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 760 •S 4486 IS (ii) significant racial or ethnic inequi- 1 ties in maternal health outcomes; and 2 (C) is operating in a health professional 3 shortage area designated under section 332 of 4 the Public Health Service Act (42 U.S.C. 5 254e). 6 (4) USE OF FUNDS.—An eligible entity that re- 7 ceives a grant under this subsection shall use funds 8 for the following: 9 (A) Establishing or expanding maternity 10 care programs to improve the integration of 11 maternal health and behavioral health care 12 services into primary care settings where preg- 13 nant individuals regularly receive health care 14 services. 15 (B) Establishing or expanding group pre- 16 natal care programs or postpartum care pro- 17 grams. 18 (C) Expanding existing programs that im- 19 prove maternal mental and behavioral health 20 during the prenatal and postpartum periods, 21 with a focus on individuals from racial and eth- 22 nic minority groups. 23 (D) Providing services and support for 24 pregnant and postpartum individuals with ma- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00760 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 761 •S 4486 IS ternal mental health conditions and substance 1 use disorders, including referrals to addiction 2 treatment centers that offer evidence-based 3 treatment options. 4 (E) Addressing stigma associated with ma- 5 ternal mental health conditions and substance 6 use disorders, with a focus on racial and ethnic 7 minority groups. 8 (F) Raising awareness of warning signs of 9 maternal mental health conditions and sub- 10 stance use disorders, with a focus on pregnant 11 and postpartum individuals from racial and eth- 12 nic minority groups. 13 (G) Establishing or expanding programs to 14 prevent suicide or self-harm among pregnant 15 and postpartum individuals. 16 (H) Offering evidence-aligned programs at 17 freestanding birth centers that provide maternal 18 mental and behavioral health care education, 19 treatments, and services, and other services for 20 individuals throughout the prenatal and 21 postpartum period. 22 (I) Establishing or expanding programs to 23 provide education and training to maternity 24 care providers with respect to— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00761 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 762 •S 4486 IS (i) identifying potential warning signs 1 for maternal mental health conditions or 2 substance use disorders in pregnant and 3 postpartum individuals, with a focus on in- 4 dividuals from racial and ethnic minority 5 groups; and 6 (ii) in the case where such providers 7 identify such warning signs, offering refer- 8 rals to mental and behavioral health care 9 professionals. 10 (J) Developing a website, or other source, 11 that includes information on health care pro- 12 viders who treat maternal mental health condi- 13 tions and substance use disorders. 14 (K) Establishing or expanding programs in 15 communities to improve coordination between 16 maternity care providers and mental and behav- 17 ioral health care providers who treat maternal 18 mental health conditions and substance use dis- 19 orders, including through the use of toll-free 20 hotlines. 21 (L) Carrying out other programs aligned 22 with evidence-based practices for addressing 23 maternal mental health conditions and sub- 24 stance use disorders for pregnant and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00762 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 763 •S 4486 IS postpartum individuals from racial and ethnic 1 minority groups. 2 (5) REPORTING.— 3 (A) ELIGIBLE ENTITIES.—An eligible enti- 4 ty that receives a grant under paragraph (1) 5 shall submit annually to the Secretary, and 6 make publicly available, a report on the activi- 7 ties conducted using funds received through a 8 grant under this subsection. Such reports shall 9 include quantitative and qualitative evaluations 10 of such activities, including the experience of in- 11 dividuals who received health care through such 12 grant. 13 (B) SECRETARY.—Not later than the end 14 of fiscal year 2024, the Secretary shall submit 15 to Congress a report that includes— 16 (i) a summary of the reports received 17 under subparagraph (A); 18 (ii) an evaluation of the effectiveness 19 of grants awarded under this subsection; 20 (iii) recommendations with respect to 21 expanding coverage of evidence-based 22 screenings and treatments for maternal 23 mental health conditions and substance use 24 disorders; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00763 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 764 •S 4486 IS (iv) recommendations with respect to 1 ensuring activities described under para- 2 graph (4) continue after the end of a grant 3 period. 4 (6) DEFINITIONS.—In this subsection: 5 (A) CULTURALLY CONGRUENT.—The term 6 ‘‘culturally congruent’’, with respect to care or 7 maternity care, means care that is in agreement 8 with the preferred cultural values, beliefs, 9 worldview, language, and practices of the health 10 care consumer and other stakeholders. 11 (B) ELIGIBLE ENTITY.—The term ‘‘eligible 12 entity’’ means— 13 (i) a community-based organization 14 serving pregnant and postpartum individ- 15 uals, including such organizations serving 16 individuals from racial and ethnic minority 17 groups and other underserved populations; 18 (ii) a nonprofit or patient advocacy 19 organization with expertise in maternal 20 mental and behavioral health; 21 (iii) a maternity care provider; 22 (iv) a mental or behavioral health care 23 provider who treats maternal mental health 24 conditions or substance use disorders; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00764 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 765 •S 4486 IS (v) a State or local governmental enti- 1 ty, including a State or local public health 2 department; 3 (vi) an Indian Tribe or Tribal organi- 4 zation (as such terms are defined in sec- 5 tion 4 of the Indian Self-Determination 6 and Education Assistance Act (25 U.S.C. 7 5304)); and 8 (vii) an Urban Indian organization (as 9 such term is defined in section 4 of the In- 10 dian Health Care Improvement Act (25 11 U.S.C. 1603)). 12 (C) FREESTANDING BIRTH CENTER.—The 13 term ‘‘freestanding birth center’’ has the mean- 14 ing given that term under section 1905(l) of the 15 Social Security Act (42 U.S.C. 1396d(1)). 16 (D) MATERNITY CARE PROVIDER.—The 17 term ‘‘maternity care provider’’ means a health 18 care provider who— 19 (i) is a physician, physician assistant, 20 midwife who meets at a minimum the 21 international definition of the midwife and 22 global standards for midwifery education 23 as established by the International Confed- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00765 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 766 •S 4486 IS eration of Midwives, nurse practitioner, or 1 clinical nurse specialist; and 2 (ii) has a focus on maternal or 3 perinatal health. 4 (E) SECRETARY.—The term ‘‘Secretary’’ 5 means the Secretary of Health and Human 6 Services. 7 (7) AUTHORIZATION OF APPROPRIATIONS.—To 8 carry out this subsection, there is authorized to be 9 appropriated $25,000,000 for each of fiscal years 10 2023 through 2026. 11 (b) GRANTS TO GROW AND DIVERSIFY THE MATER- 12 NAL MENTAL AND BEHAVIORAL HEALTH CARE WORK- 13 FORCE.—Title VII of the Public Health Service Act is 14 amended by inserting after section 757 of such Act (42 15 U.S.C. 294f) the following new section: 16 ‘‘SEC. 758. MATERNAL MENTAL AND BEHAVIORAL HEALTH 17 CARE WORKFORCE GRANTS. 18 ‘‘(a) IN GENERAL.—The Secretary may award grants 19 to entities to establish or expand programs described in 20 subsection (b) to grow and diversify the maternal mental 21 and behavioral health care workforce. 22 ‘‘(b) USE OF FUNDS.—Recipients of grants under 23 this section shall use the grants to grow and diversify the 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00766 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 767 •S 4486 IS maternal mental and behavioral health care workforce 1 by— 2 ‘‘(1) establishing schools or programs that pro- 3 vide education and training to individuals seeking 4 appropriate licensing or certification as mental or 5 behavioral health care providers who will specialize 6 in maternal mental health conditions or substance 7 use disorders; or 8 ‘‘(2) expanding the capacity of existing schools 9 or programs described in paragraph (1), for the pur- 10 poses of increasing the number of students enrolled 11 in such schools or programs, including by awarding 12 scholarships for students. 13 ‘‘(c) PRIORITIZATION.—In awarding grants under 14 this section, the Secretary shall give priority to any entity 15 that— 16 ‘‘(1) has demonstrated a commitment to re- 17 cruiting and retaining students and faculty from ra- 18 cial and ethnic minority groups; 19 ‘‘(2) has developed a strategy to recruit and re- 20 tain a diverse pool of students into the maternal 21 mental or behavioral health care workforce program 22 or school supported by funds received through the 23 grant, particularly from racial and ethnic minority 24 groups and other underserved populations; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00767 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 768 •S 4486 IS ‘‘(3) has developed a strategy to recruit and re- 1 tain students who plan to practice in a health pro- 2 fessional shortage area designated under section 3 332; 4 ‘‘(4) has developed a strategy to recruit and re- 5 tain students who plan to practice in an area with 6 significant racial and ethnic inequities in maternal 7 health outcomes, to the extent practicable; and 8 ‘‘(5) includes in the standard curriculum for all 9 students within the maternal mental or behavioral 10 health care workforce program or school a bias, rac- 11 ism, or discrimination training program that in- 12 cludes training on implicit bias and racism. 13 ‘‘(d) REPORTING.—As a condition on receipt of a 14 grant under this section for a maternal mental or behav- 15 ioral health care workforce program or school, an entity 16 shall agree to submit to the Secretary an annual report 17 on the activities conducted through the grant, including— 18 ‘‘(1) the number and demographics of students 19 participating in the program or school; 20 ‘‘(2) the extent to which students in the pro- 21 gram or school are entering careers in— 22 ‘‘(A) health professional shortage areas 23 designated under section 332; and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00768 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 769 •S 4486 IS ‘‘(B) areas with significant racial and eth- 1 nic inequities in maternal health outcomes, to 2 the extent such data are available; and 3 ‘‘(3) whether the program or school has in- 4 cluded in the standard curriculum for all students a 5 bias, racism, or discrimination training program that 6 includes training on implicit bias and racism, and if 7 so the effectiveness of such training program. 8 ‘‘(e) PERIOD OF GRANTS.—The period of a grant 9 under this section shall be up to 5 years. 10 ‘‘(f) APPLICATION.—To seek a grant under this sec- 11 tion, an entity shall submit to the Secretary an application 12 at such time, in such manner, and containing such infor- 13 mation as the Secretary may require, including any infor- 14 mation necessary for prioritization under subsection (c). 15 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 16 provide, directly or by contract, technical assistance to en- 17 tities seeking or receiving a grant under this section on 18 the development, use, evaluation, and post-grant period 19 sustainability of the maternal mental or behavioral health 20 care workforce programs or schools proposed to be, or 21 being, established or expanded through the grant. 22 ‘‘(h) REPORT BY THE SECRETARY.—Not later than 23 4 years after the date of enactment of this section, the 24 Secretary shall prepare and submit to the Congress, and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00769 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 770 •S 4486 IS post on the internet website of the Department of Health 1 and Human Services, a report on the effectiveness of the 2 grant program under this section at— 3 ‘‘(1) recruiting students from racial and ethnic 4 minority groups and other underserved populations; 5 ‘‘(2) increasing the number of mental or behav- 6 ioral health care providers specializing in maternal 7 mental health conditions or substance use disorders 8 from racial and ethnic minority groups and other 9 underserved populations; 10 ‘‘(3) increasing the number of mental or behav- 11 ioral health care providers specializing in maternal 12 mental health conditions or substance use disorders 13 working in health professional shortage areas des- 14 ignated under section 332; and 15 ‘‘(4) increasing the number of mental or behav- 16 ioral health care providers specializing in maternal 17 mental health conditions or substance use disorders 18 working in areas with significant racial and ethnic 19 inequities in maternal health outcomes, to the extent 20 such data are available. 21 ‘‘(i) DEFINITIONS.—In this section: 22 ‘‘(1) RACIAL AND ETHNIC MINORITY GROUP.— 23 The term ‘racial and ethnic minority group’ has the 24 meaning given such term in section 1707(g)(1). 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00770 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 771 •S 4486 IS ‘‘(2) MENTAL OR BEHAVIORAL HEALTH CARE 1 PROVIDER.—The term ‘mental or behavioral health 2 care provider’ refers to a health care provider in the 3 field of mental and behavioral health, including sub- 4 stance use disorders, acting in accordance with State 5 law. 6 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—To 7 carry out this section, there is authorized to be appro- 8 priated $15,000,000 for each of fiscal years 2023 through 9 2027.’’. 10 SEC. 5211. TASKFORCE RECOMMENDING IMPROVEMENTS 11 FOR UNADDRESSED MENTAL PERINATAL & 12 POSTPARTUM HEALTH (TRIUMPH) FOR NEW 13 MOMS. 14 Part B of title III of the Public Health Service Act 15 (42 U.S.C. 243 et seq.) is amended by inserting after sec- 16 tion 317L–1 (42 U.S.C. 247b–13a) the following: 17 ‘‘SEC. 317L–2. TASK FORCE ON MATERNAL MENTAL 18 HEALTH. 19 ‘‘(a) ESTABLISHMENT.—Not later than 90 days after 20 the date of enactment of this section, the Secretary shall 21 establish a task force, to be known as the Task Force on 22 Maternal Mental Health (in this section referred to as the 23 ‘Task Force’) to identify, evaluate, and make rec- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00771 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 772 •S 4486 IS ommendations to coordinate and improve, Federal re- 1 sponses to maternal mental health conditions. 2 ‘‘(b) MEMBERSHIP.— 3 ‘‘(1) COMPOSITION.—The Task Force shall be 4 composed of— 5 ‘‘(A) the Assistant Secretary for Health of 6 the Department of Health and Human Services 7 (or the Assistant Secretary’s designee) who 8 shall serve as the Chair of the Task Force; 9 ‘‘(B) the Federal members under para- 10 graph (2); and 11 ‘‘(C) the non-Federal members under para- 12 graph (3). 13 ‘‘(2) FEDERAL MEMBERS.—In addition to the 14 Assistant Secretary for Health, the Federal mem- 15 bers of the Task Force shall consist of the heads of 16 the following Federal departments and agencies (or 17 their designees): 18 ‘‘(A) The Administration for Children and 19 Families. 20 ‘‘(B) The Agency for Healthcare Research 21 and Quality. 22 ‘‘(C) The Centers for Disease Control and 23 Prevention. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00772 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 773 •S 4486 IS ‘‘(D) The Centers for Medicare & Medicaid 1 Services. 2 ‘‘(E) The Health Resources and Services 3 Administration. 4 ‘‘(F) The Food and Drug Administration. 5 ‘‘(G) The Indian Health Service. 6 ‘‘(H) The Office of the Assistant Secretary 7 for Planning and Evaluation of the Department 8 of Health and Human Services. 9 ‘‘(I) The Office of Minority Health of the 10 Department of Health and Human Services. 11 ‘‘(J) The Office of the Surgeon General of 12 the Department of Health and Human Services. 13 ‘‘(K) The Office on Women’s Health of the 14 Department of Health and Human Services. 15 ‘‘(L) The National Institutes of Health. 16 ‘‘(M) The Substance Abuse and Mental 17 Health Services Administration. 18 ‘‘(N) Such other Federal departments and 19 agencies as the Secretary determines that serve 20 individuals with maternal mental health condi- 21 tions, such as the Department of Veterans Af- 22 fairs, the Department of Justice, the Depart- 23 ment of Labor, the Department of Housing and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00773 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 774 •S 4486 IS Urban Development, and the Department of 1 Defense. 2 ‘‘(3) NON-FEDERAL MEMBERS.—The non-Fed- 3 eral members of the Task Force shall— 4 ‘‘(A) compose not more than one-half, and 5 not less than one-third, of the total membership 6 of the Task Force; 7 ‘‘(B) be appointed by the Secretary; and 8 ‘‘(C) include— 9 ‘‘(i) representatives of medical soci- 10 eties with expertise in maternal or mental 11 health; 12 ‘‘(ii) representatives of nonprofit orga- 13 nizations with expertise in maternal or 14 mental health; 15 ‘‘(iii) relevant industry representa- 16 tives; and 17 ‘‘(iv) other representatives, as appro- 18 priate. 19 ‘‘(4) DEADLINE FOR DESIGNATING DES- 20 IGNEES.—If the Assistant Secretary for Health, or 21 the head of a Federal department or agency serving 22 as a member of the Task Force under paragraph 23 (2), chooses to be represented on the Task Force by 24 a designee, the Assistant Secretary or head shall 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00774 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 775 •S 4486 IS designate such designee not later than 90 days after 1 the date of the enactment of this section. 2 ‘‘(c) DUTIES.—The Task Force shall— 3 ‘‘(1) create and regularly update a report that 4 identifies, analyzes, and evaluates the state of na- 5 tional maternal mental health policy and programs 6 at the Federal, State, and local levels, and identifies 7 best practices including— 8 ‘‘(A) a set of evidence-based, evidence-in- 9 formed, and promising practices with respect 10 to— 11 ‘‘(i) prevention strategies for individ- 12 uals at risk of experiencing a maternal 13 mental health condition, including strate- 14 gies and recommendations to address so- 15 cial determinants of health; 16 ‘‘(ii) the identification, screening, di- 17 agnosis, intervention, and treatment of in- 18 dividuals and families affected by a mater- 19 nal mental health condition; 20 ‘‘(iii) the expeditious referral to, and 21 implementation of, practices and supports 22 that prevent and mitigate the effects of a 23 maternal mental health condition, includ- 24 ing strategies and recommendations to 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00775 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 776 •S 4486 IS eliminate the racial and ethnic inequities 1 that exist in maternal mental health; and 2 ‘‘(iv) community-based or 3 multigenerational practices that support 4 individuals and families affected by a ma- 5 ternal mental health condition; and 6 ‘‘(B) Federal and State programs and ac- 7 tivities to prevent, screen, diagnose, intervene, 8 and treat maternal mental health conditions; 9 ‘‘(2) develop and regularly update a national 10 strategy for maternal mental health, taking into con- 11 sideration the findings of the reports under para- 12 graph (1), on how the Task Force and Federal de- 13 partments and agencies represented on the Task 14 Force will prioritize options for, and implement a co- 15 ordinated approach to, addressing maternal mental 16 health conditions, including by— 17 ‘‘(A) increasing prevention, screening, di- 18 agnosis, intervention, treatment, and access to 19 care, including clinical and nonclinical care such 20 as peer-support and community health workers, 21 through the public and private sectors; 22 ‘‘(B) providing support for pregnant or 23 postpartum individuals who are at risk for or 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00776 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 777 •S 4486 IS experiencing a maternal mental health condi- 1 tion, and their families as appropriate; 2 ‘‘(C) reducing racial, ethnic, geographic, 3 and other health inequities for prevention, diag- 4 nosis, intervention, treatment, and access to 5 care; 6 ‘‘(D) identifying opportunities for local- 7 and State-level partnerships; 8 ‘‘(E) identifying options for modifying, 9 strengthening, and coordinating Federal pro- 10 grams and activities, including existing infant 11 and maternity programs, such as the Medicaid 12 program under title XIX of the Social Security 13 Act and the State Children’s Health Insurance 14 Program under title XXI of such Act, in order 15 to increase research, prevention, identification, 16 intervention, and treatment with respect to ma- 17 ternal mental health; 18 ‘‘(F) providing recommendations to ensure 19 research, services, supports, and prevention ac- 20 tivities are not unnecessarily duplicative; and 21 ‘‘(G) planning, data sharing, and commu- 22 nication within and across Federal depart- 23 ments, agencies, offices, and programs; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00777 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 778 •S 4486 IS ‘‘(3) solicit public comments from stakeholders 1 for the report under paragraph (1) and the national 2 strategy under paragraph (2), including comments 3 from frontline service providers, mental health pro- 4 fessionals, researchers, experts in maternal mental 5 health, institutions of higher education, public health 6 agencies (including maternal and child health pro- 7 grams), and industry representatives, in order to in- 8 form the activities and reports of the Task Force; 9 and 10 ‘‘(4) disaggregate any data collected under this 11 section by race, ethnicity, geographical location, age, 12 marital status, socioeconomic level, and other factors 13 as determined appropriate by the Secretary. 14 ‘‘(d) MEETINGS.—The Task Force shall— 15 ‘‘(1) meet not less than two times each year; 16 and 17 ‘‘(2) convene public meetings, as appropriate, to 18 fulfill its duties under this section. 19 ‘‘(e) REPORTS TO PUBLIC AND FEDERAL LEAD- 20 ERS.—The Task Force shall make publicly available and 21 submit to the heads of relevant Federal departments and 22 agencies, the Committee on Energy and Commerce of the 23 House of Representatives, the Committee on Health, Edu- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00778 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 779 •S 4486 IS cation, Labor, and Pensions of the Senate, and other rel- 1 evant congressional committees, the following: 2 ‘‘(1) Not later than 1 year after the first meet- 3 ing of the Task Force, an initial report under sub- 4 section (c)(1). 5 ‘‘(2) Not later than 2 years after the first meet- 6 ing of the Task Force, an initial national strategy 7 under subsection (c)(2). 8 ‘‘(3) Each year thereafter— 9 ‘‘(A) an updated report under subsection 10 (c)(1); 11 ‘‘(B) an updated national strategy under 12 subsection (c)(2); or 13 ‘‘(C) if no such update is made, a report 14 summarizing the activities of the Task Force. 15 ‘‘(f) REPORTS TO GOVERNORS.—Upon finalizing the 16 initial national strategy under subsection (c)(2), and upon 17 making relevant updates to such strategy, the Task Force 18 shall submit a report to the Governors of all States de- 19 scribing opportunities for local- and State-level partner- 20 ships identified under subsection (c)(2)(D). 21 ‘‘(g) SUNSET.—The Task Force shall terminate on 22 the date that is 6 years after the date on which the Task 23 Force is established under subsection (a).’’. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00779 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 780 •S 4486 IS SEC. 5212. PROTECT MOMS FROM DOMESTIC VIOLENCE. 1 (a) STUDY BY DEPARTMENT OF HEALTH AND 2 HUMAN SERVICES.— 3 (1) STUDY.—The Secretary, in collaboration 4 with the Health Resources and Services Administra- 5 tion, the Substance Abuse and Mental Health Serv- 6 ices Administration, and the Administration for 7 Children and Families, and in consultation with the 8 Attorney General of the United States, the Director 9 of the Indian Health Service, and stakeholders (in- 10 cluding community-based organizations, culturally 11 specific organizations, and Tribal public health au- 12 thorities), shall conduct a study on the extent to 13 which individuals are more at risk of maternal mor- 14 tality or severe maternal morbidity as a result of 15 being a victim of domestic violence, dating violence, 16 sexual assault, stalking, human trafficking, sex traf- 17 ficking, child sexual abuse, or forced marriage. 18 (2) REPORTS.—Not later than 2 years after the 19 date of enactment of this Act, the Secretary shall 20 complete the study under paragraph (1) and submit 21 a report to the Congress on the results of such 22 study. Such report shall include— 23 (A) an analysis of the extent to which do- 24 mestic violence, dating violence, sexual assault, 25 stalking, human trafficking, sex trafficking, 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00780 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 781 •S 4486 IS child sexual abuse, and forced marriage con- 1 tribute to, or result in, maternal mortality; 2 (B) an analysis of the impact of domestic 3 violence, dating violence, sexual assault, stalk- 4 ing, human trafficking, sex trafficking, child 5 sexual abuse, and forced marriage on access to 6 health care (including mental health care) and 7 substance use disorder treatment and recovery 8 support; 9 (C) a breakdown (including by race and 10 ethnicity) of categories of individuals who are 11 disproportionately victims of domestic violence, 12 dating violence, sexual assault, stalking, human 13 trafficking, sex trafficking, child sexual abuse, 14 or forced marriage that contributes to, or re- 15 sults in, pregnancy-related death; 16 (D) an analysis of the impact on health, 17 mental health, and substance use resulting from 18 domestic violence, dating violence, sexual as- 19 sault, stalking, human trafficking, sex traf- 20 ficking, child sexual abuse, and forced marriage 21 among Alaskan Natives, Native Hawaiians, and 22 American Indians during the prenatal and 23 postpartum period; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00781 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 782 •S 4486 IS (E) an assessment of the factors that in- 1 crease or decrease risks for maternal mortality 2 or severe maternal morbidity among victims of 3 domestic violence, dating violence, sexual as- 4 sault, stalking, human trafficking, sex traf- 5 ficking, child sexual abuse, or forced marriage; 6 (F) an assessment of increased risk of ma- 7 ternal mortality or severe maternal morbidity 8 stemming from suicide, substance use disorders, 9 or drug overdose due to domestic violence, dat- 10 ing violence, sexual assault, stalking, human 11 trafficking, sex trafficking, child sexual abuse, 12 or forced marriage; 13 (G) recommendations for legislative or pol- 14 icy changes— 15 (i) to reduce maternal mortality rates; 16 and 17 (ii) to address health inequities that 18 contribute to inequities in such rates and 19 deaths; 20 (H) best practices to reduce maternal mor- 21 tality and severe maternal morbidity among vic- 22 tims of domestic violence, dating violence, sex- 23 ual assault, stalking, human trafficking, sex 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00782 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 783 •S 4486 IS trafficking, child sexual abuse, and forced mar- 1 riage, including— 2 (i) reducing reproductive coercion, 3 mental health conditions, and substance 4 use coercion; and 5 (ii) routinely assessing pregnant peo- 6 ple for domestic violence and other forms 7 of reproductive violence; and 8 (I) any other information on maternal 9 mortality or severe maternal morbidity the Sec- 10 retary determines appropriate to include in the 11 report. 12 (b) STUDY BY NATIONAL ACADEMY OF MEDICINE.— 13 (1) IN GENERAL.—The Secretary shall seek to 14 enter into an arrangement with the National Acad- 15 emy of Medicine (or, if the Academy declines to 16 enter into such arrangement, another appropriate 17 entity) to study— 18 (A) the impact of domestic violence, dating 19 violence, sexual assault, stalking, human traf- 20 ficking, sex trafficking, child sexual abuse, and 21 forced marriage on an individual’s health; rel- 22 ative to 23 (B) maternal mortality and severe mater- 24 nal morbidity. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00783 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 784 •S 4486 IS (2) TOPICS.—The study under paragraph (1) 1 shall— 2 (A) examine— 3 (i) whether domestic violence, dating 4 violence, sexual assault, stalking, human 5 trafficking, sex trafficking, child sexual 6 abuse, or forced marriage, or generational 7 intimate partner violence, trauma, and psy- 8 chiatric disorders, increase the risk of sui- 9 cide, substance use, and drug overdose 10 among pregnant and postpartum persons; 11 and 12 (ii) the intersection of domestic vio- 13 lence, dating violence, sexual assault, stalk- 14 ing, human trafficking, sex trafficking, 15 child sexual abuse, and forced marriage as 16 a social determinant of health; and 17 (B) give particular focus to impacts among 18 African American, American Indian, Native Ha- 19 waiian, Alaskan Native, and LGBTQ birthing 20 persons. 21 (c) GRANTS FOR INNOVATIVE APPROACHES.— 22 (1) IN GENERAL.—The Secretary, acting 23 through the Administrator of the Health Resources 24 and Services Administration, and in collaboration 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00784 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 785 •S 4486 IS with the Administration for Children and Families, 1 the Indian Health Service, and the Substance Abuse 2 and Mental Health Services Administration, shall 3 award grants to eligible entities for developing and 4 implementing innovative approaches to improve ma- 5 ternal and child health outcomes of victims of do- 6 mestic violence, dating violence, sexual assault, 7 stalking, human trafficking, sex trafficking, child 8 sexual abuse, or forced marriage. 9 (2) ELIGIBLE ENTITY.—To seek a grant under 10 this subsection, an entity shall be— 11 (A) a State, local, or federally recognized 12 Tribal government; 13 (B) a nonprofit organization or commu- 14 nity-based organization that provides prevention 15 or intervention services related to domestic vio- 16 lence, dating violence, sexual assault, stalking, 17 human trafficking, sex trafficking, child sexual 18 abuse, or forced marriage; 19 (C) a tribal organization or Urban Indian 20 organization (as such terms are defined in sec- 21 tion 4 of the Indian Health Care Improvement 22 Act (25 U.S.C. 1603)); 23 (D) an entity, the principal purpose of 24 which is to provide health care, such as a hos- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00785 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 786 •S 4486 IS pital, clinic, health department, freestanding 1 birthing center, perinatal health worker, or ma- 2 ternity care provider; 3 (E) an institution of higher education; or 4 (F) a comprehensive substance use dis- 5 order parenting program. 6 (3) PRIORITY.—In awarding grants under this 7 subsection, the Secretary shall give priority to appli- 8 cants proposing to address— 9 (A) mental health and substance use dis- 10 orders among pregnant persons; or 11 (B) pregnant and postpartum persons ex- 12 periencing intimate partner violence. 13 (4) FREESTANDING BIRTH CENTER DEFINED.— 14 In this subsection, the term ‘‘freestanding birth cen- 15 ter’’ has the meaning given that term in section 16 1905(l) of the Social Security Act (42 U.S.C. 17 1396d(1)). 18 (5) AUTHORIZATION OF APPROPRIATIONS.—To 19 carry out this subsection, there is authorized to be 20 appropriated $25,000,000 for the period of fiscal 21 years 2023 through 2025. 22 (d) GUIDANCE.—Not later than 2 years after the 23 date of enactment of this Act, the Secretary shall issue 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00786 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 787 •S 4486 IS and disseminate guidance to States, Tribes, territories, 1 maternity care providers, and managed care entities on— 2 (1) providing universal education on healthy re- 3 lationships and intimate partner violence; 4 (2) developing protocols on— 5 (A) routine assessment of intimate partner 6 violence; and 7 (B) health promotion and strategies for 8 trauma-informed care plans; and 9 (3) creating sustainable partnerships with com- 10 munity-based organizations that address domestic vi- 11 olence, dating violence, sexual assault, stalking, 12 human trafficking, sex trafficking, child sexual 13 abuse, or forced marriage. 14 (e) DEFINITIONS.—In this section: 15 (1) The term ‘‘maternal mortality’’— 16 (A) means death that— 17 (i) occurs during, or within the 1-year 18 period after, pregnancy; and 19 (ii) is attributed to or aggravated by 20 pregnancy-related or childbirth complica- 21 tions; and 22 (B) includes a suicide, drug overdose 23 death, homicide (including a domestic violence- 24 related homicide), or other death resulting from 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00787 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 788 •S 4486 IS a mental health or substance use disorder at- 1 tributed to or aggravated by pregnancy-related 2 or childbirth complications. 3 (2) The term ‘‘maternity care provider’’ means 4 a health care provider who— 5 (A) is a physician, physician assistant, 6 nurse, midwife who meets at a minimum the 7 international definition of the midwife and glob- 8 al standards for midwifery education as estab- 9 lished by the International Confederation of 10 Midwives, nurse practitioner, or clinical nurse 11 specialist; and 12 (B) has a focus on maternal or perinatal 13 health. 14 (3) The term ‘‘perinatal health worker’’ means 15 a worker who— 16 (A) is a doula, community health worker, 17 peer supporter, breastfeeding and lactation edu- 18 cator or counselor, nutritionist or dietitian, 19 childbirth educator, social worker, home visitor, 20 language interpreter, or navigator; and 21 (B) provides assistance with perinatal 22 health. 23 (4) The term ‘‘postpartum’’ refers to the 12- 24 month period following childbirth. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00788 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 789 •S 4486 IS (5) The term ‘‘Secretary’’ means the Secretary 1 of Health and Human Services. 2 (6) The term ‘‘severe maternal morbidity’’ 3 means a health condition, including a mental health 4 condition or substance use disorder, that— 5 (A) is attributed to or aggravated by preg- 6 nancy or childbirth; and 7 (B) results in significant short-term or 8 long-term consequences to the health of the in- 9 dividual who was pregnant. 10 SEC. 5213. PERINATAL WORKFORCE. 11 (a) HHS AGENCY DIRECTIVES.— 12 (1) GUIDANCE TO STATES.— 13 (A) IN GENERAL.—Not later than 2 years 14 after the date of enactment of this Act, the Sec- 15 retary of Health and Human Services shall 16 issue and disseminate guidance to States to 17 educate providers, managed care entities, and 18 other insurers about the value and process of 19 delivering respectful maternal health care 20 through diverse and multidisciplinary care pro- 21 vider models. 22 (B) CONTENTS.—The guidance required 23 by subparagraph (A) shall address how States 24 can encourage and incentivize hospitals, health 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00789 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 790 •S 4486 IS systems, midwifery practices, freestanding birth 1 centers, other maternity care provider groups, 2 managed care entities, and other insurers— 3 (i) to recruit and retain maternity 4 care providers, mental and behavioral 5 health care providers acting in accordance 6 with State law, registered dietitians or nu- 7 trition professionals (as such term is de- 8 fined in section 1861(vv)(2) of the Social 9 Security Act (42 U.S.C. 1395x(vv)(2))), 10 and lactation consultants certified by the 11 International Board of Lactation Consult- 12 ants Examiners— 13 (I) from racially, ethnically, and 14 linguistically diverse backgrounds; 15 (II) with experience practicing in 16 racially and ethnically diverse commu- 17 nities; and 18 (III) who have undergone train- 19 ing on implicit bias and racism; 20 (ii) to incorporate into maternity care 21 teams— 22 (I) midwives who meet, at a min- 23 imum, the international definition of 24 the midwife and global standards for 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00790 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 791 •S 4486 IS midwifery education, as established by 1 the International Confederation of 2 Midwives; and 3 (II) perinatal health workers; 4 (iii) to provide collaborative, culturally 5 congruent care; and 6 (iv) to provide opportunities for indi- 7 viduals enrolled in accredited midwifery 8 education programs to participate in job 9 shadowing with maternity care teams in 10 hospitals, health systems, midwifery prac- 11 tices, and freestanding birth centers. 12 (2) STUDY ON RESPECTFUL AND CULTURALLY 13 CONGRUENT MATERNITY CARE.— 14 (A) STUDY.—The Secretary of Health and 15 Human Services, acting through the Director of 16 the National Institutes of Health (in this para- 17 graph referred to as the ‘‘Secretary’’), shall 18 conduct a study on best practices in respectful 19 and culturally congruent maternity care. 20 (B) REPORT.—Not later than 2 years after 21 the date of enactment of this Act, the Secretary 22 shall— 23 (i) complete the study required by 24 subparagraph (A); 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00791 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 792 •S 4486 IS (ii) submit to the Congress, and make 1 publicly available, a report on the results 2 of such study; and 3 (iii) include in such report— 4 (I) a compendium of examples of 5 hospitals, health systems, midwifery 6 practices, freestanding birth centers, 7 other maternity care provider groups, 8 managed care entities, and other in- 9 surers that are delivering respectful 10 and culturally congruent maternal 11 health care; 12 (II) a compendium of examples 13 of hospitals, health systems, midwifery 14 practices, freestanding birth centers, 15 other maternity care provider groups, 16 managed care entities, and other in- 17 surers that have made progress in re- 18 ducing inequities in maternal health 19 outcomes and improving birthing ex- 20 periences for pregnant and 21 postpartum individuals from racial 22 and ethnic minority groups; and 23 (III) recommendations to hos- 24 pitals, health systems, midwifery prac- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00792 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 793 •S 4486 IS tices, freestanding birth centers, other 1 maternity care provider groups, man- 2 aged care entities, and other insurers, 3 for best practices in respectful and 4 culturally congruent maternity care. 5 (b) GRANTS TO GROW AND DIVERSIFY THE 6 PERINATAL WORKFORCE.—Title VII of the Public Health 7 Service Act is amended by inserting after section 758, as 8 added by section 5210(b), the following new section: 9 ‘‘SEC. 758A. PERINATAL WORKFORCE GRANTS. 10 ‘‘(a) IN GENERAL.—The Secretary shall award 11 grants to entities to establish or expand programs de- 12 scribed in subsection (b) to grow and diversify the 13 perinatal workforce. 14 ‘‘(b) USE OF FUNDS.—Recipients of grants under 15 this section shall use the grants to grow and diversify the 16 perinatal workforce by— 17 ‘‘(1) establishing schools or programs that pro- 18 vide education and training to individuals seeking 19 appropriate licensing or certification as— 20 ‘‘(A) physician assistants who will complete 21 clinical training in the field of maternal and 22 perinatal health; or 23 ‘‘(B) perinatal health workers; and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00793 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 794 •S 4486 IS ‘‘(2) expanding the capacity of existing schools 1 or programs described in paragraph (1), for the pur- 2 poses of increasing the number of students enrolled 3 in such schools or programs, including by awarding 4 scholarships for students. 5 ‘‘(c) PRIORITIZATION.—In awarding grants under 6 this section, the Secretary shall give priority to any entity 7 that— 8 ‘‘(1) has demonstrated a commitment to re- 9 cruiting and retaining students and faculty from ra- 10 cial and ethnic minority groups; 11 ‘‘(2) has developed a strategy to recruit and re- 12 tain a diverse pool of students into the perinatal 13 workforce program or school supported by funds re- 14 ceived through the grant, particularly from racial 15 and ethnic minority groups and other underserved 16 populations; 17 ‘‘(3) has developed a strategy to recruit and re- 18 tain students who plan to practice in a health pro- 19 fessional shortage area designated under section 20 332; 21 ‘‘(4) has developed a strategy to recruit and re- 22 tain students who plan to practice in an area with 23 significant racial and ethnic inequities in maternal 24 health outcomes, to the extent practicable; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00794 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 795 •S 4486 IS ‘‘(5) includes in the standard curriculum for all 1 students within the perinatal workforce program or 2 school a bias, racism, or discrimination training pro- 3 gram that includes training on implicit bias and rac- 4 ism. 5 ‘‘(d) REPORTING.—As a condition on receipt of a 6 grant under this section for a perinatal workforce program 7 or school, an entity shall agree to submit to the Secretary 8 an annual report on the activities conducted through the 9 grant, including— 10 ‘‘(1) the number and demographics of students 11 participating in the program or school; 12 ‘‘(2) the extent to which students in the pro- 13 gram or school are entering careers in— 14 ‘‘(A) health professional shortage areas 15 designated under section 332; and 16 ‘‘(B) areas with significant racial and eth- 17 nic inequities in maternal health outcomes, to 18 the extent such data are available; and 19 ‘‘(3) whether the program or school has in- 20 cluded in the standard curriculum for all students a 21 bias, racism, or discrimination training program that 22 includes explicit and implicit bias, and if so the ef- 23 fectiveness of such training program. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00795 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 796 •S 4486 IS ‘‘(e) PERIOD OF GRANTS.—The period of a grant 1 under this section shall not exceed 5 years. 2 ‘‘(f) APPLICATION.—To seek a grant under this sec- 3 tion, an entity shall submit to the Secretary an application 4 at such time, in such manner, and containing such infor- 5 mation as the Secretary may require, including any infor- 6 mation necessary for prioritization under subsection (c). 7 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 8 provide, directly or by contract, technical assistance to en- 9 tities seeking or receiving a grant under this section on 10 the development, use, evaluation, and post-grant period 11 sustainability of the perinatal workforce programs or 12 schools proposed to be, or being, established or expanded 13 through the grant. 14 ‘‘(h) REPORT BY THE SECRETARY.—Not later than 15 4 years after the date of enactment of this section, the 16 Secretary shall prepare and submit to the Congress, and 17 post on the internet website of the Department of Health 18 and Human Services, a report on the effectiveness of the 19 grant program under this section at— 20 ‘‘(1) recruiting students from racial and ethnic 21 minority groups; 22 ‘‘(2) increasing the number of physician assist- 23 ants who will complete clinical training in the field 24 of maternal and perinatal health, and perinatal 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00796 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 797 •S 4486 IS health workers, from racial and ethnic minority 1 groups and other underserved populations; 2 ‘‘(3) increasing the number of physician assist- 3 ants who will complete clinical training in the field 4 of maternal and perinatal health, and perinatal 5 health workers, working in health professional short- 6 age areas designated under section 332; and 7 ‘‘(4) increasing the number of physician assist- 8 ants who will complete clinical training in the field 9 of maternal and perinatal health, and perinatal 10 health workers, working in areas with significant ra- 11 cial and ethnic inequities in maternal health out- 12 comes, to the extent such data are available. 13 ‘‘(i) DEFINITION.—In this section, the term ‘racial 14 and ethnic minority group’ has the meaning given such 15 term in section 1707(g). 16 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—To 17 carry out this section, there is authorized to be appro- 18 priated $15,000,000 for each of fiscal years 2023 through 19 2027.’’. 20 (c) GRANTS TO GROW AND DIVERSIFY THE NURSING 21 WORKFORCE IN MATERNAL AND PERINATAL HEALTH.— 22 Title VIII of the Public Health Service Act is amended 23 by inserting after section 811 of that Act (42 U.S.C. 296j) 24 the following: 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00797 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 798 •S 4486 IS ‘‘SEC. 812. PERINATAL NURSING WORKFORCE GRANTS. 1 ‘‘(a) IN GENERAL.—The Secretary shall award 2 grants to schools of nursing to grow and diversify the 3 perinatal nursing workforce. 4 ‘‘(b) USE OF FUNDS.—Recipients of grants under 5 this section shall use the grants to grow and diversify the 6 perinatal nursing workforce by providing scholarships to 7 students seeking to become— 8 ‘‘(1) nurse practitioners whose education in- 9 cludes a focus on maternal and perinatal health; or 10 ‘‘(2) clinical nurse specialists whose education 11 includes a focus on maternal and perinatal health. 12 ‘‘(c) PRIORITIZATION.—In awarding grants under 13 this section, the Secretary shall give priority to any school 14 of nursing that— 15 ‘‘(1) has developed a strategy to recruit and re- 16 tain a diverse pool of students seeking to enter ca- 17 reers focused on maternal and perinatal health, par- 18 ticularly students from racial and ethnic minority 19 groups and other underserved populations; 20 ‘‘(2) has developed a partnership with a prac- 21 tice setting in a health professional shortage area 22 designated under section 332 for the clinical place- 23 ments of the school’s students; 24 ‘‘(3) has developed a strategy to recruit and re- 25 tain students who plan to practice in an area with 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00798 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 799 •S 4486 IS significant racial and ethnic inequities in maternal 1 health outcomes, to the extent practicable; and 2 ‘‘(4) includes in the standard curriculum for all 3 students seeking to enter careers focused on mater- 4 nal and perinatal health a bias, racism, or discrimi- 5 nation training program that includes education on 6 implicit bias and racism. 7 ‘‘(d) REPORTING.—As a condition on receipt of a 8 grant under this section, a school of nursing shall agree 9 to submit to the Secretary an annual report on the activi- 10 ties conducted through the grant, including, to the extent 11 practicable— 12 ‘‘(1) the number and demographics of students 13 in the school of nursing seeking to enter careers fo- 14 cused on maternal and perinatal health; 15 ‘‘(2) the extent to which such students are pre- 16 paring to enter careers in— 17 ‘‘(A) health professional shortage areas 18 designated under section 332; and 19 ‘‘(B) areas with significant racial and eth- 20 nic inequities in maternal health outcomes, to 21 the extent such data are available; and 22 ‘‘(3) whether the standard curriculum for all 23 students seeking to enter careers focused on mater- 24 nal and perinatal health includes a bias, racism, or 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00799 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 800 •S 4486 IS discrimination training program that includes edu- 1 cation on implicit bias and racism. 2 ‘‘(e) PERIOD OF GRANTS.—The period of a grant 3 under this section shall be up to 5 years. 4 ‘‘(f) APPLICATION.—To seek a grant under this sec- 5 tion, an entity shall submit to the Secretary an applica- 6 tion, at such time, in such manner, and containing such 7 information as the Secretary may require, including any 8 information necessary for prioritization under subsection 9 (c). 10 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 11 provide, directly or by contract, technical assistance to 12 schools of nursing seeking or receiving a grant under this 13 section on the processes of awarding and evaluating schol- 14 arships through the grant. 15 ‘‘(h) REPORT BY THE SECRETARY.—Not later than 16 4 years after the date of enactment of this section, the 17 Secretary shall prepare and submit to the Congress, and 18 post on the internet website of the Department of Health 19 and Human Services, a report on the effectiveness of the 20 grant program under this section at— 21 ‘‘(1) recruiting students from racial and ethnic 22 minority groups and other underserved populations; 23 ‘‘(2) increasing the number of nurse practi- 24 tioners and clinical nurse specialists entering careers 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00800 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 801 •S 4486 IS focused on maternal and perinatal health from racial 1 and ethnic minority groups and other underserved 2 populations; 3 ‘‘(3) increasing the number of nurse practi- 4 tioners and clinical nurse specialists entering careers 5 focused on maternal and perinatal health working in 6 health professional shortage areas designated under 7 section 332; and 8 ‘‘(4) increasing the number of nurse practi- 9 tioners and clinical nurse specialists entering careers 10 focused on maternal and perinatal health working in 11 areas with significant racial and ethnic inequities in 12 maternal health outcomes, to the extent such data 13 are available. 14 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—To 15 carry out this section, there is authorized to be appro- 16 priated $15,000,000 for each of fiscal years 2023 through 17 2027.’’. 18 (d) GAO REPORT.— 19 (1) IN GENERAL.—Not later than 2 years after 20 the date of enactment of this Act, and every 5 years 21 thereafter, the Comptroller General of the United 22 States shall submit to Congress a report on barriers 23 to maternal health education and access to care in 24 the United States. Such report shall include the in- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00801 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 802 •S 4486 IS formation and recommendations described in para- 1 graph (2). 2 (2) CONTENT OF REPORT.—The report under 3 paragraph (1) shall include— 4 (A) an assessment of current barriers to 5 entering accredited midwifery education pro- 6 grams, and recommendations for addressing 7 such barriers, particularly for low-income people 8 and people from racial and ethnic minority 9 groups; 10 (B) an assessment of current barriers to 11 entering and successfully completing accredited 12 education programs for other health profes- 13 sional careers related to maternity care, includ- 14 ing maternity care providers, mental and behav- 15 ioral health care providers acting in accordance 16 with State law, registered dietitians or nutrition 17 professionals (as such term is defined in section 18 1861(vv)(2) of the Social Security Act (42 19 U.S.C. 1395x(vv)(2))), and lactation consult- 20 ants certified by the International Board of 21 Lactation Consultants Examiners, particularly 22 for low-income people and people from racial 23 and ethnic minority groups; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00802 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 803 •S 4486 IS (C) an assessment of current barriers that 1 prevent midwives from meeting the inter- 2 national definition of the midwife and global 3 standards for midwifery education as estab- 4 lished by the International Confederation of 5 Midwives, and recommendations for addressing 6 such barriers, particularly for low-income people 7 and people from racial and ethnic minority 8 groups; 9 (D) an assessment of inequities in access 10 to maternity care providers, mental or behav- 11 ioral health care providers acting in accordance 12 with State law, registered dietitians or nutrition 13 professionals (as such term is defined in section 14 1861(vv)(2) of the Social Security Act (42 15 U.S.C. 1395x(vv)(2))), lactation consultants 16 certified by the International Board of Lacta- 17 tion Consultants Examiners, and perinatal 18 health workers, stratified by race, ethnicity, 19 gender identity, geographic location, and insur- 20 ance type and recommendations to promote 21 greater access equity; and 22 (E) recommendations to promote greater 23 equity in compensation for perinatal health 24 workers under public and private insurers, par- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00803 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 804 •S 4486 IS ticularly for such individuals from racially and 1 ethnically diverse backgrounds. 2 (e) DEFINITIONS.—In this section: 3 (1) CULTURALLY CONGRUENT.—The term ‘‘cul- 4 turally congruent’’, with respect to care or maternity 5 care, means care that is in agreement with the pre- 6 ferred cultural values, beliefs, worldview, language, 7 and practices of the health care consumer and other 8 stakeholders. 9 (2) MATERNITY CARE PROVIDER.—The term 10 ‘‘maternity care provider’’ means a health care pro- 11 vider who— 12 (A) is a physician, physician assistant, 13 midwife who meets at a minimum the inter- 14 national definition of the midwife and global 15 standards for midwifery education as estab- 16 lished by the International Confederation of 17 Midwives, nurse practitioner, or clinical nurse 18 specialist; and 19 (B) has a focus on maternal or perinatal 20 health. 21 (3) PERINATAL HEALTH WORKER.—The term 22 ‘‘perinatal health worker’’ means a doula, commu- 23 nity health worker, peer supporter, breastfeeding 24 and lactation educator or counselor, nutritionist or 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00804 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 805 •S 4486 IS dietitian, childbirth educator, social worker, home 1 visitor, language interpreter, or navigator. 2 (4) POSTPARTUM AND POSTPARTUM PERIOD.— 3 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 4 refer to the 1-year period beginning on the last day 5 of the pregnancy of an individual. 6 (5) RACIAL AND ETHNIC MINORITY GROUP.— 7 The term ‘‘racial and ethnic minority group’’ has the 8 meaning given such term in section 1707(g)(1) of 9 the Public Health Service Act (42 U.S.C. 300u– 10 6(g)(1)). 11 SEC. 5214. MIDWIVES SCHOOLS AND PROGRAMS EXPAN- 12 SION. 13 (a) MIDWIFERY SCHOOLS AND PROGRAMS.— 14 (1) IN GENERAL.—Title VII of the Public 15 Health Service Act is amended by inserting after 16 section 760 of such Act (42 U.S.C. 294k) the fol- 17 lowing: 18 ‘‘SEC. 760A. MIDWIFERY SCHOOLS AND PROGRAMS. 19 ‘‘(a) IN GENERAL.—The Secretary may award grants 20 to institutions of higher education (as defined in sub- 21 sections (a) and (b) of section 101 of the Higher Edu- 22 cation Act of 1965) for the following: 23 ‘‘(1) Direct support of students in an accredited 24 midwifery school or program. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00805 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 806 •S 4486 IS ‘‘(2) Establishment or expansion of an accred- 1 ited midwifery school or program. 2 ‘‘(3) Securing, preparing, or providing support 3 for increasing the number of, qualified preceptors 4 for training the students of an accredited midwifery 5 school or program. 6 ‘‘(b) SPECIAL CONSIDERATIONS.—In awarding 7 grants under subsection (a), the Secretary shall give spe- 8 cial consideration to any institution of higher education 9 that— 10 ‘‘(1) agrees to prioritize students who plan to 11 practice in a health professional shortage area des- 12 ignated under section 332; and 13 ‘‘(2) demonstrates a focus on increasing racial 14 and ethnic minority representation in midwifery edu- 15 cation. 16 ‘‘(c) RESTRICTION.—The Secretary shall not provide 17 any assistance under this section to be used with respect 18 to a midwifery school or program within a school of nurs- 19 ing (as defined in section 801). 20 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.— 21 ‘‘(1) IN GENERAL.—There is authorized to be 22 appropriated to carry out this section $15,000,000 23 for the period of fiscal years 2023 through 2027. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00806 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 807 •S 4486 IS ‘‘(2) ALLOCATION.—Of the amounts made 1 available to carry out this section for any fiscal year, 2 the Secretary shall use— 3 ‘‘(A) 50 percent to award grants for pur- 4 poses specified in subsection (a)(1); 5 ‘‘(B) 25 percent to award grants for pur- 6 poses specified in subsection (a)(2); and 7 ‘‘(C) 25 percent to award grants for pur- 8 poses specified in subsection (a)(3).’’. 9 (2) DEFINITIONS.— 10 (A) MIDWIFERY SCHOOL OR PROGRAM.— 11 Section 799B(1)(A) of the Public Health Serv- 12 ice Act (42 U.S.C. 295p(1)(A)) is amended— 13 (i) by inserting ‘‘ ‘midwifery school or 14 program’,’’ before ‘‘and ‘school of chiro- 15 practic’ ’’; 16 (ii) by inserting ‘‘a degree or certifi- 17 cate in midwifery or an equivalent degree 18 or certificate,’’ before ‘‘and a degree of 19 doctor of chiropractic or an equivalent de- 20 gree’’; and 21 (iii) by striking ‘‘any such school’’ and 22 inserting ‘‘any such school or program’’. 23 (B) ACCREDITED.—Section 799B(1)(E) of 24 the Public Health Service Act (42 U.S.C. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00807 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 808 •S 4486 IS 295p(1)(E)) is amended by inserting ‘‘a mid- 1 wifery school or program,’’ before ‘‘or a grad- 2 uate program in health administration’’. 3 (b) NURSE-MIDWIVES.—Title VIII of the Public 4 Health Service Act, as amended by section 5213, is fur- 5 ther amended by inserting after section 812 of that Act, 6 as added by section 5213, the following: 7 ‘‘SEC. 812A. MIDWIFERY EXPANSION PROGRAM. 8 ‘‘(a) IN GENERAL.—The Secretary may award grants 9 to schools of nursing for the following: 10 ‘‘(1) Direct support of students in an accredited 11 nurse-midwifery school or program. 12 ‘‘(2) Establishment or expansion of an accred- 13 ited nurse-midwifery school or program. 14 ‘‘(3) Securing, preparing, or providing support 15 for increasing the numbers of, preceptors at clinical 16 training sites to precept students training to become 17 certified nurse-midwives. 18 ‘‘(b) SPECIAL CONSIDERATIONS.—In awarding 19 grants under subsection (a), the Secretary shall give spe- 20 cial consideration to any school of nursing that— 21 ‘‘(1) agrees to prioritize students who choose to 22 pursue an advanced education degree in nurse-mid- 23 wifery to practice in a health professional shortage 24 area designated under section 332; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00808 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 809 •S 4486 IS ‘‘(2) demonstrates a focus on increasing racial 1 and ethnic minority representation in nurse-mid- 2 wifery education. 3 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.— 4 ‘‘(1) IN GENERAL.—To carry out this section, 5 there is authorized to be appropriated $20,000,000 6 for the period of fiscal years 2023 through 2027. 7 ‘‘(2) ALLOCATION.—Of the amounts made 8 available to carry out this section for any fiscal year, 9 the Secretary shall use— 10 ‘‘(A) 50 percent to award grants for pur- 11 poses specified in subsection (a)(1); 12 ‘‘(B) 25 percent to award grants for pur- 13 poses specified in subsection (a)(2); and 14 ‘‘(C) 25 percent to award grants for pur- 15 poses specified in subsection (a)(3).’’. 16 SEC. 5215. GESTATIONAL DIABETES. 17 Part B of title III of the Public Health Service Act 18 (42 U.S.C. 243 et seq.) is amended by adding after section 19 317H the following: 20 ‘‘SEC. 317H–1. GESTATIONAL DIABETES. 21 ‘‘(a) UNDERSTANDING AND MONITORING GESTA- 22 TIONAL DIABETES.— 23 ‘‘(1) IN GENERAL.—The Secretary, acting 24 through the Director of the Centers for Disease 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00809 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 810 •S 4486 IS Control and Prevention, in consultation with the Di- 1 abetes Mellitus Interagency Coordinating Committee 2 established under section 429 and representatives of 3 appropriate national health organizations, shall de- 4 velop a multisite gestational diabetes research 5 project within the diabetes program of the Centers 6 for Disease Control and Prevention to expand and 7 enhance surveillance data and public health research 8 on gestational diabetes. 9 ‘‘(2) AREAS TO BE ADDRESSED.—The research 10 project developed under paragraph (1) shall ad- 11 dress— 12 ‘‘(A) procedures to establish accurate and 13 efficient systems for the collection of gestational 14 diabetes data within each State and common- 15 wealth, territory, or possession of the United 16 States; 17 ‘‘(B) the progress of collaborative activities 18 with the National Vital Statistics System, the 19 National Center for Health Statistics, and 20 State health departments with respect to the 21 standard birth certificate, in order to improve 22 surveillance of gestational diabetes; 23 ‘‘(C) postpartum methods of tracking indi- 24 viduals with gestational diabetes after delivery 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00810 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 811 •S 4486 IS as well as targeted interventions proven to 1 lower the incidence of type 2 diabetes in that 2 population; 3 ‘‘(D) variations in the distribution of diag- 4 nosed and undiagnosed gestational diabetes, 5 and of impaired fasting glucose tolerance and 6 impaired fasting glucose, within and among 7 groups of pregnant individuals; and 8 ‘‘(E) factors and culturally sensitive inter- 9 ventions that influence risks and reduce the in- 10 cidence of gestational diabetes and related com- 11 plications during childbirth, including cultural, 12 behavioral, racial, ethnic, geographic, demo- 13 graphic, socioeconomic, and genetic factors. 14 ‘‘(3) REPORT.—Not later than 2 years after the 15 date of the enactment of this section, and annually 16 thereafter, the Secretary shall generate a report on 17 the findings and recommendations of the research 18 project including prevalence of gestational diabetes 19 in the multisite area and disseminate the report to 20 the appropriate Federal and non-Federal agencies. 21 ‘‘(b) EXPANSION OF GESTATIONAL DIABETES RE- 22 SEARCH.— 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00811 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 812 •S 4486 IS ‘‘(1) IN GENERAL.—The Secretary shall expand 1 and intensify public health research regarding gesta- 2 tional diabetes. Such research may include— 3 ‘‘(A) developing and testing novel ap- 4 proaches for improving postpartum diabetes 5 testing or screening and for preventing type 2 6 diabetes in individuals who can become preg- 7 nant with a history of gestational diabetes; and 8 ‘‘(B) conducting public health research to 9 further understanding of the epidemiologic, 10 socioenvironmental, behavioral, translation, and 11 biomedical factors and health systems that in- 12 fluence the risk of gestational diabetes and the 13 development of type 2 diabetes in individuals 14 who can become pregnant with a history of ges- 15 tational diabetes. 16 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 17 There is authorized to be appropriated to carry out 18 this subsection $5,000,000 for each of fiscal years 19 2023 through 2027. 20 ‘‘(c) DEMONSTRATION GRANTS TO LOWER THE 21 RATE OF GESTATIONAL DIABETES.— 22 ‘‘(1) IN GENERAL.—The Secretary, acting 23 through the Director of the Centers for Disease 24 Control and Prevention, shall award grants, on a 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00812 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 813 •S 4486 IS competitive basis, to eligible entities for demonstra- 1 tion projects that implement evidence-based inter- 2 ventions to reduce the incidence of gestational diabe- 3 tes, the recurrence of gestational diabetes in subse- 4 quent pregnancies, and the development of type 2 di- 5 abetes in individuals who can become pregnant with 6 a history of gestational diabetes. 7 ‘‘(2) PRIORITY.—In making grants under this 8 subsection, the Secretary shall give priority to 9 projects focusing on— 10 ‘‘(A) helping individuals who can become 11 pregnant who have 1 or more risk factors for 12 developing gestational diabetes; 13 ‘‘(B) working with individuals who can be- 14 come pregnant with a history of gestational dia- 15 betes during a previous pregnancy; 16 ‘‘(C) providing postpartum care for indi- 17 viduals who can become pregnant with gesta- 18 tional diabetes; 19 ‘‘(D) tracking cases where individuals who 20 can become pregnant with a history of gesta- 21 tional diabetes developed type 2 diabetes; 22 ‘‘(E) educating mothers with a history of 23 gestational diabetes about the increased risk of 24 their child developing diabetes; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00813 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 814 •S 4486 IS ‘‘(F) working to prevent gestational diabe- 1 tes and prevent or delay the development of 2 type 2 diabetes in individuals who can become 3 pregnant with a history of gestational diabetes; 4 and 5 ‘‘(G) achieving outcomes designed to assess 6 the efficacy and cost-effectiveness of interven- 7 tions that can inform decisions on long-term 8 sustainability, including third-party reimburse- 9 ment. 10 ‘‘(3) APPLICATION.—An eligible entity desiring 11 to receive a grant under this subsection shall submit 12 to the Secretary— 13 ‘‘(A) an application at such time, in such 14 manner, and containing such information as the 15 Secretary may require; and 16 ‘‘(B) a plan to— 17 ‘‘(i) lower the rate of gestational dia- 18 betes during pregnancy; or 19 ‘‘(ii) develop methods of tracking indi- 20 viduals who can become pregnant with a 21 history of gestational diabetes and develop 22 effective interventions to lower the inci- 23 dence of the recurrence of gestational dia- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00814 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 815 •S 4486 IS betes in subsequent pregnancies and the 1 development of type 2 diabetes. 2 ‘‘(4) USES OF FUNDS.—An eligible entity re- 3 ceiving a grant under this subsection shall use the 4 grant funds to carry out demonstration projects de- 5 scribed in paragraph (1), including— 6 ‘‘(A) expanding community-based health 7 promotion education, activities, and incentives 8 focused on the prevention of gestational diabe- 9 tes and development of type 2 diabetes in indi- 10 viduals who can become pregnant with a history 11 of gestational diabetes; 12 ‘‘(B) aiding State- and Tribal-based diabe- 13 tes prevention and control programs to collect, 14 analyze, disseminate, and report surveillance 15 data on individuals who can become pregnant 16 with, and at risk for, gestational diabetes, the 17 recurrence of gestational diabetes in subsequent 18 pregnancies, and, for individuals who can be- 19 come pregnant with a history of gestational dia- 20 betes, the development of type 2 diabetes; and 21 ‘‘(C) training and encouraging health care 22 providers— 23 ‘‘(i) to promote risk assessment, high- 24 quality care, and self-management for ges- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00815 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 816 •S 4486 IS tational diabetes and the recurrence of ges- 1 tational diabetes in subsequent preg- 2 nancies; and 3 ‘‘(ii) to prevent the development of 4 type 2 diabetes in individuals who can be- 5 come pregnant with a history of gesta- 6 tional diabetes, and its complications in the 7 practice settings of the health care pro- 8 viders. 9 ‘‘(5) REPORT.—Not later than 4 years after the 10 date of the enactment of this section, the Secretary 11 shall prepare and submit to the Congress a report 12 concerning the results of the demonstration projects 13 conducted through the grants awarded under this 14 subsection. 15 ‘‘(6) DEFINITION OF ELIGIBLE ENTITY.—In 16 this subsection, the term ‘eligible entity’ means a 17 nonprofit organization (such as a nonprofit academic 18 center or community health center) or a State, Trib- 19 al, or local health agency. 20 ‘‘(7) AUTHORIZATION OF APPROPRIATIONS.— 21 There is authorized to be appropriated to carry out 22 this subsection $5,000,000 for each of fiscal years 23 2023 through 2027. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00816 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 817 •S 4486 IS ‘‘(d) POSTPARTUM FOLLOWUP REGARDING GESTA- 1 TIONAL DIABETES.—The Secretary, acting through the 2 Director of the Centers for Disease Control and Preven- 3 tion, shall work with the State- and Tribal-based diabetes 4 prevention and control programs assisted by the Centers 5 to encourage postpartum followup after gestational diabe- 6 tes, as medically appropriate, for the purpose of reducing 7 the incidence of gestational diabetes, the recurrence of 8 gestational diabetes in subsequent pregnancies, the devel- 9 opment of type 2 diabetes in individuals with a history 10 of gestational diabetes, and related complications.’’. 11 SEC. 5216. CONSUMER EDUCATION CAMPAIGN. 12 Section 229(b) of the Public Health Service Act (42 13 U.S.C. 237a(b)), as amended— 14 (1) in paragraph (6), at the end, by striking 15 ‘‘and’’; 16 (2) in paragraph (7), at the end, by striking the 17 period and inserting a semicolon; and 18 (3) by adding at the end the following: 19 ‘‘(8) not later than one year after the date of 20 the enactment of this paragraph, develop and imple- 21 ment a 4-year culturally and linguistically appro- 22 priate multimedia consumer education campaign 23 that is designed to promote understanding and ac- 24 ceptance of evidence-based maternity practices and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00817 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 818 •S 4486 IS models of care for optimal maternity outcomes 1 among individuals of childbearing ages and families 2 of such individuals and that— 3 ‘‘(A) highlights the importance of pro- 4 tecting, promoting, and supporting the innate 5 capacities of childbearing individuals and their 6 newborns for childbirth, breastfeeding, and at- 7 tachment; 8 ‘‘(B) promotes understanding of the impor- 9 tance of using obstetric interventions when 10 medically necessary and when supported by 11 strong, high-quality evidence; 12 ‘‘(C) highlights the widespread overuse of 13 maternity practices that have been shown to 14 have benefit when used appropriately in situa- 15 tions of medical necessity, but which can expose 16 pregnant individuals, infants, or both to risk of 17 harm if used routinely and indiscriminately; 18 ‘‘(D) emphasizes the noninvasive maternity 19 practices that have proven correlation or may 20 be associated with improvement in outcomes 21 with no detrimental side effects, and are signifi- 22 cantly underused in the United States, includ- 23 ing smoking cessation programs in pregnancy, 24 group model prenatal care, continuous labor 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00818 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 819 •S 4486 IS support, nonsupine positions for birth, and ex- 1 ternal version to turn breech babies at term; 2 ‘‘(E) educates consumers about— 3 ‘‘(i) the qualifications of licensed pro- 4 viders of maternity care, including obstetri- 5 cian-gynecologists, family physicians, cer- 6 tified nurse-midwives, certified midwives, 7 and certified professional midwives; and 8 ‘‘(ii) the best evidence about the safe- 9 ty, satisfaction, outcomes, and costs of 10 such providers; 11 ‘‘(F) informs consumers about the best 12 available research comparing birth center 13 births, planned home births, and hospital 14 births, including information about each set- 15 ting’s safety, satisfaction, outcomes, and costs; 16 ‘‘(G) fosters participation in high-quality, 17 evidence-based childbirth education that pro- 18 motes a healthy and safe approach to preg- 19 nancy, childbirth, and early parenting; is taught 20 by certified educators, peer counselors, and 21 health professionals; and promotes informed de- 22 cision making by childbearing individuals; 23 ‘‘(H) informs consumers about— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00819 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 820 •S 4486 IS ‘‘(i) the effects of systemic, institu- 1 tional, and interpersonal racism on the 2 health, well-being, and outcomes of birth- 3 ing people; 4 ‘‘(ii) the importance of respectful, cul- 5 turally and linguistically appropriate, and 6 culturally congruent care; and 7 ‘‘(iii) the value of community-based 8 and community-led maternal care and sup- 9 port; and 10 ‘‘(I) is pilot tested for consumer com- 11 prehension, cultural sensitivity, and acceptance 12 of the messages across geographically, racially, 13 ethnically, and linguistically diverse popu- 14 lations;’’. 15 SEC. 5217. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC RE- 16 VIEWS FOR CARE OF CHILDBEARING INDI- 17 VIDUALS AND NEWBORNS. 18 (a) IN GENERAL.—Not later than one year after the 19 date of the enactment of this Act, the Secretary of Health 20 and Human Services, acting through the Director of the 21 Agency for Healthcare Research and Quality, shall— 22 (1) make publicly available an online biblio- 23 graphic database identifying systematic reviews, in- 24 cluding an explanation of the level and quality of 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00820 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 821 •S 4486 IS evidence, for care of childbearing individuals and 1 newborns; and 2 (2) initiate regular updates that incorporate 3 newly issued and updated systematic reviews. 4 (b) SOURCES.—To aim for a comprehensive inventory 5 of systematic reviews relevant to maternal and newborn 6 care, the database shall identify reviews from diverse 7 sources, including— 8 (1) scientific peer-reviewed journals; 9 (2) databases, including the Cochrane Database 10 of Systematic Reviews; and 11 (3) internet websites of agencies and organiza- 12 tions throughout the world that produce such sys- 13 tematic reviews. 14 (c) FEATURES.—The database shall— 15 (1) provide bibliographic citations for each 16 record within the database, and for each such cita- 17 tion include an explanation of the level and quality 18 of evidence; 19 (2) include abstracts, as available; 20 (3) provide reference to companion documents 21 as may exist for each review, such as evidence tables 22 and guidelines or consumer educational materials de- 23 veloped from the review; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00821 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 822 •S 4486 IS (4) provide links to the source of the full review 1 and to any companion documents; 2 (5) provide links to the source of a previous 3 version or update of the review; 4 (6) be searchable by intervention or other topic 5 of the review, reported outcomes, author, title, and 6 source; and 7 (7) offer to users periodic electronic notification 8 of database updates relating to users’ topics of inter- 9 est. 10 (d) OUTREACH.—Not later than the first date the 11 database is made publicly available and periodically there- 12 after, the Secretary of Health and Human Services shall 13 publicize the availability, features, and uses of the data- 14 base under this section to the stakeholders described in 15 subsection (e). 16 (e) CONSULTATION.—For purposes of developing the 17 database under this section and maintaining and updating 18 such database, the Secretary of Health and Human Serv- 19 ices shall convene and consult with an advisory committee 20 composed of relevant stakeholders, including— 21 (1) Federal Medicaid administrators and State 22 agencies administrating State plans under title XIX 23 of the Social Security Act pursuant to section 24 1902(a)(5) of such Act (42 U.S.C. 1396a(a)(5)); 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00822 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 823 •S 4486 IS (2) providers of maternity and newborn care 1 from both academic and community-based settings, 2 including obstetrician-gynecologists, family physi- 3 cians, certified nurse midwives, certified midwives, 4 certified professional midwives, physician assistants, 5 perinatal nurses, pediatricians, and nurse practi- 6 tioners; 7 (3) maternal-fetal medicine specialists; 8 (4) neonatologists; 9 (5) childbearing individuals and advocates for 10 such individuals, including childbirth educators cer- 11 tified by a nationally accredited program, rep- 12 resenting communities that are diverse in terms of 13 race, ethnicity, indigenous status, and geographic 14 area; 15 (6) employers and purchasers; 16 (7) health facility and system leaders, including 17 both hospital and birth center facilities; 18 (8) journalists; and 19 (9) bibliographic informatics specialists. 20 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 21 authorized to be appropriated $2,500,000 for each of the 22 fiscal years 2023 through 2025 for the purpose of devel- 23 oping the database and such sums as may be necessary 24 for each subsequent fiscal year for updating the database 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00823 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 824 •S 4486 IS and providing outreach and notification to users, as de- 1 scribed in this section. 2 SEC. 5218. DEVELOPMENT OF INTERPROFESSIONAL MA- 3 TERNITY CARE EDUCATIONAL MODELS AND 4 TOOLS. 5 (a) IN GENERAL.—Not later than 6 months after the 6 date of the enactment of this Act, the Secretary of Health 7 and Human Services, acting in conjunction with the Ad- 8 ministrator of Health Resources and Services Administra- 9 tion, shall convene, for a 1-year period, an Interprofes- 10 sional Maternity Provider Education Commission (re- 11 ferred to in this section as the ‘‘Commission’’) to discuss 12 and make recommendations for— 13 (1) a consensus standard physiologic maternity 14 care curriculum that takes into account the core 15 competencies for basic midwifery practice such as 16 those developed by the American College of Nurse- 17 Midwives and the North American Registry of Mid- 18 wives, and the educational objectives for physicians 19 practicing in obstetrics and gynecology as deter- 20 mined by the Council on Resident Education in Ob- 21 stetrics and Gynecology; 22 (2) suggestions for multidisciplinary use of the 23 consensus physiologic curriculum; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00824 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 825 •S 4486 IS (3) strategies to integrate and coordinate edu- 1 cation across maternity care disciplines, including 2 recommendations to increase medical and midwifery 3 student exposure to out-of-hospital birth; 4 (4) curriculum and strategies for continuing 5 education of practicing perinatal professionals who 6 have completed their undergraduate and graduate 7 education; and 8 (5) pilot demonstrations of interprofessional 9 educational models. 10 (b) PARTICIPANTS.— 11 (1) PROFESSIONS.—The Commission shall in- 12 clude maternity care educators, curriculum devel- 13 opers, service leaders, certification leaders, and ac- 14 creditation leaders from the various professions that 15 provide or support maternity care in the United 16 States. Such professions shall include obstetrician 17 gynecologists, certified nurse midwives or certified 18 midwives, family practice physicians, nurse practi- 19 tioners, physician assistants, certified professional 20 midwives, perinatal nurses, doulas, lactation per- 21 sonnel, and community health workers. 22 (2) CONSUMER ADVOCATES.—The Commission 23 shall also include representation from maternity care 24 consumer advocates. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00825 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 826 •S 4486 IS (c) CURRICULUM.—The consensus standard physio- 1 logic maternity care curriculum described in subsection 2 (a)(1) shall— 3 (1) have a public health focus with a foundation 4 in health promotion and disease prevention; 5 (2) foster physiologic childbearing and person 6 and family centered care; 7 (3) reflect the extensive, growing research evi- 8 dence about— 9 (A) the innate abilities and processes of 10 the birthing person and the fetus or newborn 11 for labor, birth, postpartum transition, 12 breastfeeding, and attachment, when promoted, 13 supported, and protected; and 14 (B) the effects of factors that disturb and 15 disrupt these processes; 16 (4) integrate strategies to reduce maternal and 17 infant morbidity and mortality; 18 (5) incorporate recommendations to ensure re- 19 spectful, safe, and seamless consultation, referral, 20 transport, and transfer of care when necessary; 21 (6) include cultural sensitivity and strategies to 22 decrease inequities in maternity outcomes; and 23 (7) include implicit bias training. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00826 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 827 •S 4486 IS (d) REPORT.—Not later than 6 months after the final 1 meeting of the Commission, the Secretary of Health and 2 Human Services shall— 3 (1) submit to Congress a report containing the 4 recommendations made by the Commission under 5 this section; and 6 (2) make such report publicly available. 7 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 8 authorized to be appropriated to carry out this section 9 $1,000,000 for each of the fiscal years 2023 and 2024, 10 and such sums as are necessary for each of the fiscal years 11 2025 through 2027. 12 SEC. 5219. DISSEMINATION OF THE QUALITY FAMILY PLAN- 13 NING GUIDELINES. 14 (a) IN GENERAL.—Not later than 180 days after the 15 date of enactment of this Act, the Secretary of Health and 16 Human Services and the Director of the Centers for Dis- 17 ease Control and Prevention shall— 18 (1) develop a plan for outreach to publicly fund- 19 ed health care providers, including federally qualified 20 health centers (as defined in section 1861(aa)(4) of 21 the Social Security Act (42 U.S.C. 1395x(aa)(4))) 22 and branches of the Indian Health Service, about 23 the quality family planning guidelines referred to in 24 section 5304; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00827 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 828 •S 4486 IS (2) award grants to eligible entities to imple- 1 ment such guidelines for all patients seeking family 2 planning services. 3 (b) DEFINITION.—In this section, the term ‘‘eligible 4 entity’’ means a publicly funded health care provider that 5 serves persons of reproductive age. 6 Subtitle D—Federal Agency 7 Coordination on Maternal Health 8 SEC. 5301. INTERAGENCY COORDINATING COMMITTEE ON 9 THE PROMOTION OF OPTIMAL MATERNITY 10 OUTCOMES. 11 (a) IN GENERAL.—Part A of title II of the Public 12 Health Service Act (42 U.S.C. 202 et seq.) is amended 13 by adding at the end the following: 14 ‘‘SEC. 229A. INTERAGENCY COORDINATING COMMITTEE ON 15 THE PROMOTION OF OPTIMAL MATERNITY 16 OUTCOMES. 17 ‘‘(a) IN GENERAL.—The Secretary, acting through 18 the Deputy Assistant Secretary for Women’s Health under 19 section 229 and in collaboration with the Federal officials 20 specified in subsection (b), shall establish the Interagency 21 Coordinating Committee on the Promotion of Optimal Ma- 22 ternity Outcomes (referred to in this section as the 23 ‘ICCPOM’). 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00828 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 829 •S 4486 IS ‘‘(b) OTHER AGENCIES.—The officials specified in 1 this subsection are the Secretary of Labor, the Secretary 2 of Defense, the Secretary of Veterans Affairs, the Surgeon 3 General, the Director of the Centers for Disease Control 4 and Prevention, the Administrator of the Health Re- 5 sources and Services Administration, the Administrator of 6 the Centers for Medicare & Medicaid Services, the Direc- 7 tor of the Indian Health Service, the Administrator of the 8 Substance Abuse and Mental Health Services Administra- 9 tion, the Director of the National Institute of Child Health 10 and Human Development, the Director of the Agency for 11 Healthcare Research and Quality, the Assistant Secretary 12 for Children and Families, the Deputy Assistant Secretary 13 for Minority Health, the Director of the Office of Per- 14 sonnel Management, and such other Federal officials as 15 the Secretary of Health and Human Services determines 16 to be appropriate. 17 ‘‘(c) CHAIR.—The Deputy Assistant Secretary for 18 Women’s Health shall serve as the chair of the ICCPOM. 19 ‘‘(d) DUTIES.—The ICCPOM shall guide policy and 20 program development across the Federal Government with 21 respect to promotion of optimal maternity care, provided, 22 however, that nothing in this section shall be construed 23 as transferring regulatory or program authority from an 24 agency to the ICCPOM. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00829 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 830 •S 4486 IS ‘‘(e) CONSULTATIONS.—The ICCPOM shall actively 1 seek the input of, and shall consult with, all appropriate 2 and interested stakeholders, including State health depart- 3 ments, public health research and interest groups, founda- 4 tions, childbearing individuals and their advocates, and 5 maternity care professional associations and organiza- 6 tions, reflecting racially, ethnically, demographically, and 7 geographically diverse communities. 8 ‘‘(f) ANNUAL REPORT.— 9 ‘‘(1) IN GENERAL.—The Secretary, on behalf of 10 the ICCPOM, shall annually submit to Congress a 11 report that summarizes— 12 ‘‘(A) all programs and policies of Federal 13 agencies (including the Medicare Program 14 under title XVIII of the Social Security Act and 15 the Medicaid program under title XIX of such 16 Act) designed to promote optimal maternity 17 care, focusing particularly on programs and 18 policies that support the adoption of evidence- 19 based maternity care, as defined by timely, sci- 20 entifically sound systematic reviews; 21 ‘‘(B) all programs and policies of Federal 22 agencies (including the Medicare Program 23 under title XVIII of the Social Security Act and 24 the Medicaid program under title XIX of such 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00830 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 831 •S 4486 IS Act) designed to address the problems of mater- 1 nal mortality and morbidity, infant mortality, 2 prematurity, and low birth weight, including 3 such programs and policies designed to address 4 racial and ethnic inequities with respect to each 5 of such problems; 6 ‘‘(C) the extent of progress in reducing 7 maternal mortality and infant mortality, low 8 birth weight, and prematurity at State and na- 9 tional levels; and 10 ‘‘(D) such other information regarding op- 11 timal maternity care (such as quality and per- 12 formance measures) as the Secretary deter- 13 mines to be appropriate. 14 ‘‘(2) REDUCING INEQUITIES WITH RESPECT TO 15 INDIGENOUS STATUS.—The information specified in 16 paragraph (1)(C) shall be included in each such re- 17 port in a manner that disaggregates such informa- 18 tion by race, ethnicity, and indigenous status in 19 order to determine the extent of progress in reduc- 20 ing racial and ethnic inequities and inequities related 21 to indigenous status. 22 ‘‘(3) CERTAIN INFORMATION.—Each report 23 under paragraph (1) shall include information 24 (disaggregated by race, ethnicity, and indigenous 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00831 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 832 •S 4486 IS status, as applicable) on the following rates, trends, 1 and costs by State: 2 ‘‘(A) The rate and trend of primary cesar- 3 ean deliveries and repeat cesarean deliveries. 4 ‘‘(B) The rate and trend of vaginal births 5 after cesarean. 6 ‘‘(C) The rate and trend of vaginal breech 7 births. 8 ‘‘(D) The rate and trend of induction of 9 labor. 10 ‘‘(E) The rate and trend of freestanding 11 birth center births. 12 ‘‘(F) The rate and trend of planned and 13 unplanned home birth. 14 ‘‘(G) The rate and trends of attended 15 births by different types of maternity care pro- 16 viders, including by an obstetrician-gyne- 17 cologist, family practice physician, obstetrician- 18 gynecologist physician assistant, certified nurse- 19 midwife, certified midwife, and certified profes- 20 sional midwife. 21 ‘‘(H) The rate and trend of severe mater- 22 nal morbidity. 23 ‘‘(I) The rates and trends of prenatal and 24 postpartum anxiety and depression. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00832 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 833 •S 4486 IS ‘‘(J) The rate and trend of pre-term birth. 1 ‘‘(K) The rate and trend of low birth 2 weight. 3 ‘‘(L) The cost of maternity care 4 disaggregated by place of birth and provider of 5 care, including— 6 ‘‘(i) uncomplicated vaginal birth; 7 ‘‘(ii) complicated vaginal birth; 8 ‘‘(iii) uncomplicated cesarean birth; 9 and 10 ‘‘(iv) complicated cesarean birth. 11 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 12 is authorized to be appropriated, in addition to amounts 13 authorized to be appropriated under section 229(e), to 14 carry out this section $1,000,000 for each of the fiscal 15 years 2023 through 2027.’’. 16 (b) CONFORMING AMENDMENTS.— 17 (1) INCLUSION AS DUTY OF HHS OFFICE ON 18 WOMEN’S HEALTH.—Section 229(b) of such Act (42 19 U.S.C. 237a(b)), as amended by section 5216, is 20 further amended by adding at the end the following 21 new paragraph: 22 ‘‘(9) establish the Interagency Coordinating 23 Committee on the Promotion of Optimal Maternity 24 Outcomes in accordance with section 229A; and’’. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00833 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 834 •S 4486 IS (2) TREATMENT OF BIENNIAL REPORTS.—Sec- 1 tion 229(d) of such Act (42 U.S.C. 237a(d)) is 2 amended by inserting ‘‘(other than under subsection 3 (b)(9))’’ after ‘‘under this section’’. 4 SEC. 5302. EXPANSION OF CDC PREVENTION RESEARCH 5 CENTERS PROGRAM TO INCLUDE CENTERS 6 ON OPTIMAL MATERNITY OUTCOMES. 7 (a) IN GENERAL.—Not later than one year after the 8 date of the enactment of this Act, the Secretary of Health 9 and Human Services shall support the establishment of 10 additional Prevention Research Centers under the Preven- 11 tion Research Center Program administered by the Cen- 12 ters for Disease Control and Prevention. Such additional 13 centers shall each be known as a Center for Excellence 14 on Optimal Maternity Outcomes. 15 (b) RESEARCH.—Each Center for Excellence on Opti- 16 mal Maternity Outcomes shall— 17 (1) conduct at least one focused program of re- 18 search to improve maternity outcomes, including the 19 reduction of cesarean birth rates, early elective in- 20 ductions, prematurity rates, and low birth weight 21 rates within an underserved population that has a 22 disproportionately large burden of suboptimal mater- 23 nity outcomes, including maternal mortality and 24 morbidity, infant mortality, prematurity, or low 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00834 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 835 •S 4486 IS birth weight, which such program shall include de- 1 veloping performance and quality measures for ac- 2 countability; 3 (2) work with partners on special interest 4 projects, as specified by the Centers for Disease 5 Control and Prevention and other relevant agencies 6 within the Department of Health and Human Serv- 7 ices, and on projects funded by other sources; and 8 (3) involve a minimum of two distinct birth set- 9 ting models, such as— 10 (A) a hospital labor and delivery model 11 and freestanding birth center model; or 12 (B) a hospital labor and delivery model 13 and planned home birth model. 14 (c) INTERDISCIPLINARY PROVIDERS.—Each Center 15 for Excellence on Optimal Maternity Outcomes shall in- 16 clude the following interdisciplinary providers of maternity 17 care: 18 (1) Obstetrician-gynecologists. 19 (2) At least two of the following providers: 20 (A) Family practice physicians. 21 (B) Nurse practitioners. 22 (C) Physician assistants. 23 (D) Certified professional midwives, cer- 24 tified nurse-midwives, or certified midwives. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00835 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 836 •S 4486 IS (d) SERVICES.—Research conducted by each Center 1 for Excellence on Optimal Maternity Outcomes shall in- 2 clude at least 2 (and preferably more) of the following sup- 3 portive provider services: 4 (1) Mental health. 5 (2) Doula labor support. 6 (3) Nutrition education. 7 (4) Childbirth education. 8 (5) Social work. 9 (6) Physical therapy or occupation therapy. 10 (7) Substance use disorder services. 11 (8) Home visiting. 12 (e) COORDINATION.—The programs of research at 13 each of the Centers of Excellence on Optimal Maternity 14 Outcomes shall complement and not replicate the work of 15 the other. 16 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 17 authorized to be appropriated to carry out this section 18 $2,000,000 for each of the fiscal years 2023 through 19 2027. 20 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00836 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 837 •S 4486 IS SEC. 5303. EXPANDING MODELS TO BE TESTED BY CENTER 1 FOR MEDICARE AND MEDICAID INNOVATION 2 TO EXPLICITLY INCLUDE MATERNITY CARE 3 AND CHILDREN’S HEALTH MODELS. 4 Section 1115A(b)(2) of the Social Security Act (42 5 U.S.C. 1315a(b)(2)), as amended by section 5206(b), is 6 amended— 7 (1) in subparagraph (B), by adding at the end 8 the following: 9 ‘‘(xxix) Promoting evidence-based 10 models of care that have been associated 11 with reductions in pregnancy-related and 12 infant health inequities, including incor- 13 porating the use of and payment for 14 doulas, particularly community-based 15 doulas, and promoting support for people 16 during pregnancy and for the one-year pe- 17 riod after the last day of such person’s 18 pregnancy, through evidence-based models 19 of antepartum, birth, postpartum care, and 20 two-generation birthing person and new- 21 born care models, and supporting the risk- 22 appropriate use of out-of-hospital birth 23 models, including births at home and in 24 freestanding birth centers. Such models 25 shall be selected and evaluated based on 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00837 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 838 •S 4486 IS their impact on quality, equity, and devel- 1 opmental outcomes, notwithstanding any 2 other provision of this section.’’; 3 (2) in subparagraph (C), by adding at the end 4 the following: 5 ‘‘(ix) Whether the model includes a 6 regular process for ensuring the provision 7 of culturally and linguistically appropriate 8 services. 9 ‘‘(x) Whether health care services and 10 supportive services included in the model 11 are tailored to community health and 12 health-related social needs and provided by 13 community-based and community-led pro- 14 viders. 15 ‘‘(xi) Whether the model is designed 16 to mitigate harmful effects of discrimina- 17 tion on the basis of race, sex, disability, 18 ethnicity, language, and age.’’; and 19 (3) by adding at the end the following: 20 ‘‘(D) MANDATORY HEALTH EQUITY MOD- 21 ELS TO BE TESTED.—The Secretary shall se- 22 lect— 23 ‘‘(i) Medicaid global and episode-based 24 payment models for culturally and linguis- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00838 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 839 •S 4486 IS tically appropriate antepartum, labor and 1 delivery, and postpartum doula services, in- 2 cluding community-based doula services, 3 that are— 4 ‘‘(I) structured to provide pay- 5 ment to doulas as individuals, health 6 care entity staff, or members of a 7 doula group or collective, or through a 8 third-party administrator; 9 ‘‘(II) designed to reduce racial 10 and intersecting health inequities; 11 ‘‘(III) designed to provide doulas 12 providing support with an equitable 13 and sustainable reimbursement rate; 14 ‘‘(IV) designed to reduce barriers 15 to workforce entry for culturally and 16 linguistically competent and racially 17 congruent doulas to provide services 18 to Medicaid enrollees; and 19 ‘‘(V) designed with input from 20 community-based doulas, maternal 21 health advocates, reproductive justice 22 advocates, and Medicaid beneficiaries; 23 ‘‘(ii) a Medicaid episode-based pay- 24 ment model for pregnancy-related services, 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00839 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 840 •S 4486 IS including health care services and sup- 1 portive services to address health-related 2 social needs, during the prenatal, 3 intrapartum, and postpartum periods, to 4 improve health outcomes and reduce racial 5 health inequities, and to be designed with 6 input from maternity care providers, ma- 7 ternal health advocates, reproductive jus- 8 tice advocates, and Medicaid beneficiaries; 9 ‘‘(iii) a Medicaid alternative payment 10 model for a pregnancy-related health home 11 service to improve health outcomes during 12 and for one year after pregnancy and dur- 13 ing the newborn period, and to reduce ra- 14 cial health inequities, designed with input 15 from maternity care providers, maternal 16 health advocates, reproductive justice advo- 17 cates, and Medicaid beneficiaries; 18 ‘‘(iv) a Medicaid perinatal health 19 worker service delivery model for culturally 20 and linguistically appropriate and respect- 21 ful health care and supportive services that 22 are tailored to community health and 23 health-related social needs, designed to im- 24 prove health outcomes and mitigate harm- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00840 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 841 •S 4486 IS ful effects of racism and other forms of 1 discrimination, and provided by commu- 2 nity-based and community-led providers; 3 and 4 ‘‘(v) one or more models exclusively 5 focused on early intervention and preven- 6 tion for children enrolled in a State plan 7 (or waiver of such plan) under title XIX or 8 a State child health plan under title XXI 9 using evidence-based interventions includ- 10 ing parenting support programs, home-vis- 11 iting services, and dyadic therapy treat- 12 ment for children and adolescents at risk. 13 Such models shall be selected and evaluated 14 based on their impact on quality, equity, and 15 developmental outcomes, notwithstanding any 16 other provision of this section.’’. 17 SEC. 5304. INTERAGENCY UPDATE TO THE QUALITY FAMILY 18 PLANNING GUIDELINES. 19 (a) IN GENERAL.—Not later than six months after 20 the date of enactment of this Act, the Director of the Cen- 21 ters for Disease Control and Prevention and the Office 22 of Population Affairs shall review and expand the 2014 23 Quality Family Planning Guidelines to address— 24 (1) health inequities; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00841 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 842 •S 4486 IS (2) the importance of patient-directed contra- 1 ceptive decision making. 2 (b) CONSULTATION.—In carrying out subsection (a), 3 the Director of the Centers for Disease Control and Pre- 4 vention and the Office of Population Affairs shall convene 5 a meeting, and solicit the views of, stakeholders including 6 experts on health inequities, experts on reproductive coer- 7 cion, representatives of provider organizations, patient ad- 8 vocates, reproductive justice organizations, organizations 9 that represent racial and ethnic minority communities, or- 10 ganizations that represent people with disabilities, organi- 11 zations that represent LGBTQ persons, and organizations 12 that represent people with limited English proficiency. 13 Subtitle E—Reproductive and 14 Sexual Health 15 SEC. 5401. FINDINGS; SENSE OF CONGRESS ON URGENT 16 BARRIERS TO ABORTION ACCESS AND VITAL 17 SOLUTIONS. 18 (a) FINDINGS.—Congress finds the following: 19 (1) Affordable, comprehensive health insurance 20 that includes coverage for a full range of pregnancy- 21 related care, including abortion, is critical to the 22 health of every person regardless of actual or per- 23 ceived race, color, national origin, immigration sta- 24 tus, sex (including sexual orientation, gender iden- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00842 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 843 •S 4486 IS tity, pregnancy, childbirth, a medical condition relat- 1 ing to pregnancy or childbirth, or sex stereotyping), 2 age, or disability status. 3 (2) Abortion services are essential to health 4 care and access to those services is central to peo- 5 ple’s ability to participate equally in the economic 6 and social life of the United States. Abortion access 7 allows people who are pregnant to make their own 8 decisions about their pregnancies, their families, and 9 their lives. 10 (3) Reproductive justice seeks to address re- 11 strictions on reproductive health, including abortion, 12 that perpetuate systems of oppression, lack of bodily 13 autonomy, White supremacy, and anti-Black racism. 14 The violent legacy of these systems of oppression has 15 manifested in policies including enslavement, rape, 16 and experimentation on Black people, forced steri- 17 lizations, medical experimentation on low-income 18 people’s reproductive systems, and the forcible re- 19 moval of Indigenous children. Access to equitable re- 20 productive health care, including abortion services, 21 has always been deficient in the United States for 22 Black, Indigenous, and other People of Color 23 (BIPOC) and their families. Transgender, non- 24 binary, and gender expansive individuals, and spe- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00843 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 844 •S 4486 IS cifically those who are Black, disabled, and at the 1 intersections of multiple forms of oppression, also 2 experience inequitable access to abortion services due 3 to systemic violence. Centering abortion rights and 4 access as a ‘‘women’s health’’ issue restricts access 5 to those with reproductive needs who do not identify 6 as cisgender women. In order to work towards repro- 7 ductive justice for all communities, transgender, 8 nonbinary, and gender expansive individuals must be 9 centered in conversations of abortion access. Improv- 10 ing abortion access for this community requires a 11 gender-neutral approach to abortion care, rights, 12 and justice policy. 13 (4) The legacy of restrictions on reproductive 14 health, rights, and justice is not a dated vestige of 15 a dark history. Access to abortion services is ob- 16 structed across the United States in various ways, 17 including blockades of health care facilities and asso- 18 ciated violence, prohibitions of, and restrictions on, 19 insurance coverage, parental involvement laws (noti- 20 fication and consent), restrictions that shame and 21 stigmatize people seeking abortion services, and 22 medically unnecessary regulations that neither con- 23 fer any health benefit nor further the safety of abor- 24 tion services, but which harm people by delaying, 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00844 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 845 •S 4486 IS complicating access to, and reducing the availability 1 of, abortion services. As of December 2, 2021, 19 2 States have enacted 106 restrictions, including 12 3 new abortion bans, making 2021 the year with the 4 highest number of restrictions passed since Roe v. 5 Wade was decided in 1973. Additionally, 21 States 6 are poised to immediately ban or significantly re- 7 strict access to abortion services if the Supreme 8 Court chooses to overturn or weaken Roe v. Wade. 9 These unprecedented attacks on abortion rights and 10 access fall especially heavily on people with low in- 11 comes, BIPOC, immigrants, young people, people 12 with disabilities, those living in rural and other 13 medically underserved areas, and transgender, non- 14 binary, and gender expansive individuals. 15 (5) Since 1976, the Federal Government has 16 withheld funds for abortion coverage in most cir- 17 cumstances through the Hyde amendment and simi- 18 lar coverage restrictions, affecting individuals of re- 19 productive age in the United States who are insured 20 through the Medicaid program, as well as individuals 21 who receive insurance or care through other Federal 22 health plans and programs. Of women aged 15 to 44 23 enrolled in Medicaid in 2017, 55 percent lived in the 24 35 States and the District of Columbia that do not 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00845 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 846 •S 4486 IS cover abortion, except in limited circumstances. This 1 amounts to roughly 7,300,000 women of reproduc- 2 tive age, including 3,100,000 women living below the 3 Federal poverty level. Women of color are dispropor- 4 tionately likely to be insured by the Medicaid pro- 5 gram, and nationwide, 32 percent of Black women 6 and 27 percent of Hispanic women aged 15 to 44 7 were enrolled in Medicaid in 2017, compared with 8 16 percent of White women. 9 (6) Abortion-specific restrictions are even more 10 compounded by the ongoing criminalization of people 11 who are pregnant, including those who are incarcer- 12 ated, living with HIV, or with substance use dis- 13 orders. These communities already experience health 14 inequities due to social, political, and environmental 15 inequities, and restrictions on abortion services exac- 16 erbate these harms. Removing medically unjustified 17 restrictions on abortion services would constitute one 18 important step on the path toward realizing repro- 19 ductive justice by ensuring that the full range of re- 20 productive health care is accessible to all who need 21 it. 22 (7) Abortion-specific restrictions are a tool of 23 gender oppression, as they target health care serv- 24 ices that are used primarily by individuals with re- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00846 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 847 •S 4486 IS productive needs. These paternalistic restrictions 1 rely on and reinforce harmful stereotypes about gen- 2 der roles, people’s decision making, and people’s 3 need for protection instead of support, undermining 4 their ability to control their own lives and well-being. 5 These restrictions harm the basic autonomy, dignity, 6 and equality of individuals with reproductive health 7 needs, and their ability to participate in the social 8 and economic life of the Nation. 9 (8) Many abortion-specific restrictions do not 10 confer any health or safety benefits on the patient. 11 Instead, these restrictions have the purpose and ef- 12 fect of unduly burdening people’s personal and pri- 13 vate medical decisions to end their pregnancies by 14 making access to abortion services more difficult, 15 invasive, and costly, often forcing people to travel 16 significant distances and make multiple unnecessary 17 visits to the provider, and in some cases, foreclosing 18 the option altogether. 19 (9) Congress has used its authority in the past 20 to protect access to abortion services and health care 21 providers’ ability to provide abortion services. In the 22 early 1990s, protests and blockades at health care 23 facilities where abortion services were provided, and 24 associated violence, increased dramatically and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00847 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 848 •S 4486 IS reached crisis level, requiring congressional action. 1 Congress passed the Freedom of Access to Clinic 2 Entrances Act (Public Law 103–259; 108 Stat. 694) 3 to address that situation and protect physical access 4 to abortion services. 5 (10) Congressional action is necessary to put an 6 end to harmful restrictions, to federally protect ac- 7 cess to abortion services for everyone regardless of 8 where they live, and to protect the ability of health 9 care providers to provide these services in a safe and 10 accessible manner. 11 (11) The Equal Access to Abortion Coverage in 12 Health Insurance Act of 2021 or the EACH Act of 13 2021 (H.R. 2234, S. 1021) introduced in the 117th 14 Congress, would reverse the Hyde amendment and 15 related abortion coverage restrictions. It would cre- 16 ate an enforceable statutory right for people who re- 17 ceive health coverage or care through enumerated 18 Federal programs (including Medicaid, the Chil- 19 dren’s Health Insurance Program, Medicare, and the 20 Indian Health Service, among others) and plans (in- 21 cluding government-sponsored health insurance due 22 to a current or former employment relationship) to 23 receive abortion coverage. It would require the Fed- 24 eral Government to facilitate abortion access for in- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00848 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 849 •S 4486 IS dividuals eligible to receive health care in Federal fa- 1 cilities or in facilities with which it contracts to pro- 2 vide health care, such as immigration detention cen- 3 ters. It also prohibits the Federal Government from 4 prohibiting, restricting, or otherwise inhibiting State 5 or local governments or private health insurance 6 issuers from providing abortion coverage. 7 (12) The Women’s Health Protection Act of 8 2021 (H.R. 3755, S. 1975) introduced in the 117th 9 Congress, would establish an enforceable statutory 10 right for health care providers to provide, and abor- 11 tion patients to receive, abortions free from medi- 12 cally unnecessary restrictions, limitations, and bans 13 that delay, and at times, completely obstruct, access 14 to abortion. 15 (b) SENSE OF CONGRESS.—It is the sense of Con- 16 gress that eliminating the Hyde amendment, enacting the 17 Equal Access to Abortion Coverage in Health Insurance 18 Act of 2021, and enacting the Women’s Health Protection 19 Act of 2021, are critical to— 20 (1) promoting equitable abortion access, includ- 21 ing coverage, for all who seek care; 22 (2) creating enforceable rights to receive, and 23 receive coverage for, such care; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00849 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 850 •S 4486 IS (3) advancing equitable access to comprehensive 1 health coverage, which cannot be achieved without 2 abortion coverage; and 3 (4) alleviating urgent racial, gender, and other 4 inequities in health and health care and cor- 5 responding reproductive injustices. 6 SEC. 5402. EMERGENCY CONTRACEPTION EDUCATION AND 7 INFORMATION PROGRAMS. 8 (a) EMERGENCY CONTRACEPTION PUBLIC EDU- 9 CATION PROGRAM.— 10 (1) IN GENERAL.—The Secretary, acting 11 through the Director of the Centers for Disease 12 Control and Prevention, shall develop and dissemi- 13 nate to the public medically accurate and complete 14 information on emergency contraceptives. 15 (2) DISSEMINATION.—The Secretary may dis- 16 seminate medically accurate and complete informa- 17 tion under paragraph (1) directly or through ar- 18 rangements with nonprofit organizations, community 19 health workers, including promotores, consumer 20 groups, institutions of higher education, clinics, the 21 media, and Federal, State, and local agencies. 22 (3) INFORMATION.—The information dissemi- 23 nated under paragraph (1) shall— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00850 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 851 •S 4486 IS (A) include, at a minimum, a description 1 of emergency contraceptives and an explanation 2 of the use, safety, efficacy, affordability, and 3 availability, including over-the-counter access, 4 of such contraceptives and options for access to 5 such contraceptives without cost-sharing 6 through insurance and other programs; and 7 (B) be pilot tested for consumer com- 8 prehension, cultural and linguistic appropriate- 9 ness, and acceptance of the messages across 10 geographically, racially, ethnically, and linguis- 11 tically diverse populations. 12 (b) EMERGENCY CONTRACEPTION INFORMATION 13 PROGRAM FOR HEALTH CARE PROVIDERS.— 14 (1) IN GENERAL.—The Secretary, acting 15 through the Administrator of the Health Resources 16 and Services Administration and in consultation 17 with major medical and public health organizations, 18 shall develop and disseminate to health care pro- 19 viders, including pharmacists, information on emer- 20 gency contraceptives. 21 (2) INFORMATION.—The information dissemi- 22 nated under paragraph (1) shall include, at a min- 23 imum— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00851 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 852 •S 4486 IS (A) information describing the use, safety, 1 efficacy, and availability of emergency contra- 2 ceptives, and options for access without cost- 3 sharing through insurance and other programs; 4 (B) a recommendation regarding the use of 5 such contraceptives; and 6 (C) information explaining how to obtain 7 copies of the information developed under sub- 8 section (a) for distribution to the patients of 9 the providers. 10 (c) DEFINITIONS.—In this section: 11 (1) HEALTH CARE PROVIDER.—The term 12 ‘‘health care provider’’ means an individual who is li- 13 censed or certified under State law to provide health 14 care services and who is operating within the scope 15 of such license. Such term shall include a phar- 16 macist. 17 (2) INSTITUTION OF HIGHER EDUCATION.—The 18 term ‘‘institution of higher education’’ has the same 19 meaning given such term in section 101(a) of the 20 Higher Education Act of 1965 (20 U.S.C. 1001(a)). 21 (3) SECRETARY.—The term ‘‘Secretary’’ means 22 the Secretary of Health and Human Services. 23 (d) AUTHORIZATION OF APPROPRIATIONS.—There 24 are authorized to be appropriated to carry out this section 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00852 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 853 •S 4486 IS such sums as may be necessary for each of the fiscal years 1 2023 through 2027. 2 SEC. 5403. DUTIES OF PHARMACIES TO ENSURE PROVISION 3 OF FDA-APPROVED CONTRACEPTION. 4 Part B of title II of the Public Health Service Act 5 (42 U.S.C. 238 et seq.) is amended by adding at the end 6 the following: 7 ‘‘SEC. 249. DUTIES OF PHARMACIES TO ENSURE PROVISION 8 OF FDA-APPROVED CONTRACEPTION. 9 ‘‘(a) IN GENERAL.—Subject to subsection (c), a 10 pharmacy that receives Food and Drug Administration- 11 approved drugs or devices in interstate commerce shall 12 maintain compliance with the following: 13 ‘‘(1) If a customer requests a contraceptive or 14 a medication related to a contraceptive, including 15 emergency contraception, that is in stock, the phar- 16 macy shall ensure that the contraceptive is provided 17 to the customer without delay. 18 ‘‘(2) If a customer requests a contraceptive or 19 a medication related to a contraceptive that is not 20 in stock and the pharmacy in the normal course of 21 business stocks contraception, the pharmacy shall 22 immediately inform the customer that the contracep- 23 tive is not in stock and without delay offer the cus- 24 tomer the following options: 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00853 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 854 •S 4486 IS ‘‘(A) If the customer prefers to obtain the 1 contraceptive or a medication related to a con- 2 traceptive through a referral or transfer, the 3 pharmacy shall— 4 ‘‘(i) locate a pharmacy of the cus- 5 tomer’s choice or the closest pharmacy 6 confirmed to have the contraceptive or a 7 medication related to a contraceptive in 8 stock; and 9 ‘‘(ii) refer the customer or transfer 10 the prescription to that pharmacy. 11 ‘‘(B) If the customer prefers for the phar- 12 macy to order the contraceptive or a medication 13 related to a contraceptive, the pharmacy shall 14 obtain the contraceptive or medication under 15 the pharmacy’s standard procedure for expe- 16 dited ordering of medication and notify the cus- 17 tomer when the contraceptive or medication ar- 18 rives. 19 ‘‘(3) The pharmacy shall ensure that— 20 ‘‘(A) the pharmacy does not operate an en- 21 vironment in which customers are intimidated, 22 threatened, or harassed in the delivery of serv- 23 ices relating to a request for contraception or a 24 medication related to a contraceptive; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00854 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 855 •S 4486 IS ‘‘(B) the pharmacy’s employees do not 1 interfere with or obstruct the delivery of serv- 2 ices relating to a request for contraception or a 3 medication related to a contraceptive; 4 ‘‘(C) the pharmacy’s employees do not in- 5 tentionally misrepresent or deceive customers 6 about the availability of a contraceptive or a 7 medication related to a contraceptive, or the 8 mechanism of action of such contraceptive or 9 medication; 10 ‘‘(D) the pharmacy’s employees do not 11 breach medical confidentiality with respect to a 12 request for a contraceptive or a medication re- 13 lated to a contraceptive or threaten to breach 14 such confidentiality; or 15 ‘‘(E) the pharmacy’s employees do not 16 refuse to return a valid, lawful prescription for 17 a contraceptive or a medication related to a 18 contraceptive upon customer request. 19 ‘‘(b) CONTRACEPTIVES NOT ORDINARILY 20 STOCKED.—Nothing in subsection (a)(2) shall be con- 21 strued to require any pharmacy to comply with such sub- 22 section if the pharmacy does not ordinarily stock contra- 23 ceptives or a medication related to a contraceptive in the 24 normal course of business. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00855 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 856 •S 4486 IS ‘‘(c) REFUSALS PURSUANT TO STANDARD PHAR- 1 MACY PRACTICE.—This section does not prohibit a phar- 2 macy from refusing to provide a contraceptive or a medi- 3 cation related to a contraceptive to a customer in accord- 4 ance with any of the following: 5 ‘‘(1) If it is unlawful to dispense the contracep- 6 tive or a medication related to a contraceptive to the 7 customer without a valid, lawful prescription and no 8 such prescription is presented. 9 ‘‘(2) If the customer is unable to pay for the 10 contraceptive or the medication related to a contra- 11 ceptive. 12 ‘‘(3) If the employee of the pharmacy refuses to 13 provide the contraceptive or a medication related to 14 a contraceptive on the basis of a professional clinical 15 judgment. 16 ‘‘(d) RELATION TO OTHER LAW.— 17 ‘‘(1) RULE OF CONSTRUCTION.—Nothing in 18 this section shall be construed to invalidate or limit 19 rights, remedies, procedures, or legal standards 20 under title VII of the Civil Rights Act of 1964. 21 ‘‘(2) CERTAIN CLAIMS.—The Religious Free- 22 dom Restoration Act of 1993 shall not provide a 23 basis for a claim concerning, or a defense to a claim 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00856 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 857 •S 4486 IS under, this section, or provide a basis for challenging 1 the application or enforcement of this section. 2 ‘‘(e) PREEMPTION.—This section does not preempt 3 any provision of State law or any professional obligation 4 made applicable by a State board or other entity respon- 5 sible for licensing or discipline of pharmacies or phar- 6 macists, to the extent that such State law or professional 7 obligation provides protections for customers that are 8 greater than the protections provided by this section. 9 ‘‘(f) ENFORCEMENT.— 10 ‘‘(1) CIVIL PENALTY.—A pharmacy that vio- 11 lates a requirement of subsection (a) is liable to the 12 United States for a civil penalty in an amount not 13 exceeding $1,000 per day of violation, not to exceed 14 $100,000 for all violations adjudicated in a single 15 proceeding. 16 ‘‘(2) PRIVATE CAUSE OF ACTION.—Any person 17 aggrieved as a result of a violation of a requirement 18 of subsection (a) may, in any court of competent ju- 19 risdiction, commence a civil action against the phar- 20 macy involved to obtain appropriate relief, including 21 actual and punitive damages, injunctive relief, and a 22 reasonable attorney’s fee and cost. 23 ‘‘(3) LIMITATIONS.—A civil action under para- 24 graph (1) or (2) may not be commenced against a 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00857 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 858 •S 4486 IS pharmacy after the expiration of the 5-year period 1 beginning on the date on which the pharmacy alleg- 2 edly engaged in the violation involved. 3 ‘‘(g) DEFINITIONS.—In this section: 4 ‘‘(1) CONTRACEPTION.—The term ‘contracep- 5 tion’ or ‘contraceptive’ means any drug or device ap- 6 proved by the Food and Drug Administration to pre- 7 vent pregnancy. 8 ‘‘(2) EMPLOYEE.—The term ‘employee’ means 9 a person hired, by contract or any other form of an 10 agreement, by a pharmacy. 11 ‘‘(3) MEDICATION RELATED TO A CONTRACEP- 12 TIVE.—The term ‘medication related to a contracep- 13 tive’ means any drug or device approved by the Food 14 and Drug Administration that a medical professional 15 determines necessary to use before or in conjunction 16 with a contraceptive. 17 ‘‘(4) PHARMACY.—The term ‘pharmacy’ means 18 an entity that— 19 ‘‘(A) is authorized by a State to engage in 20 the business of selling prescription drugs at re- 21 tail; and 22 ‘‘(B) employs one or more employees. 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00858 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 859 •S 4486 IS ‘‘(5) PRODUCT.—The term ‘product’ means a 1 Food and Drug Administration-approved drug or de- 2 vice. 3 ‘‘(6) PROFESSIONAL CLINICAL JUDGMENT.— 4 The term ‘professional clinical judgment’ means the 5 use of professional knowledge and skills to form a 6 clinical judgment, in accordance with prevailing 7 medical standards. 8 ‘‘(7) WITHOUT DELAY.—The term ‘without 9 delay’, with respect to a pharmacy providing, pro- 10 viding a referral for, or ordering contraception, or 11 transferring the prescription for contraception, 12 means within the usual and customary timeframe at 13 the pharmacy for providing, providing a referral for, 14 or ordering other products, or transferring the pre- 15 scription for other products, respectively. 16 ‘‘(h) EFFECTIVE DATE.—This section shall take ef- 17 fect on the 31st day after the date of the enactment of 18 this section, without regard to whether the Secretary has 19 issued any guidance or final rule regarding this section.’’. 20 SEC. 5404. REAL EDUCATION AND ACCESS FOR HEALTHY 21 YOUTH. 22 (a) PURPOSE.—The purpose of this section is to pro- 23 vide young people with sex education and sexual health 24 services that— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00859 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 860 •S 4486 IS (1) promote and uphold the rights of young 1 people to information and services that empower 2 them to make decisions about their bodies, health, 3 sexuality, families, and communities in all areas of 4 life; 5 (2) are evidence-informed, comprehensive in 6 scope, confidential, equitable, accessible, medically 7 accurate and complete, age and developmentally ap- 8 propriate, culturally responsive, and trauma-in- 9 formed and resilience-oriented; 10 (3) provide information about the prevention, 11 treatment, and care of pregnancy, sexually trans- 12 mitted infections, and interpersonal violence; 13 (4) provide information about the importance of 14 consent as a basis for healthy relationships and for 15 autonomy in health care; 16 (5) provide information on gender roles and 17 gender discrimination; 18 (6) provide information on the historical and 19 current condition in which education and health sys- 20 tems, policies, programs, services, and practices have 21 uniquely and adversely impacted Black, Indigenous, 22 Latinx, Asian, Asian American and Pacific Islander, 23 and other People of Color; and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00860 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 861 •S 4486 IS (7) redress inequities in the delivery of sex edu- 1 cation and sexual health services to marginalized 2 young people. 3 (b) DEFINITIONS.—In this section: 4 (1) AGE AND DEVELOPMENTALLY APPRO- 5 PRIATE.—The term ‘‘age and developmentally appro- 6 priate’’ means topics, messages, and teaching meth- 7 ods suitable to particular ages, age groups, or devel- 8 opmental levels, based on cognitive, emotional, so- 9 cial, and behavioral capacity of most young people at 10 that age level. 11 (2) CHARACTERISTICS OF EFFECTIVE PRO- 12 GRAMS.—The term ‘‘characteristics of effective pro- 13 grams’’ means the aspects of evidence-informed pro- 14 grams, including development, content, and imple- 15 mentation of such programs, that— 16 (A) have been shown to be effective in 17 terms of increasing knowledge, clarifying values 18 and attitudes, increasing skills, and impacting 19 behavior; and 20 (B) are widely recognized by leading med- 21 ical and public health agencies to be effective in 22 changing sexual behaviors that lead to sexually 23 transmitted infections, unintended pregnancy, 24 and interpersonal violence among young people. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00861 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 862 •S 4486 IS (3) CONSENT.—The term ‘‘consent’’ means af- 1 firmative, conscious, and voluntary agreement to en- 2 gage in interpersonal, physical, or sexual activity. 3 (4) CULTURALLY RESPONSIVE.—The term ‘‘cul- 4 turally responsive’’ means education and services 5 that— 6 (A) embrace and actively engage and ad- 7 just to young people and their various cultural 8 identities; 9 (B) recognize the ways in which many 10 marginalized young people face unique barriers 11 in our society that result in increased adverse 12 health outcomes and associated stereotypes; and 13 (C) may address the ways in which racism 14 has shaped national health care policy, the last- 15 ing historical trauma associated with reproduc- 16 tive health experiments and forced sterilizations 17 of Black, Latinx, and Indigenous communities, 18 or sexual stereotypes assigned to young People 19 of Color or LGBTQ+ people. 20 (5) EVIDENCE-INFORMED.—The term ‘‘evi- 21 dence-informed’’ means incorporates characteristics, 22 content, or skills that have been proven to be effec- 23 tive through evaluation in changing sexual behavior. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00862 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 863 •S 4486 IS (6) GENDER EXPRESSION.—The term ‘‘gender 1 expression’’ means the expression of one’s gender, 2 such as through behavior, clothing, haircut, or voice, 3 and which may or may not conform to socially de- 4 fined behaviors and characteristics typically associ- 5 ated with being either masculine or feminine. 6 (7) GENDER IDENTITY.—The term ‘‘gender 7 identity’’ means the gender-related identity, appear- 8 ance, mannerisms, or other gender-related character- 9 istics of an individual, regardless of the individual’s 10 designated sex at birth. 11 (8) INCLUSIVE.—The term ‘‘inclusive’’ means 12 content and skills that ensure marginalized young 13 people are valued, respected, centered, and sup- 14 ported in sex education instruction and materials. 15 (9) INSTITUTION OF HIGHER EDUCATION.—The 16 term ‘‘institution of higher education’’ has the 17 meaning given the term in section 101 of the Higher 18 Education Act of 1965 (20 U.S.C. 1001). 19 (10) INTERPERSONAL VIOLENCE.—The term 20 ‘‘interpersonal violence’’ means abuse, assault, bul- 21 lying, dating violence, domestic violence, harassment, 22 intimate partner violence, or stalking. 23 (11) MARGINALIZED YOUNG PEOPLE.—The 24 term ‘‘marginalized young people’’ means young peo- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00863 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 864 •S 4486 IS ple who are disadvantaged by underlying structural 1 barriers and social inequities, including young people 2 who are— 3 (A) Black, Indigenous, and other People of 4 Color; 5 (B) immigrants; 6 (C) in contact with the foster care system; 7 (D) in contact with the juvenile justice sys- 8 tem; 9 (E) experiencing homelessness; 10 (F) pregnant or parenting; 11 (G) lesbian, gay, bisexual, transgender, or 12 queer; 13 (H) living with HIV; 14 (I) living with disabilities; 15 (J) from families with low incomes; or 16 (K) living in rural areas. 17 (12) MEDICALLY ACCURATE AND COMPLETE.— 18 The term ‘‘medically accurate and complete’’ means 19 that— 20 (A) the information provided through the 21 education is verified or supported by the weight 22 of research conducted in compliance with ac- 23 cepted scientific methods and is published in 24 peer-reviewed journals, where applicable; or 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00864 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 865 •S 4486 IS (B) the education contains information 1 that leading professional organizations and 2 agencies with relevant expertise in the field rec- 3 ognize as accurate, objective, and complete. 4 (13) RESILIENCE.—The term ‘‘resilience’’ 5 means the ability to adapt to trauma and tragedy. 6 (14) SECRETARY.—The term ‘‘Secretary’’ 7 means the Secretary of Health and Human Services. 8 (15) SEX EDUCATION.—The term ‘‘sex edu- 9 cation’’ means high-quality teaching and learning 10 that— 11 (A) is delivered, to the maximum extent 12 practicable, following the National Sexuality 13 Education Standards of the Future of Sex Edu- 14 cation Initiative; 15 (B) is about a broad variety of topics re- 16 lated to sex and sexuality, including— 17 (i) puberty and adolescent develop- 18 ment; 19 (ii) sexual and reproductive anatomy 20 and physiology; 21 (iii) sexual orientation, gender iden- 22 tity, and gender expression; 23 (iv) contraception, pregnancy, and re- 24 production; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00865 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 866 •S 4486 IS (v) HIV and other STIs; 1 (vi) consent and healthy relationships; 2 and 3 (vii) interpersonal violence; 4 (C) explores values and beliefs about such 5 topics; and 6 (D) helps young people in gaining the 7 skills that are needed to navigate relationships 8 and manage one’s own sexual health. 9 (16) SEXUAL DEVELOPMENT.—The term ‘‘sex- 10 ual development’’ means the lifelong process of phys- 11 ical, behavioral, cognitive, and emotional growth and 12 change as it relates to an individual’s sexuality and 13 sexual maturation, including puberty, identity devel- 14 opment, socio-cultural influences, and sexual behav- 15 iors. 16 (17) SEXUAL HEALTH SERVICES.—The term 17 ‘‘sexual health services’’ includes— 18 (A) sexual health information, education, 19 and counseling; 20 (B) all methods of contraception approved 21 by the Food and Drug Administration; 22 (C) routine gynecological care, including 23 human papillomavirus (HPV) vaccines and can- 24 cer screenings; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00866 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 867 •S 4486 IS (D) pre-exposure prophylaxis or post-expo- 1 sure prophylaxis; 2 (E) substance use and mental health serv- 3 ices; 4 (F) interpersonal violence survivor services; 5 and 6 (G) other prevention, care, or treatment 7 services. 8 (18) SEXUAL ORIENTATION.—The term ‘‘sexual 9 orientation’’ means an individual’s romantic, emo- 10 tional, or sexual attraction to other people. 11 (19) TRAUMA.—The term ‘‘trauma’’ means a 12 response to an event, series of events, or set of cir- 13 cumstances that is experienced or witnessed by an 14 individual or group of people as physically or emo- 15 tionally harmful or life-threatening with lasting ad- 16 verse effects on their functioning and mental, phys- 17 ical, social, emotional, or spiritual well-being. 18 (20) TRAUMA-INFORMED AND RESILIENCE-ORI- 19 ENTED.—The term ‘‘trauma-informed and resil- 20 ience-oriented’’ means an approach that realizes the 21 prevalence of trauma, recognizes the various ways 22 individuals, organizations, and communities may re- 23 spond to trauma differently, recognizes that resil- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00867 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 868 •S 4486 IS ience can be built, and responds by putting this 1 knowledge into practice. 2 (21) YOUNG PEOPLE.—The term ‘‘young peo- 3 ple’’ means individuals who are ages 10 through 29 4 at the time of commencement of participation in a 5 project supported under this section. 6 (22) YOUTH-FRIENDLY SEXUAL HEALTH SERV- 7 ICES.—The term ‘‘youth-friendly sexual health serv- 8 ices’’ means sexual health services that are provided 9 in a confidential, equitable, and accessible manner 10 that makes it easy and comfortable for young people 11 to seek out and receive services. 12 (c) GRANTS FOR SEX EDUCATION AT ELEMENTARY 13 AND SECONDARY SCHOOLS AND YOUTH-SERVING ORGA- 14 NIZATIONS.— 15 (1) PROGRAM AUTHORIZED.—The Secretary, in 16 coordination with the Secretary of Education, shall 17 award grants, on a competitive basis, to eligible enti- 18 ties to enable such eligible entities to carry out 19 projects that provide young people with sex edu- 20 cation. 21 (2) DURATION.—Grants awarded under this 22 subsection shall be for a period of 5 years. 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00868 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 869 •S 4486 IS (3) ELIGIBLE ENTITY.—In this subsection, the 1 term ‘‘eligible entity’’ means a public or private enti- 2 ty that delivers health education to young people. 3 (4) APPLICATIONS.—An eligible entity desiring 4 a grant under this subsection shall submit an appli- 5 cation to the Secretary at such time, in such man- 6 ner, and containing such information as the Sec- 7 retary may require. 8 (5) PRIORITY.—In awarding grants under this 9 subsection, the Secretary shall give priority to eligi- 10 ble entities that are— 11 (A) State educational agencies or local 12 educational agencies; or 13 (B) Indian Tribes or Tribal organizations, 14 as defined in section 4 of the Indian Self-Deter- 15 mination and Education Assistance Act (25 16 U.S.C. 5304). 17 (6) USE OF FUNDS.—Each eligible entity that 18 receives a grant under this subsection shall use the 19 grant funds to carry out a project that provides 20 young people with sex education. 21 (d) GRANTS FOR SEX EDUCATION AT INSTITUTIONS 22 OF HIGHER EDUCATION.— 23 (1) PROGRAM AUTHORIZED.—The Secretary, in 24 coordination with the Secretary of Education, shall 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00869 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 870 •S 4486 IS award grants, on a competitive basis, to institutions 1 of higher education or consortia of such institutions 2 to enable such institutions to provide students with 3 age and developmentally appropriate sex education. 4 (2) DURATION.—Grants awarded under this 5 subsection shall be for a period of 5 years. 6 (3) APPLICATIONS.—An institution of higher 7 education or consortium of such institutions desiring 8 a grant under this subsection shall submit an appli- 9 cation to the Secretary at such time, in such man- 10 ner, and containing such information as the Sec- 11 retary may require. 12 (4) PRIORITY.—In awarding grants under this 13 subsection, the Secretary shall give priority to an in- 14 stitution of higher education that— 15 (A) has an enrollment of needy students, 16 as defined in section 318(b) of the Higher Edu- 17 cation Act of 1965 (20 U.S.C. 1059e(b)); 18 (B) is a Hispanic-serving institution, as 19 defined in section 502(a) of such Act (20 20 U.S.C. 1101a(a)); 21 (C) is a Tribal College or University, as 22 defined in section 316(b) of such Act (20 23 U.S.C. 1059c(b)); 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00870 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 871 •S 4486 IS (D) is an Alaska Native-serving institution, 1 as defined in section 317(b) of such Act (20 2 U.S.C. 1059d(b)); 3 (E) is a Native Hawaiian-serving institu- 4 tion, as defined in section 317(b) of such Act 5 (20 U.S.C. 1059d(b)); 6 (F) is a Predominantly Black Institution, 7 as defined in section 318(b) of such Act (20 8 U.S.C. 1059e(b)); 9 (G) is a Native American-serving, non- 10 tribal institution, as defined in section 319(b) 11 of such Act (20 U.S.C. 1059f(b)); 12 (H) is an Asian American and Native 13 American Pacific Islander-serving institution, as 14 defined in section 320(b) of such Act (20 15 U.S.C. 1059g(b)); or 16 (I) is a minority institution, as defined in 17 section 365 of such Act (20 U.S.C. 1067k), 18 with an enrollment of needy students, as de- 19 fined in section 312 of such Act (20 U.S.C. 20 1058). 21 (5) USES OF FUNDS.—An institution of higher 22 education or consortium of such institutions receiv- 23 ing a grant under this subsection shall use grant 24 funds to develop and implement a project to inte- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00871 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 872 •S 4486 IS grate sex education into the institution of higher 1 education in order to reach a large number of stu- 2 dents, by carrying out 1 or more of the following ac- 3 tivities: 4 (A) Adopting and incorporating age and 5 developmentally appropriate sex education into 6 student orientation, general education, or 7 courses. 8 (B) Developing or adopting and imple- 9 menting educational programming outside of 10 class that delivers age and developmentally ap- 11 propriate sex education to students. 12 (C) Developing or adopting and imple- 13 menting innovative technology-based approaches 14 to deliver age and developmentally appropriate 15 sex education to students. 16 (D) Developing or adopting and imple- 17 menting peer-led activities to generate discus- 18 sion, educate, and raise awareness among stu- 19 dents about age and developmentally appro- 20 priate sex education. 21 (E) Developing or adopting and imple- 22 menting policies and practices to link students 23 to sexual health services. 24 (e) GRANTS FOR EDUCATOR TRAINING.— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00872 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 873 •S 4486 IS (1) PROGRAM AUTHORIZED.—The Secretary, in 1 coordination with the Secretary of Education, shall 2 award grants, on a competitive basis, to eligible enti- 3 ties to enable such eligible entities to carry out the 4 activities described in paragraph (5). 5 (2) DURATION.—Grants awarded under this 6 subsection shall be for a period of 5 years. 7 (3) ELIGIBLE ENTITY.—In this subsection, the 8 term ‘‘eligible entity’’ means— 9 (A) a State educational agency or local 10 educational agency; 11 (B) an Indian Tribe or Tribal organiza- 12 tion, as defined in section 4 of the Indian Self- 13 Determination and Education Assistance Act 14 (25 U.S.C. 5304); 15 (C) a State or local department of health; 16 (D) an educational service agency; 17 (E) a nonprofit institution of higher edu- 18 cation or a consortium of such institutions; or 19 (F) a national or statewide nonprofit orga- 20 nization or consortium of nonprofit organiza- 21 tions that has as its primary purpose the im- 22 provement of provision of sex education through 23 training and effective teaching of sex education. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00873 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 874 •S 4486 IS (4) APPLICATION.—An eligible entity desiring a 1 grant under this subsection shall submit an applica- 2 tion to the Secretary at such time, in such manner, 3 and containing such information as the Secretary 4 may require. 5 (5) AUTHORIZED ACTIVITIES.— 6 (A) REQUIRED ACTIVITY.—Each eligible 7 entity receiving a grant under this subsection 8 shall use grant funds for professional develop- 9 ment and training of relevant teachers, health 10 educators, faculty, administrators, and staff, in 11 order to increase effective teaching of sex edu- 12 cation to young people. 13 (B) PERMISSIBLE ACTIVITIES.—Each eligi- 14 ble entity receiving a grant under this sub- 15 section may use grant funds to— 16 (i) provide training and support for 17 educators about the content, skills, and 18 professional disposition needed to imple- 19 ment sex education effectively; 20 (ii) develop and provide training and 21 support to educators on incorporating anti- 22 racist and gender-inclusive policies and 23 practices in sex education; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00874 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 875 •S 4486 IS (iii) support the dissemination of in- 1 formation on effective practices and re- 2 search findings concerning the teaching of 3 sex education; 4 (iv) support research on— 5 (I) effective sex education teach- 6 ing practices; and 7 (II) the development of assess- 8 ment instruments and strategies to 9 document— 10 (aa) young people’s under- 11 standing of sex education; and 12 (bb) the effects of sex edu- 13 cation; 14 (v) convene conferences on sex edu- 15 cation, in order to effectively train edu- 16 cators in the provision of sex education; 17 and 18 (vi) develop and disseminate appro- 19 priate research-based materials to foster 20 sex education. 21 (C) SUBGRANTS.—Each eligible entity re- 22 ceiving a grant under this subsection may 23 award subgrants to nonprofit organizations that 24 possess a demonstrated record of providing 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00875 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 876 •S 4486 IS training to teachers, health educators, faculty, 1 administrators, and staff on sex education to— 2 (i) train educators in sex education; 3 (ii) support internet or distance learn- 4 ing related to sex education; 5 (iii) promote rigorous academic stand- 6 ards and assessment techniques to guide 7 and measure student performance in sex 8 education; 9 (iv) encourage replication of best 10 practices and model programs to promote 11 sex education; 12 (v) develop and disseminate effective, 13 research-based sex education learning ma- 14 terials; or 15 (vi) develop academic courses on the 16 pedagogy of sex education at institutions 17 of higher education. 18 (f) AUTHORIZATION OF GRANTS TO SUPPORT THE 19 DELIVERY OF SEXUAL HEALTH SERVICES TO 20 MARGINALIZED YOUNG PEOPLE.— 21 (1) PROGRAM AUTHORIZED.—The Secretary 22 shall award grants, on a competitive basis, to eligible 23 entities to enable such entities to provide youth- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00876 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 877 •S 4486 IS friendly sexual health services to marginalized young 1 people. 2 (2) DURATION.—Grants awarded under this 3 subsection shall be for a period of 5 years. 4 (3) ELIGIBLE ENTITY.—In this subsection, the 5 term ‘‘eligible entity’’ means— 6 (A) a public or private youth-serving orga- 7 nization; or 8 (B) a covered entity, as defined in section 9 340B of the Public Health Service Act (42 10 U.S.C. 256b). 11 (4) APPLICATIONS.—An eligible entity desiring 12 a grant under this subsection shall submit an appli- 13 cation to the Secretary at such time, in such man- 14 ner, and containing such information as the Sec- 15 retary may require. 16 (5) USES OF FUNDS.—Each eligible entity that 17 receives a grant under this subsection may use the 18 grant funds to— 19 (A) develop and implement an evidence-in- 20 formed project to deliver sexual health services 21 to marginalized young people; 22 (B) establish, alter, or modify staff posi- 23 tions, service delivery policies and practices, 24 service delivery locations, service delivery envi- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00877 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 878 •S 4486 IS ronments, service delivery schedules, or other 1 services components in order to increase youth- 2 friendly sexual health services to marginalized 3 young people; 4 (C) conduct outreach to marginalized 5 young people to invite them to participate in 6 the eligible entity’s sexual health services and to 7 provide feedback to inform improvements in the 8 delivery of such services; 9 (D) establish and refine systems of referral 10 to connect marginalized young people to other 11 sexual health services and supportive services; 12 (E) establish partnerships and collabora- 13 tions with entities providing services to 14 marginalized young people to link such young 15 people to sexual health services, such as by de- 16 livering health services at locations where they 17 congregate, providing transportation to loca- 18 tions where sexual health services are provided, 19 or other linkages to services approaches; 20 (F) provide evidence-informed, comprehen- 21 sive in scope, confidential, equitable, accessible, 22 medically accurate and complete, age and devel- 23 opmentally appropriate, culturally responsive, 24 and trauma-informed and resilience-oriented 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00878 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 879 •S 4486 IS sexual health information to marginalized 1 young people in the languages and cultural con- 2 texts that are most appropriate for the 3 marginalized young people to be served by the 4 eligible entity; 5 (G) promote effective communication re- 6 garding sexual health among marginalized 7 young people; and 8 (H) provide training and support for eligi- 9 ble entity personnel and community members 10 who work with marginalized young people about 11 the content, skills, and professional disposition 12 needed to provide youth-friendly sex education 13 and youth-friendly sexual health services. 14 (g) REPORTING AND IMPACT EVALUATION.— 15 (1) GRANTEE REPORT TO SECRETARY.—For 16 each year an eligible entity receives grant funds 17 under subsection (c), (d), (e), or (f), the eligible enti- 18 ty shall submit to the Secretary a report that in- 19 cludes— 20 (A) the use of grant funds by the eligible 21 entity; 22 (B) how the use of grant funds has in- 23 creased the access of young people to sex edu- 24 cation or sexual health services; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00879 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 880 •S 4486 IS (C) such other information as the Sec- 1 retary may require. 2 (2) SECRETARY’S REPORT TO CONGRESS.—Not 3 later than 1 year after the date of the enactment of 4 this Act, and annually thereafter for a period of 5 5 years, the Secretary shall prepare and submit to 6 Congress a report on the activities funded under this 7 section. The Secretary’s report to Congress shall in- 8 clude— 9 (A) a statement of how grants awarded by 10 the Secretary meet the purposes described in 11 subsection (a); and 12 (B) information about— 13 (i) the number of eligible entities that 14 are receiving grant funds under sub- 15 sections (c), (d), (e), and (f); 16 (ii) the specific activities supported by 17 grant funds awarded under subsections (c), 18 (d), (e), and (f); 19 (iii) the number of young people 20 served by projects funded under sub- 21 sections (c), (d), (e), and (f), in the aggre- 22 gate and disaggregated and cross-tabulated 23 by grant program, race and ethnicity, sex, 24 sexual orientation, gender identity, and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00880 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 881 •S 4486 IS other characteristics determined by the 1 Secretary (except that such disaggregation 2 or cross-tabulation shall not be required in 3 a case in which the results would reveal 4 personally identifiable information about 5 an individual young person); 6 (iv) the number of teachers, health 7 educators, faculty, school administrators, 8 and staff trained under subsection (e); and 9 (v) the status of the evaluation re- 10 quired under paragraph (3). 11 (3) MULTI-YEAR EVALUATION.— 12 (A) IN GENERAL.—Not later than 6 13 months after the date of the enactment of this 14 Act, the Secretary shall enter into a contract 15 with a nonprofit organization with experience in 16 conducting impact evaluations to conduct a 17 multi-year evaluation on the impact of the 18 projects funded under subsections (c), (d), (e), 19 and (f) and to report to Congress and the Sec- 20 retary on the findings of such evaluation. 21 (B) EVALUATION.—The evaluation con- 22 ducted under this paragraph shall— 23 (i) be conducted in a manner con- 24 sistent with relevant, nationally recognized 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00881 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 882 •S 4486 IS professional and technical evaluation 1 standards; 2 (ii) use sound statistical methods and 3 techniques relating to the behavioral 4 sciences, including quasi-experimental de- 5 signs, inferential statistics, and other 6 methodologies and techniques that allow 7 for conclusions to be reached; 8 (iii) be carried out by an independent 9 organization that has not received a grant 10 under subsection (c), (d), (e), or (f); and 11 (iv) be designed to provide informa- 12 tion on output measures and outcome 13 measures to be determined by the Sec- 14 retary. 15 (C) REPORT.—Not later than 6 years after 16 the date of enactment of this Act, the organiza- 17 tion conducting the evaluation under this para- 18 graph shall prepare and submit to the appro- 19 priate committees of Congress and the Sec- 20 retary a report on such evaluation. Such report 21 shall be made publicly available, including on 22 the website of the Department of Health and 23 Human Services. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00882 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 883 •S 4486 IS (h) NONDISCRIMINATION.—Activities funded under 1 this section shall not discriminate on the basis of actual 2 or perceived sex (including sexual orientation and gender 3 identity), age, parental status, race, color, ethnicity, na- 4 tional origin, disability, or religion. Nothing in this section 5 shall be construed to invalidate or limit rights, remedies, 6 procedures, or legal standards available under any other 7 Federal law or any law of a State or a political subdivision 8 of a State, including the Civil Rights Act of 1964 (42 9 U.S.C. 2000a et seq.), title IX of the Education Amend- 10 ments of 1972 (20 U.S.C. 1681 et seq.), section 504 of 11 the Rehabilitation Act of 1973 (29 U.S.C. 794), the Amer- 12 icans with Disabilities Act of 1990 (42 U.S.C. 12101 et 13 seq.), and section 1557 of the Patient Protection and Af- 14 fordable Care Act (42 U.S.C. 18116). 15 (i) LIMITATION.—No Federal funds provided under 16 this section may be used for sex education or sexual health 17 services that— 18 (1) withhold health-promoting or life-saving in- 19 formation about sexuality-related topics, including 20 HIV; 21 (2) are medically inaccurate or incomplete; 22 (3) promote gender or racial stereotypes or are 23 unresponsive to gender or racial inequities; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00883 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 884 •S 4486 IS (4) fail to address the needs of sexually active 1 young people; 2 (5) fail to address the needs of pregnant or par- 3 enting young people; 4 (6) fail to address the needs of survivors of 5 interpersonal violence; 6 (7) fail to address the needs of young people of 7 all physical, developmental, or mental abilities; 8 (8) fail to be inclusive of individuals with vary- 9 ing gender identities, gender expressions, and sexual 10 orientations; or 11 (9) are inconsistent with the ethical imperatives 12 of medicine and public health. 13 (j) AMENDMENTS TO OTHER LAWS.— 14 (1) AMENDMENT TO THE PUBLIC HEALTH 15 SERVICE ACT.—Section 2500 of the Public Health 16 Service Act (42 U.S.C. 300ee) is amended by strik- 17 ing subsections (b) through (d) and inserting the fol- 18 lowing: 19 ‘‘(b) CONTENTS OF PROGRAMS.—All programs of 20 education and information receiving funds under this title 21 shall include information about the potential effects of in- 22 travenous substance use.’’. 23 (2) AMENDMENTS TO THE ELEMENTARY AND 24 SECONDARY EDUCATION ACT OF 1965.—Section 8526 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00884 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 885 •S 4486 IS of the Elementary and Secondary Education Act of 1 1965 (20 U.S.C. 7906) is amended— 2 (A) by striking paragraphs (3), (5), and 3 (6); 4 (B) in paragraph (2), by inserting ‘‘or’’ 5 after the semicolon; 6 (C) by redesignating paragraph (4) as 7 paragraph (3); and 8 (D) in paragraph (3), as redesignated by 9 subparagraph (C), by striking the semicolon 10 and inserting a period. 11 (k) FUNDING.— 12 (1) AUTHORIZATION.—For the purpose of car- 13 rying out this section, there is authorized to be ap- 14 propriated $100,000,000 for each of fiscal years 15 2022 through 2027. Amounts appropriated under 16 this paragraph shall remain available until expended. 17 (2) RESERVATIONS OF FUNDS.— 18 (A) IN GENERAL.—Of the amount author- 19 ized under paragraph (1), the Secretary shall 20 reserve— 21 (i) not more than 30 percent for the 22 purposes of awarding grants for sex edu- 23 cation at elementary and secondary schools 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00885 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 886 •S 4486 IS and youth-serving organizations under sub- 1 section (c); 2 (ii) not more than 10 percent for the 3 purpose of awarding grants for sex edu- 4 cation at institutions of higher education 5 under subsection (d); 6 (iii) not more than 15 percent for the 7 purpose of awarding grants for educator 8 training under subsection (e); 9 (iv) not more than 30 percent for the 10 purpose of awarding grants for sexual 11 health services for marginalized youth 12 under subsection (f); and 13 (v) not less than 5 percent for the 14 purpose of carrying out the reporting and 15 impact evaluation required under sub- 16 section (g). 17 (B) RESEARCH, TRAINING AND TECHNICAL 18 ASSISTANCE.—The Secretary shall reserve not 19 less than 10 percent of the amount authorized 20 under paragraph (1) for expenditures by the 21 Secretary to provide, directly or through a com- 22 petitive grant process, research, training, and 23 technical assistance, including dissemination of 24 research and information regarding effective 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00886 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 887 •S 4486 IS and promising practices, providing consultation 1 and resources, and developing resources and 2 materials to support the activities of recipients 3 of grants. In carrying out such functions, the 4 Secretary shall collaborate with a variety of en- 5 tities that have expertise in sex education and 6 sexual health services standards setting, design, 7 development, delivery, research, monitoring, and 8 evaluation. 9 (3) REPROGRAMMING OF ABSTINENCE ONLY 10 UNTIL MARRIAGE PROGRAM FUNDING.—The unobli- 11 gated balance of funds made available to carry out 12 section 510 of the Social Security Act (42 U.S.C. 13 710) (as in effect on the day before the date of en- 14 actment of this Act) are hereby transferred and shall 15 be used by the Secretary to carry out this section. 16 The amounts transferred and made available to 17 carry out this section shall remain available until ex- 18 pended. 19 (4) REPEAL OF ABSTINENCE ONLY UNTIL MAR- 20 RIAGE PROGRAM.—Section 510 of the Social Secu- 21 rity Act (42 U.S.C. 710 et seq.) is repealed. 22 SEC. 5405. COMPASSIONATE ASSISTANCE FOR RAPE EMER- 23 GENCIES. 24 (a) MEDICARE.— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00887 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 888 •S 4486 IS (1) LIMITATION ON PAYMENT.—Section 1 1866(a)(1) of the Social Security Act (42 U.S.C. 2 1395cc(a)(1)) is amended— 3 (A) by moving the indentation of subpara- 4 graph (W) 2 ems to the left; 5 (B) in subparagraph (X)— 6 (i) by moving the indentation 2 ems 7 to the left; and 8 (ii) by striking ‘‘and’’ at the end; 9 (C) in subparagraph (Y), by striking the 10 period at the end and inserting ‘‘; and’’; and 11 (D) by inserting after subparagraph (Y) 12 the following new subparagraph: 13 ‘‘(Z) in the case of a hospital or critical access 14 hospital, to adopt and enforce a policy to ensure 15 compliance with the requirements of subsection (l) 16 and to meet the requirements of such subsection.’’. 17 (2) ASSISTANCE TO VICTIMS.—Section 1866 of 18 the Social Security Act (42 U.S.C. 1395cc) is 19 amended by adding at the end the following new 20 subsection: 21 ‘‘(l) COMPASSIONATE ASSISTANCE FOR RAPE EMER- 22 GENCIES.— 23 ‘‘(1) IN GENERAL.—For purposes of subsection 24 (a)(1)(Z), a hospital meets the requirements of this 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00888 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 889 •S 4486 IS subsection if the hospital provides each of the serv- 1 ices described in paragraph (2) to each individual, 2 whether or not eligible for benefits under this title 3 or under any other form of health insurance, who 4 comes to the hospital on or after January 1, 2022, 5 and— 6 ‘‘(A) who states to hospital personnel that 7 they are victims of sexual assault; 8 ‘‘(B) who is accompanied by an individual 9 who states to hospital personnel that the indi- 10 vidual is a victim of sexual assault; or 11 ‘‘(C) whom hospital personnel, during the 12 course of treatment and care for the individual, 13 have reason to believe is a victim of sexual as- 14 sault. 15 ‘‘(2) REQUIRED SERVICES DESCRIBED.—For 16 purposes of paragraph (1), the services described in 17 this subparagraph are the following: 18 ‘‘(A) Provision of medically and factually 19 accurate and unbiased written and oral infor- 20 mation about emergency contraception that— 21 ‘‘(i) is written in clear and concise 22 language; 23 ‘‘(ii) is readily comprehensible; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00889 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 890 •S 4486 IS ‘‘(iii) includes an explanation that 1 emergency contraceptives— 2 ‘‘(I) have been approved by the 3 Food and Drug Administration for in- 4 dividuals and are a safe and effective 5 way to prevent pregnancy after unpro- 6 tected intercourse or contraceptive 7 failure if taken in a timely manner; 8 ‘‘(II) are more effective the soon- 9 er it is taken; and 10 ‘‘(III) do not cause an abortion 11 and cannot interrupt an established 12 pregnancy; 13 ‘‘(iv) meet such conditions regarding 14 the provision of such information in lan- 15 guages other than English as the Secretary 16 may establish; and 17 ‘‘(v) are provided without regard to 18 the ability of the individual or their family 19 to pay costs associated with the provision 20 of such information to the individual. 21 ‘‘(B) Immediate offer to provide emergency 22 contraception to the individual at the hospital 23 and, in the case that such individual accepts 24 such offer, immediate provision to such indi- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00890 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 891 •S 4486 IS vidual of such contraception on the same day it 1 is requested without regard to the inability of 2 the individual or their family to pay costs asso- 3 ciated with the offer and provision of such con- 4 traception. 5 ‘‘(C) Development and implementation of a 6 written policy to ensure that an individual is 7 present at the hospital, or on-call, who— 8 ‘‘(i) has authority to dispense or pre- 9 scribe emergency contraception, independ- 10 ently, or under a protocol prepared by a 11 physician for the administration of emer- 12 gency contraception at the hospital to a 13 victim of sexual assault; and 14 ‘‘(ii) is trained to comply with the re- 15 quirements of this section. 16 ‘‘(D) Provision of medically and factually 17 accurate and unbiased written and oral infor- 18 mation and counseling about post-exposure pro- 19 phylaxis (PEP) protocol for the prevention of 20 HIV. 21 ‘‘(E) Immediate offer to begin PEP to the 22 individual at the hospital except in cases where 23 the medical professional’s best judgement is 24 that further evaluation is required or that such 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00891 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 892 •S 4486 IS a regimen will be substantially detrimental to 1 the health of such individual. Such provision 2 shall be offered regardless of the individual’s 3 ability to pay. Hospitals shall be responsible for 4 ensuring adequate supply of PEP medications 5 to provide to patients. 6 ‘‘(3) HOSPITAL DEFINED.—For purposes of 7 this paragraph, the term ‘hospital’ includes a critical 8 access hospital, as defined in section 9 1861(mm)(1).’’. 10 (b) LIMITATION ON PAYMENT UNDER MEDICAID.— 11 Section 1903(i) of the Social Security Act (42 U.S.C. 12 1396b(i)), as amended by section 4106(b)(2), is further 13 amended— 14 (1) in paragraph (27), by striking ‘‘or’’ after 15 the semicolon; 16 (2) in paragraph (28), by striking the period 17 and inserting ‘‘; or’’; and 18 (3) by inserting after paragraph (28) the fol- 19 lowing new paragraph: 20 ‘‘(29) with respect to any amount expended for 21 care or services furnished under the plan by a hos- 22 pital on or after January 1, 2023, unless such hos- 23 pital meets the requirements specified in section 24 1866(l) for purposes of title XVIII.’’. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00892 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 893 •S 4486 IS SEC. 5406. MENSTRUAL EQUITY FOR ALL ACT OF 2022. 1 (a) SHORT TITLE.—This section may be cited as the 2 ‘‘Menstrual Equity for All Act of 2022’’. 3 (b) MENSTRUAL PRODUCTS FOR STUDENTS AT ELE- 4 MENTARY AND SECONDARY SCHOOLS.— 5 (1) IN GENERAL.—Section 4108(5)(C) of the 6 Elementary and Secondary Education Act of 1965 7 (20 U.S.C. 7118(5)(C)) is amended— 8 (A) in clause (vi), by striking ‘‘or’’ after 9 the semicolon; 10 (B) in clause (vii), by inserting ‘‘or’’ after 11 the semicolon; and 12 (C) by adding at the end the following: 13 ‘‘(viii) provide free menstrual products 14 to students who use menstrual products;’’. 15 (2) DEFINITIONS.—Section 4102 of the Ele- 16 mentary and Secondary Education Act of 1965 (20 17 U.S.C. 7112) is amended— 18 (A) by redesignating paragraphs (6) 19 through (8) as paragraphs (7) through (9), re- 20 spectively; and 21 (B) by inserting after paragraph (5) the 22 following: 23 ‘‘(6) MENSTRUAL PRODUCTS.—The term ‘men- 24 strual products’ means sanitary napkins and tam- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00893 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 894 •S 4486 IS pons that conform to applicable industry stand- 1 ards.’’. 2 (3) RULEMAKING.—Not later than 1 year after 3 the date of enactment of this section, the Secretary 4 of Education, in consultation with the Secretary of 5 Health and Human Services, shall promulgate rules 6 with respect to the definition of ‘‘menstrual prod- 7 ucts’’ in paragraph (6) of section 4102 of the Ele- 8 mentary and Secondary Education Act of 1965 (20 9 U.S.C. 7112), as amended by paragraph (2). 10 (c) MENSTRUAL PRODUCTS FOR STUDENTS AT IN- 11 STITUTIONS OF HIGHER EDUCATION.— 12 (1) PURPOSE.—The purpose of this section is 13 to alleviate— 14 (A) the barriers to academic success faced 15 by many college and graduate students due to 16 the inability of such students to afford to pur- 17 chase menstrual products; and 18 (B) the unique set of burdens that college 19 and graduate students experiencing period pov- 20 erty face that can be compounded by lack of ac- 21 cess to basic needs such as housing, food, trans- 22 portation, and access to physical and mental 23 health services. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00894 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 895 •S 4486 IS (2) IN GENERAL.—The Secretary of Education 1 shall establish a program to award grants, on a com- 2 petitive basis, to at least 4 institutions of higher 3 education, to— 4 (A) support programs that provide free 5 menstrual products to students; and 6 (B) report on best practices of such pro- 7 grams. 8 (3) APPLICATION.—To apply for a grant under 9 this subsection, an institution of higher education 10 shall submit to the Secretary an application in such 11 form, at such time, and containing such information 12 as the Secretary determines appropriate, including 13 an assurance that such grant will be used to carry 14 out the activities described in paragraph (5). 15 (4) COMMUNITY COLLEGES.—At least 50 per- 16 cent of the grants awarded under this subsection 17 shall be awarded to community colleges. 18 (5) GRANT USES.—A grant awarded under this 19 subsection may only be used to— 20 (A) carry out or expand activities that 21 fund programs that support direct provision of 22 free menstrual products to students in appro- 23 priate campus locations, including— 24 (i) campus restroom facilities; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00895 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 896 •S 4486 IS (ii) wellness centers; and 1 (iii) on-campus residential buildings; 2 (B) report on best practices of such pro- 3 grams; 4 (C) conduct outreach to students to en- 5 courage participation in menstrual equity pro- 6 grams and services; 7 (D) help eligible students apply for and en- 8 roll in local, State, and Federal public assist- 9 ance programs; and 10 (E) coordinate and collaborate with gov- 11 ernment or community-based organizations to 12 carry out the activities described in subpara- 13 graphs (A) through (D). 14 (6) PRIORITY.—In awarding grants under this 15 subsection, the Secretary shall prioritize— 16 (A) institutions with Federal Pell Grant 17 enrollment that is at least 25 percent of the 18 total enrollment of such institution; and 19 (B) historically Black colleges and univer- 20 sities, Hispanic-serving institutions, Asian 21 American and Native American Pacific Is- 22 lander-serving institutions, and other minority 23 serving institutions. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00896 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 897 •S 4486 IS (7) MENSTRUAL PRODUCT DEFINED.—In this 1 subsection, the term ‘‘menstrual product’’ means a 2 sanitary napkin or tampon that conforms to industry 3 standards. 4 (8) AUTHORIZATION OF APPROPRIATIONS.— 5 There are authorized to be appropriated, out of 6 funds appropriated for a fiscal year to the Fund for 7 the Improvement of Postsecondary Education under 8 section 741 of the Higher Education Act of 1965 9 (20 U.S.C. 1138), $5,000,000 to carry out the grant 10 program under this subsection. 11 (d) MENSTRUAL PRODUCTS FOR INCARCERATED IN- 12 DIVIDUALS AND DETAINEES.— 13 (1) REQUIREMENT FOR STATES.—Not later 14 than 180 days after the date of enactment of this 15 section, and annually thereafter, the chief executive 16 officer of each State that receives a grant under sub- 17 part 1 of part E of title I of the Omnibus Crime 18 Control and Safe Streets Act of 1968 (34 U.S.C. 19 10151 et seq.) (commonly referred to as the ‘‘Ed- 20 ward Byrne Memorial Justice Assistance Grant Pro- 21 gram’’) shall submit to the Attorney General a cer- 22 tification, in such form and containing such informa- 23 tion as the Attorney General may require, that— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00897 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 898 •S 4486 IS (A) all incarcerated individuals and detain- 1 ees in the custody of that State, a political sub- 2 division thereof, or an agent of that State or a 3 political subdivision thereof have access to men- 4 strual products— 5 (i) on demand; and 6 (ii) at no cost to such individuals and 7 detainees; and 8 (B) no visitor is prohibited from visiting an 9 incarcerated individual due to the visitor’s use 10 of menstrual products. 11 (2) REDUCTION IN GRANT FUNDING.—If the 12 chief executive officer of a State fails to submit a 13 certification required under paragraph (1) during a 14 fiscal year, the Attorney General shall reduce the 15 amount that the State would have otherwise received 16 under section 505 of title I of the Omnibus Crime 17 Control and Safe Streets Act of 1968 (34 U.S.C. 18 10156) by 20 percent for the following fiscal year. 19 (3) REALLOCATION.—Amounts not allocated to 20 a State under section 505 of title I of the Omnibus 21 Crime Control and Safe Streets Act of 1968 (34 22 U.S.C. 10156) for a fiscal year pursuant to para- 23 graph (2) shall be reallocated under such section to 24 States that submit such certifications. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00898 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 899 •S 4486 IS (4) MENSTRUAL PRODUCTS.—For the purposes 1 of paragraph (1), the term ‘‘menstrual products’’ 2 means sanitary napkins and tampons that conform 3 to applicable industry standards. 4 (5) AVAILABILITY FOR FEDERAL PRISONERS.— 5 The Attorney General shall issue rules requiring, 6 and the Director of the Bureau of Prisons shall take 7 such actions as may be necessary to ensure— 8 (A) the distribution and accessibility (with- 9 out charge) of menstrual products to prisoners 10 in the custody of the Bureau of Prisons, includ- 11 ing any prisoner in a Federal penal or correc- 12 tional institution, any Federal prisoner in a 13 State penal or correctional institution, and any 14 Federal prisoner in a facility administered by a 15 private detention entity; and 16 (B) that each prisoner described in sub- 17 paragraph (A) who requires menstrual products 18 may receive them in sufficient quantity. 19 (6) AVAILABILITY FOR DETAINEES.—The Sec- 20 retary of Homeland Security shall take such actions 21 as may be necessary to ensure that menstrual prod- 22 ucts are distributed and made accessible to each 23 alien detained by the Secretary of Homeland Secu- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00899 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 900 •S 4486 IS rity, including any alien in a facility administered by 1 a private detention entity, at no expense to the alien. 2 (e) MENSTRUAL PRODUCTS AVAILABILITY FOR 3 HOMELESS INDIVIDUALS UNDER EMERGENCY FOOD AND 4 SHELTER GRANT PROGRAM.—Section 316(a) of the 5 McKinney-Vento Homeless Assistance Act (42 U.S.C. 6 11346(a)) is amended— 7 (1) in paragraph (5), by striking ‘‘and’’ at the 8 end; 9 (2) in paragraph (6), by striking the period at 10 the end and inserting ‘‘; and’’; and 11 (3) by adding at the end the following new 12 paragraph: 13 ‘‘(7) guidelines that ensure that amounts pro- 14 vided under the program to private nonprofit organi- 15 zations and local governments may be used to pro- 16 vide sanitary napkins and tampons that conform to 17 applicable industry standards.’’. 18 (f) MENSTRUAL PRODUCTS COVERED BY MED- 19 ICAID.— 20 (1) IN GENERAL.—Section 1905 of the Social 21 Security Act (42 U.S.C. 1396d), as amended by sec- 22 tions 2007(d)(3) and 5201(a)(5)(G)(i), is amend- 23 ed— 24 (A) in subsection (a)— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00900 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 901 •S 4486 IS (i) by redesignating paragraph (32) as 1 paragraph (33); 2 (ii) in paragraph (31), by striking 3 ‘‘and’’ after the semicolon; and 4 (iii) by inserting after paragraph (31) 5 the following new paragraph: 6 ‘‘(32) menstrual products (as defined in sub- 7 section (oo)); and’’; and 8 (B) by adding at the end the following: 9 ‘‘(oo) MENSTRUAL PRODUCTS.—For purposes of 10 subsection (a)(32), the term ‘menstrual products’ means 11 sanitary napkins, tampons, liners, cups, and similar items 12 used by individuals with respect to menstruation and that 13 conform to industry standards.’’. 14 (2) EFFECTIVE DATE.— 15 (A) IN GENERAL.—Subject to subpara- 16 graph (B), the amendments made by this sub- 17 section shall apply with respect to medical as- 18 sistance furnished during or after the first cal- 19 endar quarter beginning on or after the date 20 that is 1 year after the date of the enactment 21 of this section. 22 (B) EXCEPTION FOR STATE LEGISLA- 23 TION.—In the case of a State plan under title 24 XIX of the Social Security Act (42 U.S.C. 1396 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00901 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 902 •S 4486 IS et seq.) that the Secretary of Health and 1 Human Services determines requires State leg- 2 islation in order for the respective plan to meet 3 any requirement imposed by amendments made 4 by this section, the respective plan shall not be 5 regarded as failing to comply with the require- 6 ments of such title solely on the basis of its fail- 7 ure to meet such an additional requirement be- 8 fore the first day of the first calendar quarter 9 beginning after the close of the first regular 10 session of the State legislature that begins after 11 the date of the enactment of this section. For 12 purposes of the previous sentence, in the case 13 of a State that has a 2-year legislative session, 14 each year of the session shall be considered to 15 be a separate regular session of the State legis- 16 lature. 17 (g) MENSTRUAL PRODUCTS FOR EMPLOYEES.—Sec- 18 tion 6 of the Occupational Safety and Health Act of 1970 19 (29 U.S.C. 655) is amended by adding at the end the fol- 20 lowing: 21 ‘‘(h) The Secretary shall by rule promulgate a re- 22 quirement that each employer with not less than 100 em- 23 ployees provide menstrual products free of charge for em- 24 ployees of the employer. For purposes of the preceding 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00902 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 903 •S 4486 IS sentence, ‘menstrual products’ means sanitary napkins 1 and tampons that conform to applicable industry stand- 2 ards.’’. 3 (h) MENSTRUAL PRODUCTS IN FEDERAL BUILD- 4 INGS.— 5 (1) DEFINITIONS.—In this subsection: 6 (A) APPROPRIATE AUTHORITY.—The term 7 ‘‘appropriate authority’’ means the head of a 8 Federal agency, the Architect of the Capitol, or 9 any other official authority responsible for the 10 operation of a covered public building. 11 (B) COVERED PUBLIC BUILDING.— 12 (i) IN GENERAL.—The term ‘‘covered 13 public building’’ means a public building 14 (as defined in section 3301(a) of title 40, 15 United States Code) that is open to the 16 public and contains a public restroom. 17 (ii) INCLUSIONS.—The term ‘‘covered 18 public building’’ includes specified build- 19 ings and grounds (as defined in section 20 6301 of title 40, United States Code) and 21 the Capitol Buildings (as defined in section 22 5101 of that title). 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00903 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 904 •S 4486 IS (C) COVERED RESTROOM.—The term ‘‘cov- 1 ered restroom’’ means a public restroom in a 2 covered public building. 3 (D) MENSTRUAL PRODUCTS.—The term 4 ‘‘menstrual products’’ means sanitary napkins 5 and tampons that conform to applicable indus- 6 try standards. 7 (2) REQUIREMENT.—Each appropriate author- 8 ity shall ensure that menstrual products are stocked 9 in, and available free of charge in, each covered rest- 10 room in each covered public building under the juris- 11 diction of that authority. 12 SEC. 5407. ADDITIONAL FOCUS AREA FOR THE OFFICE ON 13 WOMEN’S HEALTH. 14 Section 229(b) of the Public Health Service Act (42 15 U.S.C. 237a(b)), as amended by sections 5216 and 5301, 16 is further amended by adding at the end the following: 17 ‘‘(10) facilitate policymakers, health system 18 leaders and providers, consumers, and other stake- 19 holders in understanding optimal maternity care and 20 support for the provision of such care, including the 21 priorities of— 22 ‘‘(A) protecting, promoting, and supporting 23 the innate capacities of childbearing individuals 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00904 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 905 •S 4486 IS and their newborns for childbirth, 1 breastfeeding, and attachment; 2 ‘‘(B) using obstetric interventions only 3 when such interventions are supported by 4 strong, high-quality evidence, and minimizing 5 overuse of maternity practices that have been 6 shown to have benefit in limited situations and 7 that can expose people, infants, or both to risk 8 of harm if used routinely and indiscriminately, 9 including continuous electronic fetal monitoring, 10 labor induction, epidural analgesia, primary ce- 11 sarean section, and routine repeat cesarean 12 birth; 13 ‘‘(C) reliably incorporating noninvasive, 14 evidence-based practices that have a docu- 15 mented correlation with considerable improve- 16 ment in outcomes with no detrimental side ef- 17 fects, such as smoking cessation programs in 18 pregnancy, maternal immunizations, and proven 19 models (including group prenatal care, mid- 20 wifery care, and doula support) that integrate 21 health assessment, education, and support into 22 a unified program and supporting evidence- 23 based breastfeeding promotion efforts with re- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00905 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 906 •S 4486 IS spect for a breastfeeding individual’s personal 1 decision making; 2 ‘‘(D) a shared understanding of the quali- 3 fications of licensed providers of maternity care 4 and the best evidence about the safety, satisfac- 5 tion, outcomes, and costs of maternity care, and 6 appropriate deployment of such caregivers with- 7 in the maternity care workforce to address the 8 needs of childbearing individuals and newborns 9 and the growing shortage of maternity care- 10 givers; 11 ‘‘(E) a shared understanding of the results 12 of the best available research comparing hos- 13 pital, birth center, and planned home births, in- 14 cluding information about each setting’s safety, 15 satisfaction, outcomes, and costs; 16 ‘‘(F) a shared understanding of the impor- 17 tance for the safety and choices of birthing 18 families of an integrated maternity care system 19 with seamless processes for consultation, shared 20 care, transfer and transport across maternity 21 care settings, and providers when birthing peo- 22 ple and their newborns require a higher level of 23 care; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00906 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 907 •S 4486 IS ‘‘(G) high-quality, evidence-based child- 1 birth education that— 2 ‘‘(i) promotes a healthy and safe ap- 3 proach to pregnancy, childbirth, and early 4 parenting; 5 ‘‘(ii) is taught by certified educators, 6 peer counselors, and health professionals; 7 and 8 ‘‘(iii) promotes informed decision 9 making by childbearing individuals; and 10 ‘‘(H) developing measures that enable a 11 more robust, balanced set of standardized ma- 12 ternity care measures, including performance 13 and quality measures.’’. 14 SEC. 5408. INCLUDING SERVICES FURNISHED BY CERTAIN 15 STUDENTS, INTERNS, AND RESIDENTS SU- 16 PERVISED BY CERTIFIED NURSE MIDWIVES 17 OR CERTIFIED MIDWIVES WITHIN INPATIENT 18 HOSPITAL SERVICES UNDER MEDICARE. 19 (a) IN GENERAL.—Section 1861(b) of the Social Se- 20 curity Act (42 U.S.C. 1395x(b)) is amended— 21 (1) in paragraph (6), by striking ‘‘; or’’ at the 22 end and inserting ‘‘, or in the case of services in a 23 hospital or osteopathic hospital by a student midwife 24 or an intern or resident-in-training under a teaching 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00907 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 908 •S 4486 IS program previously described in this paragraph who 1 is in the field of obstetrics and gynecology, if such 2 student midwife, intern, or resident-in-training is su- 3 pervised by a certified nurse-midwife or certified 4 midwife to the extent permitted under applicable 5 State law and as may be authorized by the hos- 6 pital;’’; 7 (2) in paragraph (7), by striking the period at 8 the end and inserting ‘‘; or’’; and 9 (3) by adding at the end the following new 10 paragraph: 11 ‘‘(8) a certified nurse-midwife or certified mid- 12 wife where the hospital has a teaching program ap- 13 proved as specified in paragraph (6), if— 14 ‘‘(A) the hospital elects to receive any pay- 15 ment due under this title for reasonable costs of 16 such services; and 17 ‘‘(B) all certified nurse-midwives or cer- 18 tified midwives in such hospital agree not to bill 19 charges for professional services rendered in 20 such hospital to individuals covered under the 21 insurance program established by this title.’’. 22 (b) EFFECTIVE DATE.—The amendments made by 23 subsection (a) shall apply to services furnished on or after 24 the date of the enactment of this Act. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00908 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 909 •S 4486 IS SEC. 5409. GRANTS TO PROFESSIONAL ORGANIZATIONS 1 AND MINORITY-SERVING INSTITUTIONS TO 2 INCREASE DIVERSITY IN MATERNAL, REPRO- 3 DUCTIVE, AND SEXUAL HEALTH PROFES- 4 SIONALS. 5 (a) GRANTS TO HEALTH PROFESSIONAL ORGANIZA- 6 TIONS.— 7 (1) IN GENERAL.—The Secretary of Health and 8 Human Services, acting through the Administrator 9 of the Health Resources and Services Administra- 10 tion, shall carry out a grant program under which 11 the Secretary may make to eligible organizations— 12 (A) for fiscal year 2023, planning grants 13 described in paragraph (2); and 14 (B) for the subsequent 4-year period, im- 15 plementation grants described in paragraph (3). 16 (2) PLANNING GRANTS.— 17 (A) IN GENERAL.—Planning grants de- 18 scribed in this paragraph are grants for the fol- 19 lowing purposes: 20 (i) To collect data and identify any 21 workforce inequalities, with respect to a 22 health profession, at each of the following 23 areas along the health professional con- 24 tinuum: 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00909 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 910 •S 4486 IS (I) Pipeline availability, with re- 1 spect to students at the high school 2 and college or university levels consid- 3 ering, and working toward, entrance 4 in the profession, including barriers 5 triggered by criminal records. 6 (II) Entrance into the training 7 program for the profession. 8 (III) Graduation from such train- 9 ing program. 10 (IV) Entrance into practice, in- 11 cluding barriers triggered by criminal 12 records. 13 (V) Retention in practice for 14 more than a 5-year period. 15 (ii) To develop one or more strategies 16 to address the workforce inequalities with- 17 in the health profession, as identified 18 under (and in response to the findings pur- 19 suant to) clause (i). 20 (B) APPLICATION.—To be eligible to re- 21 ceive a grant under this paragraph, an eligible 22 health professional organization shall submit to 23 the Secretary an application in such form and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00910 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 911 •S 4486 IS manner and containing such information as 1 specified by the Secretary. 2 (C) AMOUNT.—Each grant awarded under 3 this paragraph shall be for an amount not to 4 exceed $300,000. 5 (D) REPORT.—Each recipient of a grant 6 under this paragraph shall submit to the Sec- 7 retary a report containing— 8 (i) information on the extent and dis- 9 tribution of workforce inequities identified 10 through the grant; and 11 (ii) reasonable objectives and strate- 12 gies developed to address such inequalities 13 within a 5-, 10-, and 25-year period. 14 (3) IMPLEMENTATION GRANTS.— 15 (A) IN GENERAL.—Implementation grants 16 described in this paragraph are grants to imple- 17 ment one or more of the strategies developed 18 pursuant to a planning grant awarded under 19 paragraph (2). 20 (B) APPLICATION.—To be eligible to re- 21 ceive a grant under this paragraph, an eligible 22 health professional organization shall submit to 23 the Secretary an application in such form and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00911 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 912 •S 4486 IS manner as specified by the Secretary. Each 1 such application shall contain information on— 2 (i) the capability of the organization 3 to carry out a strategy described in sub- 4 paragraph (A); 5 (ii) the involvement of partners or 6 coalitions; and 7 (iii) the organization’s plans for devel- 8 oping sustainability of the efforts after the 9 culmination of the grant cycle, and any 10 other information specified by the Sec- 11 retary. 12 (C) AMOUNT; DURATION.—Each grant 13 awarded under this paragraph shall be for an 14 amount not to exceed $500,000 each year of 15 the grant. The term of a grant under this sub- 16 section shall not exceed 4 years. 17 (D) REPORTS.—For each of the first 3 18 years for which an eligible health professional 19 organization is awarded a grant under this 20 paragraph, the organization shall submit to the 21 Secretary of Health and Human Services a re- 22 port on the activities carried out by such orga- 23 nization through the grant during such year 24 and objectives for the subsequent year. For the 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00912 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 913 •S 4486 IS fourth year for which an eligible health profes- 1 sional organization is awarded a grant under 2 this paragraph, the organization shall submit to 3 the Secretary a report that includes an analysis 4 of all the activities carried out by the organiza- 5 tion through the grant and a detailed plan for 6 the continuation of the organization’s outreach 7 efforts. 8 (4) ELIGIBLE HEALTH PROFESSIONAL ORGANI- 9 ZATION DEFINED.—For purposes of this subsection, 10 the term ‘‘eligible health professional organization’’ 11 means a professional organization representing ob- 12 stetrician-gynecologists, certified nurse midwives, 13 certified midwives, family practice physicians, nurse 14 practitioners whose scope of practice includes mater- 15 nity or sexual and reproductive health care, physi- 16 cian assistants whose scope of practice includes ob- 17 stetrical or sexual and reproductive health care, or 18 certified professional midwives, adolescent medicine 19 specialists, and pediatricians who provide sexual and 20 reproductive health care. 21 (b) GRANTS TO MINORITY-SERVING INSTITU- 22 TIONS.— 23 (1) IN GENERAL.—The Secretary of Health and 24 Human Services, acting through the Administrator 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00913 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 914 •S 4486 IS of the Health Resources and Services Administration 1 (referred to in this section as the ‘‘Secretary’’), shall 2 carry out a grant program under which the Sec- 3 retary may make to eligible minority-serving institu- 4 tions— 5 (A) for fiscal years 2023 and 2024, plan- 6 ning grants described in paragraph (2); and 7 (B) for the subsequent ten-year period, im- 8 plementation grants described in paragraph (3). 9 (2) PLANNING GRANTS.— 10 (A) IN GENERAL.—Planning grants de- 11 scribed in this paragraph are grants for plans 12 relating to the following purposes: 13 (i) To develop or expand academic 14 programs to educate maternity care clini- 15 cians and maternity care support per- 16 sonnel, including— 17 (I) nurses with the intention of 18 providing maternity, newborn, or sex- 19 ual and reproductive health care; 20 (II) nurse-practitioners whose 21 scope of practice includes maternity, 22 newborn, or sexual and reproductive 23 health care; and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00914 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 915 •S 4486 IS (III) maternity care support per- 1 sonnel, such as doulas and lactation 2 counselors. 3 (ii) To develop or expand academic 4 programs to educate obstetrician-gyne- 5 cologists. 6 (B) APPLICATION.—To be eligible to re- 7 ceive a grant under this paragraph, an eligible 8 minority-serving institution shall submit to the 9 Secretary an application in such form and man- 10 ner and containing such information as speci- 11 fied by the Secretary. 12 (C) AMOUNT.—Each grant awarded under 13 this paragraph shall be for an amount not to 14 exceed $400,000 for each of two years. 15 (D) REPORT.—Each recipient of a grant 16 under this paragraph shall submit to the Sec- 17 retary an annual report describing the planned 18 development or expansion of educational pro- 19 grams, including— 20 (i) the types of clinical or support per- 21 sonnel and the degrees or certificates to be 22 conferred; 23 (ii) the associated curricula; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00915 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 916 •S 4486 IS (iii) the faculty and their capabilities 1 and commitments, including any plans for 2 recruitment; 3 (iv) the anticipated number of stu- 4 dents to be enrolled and plans for their re- 5 cruitment and social, emotional, and finan- 6 cial support; and 7 (v) the objectives and strategies for 8 addressing inequities and preparing stu- 9 dents to provide high-quality culturally 10 congruent care. 11 (3) IMPLEMENTATION GRANTS.— 12 (A) IN GENERAL.—Implementation grants 13 described in this paragraph are grants to imple- 14 ment the strategies developed under paragraph 15 (2). 16 (B) APPLICATION.—To be eligible to re- 17 ceive a grant under this paragraph, an eligible 18 minority-serving institution shall submit to the 19 Secretary of Health and Human Services an 20 application in such form and manner as speci- 21 fied by the Secretary. Each such application 22 shall contain information on the capability of 23 the institution to carry out a strategy described 24 in paragraph (2), plans for sustainability of the 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00916 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 917 •S 4486 IS program after the culmination of the grant 1 cycle, and any other information specified by 2 the Secretary. 3 (C) AMOUNT.—Each grant under this 4 paragraph shall be for an amount not to exceed 5 $1,000,000 each year during the 10-year period 6 of the grant. 7 (D) REPORTS.— 8 (i) INITIAL PERIOD.—For each of the 9 first 9 years for which an eligible minority- 10 serving institution is awarded a grant 11 under this paragraph, the institution shall 12 submit a report to the Secretary on the ac- 13 tivities carried out by such institution 14 through the grant during such year and 15 objectives for the subsequent year. 16 (ii) FINAL YEAR.—For the tenth year 17 for which an eligible minority-serving insti- 18 tution is awarded a grant under this para- 19 graph, the organization shall submit to the 20 Secretary a report that includes an anal- 21 ysis of all the activities carried out by the 22 institution through the grant and a de- 23 tailed plan for continuation of the edu- 24 cational program. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00917 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 918 •S 4486 IS (4) ELIGIBLE MINORITY-SERVING INSTITUTIONS 1 DEFINED.—For the purposes of this subsection, the 2 term ‘‘minority-serving institution’’ means a histori- 3 cally Black college or university, Tribal college or 4 university, Latino-serving institution, Asian Amer- 5 ican and Pacific Islander serving institution, or 6 other minority-serving institution of higher edu- 7 cation. 8 (c) AUTHORIZATION OF APPROPRIATIONS.—There is 9 authorized to be appropriated to carry out— 10 (1) subsection (a), $2,000,000 for fiscal year 11 2023 and $3,000,000 for each of the fiscal years 12 2024 through 2027; and 13 (2) subsection (b), $4,000,000 for each of fiscal 14 years 2023 and 2024 and $10,000,000 for each of 15 fiscal years 2025 through 2034. 16 Subtitle F—Children’s Health 17 SEC. 5501. CARING FOR KIDS ACT. 18 (a) PERMANENT EXTENSION OF CHILDREN’S 19 HEALTH INSURANCE PROGRAM.— 20 (1) IN GENERAL.—Section 2104(a)(28) of the 21 Social Security Act (42 U.S.C. 1397dd(a)(28)) is 22 amended to read as follows: 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00918 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 919 •S 4486 IS ‘‘(28) for fiscal year 2027 and each subsequent 1 year, such sums as are necessary to fund allotments 2 to States under subsections (c) and (m).’’. 3 (2) ALLOTMENTS.— 4 (A) IN GENERAL.—Section 2104(m) of the 5 Social Security Act (42 U.S.C. 1397dd(m)) is 6 amended— 7 (i) in paragraph (2)(B)(i), by striking 8 ‘‘,, 2023, and 2027’’ and inserting ‘‘and 9 2023’’; 10 (ii) in paragraph (7)— 11 (I) in subparagraph (A), by strik- 12 ing ‘‘and ending with fiscal year 13 2027,’’; and 14 (II) in the flush left matter at 15 the end, by striking ‘‘or fiscal year 16 2026’’ and inserting ‘‘fiscal year 17 2026, or a subsequent even-numbered 18 fiscal year’’; 19 (iii) in paragraph (9)— 20 (I) by striking ‘‘(10), or (11)’’ 21 and inserting ‘‘or (10)’’; and 22 (II) by striking ‘‘2023, or 2027,’’ 23 and inserting ‘‘or 2023’’; and 24 (iv) by striking paragraph (11). 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00919 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 920 •S 4486 IS (B) CONFORMING AMENDMENT.—Section 1 50101(b)(2) of the Bipartisan Budget Act of 2 2018 (Public Law 115–123) is repealed. 3 (b) PERMANENT EXTENSIONS OF OTHER PROGRAMS 4 AND DEMONSTRATION PROJECTS.— 5 (1) PEDIATRIC QUALITY MEASURES PRO- 6 GRAM.—Section 1139A(i)(1) of the Social Security 7 Act (42 U.S.C. 1320b–9a(i)(1)) is amended— 8 (A) in subparagraph (C), by striking at the 9 end ‘‘and’’; 10 (B) in subparagraph (D), by striking the 11 period at the end and insert a semicolon; and 12 (C) by adding at the end the following new 13 subparagraphs: 14 ‘‘(E) for fiscal year 2028, $15,000,000 for 15 the purpose of carrying out this section (other 16 than subsections (e), (f), and (g)); and 17 ‘‘(F) for a subsequent fiscal year, the 18 amount appropriated under this paragraph for 19 the previous fiscal year, increased by the per- 20 centage increase in the consumer price index for 21 all urban consumers (all items; United States 22 city average) over such previous fiscal year, for 23 the purpose of carrying out this section (other 24 than subsections (e), (f), and (g)).’’. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00920 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 921 •S 4486 IS (2) EXPRESS LANE ELIGIBILITY OPTION.—Sec- 1 tion 1902(e)(13) of the Social Security Act (42 2 U.S.C. 1396a(e)(13)) is amended by striking sub- 3 paragraph (I). 4 (3) ASSURANCE OF AFFORDABILITY STANDARD 5 FOR CHILDREN AND FAMILIES.— 6 (A) IN GENERAL.—Section 2105(d)(3) of 7 the Social Security Act (42 U.S.C. 8 1397ee(d)(3)) is amended— 9 (i) in the paragraph heading, by strik- 10 ing ‘‘THROUGH SEPTEMBER 30, 2027’’; and 11 (ii) in subparagraph (A), in the mat- 12 ter preceding clause (i)— 13 (I) by striking ‘‘During the pe- 14 riod that begins on the date of enact- 15 ment of the Patient Protection and 16 Affordable Care Act and ends on Sep- 17 tember 30, 2027’’ and inserting ‘‘Be- 18 ginning on the date of the enactment 19 of the Patient Protection and Afford- 20 able Care Act’’; 21 (II) by striking ‘‘During the pe- 22 riod that begins on October 1, 2019, 23 and ends on September 30, 2027’’ 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00921 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 922 •S 4486 IS and inserting ‘‘Beginning on October 1 1, 2019’’; and 2 (III) by striking ‘‘The preceding 3 sentences shall not be construed as 4 preventing a State during any such 5 periods from’’ and inserting ‘‘The pre- 6 ceding sentences shall not be con- 7 strued as preventing a State from’’. 8 (B) CONFORMING AMENDMENTS.—Section 9 1902(gg)(2) of the Social Security Act (42 10 U.S.C. 1396a(gg)(2)) is amended— 11 (i) in the paragraph heading, by strik- 12 ing ‘‘THROUGH SEPTEMBER 30, 2027’’; and 13 (ii) by striking ‘‘through September 14 30’’ and all that follows through ‘‘ends on 15 September 30, 2027’’ and inserting ‘‘(but 16 beginning on October 1, 2019,’’. 17 (4) QUALIFYING STATES OPTION.—Section 18 2105(g)(4) of the Social Security Act (42 U.S.C. 19 1397ee(g)(4)) is amended— 20 (A) in the paragraph heading, by striking 21 ‘‘FOR FISCAL YEARS 2009 THROUGH 2027’’ and 22 inserting ‘‘AFTER FISCAL YEAR 2008’’; and 23 (B) in subparagraph (A), by striking ‘‘for 24 any of fiscal years 2009 through 2027’’ and in- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00922 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 923 •S 4486 IS serting ‘‘for any fiscal year after fiscal year 1 2008’’. 2 (5) OUTREACH AND ENROLLMENT PROGRAM.— 3 Section 2113 of the Social Security Act (42 U.S.C. 4 1397mm) is amended— 5 (A) in subsection (a)— 6 (i) in paragraph (1), by striking ‘‘dur- 7 ing the period of fiscal years 2009 through 8 2027’’ and inserting ‘‘, beginning with fis- 9 cal year 2009,’’; 10 (ii) in paragraph (2)— 11 (I) by striking ‘‘10 percent of 12 such amounts’’ and inserting ‘‘10 per- 13 cent of such amounts for the period or 14 the fiscal year for which such amounts 15 are appropriated’’; and 16 (II) by striking ‘‘during such pe- 17 riod’’ and inserting ‘‘, during such pe- 18 riod or such fiscal year,’’; and 19 (iii) in paragraph (3), by striking 20 ‘‘For the period of fiscal years 2024 21 through 2027, an amount equal to 10 per- 22 cent of such amounts’’ and inserting ‘‘Be- 23 ginning with fiscal year 2024, an amount 24 equal to 10 percent of such amounts for 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00923 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 924 •S 4486 IS the period or the fiscal year for which such 1 amounts are appropriated’’; and 2 (B) in subsection (g)— 3 (i) by striking ‘‘2017,,’’ and inserting 4 ‘‘2017,’’; 5 (ii) by striking ‘‘and $48,000,000’’ 6 and inserting ‘‘$48,000,000’’; and 7 (iii) by inserting after ‘‘through 8 2027’’ the following: ‘‘, $12,000,000 for 9 fiscal year 2028, and, for each fiscal year 10 after fiscal year 2028, the amount appro- 11 priated under this subsection for the pre- 12 vious fiscal year, increased by the percent- 13 age increase in the consumer price index 14 for all urban consumers (all items; United 15 States city average) over such previous fis- 16 cal year’’. 17 (6) CHILD ENROLLMENT CONTINGENCY 18 FUND.—Section 2104(n) of the Social Security Act 19 (42 U.S.C. 1397dd(n)) is amended— 20 (A) in paragraph (2)— 21 (i) in subparagraph (A)(ii)— 22 (I) by striking ‘‘and 2024 23 through 2026’’ and inserting ‘‘begin- 24 ning with fiscal year 2024’’; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00924 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 925 •S 4486 IS (II) by striking ‘‘2023, and 1 2027’’ and inserting ‘‘, and 2023’’; 2 and 3 (ii) in subparagraph (B)— 4 (I) by striking ‘‘2024 through 5 2026’’ and inserting ‘‘beginning with 6 fiscal year 2024’’; and 7 (II) by striking ‘‘2023, and 8 2027’’ and inserting ‘‘, and 2023’’; 9 and 10 (B) in paragraph (3)(A)— 11 (i) by striking ‘‘fiscal years 2024 12 through 2026’’ and inserting ‘‘beginning 13 with fiscal year 2024’’; and 14 (ii) by striking ‘‘2023, or 2027’’ and 15 inserting ‘‘, or 2023’’. 16 SEC. 5502. END DIAPER NEED ACT OF 2022. 17 (a) TARGETED FUNDING FOR DIAPER ASSISTANCE 18 (INCLUDING DIAPERING SUPPLIES AND ADULT INCONTI- 19 NENCE MATERIALS AND SUPPLIES) THROUGH THE SO- 20 CIAL SERVICES BLOCK GRANT PROGRAM.— 21 (1) INCREASE IN FUNDING FOR SOCIAL SERV- 22 ICES BLOCK GRANT PROGRAM.— 23 (A) IN GENERAL.—The amount specified 24 in subsection (c) of section 2003 of the Social 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00925 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 926 •S 4486 IS Security Act (42 U.S.C. 1397b) for purposes of 1 subsections (a) and (b) of such section is 2 deemed to be $1,900,000,000 for each of fiscal 3 years 2023 through 2026, of which, the amount 4 equal to $200,000,000, reduced by the amounts 5 reserved under subparagraph (B)(ii) for each 6 such fiscal year, shall be obligated by States in 7 accordance with paragraph (2). 8 (B) APPROPRIATION.— 9 (i) IN GENERAL.—Out of any money 10 in the Treasury of the United States not 11 otherwise appropriated, there is appro- 12 priated $200,000,000 for each of fiscal 13 years 2023 through 2026, to carry out this 14 subsection. 15 (ii) RESERVATIONS.— 16 (I) PURPOSES.—The Secretary 17 shall reserve, from the amount appro- 18 priated under clause (i) to carry out 19 this subsection— 20 (aa) for each of fiscal years 21 2023 through 2026, not more 22 than 2 percent of the amount ap- 23 propriated for the fiscal year for 24 purposes of entering into an 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00926 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 927 •S 4486 IS agreement with a national entity 1 described in clause (iii) to assist 2 in providing technical assistance 3 and training, to support effective 4 policy, practice, research, and 5 cross-system collaboration among 6 grantees and subgrantees, and to 7 assist in the administration of 8 the program described in this 9 subsection; and 10 (bb) for fiscal year 2023, an 11 amount, not to exceed 12 $2,000,000, for purposes of con- 13 ducting an evaluation under 14 paragraph (4). 15 (II) NO STATE ENTITLEMENT TO 16 RESERVED FUNDS.—The State enti- 17 tlement under section 2002(a) of the 18 Social Security Act (42 U.S.C. 19 1397a(a)) shall not apply to the 20 amounts reserved under subclause (I). 21 (iii) NATIONAL ENTITY DESCRIBED.— 22 A national entity described in this clause is 23 a nonprofit organization described in sec- 24 tion 501(c)(3) of the Internal Revenue 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00927 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 928 •S 4486 IS Code of 1986 and exempt from taxation 1 under section 501(a) of such Code, that— 2 (I) has experience in more than 1 3 State in the area of— 4 (aa) community distribu- 5 tions of basic need services, in- 6 cluding experience collecting, 7 warehousing, and distributing 8 basic necessities such as diapers, 9 food, or menstrual products; 10 (bb) child care; 11 (cc) child development ac- 12 tivities in low-income commu- 13 nities; or 14 (dd) motherhood, father- 15 hood, or parent education efforts 16 serving low-income parents of 17 young children; 18 (II) demonstrates competency to 19 implement a project, provide fiscal ac- 20 countability, collect data, and prepare 21 reports and other necessary docu- 22 mentation; and 23 (III) demonstrates a willingness 24 to share information with researchers, 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00928 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 929 •S 4486 IS practitioners, and other interested 1 parties. 2 (2) RULES GOVERNING USE OF ADDITIONAL 3 FUNDS.— 4 (A) IN GENERAL.—Funds are used in ac- 5 cordance with this paragraph if— 6 (i) the State, in consultation with rel- 7 evant stakeholders, including agencies, pro- 8 fessional associations, and nonprofit orga- 9 nizations, distributes the funds to eligible 10 entities to— 11 (I) decrease the need for diapers 12 and diapering supplies and adult in- 13 continence materials and supplies in 14 low-income families and meet such 15 unmet needs of infants and toddlers, 16 medically complex children, and low- 17 income adults and adults with disabil- 18 ities in such families through— 19 (aa) the distribution of free 20 diapers and diapering supplies, 21 medically necessary diapers, and 22 adult incontinence materials and 23 supplies; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00929 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 930 •S 4486 IS (bb) community outreach to 1 assist in participation in existing 2 diaper distribution programs or 3 programs that distribute medi- 4 cally necessary diapers or adult 5 incontinence materials and sup- 6 plies; or 7 (cc) improving access to dia- 8 pers and diapering supplies, 9 medically necessary diapers, and 10 adult incontinence materials and 11 supplies; and 12 (II) increase the ability of com- 13 munities and low-income families in 14 such communities to provide for the 15 need for diapers and diapering sup- 16 plies, medically necessary diapers, and 17 adult incontinence materials and sup- 18 plies, of infants and toddlers, medi- 19 cally complex children, and low-income 20 adults and adults with disabilities; 21 (ii) the funds are used subject to the 22 limitations in section 2005 of the Social 23 Security Act (42 U.S.C. 1397d); 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00930 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 931 •S 4486 IS (iii) the funds are used to supplement, 1 not supplant, State general revenue funds 2 provided for the purposes described in 3 clause (i); and 4 (iv) the funds are not used for costs 5 that are reimbursable by the Federal 6 Emergency Management Agency, under a 7 contract for insurance, or by self-insur- 8 ance. 9 (B) ALLOWABLE USES BY ELIGIBLE ENTI- 10 TIES.—An eligible entity receiving funds made 11 available under paragraph (1) shall use the 12 funds for any of the following: 13 (i) To pay for the purchase and dis- 14 tribution of diapers and diapering supplies, 15 medically necessary diapers, and funding 16 diaper (including medically necessary dia- 17 pers) distribution that serves low-income 18 families with— 19 (I) 1 or more children 3 years of 20 age or younger; or 21 (II) 1 or more medically complex 22 children. 23 (ii) To pay for the purchase and dis- 24 tribution of adult incontinence materials 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00931 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 932 •S 4486 IS and supplies and funding distribution of 1 such materials and supplies that serves 2 low-income families with 1 or more low-in- 3 come adults or adults with disabilities who 4 rely on adult incontinence materials and 5 supplies. 6 (iii) To integrate activities carried out 7 under clause (i) with other basic needs as- 8 sistance programs serving eligible children 9 and their families, including the following: 10 (I) Programs funded by the tem- 11 porary assistance for needy families 12 program under part A of title IV of 13 the Social Security Act (42 U.S.C. 14 601 et seq.), including the State 15 maintenance of effort provisions of 16 such program. 17 (II) Programs designed to sup- 18 port the health of eligible children, 19 such as the Children’s Health Insur- 20 ance Program under title XXI of the 21 Social Security Act, the Medicaid pro- 22 gram under title XIX of such Act, or 23 State-funded health care programs. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00932 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 933 •S 4486 IS (III) Programs funded through 1 the special supplemental nutrition 2 program for women, infants, and chil- 3 dren under section 17 of the Child 4 Nutrition Act of 1966. 5 (IV) Programs that offer early 6 home visiting services, including the 7 maternal, infant, and early childhood 8 home visiting program (including the 9 Tribal home visiting program) under 10 section 511 of the Social Security Act 11 (42 U.S.C. 711). 12 (V) Programs to provide im- 13 proved and affordable access to child 14 care, including programs funded 15 through the Child Care and Develop- 16 ment Fund, the temporary assistance 17 for needy families program under part 18 A of title IV of the Social Security 19 Act (42 U.S.C. 601 et seq.), or a 20 State-funded program. 21 (C) AVAILABILITY OF FUNDS.— 22 (i) FUNDS DISTRIBUTED TO ELIGIBLE 23 ENTITIES.—Funds made available under 24 paragraph (1) that are distributed to an el- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00933 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 934 •S 4486 IS igible entity by a State for a fiscal year 1 may be expended by the eligible entity only 2 in such fiscal year or the succeeding fiscal 3 year. 4 (ii) EVALUATION.—Funds reserved 5 under paragraph (1)(B)(ii)(I)(aa) to carry 6 out the evaluation under paragraph (4) 7 shall be available for expenditure during 8 the 3-year period that begins on the date 9 of enactment of this Act. 10 (D) NO EFFECT ON OTHER PROGRAMS.— 11 Any assistance or benefits received by a family 12 through funds made available under paragraph 13 (1) shall be disregarded for purposes of deter- 14 mining the family’s eligibility for, or amount of, 15 benefits under any other Federal needs-based 16 programs. 17 (3) ANNUAL REPORTS.—A State shall include 18 in the annual report required under section 2006 of 19 the Social Security Act (42 U.S.C. 1397e) covering 20 each of fiscal years 2022 through 2025, information 21 detailing how eligible entities, including subgrantees, 22 used funds made available under paragraph (1) to 23 distribute diapers and diapering supplies and adult 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00934 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 935 •S 4486 IS incontinence materials and supplies to families in 1 need. Each such report shall include the following: 2 (A) The number and age of infants, tod- 3 dlers, medically complex children, and low-in- 4 come adults and adults with disabilities who re- 5 ceived assistance or benefits through such 6 funds. 7 (B) The number of families that have re- 8 ceived assistance or benefits through such 9 funds. 10 (C) The number of diapers, medically nec- 11 essary diapers, or adult incontinence materials 12 and supplies (such as adult diapers, briefs, pro- 13 tective underwear, pull-ons, pull-ups, liners, 14 shields, guards, pads, undergarments), and the 15 number of each type of diapering or adult in- 16 continence supply, distributed through the use 17 of such funds. 18 (D) The ZIP Code or ZIP Codes where the 19 eligible entity (or subgrantee) distributed dia- 20 pers and diapering supplies and adult inconti- 21 nence materials and supplies. 22 (E) The method or methods the eligible en- 23 tity (or subgrantee) uses to distribute diapers 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00935 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 936 •S 4486 IS and diapering supplies and, adult incontinence 1 materials and supplies. 2 (F) Such other information as the Sec- 3 retary may specify. 4 (4) EVALUATION.—The Secretary, in consulta- 5 tion with States, the national entity described in 6 paragraph (1)(B)(iii), and eligible entities receiving 7 funds made available under this subsection, shall— 8 (A) not later than 2 years after the date 9 of enactment of this Act— 10 (i) complete an evaluation of the effec- 11 tiveness of the assistance program carried 12 out pursuant to this subsection, such as 13 the effect of activities carried out under 14 this section on mitigating the health and 15 developmental risks of unmet diaper need 16 among infants, toddlers, medically complex 17 children, and other family members in low- 18 income families, including the risks of dia- 19 per dermatitis, urinary tract infections, 20 and parental and child depression and anx- 21 iety; 22 (ii) submit to the relevant congres- 23 sional committees a report on the results 24 of such evaluation; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00936 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 937 •S 4486 IS (iii) publish the results of the evalua- 1 tion on the internet website of the Depart- 2 ment of Health and Human Services; 3 (B) not later than 3 years after the date 4 of enactment of this Act, update the evaluation 5 required by subparagraph (A)(i); and 6 (C) not later than 90 days after completion 7 of the updated evaluation under subparagraph 8 (B)— 9 (i) submit to the relevant congres- 10 sional committees a report describing the 11 results of such updated evaluation; and 12 (ii) publish the results of such evalua- 13 tion on the internet website of the Depart- 14 ment of Health and Human Services. 15 (5) GUIDANCE.—Not later than 180 days after 16 enactment of this Act, the Secretary shall issue 17 guidance regarding how the provisions of this sub- 18 section should be carried out, including information 19 regarding eligible entities, allowable use of funds, 20 and reporting requirements. 21 (6) DEFINITIONS.—In this subsection: 22 (A) ADULT INCONTINENCE MATERIALS 23 AND SUPPLIES.—The term ‘‘adult incontinence 24 materials and supplies’’ means those supplies 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00937 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 938 •S 4486 IS that are used to assist low-income adults or 1 adults with disabilities and includes adult dia- 2 pers, briefs, protective underwear, pull-ons, 3 pull-ups, liners, shields, guards, pads, undergar- 4 ments, disposable wipes, over-the-counter adult 5 diaper rash cream products, intermittent cath- 6 eterization, indwelling catheters, condom cath- 7 eters, urinary drainage bags, external collection 8 devices, wearable urinals, and penile clamps. 9 (B) ADULTS WITH DISABILITIES.—The 10 term ‘‘adults with disabilities’’ means individ- 11 uals who— 12 (i) have attained age 18; and 13 (ii) have a disability (as such term is 14 defined, with respect to an individual, in 15 section 3 of the Americans with Disabil- 16 ities Act of 1990 (42 U.S.C. 12102)). 17 (C) DIAPER.—The term ‘‘diaper’’ means 18 an absorbent garment that— 19 (i) is washable or disposable that may 20 be worn by an infant or toddler who is not 21 toilet-trained; and 22 (ii) if disposable— 23 (I) does not use any latex or 24 common allergens; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00938 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 939 •S 4486 IS (II) meets or exceeds the quality 1 standards for diapers commercially 2 available through retail sale in the fol- 3 lowing categories: 4 (aa) Absorbency (with ac- 5 ceptable rates for first and sec- 6 ond wetting). 7 (bb) Waterproof outer cover. 8 (cc) Flexible leg openings. 9 (dd) Refastening closures. 10 (D) DIAPERING SUPPLIES.—The term 11 ‘‘diapering supplies’’ means items, including di- 12 aper wipes and diaper cream, necessary to en- 13 sure that— 14 (i) an eligible child using a diaper is 15 properly cleaned and protected from diaper 16 rash; or 17 (ii) a medically complex child who 18 uses a medically necessary diaper is prop- 19 erly cleaned and protected from diaper 20 rash. 21 (E) ELIGIBLE CHILD.—The term ‘‘eligible 22 child’’ means a child who— 23 (i) has not attained 4 years of age; 24 and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00939 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 940 •S 4486 IS (ii) is a member of a low-income fam- 1 ily. 2 (F) ELIGIBLE ENTITIES.—The term ‘‘eligi- 3 ble entity’’ means a State or local governmental 4 entity, an Indian tribe or tribal organization (as 5 defined in section 4 of the Indian Self-Deter- 6 mination and Education Assistance Act), or a 7 nonprofit organization described in section 8 501(c)(3) of the Internal Revenue Code of 1986 9 and exempt from taxation under section 501(a) 10 of such Code that— 11 (i) has experience in the area of— 12 (I) community distributions of 13 basic need services, including experi- 14 ence collecting, warehousing, and dis- 15 tributing basic necessities such as dia- 16 pers, food, or menstrual products; 17 (II) child care; 18 (III) child development activities 19 in low-income communities; or 20 (IV) motherhood, fatherhood, or 21 parent education efforts serving low- 22 income parents of young children; 23 (ii) demonstrates competency to im- 24 plement a project, provide fiscal account- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00940 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 941 •S 4486 IS ability, collect data, and prepare reports 1 and other necessary documentation; and 2 (iii) demonstrates a willingness to 3 share information with researchers, practi- 4 tioners, and other interested parties. 5 (G) FEDERAL POVERTY LINE.—The term 6 ‘‘Federal poverty line’’ means the Federal pov- 7 erty line as defined by the Office of Manage- 8 ment and Budget and revised annually in ac- 9 cordance with section 673(2) of the Omnibus 10 Budget Reconciliation Act of 1981 applicable to 11 a family of the size involved. 12 (H) LOW-INCOME.—The term ‘‘low-in- 13 come’’, with respect to a family, means a family 14 whose self-certified income is not more than 15 200 percent of the Federal poverty line. 16 (I) MEDICALLY COMPLEX CHILD.—The 17 term ‘‘medically complex child’’ means an indi- 18 vidual who has attained age 3 and for whom a 19 licensed health care provider has provided a di- 20 agnosis of bowel or bladder incontinence, a 21 bowel or bladder condition that causes excess 22 urine or stool (such as short gut syndrome or 23 diabetes insipidus), or a severe skin condition 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00941 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 942 •S 4486 IS that causes skin erosions (such as epidermolysis 1 bullosa). 2 (J) MEDICALLY NECESSARY DIAPER.—The 3 term ‘‘medically necessary diaper’’ means an 4 absorbent garment that is— 5 (i) washable or disposable; 6 (ii) worn by a medically complex child 7 who has been diagnosed with bowel or 8 bladder incontinence, a bowel or bladder 9 condition that causes excess urine or stool 10 (such as short gut syndrome or diabetes 11 insipidus), or a severe skin condition that 12 causes skin erosions (such as epidermolysis 13 bullosa) and needs such garment to correct 14 or ameliorate such condition; and 15 (iii) if disposable— 16 (I) does not use any latex or 17 common allergens; and 18 (II) meets or exceeds the quality 19 standards for diapers commercially 20 available through retail sale in the fol- 21 lowing categories: 22 (aa) Absorbency (with ac- 23 ceptable rates for first and sec- 24 ond wetting). 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00942 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 943 •S 4486 IS (bb) Waterproof outer cover. 1 (cc) Flexible leg openings. 2 (dd) Refastening closures. 3 (7) EXEMPTION OF PROGRAM FROM SEQUES- 4 TRATION.— 5 (A) IN GENERAL.—Section 255(h) of the 6 Balanced Budget and Emergency Deficit Con- 7 trol Act of 1985 (2 U.S.C. 905(h)) is amended 8 by inserting after ‘‘Supplemental Security In- 9 come Program (28–0406–0–1–609).’’ the fol- 10 lowing: 11 ‘‘Targeted funding for States for diaper assist- 12 ance (including diapering supplies and adult inconti- 13 nence materials and supplies) through the Social 14 Services Block Grant Program.’’. 15 (B) APPLICABILITY.—The amendment 16 made by this paragraph shall apply to any se- 17 questration order issued under the Balanced 18 Budget and Emergency Deficit Control Act of 19 1985 (2 U.S.C. 900 et seq.) on or after the 20 date of enactment of this Act. 21 (b) IMPROVING ACCESS TO DIAPERS FOR MEDICALLY 22 COMPLEX CHILDREN.—Section 1915(c) of the Social Se- 23 curity Act (42 U.S.C. 1396n(c)) is amended by adding at 24 the end the following new paragraph: 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00943 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 944 •S 4486 IS ‘‘(11)(A) In the case of any waiver under this sub- 1 section that provides medical assistance to a medically 2 complex child who has been diagnosed with bowel or blad- 3 der incontinence, a bowel or bladder condition that causes 4 excess urine or stool (such as short gut syndrome or diabe- 5 tes insipidus), or a severe skin condition that causes skin 6 erosions (such as epidermolysis bullosa), such medical as- 7 sistance shall include, for the duration of the waiver, the 8 provision of 200 medically necessary diapers per month 9 and diapering supplies. Such medical assistance may in- 10 clude the provision of medically necessary diapers in 11 amounts greater than 200 if a licensed health care pro- 12 vider (such as a physician, nurse practitioner, or physician 13 assistant) specifies that such greater amounts are nec- 14 essary for such medically complex child. 15 ‘‘(B) For purposes of this paragraph: 16 ‘‘(i) The term ‘medically complex child’ means 17 an individual who has attained age 3 and for whom 18 a licensed health care provider has provided a diag- 19 nosis of 1 or more significant chronic conditions. 20 ‘‘(ii) The term ‘medically necessary diaper’ 21 means an absorbent garment that is— 22 ‘‘(I) washable or disposable; 23 ‘‘(II) worn by a medically complex child 24 who has been diagnosed with a condition de- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00944 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 945 •S 4486 IS scribed in subparagraph (A) and needs such 1 garment to correct or ameliorate such condition; 2 and 3 ‘‘(III) if disposable— 4 ‘‘(aa) does not use any latex or com- 5 mon allergens; and 6 ‘‘(bb) meets or exceeds the quality 7 standards for diapers commercially avail- 8 able through retail sale in the following 9 categories: 10 ‘‘(AA) Absorbency (with accept- 11 able rates for first and second wet- 12 ting). 13 ‘‘(BB) Waterproof outer cover. 14 ‘‘(CC) Flexible leg openings. 15 ‘‘(DD) Refastening closures. 16 ‘‘(iii) The term ‘diapering supplies’ means 17 items, including diaper wipes and diaper creams, 18 necessary to ensure that a medically complex child 19 who has been diagnosed with a condition described 20 in subparagraph (A) and uses a medically necessary 21 diaper is properly cleaned and protected from diaper 22 rash.’’. 23 (c) INCLUSION OF DIAPERS AND DIAPERING SUP- 24 PLIES AS QUALIFIED MEDICAL EXPENSES.— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00945 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 946 •S 4486 IS (1) HEALTH SAVINGS ACCOUNTS.—Section 1 223(d)(2) of the Internal Revenue Code of 1986 is 2 amended— 3 (A) by inserting ‘‘, medically necessary dia- 4 pers, and diapering supplies’’ after ‘‘menstrual 5 care products’’ in the last sentence of subpara- 6 graph (A); and 7 (B) by adding at the end the following new 8 subparagraph: 9 ‘‘(E) MEDICALLY NECESSARY DIAPERS 10 AND DIAPERING SUPPLIES.—For purposes of 11 this paragraph— 12 ‘‘(i) MEDICALLY NECESSARY DIA- 13 PERS.—The term ‘medically necessary dia- 14 per’ means an absorbent garment which is 15 washable or disposable and which is worn 16 by an individual who has attained 3 years 17 of age because of medical necessity, such 18 as someone who has been diagnosed with 19 bowel or bladder incontinence, a bowel or 20 bladder condition that causes excess urine 21 or stool (such as short gut syndrome or di- 22 abetes insipidus), or a severe skin condi- 23 tion that causes skin erosions (such as 24 epidermolysis bullosa) and needs such gar- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00946 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 947 •S 4486 IS ment to correct or ameliorate such condi- 1 tion, to serve a preventative medical pur- 2 pose, or to correct or ameliorate defects or 3 physical or mental illnesses or conditions 4 diagnosed by a licensed health care pro- 5 vider, and, if disposable— 6 ‘‘(I) does not use any latex or 7 common allergens; and 8 ‘‘(II) meets or exceeds the quality 9 standards for diapers commercially 10 available through retail sale in the fol- 11 lowing categories: 12 ‘‘(aa) Absorbency (with ac- 13 ceptable rates for first and sec- 14 ond wetting). 15 ‘‘(bb) Waterproof outer 16 cover. 17 ‘‘(cc) Flexible leg openings. 18 ‘‘(dd) Refastening closures. 19 ‘‘(ii) DIAPERING SUPPLIES.—The 20 term ‘diapering supplies’ means items, in- 21 cluding diaper wipes and diaper creams, 22 necessary to ensure that an individual 23 wearing medically necessary diapers is 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00947 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 948 •S 4486 IS properly cleaned and protected from diaper 1 rash.’’. 2 (2) ARCHER MSAS.—The last sentence of sec- 3 tion 220(d)(2)(A) of such Code is amended by in- 4 serting ‘‘, medically necessary diapers (as defined in 5 section 223(d)(2)(E)), and diapering supplies (as de- 6 fined in section 223(d)(2)(E))’’ after ‘‘menstrual 7 care products (as defined in section 223(d)(2)(D))’’. 8 (3) HEALTH FLEXIBLE SPENDING ARRANGE- 9 MENTS AND HEALTH REIMBURSEMENT ARRANGE- 10 MENTS.—Section 106(f) of such Code is amended— 11 (A) by inserting ‘‘, medically necessary dia- 12 pers (as defined in section 223(d)(2)(E)), and 13 diapering supplies (as defined in section 14 223(d)(2)(E))’’ after ‘‘menstrual care products 15 (as defined in section 223(d)(2)(D))’’; and 16 (B) in the heading, by inserting ‘‘, MEDI- 17 CALLY NECESSARY DIAPERS, AND DIAPERING 18 SUPPLIES’’ after ‘‘MENSTRUAL CARE PROD- 19 UCTS’’. 20 (4) EFFECTIVE DATES.— 21 (A) DISTRIBUTIONS FROM CERTAIN AC- 22 COUNTS.—The amendments made by para- 23 graphs (1) and (2) shall apply to amounts paid 24 after December 31, 2023. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00948 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 949 •S 4486 IS (B) REIMBURSEMENTS.—The amendment 1 made by paragraph (3) shall apply to expenses 2 incurred after December 31, 2023. 3 SEC. 5503. DECREASING THE RISK FACTORS FOR SUDDEN 4 UNEXPECTED INFANT DEATH AND SUDDEN 5 UNEXPLAINED DEATH IN CHILDHOOD. 6 (a) ESTABLISHMENT.—The Secretary of Health and 7 Human Services, acting through the Administrator of the 8 Health Resources and Services Administration and in con- 9 sultation with the Director of the Centers for Disease Con- 10 trol and Prevention and the Director of the National Insti- 11 tutes of Health (in this section referred to as the ‘‘Sec- 12 retary’’), shall establish and implement a culturally and 13 linguistically competent public health awareness and edu- 14 cation campaign to provide information that is focused on 15 decreasing the risk factors for sudden unexpected infant 16 death and sudden unexplained death in childhood, includ- 17 ing educating individuals about safe sleep environments, 18 sleep positions, and reducing exposure to smoking during 19 pregnancy and after birth. 20 (b) TARGETED POPULATIONS.—The campaign under 21 subsection (a) shall be designed to reduce health inequities 22 through the targeting of populations with high rates of 23 sudden unexpected infant death and sudden unexplained 24 death in childhood. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00949 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 950 •S 4486 IS (c) CONSULTATION.—In establishing and imple- 1 menting the campaign under subsection (a), the Secretary 2 shall consult with national organizations representing 3 health care providers, including nurses and physicians, 4 parents, child care providers, children’s advocacy and safe- 5 ty organizations, maternal and child health programs, nu- 6 trition professionals focusing on people, infants, and chil- 7 dren, and other individuals and groups determined nec- 8 essary by the Secretary for such establishment and imple- 9 mentation. 10 (d) GRANTS.— 11 (1) IN GENERAL.—In carrying out the cam- 12 paign under subsection (a), the Secretary shall 13 award grants to national organizations, State and 14 local health departments, and community-based or- 15 ganizations for the conduct of education and out- 16 reach programs for nurses, parents, child care pro- 17 viders, public health agencies, and community orga- 18 nizations. 19 (2) APPLICATION.—To be eligible to receive a 20 grant under paragraph (1), an entity shall submit to 21 the Secretary an application at such time, in such 22 manner, and containing such information as the Sec- 23 retary may require. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00950 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 951 •S 4486 IS (e) AUTHORIZATION OF APPROPRIATIONS.—There is 1 authorized to be appropriated to carry out this section 2 such sums as may be necessary for each of fiscal years 3 2023 through 2027. 4 Subtitle G—Nutrition for Women, 5 Children, Families 6 SEC. 5601. CLOSING THE MEAL GAP. 7 (a) ELIMINATION OF TIME LIMIT.— 8 (1) IN GENERAL.—Section 6 of the Food and 9 Nutrition Act of 2008 (7 U.S.C. 2015) is amend- 10 ed— 11 (A) by striking subsection (o); and 12 (B) by redesignating subsections (p) 13 through (s) as subsections (o) through (r), re- 14 spectively. 15 (2) ADDITIONAL ALLOCATIONS FOR STATES 16 THAT ENSURE AVAILABILITY OF WORK OPPORTUNI- 17 TIES.—Section 16(h) of the Food and Nutrition Act 18 of 2008 (7 U.S.C. 2025(h)) is amended— 19 (A) in paragraph (1)— 20 (i) in subparagraph (C)(iv)(I)— 21 (I) by striking ‘‘(F)(viii)’’ each 22 place it appears and inserting 23 ‘‘(E)(viii)’’; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00951 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 952 •S 4486 IS (II) by striking ‘‘(F)(vii)(I)’’ each 1 place it appears and inserting 2 ‘‘(E)(vii)(I)’’; 3 (III) in item (bb)(BB), by strik- 4 ing ‘‘(F)(vii)(II)’’ and inserting 5 ‘‘(E)(vii)(II)’’; and 6 (IV) in item (cc), by striking 7 ‘‘(F)(vii)’’ and inserting ‘‘(E)(vii)’’; 8 (ii) by striking subparagraph (E); and 9 (iii) by redesignating subparagraph 10 (F) as subparagraph (E); 11 (B) in paragraphs (3) and (4), by striking 12 ‘‘(1)(F)’’ each place it appears and inserting 13 ‘‘(1)(E)’’; and 14 (C) in paragraph (5)(C)— 15 (i) in clause (ii), by adding ‘‘and’’ at 16 the end; 17 (ii) in clause (iii), by striking ‘‘; and’’ 18 and inserting a period; and 19 (iii) by striking clause (iv). 20 (3) CONFORMING AMENDMENTS.— 21 (A) Section 5 of the Food and Nutrition 22 Act of 2008 (7 U.S.C. 2014) is amended— 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00952 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 953 •S 4486 IS (i) in subsection (a), in the second 1 sentence, by striking ‘‘(r)’’ and inserting 2 ‘‘(q)’’; and 3 (ii) in subsection (g)(3), in the first 4 sentence, by striking ‘‘16(h)(1)(F)’’ and 5 inserting ‘‘16(h)(1)(E)’’. 6 (B) Section 6(d)(4) of the Food and Nutri- 7 tion Act of 2008 (7 U.S.C. 2015(d)(4)) is 8 amended— 9 (i) in subparagraph 10 (B)(ii)(I)(bb)(DD), by striking ‘‘or sub- 11 section (o)’’; and 12 (ii) in subparagraph (N), by striking 13 ‘‘or subsection (o)’’ each place it appears. 14 (C) Section 7 of the Food and Nutrition 15 Act of 2008 (7 U.S.C. 2016) is amended— 16 (i) in subsection (a), by striking ‘‘Ex- 17 cept as provided in subsection (i), EBT’’ 18 and inserting ‘‘EBT’’; 19 (ii) in subsection (f)(3)— 20 (I) by striking subparagraph (B); 21 and 22 (II) by redesignating subpara- 23 graph (C) as subparagraph (B); 24 (iii) in subsection (h)— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00953 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 954 •S 4486 IS (I) in paragraph (13)(B), by 1 striking ‘‘subsection (j)(1)(H)’’ and 2 inserting ‘‘subsection (i)(1)’’; and 3 (II) in paragraph 4 (14)(B)(ii)(III), by striking ‘‘section 5 7(f)(2)(B)’’ and inserting ‘‘subsection 6 (f)(2)(B)’’; 7 (iv) by striking subsection (i); and 8 (v) by redesignating subsections (j) 9 and (k) as subsections (i) and (j), respec- 10 tively. 11 (D) Section 16(h)(1) of the Food and Nu- 12 trition Act of 2008 (7 U.S.C. 2025(h)) is 13 amended— 14 (i) in subparagraph (B), in the matter 15 preceding clause (i), by striking ‘‘that—’’ 16 and all that follows through the period at 17 the end of clause (ii) and inserting ‘‘that 18 is determined and adjusted by the Sec- 19 retary.’’; and 20 (ii) in clause (ii)(III)(ee)(AA) of sub- 21 paragraph (E) (as redesignated by para- 22 graph (2)(A)(iii)), by striking ‘‘, individ- 23 uals subject to the requirements under sec- 24 tion 6(o),’’. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00954 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 955 •S 4486 IS (E) Section 17(b)(1)(B)(iv) of the Food 1 and Nutrition Act of 2008 (7 U.S.C. 2 2026(b)(1)(B)(iv)) is amended— 3 (i) in subclause (V), by adding ‘‘or’’ 4 at the end after the semicolon; 5 (ii) in subclause (VI), by striking ‘‘; 6 or’’ and inserting a period; and 7 (iii) by striking subclause (VII). 8 (F) Section 51(d)(8)(A)(ii) of the Internal 9 Revenue Code of 1986 is amended— 10 (i) in subclause (I), by striking ‘‘, or’’ 11 at the end and inserting a period; 12 (ii) in the matter preceding subclause 13 (I), by striking ‘‘family—’’ and all that fol- 14 lows through ‘‘receiving’’ in subclause (I) 15 and inserting ‘‘family receiving’’; and 16 (iii) by striking subclause (II). 17 (G) Section 103(a)(2) of the Workforce In- 18 novation and Opportunity Act (29 U.S.C. 3113) 19 is amended— 20 (i) by striking subparagraph (D); and 21 (ii) by redesignating subparagraphs 22 (E) through (K) as subparagraphs (D) 23 through (J), respectively. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00955 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 956 •S 4486 IS (H) Section 121(b)(2)(B) of the Workforce 1 Innovation and Opportunity Act (29 U.S.C. 2 3151) is amended— 3 (i) by striking clause (iv); and 4 (ii) by redesignating clauses (v) 5 through (vii) as clauses (iv) through (vi), 6 respectively. 7 (4) Section 703(c)(1) of division N of the Con- 8 solidated Appropriations Act, 2021 (7 U.S.C. 2016 9 note; Public Law 116–260), is amended by striking 10 ‘‘section 7(k)(14) of the Food and Nutrition Act of 11 2008’’ and inserting ‘‘section 7(j)(4) of the Food 12 and Nutrition Act of 2008 (7 U.S.C. 2016(j)(4))’’. 13 (b) PARTICIPATION OF PUERTO RICO, AMERICAN 14 SAMOA, AND THE NORTHERN MARIANA ISLANDS IN SUP- 15 PLEMENTAL NUTRITION ASSISTANCE PROGRAM.— 16 (1) DEFINITIONS.— 17 (A) STATE.—Section 3(r) of the Food and 18 Nutrition Act of 2008 (7 U.S.C. 2012(r)) is 19 amended by inserting ‘‘the Commonwealth of 20 Puerto Rico, American Samoa, the Common- 21 wealth of the Northern Mariana Islands,’’ after 22 ‘‘Guam,’’. 23 (B) THRIFTY FOOD PLAN.—Section 24 3(u)(3) of the Food and Nutrition Act of 2008 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00956 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 957 •S 4486 IS (7 U.S.C. 2012(u)(3)) is amended by inserting 1 ‘‘the Commonwealth of Puerto Rico, American 2 Samoa, the Commonwealth of the Northern 3 Mariana Islands,’’ after ‘‘Guam,’’. 4 (2) ELIGIBLE HOUSEHOLDS.—Section 5 of the 5 Food and Nutrition Act of 2008 (7 U.S.C. 2014) (as 6 amended by section 4003(g)(1)(A)(iv)) is amended— 7 (A) in subsection (c), in the undesignated 8 matter at the end, by striking ‘‘States or 9 Guam’’ and inserting ‘‘States, Guam, the Com- 10 monwealth of Puerto Rico, American Samoa, or 11 the Commonwealth of the Northern Mariana Is- 12 lands’’; 13 (B) in subsection (e)(1)(B)— 14 (i) in the subparagraph heading, by 15 striking ‘‘GUAM’’ and inserting ‘‘GUAM, 16 THE COMMONWEALTH OF THE NORTHERN 17 MARIANA ISLANDS, AND AMERICAN 18 SAMOA’’; 19 (ii) in clause (i), in the matter pre- 20 ceding subclause (I), by inserting ‘‘, the 21 Commonwealth of the Northern Mariana 22 Islands, and American Samoa’’ after 23 ‘‘Guam’’; and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00957 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 958 •S 4486 IS (iii) in clause (ii), in the matter pre- 1 ceding subclause (I), by inserting ‘‘, the 2 Commonwealth of the Northern Mariana 3 Islands, and American Samoa’’ after 4 ‘‘Guam’’; and 5 (C) by adding at the end the following: 6 ‘‘(n) PUERTO RICO, AMERICAN SAMOA, AND THE 7 NORTHERN MARIANA ISLANDS.—Notwithstanding any 8 other provision of this Act, including the requirements 9 under this section, the Commonwealth of Puerto Rico, 10 American Samoa, and the Commonwealth of the Northern 11 Mariana Islands shall each establish their own standards 12 of eligibility for participation by households in the supple- 13 mental nutrition assistance program.’’. 14 (3) EFFECTIVE DATE.— 15 (A) IN GENERAL.—The amendments made 16 by paragraphs (1) and (2) shall be effective 17 with respect to the Commonwealth of Puerto 18 Rico, American Samoa, and the Commonwealth 19 of the Northern Mariana Islands, as applicable, 20 on the date described in subparagraph (B) if 21 the Secretary of Agriculture submits to Con- 22 gress a certification under subsection (f)(2)(B) 23 of section 19 of the Food and Nutrition Act of 24 2008 (7 U.S.C. 2028). 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00958 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 959 •S 4486 IS (B) DATE DESCRIBED.—The date referred 1 to in subparagraph (A) is, with respect to the 2 Commonwealth of Puerto Rico, American 3 Samoa, and the Commonwealth of the Northern 4 Mariana Islands, the date established by the 5 Commonwealth of Puerto Rico, American 6 Samoa, or the Commonwealth of the Northern 7 Mariana Islands, respectively, in the applicable 8 plan of operation submitted to the Secretary of 9 Agriculture under subsection (f)(1) of section 10 19 of the Food and Nutrition Act of 2008 (7 11 U.S.C. 2028). 12 (c) TRANSITION OF PUERTO RICO, AMERICAN 13 SAMOA, AND THE NORTHERN MARIANA ISLANDS TO SUP- 14 PLEMENTAL NUTRITION ASSISTANCE PROGRAM.—Section 15 19 of the Food and Nutrition Act of 2008 (7 U.S.C. 2028) 16 is amended— 17 (1) in subsection (a)(1)— 18 (A) in subparagraph (A), by striking 19 ‘‘and’’ at the end; 20 (B) in subparagraph (B), by striking the 21 period at the end and inserting ‘‘; and’’; and 22 (C) by adding at the end the following: 23 ‘‘(C) the Commonwealth of the Northern 24 Mariana Islands.’’; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00959 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 960 •S 4486 IS (2) by adding at the end the following: 1 ‘‘(f) TRANSITION OF PUERTO RICO, AMERICAN 2 SAMOA, AND THE NORTHERN MARIANA ISLANDS TO SUP- 3 PLEMENTAL NUTRITION ASSISTANCE PROGRAM.— 4 ‘‘(1) REQUEST FOR PARTICIPATION.—A govern- 5 mental entity may submit to the Secretary a request 6 to participate in the supplemental nutrition assist- 7 ance program, which shall include a plan of oper- 8 ation described in section 11(d), which shall include 9 the date on which the governmental entity intends to 10 begin participation in the program. 11 ‘‘(2) CERTIFICATION BY SECRETARY.— 12 ‘‘(A) IN GENERAL.—The Secretary shall 13 certify a governmental entity that submits a re- 14 quest under paragraph (1) as qualified to par- 15 ticipate in the supplemental nutrition assistance 16 program if the Secretary— 17 ‘‘(i) approves the plan of operation 18 submitted with the request, in accordance 19 with this subsection; and 20 ‘‘(ii) approves the applications de- 21 scribed in paragraph (4) in accordance 22 with that paragraph. 23 ‘‘(B) SUBMISSION OF CERTIFICATION TO 24 CONGRESS.—The Secretary shall submit each 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00960 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 961 •S 4486 IS certification under subparagraph (A) to Con- 1 gress. 2 ‘‘(3) DETERMINATION OF PLAN OF OPER- 3 ATION.— 4 ‘‘(A) APPROVAL.—The Secretary shall ap- 5 prove a plan of operation submitted with a re- 6 quest under paragraph (1) if the plan satisfies 7 the requirements under this Act for a plan of 8 operation. 9 ‘‘(B) DISAPPROVAL.—If the Secretary does 10 not approve a plan of operation submitted with 11 a request under paragraph (1), the Secretary 12 shall provide to the governmental entity a state- 13 ment that describes each requirement under 14 this Act that is not satisfied by the plan. 15 ‘‘(4) APPROVAL OF RETAIL FOOD STORES.— 16 ‘‘(A) SOLICITATION OF APPLICATIONS.—If 17 the Secretary approves a plan of operation 18 under paragraph (3)(A) for a governmental en- 19 tity, the Secretary shall accept applications 20 from retail food stores located in that govern- 21 mental entity to be authorized under section 9 22 to participate in the supplemental nutrition as- 23 sistance program. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00961 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 962 •S 4486 IS ‘‘(B) DETERMINATION.—The Secretary 1 shall authorize a retail food store applying to 2 participate in the supplemental nutrition assist- 3 ance program under subparagraph (A) if the 4 application satisfies the requirements under this 5 Act for authorization of a retail food store. 6 ‘‘(5) PUERTO RICO.—In the case of a request 7 under paragraph (1) by the Commonwealth of Puer- 8 to Rico, notwithstanding subsection (g), the Sec- 9 retary shall allow the Commonwealth of Puerto Rico 10 to continue to carry out under the supplemental nu- 11 trition assistance program the Family Market Pro- 12 gram established pursuant to this section. 13 ‘‘(6) AUTHORIZATION OF APPROPRIATIONS.— 14 There are authorized to be appropriated to the Sec- 15 retary to carry out this subsection such sums as are 16 necessary for fiscal year 2023, to remain available 17 until expended. 18 ‘‘(g) TERMINATION OF EFFECTIVENESS.— 19 ‘‘(1) IN GENERAL.—Subsections (a) through (e) 20 shall cease to be effective with respect to the Com- 21 monwealth of Puerto Rico, American Samoa, and 22 the Commonwealth of the Northern Mariana Is- 23 lands, as applicable, on the date described in para- 24 graph (2) if the Secretary submits to Congress a 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00962 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 963 •S 4486 IS certification under subsection (f)(2)(B) for that gov- 1 ernmental entity. 2 ‘‘(2) DATE DESCRIBED.—The date referred to 3 in paragraph (1) is, with respect to the Common- 4 wealth of Puerto Rico, American Samoa, and the 5 Commonwealth of the Northern Mariana Islands, 6 the date established by the Commonwealth of Puerto 7 Rico, American Samoa, or the Commonwealth of the 8 Northern Mariana Islands, respectively, in the appli- 9 cable plan of operation submitted to the Secretary 10 under subsection (f)(1).’’. 11 SEC. 5602. REPEAL OF DENIAL OF SUPPLEMENTAL NUTRI- 12 TION ASSISTANCE PROGRAM BENEFITS. 13 Section 115 of the Personal Responsibility and Work 14 Opportunity Reconciliation Act of 1996 (21 U.S.C. 862a) 15 is amended— 16 (1) in subsection (a)— 17 (A) by striking paragraph (2); 18 (B) in paragraph (1), by striking ‘‘, or’’ 19 and inserting a period; and 20 (C) in the matter preceding paragraph (1), 21 by striking ‘‘for—’’ and all that follows through 22 ‘‘assistance’’ in paragraph (1) and inserting 23 ‘‘for assistance’’; 24 (2) in subsection (b)— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00963 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 964 •S 4486 IS (A) by striking paragraph (2); 1 (B) in paragraph (1), by striking the para- 2 graph designation and heading and all that fol- 3 lows through ‘‘The amount’’ and inserting ‘‘The 4 amount’’; and 5 (3) in subsection (e)— 6 (A) by striking paragraph (2); 7 (B) in paragraph (1), by striking ‘‘, and’’ 8 and inserting a period; and 9 (C) in the matter preceding paragraph (1), 10 by striking ‘‘it—’’ and all that follows through 11 ‘‘in section 419(5)’’ in paragraph (1) and in- 12 serting ‘‘the term in section 419(5)’’. 13 Subtitle H—Universal School Meals 14 Program 15 SEC. 5701. SHORT TITLE. 16 This subtitle may be cited as the ‘‘Universal School 17 Meals Program Act of 2022’’. 18 SEC. 5702. EFFECTIVE DATE. 19 Unless otherwise provided, this subtitle, and the 20 amendments made by this subtitle, shall take effect 1 year 21 after the date of enactment of this Act. 22 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00964 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 965 •S 4486 IS SEC. 5703. FREE SCHOOL BREAKFAST PROGRAM. 1 (a) IN GENERAL.—Section 4(a) of the Child Nutri- 2 tion Act of 1966 (42 U.S.C. 1773(a)) is amended, in the 3 first sentence— 4 (1) by striking ‘‘is hereby’’ and inserting ‘‘are’’; 5 and 6 (2) by inserting ‘‘to provide free breakfast to all 7 children enrolled at those schools’’ before ‘‘in accord- 8 ance’’. 9 (b) APPORTIONMENT TO STATES.—Section 4(b) of 10 the Child Nutrition Act of 1966 (42 U.S.C. 1773(b)) is 11 amended— 12 (1) in paragraph (1)— 13 (A) in subparagraph (A)(i), by striking 14 subclause (II) and inserting the following: 15 ‘‘(II) the national average pay- 16 ment for free breakfasts, as specified 17 in subparagraph (B).’’; 18 (B) by striking subparagraph (B) and in- 19 serting the following: 20 ‘‘(B) PAYMENT AMOUNTS.— 21 ‘‘(i) IN GENERAL.—The national aver- 22 age payment for each free breakfast shall 23 be $2.72, adjusted annually for inflation in 24 accordance with clause (ii) and rounded in 25 accordance with clause (iii). 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00965 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 966 •S 4486 IS ‘‘(ii) INFLATION ADJUSTMENT.— 1 ‘‘(I) IN GENERAL.—The annual 2 inflation adjustment under clause (i) 3 shall reflect changes in the cost of op- 4 erating the free breakfast program 5 under this section, as indicated by the 6 change in the Consumer Price Index 7 for food away from home for all urban 8 consumers. 9 ‘‘(II) BASIS.—Each inflation an- 10 nual adjustment under clause (i) shall 11 reflect the changes in the Consumer 12 Price Index for food away from home 13 for the most recent 12-month period 14 for which that data is available. 15 ‘‘(iii) ROUNDING.—On July 1, 2022, 16 and annually thereafter, the national aver- 17 age payment rate for free breakfast shall 18 be— 19 ‘‘(I) adjusted to the nearest 20 lower-cent increment; and 21 ‘‘(II) based on the unrounded 22 amounts for the preceding 12-month 23 period.’’; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00966 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 967 •S 4486 IS (C) by striking subparagraphs (C) and 1 (E); and 2 (D) by redesignating subparagraph (D) as 3 subparagraph (C); 4 (2) by striking paragraphs (2) and (3); 5 (3) by redesignating paragraphs (4) and (5) as 6 paragraphs (2) and (3), respectively; and 7 (4) in paragraph (3) (as so redesignated), by 8 striking ‘‘paragraph (3) or (4)’’ and inserting ‘‘para- 9 graph (2)’’. 10 (c) STATE DISBURSEMENT TO SCHOOLS.—Section 4 11 of the Child Nutrition Act of 1966 (42 U.S.C. 1773) is 12 amended by striking subsection (c) and inserting the fol- 13 lowing: 14 ‘‘(c) STATE DISBURSEMENT TO SCHOOLS.—Funds 15 apportioned and paid to any State for the purpose of this 16 section shall be disbursed by the State educational agency 17 to schools selected by the State educational agency to as- 18 sist those schools in operating a breakfast program.’’. 19 (d) NO COLLECTION OF DEBT.— 20 (1) IN GENERAL.—Notwithstanding any other 21 provision of the Child Nutrition Act of 1966 (42 22 U.S.C. 1771 et seq.) or any other provision of law, 23 effective beginning on the date of enactment of this 24 Act, as a condition of participation in the breakfast 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00967 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 968 •S 4486 IS program under section 4 of that Act (42 U.S.C. 1 1773), a school— 2 (A) shall not collect any debt owed to the 3 school for unpaid meal charges; and 4 (B) shall continue to accrue debt for un- 5 paid meal charges— 6 (i) for the purpose of receiving reim- 7 bursement under section 5715; and 8 (ii) until the effective date specified in 9 section 5702. 10 (2) CHILD NUTRITION ACT OF 1966.— 11 (A) IN GENERAL.—Section 4 of the Child 12 Nutrition Act of 1966 (42 U.S.C. 1773) is 13 amended by striking subsection (d) and insert- 14 ing the following: 15 ‘‘(d) NO COLLECTION OF DEBT.—A school partici- 16 pating in the free breakfast program under this section 17 shall not collect any debt owed to the school for unpaid 18 meal charges.’’. 19 (B) CONFORMING AMENDMENT.—Section 20 23(a) of the Child Nutrition Act of 1966 (42 21 U.S.C. 1793(a)) is amended by striking ‘‘school 22 in severe need, as described in section 4(d)(1)’’ 23 and inserting the following: ‘‘school— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00968 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 969 •S 4486 IS ‘‘(1) that has a free breakfast program under 1 section 4 or seeks to initiate a free breakfast pro- 2 gram under that section; and 3 ‘‘(2) of which not less than 40 percent of the 4 students are identified students (as defined in para- 5 graph (8) of section 1113(a) of the Elementary and 6 Secondary Education Act of 1965 (20 U.S.C. 7 6313(a)))’’. 8 (e) NUTRITIONAL AND OTHER PROGRAM REQUIRE- 9 MENTS.—Section 4(e) of the Child Nutrition Act of 1966 10 (42 U.S.C. 1773(e)) is amended— 11 (1) in paragraph (1)(A), in the second sentence, 12 by striking ‘‘free or’’ and all that follows through 13 the period at the end and inserting ‘‘free to all chil- 14 dren enrolled at a school participating in the school 15 breakfast program.’’; and 16 (2) in paragraph (2), in the second sentence, by 17 striking ‘‘the full charge to the student for a break- 18 fast meeting the requirements of this section or’’. 19 (f) PROHIBITION ON BREAKFAST SHAMING, MEAL 20 DENIAL.— 21 (1) IN GENERAL.—Effective beginning on the 22 date of enactment of this Act, a school or school 23 food authority— 24 (A) shall not— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00969 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 970 •S 4486 IS (i) physically segregate or otherwise 1 discriminate against any child participating 2 in the breakfast program under section 4 3 of the Child Nutrition Act of 1966 (42 4 U.S.C. 1773); or 5 (ii) overtly identify a child described 6 in clause (i) by a special token or ticket, 7 an announced or published list of names, 8 or any other means; and 9 (B) shall provide the program meal to any 10 child eligible under the program. 11 (2) CHILD NUTRITION ACT OF 1966.—Section 4 12 of the Child Nutrition Act of 1966 (42 U.S.C. 1773) 13 is amended by adding at the end the following: 14 ‘‘(f) PROHIBITION ON BREAKFAST SHAMING.—A 15 school or school food authority shall not— 16 ‘‘(1) physically segregate or otherwise discrimi- 17 nate against any child participating in the free 18 breakfast program under this section; or 19 ‘‘(2) overtly identify a child described in para- 20 graph (1) by a special token or ticket, an announced 21 or published list of names, or any other means.’’. 22 (g) DEPARTMENT OF DEFENSE OVERSEAS DEPEND- 23 ENTS’ SCHOOLS.—Section 20(b) of the Child Nutrition 24 Act of 1966 (42 U.S.C. 1789(b)) is amended— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00970 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 971 •S 4486 IS (1) by striking ‘‘and reduced-price’’; and 1 (2) by striking ‘‘and shall’’ and all that follows 2 through ‘‘section’’. 3 (h) CONFORMING AMENDMENTS.—The Child Nutri- 4 tion Act of 1966 (42 U.S.C. 1771 et seq.) is amended— 5 (1) by striking ‘‘or reduced price’’ each place it 6 appears; 7 (2) by striking ‘‘and reduced price’’ each place 8 it appears; and 9 (3) by striking ‘‘a reduced price’’ each place it 10 appears. 11 SEC. 5704. APPORTIONMENT TO STATES. 12 Section 4(b) of the Richard B. Russell National 13 School Lunch Act (42 U.S.C. 1753(b)) is amended— 14 (1) by striking paragraph (2) and inserting the 15 following: 16 ‘‘(2) PAYMENT AMOUNTS.— 17 ‘‘(A) IN GENERAL.—The national average 18 payment for each free lunch shall be $3.81, ad- 19 justed annually for inflation in accordance with 20 subparagraph (C) and rounded in accordance 21 with subparagraph (D). 22 ‘‘(B) ADDITIONAL PAYMENT FOR LOCAL 23 FOOD.— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00971 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 972 •S 4486 IS ‘‘(i) DEFINITION OF LOCALLY 1 SOURCED FARM PRODUCT.—In this sub- 2 paragraph, the term ‘locally sourced farm 3 product’ means a farm product that— 4 ‘‘(I) is marketed to consumers— 5 ‘‘(aa) directly; or 6 ‘‘(bb) through intermediated 7 channels (such as food hubs and 8 cooperatives); and 9 ‘‘(II) with respect to the school 10 food authority purchasing the farm 11 product, is produced and distrib- 12 uted— 13 ‘‘(aa) in the State in which 14 the school food authority is lo- 15 cated; or 16 ‘‘(bb) not more than 250 17 miles from the location of the 18 school food authority. 19 ‘‘(ii) ADDITIONAL PAYMENT ELIGI- 20 BILITY.—During a school year, a school 21 food authority shall receive an additional 22 payment described in clause (iii) if the 23 State certifies that the school food author- 24 ity served meals (including breakfasts, 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00972 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 973 •S 4486 IS lunches, suppers, and supplements) during 1 the last school year of which not less than 2 25 percent were made with locally sourced 3 farm products. 4 ‘‘(iii) PAYMENT AMOUNT.— 5 ‘‘(I) IN GENERAL.—The addi- 6 tional payment amount under this 7 subparagraph shall be— 8 ‘‘(aa) $0.30 for each free 9 lunch and supper; 10 ‘‘(bb) $0.21 for each free 11 breakfast; and 12 ‘‘(cc) $0.08 for each free 13 supplement. 14 ‘‘(II) ADJUSTMENTS.—Each ad- 15 ditional payment amount under sub- 16 clause (I) shall be adjusted annually 17 in accordance with subparagraph (C) 18 and rounded in accordance with sub- 19 paragraph (D). 20 ‘‘(iv) DISBURSEMENT.—The State 21 agency shall disburse funds made available 22 under this clause to school food authorities 23 eligible to receive additional reimburse- 24 ment. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00973 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 974 •S 4486 IS ‘‘(C) INFLATION ADJUSTMENT.— 1 ‘‘(i) IN GENERAL.—The annual infla- 2 tion adjustment under subparagraphs (A) 3 and (B)(iii) shall reflect changes in the 4 cost of operating the free lunch program 5 under this Act, as indicated by the change 6 in the Consumer Price Index for food away 7 from home for all urban consumers. 8 ‘‘(ii) BASIS.—Each annual inflation 9 adjustment under subparagraphs (A) and 10 (B)(iii) shall reflect the changes in the 11 Consumer Price Index for food away from 12 home for the most recent 12-month period 13 for which that data is available. 14 ‘‘(D) ROUNDING.—On July 1, 2022, and 15 annually thereafter, the national average pay- 16 ment rate for free lunch and the additional pay- 17 ment amount for free breakfast, lunch, supper, 18 and supplement under subparagraph (B) shall 19 be— 20 ‘‘(i) adjusted to the nearest lower-cent 21 increment; and 22 ‘‘(ii) based on the unrounded amounts 23 for the preceding 12-month period.’’; and 24 (2) by striking paragraph (3). 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00974 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 975 •S 4486 IS SEC. 5705. NUTRITIONAL AND OTHER PROGRAM REQUIRE- 1 MENTS. 2 (a) ELIMINATION OF FREE LUNCH ELIGIBILITY RE- 3 QUIREMENTS.— 4 (1) IN GENERAL.—Section 9 of the Richard B. 5 Russell National School Lunch Act (42 U.S.C. 6 1758) is amended by striking subsection (b) and in- 7 serting the following: 8 ‘‘(b) ELIGIBILITY.—All children enrolled in a school 9 that participates in the school lunch program under this 10 Act shall be eligible to receive free lunch under this Act.’’. 11 (2) CONFORMING AMENDMENTS.— 12 (A) Section 9 of the Richard B. Russell 13 National School Lunch Act (42 U.S.C. 1758) is 14 amended— 15 (i) in subsection (c), in the third sen- 16 tence, by striking ‘‘or at a reduced cost’’; 17 and 18 (ii) in subsection (e), by striking ‘‘, re- 19 duced price,’’. 20 (B) Section 18 of the Richard B. Russell 21 National School Lunch Act (42 U.S.C. 1769) is 22 amended— 23 (i) by striking subsection (j); and 24 (ii) by redesignating subsection (k) as 25 subsection (j). 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00975 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 976 •S 4486 IS (C) Section 28(b)(4) of the Richard B. 1 Russell National School Lunch Act (42 U.S.C. 2 1769i(b)(4)) is amended— 3 (i) by striking subparagraph (B); and 4 (ii) in subparagraph (A), by striking 5 the subparagraph designation and heading 6 and all that follows through ‘‘the Sec- 7 retary’’ and inserting ‘‘The Secretary’’. 8 (D) Section 17 of the Child Nutrition Act 9 of 1966 (42 U.S.C. 1786) is amended— 10 (i) in subsection (d)(2)(A)— 11 (I) by striking clause (i); and 12 (II) by redesignating clauses (ii) 13 and (iii) as clauses (i) and (ii), respec- 14 tively; and 15 (ii) in subsection (f)(17), by striking 16 ‘‘Notwithstanding subsection (d)(2)(A)(i), 17 not later’’ and inserting ‘‘Not later’’. 18 (E) Section 1902(a) of the Social Security 19 Act (42 U.S.C. 1396a(a)) is amended by strik- 20 ing paragraph (7) and inserting the following: 21 ‘‘(7) provide safeguards which restrict the use 22 or disclosure of information concerning applicants 23 and recipients to purposes directly connected with 24 the administration of the plan;’’. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00976 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 977 •S 4486 IS (F) Section 1154(a)(2)(A)(i) of title 10, 1 United States Code, is amended by striking ‘‘in 2 accordance with section 9(b)(1) of the Richard 3 B. Russell National School Lunch Act (42 4 U.S.C. 1758(b)(1)’’. 5 (G) Section 4301 of the Food, Conserva- 6 tion, and Energy Act of 2008 (42 U.S.C. 7 1758a) is repealed. 8 (b) NO COLLECTION OF DEBT.— 9 (1) IN GENERAL.—Notwithstanding any other 10 provision of the Richard B. Russell National School 11 Lunch Act (42 U.S.C. 1751 et seq.) or any other 12 provision of law, effective beginning on the date of 13 enactment of this Act, as a condition of participation 14 in the school lunch program under that Act, a 15 school— 16 (A) shall not collect any debt owed to the 17 school for unpaid meal charges; and 18 (B) shall continue to accrue debt for un- 19 paid meal charges— 20 (i) for the purpose of receiving reim- 21 bursement under section 5715; and 22 (ii) until the effective date specified in 23 section 5702. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00977 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 978 •S 4486 IS (2) NATIONAL SCHOOL LUNCH ACT.—Section 9 1 of the Richard B. Russell National School Lunch 2 Act (42 U.S.C. 1758) is amended by striking sub- 3 section (d) and inserting the following: 4 ‘‘(d) NO COLLECTION OF DEBT.—A school partici- 5 pating in the school lunch program under this Act shall 6 not collect any debt owed to the school for unpaid meal 7 charges.’’. 8 SEC. 5706. SPECIAL ASSISTANCE PROGRAM. 9 (a) IN GENERAL.—Section 11 of the Richard B. Rus- 10 sell National School Lunch Act (42 U.S.C. 1759a) is re- 11 pealed. 12 (b) CONFORMING AMENDMENTS.— 13 (1) Section 6 of the Richard B. Russell Na- 14 tional School Lunch Act (42 U.S.C. 1755) is amend- 15 ed— 16 (A) in subsection (a)(2), by striking ‘‘sec- 17 tions 11 and 13’’ and inserting ‘‘section 13’’; 18 and 19 (B) in subsection (e)(1), in the matter pre- 20 ceding subparagraph (A), by striking ‘‘section 21 4, this section, and section 11’’ and inserting 22 ‘‘this section and section 4’’. 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00978 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 979 •S 4486 IS (2) Section 7(d) of the Richard B. Russell Na- 1 tional School Lunch Act (42 U.S.C. 1756(d)) is 2 amended by striking ‘‘or 11’’. 3 (3) Section 8(g) of the Richard B. Russell Na- 4 tional School Lunch Act (42 U.S.C. 1757(g)) is 5 amended by striking ‘‘and under section 11 of this 6 Act’’. 7 (4) Section 12(f) of the Richard B. Russell Na- 8 tional School Lunch Act (42 U.S.C. 1760(f)) is 9 amended by striking ‘‘11,’’. 10 (5) Section 7(a) of the Child Nutrition Act of 11 1966 (42 U.S.C. 1766(a)) is amended— 12 (A) in paragraph (1)(A), by striking ‘‘4, 13 11, and 17’’ and inserting ‘‘4 and 17’’; and 14 (B) in paragraph (2)(A), by striking ‘‘sec- 15 tions 4 and 11’’ and inserting ‘‘section 4’’. 16 SEC. 5707. PRICE FOR A PAID LUNCH. 17 Section 12 of the Richard B. Russell National School 18 Lunch Act (42 U.S.C. 1760) is amended— 19 (1) by striking subsection (p); and 20 (2) by redesignating subsections (q) and (r) as 21 subsections (p) and (q), respectively. 22 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00979 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 980 •S 4486 IS SEC. 5708. SUMMER FOOD SERVICE PROGRAM FOR CHIL- 1 DREN. 2 Section 13 of the Richard B. Russell National School 3 Lunch Act (42 U.S.C. 1761) is amended— 4 (1) in subsection (a)— 5 (A) in paragraph (2), by adding at the end 6 the following: 7 ‘‘(C) WAIVER.—If the Secretary deter- 8 mines that a program requirement under this 9 section limits the access of children to meals 10 served under this section, the Secretary may 11 waive that program requirement. 12 ‘‘(D) ELIGIBILITY.—All children shall be 13 eligible to participate in the program under this 14 section.’’; and 15 (B) in paragraph (5), by striking ‘‘only 16 for’’ and all that follows through the period at 17 the end and inserting ‘‘for meals served to all 18 children.’’; 19 (2) in subsection (b)(2), by striking ‘‘may only 20 serve’’ and all that follows through ‘‘migrant chil- 21 dren’’; 22 (3) by striking subsection (c) and inserting the 23 following: 24 ‘‘(c) PAYMENTS.— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00980 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 981 •S 4486 IS ‘‘(1) IN GENERAL.—Payments shall be made to 1 service institutions for meals served— 2 ‘‘(A) during the months of May through 3 September; 4 ‘‘(B) during school vacation at any time 5 during an academic school year; 6 ‘‘(C) during a teacher in-service day; and 7 ‘‘(D) on days that school is closed during 8 the months of October through April due to a 9 natural disaster, building repair, court order, or 10 similar cause, as determined by the Secretary. 11 ‘‘(2) LIMITATION ON PAYMENTS.—A service in- 12 stitution shall receive payments under this section 13 for not more than 3 meals and 1 supplement per 14 child per day.’’; and 15 (4) in subsection (f)(3), by striking ‘‘, except 16 that’’ and all that follows through ‘‘section’’. 17 SEC. 5709. SUMMER ELECTRONIC BENEFIT TRANSFER FOR 18 CHILDREN PROGRAM. 19 Section 13(a) of the Richard B. Russell National 20 School Lunch Act (42 U.S.C. 1761(a)) is amended by add- 21 ing at the end the following: 22 ‘‘(13) SUMMER ELECTRONIC BENEFIT TRANS- 23 FER FOR CHILDREN PROGRAM.— 24 ‘‘(A) DEFINITIONS.—In this paragraph: 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00981 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 982 •S 4486 IS ‘‘(i) EBT CARD.—The term ‘EBT 1 card’ means an electronic benefit transfer 2 card. 3 ‘‘(ii) ELIGIBLE HOUSEHOLD.—The 4 term ‘eligible household’ means a house- 5 hold with— 6 ‘‘(I) an income that does not ex- 7 ceed 200 percent of the poverty line 8 (as defined in section 673 of the Com- 9 munity Services Block Grant Act (42 10 U.S.C. 9902)); and 11 ‘‘(II) 1 or more children. 12 ‘‘(iii) PROGRAM.—The term ‘Program’ 13 means the Summer Electronic Benefit 14 Transfer for Children Program established 15 under subparagraph (B). 16 ‘‘(B) ESTABLISHMENT.—The Secretary 17 shall establish a national program, to be known 18 as the ‘Summer Electronic Benefit Transfer for 19 Children Program’, under which the Secretary 20 shall issue EBT cards to eligible households to 21 provide food assistance during the summer 22 months. 23 ‘‘(C) EBT AMOUNT.— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00982 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 983 •S 4486 IS ‘‘(i) IN GENERAL.—The value of an 1 EBT card provided under the Program to 2 an eligible household shall be $60 per 3 month per child (adjusted for inflation). 4 ‘‘(ii) ANNUAL LIMITATION.—No eligi- 5 ble household shall receive benefits under 6 the Program for more than 3 months in a 7 calendar year. 8 ‘‘(D) ADMINISTRATION.— 9 ‘‘(i) IN GENERAL.—Except as pro- 10 vided under this paragraph, the Program 11 shall be based on the summer electronic 12 benefit transfer for children demonstration 13 program carried out pursuant to section 14 749(g) of the Agriculture, Rural Develop- 15 ment, Food and Drug Administration, and 16 Related Agencies Appropriations Act, 2010 17 (Public Law 111–80; 123 Stat. 2132). 18 ‘‘(ii) SNAP OR WIC.— 19 ‘‘(I) IN GENERAL.—Subject to 20 subclause (II), a State shall admin- 21 ister the Program through the supple- 22 mental nutrition assistance program 23 established under the Food and Nutri- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00983 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 984 •S 4486 IS tion Act of 2008 (7 U.S.C. 2011 et 1 seq.). 2 ‘‘(II) WIC OPTION.—If a State 3 has participated in the demonstration 4 program described in clause (i) before 5 the effective date specified in section 6 5702 of the Universal School Meals 7 Program Act of 2022, the State may 8 elect to administer the Program 9 through the special supplemental nu- 10 trition program for women, infants, 11 and children established by section 17 12 of the Child Nutrition Act of 1966 13 (42 U.S.C. 1786). 14 ‘‘(E) AUTHORIZATION OF APPROPRIA- 15 TIONS.—There are authorized to be appro- 16 priated to the Secretary to carry out this para- 17 graph such sums as are necessary for fiscal 18 year 2022 and each fiscal year thereafter.’’. 19 SEC. 5710. CHILD AND ADULT CARE FOOD PROGRAM. 20 Section 17 of the Richard B. Russell National School 21 Lunch Act (42 U.S.C. 1766) is amended— 22 (1) in subsection (a)(2), by striking subpara- 23 graph (B) and inserting the following: 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00984 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 985 •S 4486 IS ‘‘(B) any other private organization pro- 1 viding nonresidential child care or day care out- 2 side school hours for school children;’’; 3 (2) by striking subsection (c) and inserting the 4 following: 5 ‘‘(c) FREE MEALS.—Notwithstanding any other pro- 6 vision of law— 7 ‘‘(1) all meals and supplements served under 8 the program authorized under this section shall be 9 provided for free to participants of the program; and 10 ‘‘(2) an institution that serves those meals and 11 supplements shall be reimbursed— 12 ‘‘(A) in the case of breakfast, at the rate 13 established for free breakfast under section 14 4(b)(1)(B)(i) of the Child Nutrition Act of 15 1966 (42 U.S.C. 1773(b)(1)(B)(i)); 16 ‘‘(B) in the case of lunch, at the rate es- 17 tablished for free lunch under section 18 4(b)(2)(A); and 19 ‘‘(C) in the case of a supplemental meal, 20 $0.96, adjusted for inflation in accordance with 21 section 4(b)(2)(C).’’; 22 (3) in subsection (f)— 23 (A) in paragraph (2), by striking subpara- 24 graph (B) and inserting the following: 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00985 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 986 •S 4486 IS ‘‘(B) LIMITATION TO REIMBURSEMENTS.— 1 An institution may claim reimbursement under 2 this paragraph for not more than 3 meals and 3 1 supplement per day per child.’’; 4 (B) by striking paragraph (3); and 5 (C) by redesignating paragraph (4) as 6 paragraph (3); and 7 (4) in subsection (r)— 8 (A) in the subsection heading, by striking 9 ‘‘PROGRAM FOR AT-RISK SCHOOL CHILDREN’’ 10 and inserting ‘‘AFTERSCHOOL MEAL AND 11 SNACK PROGRAM’’; 12 (B) by striking ‘‘at-risk school’’ each place 13 it appears and inserting ‘‘eligible’’; 14 (C) in paragraph (1)— 15 (i) in the paragraph heading, by strik- 16 ing ‘‘AT-RISK SCHOOL’’ and inserting ‘‘ELI- 17 GIBLE’’; and 18 (ii) in subparagraph (B), by striking 19 ‘‘operated’’ and all that follows through 20 the period at the end and inserting a pe- 21 riod; and 22 (D) in paragraph (4)(A), by striking ‘‘only 23 for’’ and all that follows through the period at 24 the end and inserting the following: ‘‘for— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00986 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 987 •S 4486 IS ‘‘(i) not more than 1 meal and 1 sup- 1 plement per child per day served on a reg- 2 ular school day; and 3 ‘‘(ii) not more than 3 meals and 1 4 supplement per child per day served on 5 any day other than a regular school day.’’. 6 SEC. 5711. MEALS AND SUPPLEMENTS FOR CHILDREN IN 7 AFTERSCHOOL CARE. 8 Section 17A of the Richard B. Russell National 9 School Lunch Act (42 U.S.C. 1766a) is amended— 10 (1) in the section heading, by striking ‘‘MEAL 11 SUPPLEMENTS’’ and inserting ‘‘MEALS AND SUP- 12 PLEMENTS’’; 13 (2) in subsection (a)(1), by striking ‘‘meal sup- 14 plements’’ and inserting ‘‘free meals and supple- 15 ments’’; 16 (3) in subsection (b), by inserting ‘‘meals and’’ 17 before ‘‘supplements’’; and 18 (4) by striking subsection (c) and inserting the 19 following: 20 ‘‘(c) REIMBURSEMENT.— 21 ‘‘(1) IN GENERAL.— 22 ‘‘(A) MEALS.—A free meal provided under 23 this section to a child shall be reimbursed at a 24 rate of $3.81, adjusted annually for inflation in 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00987 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 988 •S 4486 IS accordance with paragraph (3)(A) and rounded 1 in accordance with paragraph (3)(B). 2 ‘‘(B) SUPPLEMENTS.—A free supplement 3 provided under this section to a child shall be 4 reimbursed at the rate at which free supple- 5 ments are reimbursed under section 6 17(c)(2)(C). 7 ‘‘(2) LIMITATION TO REIMBURSEMENTS.—An 8 institution may claim reimbursement under this sec- 9 tion for not more than 1 meal and 1 supplement per 10 day per child served on a regular school day. 11 ‘‘(3) INFLATION; ROUNDING.— 12 ‘‘(A) INFLATION ADJUSTMENT.— 13 ‘‘(i) IN GENERAL.—The annual infla- 14 tion adjustment under paragraph (1)(A) 15 shall reflect changes in the cost of oper- 16 ating the program under this section, as 17 indicated by the change in the Consumer 18 Price Index for food away from home for 19 all urban consumers. 20 ‘‘(ii) BASIS.—Each inflation annual 21 adjustment under paragraph (1)(A) shall 22 reflect the changes in the Consumer Price 23 Index for food away from home for the 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00988 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 989 •S 4486 IS most recent 12-month period for which 1 that data is available. 2 ‘‘(B) ROUNDING.—On July 1, 2022, and 3 annually thereafter, the reimbursement rate for 4 a free meal under this section shall be— 5 ‘‘(i) adjusted to the nearest lower-cent 6 increment; and 7 ‘‘(ii) based on the unrounded amounts 8 for the preceding 12-month period.’’. 9 SEC. 5712. ACCESS TO LOCAL FOODS: FARM TO SCHOOL 10 PROGRAM. 11 Section 18(g)(5) of the Richard B. Russell National 12 School Lunch Act (42 U.S.C. 1769(g)(5)) is amended by 13 striking subparagraph (B) and inserting the following: 14 ‘‘(B) serve a high proportion of identified 15 students (as defined in paragraph (8) of section 16 1113(a) of the Elementary and Secondary Edu- 17 cation Act of 1965 (20 U.S.C. 6313(a)));’’. 18 SEC. 5713. FRESH FRUIT AND VEGETABLE PROGRAM. 19 Section 19(d) of the Richard B. Russell National 20 School Lunch Act (42 U.S.C. 1769a(d)) is amended— 21 (1) in paragraph (1)— 22 (A) in the matter preceding subparagraph 23 (A), by striking ‘‘paragraph (2) of this sub- 24 section and’’; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00989 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 990 •S 4486 IS (B) in subparagraph (A), in the matter 1 preceding clause (i), by striking ‘‘school—’’ and 2 all that follows through ‘‘submits’’ in clause (ii) 3 and inserting ‘‘school that submits’’; 4 (C) in subparagraph (B), by striking 5 ‘‘schools’’ and all that follows through ‘‘Act’’ 6 and inserting ‘‘high-need schools (as defined in 7 section 2211(b) of the Elementary and Sec- 8 ondary Education Act of 1965 (20 U.S.C. 9 6631(b)))’’; and 10 (D) in subparagraph (D)— 11 (i) by striking clause (i); and 12 (ii) by redesignating clauses (ii) 13 through (iv) as clauses (i) through (iii), re- 14 spectively; and 15 (2) by striking paragraphs (2) and (3) and in- 16 serting the following: 17 ‘‘(2) OUTREACH TO HIGH-NEED SCHOOLS.— 18 Prior to making decisions regarding school participa- 19 tion in the program, a State agency shall inform 20 high-need schools (as defined in section 2211(b) of 21 the Elementary and Secondary Education Act of 22 1965 (20 U.S.C. 6631(b))), including Tribal schools, 23 of the eligibility of the schools for the program.’’. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00990 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 991 •S 4486 IS SEC. 5714. TRAINING, TECHNICAL ASSISTANCE, AND FOOD 1 SERVICE MANAGEMENT INSTITUTE. 2 Section 21(a)(1)(B) of the Richard B. Russell Na- 3 tional School Lunch Act (42 U.S.C. 1769b–1(a)(1)(B)) is 4 amended in the matter preceding clause (i) by striking 5 ‘‘certified to receive free or reduced price meals’’ and in- 6 serting ‘‘who are identified students (as defined in para- 7 graph (8) of section 1113(a) of the Elementary and Sec- 8 ondary Education Act of 1965 (20 U.S.C. 6313(a))’’. 9 SEC. 5715. REIMBURSEMENT OF SCHOOL MEAL DELIN- 10 QUENT DEBT PROGRAM. 11 (a) DEFINITIONS.—In this section: 12 (1) DELINQUENT DEBT.—The term ‘‘delinquent 13 debt’’ means the debt owed by a parent or guardian 14 of a child to a school— 15 (A) as of the effective date specified in sec- 16 tion 5702; and 17 (B) for meals served by the school under— 18 (i) the school breakfast program 19 under section 4 of the Child Nutrition Act 20 of 1966 (42 U.S.C. 1773); 21 (ii) the school lunch program estab- 22 lished under the Richard B. Russell Na- 23 tional School Lunch Act (42 U.S.C. 1751 24 et seq.); or 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00991 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 992 •S 4486 IS (iii) both of the programs described in 1 clauses (i) and (ii). 2 (2) PROGRAM.—The term ‘‘program’’ means 3 the program established under subsection (b)(1). 4 (3) SECRETARY.—The term ‘‘Secretary’’ means 5 the Secretary of Agriculture. 6 (b) REIMBURSEMENT PROGRAM.— 7 (1) ESTABLISHMENT.—Not later than 60 days 8 after the effective date specified in section 5702, the 9 Secretary shall establish a program under which the 10 Secretary shall reimburse each school participating 11 in a program described in clause (i) or (ii) of sub- 12 section (a)(1)(B) for all delinquent debt. 13 (2) FORM FOR REIMBURSEMENT.—To carry out 14 the program, the Secretary shall design and dis- 15 tribute a form to State agencies to collect data on 16 all delinquent debt in applicable schools in the State, 17 grouped by school food authority. 18 (3) COMPLETION DATE.—The Secretary shall 19 provide all reimbursements under the program not 20 later than 180 days after the effective date specified 21 in section 5702. 22 (c) REPORT.—Not later than 2 years after the effec- 23 tive date specified in section 5702, the Comptroller Gen- 24 eral of the United States shall submit to Congress and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00992 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 993 •S 4486 IS make publicly available a report that describes the suc- 1 cesses and challenges of the program. 2 SEC. 5716. CONFORMING AMENDMENTS. 3 The Richard B. Russell National School Lunch Act 4 (42 U.S.C. 1751 et seq.) is amended— 5 (1) by striking ‘‘or reduced price’’ each place it 6 appears; 7 (2) by striking ‘‘or a reduced price’’ each place 8 it appears; 9 (3) by striking ‘‘and reduced price’’ each place 10 it appears; and 11 (4) by striking ‘‘a reduced price’’ each place it 12 appears. 13 SEC. 5717. MEASURE OF POVERTY. 14 Section 1113(a) of the Elementary and Secondary 15 Education Act of 1965 (20 U.S.C. 6313(a)) is amended— 16 (1) in paragraph (5)(A), by striking ‘‘the num- 17 ber of children eligible for a free or reduced price 18 lunch under the Richard B. Russell National School 19 Lunch Act (42 U.S.C. 1751 et seq.)’’ and inserting 20 ‘‘the number of identified students’’; and 21 (2) by adding at the end the following: 22 ‘‘(8) IDENTIFIED STUDENTS DEFINED.— 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00993 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 994 •S 4486 IS ‘‘(A) IN GENERAL.—In this subsection, the 1 term ‘identified students’ means the number of 2 students— 3 ‘‘(i) who are— 4 ‘‘(I) homeless children and 5 youths, as defined under section 6 725(2) of the McKinney-Vento Home- 7 less Assistance Act (42 U.S.C. 8 11434a(2)); 9 ‘‘(II) runaway and homeless 10 youth served by programs established 11 under the Runaway and Homeless 12 Youth Act (34 U.S.C. 11201 et seq.); 13 ‘‘(III) migratory children, as de- 14 fined under section 1309; or 15 ‘‘(IV) foster children; 16 ‘‘(ii) who are eligible for and receiving 17 medical assistance under the program of 18 medical assistance established under title 19 XIX of the Social Security Act (42 U.S.C. 20 1396 et seq.); or 21 ‘‘(iii) who participate (or who are part 22 of a household that participates) in at least 23 one of the following: 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00994 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 995 •S 4486 IS ‘‘(I) The supplemental nutrition 1 assistance program established under 2 the Food and Nutrition Act of 2008 3 (7 U.S.C. 2011 et seq.). 4 ‘‘(II) A State program funded 5 under the program of block grants to 6 States for temporary assistance for 7 needy families established under part 8 A of title IV of the Social Security 9 Act (42 U.S.C. 601 et seq.). 10 ‘‘(III) The food distribution pro- 11 gram on Indian reservations estab- 12 lished under section 4(b) of the Food 13 and Nutrition Act of 2008 (7 U.S.C. 14 2013(b)). 15 ‘‘(IV) A Head Start program au- 16 thorized under the Head Start Act 17 (42 U.S.C. 9831 et seq.) or a com- 18 parable State-funded Head Start or 19 pre-kindergarten program. 20 ‘‘(B) MULTIPLIER.—In determining the 21 number of identified students under subpara- 22 graph (A), the local educational agency shall 23 multiply the number determined under such 24 subparagraph by 1.6.’’. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00995 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 996 •S 4486 IS SEC. 5718. SUPPLEMENTAL NUTRITION ASSISTANCE PRO- 1 GRAM. 2 (a) AGREEMENT FOR DIRECT CERTIFICATION.— 3 (1) IN GENERAL.—Section 11 of the Food and 4 Nutrition Act of 2008 (7 U.S.C. 2020) is amend- 5 ed— 6 (A) by striking subsection (u); and 7 (B) by redesignating subsections (v) 8 through (x) as subsections (u) through (w), re- 9 spectively. 10 (2) CONFORMING AMENDMENTS.—Section 11(e) 11 of the Food and Nutrition Act of 2008 (7 U.S.C. 12 2020(e)) is amended— 13 (A) in paragraph (8)(F), by striking ‘‘or 14 subsection (u)’’; and 15 (B) in paragraph (26)(B), by striking 16 ‘‘(x)’’ and inserting ‘‘(w)’’. 17 (b) NUTRITION EDUCATION AND OBESITY PREVEN- 18 TION GRANT PROGRAM.—Section 28(a) of the Food and 19 Nutrition Act of 2008 (7 U.S.C. 2036a(a)) is amended 20 by striking paragraph (1) and inserting the following: 21 ‘‘(1) an individual eligible for benefits under 22 this Act;’’. 23 SEC. 5719. HIGHER EDUCATION ACT OF 1965. 24 (a) TEACHER QUALITY ENHANCEMENT.—Subpara- 25 graph (A) of section 200(11) of the Higher Education Act 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00996 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 997 •S 4486 IS of 1965 (20 U.S.C. 1021(11)) is amended to read as fol- 1 lows: 2 ‘‘(A) IN GENERAL.—The term ‘high-need 3 school’ means a school that is in the highest 4 quartile of schools in a ranking of all schools 5 served by a local educational agency, ranked in 6 descending order by percentage of students 7 from low-income families enrolled in such 8 schools, as determined by the local educational 9 agency based on one of the following measures 10 of poverty: 11 ‘‘(i) The percentage of students aged 12 5 through 17 in poverty counted in the 13 most recent census data approved by the 14 Secretary. 15 ‘‘(ii) The percentage of students in 16 families receiving assistance under the 17 State program funded under the program 18 of block grants to States for temporary as- 19 sistance for needy families established 20 under part A of title IV of the Social Secu- 21 rity Act (42 U.S.C. 601 et seq.). 22 ‘‘(iii) The percentage of students eligi- 23 ble to receive medical assistance under the 24 program of medical assistance established 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00997 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 998 •S 4486 IS under title XIX of the Social Security Act 1 (42 U.S.C. 1396 et seq.). 2 ‘‘(iv) A composite of two or more of 3 the measures described in clauses (i) 4 through (iii).’’. 5 (b) GEAR UP.—Subparagraph (A) of section 6 404B(d)(1) of the Higher Education Act of 1965 (20 7 U.S.C. 1070a–22(d)(1)) is amended to read as follows: 8 ‘‘(A) provide services under this chapter to 9 at least one grade level of students, beginning 10 not later than 7th grade, in a participating 11 school— 12 ‘‘(i) that has a 7th grade; and 13 ‘‘(ii) in which— 14 ‘‘(I) at least 50 percent of the 15 students enrolled are identified stu- 16 dents (as described in clause (i), (ii), 17 or (iii) of section 1113(a)(8)(A) of the 18 Elementary and Secondary Education 19 Act of 1965); or 20 ‘‘(II) if an eligible entity deter- 21 mines that it would promote the effec- 22 tiveness of a program, an entire grade 23 level of students, beginning not later 24 than the 7th grade, reside in public 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00998 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 999 •S 4486 IS housing, as defined in section 3(b)(1) 1 of the United States Housing Act of 2 1937 (42 U.S.C. 1437a(b)(1)).’’. 3 (c) SIMPLIFIED NEEDS TEST.—Section 479(d)(2) of 4 the Higher Education Act of 1965 (20 U.S.C. 5 1087ss(d)(2)) is amended— 6 (1) by striking subparagraph (C); and 7 (2) by redesignating subparagraphs (D) 8 through (F) as subparagraphs (C) through (E), re- 9 spectively. 10 (d) EARLY FEDERAL PELL GRANT COMMITMENT 11 DEMONSTRATION PROGRAM.—Section 894(b) of the 12 Higher Education Act of 1965 (20 U.S.C. 1161y(b)) is 13 amended— 14 (1) in paragraph (1)(B), by striking ‘‘qualify 15 for a free or reduced price school lunch under the 16 Richard B. Russell National School Lunch Act (42 17 U.S.C. 1751 et seq.) or the Child Nutrition Act of 18 1966 (42 U.S.C. 1771 et seq.)’’ and inserting ‘‘are 19 identified students (as described in clause (i), (ii), or 20 (iii) of section 1113(a)(8)(A) of the Elementary and 21 Secondary Education Act of 1965)’’; and 22 (2) in paragraph (5), by striking ‘‘eligible for a 23 free or reduced price school lunch under the Richard 24 B. Russell National School Lunch Act (42 U.S.C. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00999 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1000 •S 4486 IS 1751 et seq.) or the Child Nutrition Act of 1966 (42 1 U.S.C. 1771 et seq.)’’ and inserting ‘‘identified stu- 2 dents (as described in clause (i), (ii), or (iii) of sec- 3 tion 1113(a)(8)(A) of the Elementary and Sec- 4 ondary Education Act of 1965)’’. 5 SEC. 5720. ELEMENTARY AND SECONDARY EDUCATION ACT 6 OF 1965. 7 (a) LITERACY EDUCATION FOR ALL.—Section 8 2221(b)(3)(B) of the Elementary and Secondary Edu- 9 cation Act of 1965 (20 U.S.C. 6641(b)(3)(B)) is amend- 10 ed— 11 (1) by striking clause (i); and 12 (2) by redesignating clauses (ii) and (iii) as 13 clauses (i) and (ii), respectively. 14 (b) GRANTS FOR EDUCATION INNOVATION AND RE- 15 SEARCH.—Section 4611(d)(2) of the Elementary and Sec- 16 ondary Education Act of 1965 (20 U.S.C. 7261(d)(2)) is 17 amended— 18 (1) by striking subparagraph (B); and 19 (2) by redesignating subparagraphs (C) and 20 (D) as subparagraphs (B) and (C), respectively. 21 (c) ELIGIBILITY FOR HEAVILY IMPACTED LOCAL 22 EDUCATIONAL AGENCIES.—Item (bb) of section 23 7003(b)(2)(B)(i)(III) of the Elementary and Secondary 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01000 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1001 •S 4486 IS Education Act of 1965 (20 U.S.C. 7703(b)(2)(B)(i)(III)) 1 is amended to read as follows: 2 ‘‘(bb) has an enrollment of 3 children described in subsection 4 (a)(1) that constitutes a percent- 5 age of the total student enroll- 6 ment of the agency that is not 7 less than 30 percent; or’’. 8 SEC. 5721. AMERICA COMPETES ACT. 9 Section 6122(3) of the America COMPETES Act (20 10 U.S.C. 9832(3)) is amended by striking ‘‘data on children 11 eligible for free or reduced-price lunches under the Rich- 12 ard B. Russell National School Lunch Act,’’. 13 SEC. 5722. WORKFORCE INNOVATION AND OPPORTUNITY 14 ACT. 15 Section 3(36)(A) of the Workforce Innovation and 16 Opportunity Act (29 U.S.C. 3102(36)(A)) is amended— 17 (1) by striking clause (iv); and 18 (2) by redesignating clauses (v) and (vi) as 19 clauses (iv) and (v), respectively. 20 SEC. 5723. NATIONAL SCIENCE FOUNDATION AUTHORIZA- 21 TION ACT OF 2002. 22 Section 4(8) of the National Science Foundation Au- 23 thorization Act of 2002 (42 U.S.C. 1862n note) is amend- 24 ed— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01001 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1002 •S 4486 IS (1) by striking subparagraph (A); and 1 (2) by redesignating subparagraphs (B) and 2 (C) as subparagraphs (A) and (B), respectively. 3 SEC. 5724. CHILD CARE AND DEVELOPMENT BLOCK GRANT. 4 Section 658O(b) of the Child Care and Development 5 Block Grant Act of 1990 (42 U.S.C. 9858m(b)) is amend- 6 ed— 7 (1) in paragraph (1)(B), by striking ‘‘school 8 lunch factor’’ and inserting ‘‘identified students fac- 9 tor’’; and 10 (2) by striking paragraph (3) and inserting the 11 following: 12 ‘‘(3) IDENTIFIED STUDENTS FACTOR.—The 13 term ‘identified students factor’ means the ratio of 14 the number of children who are identified students 15 (as determined under paragraph (8) of section 16 1113(a) of the Elementary and Secondary Edu- 17 cation Act of 1965 (20 U.S.C. 6313(a))) in the 18 State to the number of such children in all the 19 States as determined annually by the Secretary of 20 Education.’’. 21 SEC. 5725. CHILDREN’S HEALTH ACT OF 2000. 22 Section 1404(b) of the Children’s Health Act of 2000 23 (42 U.S.C. 9859c(b)) is amended— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01002 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1003 •S 4486 IS (1) in paragraph (1)(B), by striking ‘‘school 1 lunch factor’’ and inserting ‘‘identified students fac- 2 tor’’; and 3 (2) by amending paragraph (3) to read as fol- 4 lows: 5 ‘‘(3) IDENTIFIED STUDENTS FACTOR.—In this 6 subsection, the term ‘identified students factor’ 7 means the ratio of the number of children who are 8 identified students (as determined under paragraph 9 (8) of section 1113(a) of the Elementary and Sec- 10 ondary Education Act of 1965 (20 U.S.C. 6313(a))) 11 in the State to the number of such children in all 12 the States as determined annually by the Secretary 13 of Education.’’. 14 SEC. 5726. JUVENILE JUSTICE AND DELINQUENCY PREVEN- 15 TION. 16 Section 252(i) of the Juvenile Justice and Delin- 17 quency Prevention Act of 1974 (34 U.S.C. 11162(i)) is 18 amended to read as follows: 19 ‘‘(i) FREE SCHOOL LUNCHES FOR INCARCERATED 20 JUVENILES.— 21 ‘‘(1) ELIGIBLE JUVENILE DETENTION CENTER 22 DEFINED.—In this subsection, the term ‘eligible ju- 23 venile detention center’ does not include any private, 24 for-profit detention center. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01003 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1004 •S 4486 IS ‘‘(2) ELIGIBILITY FOR FREE LUNCH.—A juve- 1 nile who is incarcerated in an eligible juvenile deten- 2 tion center is eligible to receive free lunch under the 3 Richard B. Russell National School Lunch Act (42 4 U.S.C. 1751 et seq.). 5 ‘‘(3) GUIDANCE.—Not later than 1 year after 6 the date of enactment of the Universal School Meals 7 Program Act of 2022, the Attorney General, in con- 8 sultation with the Secretary of Agriculture, shall 9 provide guidance to States relating to the options for 10 school food authorities in the States to apply for re- 11 imbursement for free lunches under the Richard B. 12 Russell National School Lunch Act (42 U.S.C. 1751 13 et seq.) for juveniles who are incarcerated.’’. 14 Subtitle I—Elder Care 15 SEC. 5801. EXPENSES FOR HOUSEHOLD AND ELDER CARE 16 SERVICES NECESSARY FOR GAINFUL EM- 17 PLOYMENT. 18 (a) IN GENERAL.—Subpart A of part IV of sub- 19 chapter A of chapter 1 of the Internal Revenue Code of 20 1986 is amended by inserting after section 25D the fol- 21 lowing new section: 22 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01004 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1005 •S 4486 IS ‘‘SEC. 25E. EXPENSES FOR HOUSEHOLD AND ELDER CARE 1 SERVICES NECESSARY FOR GAINFUL EM- 2 PLOYMENT. 3 ‘‘(a) ALLOWANCE OF CREDIT.— 4 ‘‘(1) IN GENERAL.—In the case of an individual 5 for which there are one or more qualifying individ- 6 uals (as defined in subsection (b)(1)) with respect to 7 such individual, there shall be allowed as a credit 8 against the tax imposed by this chapter for the tax- 9 able year an amount equal to the applicable percent- 10 age of the employment-related expenses (as defined 11 in subsection (b)(3)) paid by such individual during 12 the taxable year. 13 ‘‘(2) APPLICABLE PERCENTAGE DEFINED.—For 14 purposes of paragraph (1), the term ‘applicable per- 15 centage’ means 35 percent reduced (but not below 16 20 percent) by 1 percentage point for each $2,000 17 (or fraction thereof) by which the taxpayer’s ad- 18 justed gross income for the taxable year exceeds 19 $15,000. 20 ‘‘(b) DEFINITIONS OF QUALIFYING INDIVIDUAL AND 21 EMPLOYMENT-RELATED EXPENSES.—For purposes of 22 this section— 23 ‘‘(1) QUALIFYING INDIVIDUAL.—The term 24 ‘qualifying individual’ means an individual who— 25 ‘‘(A) has attained age 50, and 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01005 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1006 •S 4486 IS ‘‘(B) satisfies the requirements of any of 1 the following clauses: 2 ‘‘(i) An individual who bears a rela- 3 tionship to the taxpayer described in sub- 4 paragraph (C) or (D) of section 152(d)(2) 5 (relating to fathers, mothers, and ances- 6 tors). 7 ‘‘(ii) An individual who would be a de- 8 pendent of the taxpayer (as defined in sec- 9 tion 152, determined without regard to 10 subsections (b)(1) and (b)(2)) as a quali- 11 fying relative described in section 12 152(d)(1) if— 13 ‘‘(I) in lieu of the requirements 14 under subparagraphs (B) and (C) of 15 such section, with respect to such in- 16 dividual— 17 ‘‘(aa) the taxpayer has pro- 18 vided over one-half of the individ- 19 ual’s support for the calendar 20 year in which such taxable year 21 begins and each of the preceding 22 4 taxable years, and 23 ‘‘(bb) the individual’s modi- 24 fied adjusted gross income for 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01006 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1007 •S 4486 IS the calendar year in which such 1 taxable year begins is less than 2 the exemption amount (as de- 3 fined in section 151(d)), 4 ‘‘(II) the individual is physically 5 or mentally incapable of caring for 6 himself or herself, and 7 ‘‘(III) the individual has the 8 same principal place of abode as the 9 taxpayer for more than one-half of 10 such taxable year. 11 ‘‘(iii) The spouse of the taxpayer, if 12 such spouse is physically or mentally in- 13 capable of caring for himself or herself. 14 ‘‘(2) MODIFIED ADJUSTED GROSS INCOME.— 15 The term ‘modified adjusted gross income’ means 16 adjusted gross income determined without regard to 17 section 86. 18 ‘‘(3) EMPLOYMENT-RELATED EXPENSES.— 19 ‘‘(A) IN GENERAL.—The term ‘employ- 20 ment-related expenses’ means amounts paid for 21 the following expenses, but only if such ex- 22 penses are incurred to enable the taxpayer to be 23 gainfully employed for any period for which 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01007 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1008 •S 4486 IS there are one or more qualifying individuals 1 with respect to the taxpayer: 2 ‘‘(i) Expenses for household services 3 with respect to the qualifying individual. 4 ‘‘(ii) Expenses for the care of a quali- 5 fying individual, including expenses for res- 6 pite care and hospice care. 7 ‘‘(B) EXCEPTION.—The term ‘employ- 8 ment-related expenses’ shall not include services 9 provided outside the taxpayer’s household un- 10 less such expenses are incurred for the care 11 of— 12 ‘‘(i) a qualifying individual described 13 in paragraph (1)(A), or 14 ‘‘(ii) a qualifying individual (not de- 15 scribed in paragraph (1)(A)) who regularly 16 spends at least 8 hours each day in the 17 taxpayer’s household. 18 ‘‘(C) DEPENDENT CARE CENTERS.—The 19 term ‘employment-related expenses’ shall not 20 include services provided outside the taxpayer’s 21 household by a dependent care center (as de- 22 fined in subparagraph (D)) unless— 23 ‘‘(i) such center complies with all ap- 24 plicable laws and regulations of the State 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01008 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1009 •S 4486 IS and local government in which such center 1 is located, and 2 ‘‘(ii) the requirements of subpara- 3 graph (B) are met. 4 ‘‘(D) DEPENDENT CARE CENTER DE- 5 FINED.—For purposes of this paragraph, the 6 term ‘dependent care center’ means any facility 7 which— 8 ‘‘(i) provides care for more than 6 in- 9 dividuals (other than individuals who re- 10 side at the facility), and 11 ‘‘(ii) receives a fee, payment, or grant 12 for providing services for any of the indi- 13 viduals (regardless of whether such facility 14 is operated for profit). 15 ‘‘(c) DOLLAR LIMIT ON AMOUNT CREDITABLE.—The 16 amount of the employment-related expenses incurred dur- 17 ing any taxable year which may be taken into account 18 under subsection (a) shall not exceed— 19 ‘‘(1) if there is 1 qualifying individual with re- 20 spect to the taxpayer for such taxable year, $3,000, 21 or 22 ‘‘(2) if there are 2 or more qualifying individ- 23 uals with respect to the taxpayer for such taxable 24 year, $6,000. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01009 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1010 •S 4486 IS The amount determined under this subsection shall be re- 1 duced by the aggregate amount excludable from gross in- 2 come under section 129 for the taxable year. 3 ‘‘(d) EARNED INCOME LIMITATION.—The amount of 4 the employment-related expenses incurred during any tax- 5 able year which may be taken into account under sub- 6 section (a) shall not exceed— 7 ‘‘(1) in the case of an individual who is not 8 married at the close of such year, such individual’s 9 earned income for such year, or 10 ‘‘(2) in the case of an individual who is married 11 at the close of such year, the lesser of such individ- 12 ual’s earned income or the earned income of his 13 spouse for such year. 14 ‘‘(e) SPECIAL RULES.—For purposes of this sec- 15 tion— 16 ‘‘(1) PLACE OF ABODE.—An individual shall 17 not be treated as having the same principal place of 18 abode of the taxpayer if at any time during the tax- 19 able year of the taxpayer the relationship between 20 the individual and the taxpayer is in violation of 21 local law. 22 ‘‘(2) MARRIED COUPLES MUST FILE JOINT RE- 23 TURN.—In the case of an individual who is married 24 as of the close of the taxable year, the credit shall 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01010 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1011 •S 4486 IS be allowed under subsection (a) only if a joint return 1 is filed for the taxable year under section 6013. 2 ‘‘(3) MARITAL STATUS.—An individual legally 3 separated from his or her spouse under a decree of 4 divorce or of separate maintenance shall not be con- 5 sidered as married. 6 ‘‘(4) CERTAIN MARRIED INDIVIDUALS LIVING 7 APART.—In the case of an individual who is married 8 and does not file a joint return for the taxable year, 9 if— 10 ‘‘(A) such individual— 11 ‘‘(i) maintains as his or her home a 12 household which constitutes for more than 13 one-half of the taxable year the principal 14 place of abode of a qualifying individual, 15 ‘‘(ii) furnishes over half of the cost of 16 maintaining such household during the 17 taxable year, and 18 ‘‘(B) during the last 6 months of such tax- 19 able year, such individual’s spouse is not a 20 member of such household, 21 such individual shall not be considered as married. 22 ‘‘(5) PAYMENTS TO RELATED INDIVIDUALS.— 23 No credit shall be allowed under subsection (a) for 24 any amount paid by the taxpayer to an individual— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01011 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1012 •S 4486 IS ‘‘(A) with respect to whom, for the taxable 1 year, a deduction under section 151(c) (relating 2 to deduction for personal exemptions for de- 3 pendents) is allowable either to the taxpayer or 4 the taxpayer’s spouse, or 5 ‘‘(B) who— 6 ‘‘(i) is a child of the taxpayer (within 7 the meaning of section 152(f)(1)), and 8 ‘‘(ii) has not attained the age of 19 at 9 the close of the taxable year. 10 For purposes of this paragraph, the term ‘taxable 11 year’ means the taxable year of the taxpayer in 12 which the service (as described in clause (i) of sub- 13 section (b)(3)(A)) is performed or the care (as de- 14 scribed in clause (ii) of such subsection) is provided. 15 ‘‘(6) IDENTIFYING INFORMATION REQUIRED 16 WITH RESPECT TO SERVICE PROVIDER.—No credit 17 shall be allowed under subsection (a) for any amount 18 paid to any person unless— 19 ‘‘(A) the name, address, and taxpayer 20 identification number of such person are in- 21 cluded on the return of tax for the taxable year 22 in which the credit under this section is being 23 claimed, or 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01012 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1013 •S 4486 IS ‘‘(B) if such person is an organization de- 1 scribed in section 501(c)(3) and exempt from 2 tax under section 501(a), the name and address 3 of such person are included on the return of tax 4 for the taxable year in which the credit under 5 this section is being claimed. 6 In the case of a failure to provide the information 7 required under the preceding sentence, the preceding 8 sentence shall not apply if it is shown that the tax- 9 payer exercised due diligence in attempting to pro- 10 vide the information so required. 11 ‘‘(7) IDENTIFYING INFORMATION REQUIRED 12 WITH RESPECT TO QUALIFYING INDIVIDUALS.—No 13 credit shall be allowed under this section with re- 14 spect to any qualifying individual unless the TIN of 15 such individual is included on the return of tax for 16 the taxable year in which the credit under this sec- 17 tion is being claimed. 18 ‘‘(f) REGULATIONS.—The Secretary shall prescribe 19 such regulations as may be necessary to carry out the pur- 20 poses of this section.’’. 21 (b) CLERICAL AMENDMENT.—The table of sections 22 for subpart A of part IV of subchapter A of chapter 1 23 of the Internal Revenue Code of 1986 is amended by in- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01013 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1014 •S 4486 IS serting after the item relating to section 25D the following 1 new item: 2 ‘‘Sec. 25E. Expenses for household and elder care services necessary for gainful employment.’’. (c) EFFECTIVE DATE.—The amendments made by 3 this section shall apply to taxable years beginning after 4 the date of the enactment of this Act. 5 Subtitle J—Miscellaneous 6 Provisions 7 SEC. 5901. CLARIFICATION SUPPORTING PERMISSIBLE USE 8 OF FUNDS FOR STILLBIRTH PREVENTION AC- 9 TIVITIES. 10 Section 501(a) of the Social Security Act (42 U.S.C. 11 701(a)) is amended— 12 (1) in paragraph (1)(B), by inserting ‘‘to re- 13 duce the incidence of stillbirth,’’ after ‘‘among chil- 14 dren,’’; and 15 (2) in paragraph (2), by inserting after ‘‘follow- 16 up services’’ the following: ‘‘, and for evidence-based 17 programs and activities and outcome research to re- 18 duce the incidence of stillbirth (including tracking 19 and awareness of fetal movements, improvement of 20 birth timing for pregnancies with risk factors, initia- 21 tives that encourage safe sleeping positions during 22 pregnancy, screening and surveillance for fetal 23 growth restriction, efforts to achieve smoking ces- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01014 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1015 •S 4486 IS sation during pregnancy, community-based programs 1 that provide home visits or other types of support, 2 and any other research or evidence-based program- 3 ming to prevent stillbirths)’’. 4 TITLE VI—MENTAL HEALTH AND 5 SUBSTANCE USE DISORDERS 6 SEC. 6001. MENTAL HEALTH FINDINGS. 7 Congress finds the following: 8 (1) Despite the existence of effective treat- 9 ments, inequities lie in the availability, accessibility, 10 and quality of mental health services for racial and 11 ethnic minorities and people with disabilities. 12 (2) These inequities have powerful significance 13 for minority groups and for society as a whole. 14 (3) Racial and ethnic minorities 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) Improving community conditions and one’s 19 home environment, paired with high-quality, acces- 20 sible, and culturally and linguistically tailored men- 21 tal health services, can reduce the likelihood, fre- 22 quency, and intensity of challenges to one’s mental 23 health. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01015 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1016 •S 4486 IS (5) The presence of strong social connections 1 and trust, opportunities to experience and share cul- 2 tural identity, safe gathering places, and economic 3 opportunity are community factors that benefit men- 4 tal health. 5 (6) The social, physical, economic, and other 6 conditions, otherwise known as social determinants 7 of health, in communities can have tremendous in- 8 fluence on daily stressors that shape mental health 9 outcomes. 10 (7) Significant barriers include the cost of and 11 access to quality care, societal stigma, mental health 12 workforce shortages, the fragmented organization of 13 services and needed social supports, and the history 14 of racism and discrimination in the mental health 15 system. 16 (8) People with severe and persistent mental ill- 17 ness who are racial or ethnic minorities often have 18 co-occurring health and mental health conditions 19 and experience direct inequities in access to nec- 20 essary supports, resources, and services which, with- 21 out proper accommodations and support, further 22 stigmatize them and limit their participation in soci- 23 ety. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01016 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1017 •S 4486 IS (9) African-American, Latinx, Asian American, 1 Pacific Islander, Native, Middle Eastern and North 2 African (MENA), and other people of color commu- 3 nities are more likely to experience systemic dis- 4 crimination by health care and social service pro- 5 viders and may be reluctant to seek mental health 6 care and other health interventions. 7 (10) Mental health conditions and substance 8 abuse disorders retain considerable stigma in many 9 communities of color and seeking treatment is not 10 always encouraged. 11 (11) Addressing mental health stigma and in- 12 creasing access to culturally and linguistically appro- 13 priate treatments and supports in communities will 14 help to increase utilization of mental health services 15 for people who have functional difficulties because of 16 mental health challenges. 17 (12) There is a link between a mental health di- 18 agnosis and the likelihood of an individual commit- 19 ting suicide. 20 (13) A comprehensive public health approach to 21 behavioral health is one that fosters and finances 22 protective factors in racial and ethnic communities 23 that support mental health. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01017 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1018 •S 4486 IS (14) Approaches to mental health and trauma 1 must keep in mind the historical and present day 2 and cultural trauma that impacts many communities 3 of color, including trauma and loss caused by ad- 4 verse weather events and structural violence. 5 (15) Culturally and linguistically appropriate 6 treatments and supports must keep approaches of 7 individual communities to mental health in mind, in- 8 cluding by considering— 9 (A) approaches to cultural healing prac- 10 tices; and 11 (B) the diverse mental health professionals 12 needed for such practices, such as peer support 13 specialists. 14 (16) Approaches to mental health and address- 15 ing trauma must keep in mind the concept of 16 intersectionality of individuals; that individuals may 17 experience many inequities that shape the way they 18 process and experience everyday life. 19 SEC. 6002. SENSE OF CONGRESS. 20 It is the sense of the Congress that it is imperative 21 that a comprehensive public health approach to addressing 22 trauma and mental health care be focused on care delivery 23 that is culturally and linguistically appropriate. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01018 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1019 •S 4486 IS Subtitle A—Access to Care and 1 Funding Streams 2 SEC. 6011. COVERAGE OF MARRIAGE AND FAMILY THERA- 3 PIST SERVICES, MENTAL HEALTH COUN- 4 SELOR SERVICES, SUBSTANCE ABUSE COUN- 5 SELOR SERVICES, AND PEER SUPPORT SPE- 6 CIALIST SERVICES UNDER PART B OF THE 7 MEDICARE PROGRAM. 8 (a) COVERAGE OF SERVICES.— 9 (1) IN GENERAL.—Section 1861(s)(2) of the 10 Social Security Act (42 U.S.C. 1395x(s)(2)), as 11 amended by section 4251(c)(1), is amended— 12 (A) in subparagraph (HH), by striking 13 ‘‘and’’ at the end; 14 (B) in subparagraph (II), by adding ‘‘and’’ 15 at the end; and 16 (C) by adding at the end the following new 17 subparagraph: 18 ‘‘(JJ) marriage and family therapist services 19 (as defined in subsection (ooo)(1)), mental health 20 counselor services (as defined in subsection 21 (ooo)(3)), substance abuse counselor services (as de- 22 fined in subsection (ooo)(5)), and peer support spe- 23 cialist services (as defined in subsection (ooo)(7));’’. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01019 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1020 •S 4486 IS (2) DEFINITIONS.—Section 1861 of the Social 1 Security Act (42 U.S.C. 1395x), as amended by sec- 2 tions 2007(b), 4221(a), and 4251(c)(2), is amended 3 by adding at the end the following new subsection: 4 ‘‘Marriage and Family Therapist Services; Marriage and 5 Family Therapist; Mental Health Counselor Serv- 6 ices; Mental Health Counselor; Substance Abuse 7 Counselor Services; Substance Abuse Counselor; 8 Peer Support Specialist Services; Peer Support Spe- 9 cialist 10 ‘‘(ooo)(1) The term ‘marriage and family therapist 11 services’ means services performed by a marriage and 12 family therapist (as defined in paragraph (2)) for the diag- 13 nosis and treatment of mental illnesses, which the mar- 14 riage and family therapist is legally authorized to perform 15 under State law (or the State regulatory mechanism pro- 16 vided by State law) of the State in which such services 17 are performed, as would otherwise be covered if furnished 18 by a physician or as an incident to a physician’s profes- 19 sional service, but only if no facility or other provider 20 charges or is paid any amounts with respect to the fur- 21 nishing of such services. 22 ‘‘(2) The term ‘marriage and family therapist’ means 23 an individual who— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01020 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1021 •S 4486 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, in- 3 cluding but not limited to, clinical social workers and 4 occupational therapists; 5 ‘‘(B) after obtaining such degree has performed 6 at least 2 years of clinical supervised experience in 7 marriage and family therapy; and 8 ‘‘(C) in the case of an individual performing 9 services in a State that provides for licensure or cer- 10 tification of marriage and family therapists, is li- 11 censed or certified as a marriage and family thera- 12 pist in such State. 13 ‘‘(3) The term ‘mental health counselor services’ 14 means services performed by a mental health counselor (as 15 defined in paragraph (4)) for the diagnosis and treatment 16 of mental health conditions and disabilities that the men- 17 tal health counselor is legally authorized to perform under 18 State law (or the State regulatory mechanism provided by 19 the State law) of the State in which such services are per- 20 formed, as would otherwise be covered if furnished by a 21 physician or as incident to a physician’s professional serv- 22 ice, but only if no facility or other provider charges or is 23 paid any amounts with respect to the furnishing of such 24 services. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01021 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1022 •S 4486 IS ‘‘(4) The term ‘mental health counselor’ means an 1 individual who— 2 ‘‘(A) possesses a master’s or doctor’s degree in 3 mental health counseling or a related field, including 4 clinical social workers and occupational therapists; 5 ‘‘(B) after obtaining such a degree has per- 6 formed at least 2 years of supervised mental health 7 counselor practice; and 8 ‘‘(C) in the case of an individual performing 9 services in a State that provides for licensure or cer- 10 tification of mental health counselors or professional 11 counselors, is licensed or certified as a mental health 12 counselor or professional counselor in such State. 13 ‘‘(5) The term ‘substance abuse counselor services’ 14 means services performed by a substance abuse counselor 15 (as defined in paragraph (6)) for the diagnosis and treat- 16 ment of substance abuse and addiction that the substance 17 abuse counselor is legally authorized to perform under 18 State law (or the State regulatory mechanism provided by 19 the State law) of the State in which such services are per- 20 formed, as would otherwise be covered if furnished by a 21 physician or as incident to a physician’s professional serv- 22 ice, but only if no facility or other provider charges or is 23 paid any amounts with respect to the furnishing of such 24 services. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01022 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1023 •S 4486 IS ‘‘(6) The term ‘substance abuse counselor’ means an 1 individual who— 2 ‘‘(A) has performed at least 2 years of super- 3 vised substance abuse counselor practice; 4 ‘‘(B) in the case of an individual performing 5 services in a State that provides for licensure or cer- 6 tification of substance abuse counselors or profes- 7 sional counselors, is licensed or certified as a sub- 8 stance abuse counselor or professional counselor in 9 such State; or 10 ‘‘(C) is a drug and alcohol counselor as defined 11 in section 40.281 of title 49, Code of Federal Regu- 12 lations. 13 ‘‘(7) The term ‘peer support specialist services’ 14 means services performed by a peer support specialist (as 15 defined in paragraph (8)) for the well-being of individuals 16 needing mental health support that the peer support spe- 17 cialist is legally authorized to perform under State law (or 18 the State regulatory mechanism provided by the State 19 law) of the State in which such services are performed, 20 as would otherwise be covered if furnished by a physician 21 or as incident to a physician’s professional service, but 22 only if no facility or other provider charges or is paid any 23 amounts with respect to the furnishing of such services. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01023 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1024 •S 4486 IS ‘‘(8) The term ‘peer support specialist’ means an in- 1 dividual who— 2 ‘‘(A) is an individual living in recovery with 3 mental illness, addiction, or systems involvement; 4 ‘‘(B) has skills learned in formal training; 5 ‘‘(C) uses assets-based framing in speaking 6 about mental health, recovery, and well-being; and 7 ‘‘(D) delivers services in behavioral health set- 8 tings to promote mind-body recovery and resil- 9 iency.’’. 10 (3) PROVISION FOR PAYMENT UNDER PART 11 B.—Section 1832(a)(2)(B) of the Social Security 12 Act (42 U.S.C. 1395k(a)(2)(B)) is amended— 13 (A) by striking ‘‘and’’ at the end of clause 14 (iv); and 15 (B) by adding at the end the following new 16 clause: 17 ‘‘(v) marriage and family therapist 18 services, mental health counselor services, 19 substance abuse counselor services, and 20 peer support specialist services; and’’. 21 (4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 22 of the Social Security Act (42 U.S.C. 1395l(a)(1)), 23 as amended by section 4251(c)(3), is amended— 24 (A) by striking ‘‘and’’ before ‘‘(EE)’’; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01024 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1025 •S 4486 IS (B) by inserting before the semicolon at 1 the end the following: ‘‘, and (FF) with respect 2 to marriage and family therapist services, men- 3 tal health counselor services, substance abuse 4 counselor services, and peer support specialist 5 services under section 1861(s)(2)(JJ), the 6 amounts paid shall be 80 percent of the lesser 7 of the actual charge for the services or 75 per- 8 cent of the amount determined for payment of 9 a psychologist under subparagraph (L)’’. 10 (5) EXCLUSION OF MARRIAGE AND FAMILY 11 THERAPIST SERVICES, MENTAL HEALTH COUNSELOR 12 SERVICES, AND PEER SUPPORT SPECIALIST SERV- 13 ICES FROM SKILLED NURSING FACILITY PROSPEC- 14 TIVE PAYMENT SYSTEM.—Section 1888(e)(2)(A)(ii) 15 of the Social Security Act (42 U.S.C. 16 1395yy(e)(2)(A)(ii)) is amended by inserting ‘‘mar- 17 riage and family therapist services (as defined in 18 section 1861(nnn)(1)), mental health counselor serv- 19 ices (as defined in section 1861(nnn)(3)), and peer 20 support specialist services (as defined in section 21 1861(nnn)(7)),’’ after ‘‘qualified psychologist serv- 22 ices,’’. 23 (6) INCLUSION OF MARRIAGE AND FAMILY 24 THERAPISTS, MENTAL HEALTH COUNSELORS, AND 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01025 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1026 •S 4486 IS SUBSTANCE ABUSE COUNSELORS AS PRACTITIONERS 1 FOR ASSIGNMENT OF CLAIMS.—Section 2 1842(b)(18)(C) of the Social Security Act (42 3 U.S.C. 1395u(b)(18)(C)) is amended by adding at 4 the end the following new clauses: 5 ‘‘(vii) A marriage and family therapist (as de- 6 fined in section 1861(nnn)(2)). 7 ‘‘(viii) A mental health counselor (as defined in 8 section 1861(nnn)(4)). 9 ‘‘(ix) A substance abuse counselor (as defined 10 in section 1861(nnn)(6)). 11 ‘‘(x) A peer support specialist (as defined in 12 section 1861(nnn)(8)).’’. 13 (b) COVERAGE OF CERTAIN MENTAL HEALTH SERV- 14 ICES PROVIDED IN CERTAIN SETTINGS.— 15 (1) RURAL HEALTH CLINICS AND FEDERALLY 16 QUALIFIED HEALTH CENTERS.—Section 17 1861(aa)(1)(B) of the Social Security Act (42 18 U.S.C. 1395x(aa)(1)(B)) is amended by striking ‘‘or 19 by a clinical social worker (as defined in subsection 20 (hh)(1)),’’ and inserting ‘‘, by a clinical social worker 21 (as defined in subsection (hh)(1)), by a marriage 22 and family therapist (as defined in subsection 23 (nnn)(2)), or by a mental health counselor (as de- 24 fined in subsection (nnn)(4)), or by a substance 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01026 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1027 •S 4486 IS abuse counselor (as defined in section 1861 1 (nnn)(6)), or by a peer support specialist (as defined 2 in section 1861(nnn)(8)).’’. 3 (2) HOSPICE PROGRAMS.—Section 4 1861(dd)(2)(B)(i)(III) of the Social Security Act (42 5 U.S.C. 1395x(dd)(2)(B)(i)(III)) is amended by in- 6 serting ‘‘or one marriage and family therapist (as 7 defined in subsection (nnn)(2))’’ after ‘‘social work- 8 er’’. 9 (c) AUTHORIZATION OF MARRIAGE AND FAMILY 10 THERAPISTS TO DEVELOP DISCHARGE PLANS FOR 11 POSTHOSPITAL SERVICES.—Section 1861(ee)(2)(G) of 12 the Social Security Act (42 U.S.C. 1395x(ee)(2)(G)) is 13 amended by inserting ‘‘marriage and family therapist (as 14 defined in subsection (nnn)(2)),’’ after ‘‘social worker,’’. 15 (d) EFFECTIVE DATE.—The amendments made by 16 this section shall apply with respect to services furnished 17 on or after January 1, 2023. 18 SEC. 6012. REAUTHORIZATION OF MINORITY FELLOWSHIP 19 PROGRAM. 20 Section 597(c) of the Public Health Service Act (42 21 U.S.C. 297ll(c)) is amended by striking ‘‘$12,669,000 for 22 each of fiscal years 2018 through 2022’’ and inserting 23 ‘‘$25,000,000 for each of fiscal years 2023 through 24 2027’’. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01027 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1028 •S 4486 IS SEC. 6013. ADDITIONAL FUNDS FOR NATIONAL INSTITUTES 1 OF HEALTH. 2 (a) IN GENERAL.—In addition to amounts otherwise 3 authorized to be appropriated to the National Institutes 4 of Health, there is authorized to be appropriated to such 5 Institutes $100,000,000 for each of fiscal years 2023 6 through 2027 to build relations with communities and con- 7 duct or support clinical research, including clinical re- 8 search on racial or ethnic disparities in physical and men- 9 tal health. 10 (b) DEFINITION.—In this section, the term ‘‘clinical 11 research’’ has the meaning given to such term in section 12 409 of the Public Health Service Act (42 U.S.C. 284d). 13 SEC. 6014. ADDITIONAL FUNDS FOR NATIONAL INSTITUTE 14 ON MINORITY HEALTH AND HEALTH DISPARI- 15 TIES. 16 In addition to amounts otherwise authorized to be ap- 17 propriated to the National Institute on Minority Health 18 and Health Disparities, there is authorized to be appro- 19 priated to such Institute $650,000,000 for each of fiscal 20 years 2023 through 2027. 21 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01028 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1029 •S 4486 IS SEC. 6015. GRANTS FOR INCREASING RACIAL AND ETHNIC 1 MINORITY ACCESS TO HIGH-QUALITY TRAU- 2 MA SUPPORT SERVICES AND MENTAL 3 HEALTH CARE. 4 (a) IN GENERAL.—The Secretary of Health and 5 Human Services (in this section referred to as the ‘‘Sec- 6 retary’’), acting through the Assistant Secretary for Men- 7 tal Health and Substance Use, shall award grants to eligi- 8 ble entities to establish or expand programs for the pur- 9 pose of increasing racial and ethnic minority access to 10 high-quality trauma support services and mental health 11 care. 12 (b) ELIGIBLE ENTITIES.—To seek a grant under this 13 section, an entity shall be a community-based program or 14 organization that— 15 (1) provides culturally and linguistically appro- 16 priate programs and resources that are aligned with 17 evidence-based practices for trauma-informed care; 18 and 19 (2) has demonstrated expertise in serving com- 20 munities of color or can partner with a program that 21 has such demonstrated expertise. 22 (c) USE OF FUNDS.—As a condition on receipt of a 23 grant under this section, a grantee shall agree to use the 24 grant to increase racial and ethnic minority access to high- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01029 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1030 •S 4486 IS quality trauma support services and mental health care, 1 such as by— 2 (1) establishing and maintaining community- 3 based programs providing evidence-based services in 4 trauma-informed care and culturally specific services 5 and other resources; 6 (2) developing innovative, culturally specific 7 strategies and projects to enhance access to trauma- 8 informed care and resources for racial and ethnic 9 minorities who face obstacles to using more tradi- 10 tional services and resources (such as obstacles in 11 geographic access to providers, insurance coverage, 12 and access to audio and video technologies); 13 (3) working with State and local governments 14 and social service agencies to develop and enhance 15 effective strategies to provide culturally specific serv- 16 ices to racial and ethnic minorities; 17 (4) increasing communities’ capacity to provide 18 culturally specific resources and support for commu- 19 nities of color; 20 (5) working in cooperation with the community 21 to develop education and prevention strategies high- 22 lighting culturally specific issues and resources re- 23 garding racial and ethnic minorities; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01030 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1031 •S 4486 IS (6) providing culturally specific programs for 1 racial and ethnic minorities exposed to law enforce- 2 ment violence; and 3 (7) examining the dynamics of culture and its 4 impact on victimization and healing. 5 (d) PRIORITY.—In awarding grants under this sec- 6 tion, the Secretary shall give priority to eligible entities 7 proposing to serve communities that have faced high rates 8 of community trauma, including from exposure to law en- 9 forcement violence, intergenerational poverty, civil unrest, 10 discrimination, or oppression. 11 (e) GRANT PERIOD.—The period of a grant under 12 this section shall be 4 years. 13 (f) EVALUATION.—Not later than 6 months after the 14 end of the period of all grants under this section, the Sec- 15 retary shall— 16 (1) conduct an evaluation of the programs 17 funded by a grant under this section; 18 (2) include in such evaluation an assessment of 19 the outcomes of each such program; and 20 (3) submit a report on the results of such eval- 21 uation to the Congress. 22 (g) AUTHORIZATION OF APPROPRIATIONS.—To carry 23 out this section, there is authorized to be appropriated 24 $20,000,000 for each of fiscal years 2023 through 2027. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01031 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1032 •S 4486 IS SEC. 6016. GRANTS FOR UNARMED 9–1–1 RESPONSE PRO- 1 GRAMS. 2 Part D of title V of the Public Health Service Act, 3 as amended by sections 6022, 6023, and 6052, is further 4 amended by adding at the end the following new section: 5 ‘‘SEC. 556. GRANTS FOR UNARMED 9–1–1 RESPONSE PRO- 6 GRAMS. 7 ‘‘(a) IN GENERAL.—The Secretary, acting through 8 the Assistant Secretary for Mental Health and Substance 9 Use, may award grants to States, territories, political sub- 10 divisions of States and territories, Tribal governments, 11 and consortia of Tribal governments to establish an un- 12 armed 9–1–1 response program under which nonviolent 9– 13 1–1 calls are referred to unarmed professional service pro- 14 viders for response, instead of to a law enforcement agen- 15 cy. 16 ‘‘(b) PROGRAM REQUIREMENTS.—An unarmed 9–1– 17 1 response program funded under this section shall— 18 ‘‘(1) dispatch unarmed professional service pro- 19 viders in groups of two or more in a timely manner; 20 ‘‘(2) be capable of providing screening, assess- 21 ment, de-escalation, trauma-informed culturally and 22 linguistically appropriate services, referrals to treat- 23 ment providers, and transportation to immediately 24 necessary treatment; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01032 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1033 •S 4486 IS ‘‘(3) when necessary, coordinate with health or 1 social services; 2 ‘‘(4) not be subject to oversight of State or local 3 law enforcement agencies; and 4 ‘‘(5) clearly outline the scope of calls that must 5 or may be referred to the unarmed 9–1–1 response 6 program. 7 ‘‘(c) USES OF FUNDS.—A grant under this section 8 may be used for— 9 ‘‘(1) hiring unarmed professional service pro- 10 viders and 9–1–1 dispatchers; 11 ‘‘(2) training unarmed professional service pro- 12 viders to respond to 9–1–1 calls by identifying, un- 13 derstanding, and responding to signs of mental ill- 14 nesses, developmental or intellectual disabilities, and 15 substance use disorders, including by means of— 16 ‘‘(A) de-escalation; 17 ‘‘(B) crisis intervention; and 18 ‘‘(C) connecting individuals to local social 19 service providers, health care providers, commu- 20 nity-based organizations, and the full range of 21 other available providers and resources, with a 22 focus on culturally and linguistically appro- 23 priate service providers; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01033 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1034 •S 4486 IS ‘‘(3) updating 9–1–1 response systems to en- 1 able triage between nonviolent 9–1–1 calls and those 2 that require a response from law enforcement; 3 ‘‘(4) training 9–1–1 dispatchers on call diver- 4 sion; 5 ‘‘(5) building the capacity— 6 ‘‘(A) to coordinate with local social service 7 providers, health care providers, suicide hotline 8 operators, and community-based organizations; 9 and 10 ‘‘(B) to provide multilingual and culturally 11 and linguistically appropriate services; and 12 ‘‘(6) collecting data for reports to the Sec- 13 retary. 14 ‘‘(d) APPLICATION.—An applicant seeking a grant 15 under this section shall submit to the Secretary an appli- 16 cation at such time, in such manner, and containing such 17 information as the Secretary may reasonably require, in- 18 cluding the applicant’s plan to train 9–1–1 dispatchers to 19 determine when a call should be diverted to the unarmed 20 9–1–1 response program. 21 ‘‘(e) REPORTS TO SECRETARY.—A recipient of a 22 grant under this section shall submit to the Secretary, on 23 a biannual basis, a report on the following: 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01034 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1035 •S 4486 IS ‘‘(1) The number of calls placed to 9–1–1 that 1 were diverted to the grantee’s unarmed 9–1–1 re- 2 sponse program. 3 ‘‘(2) Demographic information on the individ- 4 uals served by the grantee’s unarmed 9–1–1 re- 5 sponse program, disaggregated by race, ethnicity, 6 age, sex, sexual orientation, gender identity, and lo- 7 cation. 8 ‘‘(3) The effects of the grantee’s unarmed 9–1– 9 1 response program on emergency room visits, hos- 10 pitalizations, use of ambulances, and involvement of 11 law enforcement in mental health or substance use 12 disorder crises. 13 ‘‘(4) An assessment of the types of events and 14 crises to which the grantee’s unarmed 9–1–1 re- 15 sponse program responded and the services provided, 16 including— 17 ‘‘(A) the number of individuals to whom 18 services were provided who were involuntarily 19 committed for treatment; 20 ‘‘(B) the number of individuals successfully 21 transferred to an alternative destination; 22 ‘‘(C) the time between notification by a 9– 23 1–1 dispatcher and arrival at the scene by a 24 provider; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01035 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1036 •S 4486 IS ‘‘(D) the time spent by providers at scene. 1 ‘‘(5) A cost analysis of the grantee’s unarmed 2 9–1–1 response program. 3 ‘‘(6) An assessment of data sharing limitations 4 or problems associated with adherence to— 5 ‘‘(A) Federal regulations (concerning the 6 privacy of individually identifiable health infor- 7 mation) promulgated under section 264(c) of 8 the Health Insurance Portability and Account- 9 ability Act of 1996; and 10 ‘‘(B) part 2 of title 42, Code of Federal 11 Regulations. 12 ‘‘(f) REPORTS TO CONGRESS.—The Secretary shall 13 submit to the Congress, on a biannual basis, a report on 14 the program under this section, including a summary of 15 the reports submitted by grantees pursuant to subsection 16 (e). 17 ‘‘(g) GRANT AMOUNT.—The Secretary may make 18 grants to applicants that do not meet all of the criteria 19 under subsection (b), but applicants that do not meet all 20 such criteria may not receive the full grant amount. 21 ‘‘(h) DEFINITIONS.—In this section: 22 ‘‘(1) The term ‘alternative destination’— 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01036 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1037 •S 4486 IS ‘‘(A) means any service- or care-providing 1 site other than a hospital emergency depart- 2 ment or jail; and 3 ‘‘(B) includes a clinic, primary care office, 4 crisis center, and community care center. 5 ‘‘(2) The term ‘nonviolent 9–1–1 call’ means a 6 9–1–1 call that— 7 ‘‘(A) relates to mental health, homeless- 8 ness, addiction problems, social services, tru- 9 ancy, intellectual and developmental disabilities, 10 or public intoxication; and 11 ‘‘(B) does not involve obvious violent be- 12 havior. 13 ‘‘(3) The term ‘unarmed professional service 14 provider’ means a professional (which may include a 15 nurse, social worker, emergency medical technician, 16 counselor, community health worker, trauma-in- 17 formed personnel, social service provider, or peer 18 support specialist) who— 19 ‘‘(A) is trained to deal with mental health 20 or substance abuse crises or intellectual and de- 21 velopmental disabilities; and 22 ‘‘(B) does not carry a firearm.’’. 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01037 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1038 •S 4486 IS Subtitle B—Interprofessional Care 1 SEC. 6021. HEALTH PROFESSIONS COMPETENCIES TO AD- 2 DRESS RACIAL AND ETHNIC MENTAL HEALTH 3 INEQUITIES. 4 (a) IN GENERAL.—The Secretary of Health and 5 Human Services, acting through the Assistant Secretary 6 for Mental Health and Substance Use, shall award grants 7 to qualified national organizations for the purposes of— 8 (1) developing, and disseminating to health pro- 9 fessional educational programs, culturally and lin- 10 guistically appropriate curricula or core com- 11 petencies addressing mental health inequities among 12 racial and ethnic minority groups for use in the 13 training of students in the professions of social 14 work, psychology, psychiatry, marriage and family 15 therapy, mental health counseling, peer support, and 16 substance abuse counseling; and 17 (2) certifying community health workers and 18 peer wellness specialists with respect to such cur- 19 ricula and core competencies and integrating and ex- 20 panding the use of such workers and specialists into 21 health care and community-based settings to address 22 mental health inequities among racial and ethnic mi- 23 nority groups. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01038 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1039 •S 4486 IS (b) CURRICULA; CORE COMPETENCIES.—Organiza- 1 tions receiving funds under subsection (a) may use the 2 funds to engage in the following activities related to the 3 development and dissemination of curricula or core com- 4 petencies described in subsection (a)(1): 5 (1) Formation of committees or working groups 6 composed of experts from accredited health profes- 7 sions schools to identify core competencies relating 8 to mental health inequities among racial and ethnic 9 minority groups. 10 (2) Planning of workshops in collaboration with 11 community-based organizations and communities of 12 color in national fora to directly facilitate public 13 input, including input from communities of color 14 with lived experience, into the educational needs as- 15 sociated with mental health inequities among racial 16 and ethnic minority groups. 17 (3) Dissemination and promotion of the use of 18 curricula or core competencies in undergraduate and 19 graduate health professions training programs na- 20 tionwide. 21 (4) Establishing external stakeholder advisory 22 boards to provide meaningful input into policy and 23 program development and best practices to reduce 24 mental health inequities among racial and ethnic 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01039 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1040 •S 4486 IS groups, including participation and leadership from 1 communities of color with lived experience of the im- 2 pacts of mental health inequities. 3 (c) DEFINITIONS.—In this section: 4 (1) QUALIFIED NATIONAL ORGANIZATION.—The 5 term ‘‘qualified national organization’’ means a na- 6 tional organization that focuses on the education of 7 students in programs of social work, occupational 8 therapy, psychology, psychiatry, substance use coun- 9 seling, and marriage and family therapy. 10 (2) RACIAL AND ETHNIC MINORITY GROUP.— 11 The term ‘‘racial and ethnic minority group’’ has the 12 meaning given to such term in section 1707(g) of 13 the Public Health Service Act (42 U.S.C. 300u– 14 6(g)), as amended by title I of this Act. 15 (d) AUTHORIZATION OF APPROPRIATIONS.—There 16 are authorized to be appropriated to carry out this section 17 such sums as may be necessary for each of fiscal years 18 2023 through 2027. 19 SEC. 6022. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 20 BEHAVIORAL HEALTH CARE. 21 Part D of title V of the Public Health Service Act 22 (42 U.S.C. 290dd et seq.) is amended by adding at the 23 end the following: 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01040 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1041 •S 4486 IS ‘‘SEC. 553. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 1 PROVISION OF BEHAVIORAL HEALTH CARE 2 IN PRIMARY CARE SETTINGS. 3 ‘‘(a) GRANTS.—The Secretary, acting through the 4 Assistant Secretary, shall award grants to eligible entities 5 for the purpose of establishing interprofessional health 6 care teams that provide behavioral health care. 7 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 8 a grant under this section, an entity shall be a Federally 9 qualified health center (as defined in section 1861(aa) of 10 the Social Security Act), rural health clinic, women’s 11 health clinic, or behavioral health program (including any 12 such program operated by a community-based organiza- 13 tion) serving a high proportion of individuals from racial 14 and ethnic minority groups (as defined in section 15 1707(g)). 16 ‘‘(c) LOAN FORGIVENESS.—To encourage qualified 17 and diverse allied health professionals to enter the mental 18 health field, an eligible entity receiving a grant under this 19 section shall agree to use not less than $10,000 of the 20 grant funds on a loan forgiveness program for practi- 21 tioners who commit to working in the mental health field 22 for a period of 2 years. 23 ‘‘(d) SCIENTIFICALLY AND CULTURALLY BASED.— 24 Integrated health care funded through this section shall 25 be scientifically and culturally based, taking into consider- 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01041 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1042 •S 4486 IS ation the results of the most recent peer-reviewed research 1 available, including information on language accessibility, 2 cultural humility, diversity of practitioners, and consider- 3 ation of social determinants of health. 4 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—To 5 carry out this section, there is authorized to be appro- 6 priated $20,000,000 for each of fiscal years 2023 through 7 2027.’’. 8 SEC. 6023. INTEGRATED HEALTH CARE DEMONSTRATION 9 PROGRAM. 10 Part D of title V of the Public Health Service Act 11 (42 U.S.C. 290dd et seq.), as amended by sections 6022 12 and 6052, is further amended by adding at the end the 13 following: 14 ‘‘SEC. 555. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 15 PROVISION OF BEHAVIORAL HEALTH CARE 16 IN PRIMARY CARE SETTINGS. 17 ‘‘(a) GRANTS.—The Secretary shall award grants to 18 eligible entities for the purpose of establishing interprofes- 19 sional health care teams that provide behavioral health 20 care. 21 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 22 a grant under this section, an entity shall be a Federally 23 qualified health center (as defined in section 1861(aa) of 24 the Social Security Act), rural health clinic, or behavioral 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01042 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1043 •S 4486 IS health program, serving a high proportion of individuals 1 from racial and ethnic minority groups (as defined in sec- 2 tion 1707(g)). 3 ‘‘(c) SCIENTIFICALLY BASED.—Integrated health 4 care funded through this section shall be scientifically 5 based, taking into consideration the results of the most 6 recent peer-reviewed research available. 7 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—To 8 carry out this section, there is authorized to be appro- 9 priated $20,000,000 for each of the first 5 fiscal years 10 following the date of enactment of the Health Equity and 11 Accountability Act.’’. 12 Subtitle C—Workforce 13 Development 14 SEC. 6031. BUILDING AN EFFECTIVE WORKFORCE IN MEN- 15 TAL HEALTH. 16 (a) IN GENERAL.—The Secretary of Health and 17 Human Services, in coordination with the Assistant Sec- 18 retary for Mental Health and Substance Use, the Adminis- 19 trator of the Health Resources and Services Administra- 20 tion, the Secretary of Labor, and advocacy and behavioral 21 and mental health organizations serving vulnerable popu- 22 lations, including youth and young adults, people with low 23 incomes, and people of color, shall— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01043 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1044 •S 4486 IS (1) develop, strengthen, and implement strate- 1 gies to bolster career pathways for diverse mental 2 health professionals; 3 (2) identify the breadth of settings where men- 4 tal health care and behavioral health care can take 5 place; and 6 (3) identify current mental health professional 7 workforce shortages, inclusive of shortages of diverse 8 mental health professionals. 9 (b) CONTENTS.—Strategies under subsection (a) 10 shall include— 11 (1) the variety of settings where mental health 12 professionals are needed, including community-based 13 organizations, women’s centers, shelters, organiza- 14 tions focused on youth development, workforce agen- 15 cies, job placement and development centers, emer- 16 gency rooms, the special supplemental nutrition pro- 17 gram for women, infants, and children under section 18 17 of the Child Nutrition Act of 1966 (42 U.S.C. 19 1786), food banks, legal aid, and benefit issuers as 20 defined in section 3 of the Food and Nutrition Act 21 of 2008 (7 U.S.C. 2012); 22 (2) defining career pathways in mental and be- 23 havioral health, to help diverse communities under- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01044 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1045 •S 4486 IS stand the variety of careers in mental and behavioral 1 health that are available; 2 (3) building career pathways in mental and be- 3 havioral health as part of the curriculum at the 4 postsecondary education level; 5 (4) providing accessible training and certifi- 6 cation pathways for diverse lay health workers such 7 as community health workers and other peer support 8 specialists to ensure that careers pay a living wage; 9 (5) creating incentives for students in the fields 10 of occupational therapy, social work, psychology, 11 medicine, and nursing to learn more about mental 12 health, and to include a mental health rotation, with 13 a particular focus in racially and ethnically diverse 14 communities, as a part of the health professional 15 curricula; 16 (6) including training and education for teach- 17 ers about the basics of section 504 of the Rehabilita- 18 tion Act of 1973 (29 U.S.C. 794) and individualized 19 education programs (as defined in section 614(d) of 20 the Individuals with Disabilities Education Act (20 21 U.S.C. 1414(d))); 22 (7) researching, developing, and implementing 23 programs for mental and behavioral health profes- 24 sionals to prevent burnout; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01045 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1046 •S 4486 IS (8) finding better and increased avenues to en- 1 sure equity by providing better loan forgiveness pro- 2 grams, including a focus area within the National 3 Health Service Corps focused on community trauma. 4 (c) USE OF FUNDS.—Programs and activities funded 5 under this section shall be consistent with subsection 6 (a)(1) and shall include the following: 7 (1) Subgrants to entities serving youth and 8 young adults which demonstrate a need for an in- 9 creased mental health workforce, using strategies 10 mentioned in subsection (a)(1). 11 (2) Funding towards the Health Resources and 12 Services Administration’s Behavioral Health Work- 13 force Education and Training Program. 14 (3) Funding towards the development and im- 15 plementation of a National Health Service Corps 16 program focused on community trauma. 17 (d) AUTHORIZATION OF APPROPRIATIONS.—There 18 are authorized to be appropriated to carry out this section, 19 $50,000,000 for each of fiscal years 2023 through 2033. 20 SEC. 6032. PILOT PROGRAM TO INCREASE LANGUAGE AC- 21 CESS AT FEDERALLY QUALIFIED HEALTH 22 CENTERS. 23 (a) LOAN REPAYMENTS TO QUALIFIED HEALTH 24 CARE PROFESSIONALS.— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01046 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1047 •S 4486 IS (1) IN GENERAL.—For the purpose of increas- 1 ing language access to mental health services, the 2 Secretary shall carry out a demonstration project 3 under which— 4 (A) the Secretary matches qualified mental 5 health professionals with Federally qualified 6 health centers; 7 (B) the qualified mental health profes- 8 sionals each agree to a period of obligated serv- 9 ice at a Federally qualified health center with 10 which they are so matched; and 11 (C) the Secretary agrees to make loan re- 12 payments under section 338B of the Public 13 Health Service Act (42 U.S.C. 254l–1) on be- 14 half of such qualified mental health profes- 15 sionals. 16 (2) PREFERENCE.—In matching qualified men- 17 tal health professionals with Federally qualified 18 health centers under paragraph (1), the Secretary 19 shall give preference to placement at Federally quali- 20 fied health centers at which at least 20 percent of 21 the patients are best served in a language other than 22 English, as indicated by data in the Uniform Data 23 System (or any successor database). 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01047 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1048 •S 4486 IS (3) ENHANCED COMPENSATION.—For each 1 year of obligated service that a qualified mental 2 health professional contracts to serve under para- 3 graph (1) at a Federally qualified health center at 4 which at least 20 percent of the patients are best 5 served in a language other than English, as indi- 6 cated by data in the Uniform Data System (or any 7 successor database), the Secretary may pay the 8 higher of— 9 (A) $10,000 above the maximum amount 10 otherwise applicable under section 11 338B(g)(2)(A) of the Public Health Service Act 12 (42 U.S.C. 254l–1(g)(2)(A)); or 13 (B) if the qualified health professional is 14 fluent in a language other than English that is 15 needed by such Federally qualified health cen- 16 ter, $15,000 above such maximum amount. 17 (4) ACHIEVING FLUENCY.—A qualified mental 18 health professional eligible to receive the enhanced 19 pay amount specified in paragraph (3)(A) at the be- 20 ginning of the professional’s period of obligated serv- 21 ice may transition to being eligible to receive the en- 22 hanced higher pay amount specified in paragraph 23 (3)(B) if the professional is determined by the Fed- 24 erally qualified health center at which the profes- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01048 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1049 •S 4486 IS sional serves to have achieved fluency in a language 1 other than English needed by that health center. 2 (b) GRANTS TO HEALTH CENTERS.— 3 (1) IN GENERAL.—The Secretary shall carry 4 out a demonstration program consisting of awarding 5 grants under section 330 of the Public Health Serv- 6 ice Act (42 U.S.C. 254b) to Federally qualified 7 health centers to recruit, hire, employ, and supervise 8 qualified mental health professionals who are fluent 9 in a language other than English to provide mental 10 health services in such other language. 11 (2) PREFERENCE.—In selecting grant recipi- 12 ents under paragraph (1), the Secretary shall give 13 preference to Federally qualified health centers at 14 which at least 20 percent of the patients are best 15 served in a language other than English, as indi- 16 cated by data in the Uniform Data System (or any 17 successor database). 18 (3) MARKETING.—A Federally qualified health 19 center receiving a grant under this subsection shall 20 use a portion of the grant funds to disseminate in- 21 formation about, and otherwise market, the mental 22 health services supported through the grant. 23 (c) REPORTS.— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01049 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1050 •S 4486 IS (1) INITIAL REPORT.—Not later than 6 months 1 after awarding loan repayment agreements under 2 subsection (a) and grants under subsection (b), the 3 Secretary shall submit to the Committees on Appro- 4 priations of the House of Representatives and the 5 Senate, and to other appropriate congressional com- 6 mittees, a report on the implementation of the pro- 7 grams under this section. Such report shall in- 8 clude— 9 (A) the languages spoken by the qualified 10 mental health professionals receiving loan re- 11 payments pursuant to subsection (a) or re- 12 cruited pursuant to a grant under subsection 13 (b); 14 (B) the Federally qualified health centers 15 at which such professionals were placed; 16 (C) how many Federally qualified health 17 centers received funding through the grant pro- 18 gram under subsection (b); 19 (D) an analysis, conducted in consultation 20 with the Federally qualified health centers re- 21 ceiving grants under section (b), of the effec- 22 tiveness of such grants at increasing language 23 access to mental health services; and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01050 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1051 •S 4486 IS (E) best practices, developed in consulta- 1 tion with Federally qualified health centers re- 2 ceiving grants under section (b), for the recruit- 3 ment and retention of mental health profes- 4 sionals at Federally qualified health centers. 5 (2) FINAL REPORT.—Not later than the end of 6 fiscal year 2027, the Secretary shall submit to the 7 Committees on Appropriations of the House of Rep- 8 resentatives and the Senate, and to other appro- 9 priate congressional committees, a final report on 10 the implementation of the programs under this sec- 11 tion, including the information, analysis, and best 12 practices listed in subparagraphs (A) through (E) of 13 paragraph (1). 14 (d) DEFINITIONS.—In this section: 15 (1) The term ‘‘Federally qualified health cen- 16 ter’’ has the meaning given the term in section 17 1861(aa) of the Social Security Act (42 U.S.C. 18 1395x(aa)). 19 (2) The term ‘‘qualified mental health profes- 20 sional’’ means— 21 (A) physicians, allopathic physicians, osteo- 22 pathic physicians, nurse practitioners, and phy- 23 sician assistants with a specialty in mental 24 health and psychiatry; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01051 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1052 •S 4486 IS (B) health service psychologists; 1 (C) licensed clinical social workers; 2 (D) psychiatric nurse specialists; 3 (E) marriage and family therapists; 4 (F) licensed professional counselors; 5 (G) substance use disorder counselors; 6 (H) occupational therapists; and 7 (I) other individuals who— 8 (i) have not yet been licensed or cer- 9 tified to serve as a professional listed in 10 any of subparagraphs (A) through (H); 11 and 12 (ii) will serve at the Federally quali- 13 fied health center under the supervision of 14 a licensed individual or certified profes- 15 sional so listed. 16 (3) The term ‘‘Secretary’’ means the Secretary 17 of Health and Human Services. 18 (e) AUTHORIZATION OF APPROPRIATIONS.— 19 (1) IN GENERAL.—To carry out this section, 20 there is authorized to be appropriated $75,000,000 21 for each of fiscal years 2023 through 2027. 22 (2) SUPPLEMENT, NOT SUPPLANT.—Amounts 23 made available to carry out this section shall be in 24 addition to amounts otherwise available to provide 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01052 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1053 •S 4486 IS mental health services at Federally qualified health 1 centers pursuant to sections 338B and 330 of the 2 Public Health Service Act (42 U.S.C. 254l–1, 254b). 3 SEC. 6033. HEALTH PROFESSIONS COMPETENCIES TO AD- 4 DRESS RACIAL AND ETHNIC MINORITY MEN- 5 TAL HEALTH DISPARITIES. 6 (a) IN GENERAL.—The Secretary of Health and 7 Human Services may award grants to qualified national 8 organizations for the purposes of— 9 (1) developing, and disseminating to health pro- 10 fessional educational programs, best practices or 11 core competencies addressing mental health dispari- 12 ties among racial and ethnic minority groups for use 13 in the training of students in the professions of so- 14 cial work, psychology, psychiatry, marriage and fam- 15 ily therapy, mental health counseling, and substance 16 abuse counseling; and 17 (2) certifying community health workers and 18 peer wellness specialists with respect to such best 19 practices and core competencies and integrating and 20 expanding the use of such workers and specialists 21 into health care to address mental health disparities 22 among racial and ethnic minority groups. 23 (b) BEST PRACTICES; CORE COMPETENCIES.—Orga- 24 nizations receiving funds under subsection (a) may use the 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01053 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1054 •S 4486 IS funds to engage in the following activities related to the 1 development and dissemination of best practices or core 2 competencies described in subsection (a)(1): 3 (1) Formation of committees or working groups 4 composed of experts from accredited health profes- 5 sions schools to identify best practices and core com- 6 petencies relating to mental health disparities among 7 racial and ethnic minority groups. 8 (2) Planning of workshops at the national level 9 to allow for public input into the educational needs 10 associated with mental health disparities among ra- 11 cial and ethnic minority groups. 12 (3) Dissemination and promotion of the use of 13 best practices or core competencies for culturally 14 and linguistically appropriate mental health services 15 in undergraduate and graduate health professions 16 training programs nationwide. 17 (4) Establishing external stakeholder advisory 18 boards to provide meaningful input into policy and 19 program development and best practices to reduce 20 mental health disparities among racial and ethnic 21 minority groups. 22 (c) DEFINITIONS.—In this section: 23 (1) QUALIFIED NATIONAL ORGANIZATION.—The 24 term ‘‘qualified national organization’’ means a na- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01054 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1055 •S 4486 IS tional organization that focuses on the education of 1 students in one or more of the professions of social 2 work, psychology, psychiatry, marriage and family 3 therapy, mental health counseling, and substance 4 misuse counseling. 5 (2) RACIAL AND ETHNIC MINORITY GROUP.— 6 The term ‘‘racial and ethnic minority group’’ has the 7 meaning given to such term in section 1707(g) of 8 the Public Health Service Act (42 U.S.C. 300u– 9 6(g)). 10 Subtitle D—Children’s Mental 11 Health 12 SEC. 6041. PEDIATRIC BEHAVIORAL HEALTH CARE. 13 Subpart V of part D of title III of the Public Health 14 Service Act (42 U.S.C. 256 et seq.) is amended by adding 15 at the end the following: 16 ‘‘SEC. 340A–1. GRANTS TO SUPPORT PEDIATRIC BEHAV- 17 IORAL HEALTH CARE INTEGRATION AND CO- 18 ORDINATION. 19 ‘‘(a) IN GENERAL.—The Secretary, acting through 20 the Administrator of the Health Resources and Services 21 Administration, shall award grants to eligible entities for 22 the purpose of supporting pediatric behavioral health care 23 integration and coordination within communities to meet 24 local community needs. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01055 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1056 •S 4486 IS ‘‘(b) ELIGIBLE ENTITIES.—Entities eligible for 1 grants under subsection (a) include— 2 ‘‘(1) pediatricians; 3 ‘‘(2) children’s hospitals; 4 ‘‘(3) pediatric behavioral health providers with 5 the capacity to organize and implement activities 6 working with community organizations and pro- 7 viders; and 8 ‘‘(4) other entities as determined appropriate by 9 the Secretary. 10 ‘‘(c) PRIORITIZATION.—In awarding grants under 11 subsection (a), the Secretary shall prioritize applicants 12 that demonstrate the highest needs at the local level along 13 the care continuum for strengthening children’s behavioral 14 health crisis care and access. 15 ‘‘(d) USE OF FUNDS.—Activities that may be funded 16 through a grant under subsection (a) include— 17 ‘‘(1) the recruitment and retention of commu- 18 nity health workers or navigators to coordinate fam- 19 ily access to pediatric mental, emotional, and behav- 20 ioral health services; 21 ‘‘(2) training the pediatric mental, emotional, 22 and behavioral health care workforce, relevant stake- 23 holders, and community members; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01056 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1057 •S 4486 IS ‘‘(3) expanding evidence-based, integrated mod- 1 els of care for pediatric mental, emotional, and be- 2 havioral health services; 3 ‘‘(4) pediatric practice integration for the provi- 4 sion of pediatric mental, emotional, and behavioral 5 health services; 6 ‘‘(5) addressing surge capacity for pediatric 7 mental, emotional, and behavioral health needs; 8 ‘‘(6) providing pediatric mental, emotional, and 9 behavioral health services to children as delivered by 10 behavioral, emotional, and mental health profes- 11 sionals utilizing telehealth services; 12 ‘‘(7) establishing or maintaining initiatives to 13 decompress emergency departments, including par- 14 tial hospitalization, step down residency programs, 15 and intensive outpatient programs; 16 ‘‘(8) supporting, enhancing, or expanding pedi- 17 atric mental, emotional, and behavioral health pre- 18 ventive and crisis intervention services; 19 ‘‘(9) establishing or maintaining pediatric men- 20 tal, emotional, and behavioral health urgent care; 21 ‘‘(10) establishing or maintaining community- 22 based initiatives, such as school-based partnerships; 23 and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01057 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1058 •S 4486 IS ‘‘(11) addressing other access and coordination 1 gaps to mental, emotional, and behavioral health 2 services in the community for children. 3 ‘‘(e) FUNDING.—To carry out this section, there is 4 hereby appropriated, out of amounts in the Treasury not 5 otherwise obligated, $500,000,000 for each of fiscal years 6 2023 through 2027. 7 ‘‘SEC. 340A–2. PEDIATRIC BEHAVIORAL HEALTH WORK- 8 FORCE TRAINING PROGRAM. 9 ‘‘(a) IN GENERAL.—The Secretary, acting through 10 the Administrator of the Health Resources and Services 11 Administration, shall award grants to eligible entities for 12 the purpose of supporting evidence-based pediatric behav- 13 ioral health workforce training. 14 ‘‘(b) ELIGIBLE ENTITIES.—Entities eligible for 15 grants under subsection (a) include— 16 ‘‘(1) children’s hospitals; and 17 ‘‘(2) other pediatric health care providers as de- 18 termined appropriate by the Secretary. 19 ‘‘(c) USE OF FUNDS.—The training that may be sup- 20 ported through a grant under subsection (a) includes ex- 21 panded training in pediatric behavioral health for physi- 22 cians and nonphysician practitioners, including the fol- 23 lowing practitioner types: 24 ‘‘(1) Child and adolescent psychiatrists. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01058 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1059 •S 4486 IS ‘‘(2) Psychiatric nurses. 1 ‘‘(3) Psychologists. 2 ‘‘(4) Advanced practice nurses. 3 ‘‘(5) Family therapists. 4 ‘‘(6) Social workers. 5 ‘‘(7) Mental health counselors. 6 ‘‘(8) Other practitioner types as determined ap- 7 propriate by the Secretary. 8 ‘‘(d) FUNDING.—To carry out this section, there is 9 hereby appropriated, out of amounts in the Treasury not 10 otherwise obligated, $100,000,000 for each of fiscal years 11 2023 through 2027.’’. 12 SEC. 6042. MENTAL HEALTH IN SCHOOLS. 13 (a) PURPOSE.— It is the purpose of this section to— 14 (1) revise, increase funding for, and expand the 15 scope of the Project AWARE State Educational 16 Agency Grant Program carried out by the Secretary 17 of Health and Human Services, in order to provide 18 access to more comprehensive school-based mental 19 health services and supports; 20 (2) provide for comprehensive staff development 21 for school and community service personnel working 22 in the school; 23 (3) provide for comprehensive training to im- 24 prove health and academic outcomes for children 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01059 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1060 •S 4486 IS with, or who have a high likelihood of developing, 1 mental health conditions, for parents or guardians, 2 siblings, and other family members of such children, 3 and for concerned members of the community; 4 (4) provide for comprehensive, universal, evi- 5 dence-based screening to identify children and ado- 6 lescents with potential mental health conditions or 7 unmet emotional health needs; 8 (5) recognize best practices for the delivery of 9 mental health care in school-based settings, includ- 10 ing school-based health centers; 11 (6) provide for comprehensive training for par- 12 ents or guardians, siblings, other family members, 13 and concerned members of the community on behalf 14 of children and adolescents experiencing mental 15 health trauma, disorders, co-occurring conditions, or 16 disabilities; and 17 (7) establish formal working relationships 18 among health, human service, and educational enti- 19 ties that support the mental and emotional health of 20 children and adolescents in the school setting or that 21 have a child or youth focus. 22 (b) TECHNICAL AMENDMENTS.—The second part G 23 (relating to services provided through religious organiza- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01060 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1061 •S 4486 IS tions) of title V of the Public Health Service Act (42 1 U.S.C. 290kk et seq.) is amended— 2 (1) by redesignating such part as part J; and 3 (2) by redesignating sections 581 through 584 4 as sections 596 through 596C, respectively. 5 (c) SCHOOL-BASED MENTAL HEALTH AND CHIL- 6 DREN AND VIOLENCE.—Section 581 of the Public Health 7 Service Act (42 U.S.C. 290hh) (relating to children and 8 violence) is amended to read as follows: 9 ‘‘SEC. 581. SCHOOL-BASED MENTAL HEALTH; CHILDREN 10 AND ADOLESCENTS. 11 ‘‘(a) IN GENERAL.—The Secretary, in consultation 12 with the Secretary of Education, shall, through grants, 13 contracts, or cooperative agreements awarded to eligible 14 entities described in subsection (b), provide comprehensive 15 school-based mental health services and supports to assist 16 children in local communities and schools (including 17 schools funded by the Bureau of Indian Education) deal- 18 ing with traumatic experiences, grief, bereavement, risk of 19 suicide, and the risk of experiencing community or inter- 20 personal violence, such as abuse or neglect. All services 21 and supports provided under such a grant, contract, or 22 cooperative agreement shall— 23 ‘‘(1) be developmentally, linguistically, and cul- 24 turally appropriate; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01061 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1062 •S 4486 IS ‘‘(2) be trauma-informed; and 1 ‘‘(3) incorporate positive behavioral interven- 2 tions and supports. 3 ‘‘(b) ACTIVITIES.—Grants, contracts, or cooperative 4 agreements awarded under subsection (a), shall, as appro- 5 priate, be used for— 6 ‘‘(1) implementation of school and community- 7 based mental health programs that— 8 ‘‘(A) build awareness of individual trauma 9 and the intergenerational continuum of impacts 10 of trauma on populations; 11 ‘‘(B) train appropriate staff to identify, 12 and screen for, signs of trauma exposure, men- 13 tal health and co-occurring conditions, or risk 14 of suicide; and 15 ‘‘(C) incorporate positive behavioral inter- 16 ventions, family engagement, student treatment, 17 and multigenerational supports to foster the 18 health and development of children, prevent 19 mental health disorders, and ameliorate the im- 20 pact of trauma; 21 ‘‘(2) technical assistance to local communities 22 with respect to the development of programs de- 23 scribed in paragraph (1); 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01062 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1063 •S 4486 IS ‘‘(3) facilitating diverse community partnerships 1 among families, students, educational agencies, men- 2 tal health and substance use disorder service sys- 3 tems, family-based mental health service systems, 4 child welfare agencies, health care providers (includ- 5 ing primary care physicians, mental health profes- 6 sionals, and other professionals who specialize in 7 children’s mental health such as child and adolescent 8 psychiatrists), institutions of higher education, faith- 9 based programs, trauma networks, and other com- 10 munity-based systems to address child and adoles- 11 cent trauma, as well as unmet mental health needs; 12 and 13 ‘‘(4) establishing and promoting best practices 14 that are either evidence based or culturally based for 15 children and adolescents to share their experiences 16 of individual and community trauma, including their 17 exposure to community and domestic violence, with 18 trusted adults. 19 ‘‘(c) REQUIREMENTS.— 20 ‘‘(1) IN GENERAL.—To be eligible for a grant, 21 contract, or cooperative agreement under subsection 22 (a), an entity shall be a partnership that includes— 23 ‘‘(A) a State educational agency, as de- 24 fined in section 8101 of the Elementary and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01063 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1064 •S 4486 IS Secondary Education Act of 1965, in coordina- 1 tion with one or more local educational agen- 2 cies, as defined in section 8101 of the Elemen- 3 tary and Secondary Education Act of 1965, or 4 a consortium of any entities described in sub- 5 paragraph (B), (C), (D), or (E) of section 6 8101(30) of such Act; and 7 ‘‘(B) at least 1 community-based mental 8 health provider, including a public or private 9 mental health entity, health care entity, family- 10 based mental health entity, trauma network, or 11 other community-based entity, as determined by 12 the Secretary (and which may include addi- 13 tional entities such as a human services agency, 14 child welfare agency, an institution of higher 15 education, or another entity, as determined by 16 the Secretary). 17 ‘‘(2) COMPLIANCE WITH HIPAA.—Any patient 18 records developed by covered entities through activi- 19 ties under the grant shall meet the regulations pro- 20 mulgated under section 264(c) of the Health Insur- 21 ance Portability and Accountability Act of 1996. 22 ‘‘(3) COMPLIANCE WITH FERPA.—Section 444 23 of the General Education Provisions Act (commonly 24 known as the ‘Family Educational Rights and Pri- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01064 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1065 •S 4486 IS vacy Act of 1974’) shall apply to any entity that is 1 a member of the partnership in the same manner 2 that such section applies to an educational agency or 3 institution (as that term is defined in such section). 4 ‘‘(d) GEOGRAPHICAL DISTRIBUTION.—The Secretary 5 shall ensure that grants, contracts, or cooperative agree- 6 ments under subsection (a) will be distributed equitably 7 among the regions of the country and among urban and 8 rural areas. 9 ‘‘(e) DURATION OF AWARDS.—With respect to a 10 grant, contract, or cooperative agreement under sub- 11 section (a), the period during which payments under such 12 an award will be made to the recipient shall be 5 years, 13 with options for renewal. 14 ‘‘(f) EVALUATION AND MEASURES OF OUTCOMES.— 15 ‘‘(1) DEVELOPMENT OF PROCESS.—The Assist- 16 ant Secretary shall develop a fiscally appropriate 17 process for evaluating activities carried out under 18 this section. Such process shall include— 19 ‘‘(A) the development of guidelines for the 20 submission of program data by grant, contract, 21 or cooperative agreement recipients; 22 ‘‘(B) the development of measures of out- 23 comes (in accordance with paragraph (2)) to be 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01065 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1066 •S 4486 IS applied by such recipients in evaluating pro- 1 grams carried out under this section; and 2 ‘‘(C) the submission of annual reports by 3 such recipients concerning the effectiveness of 4 programs carried out under this section. 5 ‘‘(2) MEASURES OF OUTCOMES.—The Assistant 6 Secretary shall develop measures of outcomes to be 7 applied by recipients of assistance under this section 8 to evaluate the effectiveness of programs carried out 9 under this section, including outcomes related to the 10 student, family, and local educational systems sup- 11 ported by this section. 12 ‘‘(3) SUBMISSION OF ANNUAL DATA.—An eligi- 13 ble entity described in subsection (c) that receives a 14 grant, contract, or cooperative agreement under this 15 section shall annually submit to the Assistant Sec- 16 retary a report that includes data to evaluate the 17 success of the program carried out by the entity 18 based on whether such program is achieving the pur- 19 poses of the program. Such reports shall utilize the 20 measures of outcomes under paragraph (2) in a rea- 21 sonable manner to demonstrate the progress of the 22 program in achieving such purposes. 23 ‘‘(4) EVALUATION BY ASSISTANT SECRETARY.— 24 Based on the data submitted under paragraph (3), 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01066 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1067 •S 4486 IS the Assistant Secretary shall annually submit to 1 Congress a report concerning the results and effec- 2 tiveness of the programs carried out with assistance 3 received under this section. 4 ‘‘(5) LIMITATION.—An eligible entity shall use 5 not more than 20 percent of amounts received under 6 a grant under this section to carry out evaluation 7 activities under this subsection. 8 ‘‘(g) INFORMATION AND EDUCATION.—The Sec- 9 retary shall disseminate best practices based on findings 10 made pursuant to this section. 11 ‘‘(h) AMOUNT OF GRANTS AND AUTHORIZATION OF 12 APPROPRIATIONS.— 13 ‘‘(1) AMOUNT OF GRANTS.—A grant under this 14 section shall be in an amount that is not more than 15 $2,000,000 for each of the first 5 fiscal years fol- 16 lowing the date of enactment of this section. The 17 Secretary shall determine the amount of each such 18 grant based on the population of children up to age 19 21 of the area to be served under the grant. 20 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 21 There is authorized to be appropriated to carry out 22 this section, $130,000,000 for each of fiscal years 23 2023 through 2026.’’. 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01067 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1068 •S 4486 IS (d) CONFORMING AMENDMENT.—Part G of title V 1 of the Public Health Service Act (42 U.S.C. 290hh et 2 seq.), as amended by this section, is further amended, in 3 the part heading by striking ‘‘PROJECTS FOR CHIL- 4 DREN AND VIOLENCE’’ and inserting the following: 5 ‘‘SCHOOL-BASED MENTAL HEALTH’’. 6 (e) SCHOOL-BASED MENTAL HEALTH SERVICES.— 7 (1) IN GENERAL.—The Secretary of Education 8 shall award grants to State educational agencies to 9 support services provided by school-based mental 10 health services providers at schools receiving funds 11 under part A of title I of the Elementary and Sec- 12 ondary Education Act of 1965 (20 U.S.C. 6311 et 13 seq.). 14 (2) USE OF FUNDS.—Grants under this sub- 15 section shall be used to help meet the recommended 16 ratios of— 17 (A) 250 students per school counselor; 18 (B) 500 students per school psychologist; 19 and 20 (C) 250 students per school social worker. 21 (3) CONDITION.—The Secretary shall ensure 22 that funds made available under this subsection are 23 used to provide services that are developmentally, 24 linguistically, and culturally appropriate, are trau- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01068 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1069 •S 4486 IS ma-informed, and incorporate positive behavioral 1 interventions and supports. 2 (4) DEFINITIONS.—For purposes of this sub- 3 section: 4 (A) The term ‘‘school-based mental health 5 services provider’’ has the meaning given such 6 term in section 4102 of the Elementary and 7 Secondary Education Act of 1965 (20 U.S.C. 8 7112). 9 (B) The term ‘‘State educational agency’’ 10 has the meaning given such term in section 11 8101 of the Elementary and Secondary Edu- 12 cation Act of 1965 (20 U.S.C. 7801). 13 SEC. 6043. ADDITIONAL SUPPORT FOR YOUTH AND YOUNG 14 ADULT MENTAL HEALTH SERVICE PROVI- 15 SION. 16 Section 1903 of the Social Security Act (42 U.S.C. 17 1396b) is amended by adding at the end the following new 18 subsection: 19 ‘‘(cc) YOUTH AND YOUNG ADULT INTERVENTION 20 SERVICES.— 21 ‘‘(1) IN GENERAL.—Notwithstanding section 22 1902(a)(1) (relating to Statewideness), section 23 1902(a)(10)(B) (relating to comparability), section 24 1902(a)(23)(A) (relating to freedom of choice of 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01069 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1070 •S 4486 IS providers), or section 1902(a)(27) (relating to pro- 1 vider agreements), a State may, during the 5-year 2 period beginning on the first day of the fiscal year 3 quarter that begins on or after January 1, 2024, 4 provide medical assistance for qualifying youth and 5 young adult mental health and substance use inter- 6 vention services (as defined in paragraph (2)(C)) 7 under a State plan amendment or waiver approved 8 under section 1115 or 1915(c). 9 ‘‘(2) DEFINITIONS.—For the purposes of this 10 subsection: 11 ‘‘(A) PRIORITY SERVICE.—The term ‘pri- 12 ority service’ means any of the following if vol- 13 untarily received and provided in a manner that 14 maintains the privacy and confidentiality of pa- 15 tient information consistent with Federal and 16 State requirements: 17 ‘‘(i) Community-based mobile crisis 18 intervention services, as defined in section 19 1947. 20 ‘‘(ii) Telehealth. 21 ‘‘(iii) Youth peer support. 22 ‘‘(iv) Screening for adverse childhood 23 experiences. 24 ‘‘(v) Trauma responsive care. 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01070 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1071 •S 4486 IS ‘‘(vi) Other priority services for youth, 1 as defined by the Secretary. 2 ‘‘(B) QUALIFIED MENTAL HEALTH PRO- 3 VIDERS.—The term ‘qualified mental health 4 providers’ means a behavioral health care pro- 5 fessional who is capable of conducting an as- 6 sessment of the individual, in accordance with 7 the professional’s permitted scope of practice 8 under State law, and other professionals or 9 paraprofessionals with appropriate expertise in 10 youth and young adult behavioral health or 11 mental health, including social workers, peer 12 support specialists, recovery coaches, commu- 13 nity health workers, mental health clinicians, 14 and others, as designated by the State and ap- 15 proved by the Secretary. 16 ‘‘(C) QUALIFYING YOUTH AND YOUNG 17 ADULT MENTAL HEALTH AND SUBSTANCE USE 18 INTERVENTION SERVICES DEFINED.—The term 19 ‘qualifying youth and young adult mental health 20 and substance use intervention services’ means, 21 with respect to a State, items and services for 22 which medical assistance is available under the 23 State plan under this title or a waiver of such 24 plan, that are— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01071 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1072 •S 4486 IS ‘‘(i) furnished to an individual 16 to 1 25 years of age who is— 2 ‘‘(I) experiencing a mental health 3 or substance use disorder crisis; 4 ‘‘(II) subject to the juvenile or 5 adult justice system as defined in sec- 6 tion 3102 of title 29, United States 7 Code; 8 ‘‘(III)(aa) experiencing homeless- 9 ness (as defined in section 41403(6) 10 of the Violence Against Women Act of 11 1994 (42 U.S.C. 14043e–2(6))); 12 ‘‘(bb) a homeless child or youth 13 (as defined in section 725(2) of the 14 McKinney-Vento Homeless Assistance 15 Act (42 U.S.C. 11434a(2))); 16 ‘‘(cc) a runaway, in foster care, 17 or has aged out of the foster care sys- 18 tem; 19 ‘‘(dd) a child eligible for assist- 20 ance under section 477 of the Social 21 Security Act (42 U.S.C. 677); or 22 ‘‘(ee) in an out-of-home place- 23 ment; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01072 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1073 •S 4486 IS ‘‘(IV) pregnant or parenting as 1 defined in section 3102 of title 29, 2 United States Code; 3 ‘‘(V) a youth who is an individual 4 with a disability as defined in section 5 3102 of title 29, United States Code; 6 ‘‘(VI) a low-income youth requir- 7 ing additional assistance to enter or 8 complete an educational program or 9 to secure or hold employment as de- 10 fined in section 3102 of title 29, 11 United States Code; or 12 ‘‘(VII) living in a community that 13 has faced acute or long-term exposure 14 to substantial discrimination, histor- 15 ical oppression, intergenerational pov- 16 erty, civil unrest, or a high rate of vio- 17 lence or drug overdose deaths; 18 ‘‘(ii) furnished by qualified mental 19 health providers; and 20 ‘‘(iii) a priority service. 21 ‘‘(D) TELEHEALTH.—The term ‘telehealth’ 22 means use of electronic information and tele- 23 communications technologies, including voice 24 only audio, text, remote patient monitoring, and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01073 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1074 •S 4486 IS mHealth via applications, to support clinical 1 mental health care, patient and professional 2 health-related education, public health, and 3 health administration. 4 ‘‘(3) PAYMENTS.—Notwithstanding section 5 1905(b), beginning January 1, 2024, during each of 6 the first 20 fiscal quarters that a State meets the 7 requirements described in paragraph (4), the Fed- 8 eral medical assistance percentage applicable to 9 amounts expended by the State for medical assist- 10 ance for qualifying youth and young adult mental 11 health and substance use intervention services fur- 12 nished during such quarter shall be equal to 100 13 percent. 14 ‘‘(4) REQUIREMENTS.—The requirements de- 15 scribed in this paragraph are the following: 16 ‘‘(A) The State demonstrates, to the satis- 17 faction of the Secretary— 18 ‘‘(i) that it will be able to support the 19 provision of qualifying youth and young 20 adult mental health and substance use 21 intervention services that meet the condi- 22 tions specified in paragraphs (1) and (2); 23 and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01074 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1075 •S 4486 IS ‘‘(ii) how it will support coordination 1 between qualified mental health providers 2 and substance use teams and community 3 partners, including health care providers, 4 to enable the provision of services, needed 5 referrals, and other activities identified by 6 the Secretary. 7 ‘‘(B) The State provides assurances satis- 8 factory to the Secretary that— 9 ‘‘(i) any additional Federal funds re- 10 ceived by the State for qualifying youth 11 and young adult mental health and sub- 12 stance use intervention services provided 13 under this subsection that are attributable 14 to the increased Federal medical assistance 15 percentage under paragraph (3)(A) will be 16 used to supplement, and not supplant, the 17 level of State funds expended for such 18 services for fiscal year 2024; 19 ‘‘(ii) if the State made qualifying 20 youth and young adult mental health and 21 substance use intervention services avail- 22 able in a region of the State in fiscal year 23 2023 the State will continue to make such 24 services available in such region under this 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01075 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1076 •S 4486 IS subsection at the same level that the State 1 made such services available in such fiscal 2 year; and 3 ‘‘(iii) the State will conduct the eval- 4 uation and assessment, and submit the re- 5 port required under paragraph (5). 6 ‘‘(5) STATE EVALUATION AND REPORT.— 7 ‘‘(A) STATE EVALUATION.—Not later than 8 4 fiscal quarters after a State begins providing 9 qualifying youth and young adult mental health 10 and substance use intervention services in ac- 11 cordance with this subsection, the State shall 12 enter into a contract with an independent entity 13 or organization to conduct an evaluation for the 14 purposes of— 15 ‘‘(i) determining the effect of the pro- 16 vision of such services on— 17 ‘‘(I) emergency room visits; 18 ‘‘(II) use of ambulatory services; 19 ‘‘(III) hospitalizations; 20 ‘‘(IV) the involvement of law en- 21 forcement in mental health or sub- 22 stance use disorder crisis events; and 23 ‘‘(V) the diversion of individuals 24 from jails or similar settings; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01076 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1077 •S 4486 IS ‘‘(ii) assessing— 1 ‘‘(I) the types of services pro- 2 vided to individuals; 3 ‘‘(II) the types of events re- 4 sponded to; 5 ‘‘(III) cost savings or cost-effec- 6 tiveness attributable to such services; 7 ‘‘(IV) the experiences of individ- 8 uals who receive qualifying youth and 9 young adult mental health and sub- 10 stance use intervention services; 11 ‘‘(V) the successful connection of 12 individuals with follow-up services; 13 and 14 ‘‘(VI) other relevant outcomes 15 identified by the Secretary. 16 ‘‘(B) COMPARISON TO HISTORICAL MEAS- 17 URES.—The contract described in subparagraph 18 (A) shall specify that the evaluation is based on 19 a comparison of the historical measures of 20 State performance with respect to the outcomes 21 specified under such subparagraph to the 22 State’s performance with respect to such out- 23 comes during the period beginning with the 24 first quarter in which the State begins pro- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01077 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1078 •S 4486 IS viding qualifying youth and young adult mental 1 health and substance use intervention services 2 in accordance with this subsection. 3 ‘‘(C) REPORT.—Not later than 2 years 4 after a State begins to provide qualifying youth 5 and young adult mental health and substance 6 use intervention services in accordance with this 7 subsection, the State shall submit a report to 8 the Secretary on the following: 9 ‘‘(i) The results of the evaluation car- 10 ried out under subparagraph (A). 11 ‘‘(ii) The number of individuals who 12 received qualifying youth and young adult 13 mental health and substance use interven- 14 tion services. 15 ‘‘(iii) Demographic information re- 16 garding such individuals when available, 17 including the race and ethnicity, age, sex, 18 sexual orientation, gender identity, and ge- 19 ographic location of such individuals. 20 ‘‘(iv) The processes and models devel- 21 oped by the State to provide qualifying 22 youth and young adult mental health and 23 substance use intervention services under 24 such the State plan or waiver, including 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01078 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1079 •S 4486 IS the processes developed to provide referrals 1 for, or coordination with, follow-up care 2 and services. 3 ‘‘(v) Lessons learned regarding the 4 provision of such services. 5 ‘‘(D) PUBLIC AVAILABILITY.—The State 6 shall make the report required under subpara- 7 graph (C) publicly available, including on the 8 website of the appropriate State agency, upon 9 submission of such report to the Secretary. 10 ‘‘(6) BEST PRACTICES REPORT.— 11 ‘‘(A) IN GENERAL.—Not later than 3 years 12 after the first State begins to provide qualifying 13 youth and young adult mental health and sub- 14 stance use intervention services in accordance 15 with this subsection, the Secretary shall submit 16 a report to Congress that— 17 ‘‘(i) identifies the States that elected 18 to provide services in accordance with this 19 subsection; 20 ‘‘(ii) summarizes the information re- 21 ported by such States under paragraph 22 (5)(C); and 23 ‘‘(iii) identifies best practices for the 24 effective delivery of youth and young adult 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01079 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1080 •S 4486 IS mental health and substance use interven- 1 tion services. 2 ‘‘(B) PUBLIC AVAILABILITY.—The report 3 required under subparagraph (A) shall be made 4 publicly available, including on the website of 5 the Department of Health and Human Services, 6 upon submission to Congress. 7 ‘‘(7) NONDISCRIMINATION.— 8 ‘‘(A) FEDERALLY FUNDED ACTIVITIES.— 9 (i) For the purpose of applying the prohibitions 10 against discrimination on the basis of age under 11 the Age Discrimination Act of 1975 (42 U.S.C. 12 6101 et seq.), on the basis of handicap under 13 section 504 of the Rehabilitation Act of 1973 14 (29 U.S.C. 794), on the basis of sex under title 15 IX of the Education Amendments of 1972 (20 16 U.S.C. 1681 et seq.), or on the basis of race, 17 color, or national origin under title VI of the 18 Civil Rights Act of 1964 (42 U.S.C. 2000d et 19 seq.), programs and activities funded in whole 20 or in part with funds made available under this 21 subchapter are considered to be programs and 22 activities receiving Federal financial assistance. 23 ‘‘(ii) No person shall on the ground of sex 24 or religion be excluded from participation in, be 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01080 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1081 •S 4486 IS denied the benefits of, or be subjected to dis- 1 crimination under, any program or activity 2 funded in whole or in part with funds made 3 available under this title. 4 ‘‘(B) COMPLIANCE.—Whenever the Sec- 5 retary finds that a State, or an entity that has 6 received a payment from an allotment to a 7 State under section 702(c) of this title, has 8 failed to comply with a provision of law referred 9 to in subsection (a)(1), with subsection (a)(2), 10 or with an applicable regulation (including one 11 prescribed to carry out subsection (a)(2)), he 12 shall notify the chief executive officer of the 13 State and shall request him to secure compli- 14 ance. If within a reasonable period of time, not 15 to exceed 60 days, the chief executive officer 16 fails or refuses to secure compliance, the Sec- 17 retary may— 18 ‘‘(i) refer the matter to the Attorney 19 General with a recommendation that an 20 appropriate civil action be instituted; 21 ‘‘(ii) exercise the powers and functions 22 provided by title VI of the Civil Rights Act 23 of 1964 (42 U.S.C. 2000d et seq.), the 24 Age Discrimination Act of 1975 (42 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01081 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1082 •S 4486 IS U.S.C. 6101 et seq.), or section 504 of the 1 Rehabilitation Act of 1973 (29 U.S.C. 2 794), as may be applicable; or 3 ‘‘(iii) take such other action as may 4 be provided by law. 5 ‘‘(C) AUTHORITY OF ATTORNEY GENERAL; 6 CIVIL ACTIONS.—When a matter is referred to 7 the Attorney General pursuant to subsection 8 (b)(1), or whenever he has reason to believe 9 that the entity is engaged in a pattern or prac- 10 tice in violation of a provision of law referred 11 to in subsection (a)(1) or in violation of sub- 12 section (a)(2), the Attorney General may bring 13 a civil action in any appropriate district court 14 of the United States for such relief as may be 15 appropriate, including injunctive relief.’’. 16 SEC. 6044. EARLY INTERVENTION AND PREVENTION PRO- 17 GRAMS FOR TRANSITION-AGE YOUTH. 18 (a) IN GENERAL.—Section 1912(b)(1) of the Public 19 Health Service Act (42 U.S.C. 300x–1(b)(1)) is amend- 20 ed— 21 (1) by redesignating subparagraph (E) as sub- 22 paragraph (F); and 23 (2) by inserting after subparagraph (D) the fol- 24 lowing: 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01082 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1083 •S 4486 IS ‘‘(E) EARLY INTERVENTION AND PREVEN- 1 TION PROGRAMS FOR TRANSITION-AGE 2 YOUTH.—The plan shall describe the State’s 3 plans to carry out demonstration grants or con- 4 tracts for early intervention and prevention pro- 5 grams for transition-age youth of 16 to 25 6 years of age who meet one or more of the cri- 7 teria specified in section 129(a)(1)(B) of the 8 Workforce Innovation and Opportunity Act to 9 be considered out-of-school youth.’’. 10 (b) SET-ASIDE.—Section 1920 of the Public Health 11 Service Act (42 U.S.C. 300x–9) is amended by adding at 12 the end the following: 13 ‘‘(d) EARLY INTERVENTION AND PREVENTION PRO- 14 GRAMS FOR TRANSITION-AGE YOUTH.— 15 ‘‘(1) IN GENERAL.—Except as provided in para- 16 graph (2), a State shall expend at least 15 percent 17 of the amount of the allotment of the State pursuant 18 to a funding agreement under section 1911 for each 19 fiscal year to support programs described in section 20 1912(b)(1)(E). 21 ‘‘(2) STATE FLEXIBILITY.—In lieu of expending 22 15 percent of the amount of the allotment for a fis- 23 cal year as required by paragraph (1), a State may 24 elect to expend not less than 30 percent of such 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01083 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1084 •S 4486 IS amount to support such programs by the end of two 1 consecutive fiscal years.’’. 2 SEC. 6045. STRATEGIES TO INCREASE ACCESS TO TELE- 3 HEALTH UNDER MEDICAID AND CHILDREN’S 4 HEALTH INSURANCE PROGRAM. 5 (a) GUIDANCE.—Not later than 1 year after the date 6 of the enactment of this Act, the Secretary of Health and 7 Human Services shall issue and disseminate guidance to 8 States to clarify strategies to overcome existing barriers 9 and increase access to telehealth under the Medicaid pro- 10 gram under title XIX of the Social Security Act (42 11 U.S.C. 1396 et seq.) and the Children’s Health Insurance 12 Program under title XXI of such Act (42 U.S.C. 1397aa 13 et seq.). Such guidance shall include technical assistance 14 and best practices regarding— 15 (1) telehealth delivery of covered services; 16 (2) recommended voluntary billing codes, modi- 17 fiers, and place-of-service designations for telehealth 18 and other virtual health care services; 19 (3) the simplification or alignment (including 20 through reciprocity) of provider licensing, 21 credentialing, and enrollment protocols with respect 22 to telehealth across States, State Medicaid plans 23 under such title XIX, and Medicaid managed care 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01084 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1085 •S 4486 IS organizations, including during national public 1 health emergencies; 2 (4) existing strategies States can use to inte- 3 grate telehealth and other virtual health care serv- 4 ices into value-based health care models; and 5 (5) examples of States that have used waivers 6 under the Medicaid program to test expanded access 7 to telehealth, including during the emergency period 8 described in section 1135(g)(1)(B) of the Social Se- 9 curity Act (42 U.S.C. 1320b–5(g)(1)(B)). 10 (b) STUDIES.— 11 (1) TELEHEALTH IMPACT ON HEALTH CARE 12 ACCESS.—Not later than 1 year after the date of the 13 enactment of this Act, the Medicaid and CHIP Pay- 14 ment and Access Commission shall conduct a study, 15 with respect to a minimum of 10 States across geo- 16 graphic regions of the United States, and submit to 17 Congress a report, on the impact of telehealth on 18 health care access, utilization, cost, and outcomes, 19 broken down by race, ethnicity, sex, age, disability 20 status, and ZIP Code. Such report shall— 21 (A) evaluate cost, access, utilization, out- 22 comes, and patient experience data from across 23 the health care field, including States, Medicaid 24 managed care organizations, provider organiza- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01085 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1086 •S 4486 IS tions, and other organizations that provide or 1 pay for telehealth under the Medicaid program 2 and Children’s Health Insurance Program; 3 (B) identify barriers and potential solu- 4 tions to provider entry and participation in tele- 5 health that States are experiencing, as well as 6 barriers to providing telehealth across State 7 lines, including during times of public health 8 crisis or public health emergency; 9 (C) determine the frequency at which out- 10 of-State telehealth is provided to patients en- 11 rolled in the Medicaid program and the poten- 12 tial impact on access to telehealth if State Med- 13 icaid policies were more aligned; and 14 (D) identify and evaluate opportunities for 15 more alignment among such policies to promote 16 access to telehealth across all States, State 17 Medicaid plans under title XIX of the Social 18 Security Act (42 U.S.C. 1396 et seq.), State 19 child health plans under title XXI of such Act 20 (42 U.S.C. 1397aa et seq.), and Medicaid man- 21 aged care organizations, including the potential 22 for regional compacts or reciprocity agreements. 23 (2) FEDERAL AGENCY TELEHEALTH COLLABO- 24 RATION.—Not later than 1 year after the date of the 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01086 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1087 •S 4486 IS enactment of this Act, the Comptroller General of 1 the United States shall conduct a study and submit 2 to Congress a report evaluating collaboration be- 3 tween Federal agencies with respect to telehealth 4 services furnished under the Medicaid or CHIP pro- 5 gram to individuals under the age of 18, including 6 such services furnished to such individuals in early 7 care and education settings. Such report shall in- 8 clude recommendations on— 9 (A) opportunities for Federal agencies to 10 improve collaboration with respect to such tele- 11 health services; and 12 (B) opportunities for collaboration between 13 Federal agencies to expand telehealth access to 14 such individuals enrolled under the Medicaid or 15 CHIP program, including in early care and 16 education settings. 17 SEC. 6046. YOUTH AND YOUNG ADULT MENTAL HEALTH 18 PROMOTION, PREVENTION, INTERVENTION, 19 AND TREATMENT. 20 Title III of the Public Health Service Act is amended 21 by inserting after section 399Z–3, as added by section 22 5001, the following: 23 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01087 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1088 •S 4486 IS ‘‘SEC. 399Z–4. YOUTH AND YOUNG ADULT MENTAL HEALTH 1 PROMOTION, PREVENTION, INTERVENTION, 2 AND TREATMENT. 3 ‘‘(a) GRANTS.—The Secretary shall— 4 ‘‘(1) award grants to eligible entities to develop, 5 maintain, or enhance youth and young adult mental 6 health promotion, prevention, intervention, and 7 treatment programs, including— 8 ‘‘(A) programs for youth and young adults 9 who may be likely to develop, are showing early 10 signs of, or have been diagnosed with a mental 11 health condition, including a serious emotional 12 disturbance; and 13 ‘‘(B) infrastructure and organization 14 change at a State, tribal, or territorial level to 15 improve cross-system collaboration, service ca- 16 pacity, and expertise related to youth and 17 young adults; and 18 ‘‘(2) ensure that programs funded through 19 grants under this section use community-driven, evi- 20 dence-informed, or evidence-based models, practices, 21 and methods that are, as appropriate, culturally and 22 linguistically appropriate, and can be replicated in 23 other appropriate settings. 24 ‘‘(b) ELIGIBLE TRANSITION AGE YOUTH AND ENTI- 25 TIES.—In this section: 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01088 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1089 •S 4486 IS ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en- 1 tity’ means— 2 ‘‘(A) a local educational agency; 3 ‘‘(B) a State educational agency; 4 ‘‘(C) an institution of higher education (or 5 consortium of such institutions), which may in- 6 clude a recovery program at an institution of 7 higher education; 8 ‘‘(D) a local board, or a one-stop operator, 9 as defined in section 3 of the Workforce Inno- 10 vation and Opportunity Act; 11 ‘‘(E) a nonprofit organization with appro- 12 priate expertise in providing services or pro- 13 grams for children, adolescents, or young 14 adults, excluding a school; 15 ‘‘(F) a State, political subdivision of a 16 State, Indian tribe, or tribal organization; or 17 ‘‘(G) a high school or dormitory serving 18 high school students that receives funding from 19 the Bureau of Indian Education. 20 ‘‘(2) ELIGIBLE TRANSITION AGE YOUTH.—The 21 term ‘eligible transition age youth’ means a youth or 22 young adult from age 16 to not more than 25 years 23 of age who is— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01089 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1090 •S 4486 IS ‘‘(A) an out-of-school youth as defined in 1 section 129(a)(1)(B) of the Workforce Innova- 2 tion and Opportunity Act; 3 ‘‘(B) a homeless individual (as defined in 4 section 41403(6) of the Violence Against 5 Women Act of 1994), a homeless child or youth 6 (as defined in section 725(2) of the McKinney- 7 Vento Homeless Assistance Act) a runaway, in 8 foster care or has aged out of the foster care 9 system, a child eligible for assistance under sec- 10 tion 477 of the Social Security Act, or in an 11 out-of-home placement; 12 ‘‘(C) an individual who is pregnant or par- 13 enting, as referred to in section 129(a)(1)(B) of 14 the Workforce Innovation and Opportunity Act; 15 ‘‘(D) a youth who is an individual with a 16 disability, as referred to in section 129(a)(1)(B) 17 of the Workforce Innovation and Opportunity 18 Act; 19 ‘‘(E) a low-income individual who requires 20 additional assistance to enter or complete an 21 educational program or to secure or hold em- 22 ployment, as referred to in section 129(a)(1)(B) 23 of the Workforce Innovation and Opportunity 24 Act; or 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01090 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1091 •S 4486 IS ‘‘(F) living in a community that has faced 1 acute or long-term exposure to substantial dis- 2 crimination, historical oppression, intergenera- 3 tional poverty, civil unrest, a high rate of vio- 4 lence, or drug overdose deaths. 5 ‘‘(c) APPLICATION.—An eligible entity seeking a 6 grant under subsection (a) shall submit to the Secretary 7 an application at such time, in such manner, and con- 8 taining such information as the Secretary may require. 9 ‘‘(d) USE OF FUNDS FOR MENTAL HEALTH PRO- 10 MOTION, PREVENTION, INTERVENTION AND TREATMENT 11 PROGRAMS.—An eligible entity may use amounts awarded 12 under a grant under subsection (a)(1) to carry out the 13 following: 14 ‘‘(1) Creation, implementation, and expansion 15 of services and supports that are culturally and lin- 16 guistically appropriate and youth guided, involve and 17 include family and community members (including 18 business leaders and faith-based organizations), and 19 provide for continuity of care between child- and 20 adult-serving systems to ensure seamless transition. 21 ‘‘(2) Infrastructure and organization change at 22 a State, Tribal, or territorial level to improve cross- 23 system collaboration, service capacity, and expertise 24 related to youth and young adults with, or at risk 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01091 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1092 •S 4486 IS of, mental health conditions and substance use dis- 1 orders as they transition into adult roles and respon- 2 sibilities. 3 ‘‘(3) Public awareness and cross-system pro- 4 vider training for individuals employed at institu- 5 tions of higher education and community colleges, 6 behavioral health providers, individuals working in 7 the criminal justice system, primary care providers, 8 vocational service providers, and child welfare work- 9 ers. 10 ‘‘(e) MATCHING FUNDS.—The Secretary may not 11 award a grant under this section to an eligible entity un- 12 less the eligible entity agrees, with respect to the costs to 13 be incurred by the eligible entity in carrying out the activi- 14 ties described in subsection (d), to make available non- 15 Federal contributions (in cash or in kind) toward such 16 costs in an amount that is not less than 10 percent of 17 the total amount of Federal funds provided in the grant. 18 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To 19 carry out this section, there are authorized to be appro- 20 priated $25,000,000 for each of fiscal years 2024 through 21 2033.’’. 22 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01092 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1093 •S 4486 IS SEC. 6047. STUDY ON THE EFFECTS OF SMARTPHONE AND 1 SOCIAL MEDIA USE ON ADOLESCENTS. 2 (a) IN GENERAL.—Not later than 1 year after the 3 date of enactment of this Act, the Secretary of Health and 4 Human Services shall conduct or support research on— 5 (1) smartphone and social media use by adoles- 6 cents; and 7 (2) the effects of such use on— 8 (A) emotional, behavioral, and physical 9 health and development; and 10 (B) disparities in minority and under- 11 served populations. 12 (b) REPORT.—Not later than 5 years after the date 13 of the enactment of this Act, the Secretary shall submit 14 to the Congress, and make publicly available, a report on 15 the findings of research described in this section. 16 Subtitle E—Community-Based Care 17 SEC. 6051. MENTAL HEALTH AT THE BORDER. 18 (a) SHORT TITLE.—This section may be cited as the 19 ‘‘Immigrants’ Mental Health Act of 2022’’. 20 (b) DEFINITIONS.—In this section: 21 (1) FORWARD OPERATING BASE.—The term 22 ‘‘forward operating base’’ means a permanent facil- 23 ity— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01093 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1094 •S 4486 IS (A) established by U.S. Customs and Bor- 1 der Protection in forward or remote locations; 2 and 3 (B) designated as such by U.S. Customs 4 and Border Protection. 5 (2) The term ‘‘U.S. Customs and Border Pro- 6 tection facility’’ means any of the following facilities 7 that typically detain migrants on behalf of U.S. Cus- 8 toms and Border Protection: 9 (A) U.S. Border Patrol stations. 10 (B) Ports of entry. 11 (C) Checkpoints. 12 (D) Forward operating bases. 13 (E) Secondary inspection areas. 14 (F) Short-term custody facilities. 15 (c) TRAINING FOR CERTAIN CBP PERSONNEL IN 16 MENTAL HEALTH ISSUES.— 17 (1) TRAINING TO IDENTIFY RISK FACTORS AND 18 WARNING SIGNS IN IMMIGRANTS AND REFUGEES.— 19 (A) IN GENERAL.—The Commissioner of 20 U.S. Customs and Border Protection, in con- 21 sultation with the Assistant Secretary for Men- 22 tal Health and Substance Use, the Adminis- 23 trator of the Health Resources and Services Ad- 24 ministration, and nongovernmental experts in 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01094 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1095 •S 4486 IS the delivery of health care in humanitarian cri- 1 ses and in the delivery of health care to chil- 2 dren, shall develop and implement a training 3 curriculum for U.S. Customs and Border Pro- 4 tection agents and officers to enable such 5 agents and officers to identify the risk factors 6 and warning signs in immigrants and refugees 7 of mental health issues relating to trauma. 8 (B) REQUIREMENTS.—The training cur- 9 riculum required under subparagraph (A) 10 shall— 11 (i) be offered to all U.S. Customs and 12 Border Protection agents and officers 13 working at U.S. Customs and Border Pro- 14 tection facilities; 15 (ii) provide for crisis intervention 16 using a trauma-informed approach; and 17 (iii) provide for mental health 18 screenings for immigrants and refugees ar- 19 riving at the border in their preferred lan- 20 guage or with appropriate language assist- 21 ance. 22 (2) TRAINING TO ADDRESS MENTAL HEALTH 23 AND WELLNESS OF CBP AGENTS AND OFFICERS.— 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01095 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1096 •S 4486 IS (A) IN GENERAL.—The Commissioner of 1 U.S. Customs and Border Protection, in con- 2 sultation with the Assistant Secretary for Men- 3 tal Health and Substance Use, the Adminis- 4 trator of the Health Resources and Services Ad- 5 ministration, and nongovernmental experts in 6 the delivery of mental health care, shall develop 7 and implement a training curriculum for U.S. 8 Customs and Border Protection agents and offi- 9 cers assigned to U.S. Customs and Border Pro- 10 tection facilities to address the mental health 11 and wellness of individuals working at such fa- 12 cilities. 13 (B) REQUIREMENT.—The training cur- 14 riculum described in subparagraph (A) shall be 15 designed to help the agents and officers de- 16 scribed in such subparagraph— 17 (i) to better manage their own stress 18 and the stress of their coworkers; and 19 (ii) to be more aware of the psycho- 20 logical pressures experienced during their 21 jobs. 22 (3) ANNUAL REVIEW OF TRAINING.—Beginning 23 in fiscal year 2023, the Assistant Secretary for Men- 24 tal Health and Substance Use shall— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01096 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1097 •S 4486 IS (A) conduct an annual review of the train- 1 ing required under paragraphs (1) and (2); and 2 (B) submit the results of each such review, 3 including any recommendations for improve- 4 ment of such training, to— 5 (i) the Commissioner of U.S. Customs 6 and Border Protection; 7 (ii) the Committee on Appropriations 8 of the Senate; 9 (iii) the Committee on Health, Edu- 10 cation, Labor, and Pensions of the Senate; 11 (iv) the Committee on Homeland Se- 12 curity and Governmental Affairs of the 13 Senate; 14 (v) the Committee on the Judiciary of 15 the Senate; 16 (vi) the Committee on Appropriations 17 of the House of Representatives; 18 (vii) the Committee on Energy and 19 Commerce of the House of Representa- 20 tives; 21 (viii) the Committee on Homeland Se- 22 curity of the House of Representatives; 23 and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01097 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1098 •S 4486 IS (ix) the Committee on the Judiciary 1 of the House of Representatives. 2 (4) AUTHORIZATION OF APPROPRIATIONS.— 3 There is authorized to be appropriated— 4 (A) $50,000 for fiscal year 2023 to develop 5 the training curriculum required under para- 6 graphs (1) and (2); and 7 (B) for each of the fiscal years 2024 8 through 2028— 9 (i) $20,000 to provide the training re- 10 quired under paragraphs (1) and (2); and 11 (ii) such sums as may be necessary to 12 conduct the annual review of training pur- 13 suant to paragraph (3). 14 (d) STAFFING BORDER FACILITIES AND DETENTION 15 CENTERS.— 16 (1) IN GENERAL.—The Commissioner of U.S. 17 Customs and Border Protection shall assign at least 18 1 qualified mental or behavioral health expert to 19 each U.S. Customs and Border Protection facility to 20 adequately evaluate the mental health needs of im- 21 migrants, refugees, border patrol agents, and staff. 22 (2) QUALIFICATIONS.—Each mental or behav- 23 ioral health expert assigned pursuant to paragraph 24 (1)— 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01098 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1099 •S 4486 IS (A) shall be bilingual; 1 (B) shall be well-versed in culturally and 2 linguistically appropriate and trauma-informed 3 interventions; and 4 (C) shall have particular expertise in child 5 or adolescent mental health or family mental 6 health. 7 (3) AUTHORIZATION OF APPROPRIATIONS.— 8 There is authorized to be appropriated $3,000,000 9 for each of the fiscal years 2023 through 2027 to 10 carry out this subsection. 11 (e) CONFIDENTIALITY OF DEPARTMENT OF HEALTH 12 AND HUMAN SERVICES MENTAL HEALTH INFORMATION 13 FOR ASYLUM DETERMINATIONS, IMMIGRATION HEAR- 14 INGS, OR DEPORTATION PROCEEDINGS.—The officers, 15 employees, and agents of the Department of Health and 16 Human Services, including the Office of Refugee Resettle- 17 ment, may not share with the Department of Homeland 18 Security, and the officers, employees, and agents of the 19 Department of Homeland Security may not request or re- 20 ceive from the Department of Health and Human Serv- 21 ices, for the purposes of an asylum determination, immi- 22 gration hearing, or deportation proceeding, any informa- 23 tion or record that— 24 (1) concerns the mental health of an alien; and 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01099 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1100 •S 4486 IS (2) was obtained or produced by a mental or 1 behavioral health professional while the alien was in 2 a shelter or otherwise in the custody of the Federal 3 Government. 4 SEC. 6052. ASIAN AMERICAN, AFRICAN AMERICAN, NATIVE 5 HAWAIIAN, PACIFIC ISLANDER, INDIGENOUS, 6 MIDDLE EASTERN AND NORTH AFRICAN, AND 7 HISPANIC AND LATINO BEHAVIORAL AND 8 MENTAL HEALTH OUTREACH AND EDU- 9 CATION STRATEGY. 10 Part D of title V of the Public Health Service Act 11 (42 U.S.C. 290dd et seq.), as amended by section 6022, 12 is further amended by adding at the end the following new 13 section: 14 ‘‘SEC. 554. BEHAVIORAL AND MENTAL HEALTH OUTREACH 15 AND EDUCATION STRATEGY. 16 ‘‘(a) IN GENERAL.—The Secretary, acting through 17 the Assistant Secretary for Mental Health and Substance 18 Use, shall, in coordination with advocacy and behavioral 19 and mental health organizations serving populations of 20 Asian American, African American, Native Hawaiian, Pa- 21 cific Islander, Indigenous, Middle Eastern and North Afri- 22 can (in this section referred to as ‘MENA’), and Hispanic 23 and Latino/a/x individuals or communities, develop and 24 implement an outreach and education strategy to promote 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01100 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1101 •S 4486 IS behavioral and mental health, emphasize that behavioral 1 and mental health conditions are treatable and that rea- 2 sonable accommodations under section 504 of the Reha- 3 bilitation Act of 1973 and titles II and III of the Ameri- 4 cans with Disabilities Act of 1990 are necessary and may 5 help, as well as reduce stigma associated with mental 6 health conditions and substance abuse among the Asian 7 American, African American, Native Hawaiian, Pacific Is- 8 lander, Indigenous, MENA, and Hispanic and Latino/a/ 9 x populations. Such strategy shall— 10 ‘‘(1) be designed to— 11 ‘‘(A) meet the diverse cultural and lan- 12 guage needs of the various Asian American, Af- 13 rican American, Indigenous, MENA, Native 14 Hawaiian, Pacific Islander, and Hispanic and 15 Latino/a/x populations; and 16 ‘‘(B) ensure that approaches recommended 17 in the strategy are developmentally (with re- 18 spect to the beneficiary’s relative age and expe- 19 rience) and age appropriate, as well as cog- 20 nitively accessible to persons with cognitive dis- 21 abilities; 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 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01101 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1102 •S 4486 IS gender, gender identity, age, sexual orientation, dis- 1 ability, and ethnicity) of such populations; 2 ‘‘(3) provide information on evidence-based, cul- 3 turally and linguistically appropriate and adapted 4 interventions and treatments; 5 ‘‘(4) ensure full participation of, and engage, 6 both consumers and community members rep- 7 resenting the communities of focus in the develop- 8 ment and implementation of materials; and 9 ‘‘(5) seek to broaden the perspective among 10 both individuals in such communities and stake- 11 holders serving such communities to use a com- 12 prehensive public health approach to promoting be- 13 havioral and mental health that addresses a holistic 14 view of health by focusing on the intersection be- 15 tween behavioral and physical health. 16 ‘‘(b) REPORTS.—Beginning not later than 1 year 17 after the date of the enactment of this section and annu- 18 ally thereafter, the Secretary, acting through the Assistant 19 Secretary, shall submit to the Congress, and make publicly 20 available, a report on the extent to which the strategy de- 21 veloped and implemented under subsection (a) increased 22 behavioral and mental health outcomes associated with 23 mental health conditions and substance abuse among 24 Asian American, African American, Native Hawaiian, Pa- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01102 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1103 •S 4486 IS cific Islander, Indigenous, MENA, and Hispanic and 1 Latino/a/x populations. 2 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 3 is authorized to be appropriated to carry out this section 4 $10,000,000 for each of fiscal years 2024 through 2028.’’. 5 Subtitle F—Reports 6 SEC. 6061. ADDRESSING RACIAL AND ETHNIC MENTAL 7 HEALTH INEQUITIES RESEARCH GAPS. 8 (a) IN GENERAL.—Not later than 6 months after the 9 date of the enactment of this Act— 10 (1) the Director of the National Institute on 11 Minority Health and Health Disparities shall enter 12 into an arrangement with the National Academy of 13 Sciences to carry out the activities under subsection 14 (b); or 15 (2) if the National Academy of Sciences de- 16 clines to enter into such an arrangement, the Direc- 17 tor of the National Institute on Minority Health and 18 Health Disparities, in cooperation with the Agency 19 for Healthcare Research and Quality, shall carry out 20 the activities under subsection (b). 21 (b) ACTIVITIES.—The applicable entity under sub- 22 section (a) shall— 23 (1) conduct a study with respect to mental 24 health inequities in racial and ethnic minority 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01103 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1104 •S 4486 IS groups (as defined in section 1707(g) of the Public 1 Health Service Act (42 U.S.C. 300u–6(g)), as 2 amended by title I of this Act); and 3 (2) submit to the Congress a report on the re- 4 sults of such study, including— 5 (A) a compilation of information on the dy- 6 namics of mental health outcomes in such racial 7 and ethnic minority groups; 8 (B) the degree and impacts of the co-oc- 9 currence of mental conditions with other dis- 10 abilities in such racial and ethnic groups, in- 11 cluding physical disabilities, mental disabilities, 12 substance use disorders, severe and persistent 13 mental illness, and mental disorders or mental 14 health conditions which co-occur with one an- 15 other; 16 (C) a compilation of information on the 17 impact of community violence, community trau- 18 ma, adverse childhood experiences, weather ex- 19 tremes worsened by climate change (such as 20 heat waves, flooding, hurricanes, and wildfires), 21 substance use, and other psychological traumas, 22 on mental disorders in such racial and ethnic 23 minority groups, stratified by household income 24 level; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01104 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1105 •S 4486 IS (D) a compilation of information on the 1 impact of the intersectionality of transgender 2 individuals, gender nonbinary individuals, sex- 3 ual orientation, and age in racial and ethnic mi- 4 nority groups; and 5 (E) a description of how protective factors 6 contrast and compare among different commu- 7 nities of color, identifying cultural strengths. 8 SEC. 6062. RESEARCH ON ADVERSE HEALTH EFFECTS AS- 9 SOCIATED WITH INTERACTIONS WITH LAW 10 ENFORCEMENT. 11 (a) IN GENERAL.—The Secretary of Health and 12 Human Services (in this section referred to as the ‘‘Sec- 13 retary’’), acting through the Director of the Office of Mi- 14 nority Health of the Centers for Disease Control and Pre- 15 vention (established pursuant to section 1707A of the 16 Public Health Service Act (42 U.S.C. 300u–6a)), shall 17 conduct research on the adverse health effects associated 18 with interactions with law enforcement. 19 (b) EFFECTS AMONG RACIAL AND ETHNIC MINORI- 20 TIES.—The research under subsection (a) shall include re- 21 search on— 22 (1) the health consequences, both individual 23 and community-wide, of trauma related to violence 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01105 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1106 •S 4486 IS committed by law enforcement among racial and 1 ethnic minorities; and 2 (2) the disproportionate burden of morbidity 3 and mortality associated with such trauma. 4 (c) REPORT.—Not later than 1 year after the date 5 of enactment of this Act, the Secretary shall— 6 (1) complete the research under this section; 7 and 8 (2) submit to the Congress a report on the find- 9 ings, conclusions, and recommendations resulting 10 from such research. 11 SEC. 6063. GEOACCESS STUDY. 12 The Assistant Secretary for Mental Health and Sub- 13 stance Use shall— 14 (1) conduct a study to— 15 (A) determine which geographic areas of 16 the United States have shortages of racially and 17 ethnically diverse mental health providers, as 18 well as mental health providers trained to work 19 with racially and ethnically diverse clients and 20 clients with multiple mental health, cognitive, 21 and developmental disabilities; and 22 (B) assess the preparedness of mental 23 health providers to deliver culturally and lin- 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01106 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1107 •S 4486 IS guistically appropriate, affordable, and acces- 1 sible services; and 2 (2) submit a report to Congress on the results 3 of such study. 4 SEC. 6064. CO-OCCURRING CONDITIONS. 5 (a) GAO REPORT.—Not later than two years after 6 the date of enactment of this Act, the Comptroller General 7 of the United States shall submit to Congress a report 8 on barriers to care for persons with co-occurring condi- 9 tions and access to care in the United States. Such report 10 shall include the information and recommendations de- 11 scribed in subsection (b). 12 (b) CONTENT OF REPORT.—The report under sub- 13 section (a) shall include— 14 (1) an assessment of current barriers to behav- 15 ioral health and substance use disorder treatment 16 for low-income, uninsured, and Medicaid-enrolled 17 adults, and recommendations for addressing such 18 barriers, particularly for women and diverse racial 19 and ethnic groups; 20 (2) an assessment of— 21 (A) how many adults have a behavioral 22 health condition and options for adults to re- 23 ceive behavioral health and substance use dis- 24 order treatment in nonexpansion States; 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01107 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1108 •S 4486 IS (B) Medicaid expansion States who provide 1 behavioral health coverage for newly eligible en- 2 rollees; 3 (C) how enrollment in coverage affects 4 treatment availability; and 5 (D) the impacts of COVID–19 to receiving 6 and accessing treatment for behavioral health, 7 substance use disorders, and diverse racial and 8 ethnic groups, and recommendations for ad- 9 dressing such barriers; 10 (3) an assessment of current barriers, inclusive 11 of social determinants of health and cultural bar- 12 riers, that prevent adults from receiving behavioral 13 health and substance use disorder treatment, and 14 recommendations for addressing such barriers, par- 15 ticularly for low-income women and adults from ra- 16 cial and ethnic groups; 17 (4) an assessment of disparities in access to ad- 18 diction counselors and mental or behavioral health 19 care providers acting in accordance with State law, 20 stratified by race, ethnicity, gender identity, geo- 21 graphic location, and insurance type, and rec- 22 ommendations to promote greater access equity; and 23 (5) recommendations to promote greater equity 24 in access to care for behavioral services and sub- 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01108 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1109 •S 4486 IS stance use disorders, particularly for low-income 1 women and adults from diverse racial and ethnic 2 groups. 3 SEC. 6065. TECHNICAL CORRECTION. 4 Title V of the Public Health Service Act (42 U.S.C. 5 290aa et seq.) is amended— 6 (1) by redesignating the second section 550 (42 7 U.S.C. 290ee–10) (relating to Sobriety Treatment 8 And Recovery Teams) as section 552A; and 9 (2) by moving such section, as so redesignated, 10 so as to appear after section 552 (42 U.S.C. 290ee– 11 7). 12 Subtitle G—Miscellaneous 13 Provisions 14 SEC. 6071. CHILDREN’S MENTAL HEALTH INFRASTRUC- 15 TURE ACT. 16 Part D of title III of the Public Health Service Act 17 (42 U.S.C. 254b et seq.) is amended by inserting after 18 subpart V, as amended by section 6041, the following new 19 subpart: 20 ‘‘Subpart VI—Increasing Investment in Pediatric 21 Behavioral Health Services 22 ‘‘SEC. 340AA–1. GRANTS TO CHILDREN’S HOSPITALS. 23 ‘‘(a) IN GENERAL.—The Secretary, acting through 24 the Administrator of the Health Resources and Services 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01109 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1110 •S 4486 IS Administration, shall make grants to eligible entities for 1 the purpose of improving their ability to provide pediatric 2 behavioral health services, including by— 3 ‘‘(1) constructing or modernizing sites of care 4 for pediatric behavioral health services; 5 ‘‘(2) expanding capacity to provide pediatric be- 6 havioral health services, including enhancements to 7 digital infrastructure, telehealth capabilities, or other 8 improvements to patient care infrastructure; and 9 ‘‘(3) supporting the reallocation of existing re- 10 sources to accommodate pediatric behavioral health 11 patients, including by— 12 ‘‘(A) converting or adding a sufficient 13 number of beds to establish or increase the hos- 14 pital’s inventory of licensed and operational, 15 short-term psychiatric and substance use inpa- 16 tient beds; and 17 ‘‘(B) ensuring compliance with safety 18 standards. 19 ‘‘(b) ELIGIBILITY.—To be eligible to seek a grant 20 under this section, an entity shall be a hospital that pre- 21 dominantly treats individuals under the age of 21, includ- 22 ing any hospital that receives funds under section 340E. 23 ‘‘(c) FUNDING.—To carry out this section, there is 24 hereby appropriated, out of amounts in the Treasury not 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01110 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1111 •S 4486 IS otherwise obligated, $2,000,000,000 for each of fiscal 1 years 2022 through 2026.’’. 2 SEC. 6072. MENTAL HEALTH FOR LATINOS. 3 Part D of title V of the Public Health Service Act 4 (42 U.S.C. 290dd et seq.), as amended by sections 6022, 5 6023, 6052, and 6016, is further amended by adding at 6 the end the following new section: 7 ‘‘SEC. 557. BEHAVIORAL AND MENTAL HEALTH OUTREACH 8 AND EDUCATION STRATEGY. 9 ‘‘(a) IN GENERAL.—The Secretary, acting through 10 the Assistant Secretary, shall, in coordination with advo- 11 cacy and behavioral and mental health organizations serv- 12 ing populations of Hispanic and Latino individuals or 13 communities, develop and implement an outreach and edu- 14 cation strategy to promote behavioral and mental health 15 and reduce stigma associated with mental health condi- 16 tions and substance abuse among the Hispanic and Latino 17 populations. Such strategy shall— 18 ‘‘(1) be designed to— 19 ‘‘(A) meet the diverse cultural and lan- 20 guage needs of the various Hispanic and Latino 21 populations; and 22 ‘‘(B) be developmentally and age appro- 23 priate; 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01111 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1112 •S 4486 IS ‘‘(2) increase awareness of symptoms of mental 1 illnesses common among such populations, taking 2 into account differences within subgroups, such as 3 gender, gender identity, age, sexual orientation, or 4 ethnicity, of such populations; 5 ‘‘(3) provide information on evidence-based, cul- 6 turally and linguistically appropriate and adapted 7 interventions and treatments; 8 ‘‘(4) ensure full participation of, and engage, 9 both consumers and community members in the de- 10 velopment and implementation of materials; 11 ‘‘(5) seek to broaden the perspective among 12 both individuals in these communities and stake- 13 holders serving these communities to use a com- 14 prehensive public health approach to promoting be- 15 havioral health that addresses a holistic view of 16 health by focusing on the intersection between be- 17 havioral and physical health; and 18 ‘‘(6) address the impact of the SARS–CoV–2 19 pandemic on the mental and behavioral health of the 20 Hispanic and Latino populations. 21 ‘‘(b) REPORTS.—Beginning not later than 1 year 22 after the date of the enactment of this section and annu- 23 ally thereafter, the Secretary, acting through the Assistant 24 Secretary, shall submit to Congress, and make publicly 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01112 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1113 •S 4486 IS available, a report on the extent to which the strategy de- 1 veloped and implemented under subsection (a) improved 2 behavioral and mental health outcomes associated with 3 mental health conditions and substance abuse among His- 4 panic and Latino populations. 5 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 6 is authorized to be appropriated to carry out this section 7 $1,000,000 for each of fiscal years 2023 through 2025.’’. 8 SEC. 6073. STRENGTHENING MENTAL HEALTH SUPPORTS 9 FOR BIPOC COMMUNITIES. 10 (a) IN GENERAL.—Section 1942(a) of the Public 11 Health Service Act (42 U.S.C. 300x–52(a)) is amended— 12 (1) in paragraph (1), by striking ‘‘and’’ at the 13 end; 14 (2) by redesignating paragraph (2) as para- 15 graph (5); and 16 (3) by inserting after paragraph (1) the fol- 17 lowing: 18 ‘‘(2) services provided by the State to adults 19 with a serious mental illness and children with a se- 20 rious emotional disturbance who are members of ra- 21 cial and ethnic minority groups, including— 22 ‘‘(A) the extent to which such services are 23 provided to such adults and children; and 24 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01113 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1114 •S 4486 IS ‘‘(B) the outcomes experienced by such 1 adults and children as a result of the provision 2 of such services, including with respect to— 3 ‘‘(i) diversions from hospitalization 4 and criminal justice system involvement; 5 ‘‘(ii) treatment for first episode psy- 6 chosis or undefined psychosis; 7 ‘‘(iii) reductions in suicide and in- 8 creased utilization of appropriate treat- 9 ments and interventions for suicidal idea- 10 tion; 11 ‘‘(iv) response through crisis services, 12 including mobile crisis services; 13 ‘‘(v) treatment of individuals who are 14 experiencing homelessness or housing inse- 15 curity and individuals residing in rural 16 communities; and 17 ‘‘(vi) increased patient family and 18 caregiver engagement and education on se- 19 rious mental illness to reduce social stigma 20 and promote healthy social support for pa- 21 tients; 22 ‘‘(3) any outreach by the State to, and the hir- 23 ing of, providers of mental health services from mul- 24 tiple disciplines (such as a psychologist, psychiatrist, 25 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01114 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1115 •S 4486 IS peer support provider, or social worker) who are 1 members of racial and ethnic minority groups; 2 ‘‘(4) any outreach by the State to providers 3 from multiple disciplines of mental health services— 4 ‘‘(A) to provide training on culturally ef- 5 fective, culturally affirming, and linguistically 6 competent services; and 7 ‘‘(B) to increase awareness of community- 8 defined practices by practitioners of racial and 9 ethnic minority groups; and’’. 10 (b) APPLICABILITY.—The amendments made by sub- 11 section (a) shall apply with respect to funding agreements 12 entered into under section 1911 or 1921 of the Public 13 Health Service Act (42 U.S.C. 300x; 42 U.S.C. 300x–21) 14 on or after the date of the enactment of this Act. 15 SEC. 6074. STRONG SUPPORT FOR CHILDREN. 16 (a) DATA ANALYSIS AND STRATEGY IMPLEMENTA- 17 TION TO PREVENT AND MITIGATE CHILDHOOD TRAU- 18 MA.—Title XXXI of the Public Health Service Act (42 19 U.S.C. 300kk) is amended by adding at the end the fol- 20 lowing: 21 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01115 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1116 •S 4486 IS ‘‘SEC. 3102. DATA ANALYSIS AND STRATEGY IMPLEMENTA- 1 TION TO PREVENT AND MITIGATE CHILD- 2 HOOD TRAUMA. 3 ‘‘(a) IN GENERAL.—The Secretary shall establish a 4 program— 5 ‘‘(1) to support the development and implemen- 6 tation of programs that use data analysis methods 7 to identify and facilitate strategies for early inter- 8 vention and prevention, in order to prevent and miti- 9 gate childhood trauma and support communities and 10 families, including— 11 ‘‘(A) improving connections through care 12 coordination; 13 ‘‘(B) aligning community initiatives in tar- 14 geted areas of need; and 15 ‘‘(C) expanding community capacity 16 through cross-sector collaboration; and 17 ‘‘(2) to evaluate the effectiveness of these pro- 18 grams in improving outcomes for children. 19 ‘‘(b) GRANTS.—The Secretary shall award grants to 20 up to 5 eligible entities to carry out the activities described 21 in subsection (a). 22 ‘‘(c) USE OF FUNDS.—A grant for activities under 23 this section shall be used to support the development and 24 implementation of programs that use data analysis meth- 25 ods to identify and facilitate strategies for early interven- 26 VerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01116 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486 pbinns on DSKJLVW7X2PROD with $$_JOB 1117 •S 4486 IS tion and prevention, in order to prevent and mitigate 1 childhood trauma and support communities and families, 2 including as follows: 3 ‘‘(1) Utilize data analysis methods to— 4 ‘‘(A) identify specific geographic areas, 5 such as census tracts, with a high prevalence of 6 adverse childhood experiences and significant 7 risk factors for poor outcomes for children 8 (such as increased risk of experiencing adverse 9 childhood experiences), including areas with 10 high rates of— 11 ‘‘(i) poor public health outcomes in- 12 cluding illness, disease, suicide, and mor- 13 tality; 14 ‘‘(ii) exclusionary discipline practices, 15 including suspensions, expulsions, and re- 16 ferrals to law enforcement, as well as low 17 graduation rates; 18 ‘‘(iii) substance use disorders; 19