Text of US SB 4819 (2020)

II 116TH CONGRESS 2D SESSION S. 4819 To improve the health of minority individuals, and for other purposes. IN THE SENATE OF THE UNITED STATES OCTOBER 20 (legislative day, OCTOBER 19), 2020 Ms. HIRONO (for herself, Mrs. GILLIBRAND, Mr. MERKLEY, Ms. DUCKWORTH, Mr. BLUMENTHAL, Mr. SANDERS, Mr. BOOKER, Mr. CARDIN, and Mr. KAINE) 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 2020’’. 5 SEC. 2. TABLE OF CONTENTS. 6 The table of contents of this Act is as follows: 7 Sec. 1. Short title. Sec. 2. Table of contents. Sec. 3. Findings. TITLE I—DATA COLLECTION AND REPORTING VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6211 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 2 •S 4819 IS Sec. 101. Amendment to the Public Health Service Act. Sec. 102. Elimination of prerequisite of direct appropriations for data collection and analysis. Sec. 103. Collection of data for the Medicare program. Sec. 104. Revision of HIPAA claims standards. Sec. 105. National Center for Health Statistics. Sec. 106. Disparities data collected by the Federal Government. Sec. 107. Data collection and analysis grants to minority-serving institutions. Sec. 108. Standards for measuring sexual orientation, gender identity, and so- cioeconomic status in collection of health data. Sec. 109. Safety and effectiveness of drugs with respect to racial and ethnic background. Sec. 110. Improving health data regarding Native Hawaiians and other Pacific Islanders. Sec. 111. Clarification of simplified administrative reporting requirement. TITLE II—CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH AND HEALTH CARE Sec. 201. Definitions; findings. Sec. 202. Improving access to services for individuals with limited English pro- ficiency. Sec. 203. Ensuring standards for culturally and linguistically appropriate serv- ices in health care. Sec. 204. Culturally and linguistically appropriate health care in the Public Health Service Act. Sec. 205. Pilot program for improvement and development of State medical in- terpreting services. Sec. 206. Training tomorrow’s doctors for culturally and linguistically appro- priate care: graduate medical education. Sec. 207. Federal reimbursement for culturally and linguistically appropriate services under the Medicare, Medicaid, and State Children’s Health Insurance Programs. Sec. 208. Increasing understanding of and improving health literacy. Sec. 209. Requirements for health programs or activities receiving Federal funds. Sec. 210. Report on Federal efforts to provide culturally and linguistically ap- propriate health care services. Sec. 211. English for speakers of other languages. Sec. 212. Implementation. Sec. 213. Language access services. Sec. 214. Medically underserved populations. TITLE III—HEALTH WORKFORCE DIVERSITY Sec. 301. Amendment to the Public Health Service Act. Sec. 302. Hispanic-serving institutions, historically black colleges and univer- sities, Asian American and Native American Pacific Islander- serving institutions, Tribal colleges, regional community-based organizations, and national minority medical associations. Sec. 303. Loan repayment program of Centers for Disease Control and Preven- tion. Sec. 304. Cooperative agreements for online degree programs at schools of pub- lic health and schools of allied health. Sec. 305. Sense of Congress on the mission of the National Health Care Work- force Commission. VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 3 •S 4819 IS Sec. 306. Scholarship and fellowship programs. Sec. 307. McNair Postbaccalaureate Achievement Program. Sec. 308. Rules for determination of full-time equivalent residents for cost-re- porting periods. Sec. 309. Developing and implementing strategies for local health equity. Sec. 310. Loan forgiveness for mental and behavioral health social workers. Sec. 311. Health Professions Workforce Fund. Sec. 312. Findings; sense of Congress relating to graduate medical education. Sec. 313. Career support for skilled, internationally educated health profes- sionals. Sec. 314. Study and report on strategies for increasing diversity. Sec. 315. Conrad State 30 program; physician retention. TITLE IV—IMPROVING HEALTH CARE ACCESS AND QUALITY Subtitle A—Improvement of Coverage Sec. 401. Repeal of requirement for documentation evidencing citizenship or nationality under the Medicaid program. Sec. 402. Removing citizenship and immigration barriers to access to affordable health care under ACA. Sec. 403. Study on the uninsured. Sec. 404. Medicaid in the territories. Sec. 405. Extension of Medicare secondary payer. Sec. 406. Indian defined in title I of the Patient Protection and Affordable Care Act. Sec. 407. Removing Medicare barrier to health care. Sec. 408. 100 percent FMAP for medical assistance provided by urban Indian health centers. Sec. 409. 100 percent FMAP for medical assistance provided to a Native Ha- waiian through a federally qualified health center or a Native Hawaiian health care system under the Medicaid program. Sec. 410. Medicaid coverage for citizens of freely associated states. Subtitle B—Expansion of Access Sec. 412. Amendment to the Public Health Service Act. Sec. 413. Protecting sensitive locations. Sec. 414. Grants for racial and ethnic approaches to community health. Sec. 415. Border health grants. Sec. 416. Critical access hospital improvements. Sec. 417. Establishment of Rural Community Hospital (RCH) Program. Sec. 418. Medicare remote monitoring pilot projects. Sec. 419. Rural Health Quality Advisory Commission and demonstration projects. Sec. 420. Rural health care services. Sec. 421. Community health center collaborative access expansion. Sec. 422. Facilitating the provision of telehealth services across State lines. Sec. 423. Scoring of preventive health savings. Sec. 424. Sense of Congress on Maintenance of Effort Provisions Regarding Children’s Health. Sec. 425. Protection of the HHS Offices of Minority Health. Sec. 426. Office of Minority Health in Veterans Health Administration of De- partment of Veterans Affairs. Sec. 427. Study of DSH payments to ensure hospital access for low-income pa- tients. VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6211 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 4 •S 4819 IS Sec. 428. Assistant Secretary of the Indian Health Service. Sec. 429. Reauthorization of the Native Hawaiian Health Care Improvement Act. Sec. 430. Availability of non-English language speaking providers. Sec. 431. Access to essential community providers. Sec. 432. Provider network adequacy in communities of color. Sec. 433. Improving access to dental care. Sec. 434. Providing for a special enrollment period for pregnant individuals. Sec. 435. Coverage of maternity care for dependent children. Sec. 436. Federal Employee Health Benefit Plans. Sec. 437. Continuation of Medicaid income eligibility standard for pregnant in- dividuals and infants. Subtitle C—Advancing Health Equity Through Payment and Delivery Reform Sec. 441. Sense of Congress. Sec. 442. Centers for Medicare & Medicaid Services reporting and value based programs. Sec. 443. Development and testing of disparity reducing delivery and payment models. Sec. 444. Diversity in Centers for Medicare and Medicaid consultation. Sec. 445. Supporting safety net and community-based providers to compete in value-based payment systems. Subtitle D—Health Empowerment Zones Sec. 451. Short title. Sec. 452. Findings. Sec. 453. Designation of health empowerment zones. Sec. 454. Assistance to those seeking designation. Sec. 455. Benefits of designation. Sec. 456. Definition of Secretary. Sec. 457. Authorization of appropriations. TITLE V—IMPROVING HEALTH OUTCOMES FOR WOMEN, CHILDREN, AND FAMILIES Subtitle A—In General Sec. 501. Grants to promote health for underserved communities. Sec. 502. Removing barriers to health care and nutrition assistance for chil- dren, pregnant persons, and lawfully present individuals. Sec. 503. Repeal of denial of SNAP benefits. Sec. 504. Birth defects prevention, risk reduction, and awareness. Sec. 505. MOMMA’s Act. Sec. 506. Rural maternal and obstetric modernization of services. Sec. 507. Decreasing the risk factors for sudden unexpected infant death and sudden unexplained death in childhood. Sec. 508. Reducing unintended teenage pregnancies. Sec. 509. Gestational diabetes. Sec. 510. Emergency contraception education and information programs. Sec. 511. Comprehensive sex education programs. Sec. 512. Compassionate assistance for rape emergencies. Sec. 513. Access to birth control duties of pharmacies to ensure provision of FDA-approved contraception. Sec. 514. Additional focus area for the Office on Women’s Health. VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6211 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 5 •S 4819 IS Sec. 515. Interagency Coordinating Committee on the Promotion of Optimal Maternity Outcomes. Sec. 516. Consumer education campaign. Sec. 517. Bibliographic database of systematic reviews for care of childbearing individuals and newborns. Sec. 518. Expansion of CDC Prevention Research Centers Program to include Centers on Optimal Maternity Outcomes. Sec. 519. Expanding models allowed to be tested by Center for Medicare & Medicaid Innovation to include maternity care models. Sec. 520. Development of interprofessional maternity care educational models and tools. Sec. 521. Including services furnished by certain students, interns, and resi- dents supervised by certified nurse midwives within inpatient hospital services under Medicare. Sec. 522. Grants to professional organizations to increase diversity in maternal, reproductive, and sexual health professionals. Sec. 523. Interagency update to the quality family planning guidelines. Sec. 524. Dissemination of the quality family planning guidelines. Subtitle B—Pregnancy Screening Sec. 531. Pregnancy intention screening initiative demonstration program. TITLE VI—MENTAL HEALTH Sec. 601. Mental health findings. Sec. 602. 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. 603. Integrated Health Care Demonstration Program. Sec. 604. Addressing racial and ethnic mental health disparities research gaps. Sec. 605. Health professions competencies to address racial and ethnic mental health disparities. Sec. 606. Geoaccess study. Sec. 607. Asian American, Native Hawaiian, Pacific Islander, and Hispanic and Latino behavioral and mental health outreach and education strategies. Sec. 608. Mental health in schools. Sec. 609. Building an effective workforce in mental health. Sec. 610. Mental health at the border. TITLE VII—ADDRESSING HIGH IMPACT MINORITY DISEASES Subtitle A—Cancer Sec. 701. Lung cancer mortality reduction. Sec. 702. Expanding prostate cancer research, outreach, screening, testing, ac- cess, and treatment effectiveness. Sec. 703. Prostate research, imaging, and men’s education (PRIME). Sec. 704. Prostate cancer detection research and education. Sec. 705. National Prostate Cancer Council. Sec. 706. Improved Medicaid coverage for certain breast and cervical cancer pa- tients in the territories. Sec. 707. Cancer prevention and treatment demonstration for ethnic and racial minorities. Sec. 708. Reducing cancer disparities within Medicare. VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6211 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 6 •S 4819 IS Sec. 709. Cancer clinical trials. Subtitle B—Viral Hepatitis and Liver Cancer Control and Prevention Sec. 711. Viral hepatitis and liver cancer control and prevention. Subtitle C—Acquired Bone Marrow Failure Diseases Sec. 721. Acquired bone marrow failure diseases. Subtitle D—Cardiovascular Disease, Chronic Disease, Obesity, and Other Disease Issues Sec. 731. Guidelines for disease screening for minority patients. Sec. 732. CDC Wisewoman Screening Program. Sec. 733. Report on cardiovascular care for women and minorities. Sec. 734. Coverage of comprehensive tobacco cessation services in Medicaid and private health insurance. Sec. 735. Clinical research funding for oral health. Sec. 736. Participation by Medicaid beneficiaries in approved clinical trials. Sec. 737. Guide on evidence-based strategies for public health department obe- sity prevention programs. Subtitle E—HIV/AIDS Sec. 741. Statement of policy. Sec. 742. Findings. Sec. 743. Additional funding for AIDS drug assistance program treatments. Sec. 744. Enhancing the national HIV surveillance system. Sec. 745. Evidence-based strategies for improving linkage to and retention in appropriate care. Sec. 746. Improving entry into and retention in care and antiretroviral adher- ence for persons with HIV. Sec. 747. Services to reduce HIV/AIDS in racial and ethnic minority commu- nities. Sec. 748. Minority AIDS initiative. Sec. 749. Health care professionals treating individuals with HIV. Sec. 750. HIV/AIDS provider loan repayment program. Sec. 751. Dental education loan repayment program. Sec. 752. Reducing new HIV infections among injecting drug users. Sec. 753. Report on impact of HIV/AIDS in vulnerable populations. Sec. 754. National HIV/AIDS observance days. Sec. 755. Review of all Federal and State laws, policies, and regulations regard- ing the criminal prosecution of individuals for HIV-related of- fenses. Sec. 756. Expanding support for condoms in prisons. Sec. 757. Automatic reinstatement or enrollment in Medicaid for people who test positive for HIV before reentering communities. Sec. 758. Stop HIV in prison. Sec. 759. Support data system review and indicators for monitoring HIV care. Sec. 760. Transfer of funds for implementation of ending the HIV epidemic: a plan for America. Subtitle F—Diabetes Sec. 771. Research, treatment, and education. Sec. 772. Research, education, and other activities. VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6211 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 7 •S 4819 IS Sec. 773. Programs to educate health providers on the causes and effects of di- abetes in minority populations. Sec. 774. Research, education, and other activities regarding diabetes in Amer- ican Indian populations. Sec. 775. Updated report on health disparities. Subtitle G—Lung Disease Sec. 776. Expansion of the National Asthma Education and Prevention Pro- gram. Sec. 777. Asthma-related activities of the Centers for Disease Control and Pre- vention. Sec. 778. Influenza and pneumonia vaccination campaign. Sec. 779. Chronic obstructive pulmonary disease action plan. Subtitle H—Tuberculosis Sec. 781. Elimination of all forms of tuberculosis. Sec. 782. Additional funding for States in combating and eliminating tuber- culosis. Sec. 783. Strengthening clinical research funding for tuberculosis. Subtitle I—Osteoarthritis and Musculoskeletal Diseases Sec. 785. Findings. Sec. 786. Osteoarthritis and other musculoskeletal health-related activities of the Centers for Disease Control and Prevention. Sec. 787. Grants for comprehensive osteoarthritis and musculoskeletal disease health education within health professions schools. Subtitle J—Sleep and Circadian Rhythm Disorders Sec. 791. Short title; findings. Sec. 792. Sleep and circadian rhythm disorders research activities of the Na- tional Institutes of Health. Sec. 793. Sleep and circadian rhythm health disparities-related activities of the Centers for Disease Control and Prevention. Sec. 794. Grants for comprehensive sleep and circadian health education within health professions schools. Sec. 795. Report on impact of sleep and circadian health disorders in vulner- able and racial/ethnic populations. Subtitle K—Kidney Disease Research, Surveillance, Prevention, and Treatment Sec. 797. Kidney disease, research, surveillance, prevention, and treatment. Sec. 798. Kidney disease research in minority populations. Sec. 799. Kidney disease action plan. Sec. 799A. Home dialysis and increasing end-stage renal disease treatment mo- dalities in minority communities action plan. Sec. 799B. Increasing kidney transplants in minority populations. Sec. 799C. Environmental and occupational health programs. Sec. 799D. Understanding the treatment patterns associated with providing care and treatment of kidney failure in minority populations. Sec. 799E. Improving access in underserved areas. TITLE VIII—HEALTH INFORMATION TECHNOLOGY VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6211 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 8 •S 4819 IS Sec. 800. Definitions. Subtitle A—Reducing Health Disparities Through Health IT Sec. 801. HRSA assistance to health centers for promotion of Health IT. Sec. 802. Assessment of impact of Health IT on racial and ethnic minority communities; outreach and adoption of Health IT in such com- munities. Sec. 803. Nondiscrimination and health equity in health information tech- nology. Sec. 804. Language access in health information technology. Subtitle B—Modifications To Achieve Parity in Existing Programs Sec. 811. Extending funding to strengthen the Health IT infrastructure in ra- cial and ethnic minority communities. Sec. 812. Extending competitive grants for the development of loan programs to facilitate adoption of certified EHR technology by providers serving racial and ethnic minority groups. Sec. 813. Authorization of appropriations. Subtitle C—Additional Research and Studies Sec. 821. Data collection and assessments conducted in coordination with mi- nority-serving institutions. Sec. 822. Study of health information technology in medically underserved com- munities. Sec. 823. Assessment of use and misuse of de-identified health data. Subtitle D—Closing Gaps in Funding To Adopt Certified EHRs Sec. 831. Extending Medicaid EHR incentive payments to rehabilitation facili- ties, long-term care facilities, and home health agencies. Sec. 832. Extending physician assistant eligibility for Medicaid electronic health record incentive payments. TITLE IX—ACCOUNTABILITY AND EVALUATION Sec. 901. Prohibition on discrimination in Federal assisted health care services and research programs on the basis of sex (including sex ori- entation, gender identity, and pregnancy, including termination of pregnancy), race, color, national origin, marital status, fa- milial status, sexual orientation, gender identity, or disability status. Sec. 902. Treatment of Medicare payments under title VI of the Civil Rights Act of 1964. Sec. 903. Accountability and transparency within the Department of Health and Human Services. Sec. 904. United States Commission on Civil Rights. Sec. 905. Sense of Congress concerning full funding of activities to eliminate racial and ethnic health disparities. Sec. 906. GAO and NIH reports. TITLE X—ADDRESSING SOCIAL DETERMINANTS AND IMPROVING ENVIRONMENTAL JUSTICE Subtitle A—In General VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6211 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 9 •S 4819 IS Sec. 1001. Definitions. Sec. 1002. Findings. Sec. 1003. Health impact assessments. Sec. 1004. Implementation of recommendations by Environmental Protection Agency. Sec. 1005. Grant program to conduct environmental health improvement activi- ties and to improve social determinants of health. Sec. 1006. Additional research on the relationship between the built environ- ment and the health of community residents. Sec. 1007. Environment and public health restoration. Sec. 1008. GAO report on health effects of Deepwater Horizon oil rig explosion in the Gulf Coast. Sec. 1009. Establish an interagency counsel and grant programs on social de- terminants of health. Sec. 1010. Correcting hurtful and alienating names in government expression (CHANGE). Subtitle B—Gun Violence Sec. 1011. Findings. Sec. 1012. Reaffirming research authority of the Centers for Disease Control and Prevention. Sec. 1013. National Violent Death Reporting System. Sec. 1014. Report on effects of gun violence on public health. Sec. 1015. Report on effects of gun violence on mental health in minority com- munities. SEC. 3. FINDINGS. 1 The Congress finds as follows: 2 (1) The population of racial and ethnic minori- 3 ties is expected to increase over the next few dec- 4 ades, yet racial and ethnic minorities have the poor- 5 est health status and face substantial cultural, so- 6 cial, and economic barriers to obtaining quality 7 health care. 8 (2) Health disparities are a function of not only 9 access to health care, but also the social deter- 10 minants of health—including the environment, the 11 physical structure of communities, nutrition and 12 food options, educational attainment, employment, 13 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 10 •S 4819 IS race, ethnicity, sex, geography, language preference, 1 immigrant or citizenship status, sexual orientation, 2 gender identity, socioeconomic status, or disability 3 status—that directly and indirectly affect the health, 4 health care, and wellness of individuals and commu- 5 nities. 6 (3) Over the next few decades, the United 7 States will face a shortage of health care providers 8 and allied health workers. 9 (4) All efforts to reduce health disparities and 10 barriers to quality health services require better and 11 more consistent data and better and more consistent 12 collection of and access to data. 13 (5) A full range of culturally and linguistically 14 appropriate health care and public health services 15 must be available and accessible in every community. 16 (6) Racial and ethnic minorities and under- 17 served populations must be included early and equi- 18 tably in health reform innovations. 19 (7) Efforts to improve minority health have 20 been limited by inadequate resources in funding, 21 staffing, stewardship, and accountability. Targeted 22 investments that are focused on disparities elimi- 23 nation must be made in providing care and services 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 11 •S 4819 IS that are community-based, including prevention and 1 policies addressing social determinants of health. 2 (8) In 2011, the Department of Health and 3 Human Services developed the HHS Action Plan to 4 Reduce Racial and Ethnic Health Disparities and 5 the National Stakeholder Strategy for Achieving 6 Health Equity, which are 2 strategic plans that rep- 7 resent the first coordinated roadmap in the United 8 States to reducing health disparities. These com- 9 prehensive plans, along with the National Prevention 10 Strategy issued by the National Prevention Council 11 of the Department of Health and Human Services, 12 Healthy People 2030, and the National Quality 13 Strategy of the Agency for Healthcare Research and 14 Quality, as well as critical resources such as the 15 2012 National Healthcare Quality and Disparities 16 Reports, will work to increase the number of people 17 in the United States who are healthy at every stage 18 of life. 19 (9) The Secretary of Health and Human Serv- 20 ices has also reviewed and advanced updated clinical 21 guidelines and developed other strategic planning 22 documents to combat health disparities with a high 23 impact on minority populations and to provide high- 24 quality family planning services. Such guidelines and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 12 •S 4819 IS documents include the National HIV/AIDS Strategy, 1 the Action Plan for the Prevention, Care, and Treat- 2 ment of Viral Hepatitis, and recommendations of the 3 Centers for Disease Control and Prevention and the 4 Office of Population Affairs. 5 (10) The Patient Protection and Affordable 6 Care Act (Public Law 111–148), as amended by the 7 Health Care and Education Reconciliation Act (Pub- 8 lic Law 111–152), represents the biggest advance- 9 ment for minority health in the 40 years imme- 10 diately preceding the enactment of this Act. 11 (11) The Health Information Technology for 12 Economic and Clinical Health Act of 2009, part of 13 the American Recovery and Reinvestment Act of 14 2009 (Public Law 111–5), provides that the nation- 15 wide health information exchange infrastructure be 16 developed and used to reduce health disparities, 17 among other purposes. 18 TITLE I—DATA COLLECTION 19 AND REPORTING 20 SEC. 101. AMENDMENT TO THE PUBLIC HEALTH SERVICE 21 ACT. 22 (a) PURPOSE.—It is the purpose of the amendment 23 made by this section to promote data collection, analysis, 24 and reporting by race, ethnicity, sex, primary language, 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 13 •S 4819 IS sexual orientation, disability status, gender identity, age, 1 and socioeconomic status among federally supported 2 health programs. 3 (b) AMENDMENT.—Title XXXIV of the Public 4 Health Service Act, as added by titles II and III of this 5 Act, is further amended by inserting after subtitle B the 6 following: 7 ‘‘Subtitle C—Strengthening Data 8 Collection, Improving Data 9 Analysis, and Expanding Data 10 Reporting 11 ‘‘SEC. 3431. HEALTH DISPARITY DATA. 12 ‘‘(a) REQUIREMENTS.— 13 ‘‘(1) IN GENERAL.—Each health-related pro- 14 gram shall— 15 ‘‘(A) require the collection, by the agency 16 or program involved, of data on the race, eth- 17 nicity, sex, primary language, sexual orienta- 18 tion, disability status, gender identity, age, and 19 socioeconomic status of each applicant for and 20 recipient of health-related assistance under such 21 program, including— 22 ‘‘(i) using, at a minimum, standards 23 for data collection on race, ethnicity, sex, 24 primary language, sexual orientation, gen- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 14 •S 4819 IS der identity, age, socioeconomic status, and 1 disability status as each are developed 2 under section 3101; 3 ‘‘(ii) collecting data for additional 4 population groups if such groups can be 5 aggregated into the race and ethnicity cat- 6 egories outlined by standards developed 7 under section 3101; 8 ‘‘(iii) using, where practicable, the 9 standards developed by the Health and 10 Medicine Division of the National Acad- 11 emies of Sciences, Engineering, and Medi- 12 cine (formerly known as the ‘Institute of 13 Medicine’) in the 2009 publication, entitled 14 ‘Race, Ethnicity, and Language Data: 15 Standardization for Health Care Quality 16 Improvement’; and 17 ‘‘(iv) where practicable, collecting 18 such data through self-reporting; 19 ‘‘(B) with respect to the collection of the 20 data described in subparagraph (A), for appli- 21 cants and recipients who are minors, require 22 communication assistance in speech or writing, 23 and for applicants and recipients who are other- 24 wise legally incapacitated, require that— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 15 •S 4819 IS ‘‘(i) such data be collected from the 1 parent or legal guardian of such an appli- 2 cant or recipient; and 3 ‘‘(ii) the primary language of the par- 4 ent or legal guardian of such an applicant 5 or recipient be collected; 6 ‘‘(C) systematically analyze such data 7 using the smallest appropriate units of analysis 8 feasible to detect racial and ethnic disparities, 9 as well as disparities along the lines of primary 10 language, sex, disability status, sexual orienta- 11 tion, gender identity, age, and socioeconomic 12 status in health and health care, and report the 13 results of such analysis to the Secretary, the 14 Director of the Office for Civil Rights, each 15 agency listed in section 3101(c)(1), the Com- 16 mittee on Health, Education, Labor, and Pen- 17 sions and the Committee on Finance of the 18 Senate, and the Committee on Energy and 19 Commerce and the Committee on Ways and 20 Means of the House of Representatives; 21 ‘‘(D) provide such data to the Secretary on 22 at least an annual basis; and 23 ‘‘(E) ensure that the provision of assist- 24 ance to an applicant or recipient of assistance 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 16 •S 4819 IS is not denied or otherwise adversely affected be- 1 cause of the failure of the applicant or recipient 2 to provide race, ethnicity, primary language, 3 sex, sexual orientation, disability status, gender 4 identity, age, and socioeconomic status data. 5 ‘‘(2) RULES OF CONSTRUCTION.—Nothing in 6 this subsection shall be construed to— 7 ‘‘(A) permit the use of information col- 8 lected under this subsection in a manner that 9 would adversely affect any individual providing 10 any such information; or 11 ‘‘(B) diminish any requirements, including 12 such requirements in effect on or after the date 13 of enactment of this section, on health care pro- 14 viders to collect data. 15 ‘‘(3) NO COMPELLED DISCLOSURE OF DATA.— 16 This title does not authorize any health care pro- 17 vider, Federal official, or other entity to compel the 18 disclosure of any data collected under this title. The 19 disclosure of any such data by an individual pursu- 20 ant to this title shall be strictly voluntary. 21 ‘‘(b) PROTECTION OF DATA.—The Secretary shall 22 ensure (through the promulgation of regulations or other- 23 wise) that all data collected pursuant to subsection (a) are 24 protected— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 17 •S 4819 IS ‘‘(1) under the same privacy protections as the 1 Secretary applies to other health data under the reg- 2 ulations promulgated under section 264(c) of the 3 Health Insurance Portability and Accountability Act 4 of 1996 relating to the privacy of individually identi- 5 fiable health information and other protections; and 6 ‘‘(2) from all inappropriate internal use by any 7 entity that collects, stores, or receives the data, in- 8 cluding use of such data in determinations of eligi- 9 bility (or continued eligibility) in health plans, and 10 from other inappropriate uses, as defined by the 11 Secretary. 12 ‘‘(c) NATIONAL PLAN OF THE DATA COUNCIL.—The 13 Secretary shall develop and implement a national plan to 14 ensure the collection of data in a culturally and linguis- 15 tically appropriate manner, to improve the collection, anal- 16 ysis, and reporting of racial, ethnic, sex, primary lan- 17 guage, sexual orientation, disability status, gender iden- 18 tity, age, and socioeconomic status data at the Federal, 19 State, territorial, Tribal, and local levels, including data 20 to be collected under subsection (a), and to ensure that 21 data collection activities carried out under this section are 22 in compliance with standards developed under section 23 3101. The Data Council of the Department of Health and 24 Human Services, in consultation with the National Com- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 18 •S 4819 IS mittee on Vital Health Statistics, the Office of Minority 1 Health, Office on Women’s Health, and other appropriate 2 public and private entities, shall make recommendations 3 to the Secretary concerning the development, implementa- 4 tion, and revision of the national plan. Such plan shall 5 include recommendations on how to— 6 ‘‘(1) implement subsection (a) while minimizing 7 the cost and administrative burdens of data collec- 8 tion and reporting; 9 ‘‘(2) expand knowledge among Federal agen- 10 cies, States, territories, Indian Tribes, counties, mu- 11 nicipalities, health providers, health plans, and the 12 general public that data collection, analysis, and re- 13 porting by race, ethnicity, sex, primary language, 14 sexual orientation, gender identity, age, socio- 15 economic status, and disability status is legal and 16 necessary to assure equity and nondiscrimination in 17 the quality of health care services; 18 ‘‘(3) ensure that future patient record systems 19 follow Federal standards promulgated under the 20 Health Information Technology for Economic and 21 Clinical Health Act for the collection and meaningful 22 use of electronic health data on race, ethnicity, sex, 23 primary language, sexual orientation, gender iden- 24 tity, age, socioeconomic status, and disability status; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 19 •S 4819 IS ‘‘(4) improve health and health care data collec- 1 tion and analysis for more population groups if such 2 groups can be aggregated into the minimum race 3 and ethnicity categories, including exploring the fea- 4 sibility of enhancing collection efforts in States, 5 counties, and municipalities for racial and ethnic 6 groups that comprise a significant proportion of the 7 population of the State, county, or municipality; 8 ‘‘(5) provide researchers with greater access to 9 racial, ethnic, primary language, sex, sexual orienta- 10 tion, gender identity, age, socioeconomic status data, 11 and disability status data, subject to all applicable 12 privacy and confidentiality requirements, including 13 HIPAA privacy and security law as defined in sec- 14 tion 3009; and 15 ‘‘(6) safeguard and prevent the misuse of data 16 collected under subsection (a). 17 ‘‘(d) COMPLIANCE WITH STANDARDS.—Data col- 18 lected under subsection (a) shall be obtained, maintained, 19 and presented (including for reporting purposes) in ac- 20 cordance with standards developed under section 3101. 21 ‘‘(e) ANALYSIS OF HEALTH DISPARITY DATA.—The 22 Secretary, acting through the Director of the Agency for 23 Healthcare Research and Quality and in coordination with 24 the Assistant Secretary for Planning and Evaluation, the 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 20 •S 4819 IS Administrator of the Centers for Medicare & Medicaid 1 Services, the Director of the National Center for Health 2 Statistics, and the Director of the National Institutes of 3 Health, shall provide technical assistance to agencies of 4 the Department of Health and Human Services in meeting 5 Federal standards for health disparity data collection and 6 for analysis of racial, ethnic, and other disparities in 7 health and health care in programs conducted or sup- 8 ported by such agencies by— 9 ‘‘(1) identifying appropriate quality assurance 10 mechanisms to monitor for health disparities; 11 ‘‘(2) specifying the clinical, diagnostic, or thera- 12 peutic measures which should be monitored; 13 ‘‘(3) developing new quality measures relating 14 to racial and ethnic disparities and their overlap 15 with other disparity factors in health and health 16 care; 17 ‘‘(4) identifying the level at which data analysis 18 should be conducted; and 19 ‘‘(5) sharing data with external organizations 20 for research and quality improvement purposes. 21 ‘‘(f) DEFINITION OF HEALTH-RELATED PROGRAM.— 22 In this section, the term ‘health-related program’ means 23 a program that is operated by the Secretary, or that re- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 21 •S 4819 IS ceives funding or reimbursement, in whole or in part, ei- 1 ther directly or indirectly from the Secretary— 2 ‘‘(1) for activities under the Social Security Act 3 for health care services; or 4 ‘‘(2) for providing Federal financial assistance 5 for health care, biomedical research, or health serv- 6 ices research or for otherwise improving the health 7 of the public. 8 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 9 are authorized to be appropriated to carry out this section 10 such sums as may be necessary for each of fiscal years 11 2021 through 2025. 12 ‘‘SEC. 3432. ESTABLISHING GRANTS FOR DATA COLLECTION 13 IMPROVEMENT ACTIVITIES. 14 ‘‘(a) IN GENERAL.—The Secretary, acting through 15 the Director of the Agency for Healthcare Research and 16 Quality and in consultation with the Deputy Assistant 17 Secretary for Minority Health, the Director of the Na- 18 tional Institutes of Health, the Assistant Secretary for 19 Planning and Evaluation, and the Director of the National 20 Center for Health Statistics, shall establish a technical as- 21 sistance program under which the Secretary provides 22 grants to eligible entities to assist such entities in com- 23 plying with section 3431. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 22 •S 4819 IS ‘‘(b) TYPES OF ASSISTANCE.—A grant provided 1 under this section may be used to— 2 ‘‘(1) enhance or upgrade computer technology 3 that will facilitate collection, analysis, and reporting 4 of racial, ethnic, primary language, sexual orienta- 5 tion, sex, gender identity, socioeconomic status, and 6 disability status data; 7 ‘‘(2) improve methods for health data collection 8 and analysis, including additional population groups 9 if such groups can be aggregated into the race and 10 ethnicity categories outlined by standards developed 11 under section 3101; 12 ‘‘(3) develop mechanisms for submitting col- 13 lected data subject to any applicable privacy and 14 confidentiality regulations; and 15 ‘‘(4) develop educational programs to inform 16 health plans, health providers, health-related agen- 17 cies, and the general public that data collection and 18 reporting by race, ethnicity, primary language, sex- 19 ual orientation, sex, gender identity, disability sta- 20 tus, and socioeconomic status are legal and essential 21 for eliminating health and health care disparities. 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 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 23 •S 4819 IS care organization, or health plan making a demonstrated 1 effort to bring data collections into compliance with sec- 2 tion 3431. 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 2021 through 2025. 7 ‘‘SEC. 3433. 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 of the Centers for Disease Control 13 and Prevention, and other agencies within the De- 14 partment of Health and Human Services as the Sec- 15 retary determines appropriate, shall develop and im- 16 plement an ongoing and sustainable national strat- 17 egy for oversampling underrepresented populations 18 within the categories of race, ethnicity, sex, primary 19 language, sexual orientation, disability status, gen- 20 der identity, and socioeconomic status as determined 21 appropriate by the Secretary in Federal health sur- 22 veys and program data collections. Such national 23 strategy shall include a strategy for oversampling of 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 24 •S 4819 IS Asian Americans, Native Hawaiians, and Pacific Is- 1 landers. 2 ‘‘(2) CONSULTATION.—In developing and imple- 3 menting a national strategy, as described in para- 4 graph (1), not later than 180 days after the date of 5 the enactment of this section, the Secretary shall— 6 ‘‘(A) consult with representatives of com- 7 munity groups, nonprofit organizations, non- 8 governmental organizations, and government 9 agencies working with underrepresented popu- 10 lations; 11 ‘‘(B) solicit the participation of representa- 12 tives from other Federal departments and agen- 13 cies, including subagencies of the Department 14 of Health and Human Services; and 15 ‘‘(C) consult on, and use as models, the 16 2014 National Health Interview Survey over- 17 sample of Native Hawaiian and Pacific Islander 18 populations and the 2017 Behavioral Risk Fac- 19 tor Surveillance System oversample of American 20 Indian and Alaska Native communities. 21 ‘‘(b) PROGRESS REPORT.—Not later than 2 years 22 after the date of the enactment of this section, the Sec- 23 retary shall submit to the Congress a progress report, 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 25 •S 4819 IS which shall include the national strategy described in sub- 1 section (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 2021 through 2025.’’. 6 SEC. 102. 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) is amended— 11 (1) by striking subsection (h); and 12 (2) by redesignating subsection (i) as subsection 13 (h). 14 SEC. 103. COLLECTION OF DATA FOR THE MEDICARE PRO- 15 GRAM. 16 Part A of title XI of the Social Security Act (42 17 U.S.C. 1301 et seq.) is amended by adding at the end 18 the following: 19 ‘‘COLLECTION OF DATA FOR THE MEDICARE PROGRAM 20 ‘‘SEC. 1150C. 21 ‘‘(a) REQUIREMENT.— 22 ‘‘(1) IN GENERAL.—The Commissioner of So- 23 cial Security, in consultation with the Administrator 24 of the Centers for Medicare & Medicaid Services, 25 shall collect data on the race, ethnicity, sex, primary 26 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 26 •S 4819 IS language, sexual orientation, gender identity, socio- 1 economic status, and disability status of all appli- 2 cants for Social Security benefits under title II or 3 Medicare benefits under title XVIII. 4 ‘‘(2) DATA COLLECTION STANDARDS.—In col- 5 lecting data under paragraph (1), the Commissioner 6 of Social Security shall at least use the standards 7 for data collection developed under section 3101 of 8 the Public Health Service Act or the standards de- 9 veloped by the Office of Management and Budget, 10 whichever is more disaggregated. In the event there 11 are no standards for the demographic groups listed 12 under paragraph (1), the Commissioner shall consult 13 with stakeholder groups representing the various 14 identities as well as with the Office of Minority 15 Health within the Centers for Medicare & Medicaid 16 Services to develop appropriate standards. 17 ‘‘(3) DATA FOR ADDITIONAL POPULATION 18 GROUPS.—Where practicable, the information col- 19 lected by the Commissioner of Social Security under 20 paragraph (1) shall include data for additional popu- 21 lation groups if such groups can be aggregated into 22 the race and ethnicity categories outlined by the 23 data collection standards described in paragraph (2). 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 27 •S 4819 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 an indi- 17 vidual’s entitlement to, or enrollment for, benefits 18 under title XVIII, the Commissioner of Social Secu- 19 rity shall transmit the demographic data of the indi- 20 vidual as collected under paragraph (1) to the Cen- 21 ters for Medicare & Medicaid Services. 22 ‘‘(7) ANALYSIS AND REPORTING OF DATA.— 23 With respect to data transmitted under paragraph 24 (6), the Administrator of the Centers for Medicare 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 28 •S 4819 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 as ap- 7 propriate; 8 ‘‘(C) make such data available to research- 9 ers, under the protections outlined in paragraph 10 (8); 11 ‘‘(D) provide opportunities to individuals 12 entitled to, or enrolled for, benefits under title 13 XVIII to submit updated data; and 14 ‘‘(E) ensure that the provision of assist- 15 ance or benefits to an applicant is not denied 16 or otherwise adversely affected because of the 17 failure of the applicant to provide any of the 18 data collected under paragraph (1). 19 ‘‘(8) PROTECTION OF DATA.—The Commis- 20 sioner of Social Security shall ensure (through the 21 promulgation of regulations or otherwise) that all 22 data collected pursuant to this subsection is pro- 23 tected— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 29 •S 4819 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 may, 19 either directly or by grant or contract, provide technical 20 assistance to enable any entity to comply with the require- 21 ments of this section or with regulations implementing this 22 section. 23 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 24 are authorized to be appropriated to carry out this section 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 30 •S 4819 IS $500,000,000 for fiscal year 2021 and $100,000,000 for 1 each fiscal year thereafter.’’. 2 SEC. 104. 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 race, ethnicity, and primary language in a health-re- 9 lated transaction, to require— 10 (1) the use, at a minimum, of standards for 11 data collection on race, ethnicity, primary language, 12 disability, sex, sexual orientation, gender identity, 13 and socioeconomic status developed under section 14 3101 of the Public Health Service Act (42 U.S.C. 15 300kk); and 16 (2) in consultation with the Office of the Na- 17 tional Coordinator for Health Information Tech- 18 nology, the designation of the appropriate racial, 19 ethnic, primary language, disability, sex, and other 20 code sets as required for claims and enrollment data. 21 (b) DISSEMINATION.—The Secretary of Health and 22 Human Services shall disseminate the new standards de- 23 veloped under subsection (a) to all entities that are subject 24 to the regulations described in such subsection and provide 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 31 •S 4819 IS technical assistance with respect to the collection of the 1 data involved. 2 (c) COMPLIANCE.—The Secretary of Health and 3 Human Services shall require that entities comply with the 4 new standards developed under subsection (a) not later 5 than 2 years after the final promulgation of such stand- 6 ards. 7 SEC. 105. NATIONAL CENTER FOR HEALTH STATISTICS. 8 Section 306(n) of the Public Health Service Act (42 9 U.S.C. 242k(n)) is amended— 10 (1) in paragraph (1), by striking ‘‘2003’’ and 11 inserting ‘‘2022’’; 12 (2) in paragraph (2), in the first sentence, by 13 striking ‘‘2003’’ and inserting ‘‘2022’’; and 14 (3) in paragraph (3), by striking ‘‘2002’’ and 15 inserting ‘‘2022’’. 16 SEC. 106. DISPARITIES DATA COLLECTED BY THE FEDERAL 17 GOVERNMENT. 18 (a) REPOSITORY OF GOVERNMENT DATA.—The Sec- 19 retary of Health and Human Services, in coordination 20 with the departments, agencies, or offices described in 21 subsection (b), shall establish a centralized electronic re- 22 pository of Government data on factors related to the 23 health and well-being of the population of the United 24 States. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 32 •S 4819 IS (b) COLLECTION; SUBMISSION.—Not later than 180 1 days after the date of the enactment of this Act, and Jan- 2 uary 31 of each year thereafter, each department, agency, 3 and office of the Federal Government that has collected 4 data on race, ethnicity, sex, primary language, sexual ori- 5 entation, disability status, gender identity, age, or socio- 6 economic status during the preceding calendar year shall 7 submit such data to the repository of Government data 8 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, and other areas of health and 24 well-being by factors that include race, ethnicity, 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 33 •S 4819 IS sex, primary language, sexual orientation, disability 1 status, gender identity, and socioeconomic status; 2 (2) ensure that these datasets are publicly iden- 3 tified on the repository established under subsection 4 (a) as ‘‘disparities’’ data; and 5 (3) submit a report to the Congress on the 6 availability and use of such data by public stake- 7 holders. 8 SEC. 107. DATA COLLECTION AND ANALYSIS GRANTS TO MI- 9 NORITY-SERVING INSTITUTIONS. 10 (a) AUTHORITY.—The Secretary of Health and 11 Human Services, acting through the Director of the Na- 12 tional Institute on Minority Health and Health Disparities 13 and the Deputy Assistant Secretary for Minority Health, 14 shall award grants to eligible entities to access and analyze 15 racial and ethnic data on disparities in health and health 16 care, and where possible other data on disparities in health 17 and health care, to monitor and report on progress to re- 18 duce and eliminate disparities in health and health care. 19 (b) ELIGIBLE ENTITY.—In this section, the term ‘‘el- 20 igible entity’’ means an entity that has an accredited pub- 21 lic health, health policy, or health services research pro- 22 gram and is any of the following: 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 34 •S 4819 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 2021 13 through 2025. 14 SEC. 108. STANDARDS FOR MEASURING SEXUAL ORIENTA- 15 TION, GENDER IDENTITY, AND SOCIO- 16 ECONOMIC STATUS IN COLLECTION OF 17 HEALTH DATA. 18 Section 3101(a) of the Public Health Service Act (42 19 U.S.C. 300kk(a)) is amended— 20 (1) in paragraph (1)(A), by inserting ‘‘sexual 21 orientation, gender identity, socioeconomic status,’’ 22 before ‘‘and disability status’’; 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 35 •S 4819 IS (2) in paragraph (1)(C), by inserting ‘‘sexual 1 orientation, gender identity, socioeconomic status,’’ 2 before ‘‘and disability status’’; and 3 (3) in paragraph (2)(B), by inserting ‘‘sexual 4 orientation, gender identity, socioeconomic status,’’ 5 before ‘‘and disability status’’. 6 SEC. 109. SAFETY AND EFFECTIVENESS OF DRUGS WITH 7 RESPECT TO RACIAL AND ETHNIC BACK- 8 GROUND. 9 (a) IN GENERAL.—Chapter V of the Federal Food, 10 Drug, and Cosmetic Act (21 U.S.C. 351 et seq.) is amend- 11 ed by adding after section 505G the following: 12 ‘‘SEC. 505H. SAFETY AND EFFECTIVENESS OF DRUGS WITH 13 RESPECT TO RACIAL AND ETHNIC BACK- 14 GROUND. 15 ‘‘(a) PREAPPROVAL STUDIES.—If there is evidence 16 that there may be a disparity on the basis of racial or 17 ethnic background as to the safety or effectiveness of a 18 drug or biological product, then— 19 ‘‘(1)(A) in the case of a drug, the investigations 20 required under section 505(b)(1)(A) shall include 21 adequate and well-controlled investigations of the 22 disparity; or 23 ‘‘(B) in the case of a biological product, the evi- 24 dence required under section 351(a) of the Public 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 36 •S 4819 IS Health Service Act for approval of a biologics license 1 application for the biological product shall include 2 adequate and well-controlled investigations of the 3 disparity; and 4 ‘‘(2) if the investigations described in subpara- 5 graph (A) or (B) of paragraph (1) confirm that 6 there is such a disparity, the labeling of the drug or 7 biological product shall include appropriate informa- 8 tion about the disparity. 9 ‘‘(b) POSTMARKET STUDIES.— 10 ‘‘(1) IN GENERAL.—If there is evidence that 11 there may be a disparity on the basis of racial or 12 ethnic background as to the safety or effectiveness 13 of a drug for which there is an approved application 14 under section 505 of this Act or of a biological prod- 15 uct for which there is an approved license under sec- 16 tion 351 of the Public Health Service Act, the Sec- 17 retary may by order require the holder of the ap- 18 proved application or license to conduct, by a date 19 specified by the Secretary, postmarket studies to in- 20 vestigate the disparity. 21 ‘‘(2) LABELING.—If the Secretary determines 22 that the postmarket studies confirm that there is a 23 disparity described in paragraph (1), the labeling of 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00036 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 37 •S 4819 IS the drug or biological product shall include appro- 1 priate information about the disparity. 2 ‘‘(3) STUDY DESIGN.—The Secretary may, in 3 an order under paragraph (1), specify all aspects of 4 the design of the postmarket studies required under 5 such paragraph for a drug or biological product, in- 6 cluding the number of studies and study partici- 7 pants, and the other demographic characteristics of 8 the study participants. 9 ‘‘(4) MODIFICATIONS OF STUDY DESIGN.—The 10 Secretary may, by order and as necessary, modify 11 any aspect of the design of a postmarket study re- 12 quired in an order under paragraph (1) after issuing 13 such order. 14 ‘‘(5) STUDY RESULTS.—The results from a 15 study required under paragraph (1) shall be sub- 16 mitted to the Secretary as a supplement to the drug 17 application or biologics license application. 18 ‘‘(c) APPLICATIONS UNDER SECTION 505(j).— 19 ‘‘(1) IN GENERAL.—A drug for which an appli- 20 cation has been submitted or approved under section 21 505(j) shall not be considered ineligible for approval 22 under that section or misbranded under section 502 23 on the basis that the labeling of the drug omits in- 24 formation relating to a disparity on the basis of ra- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 38 •S 4819 IS cial or ethnic background as to the safety or effec- 1 tiveness of the drug, whether derived from investiga- 2 tions or studies required under this section or de- 3 rived from other sources, when the omitted informa- 4 tion is protected by patent or by exclusivity under 5 section 505(j)(5)(F). 6 ‘‘(2) LABELING.—Notwithstanding paragraph 7 (1), the Secretary may require that the labeling of 8 a drug approved under section 505(j) that omits in- 9 formation relating to a disparity on the basis of ra- 10 cial or ethnic background as to the safety or effec- 11 tiveness of the drug include a statement of any ap- 12 propriate contraindications, warnings, or precautions 13 related to the disparity that the Secretary considers 14 necessary. 15 ‘‘(d) DEFINITION.—The term ‘evidence that there 16 may be a disparity on the basis of racial or ethnic back- 17 ground as to the safety or effectiveness’, with respect to 18 a drug or biological product, includes— 19 ‘‘(1) evidence that there is a disparity on the 20 basis of racial or ethnic background as to safety or 21 effectiveness of a drug or biological product in the 22 same chemical class as the drug or biological prod- 23 uct; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00038 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 39 •S 4819 IS ‘‘(2) evidence that there is a disparity on the 1 basis of racial or ethnic background in the way the 2 drug or biological product is metabolized; and 3 ‘‘(3) other evidence as the Secretary may deter- 4 mine appropriate.’’. 5 (b) ENFORCEMENT.—Section 502 of the Federal 6 Food, Drug, and Cosmetic Act (21 U.S.C. 352) is amend- 7 ed by adding at the end the following: 8 ‘‘(gg) If it is a drug and the holder of the approved 9 application under section 505 or license under section 351 10 of the Public Health Service Act for the drug has failed 11 to complete the investigations or studies, or comply with 12 any other requirement, of section 505H.’’. 13 (c) DRUG FEES.—Section 736(a)(1)(A)(ii) of the 14 Federal Food, Drug, and Cosmetic Act (21 U.S.C. 15 379h(a)(1)(A)(ii)) is amended by inserting after ‘‘are not 16 required’’ the following: ‘‘, including postmarket studies 17 required under section 505H’’. 18 SEC. 110. IMPROVING HEALTH DATA REGARDING NATIVE 19 HAWAIIANS AND OTHER PACIFIC ISLANDERS. 20 Part B of title III of the Public Health Service Act 21 (42 U.S.C. 243 et seq.) is amended by inserting after sec- 22 tion 317U the following: 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 40 •S 4819 IS ‘‘SEC. 317V. NATIVE HAWAIIAN AND OTHER PACIFIC IS- 1 LANDER HEALTH DATA. 2 ‘‘(a) DEFINITIONS.—In this section: 3 ‘‘(1) COMMUNITY GROUP.—The term ‘commu- 4 nity group’ means a group of NHOPI who are orga- 5 nized at the community level, and may include a 6 church group, social service group, national advocacy 7 organization, or cultural group. 8 ‘‘(2) NONPROFIT, NONGOVERNMENTAL ORGANI- 9 ZATION.—The term ‘nonprofit, nongovernmental or- 10 ganization’ means a group of NHOPI with a dem- 11 onstrated history of addressing NHOPI issues, in- 12 cluding a NHOPI coalition. 13 ‘‘(3) DESIGNATED ORGANIZATION.—The term 14 ‘designated organization’ means an entity estab- 15 lished to represent NHOPI populations and which 16 has statutory responsibilities to provide, or has com- 17 munity support for providing, health care. 18 ‘‘(4) GOVERNMENT REPRESENTATIVES OF 19 NHOPI POPULATIONS.—The term ‘government rep- 20 resentatives of NHOPI populations’ means rep- 21 resentatives from Hawaii, American Samoa, the 22 Commonwealth of the Northern Mariana Islands, 23 the Federated States of Micronesia, Guam, the Re- 24 public of Palau, and the Republic of the Marshall Is- 25 lands. 26 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 41 •S 4819 IS ‘‘(5) NATIVE HAWAIIANS AND OTHER PACIFIC 1 ISLANDERS (NHOPI).—The term ‘Native Hawaiians 2 and Other Pacific Islanders’ or ‘NHOPI’ means peo- 3 ple having origins in any of the original peoples of 4 American Samoa, the Commonwealth of the North- 5 ern Mariana Islands, the Federated States of Micro- 6 nesia, Guam, Hawaii, the Republic of the Marshall 7 Islands, the Republic of Palau, or any other Pacific 8 Island. 9 ‘‘(6) INSULAR AREA.—The term ‘insular area’ 10 means Guam, the Commonwealth of the Northern 11 Mariana Islands, American Samoa, the United 12 States Virgin Islands, the Federated States of Mi- 13 cronesia, the Republic of Palau, or the Republic of 14 the Marshall Islands. 15 ‘‘(b) NATIONAL STRATEGY.— 16 ‘‘(1) IN GENERAL.—The Secretary, acting 17 through the Director of the National Center for 18 Health Statistics (referred to in this section as 19 ‘NCHS’) of the Centers for Disease Control and 20 Prevention, and other agencies within the Depart- 21 ment of Health and Human Services as the Sec- 22 retary determines appropriate, shall develop and im- 23 plement an ongoing and sustainable national strat- 24 egy for identifying and evaluating the health status 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 42 •S 4819 IS and health care needs of NHOPI populations living 1 in the continental United States, Hawaii, American 2 Samoa, the Commonwealth of the Northern Mariana 3 Islands, the Federated States of Micronesia, Guam, 4 the Republic of Palau, and the Republic of the Mar- 5 shall Islands. 6 ‘‘(2) CONSULTATION.—In developing and imple- 7 menting a national strategy, as described in para- 8 graph (1), not later than 180 days after the date of 9 enactment of the Health Equity and Accountability 10 Act of 2020, the Secretary— 11 ‘‘(A) shall consult with representatives of 12 community groups, designated organizations, 13 and nonprofit, nongovernmental organizations 14 and with government representatives of NHOPI 15 populations; and 16 ‘‘(B) may solicit the participation of rep- 17 resentatives from other Federal departments. 18 ‘‘(c) PRELIMINARY HEALTH SURVEY.— 19 ‘‘(1) IN GENERAL.—The Secretary, acting 20 through the Director of NCHS, shall conduct a pre- 21 liminary health survey in order to identify the major 22 areas and regions in the continental United States, 23 Hawaii, American Samoa, the Commonwealth of the 24 Northern Mariana Islands, the Federated States of 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 43 •S 4819 IS Micronesia, Guam, the Republic of Palau, and the 1 Republic of the Marshall Islands in which NHOPI 2 people reside. 3 ‘‘(2) CONTENTS.—The health survey described 4 in paragraph (1) shall include health data and any 5 other data the Secretary determines to be— 6 ‘‘(A) useful in determining health status 7 and health care needs; or 8 ‘‘(B) required for developing or imple- 9 menting a national strategy. 10 ‘‘(3) METHODOLOGY.—Methodology for the 11 health survey described in paragraph (1), including 12 plans for designing questions, implementation, sam- 13 pling, and analysis, shall be developed in consulta- 14 tion with community groups, designated organiza- 15 tions, nonprofit, nongovernmental organizations, and 16 government representatives of NHOPI populations, 17 as determined by the Secretary. 18 ‘‘(4) TIMEFRAME.—The survey required under 19 this subsection shall be completed not later than 18 20 months after the date of enactment of the Health 21 Equity and Accountability Act of 2020. 22 ‘‘(d) PROGRESS REPORT.—Not later than 2 years 23 after the date of enactment of the Health Equity and Ac- 24 countability Act of 2020, the Secretary shall submit to 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 44 •S 4819 IS Congress a progress report, which shall include the na- 1 tional strategy described in subsection (b)(1). 2 ‘‘(e) STUDY AND REPORT BY THE HEALTH AND 3 MEDICINE DIVISION.— 4 ‘‘(1) IN GENERAL.—The Secretary shall seek to 5 enter into an agreement with the Health and Medi- 6 cine Division of the National Academies of Sciences, 7 Engineering, and Medicine to conduct a study, with 8 input from stakeholders in insular areas, on each of 9 the following: 10 ‘‘(A) The standards and definitions of 11 health care applied to health care systems in in- 12 sular areas and the appropriateness of such 13 standards and definitions. 14 ‘‘(B) The status and performance of health 15 care systems in insular areas, evaluated based 16 upon standards and definitions, as the Sec- 17 retary determines appropriate. 18 ‘‘(C) The effectiveness of donor aid in ad- 19 dressing health care needs and priorities in in- 20 sular areas. 21 ‘‘(D) The progress toward implementation 22 of recommendations of the Committee on 23 Health Care Services in the United States—As- 24 sociated Pacific Basin that are set forth in the 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 45 •S 4819 IS 1998 report entitled ‘Pacific Partnerships for 1 Health: Charting a New Course’. 2 ‘‘(2) REPORT.—An agreement described in 3 paragraph (1) shall require the Health and Medicine 4 Division to submit to the Secretary and to Congress, 5 not later than 2 years after the date of the enact- 6 ment of the Health Equity and Accountability Act of 7 2020, a report containing a description of the results 8 of the study conducted under paragraph (1), includ- 9 ing the conclusions and recommendations of the 10 Health and Medicine Division for each of the items 11 described in subparagraphs (A) through (D) of such 12 paragraph. 13 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To 14 carry out this section, there are authorized to be appro- 15 priated such sums as may be necessary for fiscal years 16 2021 through 2025.’’. 17 SEC. 111. CLARIFICATION OF SIMPLIFIED ADMINISTRATIVE 18 REPORTING REQUIREMENT. 19 Section 11(a) of the Food and Nutrition Act of 2008 20 (7 U.S.C. 2020(a)) is amended by adding at the end the 21 following: 22 ‘‘(5) SIMPLIFIED ADMINISTRATIVE REPORTING 23 REQUIREMENT.—With respect to any obligation of a 24 State agency carrying out the supplemental nutrition 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 46 •S 4819 IS assistance program to comply with the notification 1 requirement under paragraph (2) of section 421(e) 2 of the Personal Responsibility and Work Oppor- 3 tunity Reconciliation Act of 1996 (8 U.S.C. 4 1631(e)), notwithstanding the requirement to in- 5 clude in that notification the names of the sponsor 6 and the sponsored alien involved, the State agency 7 shall be considered to have complied with the notifi- 8 cation requirement if the State agency submits to 9 the Attorney General a report that includes the ag- 10 gregate number of exceptions granted by the State 11 agency under paragraph (1) of that section.’’. 12 TITLE II—CULTURALLY AND LIN- 13 GUISTICALLY APPROPRIATE 14 HEALTH AND HEALTH CARE 15 SEC. 201. DEFINITIONS; FINDINGS. 16 (a) DEFINITIONS.—In this title, the definitions in 17 section 3400 of the Public Health Service Act, as added 18 by section 204, shall apply. 19 (b) FINDINGS.—Congress finds the following: 20 (1) Effective communication is essential to 21 meaningful access to quality physical and mental 22 health care. 23 (2) Research indicates that the lack of appro- 24 priate language services creates language barriers 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 47 •S 4819 IS that result in increased risk of misdiagnosis, ineffec- 1 tive treatment plans, and poor health outcomes for 2 individuals with limited English proficiency and indi- 3 viduals with communication disabilities such as cog- 4 nitive, hearing, vision, or print impairments. 5 (3) The number of limited English-speaking 6 residents in the United States who speak English 7 less than very well and, therefore, cannot effectively 8 communicate with health and social service providers 9 continues to increase significantly. 10 (4) The responsibility to fund language services 11 in the provision of health care and health-care-re- 12 lated services to individuals with limited English 13 proficiency and individuals with communication dis- 14 abilities such as cognitive hearing, vision, or print 15 impairments is a societal one that cannot fairly be 16 placed solely upon the health care, public health, or 17 social services community. 18 (5) Title VI of the Civil Rights Act of 1964 (42 19 U.S.C. 2000d et seq.) prohibits discrimination based 20 on the grounds of race, color, or national origin by 21 any entity receiving Federal financial assistance. In 22 order to avoid discrimination on the grounds of na- 23 tional origin, all programs or activities administered 24 by the Federal Government must take adequate 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00047 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 48 •S 4819 IS steps to ensure that their policies and procedures do 1 not deny or have the effect of denying individuals 2 with limited English proficiency with equal access to 3 benefits and services for which such persons qualify. 4 (6) Both the Americans with Disabilities Act of 5 1990 (42 U.S.C. 12101 et seq.) and the Rehabilita- 6 tion Act of 1973 (29 U.S.C. 701 et seq.) prohibit 7 discrimination on the basis of disability and require 8 the provision of appropriate auxiliary aids and serv- 9 ices necessary to ensure effective communication 10 with individuals with disabilities. The type of auxil- 11 iary aid or service necessary to ensure effective com- 12 munication will vary in accordance with the method 13 of communication used by the individual; the nature, 14 length, and complexity of the communication in- 15 volved; and the context in which the communication 16 is taking place. A public accommodation should con- 17 sult with individuals with disabilities whenever pos- 18 sible to determine what type of auxiliary aid is need- 19 ed to ensure effective communication. The public ac- 20 commodation should use the individual’s preferred 21 method of communication whenever possible, unless 22 it would be an undue burden to the public accommo- 23 dation and an alternative would provide an equally 24 effective means of communication. The ultimate de- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 49 •S 4819 IS cision as to what measures to take rests with the 1 public accommodation, provided that the method 2 chosen results in effective communication. 3 (7) Section 1557 of the Patient Protection and 4 Affordable Care Act (42 U.S.C. 18116) builds on 5 title VI of the Civil Rights Act of 1964 (42 U.S.C. 6 2000d et seq.) and section 504 of the Rehabilitation 7 Act of 1973 (29 U.S.C. 794), prohibits discrimina- 8 tion on the basis of race, color, national origin, dis- 9 ability, sex, and age, requires the provision of lan- 10 guage services to ensure effective communication 11 with individuals with limited English proficiency, 12 and requires the provision of appropriate auxiliary 13 aids and services necessary to ensure effective com- 14 munication with individuals with disabilities. 15 (8) Linguistic diversity in the health care and 16 health-care-related services workforce is important 17 for providing all patients the environment most con- 18 ducive to positive health outcomes. 19 (9) All members of the health care and health- 20 care-related services community should continue to 21 educate their staff and constituents about limited 22 English-proficient and disability communication 23 issues and help them identify resources to improve 24 access to quality care for individuals with limited 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00049 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 50 •S 4819 IS English proficiency and individuals with communica- 1 tion disabilities such as cognitive, hearing, vision, or 2 print impairments. 3 (10) Access to English as a second language, 4 foreign language, and sign language interpreters, 5 translated and alternative format documents, read- 6 ers, and other auxiliary aids and services, are essen- 7 tial to ensure effective communication and eliminate 8 the language barriers that impede access to health 9 care. 10 (11) Competent language services in health care 11 settings should be available as a matter of course. 12 SEC. 202. IMPROVING ACCESS TO SERVICES FOR INDIVID- 13 UALS WITH LIMITED ENGLISH PROFICIENCY. 14 (a) PURPOSE.—Consistent with the goals provided in 15 Executive Order 13166 (42 U.S.C. 2000d–1 note; relating 16 to improving access to services for persons with limited 17 English proficiency), it is the purpose of this section— 18 (1) to improve Federal agency performance re- 19 garding access to federally conducted and federally 20 assisted programs and activities for individuals with 21 limited English proficiency; 22 (2) to require each Federal agency to examine 23 the services it provides and develop and implement 24 a system by which individuals with limited English 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 51 •S 4819 IS proficiency can obtain culturally competence services 1 and meaningful access to those services consistent 2 with, and without substantially burdening, the fun- 3 damental mission of the agency; 4 (3) to require each Federal agency to ensure 5 that recipients of Federal financial assistance pro- 6 vide culturally competence services and meaningful 7 access to applicants and beneficiaries that are indi- 8 viduals with limited English proficiency; 9 (4) to ensure that recipients of Federal finan- 10 cial assistance take reasonable steps, consistent with 11 the guidelines set forth in the ‘‘Guidance to Federal 12 Financial Assistance Recipients Regarding Title VI 13 Prohibition Against National Origin Discrimination 14 Affecting Limited English Proficient Persons (67 15 Fed. Reg. 41455 (June 18, 2002))’’, to ensure cul- 16 turally and linguistically appropriate access to their 17 programs and activities by individuals with limited 18 English proficiency; and 19 (5) to ensure compliance with title VI of the 20 Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) 21 and section 1557 of the Patient Protection and Af- 22 fordable Care Act (42 U.S.C. 18116) as published in 23 the Federal Register on May 18, 2016, that health 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 52 •S 4819 IS care providers and organizations do not discriminate 1 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 203(a) shall prepare a plan or update a plan 9 to improve culturally and linguistically appropriate 10 access to such program or activity with respect to 11 individuals with limited English proficiency. Not 12 later than 1 year after the date of enactment of this 13 Act, each such Federal agency shall ensure that 14 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 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00052 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 53 •S 4819 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 providing a range of lan- 6 guage assistance options, notice to individuals 7 with limited English proficiency of the right to 8 competent language services, periodic training 9 of staff, monitoring and quality assessment of 10 the language services and, in appropriate cir- 11 cumstances, the translation of written mate- 12 rials; 13 (D) the steps the agency will take for such 14 program or activity to provide reasonable ac- 15 commodations necessary for individuals with 16 limited English proficiency, including those in- 17 dividuals with a communication disability, to 18 understand communications from the agency; 19 (E) the steps the agency will take to en- 20 sure that applications, forms, and other rel- 21 evant documents for such program or activity 22 are competently translated into the primary 23 language of a client that is an individual with 24 limited English proficiency where such mate- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00053 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 54 •S 4819 IS rials are needed to improve access of such client 1 to such program or activity; 2 (F) the resources the agency will provide 3 to improve cultural and linguistic appropriate- 4 ness to assist recipients of Federal funds to im- 5 prove access to health care related programs 6 and activities for individuals with limited 7 English proficiency; 8 (G) the resources the agency will provide 9 to ensure that competent language assistance is 10 provided to patients that are individuals with 11 limited English proficiency by interpreters or 12 trained bilingual staff; and 13 (H) the resources the agency will provide 14 to ensure that family, particularly minor chil- 15 dren, and friends are not used to provide inter- 16 pretation services, except as permitted under 17 regulations implementing section 1557 of the 18 Patient Protection and Affordable Care Act (42 19 U.S.C. 18116) as published in the Federal Reg- 20 ister on May 18, 2016. 21 (3) SUBMISSION OF PLAN TO DOJ.—Each agen- 22 cy that is required to prepare a plan under para- 23 graph (1) shall send a copy of such plan to the At- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 55 •S 4819 IS torney General, which shall serve as the central re- 1 pository of all such plans. 2 SEC. 203. ENSURING STANDARDS FOR CULTURALLY AND 3 LINGUISTICALLY APPROPRIATE SERVICES IN 4 HEALTH CARE. 5 (a) APPLICABILITY.—This section shall apply to any 6 health program or activity, any part of which is receiving 7 Federal financial assistance, including credits, subsidies, 8 or contracts of insurance, or any program or activity that 9 is administered by an executive agency or any entity estab- 10 lished under title I of the Patient Protection and Afford- 11 able Care Act (42 U.S.C. 18001 et seq.) (or amendments 12 made thereby). 13 (b) STANDARDS.—Each program or activity de- 14 scribed in subsection (a)— 15 (1) shall implement strategies to recruit, retain, 16 and promote individuals at all levels to maintain a 17 diverse staff and leadership that can provide cul- 18 turally and linguistically appropriate health care to 19 patient populations of the service area of the pro- 20 gram or activity; 21 (2) shall educate and train governance, leader- 22 ship, and workforce at all levels and across all dis- 23 ciplines of the program or activity in culturally and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00055 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 56 •S 4819 IS linguistically appropriate policies and practices on an 1 ongoing basis at least annually; 2 (3) shall offer and provide language assistance, 3 including trained and competent bilingual staff and 4 interpreter services, to individuals with limited 5 English proficiency or who have other communica- 6 tion needs, at no cost to the individual at all points 7 of contact, and during all hours of operation, to fa- 8 cilitate timely access to health care services and 9 health-care-related services; 10 (4) shall for each language group consisting of 11 individuals with limited English proficiency that con- 12 stitutes 5 percent or 500 individuals, whichever is 13 less, of the population of persons eligible to be 14 served or likely to be affected or encountered in the 15 service area of the program or activity, make avail- 16 able at a fifth grade reading level— 17 (A) easily understood patient-related mate- 18 rials, including print and multimedia materials, 19 in the language of such language group; 20 (B) information or notices about termi- 21 nation of benefits in such language; 22 (C) signage; and 23 (D) any other documents or types of docu- 24 ments designated by the Secretary; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00056 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 57 •S 4819 IS (5) shall develop and implement clear goals, 1 policies, operational plans, and management, ac- 2 countability, and oversight mechanisms to provide 3 culturally and linguistically appropriate services and 4 infuse them throughout the planning and operations 5 of the program or activity; 6 (6) shall conduct initial and ongoing, at least 7 annually, organizational assessments of culturally 8 and linguistically appropriate services-related activi- 9 ties and integrate valid linguistic, competence-related 10 National Standards for Culturally and Linguistically 11 Appropriate Services (CLAS) measures into the in- 12 ternal audits, performance improvement programs, 13 patient satisfaction assessments, continuous quality 14 improvement activities, and outcomes-based evalua- 15 tions of the program or activity and develop ways to 16 standardize the assessments; 17 (7) shall ensure that, consistent with the pri- 18 vacy protections provided for under the regulations 19 promulgated under section 264(c) of the Health In- 20 surance Portability and Accountability Act of 1996 21 (42 U.S.C. 1320–2 note), data on an individual re- 22 quired to be collected pursuant to section 3101, in- 23 cluding the individual’s alternative format pref- 24 erences and policy modification needs, are— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00057 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 58 •S 4819 IS (A) collected in health records; 1 (B) integrated into the management infor- 2 mation systems of the program or activity; and 3 (C) periodically updated; 4 (8) shall maintain a current demographic, cul- 5 tural, and epidemiological profile of the community, 6 conduct regular assessments of community health 7 assets and needs, and use the results of such assess- 8 ments to accurately plan for and implement services 9 that respond to the cultural and linguistic character- 10 istics of the service area of the program or activity; 11 (9) shall develop participatory, collaborative 12 partnerships with communities and utilize a variety 13 of formal and informal mechanisms to facilitate 14 community and patient involvement in designing, 15 implementing, and evaluating policies and practices 16 to ensure culturally and linguistically appropriate 17 service-related activities; 18 (10) shall ensure that conflict and grievance 19 resolution processes are culturally and linguistically 20 appropriate and capable of identifying, preventing, 21 and resolving cross-cultural conflicts or complaints 22 by patients; 23 (11) shall regularly make available to the public 24 information about their progress and successful in- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00058 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 59 •S 4819 IS novations in implementing the standards under this 1 section and provide public notice in their commu- 2 nities about the availability of this information; and 3 (12) shall, if requested, regularly make avail- 4 able to the head of each Federal entity from which 5 Federal funds are provided, information about the 6 progress and successful innovations of the program 7 or activity in implementing the standards under this 8 section as required by the head of such entity. 9 (c) COMMENTS ACCEPTED THROUGH NOTICE AND 10 COMMENT RULEMAKING.—An agency carrying out a pro- 11 gram described in subsection (a)— 12 (1) shall ensure that comments with respect to 13 such program that are accepted through notice and 14 comment rulemaking are accepted in all languages; 15 (2) may not require such comments to be sub- 16 mitted only in English; and 17 (3) shall ensure that any such comments that 18 are not submitted in English are considered, during 19 the agency’s review of such comments, equally as 20 such comments that are submitted in English. 21 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00059 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 60 •S 4819 IS SEC. 204. CULTURALLY AND LINGUISTICALLY APPRO- 1 PRIATE HEALTH CARE IN THE PUBLIC 2 HEALTH SERVICE ACT. 3 The Public Health Service Act (42 U.S.C. 201 et 4 seq.) is amended by adding at the end the following: 5 ‘‘TITLE XXXIV—CULTURALLY 6 AND LINGUISTICALLY APPRO- 7 PRIATE HEALTH CARE 8 ‘‘SEC. 3400. DEFINITIONS. 9 ‘‘(a) IN GENERAL.—In this title: 10 ‘‘(1) BILINGUAL.—The term ‘bilingual’, with 11 respect to an individual, means an individual who 12 has sufficient degree of proficiency in 2 languages. 13 ‘‘(2) CULTURAL.—The term ‘cultural’ means 14 relating to integrated patterns of human behavior 15 that include the language, thoughts, communica- 16 tions, actions, customs, beliefs, values, and institu- 17 tions of racial, ethnic, religious, or social groups, in- 18 cluding lesbian, gay, bisexual, transgender, queer, 19 and questioning individuals, and individuals with 20 physical and mental disabilities. 21 ‘‘(3) CULTURALLY AND LINGUISTICALLY AP- 22 PROPRIATE.—The term ‘culturally and linguistically 23 appropriate’ means being respectful of and respon- 24 sive to the cultural and linguistic needs of all indi- 25 viduals. 26 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00060 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 61 •S 4819 IS ‘‘(4) EFFECTIVE COMMUNICATION.—The term 1 ‘effective communication’ means an exchange of in- 2 formation between the provider of health care or 3 health-care-related services and the recipient of such 4 services who is limited in English proficiency, or has 5 a communication impairment such as a hearing, vi- 6 sion, speaking, or learning impairment, that enables 7 access to, understanding of, and benefit from health 8 care or health-care-related services, and full partici- 9 pation in the development of their treatment plan. 10 ‘‘(5) GRIEVANCE RESOLUTION PROCESS.—The 11 term ‘grievance resolution process’ means all aspects 12 of dispute resolution including filing complaints, 13 grievance and appeal procedures, and court action. 14 ‘‘(6) HEALTH CARE GROUP.—The term ‘health 15 care group’ means a group of physicians organized, 16 at least in part, for the purposes of providing physi- 17 cian services under the Medicaid program under title 18 XIX of the Social Security Act, the State Children’s 19 Health Insurance Program under title XXI of such 20 Act, or the Medicare program under title XVIII of 21 such Act and may include a hospital and any other 22 individual or entity furnishing services covered under 23 any such program that is affiliated with the health 24 care group. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00061 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 62 •S 4819 IS ‘‘(7) HEALTH CARE SERVICES.—The term 1 ‘health care services’ means services that address 2 physical as well as mental health conditions in all 3 care settings. 4 ‘‘(8) HEALTH-CARE-RELATED SERVICES.—The 5 term ‘health-care-related services’ means human or 6 social services programs or activities that provide ac- 7 cess, referrals, or links to health care. 8 ‘‘(9) HEALTH EDUCATOR.—The term ‘health 9 educator’ includes a professional with a bacca- 10 laureate degree who is responsible for designing, im- 11 plementing, and evaluating individual and population 12 health promotion and chronic disease prevention pro- 13 grams. 14 ‘‘(10) INDIAN; INDIAN TRIBE.—The terms ‘In- 15 dian’ and ‘Indian Tribe’ have the meanings given 16 such terms in section 4 of the Indian Self-Deter- 17 mination and Education Assistance Act. 18 ‘‘(11) INDIVIDUAL WITH A DISABILITY.—The 19 term ‘individual with a disability’ means any indi- 20 vidual who has a disability as defined for the pur- 21 pose of section 504 of the Rehabilitation Act of 22 1973. 23 ‘‘(12) INDIVIDUAL WITH LIMITED ENGLISH 24 PROFICIENCY.—The term ‘individual with limited 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00062 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 63 •S 4819 IS English proficiency’ means an individual whose pri- 1 mary language for communication is not English 2 and who has a limited ability to read, write, speak, 3 or understand English. 4 ‘‘(13) INTEGRATED HEALTH CARE DELIVERY 5 SYSTEM.—The term ‘integrated health care delivery 6 system’ means an interdisciplinary system that 7 brings together providers from the primary health, 8 mental health, substance use disorder, and related 9 disciplines to improve the health outcomes of an in- 10 dividual. Such providers may include hospitals, 11 health, mental health, or substance use disorder clin- 12 ics and providers, home health agencies, ambulatory 13 surgery centers, skilled nursing facilities, rehabilita- 14 tion centers, and employed, independent, or con- 15 tracted physicians. 16 ‘‘(14) INTERPRETING; INTERPRETATION.—The 17 terms ‘interpreting’ and ‘interpretation’ mean the 18 transmission of a spoken, written, or signed message 19 from one language or format into another, faithfully, 20 accurately, and objectively. 21 ‘‘(15) LANGUAGE ACCESS.—The term ‘language 22 access’ means the provision of language services to 23 an individual with limited English proficiency or an 24 individual with communication disabilities designed 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00063 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 64 •S 4819 IS to enhance that individual’s access to, understanding 1 of, or benefit from health care services or health- 2 care-related services. 3 ‘‘(16) LANGUAGE ASSISTANCE SERVICES.—The 4 term ‘language assistance services’ includes— 5 ‘‘(A) oral language assistance, including in- 6 terpretation in non-English languages provided 7 in-person or remotely by a qualified interpreter 8 for an individual with limited English pro- 9 ficiency, and the use of qualified bilingual or 10 multilingual staff to communicate directly with 11 individuals with limited English proficiency; 12 ‘‘(B) written translation, performed by a 13 qualified translator, of written content in paper 14 or electronic form into languages other than 15 English; and 16 ‘‘(C) taglines. 17 ‘‘(17) MINORITY.— 18 ‘‘(A) IN GENERAL.—The terms ‘minority’ 19 and ‘minorities’ refer to individuals from a mi- 20 nority group. 21 ‘‘(B) POPULATIONS.—The term ‘minority’, 22 with respect to populations, refers to racial and 23 ethnic minority groups, members of sexual and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00064 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 65 •S 4819 IS gender minority groups, and individuals with a 1 disability. 2 ‘‘(18) MINORITY GROUP.—The term ‘minority 3 group’ has the meaning given the term ‘racial and 4 ethnic minority group’. 5 ‘‘(19) ONSITE INTERPRETATION.—The term 6 ‘onsite interpretation’ means a method of inter- 7 preting or interpretation for which the interpreter is 8 in the physical presence of the provider of health 9 care services or health-care-related services and the 10 recipient of such services who is limited in English 11 proficiency or has a communication impairment such 12 as an impairment in hearing, vision, or learning. 13 ‘‘(20) QUALIFIED INDIVIDUAL WITH A DIS- 14 ABILITY.—The term ‘qualified individual with a dis- 15 ability’ means, with respect to a health program or 16 activity, an individual with a disability who, with or 17 without reasonable modifications to policies, prac- 18 tices, or procedures, the removal of architectural, 19 communication, or transportation barriers, or the 20 provision of auxiliary aids and services, meets the es- 21 sential eligibility requirements for the receipt of aids, 22 benefits, or services offered or provided by the health 23 program or activity. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00065 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 66 •S 4819 IS ‘‘(21) QUALIFIED INTERPRETER FOR AN INDI- 1 VIDUAL WITH A DISABILITY.—The term ‘qualified 2 interpreter for an individual with a disability’, with 3 respect to an individual with a disability— 4 ‘‘(A) means an interpreter for such indi- 5 vidual who by means of a remote interpreting 6 service or an onsite appearance; 7 ‘‘(i) adheres to generally accepted in- 8 terpreter ethics principles, including client 9 confidentiality; and 10 ‘‘(ii) is able to interpret effectively, ac- 11 curately, and impartially, both receptively 12 and expressively, using any necessary spe- 13 cialized vocabulary, terminology, and phra- 14 seology; and 15 ‘‘(B) may include— 16 ‘‘(i) sign language interpreters; 17 ‘‘(ii) oral transliterators, which are in- 18 dividuals who represent or spell in the 19 characters of another alphabet; and 20 ‘‘(iii) cued language transliterators, 21 which are individuals who represent or 22 spell by using a small number of 23 handshapes. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00066 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 67 •S 4819 IS ‘‘(22) QUALIFIED INTERPRETER FOR AN INDI- 1 VIDUAL WITH LIMITED ENGLISH PROFICIENCY.— 2 The term ‘qualified interpreter for an individual with 3 limited English proficiency’ means an interpreter 4 who by means of a remote interpreting service or an 5 onsite appearance— 6 ‘‘(A) adheres to generally accepted inter- 7 preter ethics principles, including client con- 8 fidentiality; 9 ‘‘(B) has demonstrated proficiency in 10 speaking and understanding both spoken 11 English and one or more other spoken lan- 12 guages; and 13 ‘‘(C) is able to interpret effectively, accu- 14 rately, and impartially, both receptively and ex- 15 pressly, to and from such languages and 16 English, using any necessary specialized vocab- 17 ulary, terminology, and phraseology. 18 ‘‘(23) QUALIFIED TRANSLATOR.—The term 19 ‘qualified translator’ means a translator who— 20 ‘‘(A) adheres to generally accepted trans- 21 lator ethics principles, including client confiden- 22 tiality; 23 ‘‘(B) has demonstrated proficiency in writ- 24 ing and understanding both written English 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00067 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 68 •S 4819 IS and one or more other written non-English lan- 1 guages; and 2 ‘‘(C) is able to translate effectively, accu- 3 rately, and impartially to and from such lan- 4 guages and English, using any necessary spe- 5 cialized vocabulary, terminology, and phrase- 6 ology. 7 ‘‘(24) RACIAL AND ETHNIC MINORITY GROUP.— 8 The term ‘racial and ethnic minority group’ means 9 Indians and Alaska Natives, African Americans (in- 10 cluding Caribbean Blacks, Africans, and other 11 Blacks), Asian Americans, Hispanics (including 12 Latinos), and Native Hawaiians and other Pacific 13 Islanders. 14 ‘‘(25) SEXUAL AND GENDER MINORITY 15 GROUP.—The term ‘sexual and gender minority 16 group’ encompasses lesbian, gay, bisexual, and 17 transgender populations, as well as those whose sex- 18 ual orientation, gender identity and expression, or 19 reproductive development varies from traditional, so- 20 cietal, cultural, or physiological norms. 21 ‘‘(26) SIGHT TRANSLATION.—The term ‘sight 22 translation’ means the transmission of a written 23 message in one language into a spoken or signed 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00068 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 69 •S 4819 IS message in another language, or an alternative for- 1 mat in English or another language. 2 ‘‘(27) STATE.—Notwithstanding section 2, the 3 term ‘State’ means each of the several States, the 4 District of Columbia, the Commonwealth of Puerto 5 Rico, the United States Virgin Islands, Guam, 6 American Samoa, and the Commonwealth of the 7 Northern Mariana Islands. 8 ‘‘(28) TELEPHONIC INTERPRETATION.—The 9 term ‘telephonic interpretation’ (also known as ‘over 10 the phone interpretation’ or ‘OPI’) means, with re- 11 spect to interpretation for an individual with limited 12 English proficiency, a method of interpretation in 13 which the interpreter is not in the physical presence 14 of the provider of health care services or health-care- 15 related services and such individual receiving such 16 services, but the interpreter is connected via tele- 17 phone. 18 ‘‘(29) TRANSLATION.—The term ‘translation’ 19 means the transmission of a written message in one 20 language into a written or signed message in an- 21 other language, and includes translation into an- 22 other language or alternative format, such as large 23 print font, Braille, audio recording, or CD. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00069 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 70 •S 4819 IS ‘‘(30) VIDEO REMOTE INTERPRETING SERV- 1 ICES.—The term ‘video remote interpreting services’ 2 means the provision, in health care services or 3 health-care-related services, through a qualified in- 4 terpreter for an individual with limited English pro- 5 ficiency, of video remote interpreting services that 6 are— 7 ‘‘(A) in real-time, full-motion video, and 8 audio over a dedicated high-speed, wide-band- 9 width video connection or wireless connection 10 that delivers high quality video images that do 11 not produce lags, choppy, blurry, or grainy im- 12 ages, or irregular pauses in communication; and 13 ‘‘(B) in a sharply delineated image that is 14 large enough to display. 15 ‘‘(31) VITAL DOCUMENT.—The term ‘vital doc- 16 ument’ includes applications for government pro- 17 grams that provide health care services, medical or 18 financial consent forms, financial assistance docu- 19 ments, letters containing important information re- 20 garding patient instructions (such as prescriptions, 21 referrals to other providers, and discharge plans) 22 and participation in a program (such as a Medicaid 23 managed care program), notices pertaining to the 24 reduction, denial, or termination of services or bene- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00070 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 71 •S 4819 IS fits, notices of the right to appeal such actions, and 1 notices advising individuals with limited English pro- 2 ficiency with communication disabilities of the avail- 3 ability of free language services, alternative formats, 4 and other outreach materials. 5 ‘‘(b) REFERENCE.—In any reference in this title to 6 a regulatory provision applicable to a ‘handicapped indi- 7 vidual’, the term ‘handicapped individual’ in such provi- 8 sion shall have the same meaning as the term ‘individual 9 with a disability’ as defined in subsection (a). 10 ‘‘Subtitle A—Resources and Innova- 11 tion for Culturally and Linguis- 12 tically Appropriate Health Care 13 ‘‘SEC. 3401. ROBERT T. MATSUI CENTER FOR CULTURALLY 14 AND LINGUISTICALLY APPROPRIATE HEALTH 15 CARE. 16 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 17 through the Director of the Agency for Healthcare Re- 18 search and Quality, shall establish and support a center 19 to be known as the ‘Robert T. Matsui Center for Cul- 20 turally and Linguistically Appropriate Health Care’ (re- 21 ferred to in this section as the ‘Center’) to carry out each 22 of the following activities: 23 ‘‘(1) INTERPRETATION SERVICES.—The Center 24 shall provide resources via the internet to identify 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00071 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 72 •S 4819 IS and link health care providers to competent inter- 1 preter and translation services. 2 ‘‘(2) TRANSLATION OF WRITTEN MATERIAL.— 3 ‘‘(A) VITAL DOCUMENTS.—The Center 4 shall provide, directly or through contract, vital 5 documents from competent translation services 6 for providers of health care services and health- 7 care-related services at no cost to such pro- 8 viders. Such documents may be submitted by 9 covered entities (as defined in section 92.4 of 10 title 45, Code of Federal Regulations, as in ef- 11 fect on May 18, 2016) for translation into non- 12 English languages or alternative formats at a 13 fifth-grade reading level. Such translation serv- 14 ices shall be provided in a timely and reason- 15 able manner. The quality of such translation 16 services shall be monitored and reported pub- 17 licly. 18 ‘‘(B) FORMS.—For each form developed or 19 revised by the Secretary that will be used by in- 20 dividuals with limited English proficiency in 21 health care or health-care-related settings, the 22 Center shall translate the form, at a minimum, 23 into the top 15 non-English languages in the 24 United States according to the most recent data 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00072 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 73 •S 4819 IS from the American Community Survey or its re- 1 placement. The translation shall be completed 2 within 45 calendar days of the Secretary receiv- 3 ing final approval of the form from the Office 4 of Management and Budget. The Center shall 5 post all translated forms on its website so that 6 other entities may use the same translations. 7 ‘‘(3) TOLL-FREE CUSTOMER SERVICE TELE- 8 PHONE NUMBER.—The Center shall provide, 9 through a toll-free number, a customer service line 10 for individuals with limited English proficiency— 11 ‘‘(A) to obtain information about federally 12 conducted or funded health programs, including 13 the Medicare program under title XVIII of the 14 Social Security Act, the Medicaid program 15 under title XIX of such Act, and the State Chil- 16 dren’s Health Insurance Program under title 17 XXI of such Act, and coverage available 18 through an Exchange established under title I 19 of the Patient Protection and Affordable Care 20 Act, and other sources of free or reduced care 21 including through federally qualified health cen- 22 ters, entities receiving assistance under title X, 23 and public health departments; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00073 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 74 •S 4819 IS ‘‘(B) to obtain assistance with applying for 1 or accessing these programs and understanding 2 Federal notices written in English; and 3 ‘‘(C) to learn how to access language serv- 4 ices. 5 ‘‘(4) HEALTH INFORMATION CLEARING- 6 HOUSE.— 7 ‘‘(A) IN GENERAL.—The Center shall de- 8 velop and maintain an information clearing- 9 house to facilitate the provision of language 10 services by providers of health care services and 11 health-care-related services to reduce medical 12 errors, improve medical outcomes, improve cul- 13 tural competence, reduce health care costs 14 caused by miscommunication with individuals 15 with limited English proficiency, and reduce or 16 eliminate the duplication of efforts to translate 17 materials. The clearinghouse shall include the 18 information described in subparagraphs (B) 19 through (F) and make such information avail- 20 able on the internet and in print. 21 ‘‘(B) DOCUMENT TEMPLATES.—The Cen- 22 ter shall collect and evaluate for accuracy, de- 23 velop, and make available templates for stand- 24 ard documents that are necessary for patients 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00074 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 75 •S 4819 IS and consumers to access and make educated de- 1 cisions about their health care, including tem- 2 plates for each of the following: 3 ‘‘(i) Administrative and legal docu- 4 ments, including— 5 ‘‘(I) intake forms; 6 ‘‘(II) forms related to the Medi- 7 care program under title XVIII of the 8 Social Security Act, the Medicaid pro- 9 gram under title XIX of such Act, 10 and the State Children’s Health In- 11 surance Program under title XXI of 12 such Act, including eligibility informa- 13 tion for such programs; 14 ‘‘(III) forms informing patients 15 of the compliance and consent re- 16 quirements pursuant to the regula- 17 tions under section 264(c) of the 18 Health Insurance Portability and Ac- 19 countability Act of 1996 (42 U.S.C. 20 1320–2 note); and 21 ‘‘(IV) documents concerning in- 22 formed consent, advanced directives, 23 and waivers of rights. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00075 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 76 •S 4819 IS ‘‘(ii) Clinical information, such as how 1 to take medications, how to prevent trans- 2 mission of a contagious disease, and other 3 prevention and treatment instructions. 4 ‘‘(iii) Public health, patient education, 5 and outreach materials, such as immuniza- 6 tion notices, health warnings, or screening 7 notices. 8 ‘‘(iv) Additional health or health-care- 9 related materials as determined appro- 10 priate by the Director of the Center. 11 ‘‘(C) STRUCTURE OF FORMS.—In oper- 12 ating the clearinghouse, the Center shall— 13 ‘‘(i) ensure that the documents posted 14 in English and non-English languages are 15 culturally and linguistically appropriate; 16 ‘‘(ii) allow public review of the docu- 17 ments before dissemination in order to en- 18 sure that the documents are understand- 19 able and culturally and linguistically ap- 20 propriate for the target populations; 21 ‘‘(iii) allow health care providers to 22 customize the documents for their use; 23 ‘‘(iv) facilitate access to these docu- 24 ments; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00076 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 77 •S 4819 IS ‘‘(v) provide technical assistance with 1 respect to the access and use of such infor- 2 mation; and 3 ‘‘(vi) carry out any other activities the 4 Secretary determines to be useful to fulfill 5 the purposes of the clearinghouse. 6 ‘‘(D) LANGUAGE ASSISTANCE PRO- 7 GRAMS.—The Center shall provide for the col- 8 lection and dissemination of information on cur- 9 rent examples of language assistance programs 10 and strategies to improve language services for 11 individuals with limited English proficiency, in- 12 cluding case studies using de-identified patient 13 information, program summaries, and program 14 evaluations. 15 ‘‘(E) CULTURALLY AND LINGUISTICALLY 16 APPROPRIATE MATERIALS.—The Center shall 17 provide information relating to culturally and 18 linguistically appropriate health care for minor- 19 ity populations residing in the United States to 20 all health care providers and health-care-related 21 services at no cost. Such information shall in- 22 clude— 23 ‘‘(i) tenets of culturally and linguis- 24 tically appropriate care; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00077 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 78 •S 4819 IS ‘‘(ii) culturally and linguistically ap- 1 propriate self-assessment tools; 2 ‘‘(iii) culturally and linguistically ap- 3 propriate training tools; 4 ‘‘(iv) strategic plans to increase cul- 5 tural and linguistic appropriateness in dif- 6 ferent types of providers of health care 7 services and health-care-related services, 8 including regional collaborations among 9 health care organizations; and 10 ‘‘(v) culturally and linguistically ap- 11 propriate information for educators, practi- 12 tioners, and researchers. 13 ‘‘(F) TRANSLATION GLOSSARIES.—The 14 Center shall— 15 ‘‘(i) develop and publish on its website 16 translation glossaries that provide stand- 17 ardized translations of commonly used 18 terms and phrases utilized in documents 19 translated by the Center; and 20 ‘‘(ii) make these glossaries available— 21 ‘‘(I) free of charge; 22 ‘‘(II) in each language in which 23 the Center translates forms under 24 paragraph (2)(B); and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00078 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 79 •S 4819 IS ‘‘(III) in alternative formats in 1 accordance with the Americans with 2 Disabilities Act of 1990 (42 U.S.C. 3 12101 et seq.). 4 ‘‘(G) INFORMATION ABOUT PROGRESS.— 5 The Center shall regularly collect and make 6 publicly available information about the 7 progress of entities receiving grants under sec- 8 tion 3402 regarding successful innovations in 9 implementing the obligations under this sub- 10 section and provide public notice in the entities’ 11 communities about the availability of this infor- 12 mation. 13 ‘‘(b) DIRECTOR.—The Center shall be headed by a 14 Director who shall be appointed by, and who shall report 15 to, the Director of the Agency for Healthcare Research 16 and Quality. 17 ‘‘(c) AVAILABILITY OF LANGUAGE ACCESS.—The Di- 18 rector shall collaborate with the Deputy Assistant Sec- 19 retary for Minority Health, the Administrator of the Cen- 20 ters for Medicare & Medicaid Services, and the Adminis- 21 trator of the Health Resources and Services Administra- 22 tion to notify health care providers and health care organi- 23 zations about the availability of language access services 24 by the Center. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00079 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 80 •S 4819 IS ‘‘(d) EDUCATION.—The Secretary, directly or 1 through contract, shall undertake a national education 2 campaign to inform providers, individuals with limited 3 English proficiency, individuals with hearing or vision im- 4 pairments, health professionals, graduate schools, and 5 community health centers about— 6 ‘‘(1) Federal and State laws and guidelines gov- 7 erning access to language services; 8 ‘‘(2) the value of using trained and competent 9 interpreters and the risks associated with using fam- 10 ily members, friends, minors, and untrained bilin- 11 gual staff; 12 ‘‘(3) funding sources for developing and imple- 13 menting language services; and 14 ‘‘(4) promising practices to effectively provide 15 language services. 16 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 17 are authorized to be appropriated to carry out this section 18 $5,000,000 for each of fiscal years 2021 through 2025. 19 ‘‘SEC. 3402. INNOVATIONS IN CULTURALLY AND LINGUIS- 20 TICALLY APPROPRIATE HEALTH CARE 21 GRANTS. 22 ‘‘(a) IN GENERAL.— 23 ‘‘(1) GRANTS.—The Secretary, acting through 24 the Director of the Agency for Healthcare Research 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00080 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 81 •S 4819 IS and Quality, shall award grants to eligible entities to 1 enable such entities to design, implement, and evalu- 2 ate innovative, cost-effective programs to improve 3 culturally and linguistically appropriate access to 4 health care services for individuals with limited 5 English proficiency. 6 ‘‘(2) COORDINATION.—The Director of the 7 Agency for Healthcare Research and Quality shall 8 coordinate with, and ensure the participation of, 9 other agencies including the Health Resources and 10 Services Administration, the National Institute on 11 Minority Health and Health Disparities at the Na- 12 tional Institutes of Health, and the Office of Minor- 13 ity Health, regarding the design and evaluation of 14 the grants program. 15 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 16 under subsection (a), an entity shall— 17 ‘‘(1) be— 18 ‘‘(A) a city, county, Indian Tribe, State, or 19 subdivision thereof; 20 ‘‘(B) an organization described in section 21 501(c)(3) of the Internal Revenue Code of 1986 22 and exempt from tax under section 501(a) of 23 such Code; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00081 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 82 •S 4819 IS ‘‘(C) a community health, mental health, 1 or substance use disorder center or clinic; 2 ‘‘(D) a solo or group physician practice; 3 ‘‘(E) an integrated health care delivery 4 system; 5 ‘‘(F) a public hospital; 6 ‘‘(G) a health care group, university, or 7 college; or 8 ‘‘(H) any other entity designated by the 9 Secretary; and 10 ‘‘(2) prepare and submit to the Secretary an 11 application, at such time, in such manner, and con- 12 taining such additional information as the Secretary 13 may reasonably require. 14 ‘‘(c) USE OF FUNDS.—An entity shall use funds re- 15 ceived through a grant under this section to— 16 ‘‘(1) develop, implement, and evaluate models of 17 providing competent interpretation services through 18 onsite interpretation, telephonic interpretation, or 19 video remote interpreting services; 20 ‘‘(2) implement strategies to recruit, retain, and 21 promote individuals at all levels of the organization 22 to maintain a diverse staff and leadership that can 23 promote and provide language services to patient 24 populations of the service area of the entity; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00082 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 83 •S 4819 IS ‘‘(3) develop and maintain a needs assessment 1 that identifies the current demographic, cultural, 2 and epidemiological profile of the community to ac- 3 curately plan for and implement language services 4 needed in the service area of the entity; 5 ‘‘(4) develop a strategic plan to implement lan- 6 guage services; 7 ‘‘(5) develop participatory, collaborative part- 8 nerships with communities encompassing the patient 9 populations of individuals with limited English pro- 10 ficiency served by the grant to gain input in design- 11 ing and implementing language services; 12 ‘‘(6) develop and implement grievance resolu- 13 tion processes that are culturally and linguistically 14 appropriate and capable of identifying, preventing, 15 and resolving complaints by individuals with limited 16 English proficiency; 17 ‘‘(7) develop short-term medical and mental 18 health interpretation training courses and incentives 19 for bilingual health care staff who are asked to pro- 20 vide interpretation services in the workplace; 21 ‘‘(8) develop formal training programs, includ- 22 ing continued professional development and edu- 23 cation programs as well as supervision, for individ- 24 uals interested in becoming dedicated health care in- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00083 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 84 •S 4819 IS terpreters and culturally and linguistically appro- 1 priate providers; 2 ‘‘(9) provide staff language training instruction, 3 which shall include information on the practical limi- 4 tations of such instruction for nonnative speakers; 5 ‘‘(10) develop policies that address compensa- 6 tion in salary for staff who receive training to be- 7 come either a staff interpreter or bilingual provider; 8 ‘‘(11) develop other language assistance services 9 as determined appropriate by the Secretary; 10 ‘‘(12) develop, implement, and evaluate models 11 of improving cultural competence, including cultural 12 competence programs for community health workers; 13 and 14 ‘‘(13) ensure that, consistent with the privacy 15 protections provided for under the regulations pro- 16 mulgated under section 264(c) of the Health Insur- 17 ance Portability and Accountability Act of 1996 and 18 any applicable State privacy laws, data on the indi- 19 vidual patient or recipient’s race, ethnicity, and pri- 20 mary language are collected (and periodically up- 21 dated) in health records and integrated into the or- 22 ganization’s information management systems or 23 any similar system used to store and retrieve data. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00084 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 85 •S 4819 IS ‘‘(d) PRIORITY.—In awarding grants under this sec- 1 tion, the Secretary shall give priority to entities that pri- 2 marily engage in providing direct care and that have devel- 3 oped partnerships with community organizations or with 4 agencies with experience in improving language access. 5 ‘‘(e) EVALUATION.— 6 ‘‘(1) BY GRANTEES.—An entity that receives a 7 grant under this section shall submit to the Sec- 8 retary an evaluation that describes, in the manner 9 and to the extent required by the Secretary, the ac- 10 tivities carried out with funds received under the 11 grant, and how such activities improved access to 12 health care services and health-care-related services 13 and the quality of health care for individuals with 14 limited English proficiency. Such evaluation shall be 15 collected and disseminated through the Robert T. 16 Matsui Center for Culturally and Linguistically Ap- 17 propriate Health Care established under section 18 3401. The Director of the Agency for Healthcare 19 Research and Quality shall notify grantees of the 20 availability of technical assistance for the evaluation 21 and provide such assistance upon request. 22 ‘‘(2) BY SECRETARY.—The Director of the 23 Agency for Healthcare Research and Quality shall 24 evaluate or arrange with other individuals or organi- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00085 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 86 •S 4819 IS zations to evaluate projects funded under this sec- 1 tion. 2 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 3 is authorized to be appropriated to carry out this section, 4 $5,000,000 for each of fiscal years 2021 through 2025. 5 ‘‘SEC. 3403. RESEARCH ON CULTURAL AND LANGUAGE COM- 6 PETENCE. 7 ‘‘(a) IN GENERAL.—The Secretary, acting through 8 the Director of the Agency for Healthcare Research and 9 Quality, shall expand research concerning language access 10 in the provision of health care services. 11 ‘‘(b) ELIGIBILITY.—The Director of the Agency for 12 Healthcare Research and Quality may conduct the re- 13 search described in subsection (a) or enter into contracts 14 with other individuals or organizations to conduct such re- 15 search. 16 ‘‘(c) USE OF FUNDS.—Research conducted under 17 this section shall be designed to do one or more of the 18 following: 19 ‘‘(1) To identify the barriers to mental and be- 20 havioral services that are faced by individuals with 21 limited English proficiency. 22 ‘‘(2) To identify health care providers’ and 23 health administrators’ attitudes, knowledge, and 24 awareness of the barriers to quality health care serv- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00086 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 87 •S 4819 IS ices that are faced by individuals with limited 1 English proficiency. 2 ‘‘(3) To identify optimal approaches for deliv- 3 ering language access. 4 ‘‘(4) To identify best practices for data collec- 5 tion, including— 6 ‘‘(A) the collection by providers of health 7 care services and health-care-related services of 8 data on the race, ethnicity, and primary lan- 9 guage of recipients of such services, taking into 10 account existing research conducted by the Gov- 11 ernment or private sector; 12 ‘‘(B) the development and implementation 13 of data collection and reporting systems; and 14 ‘‘(C) effective privacy safeguards for col- 15 lected data. 16 ‘‘(5) To develop a minimum data collection set 17 for primary language. 18 ‘‘(6) To evaluate the most effective ways in 19 which the Secretary can create or coordinate, and 20 subsidize or otherwise fund, telephonic interpretation 21 services for health care providers, taking into consid- 22 eration, among other factors, the flexibility necessary 23 for such a system to accommodate variations in— 24 ‘‘(A) provider type; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00087 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 88 •S 4819 IS ‘‘(B) languages needed and their frequency 1 of use; 2 ‘‘(C) type of encounter; 3 ‘‘(D) time of encounter, including regular 4 business hours and after hours; and 5 ‘‘(E) location of encounter. 6 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 7 are authorized to be appropriated to carry out this section 8 $5,000,000 for each of fiscal years 2021 through 2025.’’. 9 SEC. 205. PILOT PROGRAM FOR IMPROVEMENT AND DE- 10 VELOPMENT OF STATE MEDICAL INTER- 11 PRETING SERVICES. 12 (a) GRANTS AUTHORIZED.—The Secretary of Health 13 and Human Services shall award 1 grant in accordance 14 with this section to each of 3 States (to be selected by 15 the Secretary) to assist each such State in designing, im- 16 plementing, and evaluating a statewide program to provide 17 onsite interpreter services under the State Medicaid plan. 18 (b) GRANT PERIOD.—A grant awarded under this 19 section is authorized for the period of 3 fiscal years begin- 20 ning on October 1, 2021, and ending on September 30, 21 2024. 22 (c) PREFERENCE.—In awarding a grant under this 23 section, the Secretary shall give preference to a State— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00088 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 89 •S 4819 IS (1) that has a high proportion of qualified LEP 1 enrollees, as determined by the Secretary; 2 (2) that has a large number of qualified LEP 3 enrollees, as determined by the Secretary; 4 (3) that has a high growth rate of the popu- 5 lation of individuals with limited English proficiency, 6 as determined by the Secretary; and 7 (4) that has a population of qualified LEP en- 8 rollees that is linguistically diverse, requiring inter- 9 preter services in at least 200 non-English lan- 10 guages. 11 (d) USE OF FUNDS.—A State receiving a grant under 12 this section shall use the grant funds to— 13 (1) ensure that all health care providers in the 14 State participating in the State Medicaid plan have 15 access to onsite interpreter services, for the purpose 16 of enabling effective communication between such 17 providers and qualified LEP enrollees during the 18 furnishing of items and services and administrative 19 interactions; 20 (2) establish, expand, procure, or contract for— 21 (A) a statewide health care information 22 technology system that is designed to achieve 23 efficiencies and economies of scale with respect 24 to onsite interpreter services provided to health 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00089 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 90 •S 4819 IS care providers in the State participating in the 1 State Medicaid plan; and 2 (B) an entity to administer such system, 3 the duties of which shall include— 4 (i) procuring and scheduling inter- 5 preter services for qualified LEP enrollees; 6 (ii) procuring and scheduling inter- 7 preter services for individuals with limited 8 English proficiency seeking to enroll in the 9 State Medicaid plan; 10 (iii) ensuring that interpreters receive 11 payment for interpreter services rendered 12 under the system; and 13 (iv) consulting regularly with organi- 14 zations representing consumers, inter- 15 preters, and health care providers; and 16 (3) develop mechanisms to establish, improve, 17 and strengthen the competency of the medical inter- 18 pretation workforce that serves qualified LEP enroll- 19 ees in the State, including a national certification 20 process that is valid, credible, and vendor-neutral. 21 (e) APPLICATION.—To receive a grant under this sec- 22 tion, a State shall submit an application at such time and 23 containing such information as the Secretary may require, 24 which shall include the following: 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00090 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 91 •S 4819 IS (1) A description of the language access needs 1 of individuals in the State enrolled in the State Med- 2 icaid plan. 3 (2) A description of the extent to which the 4 program will— 5 (A) use the grant funds for the purposes 6 described in subsection (d); 7 (B) meet the health care needs of rural 8 populations of the State; and 9 (C) collect information that accurately 10 tracks the language services requested by con- 11 sumers as compared to the language services 12 provided by health care providers in the State 13 participating in the State Medicaid plan. 14 (3) A description of how the program will be 15 evaluated, including a proposal for collaboration with 16 organizations representing interpreters, consumers, 17 and individuals with limited English proficiency. 18 (f) DEFINITIONS.—In this section: 19 (1) QUALIFIED LEP ENROLLEE.—The term 20 ‘‘qualified LEP enrollee’’ means an individual— 21 (A) who is limited English proficient; and 22 (B) who is enrolled in a State Medicaid 23 plan. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00091 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 92 •S 4819 IS (2) STATE.—The term ‘‘State’’ has the mean- 1 ing given the term in section 1101(a)(1) of the So- 2 cial Security Act (42 U.S.C. 1301(a)(1)), for pur- 3 poses of title XIX of such Act (42 U.S.C. 1396 et 4 seq.). 5 (3) STATE MEDICAID PLAN.—The term ‘‘State 6 Medicaid plan’’ means a State plan under title XIX 7 of the Social Security Act (42 U.S.C. 1396 et seq.) 8 or a waiver of such a plan. 9 (4) UNITED STATES.—The term ‘‘United 10 States’’ has the meaning given the term in section 11 1101(a)(2) of the Social Security Act (42 U.S.C. 12 1301(a)(2)), for purposes of title XIX of such Act 13 (42 U.S.C. 1396 et seq.). 14 (g) CONTINUATION PAST DEMONSTRATION.—Any 15 State receiving a grant under this section must agree to 16 directly pay for language services in Medicaid for all Med- 17 icaid providers by the end of the grant period. 18 (h) FUNDING.— 19 (1) AUTHORIZATION OF APPROPRIATIONS.— 20 There is authorized to be appropriated $5,000,000 21 to carry out this section. 22 (2) AVAILABILITY OF FUNDS.—Amounts appro- 23 priated pursuant to the authorization in paragraph 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00092 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 93 •S 4819 IS (1) are authorized to remain available without fiscal 1 year limitation. 2 (3) INCREASED FEDERAL FINANCIAL PARTICI- 3 PATION.—Section 1903(a)(2)(E) of the Social Secu- 4 rity Act (42 U.S.C. 1396b(a)(2)(E)) is amended by 5 inserting ‘‘(or, in the case of a State that was 6 awarded a grant under section 205 of the Health 7 Equity and Accountability Act of 2020, 100 percent 8 for each quarter occurring during the grant period 9 specified in subsection (b) of such section)’’ after 10 ‘‘75 percent’’. 11 (i) LIMITATION.—No Federal funds awarded under 12 this section may be used to provide interpreter services 13 from a location outside the United States. 14 SEC. 206. TRAINING TOMORROW’S DOCTORS FOR CUL- 15 TURALLY AND LINGUISTICALLY APPRO- 16 PRIATE CARE: GRADUATE MEDICAL EDU- 17 CATION. 18 (a) DIRECT GRADUATE MEDICAL EDUCATION.—Sec- 19 tion 1886(h)(4) of the Social Security Act (42 U.S.C. 20 1395ww(h)(4)) is amended by adding at the end the fol- 21 lowing new subparagraph: 22 ‘‘(L) TREATMENT OF CULTURALLY AND 23 LINGUISTICALLY APPROPRIATE TRAINING.—In 24 determining a hospital’s number of full-time 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00093 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 94 •S 4819 IS equivalent residents for purposes of this sub- 1 section, all the time that is spent by an intern 2 or resident in an approved medical residency 3 training program for education and training in 4 culturally and linguistically appropriate service 5 delivery, which shall include all diverse popu- 6 lations including people with disabilities and the 7 Lesbian, gay, bisexual, transgender, queer, 8 questioning, questioning and intersex 9 (LGBTQIA) community, shall be counted to- 10 ward the determination of full-time equiva- 11 lency.’’. 12 (b) INDIRECT MEDICAL EDUCATION.—Section 13 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 14 1395ww(d)(5)(B)) is amended— 15 (1) by redesignating the clause (x) added by 16 section 5505(b) of the Patient Protection and Af- 17 fordable Care Act as clause (xi) and moving the left 18 margin of such clause and each subclause and item 19 therein 2 ems to the left; and 20 (2) by adding at the end the following new 21 clause: 22 ‘‘(xii) The provisions of subparagraph (L) of 23 subsection (h)(4) shall apply under this subpara- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00094 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 95 •S 4819 IS graph in the same manner as they apply under such 1 subsection.’’. 2 (c) EFFECTIVE DATE.—The amendments made by 3 subsections (a) and (b) shall apply with respect to pay- 4 ments made to hospitals on or after the date that is one 5 year after the date of the enactment of this Act. 6 SEC. 207. FEDERAL REIMBURSEMENT FOR CULTURALLY 7 AND LINGUISTICALLY APPROPRIATE SERV- 8 ICES UNDER THE MEDICARE, MEDICAID, AND 9 STATE CHILDREN’S HEALTH INSURANCE 10 PROGRAMS. 11 (a) LANGUAGE ACCESS GRANTS FOR MEDICARE 12 PROVIDERS.— 13 (1) ESTABLISHMENT.— 14 (A) IN GENERAL.—Not later than 6 15 months after the date of the enactment of this 16 Act, the Secretary of Health and Human Serv- 17 ices, acting through the Centers for Medicare & 18 Medicaid Services and in consultation with the 19 Center for Medicare and Medicaid Innovation 20 (as referred to in section 1115A of the Social 21 Security Act (42 U.S.C. 1315a)), shall establish 22 a demonstration program under which the Sec- 23 retary shall award grants to eligible Medicare 24 service providers to improve communication be- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00095 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 96 •S 4819 IS tween such providers and Medicare beneficiaries 1 who are limited English proficient, including 2 beneficiaries who live in diverse and under- 3 served communities. 4 (B) APPLICATION OF INNOVATION 5 RULES.—The demonstration project under sub- 6 paragraph (A) shall be conducted in a manner 7 that is consistent with the applicable provisions 8 of subsections (b), (c), and (d) of section 1115A 9 of the Social Security Act (42 U.S.C. 1315a). 10 (C) NUMBER OF GRANTS.—To the extent 11 practicable, the Secretary shall award not less 12 than 24 grants under this subsection. 13 (D) GRANT PERIOD.—Except as provided 14 under paragraph (2)(D), each grant awarded 15 under this subsection shall be for a 3-year pe- 16 riod. 17 (2) ELIGIBILITY REQUIREMENTS.—To be eligi- 18 ble for a grant under this subsection, an entity must 19 meet the following requirements: 20 (A) MEDICARE PROVIDER.—The entity 21 must be— 22 (i) a provider of services under part A 23 of title XVIII of the Social Security Act 24 (42 U.S.C. 1395c et seq.); 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00096 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 97 •S 4819 IS (ii) a provider of services under part 1 B of such title (42 U.S.C. 1395j et seq.); 2 (iii) a Medicare Advantage organiza- 3 tion offering a Medicare Advantage plan 4 under part C of such title (42 U.S.C. 5 1395w–21 et seq.); or 6 (iv) a PDP sponsor offering a pre- 7 scription drug plan under part D of such 8 title (42 U.S.C. 1395w–101 et seq.). 9 (B) UNDERSERVED COMMUNITIES.—The 10 entity must serve a community that, with re- 11 spect to necessary language services for improv- 12 ing access and utilization of health care among 13 English learners, is disproportionally under- 14 served. 15 (C) APPLICATION.—The entity must pre- 16 pare and submit to the Secretary an applica- 17 tion, at such time, in such manner, and accom- 18 panied by such additional information as the 19 Secretary may require. 20 (D) REPORTING.—In the case of a grantee 21 that received a grant under this subsection in 22 a previous year, such grantee is only eligible for 23 continued payments under a grant under this 24 subsection if the grantee met the reporting re- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00097 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 98 •S 4819 IS quirements under paragraph (9) for such year. 1 If a grantee fails to meet the requirement of 2 such paragraph for the first year of a grant, the 3 Secretary may terminate the grant and solicit 4 applications from new grantees to participate in 5 the demonstration program. 6 (3) DISTRIBUTION.—To the extent feasible, the 7 Secretary shall award— 8 (A) at least 6 grants to providers of serv- 9 ices described in paragraph (2)(A)(i); 10 (B) at least 6 grants to service providers 11 described in paragraph (2)(A)(ii); 12 (C) at least 6 grants to organizations de- 13 scribed in paragraph (2)(A)(iii); and 14 (D) at least 6 grants to sponsors described 15 in paragraph (2)(A)(iv). 16 (4) CONSIDERATIONS IN AWARDING GRANTS.— 17 (A) VARIATION IN GRANTEES.—In award- 18 ing grants under this subsection, the Secretary 19 shall select grantees to ensure the following: 20 (i) The grantees provide many dif- 21 ferent types of language services. 22 (ii) The grantees serve Medicare bene- 23 ficiaries who speak different languages, 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00098 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 99 •S 4819 IS and who, as a population, have differing 1 needs for language services. 2 (iii) The grantees serve Medicare 3 beneficiaries in both urban and rural set- 4 tings. 5 (iv) The grantees serve Medicare 6 beneficiaries in at least two geographic re- 7 gions, as defined by the Secretary. 8 (v) The grantees serve Medicare bene- 9 ficiaries in at least two large metropolitan 10 statistical areas with racial, ethnic, sexual, 11 gender, disability, and economically diverse 12 populations. 13 (B) PRIORITY FOR PARTNERSHIPS WITH 14 COMMUNITY ORGANIZATIONS AND AGENCIES.— 15 In awarding grants under this subsection, the 16 Secretary shall give priority to eligible entities 17 that have a partnership with— 18 (i) a community organization; or 19 (ii) a consortia of community organi- 20 zations, State agencies, and local agencies, 21 that has experience in providing language serv- 22 ices. 23 (5) USE OF FUNDS FOR COMPETENT LANGUAGE 24 SERVICES.— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00099 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 100 •S 4819 IS (A) IN GENERAL.—Subject to subpara- 1 graph (E), a grantee may only use grant funds 2 received under this subsection to pay for the 3 provision of competent language services to 4 Medicare beneficiaries who are English learn- 5 ers. 6 (B) COMPETENT LANGUAGE SERVICES DE- 7 FINED.—For purposes of this subsection, the 8 term ‘‘competent language services’’ means— 9 (i) interpreter and translation services 10 that— 11 (I) subject to the exceptions 12 under subparagraph (C)— 13 (aa) if the grantee operates 14 in a State that has statewide 15 health care interpreter standards, 16 meet the State standards cur- 17 rently in effect; or 18 (bb) if the grantee operates 19 in a State that does not have 20 statewide health care interpreter 21 standards, utilizes competent in- 22 terpreters who follow the Na- 23 tional Council on Interpreting in 24 Health Care’s Code of Ethics and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00100 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 101 •S 4819 IS Standards of Practice and com- 1 ply with the requirements of sec- 2 tion 1557 of the Patient Protec- 3 tion and Affordable Care Act (42 4 U.S.C. 18116) as published in 5 the Federal Register on May 18, 6 2016; and 7 (II) that, in the case of inter- 8 preter services, are provided 9 through— 10 (aa) onsite interpretation; 11 (bb) telephonic interpreta- 12 tion; or 13 (cc) video interpretation; 14 and 15 (ii) the direct provision of health care 16 or health-care-related services by a com- 17 petent bilingual health care provider. 18 (C) EXCEPTIONS.—The requirements of 19 subparagraph (B)(i)(I) do not apply, with re- 20 spect to interpreter and translation services and 21 a grantee— 22 (i) in the case of a Medicare bene- 23 ficiary who is an English learner if— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00101 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 102 •S 4819 IS (I) such beneficiary has been in- 1 formed, in the beneficiary’s primary 2 language, of the availability of free in- 3 terpreter and translation services and 4 the beneficiary instead requests that a 5 family member, friend, or other per- 6 son provide such services; and 7 (II) the grantee documents such 8 request in the beneficiary’s medical 9 record; or 10 (ii) in the case of a medical emergency 11 where the delay directly associated with ob- 12 taining a competent interpreter or trans- 13 lation services would jeopardize the health 14 of the patient. 15 Clause (ii) shall not be construed to exempt 16 emergency rooms or similar entities that regu- 17 larly provide health care services in medical 18 emergencies to patients who are English learn- 19 ers from any applicable legal or regulatory re- 20 quirements related to providing competent in- 21 terpreter and translation services without undue 22 delay. 23 (D) MEDICARE ADVANTAGE ORGANIZA- 24 TIONS AND PDP SPONSORS.—If a grantee is a 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00102 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 103 •S 4819 IS Medicare Advantage organization offering a 1 Medicare Advantage plan under part C of title 2 XVIII of the Social Security Act (42 U.S.C. 3 1395w–21 et seq.) or a PDP sponsor offering 4 a prescription drug plan under part D of such 5 title (42 U.S.C. 1395w–101 et seq.), such entity 6 must provide at least 50 percent of the grant 7 funds that the entity receives under this sub- 8 section directly to the entity’s network providers 9 (including all health providers and pharmacists) 10 for the purpose of providing support for such 11 providers to provide competent language serv- 12 ices to Medicare beneficiaries who are English 13 learners. 14 (E) ADMINISTRATIVE AND REPORTING 15 COSTS.—A grantee may use up to 10 percent of 16 the grant funds to pay for administrative costs 17 associated with the provision of competent lan- 18 guage services and for reporting required under 19 paragraph (9). 20 (6) DETERMINATION OF AMOUNT OF GRANT 21 PAYMENTS.— 22 (A) IN GENERAL.—Payments to grantees 23 under this subsection shall be calculated based 24 on the estimated numbers of Medicare bene- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00103 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 104 •S 4819 IS ficiaries who are English learners in a grantee’s 1 service area utilizing— 2 (i) data on the numbers of English 3 learners who speak English less than ‘‘very 4 well’’ from the most recently available data 5 from the Bureau of the Census or other 6 State-based study the Secretary determines 7 likely to yield accurate data regarding the 8 number of such individuals in such service 9 area; or 10 (ii) data provided by the grantee, if 11 the grantee routinely collects data on the 12 primary language of the Medicare bene- 13 ficiaries that the grantee serves and the 14 Secretary determines that the data is accu- 15 rate and shows a greater number of 16 English learners than would be estimated 17 using the data under clause (i). 18 (B) DISCRETION OF SECRETARY.—Subject 19 to subparagraph (C), the amount of payment 20 made to a grantee under this subsection may be 21 modified annually at the discretion of the Sec- 22 retary, based on changes in the data under sub- 23 paragraph (A) with respect to the service area 24 of a grantee for the year. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00104 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 105 •S 4819 IS (C) LIMITATION ON AMOUNT.—The 1 amount of a grant made under this subsection 2 to a grantee may not exceed $500,000 for the 3 period under paragraph (1)(D). 4 (7) ASSURANCES.—Grantees under this sub- 5 section shall, as a condition of receiving a grant 6 under this subsection— 7 (A) ensure that clinical and support staff 8 receive appropriate ongoing education and 9 training in linguistically appropriate service de- 10 livery; 11 (B) ensure the linguistic competence of bi- 12 lingual providers; 13 (C) offer and provide appropriate language 14 services at no additional charge to each patient 15 who is an English learner for all points of con- 16 tact between the patient and the grantee, in a 17 timely manner during all hours of operation; 18 (D) notify Medicare beneficiaries of their 19 right to receive language services in their pri- 20 mary language; 21 (E) post signage in the primary languages 22 commonly used by the patient population in the 23 service area of the organization; and 24 (F) ensure that— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00105 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 106 •S 4819 IS (i) primary language data are col- 1 lected for recipients of language services 2 and such data are consistent with stand- 3 ards developed under title XXXIV of the 4 Public Health Service Act, as added by 5 section 202 of this Act, to the extent such 6 standards are available upon the initiation 7 of the demonstration program; and 8 (ii) consistent with the privacy protec- 9 tions provided under the regulations pro- 10 mulgated pursuant to section 264(c) of the 11 Health Insurance Portability and Account- 12 ability Act of 1996 (42 U.S.C. 1320d–2 13 note), if the recipient of language services 14 is a minor or is incapacitated, primary lan- 15 guage data are collected on the parent or 16 legal guardian of such recipient. 17 (8) NO COST SHARING.—Medicare beneficiaries 18 who are English learners shall not have to pay cost 19 sharing or co-payments for competent language serv- 20 ices provided under this demonstration program. 21 (9) REPORTING REQUIREMENTS FOR GRANT- 22 EES.—Not later than the end of each calendar year, 23 a grantee that receives funds under this subsection 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00106 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 107 •S 4819 IS in such year shall submit to the Secretary a report 1 that includes the following information: 2 (A) The number of Medicare beneficiaries 3 to whom competent language services are pro- 4 vided. 5 (B) The primary languages of those Medi- 6 care beneficiaries. 7 (C) The types of language services pro- 8 vided to such beneficiaries. 9 (D) Whether such language services were 10 provided by employees of the grantee or 11 through a contract with external contractors or 12 agencies. 13 (E) The types of interpretation services 14 provided to such beneficiaries, and the approxi- 15 mate length of time such service is provided to 16 such beneficiaries. 17 (F) The costs of providing competent lan- 18 guage services. 19 (G) An account of the training or accredi- 20 tation of bilingual staff, interpreters, and trans- 21 lators providing services funded by the grant 22 under this subsection. 23 (10) EVALUATION AND REPORT TO CON- 24 GRESS.—Not later than 1 year after the completion 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00107 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 108 •S 4819 IS of a 3-year grant under this subsection, the Sec- 1 retary shall conduct an evaluation of the demonstra- 2 tion program under this subsection and shall submit 3 to the Congress a report that includes the following: 4 (A) An analysis of the patient outcomes 5 and the costs of furnishing care to the Medicare 6 beneficiaries who are English learners partici- 7 pating in the project as compared to such out- 8 comes and costs for such Medicare beneficiaries 9 not participating, based on the data provided 10 under paragraph (9) and any other information 11 available to the Secretary. 12 (B) The effect of delivering language serv- 13 ices on— 14 (i) Medicare beneficiary access to care 15 and utilization of services; 16 (ii) the efficiency and cost effective- 17 ness of health care delivery; 18 (iii) patient satisfaction; 19 (iv) health outcomes; and 20 (v) the provision of culturally appro- 21 priate services provided to such bene- 22 ficiaries. 23 (C) The extent to which bilingual staff, in- 24 terpreters, and translators providing services 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00108 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 109 •S 4819 IS under such demonstration were trained or ac- 1 credited and the nature of accreditation or 2 training needed by type of provider, service, or 3 other category as determined by the Secretary 4 to ensure the provision of high-quality interpre- 5 tation, translation, or other language services to 6 Medicare beneficiaries if such services are ex- 7 panded pursuant to section 1115A(c) of the So- 8 cial Security Act (42 U.S.C. 1315a(c)). 9 (D) Recommendations, if any, regarding 10 the extension of such project to the entire Medi- 11 care Program, subject to the provisions of such 12 section 1115A(c). 13 (11) APPROPRIATIONS.—There is appropriated 14 to carry out this subsection, in equal parts from the 15 Federal Hospital Insurance Trust Fund under sec- 16 tion 1817 of the Social Security Act (42 U.S.C. 17 1395i) and the Federal Supplementary Medical In- 18 surance Trust Fund under section 1841 of such Act 19 (42 U.S.C. 1395t), $16,000,000 for each fiscal year 20 of the demonstration program. 21 (12) ENGLISH LEARNER DEFINED.—In this 22 subsection, the term ‘‘English learner’’ has the 23 meaning given such term in section 8101(20) of the 24 Elementary and Secondary Education Act of 1965, 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00109 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 110 •S 4819 IS except that subparagraphs (A), (B), and (D) of such 1 section shall not apply. 2 (b) LANGUAGE ASSISTANCE SERVICES UNDER THE 3 MEDICARE PROGRAM.— 4 (1) INCLUSION AS RURAL HEALTH CLINIC 5 SERVICES.—Section 1861 of the Social Security Act 6 (42 U.S.C. 1395x) is amended— 7 (A) in subsection (aa)(1)— 8 (i) in subparagraph (B), by striking 9 ‘‘and’’ at the end; 10 (ii) by adding ‘‘and’’ at the end of 11 subparagraph (C); and 12 (iii) by inserting after subparagraph 13 (C) the following new subparagraph: 14 ‘‘(D) language assistance services as defined in 15 subsection (kkk)(1),’’; and 16 (B) by adding at the end the following new 17 subsection: 18 ‘‘Language Assistance Services and Related Terms 19 ‘‘(kkk)(1) The term ‘language assistance services’ 20 means ‘language access’ or ‘language assistance services’ 21 (as those terms are defined in section 3400 of the Public 22 Health Service Act) furnished by a ‘qualified interpreter 23 for an individual with limited English proficiency’ or a 24 ‘qualified translator’ (as those terms are defined in such 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00110 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 111 •S 4819 IS section 3400) to an ‘individual with limited English pro- 1 ficiency’ (as defined in such section 3400) or an ‘English 2 learner’ (as defined in paragraph (2)). 3 ‘‘(2) The term ‘English learner’ has the meaning 4 given that term in section 8101(20) of the Elementary and 5 Secondary Education Act of 1965, except that subpara- 6 graphs (A), (B), and (D) of such section shall not apply.’’. 7 (2) COVERAGE.—Section 1832(a)(2) of the So- 8 cial Security Act (42 U.S.C. 1395k(a)(2)) is amend- 9 ed— 10 (A) by striking ‘‘and’’ at the end of sub- 11 paragraph (I); 12 (B) by striking the period at the end of 13 subparagraph (J) and inserting ‘‘; and’’; and 14 (C) by adding at the end the following new 15 subparagraph: 16 ‘‘(K) language assistance services (as de- 17 fined in section 1861(kkk)(1)).’’. 18 (3) PAYMENT.—Section 1833(a) of the Social 19 Security Act (42 U.S.C. 1395l(a)) is amended— 20 (A) by striking ‘‘and’’ at the end of para- 21 graph (8); 22 (B) by striking the period at the end of 23 paragraph (9) and inserting ‘‘; and’’; and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00111 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 112 •S 4819 IS (C) by inserting after paragraph (9) the 1 following new paragraph: 2 ‘‘(10) in the case of language assistance serv- 3 ices (as defined in section 1861(kkk)(1)), 100 per- 4 cent of the reasonable charges for such services, as 5 determined in consultation with the Medicare Pay- 6 ment Advisory Commission.’’. 7 (4) WAIVER OF BUDGET NEUTRALITY.—For 8 the 3-year period beginning on the date of enact- 9 ment of this section, the budget neutrality provision 10 of section 1848(c)(2)(B)(ii) of the Social Security 11 Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not 12 apply with respect to language assistance services 13 (as defined in section 1861(kkk)(1) of such Act). 14 (c) MEDICARE PARTS C AND D.— 15 (1) IN GENERAL.—Medicare Advantage plans 16 under part C of title XVIII of the Social Security 17 Act (42 U.S.C. 1395w–21 et seq.) and prescription 18 drug plans under part D of such title (42 U.S.C. 19 1395q–101) shall comply with title VI of the Civil 20 Rights Act of 1964 (42 U.S.C. 2000d et seq.) and 21 section 1557 of the Patient Protection and Afford- 22 able Care Act (42 U.S.C. 18116) to provide effective 23 language services to enrollees of such plans. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00112 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 113 •S 4819 IS (2) MEDICARE ADVANTAGE PLANS AND PRE- 1 SCRIPTION DRUG PLANS REPORTING REQUIRE- 2 MENT.—Section 1857(e) of the Social Security Act 3 (42 U.S.C. 1395w–27(e)) is amended by adding at 4 the end the following new paragraph: 5 ‘‘(6) REPORTING REQUIREMENTS RELATING TO 6 EFFECTIVE LANGUAGE SERVICES.—A contract under 7 this part shall require a Medicare Advantage organi- 8 zation (and, through application of section 1860D– 9 12(b)(3)(D), a contract under section 1860D–12 10 shall require a PDP sponsor) to annually submit 11 (for each year of the contract) a report that contains 12 information on the internal policies and procedures 13 of the organization (or sponsor) related to recruit- 14 ment and retention efforts directed to workforce di- 15 versity and linguistically and culturally appropriate 16 provision of services in each of the following con- 17 texts: 18 ‘‘(A) The collection of data in a manner 19 that meets the requirements of title I of the 20 Health Equity and Accountability Act of 2020, 21 regarding the enrollee population. 22 ‘‘(B) Education of staff and contractors 23 who have routine contact with enrollees regard- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00113 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 114 •S 4819 IS ing the various needs of the diverse enrollee 1 population. 2 ‘‘(C) Evaluation of the language services 3 programs and services offered by the organiza- 4 tion (or sponsor) with respect to the enrollee 5 population, such as through analysis of com- 6 plaints or satisfaction survey results. 7 ‘‘(D) Methods by which the plan provides 8 to the Secretary information regarding the eth- 9 nic diversity of the enrollee population. 10 ‘‘(E) The periodic provision of educational 11 information to plan enrollees on the language 12 services and programs offered by the organiza- 13 tion (or sponsor).’’. 14 (d) IMPROVING LANGUAGE SERVICES IN MEDICAID 15 AND CHIP.— 16 (1) PAYMENTS TO STATES.—Section 17 1903(a)(2)(E) of the Social Security Act (42 U.S.C. 18 1396b(a)(2)(E)), as amended by section 205(h)(3), 19 is further amended by— 20 (A) striking ‘‘75’’ and inserting ‘‘95’’; 21 (B) striking ‘‘translation or interpretation 22 services’’ and inserting ‘‘language assistance 23 services’’; and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00114 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 115 •S 4819 IS (C) striking ‘‘children of families’’ and in- 1 serting ‘‘individuals’’. 2 (2) STATE PLAN REQUIREMENTS.—Section 3 1902(a)(10)(A) of the Social Security Act (42 4 U.S.C. 1396a(a)(10)(A)) is amended by striking 5 ‘‘and (29)’’ and inserting ‘‘(29), and (30)’’. 6 (3) DEFINITION OF MEDICAL ASSISTANCE.— 7 Section 1905(a) of the Social Security Act (42 8 U.S.C. 1396d(a)) is amended— 9 (A) in paragraph (29), by striking ‘‘and’’ 10 at the end; 11 (B) by redesignating paragraph (30) as 12 paragraph (31); and 13 (C) by inserting after paragraph (29) the 14 following new paragraph: 15 ‘‘(30) language assistance services, as such 16 term is defined in section 1861(kkk)(1), provided in 17 a timely manner to individuals with limited English 18 proficiency as defined in section 3400 of the Public 19 Health Service Act; and’’. 20 (4) USE OF DEDUCTIONS AND COST SHAR- 21 ING.—Section 1916(a)(2) of the Social Security Act 22 (42 U.S.C. 1396o(a)(2)) is amended— 23 (A) by striking ‘‘or’’ at the end of subpara- 24 graph (F); 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00115 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 116 •S 4819 IS (B) by striking ‘‘; and’’ at the end of sub- 1 paragraph (G) and inserting ‘‘, or’’; and 2 (C) by adding at the end the following new 3 subparagraph: 4 ‘‘(H) language assistance services de- 5 scribed in section 1905(a)(30); 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), (10), and (11)’’; 12 (B) in subsection (c), by adding at the end 13 the following new paragraph: 14 ‘‘(11) 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(kkk)(1), provided in a timely manner to indi- 19 viduals with limited English proficiency (as defined 20 in section 3400 of the Public Health Service Act).’’; 21 and 22 (C) in subsection (e)(2)— 23 (i) in the heading, by striking ‘‘PRE- 24 VENTIVE’’ and inserting ‘‘CERTAIN’’; and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00116 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 117 •S 4819 IS (ii) by inserting ‘‘language assistance 1 services described in subsection (c)(11),’’ 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)(11)’’. 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 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00117 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 118 •S 4819 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 English learners in an amount equal to 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00118 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 119 •S 4819 IS an eligible entity’s eligible costs for providing 1 such services for the quarter. 2 (B) FUNDING.—Out of any funds in the 3 Treasury not otherwise appropriated, there are 4 appropriated to the Secretary of Health and 5 Human Services such sums as may be nec- 6 essary for each of fiscal years 2021 through 7 2025. 8 (C) RELATION TO MEDICAID DSH.—Pay- 9 ments under this subsection shall not offset or 10 reduce payments under section 1923 of the So- 11 cial Security Act (42 U.S.C. 1396r–4), nor 12 shall payments under such section be consid- 13 ered when determining uncompensated costs as- 14 sociated with the provision of language assist- 15 ance services for the purposes of this 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 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00119 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 120 •S 4819 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 are 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 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00120 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 121 •S 4819 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 English learners, the product of— 12 (i) the average per person cost of lan- 13 guage assistance services, determined ac- 14 cording to the methodology devised under 15 paragraph (2); and 16 (ii) the number of English learners 17 who are provided language assistance serv- 18 ices by the entity and for whom no reim- 19 bursement is available for such services 20 under the amendments made by subsection 21 (a), (b), (c), or (d) or by private health in- 22 surance. 23 (B) ELIGIBLE ENTITY.—The term ‘‘eligible 24 entity’’ means an entity that— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00121 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 122 •S 4819 IS (i) is a Medicaid provider that is— 1 (I) a physician; 2 (II) a hospital with a low-income 3 utilization rate (as defined in section 4 1923(b)(3) of the Social Security Act 5 (42 U.S.C. 1396r–4(b)(3))) of greater 6 than 25 percent; or 7 (III) a federally qualified health 8 center (as defined in section 9 1905(l)(2)(B) of the Social Security 10 Act (42 U.S.C. 1396d(l)(2)(B))); 11 (ii) not later than 6 months after the 12 date of the enactment of this Act, provides 13 language assistance services to not less 14 than 8 percent of the entity’s total number 15 of patients; and 16 (iii) prepares and submits an applica- 17 tion to the Secretary, at such time, in such 18 manner, and accompanied by such infor- 19 mation as the Secretary may require, to 20 ascertain the entity’s eligibility for funding 21 under this subsection. 22 (C) ENGLISH LEARNER.—The term 23 ‘‘English learner’’ has the meaning given such 24 term in section 8101(20) of the Elementary 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00122 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 123 •S 4819 IS and Secondary Education Act of 1965 (20 1 U.S.C. 7801(20)), except that subparagraphs 2 (A), (B), and (D) of such section shall not 3 apply. 4 (D) LANGUAGE ASSISTANCE SERVICES.— 5 The term ‘‘language assistance services’’ has 6 the meaning given such term in section 7 1861(kkk)(1) of the Social Security Act, as 8 added by subsection (b). 9 (f) APPLICATION OF CIVIL RIGHTS ACT OF 1964, 10 SECTION 1557 OF THE AFFORDABLE CARE ACT, AND 11 OTHER LAWS.—Nothing in this section shall be construed 12 to limit otherwise existing obligations of recipients of Fed- 13 eral financial assistance under title VI of the Civil Rights 14 Act of 1964 (42 U.S.C. 2000d et seq.), section 1557 of 15 the Affordable Care Act, or other laws that protect the 16 civil rights of individuals. 17 (g) EFFECTIVE DATE.— 18 (1) IN GENERAL.—Except as otherwise pro- 19 vided and subject to paragraph (2), the amendments 20 made by this section shall take effect on January 1, 21 2021. 22 (2) EXCEPTION IF STATE LEGISLATION RE- 23 QUIRED.—In the case of a State plan for medical as- 24 sistance under title XIX of the Social Security Act 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00123 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 124 •S 4819 IS (42 U.S.C. 1396 et seq.) or a State plan for child 1 health assistance under title XXI of such Act (42 2 U.S.C. 1397aa et seq.) which the Secretary of 3 Health and Human Services determines requires 4 State legislation (other than legislation appro- 5 priating funds) in order for the plan to meet the ad- 6 ditional requirement imposed by the amendments 7 made by this section, such State plan shall not be 8 regarded as failing to comply with the requirements 9 of such title solely on the basis of its failure to meet 10 this additional requirement before the first day of 11 the first calendar quarter beginning after the close 12 of the first regular session of the State legislature 13 that begins after the date of the enactment of this 14 Act. For purposes of the previous sentence, in the 15 case of a State that has a 2-year legislative session, 16 each year of such session shall be deemed to be a 17 separate regular session of the State legislature. 18 SEC. 208. INCREASING UNDERSTANDING OF AND IMPROV- 19 ING HEALTH LITERACY. 20 (a) IN GENERAL.—The Secretary of Health and 21 Human Services, acting through the Director of the Agen- 22 cy for Healthcare Research and Quality with respect to 23 grants under subsection (c)(1) and through the Adminis- 24 trator of the Health Resources and Services Administra- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00124 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 125 •S 4819 IS tion with respect to grants under subsection (c)(2), in con- 1 sultation with the Director of the National Institute on 2 Minority Health and Health Disparities and the Deputy 3 Assistant Secretary for Minority Health, shall award 4 grants to eligible entities to improve health care for pa- 5 tient populations that have low functional health literacy. 6 (b) ELIGIBILITY.—To be eligible to receive a grant 7 under subsection (a), an entity shall— 8 (1) be a hospital, health center or clinic, health 9 plan, or other health entity (including a nonprofit 10 minority health organization or association); and 11 (2) prepare and submit to the Secretary an ap- 12 plication at such time, in such manner, and con- 13 taining such information as the Secretary may rea- 14 sonably require. 15 (c) USE OF FUNDS.— 16 (1) AGENCY FOR HEALTHCARE RESEARCH AND 17 QUALITY.—A grant awarded under subsection (a) 18 through the Director of the Agency for Healthcare 19 Research and Quality shall be used— 20 (A) to define and increase the under- 21 standing of health literacy; 22 (B) to investigate the correlation between 23 low health literacy and health and health care; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00125 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 126 •S 4819 IS (C) to clarify which aspects of health lit- 1 eracy have an effect on health outcomes; and 2 (D) for any other activity determined ap- 3 propriate by the Director. 4 (2) HEALTH RESOURCES AND SERVICES ADMIN- 5 ISTRATION.—A grant awarded under subsection (a) 6 through the Administrator of the Health Resources 7 and Services Administration shall be used to conduct 8 demonstration projects for interventions for patients 9 with low health literacy that may include— 10 (A) the development of new disease man- 11 agement programs for patients with low health 12 literacy; 13 (B) the tailoring of disease management 14 programs addressing mental, physical, oral, and 15 behavioral health conditions for patients with 16 low health literacy; 17 (C) the translation of written health mate- 18 rials for patients with low health literacy; 19 (D) the identification, implementation, and 20 testing of low health literacy screening tools; 21 (E) the conduct of educational campaigns 22 for patients and providers about low health lit- 23 eracy; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00126 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 127 •S 4819 IS (F) the conduct of educational campaigns 1 concerning health directed specifically at pa- 2 tients with mental disabilities, including those 3 with cognitive and intellectual disabilities, de- 4 signed to reduce the incidence of low health lit- 5 eracy among these populations, which shall 6 have instructional materials in the plain lan- 7 guage standards promulgated under the Plain 8 Writing Act of 2010 (5 U.S.C. 301 note) for 9 Federal agencies; and 10 (G) other activities determined appropriate 11 by the Administrator. 12 (d) DEFINITIONS.—In this section, the term ‘‘low 13 health literacy’’ means the inability of an individual to ob- 14 tain, process, and understand basic health information 15 and services needed to make appropriate health decisions. 16 (e) AUTHORIZATION OF APPROPRIATIONS.—There 17 are authorized to be appropriated to carry out this section, 18 such sums as may be necessary for each of fiscal years 19 2021 through 2025. 20 SEC. 209. REQUIREMENTS FOR HEALTH PROGRAMS OR AC- 21 TIVITIES RECEIVING FEDERAL FUNDS. 22 (a) COVERED ENTITY; COVERED PROGRAM OR AC- 23 TIVITY.—In this section— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00127 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 128 •S 4819 IS (1) the term ‘‘covered entity’’ has the meaning 1 given such term in section 92.4 of title 45, Code of 2 Federal Regulations, as in effect on May 18, 2016 3 (81 Fed. Reg. 31466 (May 18, 2016)); and 4 (2) the term ‘‘health program or activity’’ has 5 the meaning given such term in section 92.4 of title 6 45, Code of Federal Regulations, as in effect on May 7 18, 2016 (81 Fed. Reg. 31466 (May 18, 2016)). 8 (b) REQUIREMENTS.—A covered entity, in order to 9 ensure the right of individuals with limited English pro- 10 ficiency to receive access to high-quality health care 11 through the covered program or activity, shall— 12 (1) ensure that appropriate clinical and support 13 staff receive ongoing education and training in cul- 14 turally and linguistically appropriate service delivery; 15 (2) offer and provide appropriate language as- 16 sistance services at no additional charge to each pa- 17 tient that is an individual with limited English pro- 18 ficiency at all points of contact, in a timely manner 19 during all hours of operation; 20 (3) notify patients of their right to receive lan- 21 guage services in their primary language; and 22 (4) utilize only qualified interpreters for an in- 23 dividual with limited English proficiency or qualified 24 translators, except as provided in subsection (c). 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00128 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 129 •S 4819 IS (c) EXEMPTIONS.—The requirements of subsection 1 (b)(4) shall not apply as follows: 2 (1) When a patient requests the use of family, 3 friends, or other persons untrained in interpretation 4 or translation if each of the following conditions are 5 met: 6 (A) The interpreter requested by the pa- 7 tient is over the age of 18. 8 (B) The covered entity informs the patient 9 in the primary language of the patient that he 10 or she has the option of having the entity pro- 11 vide to the patient an interpreter and trans- 12 lation services without charge. 13 (C) The covered entity informs the patient 14 that the entity may not require an individual 15 with a limited English proficiency to use a fam- 16 ily member or friend as an interpreter. 17 (D) The covered entity evaluates whether 18 the person the patient wishes to use as an in- 19 terpreter is competent. If the covered entity has 20 reason to believe that such person is not com- 21 petent as an interpreter, the entity provides its 22 own interpreter to protect the covered entity 23 from liability if the patient’s interpreter is later 24 found not competent. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00129 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 130 •S 4819 IS (E) If the covered entity has reason to be- 1 lieve that there is a conflict of interest between 2 the interpreter and patient, the covered entity 3 may not use the patient’s interpreter. 4 (F) The covered entity has the patient sign 5 a waiver, witnessed by at least 1 individual not 6 related to the patient, that includes the infor- 7 mation stated in subparagraphs (A) through 8 (E) and is translated into the patient’s primary 9 language. 10 (2) When a medical emergency exists and the 11 delay directly associated with obtaining competent 12 interpreter or translation services would jeopardize 13 the health of the patient, but only until a competent 14 interpreter or translation service is available. 15 (d) RULE OF CONSTRUCTION.—Subsection (c)(2) 16 shall not be construed to mean that emergency rooms or 17 similar entities that regularly provide health care services 18 in medical emergencies are exempt from legal or regu- 19 latory requirements related to competent interpreter serv- 20 ices. 21 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00130 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 131 •S 4819 IS SEC. 210. REPORT ON FEDERAL EFFORTS TO PROVIDE CUL- 1 TURALLY AND LINGUISTICALLY APPRO- 2 PRIATE HEALTH CARE SERVICES. 3 (a) REPORT.—Not later than 1 year after the date 4 of enactment of this Act and annually thereafter, the Sec- 5 retary of Health and Human Services shall enter into a 6 contract with the National Academy of Medicine for the 7 preparation and publication of a report that describes 8 Federal efforts to ensure that all individuals with limited 9 English proficiency have meaningful access to health care 10 services and health-care-related services that are culturally 11 and linguistically appropriate. Such report shall include— 12 (1) a description and evaluation of the activities 13 carried out under this Act; 14 (2) a description and analysis of best practices, 15 model programs, guidelines, and other effective 16 strategies for providing access to culturally and lin- 17 guistically appropriate health care services; 18 (3) recommendations on the development and 19 implementation of policies and practices by providers 20 of health care services and health-care-related serv- 21 ices for individuals with limited English proficiency, 22 including people with cognitive, hearing, vision, or 23 print impairments; 24 (4) recommend guidelines or standards for 25 health literacy and plain language, informed consent, 26 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00131 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 132 •S 4819 IS discharge instructions, and written communications, 1 and for improvement of health care access; 2 (5) a description of the effect of providing lan- 3 guage services on quality of health care and access 4 to care; and 5 (6) a description of the costs associated with or 6 savings related to the provision of language services. 7 (b) 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 2021 through 2025. 11 SEC. 211. ENGLISH FOR SPEAKERS OF OTHER LANGUAGES. 12 (a) GRANTS AUTHORIZED.—The Secretary of Edu- 13 cation is authorized to provide grants to eligible entities 14 for the provision of English as a second language (in this 15 section referred to ‘‘ESL’’) instruction and shall deter- 16 mine, after consultation with appropriate stakeholders, the 17 mechanism for administering and distributing such 18 grants. 19 (b) ELIGIBLE ENTITY DEFINED.—In this section, 20 the term ‘‘eligible entity’’ means a State or community- 21 based organization that employs and serves minority popu- 22 lations. 23 (c) APPLICATION.—An eligible entity may apply for 24 a grant under this section by submitting such information 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00132 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 133 •S 4819 IS as the Secretary of Education may require and in such 1 form and manner as the Secretary may require. 2 (d) USE OF GRANT.—As a condition of receiving a 3 grant under this section, an eligible entity shall— 4 (1) develop and implement a plan for assuring 5 the availability of ESL instruction that effectively 6 integrates information about the nature of the 7 United States health care system, how to access 8 care, and any special language skills that may be re- 9 quired for individuals to access and regularly nego- 10 tiate the system effectively; 11 (2) develop a plan, including, where appro- 12 priate, public-private partnerships, for making ESL 13 instruction progressively available to all individuals 14 seeking instruction; and 15 (3) maintain current ESL instruction efforts by 16 using funds available under this section to supple- 17 ment rather than supplant any funds expended for 18 ESL instruction in the State as of January 1, 2020. 19 (e) ADDITIONAL DUTIES OF THE SECRETARY.—The 20 Secretary of Education shall— 21 (1) collect and publicize annual data on how 22 much Federal, State, and local governments spend 23 on ESL instruction; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00133 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 134 •S 4819 IS (2) collect data from State and local govern- 1 ments to identify the unmet needs of English lan- 2 guage learners for appropriate ESL instruction, in- 3 cluding— 4 (A) the preferred written and spoken lan- 5 guage of such English language learners; 6 (B) the extent of waiting lists for ESL in- 7 struction, including how many programs main- 8 tain waiting lists and, for programs that do not 9 have waiting lists, the reasons why not; 10 (C) the availability of programs to geo- 11 graphically isolated communities; 12 (D) the impact of course enrollment poli- 13 cies, including open enrollment, on the avail- 14 ability of ESL instruction; 15 (E) the number of individuals in the State 16 and each participating locality; 17 (F) the effectiveness of the instruction in 18 meeting the needs of individuals receiving in- 19 struction and individuals needing instruction; 20 (G) an assessment of the need for pro- 21 grams that integrate job training and ESL in- 22 struction, to assist individuals to obtain better 23 jobs; and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00134 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 135 •S 4819 IS (H) the availability of ESL slots by State 1 and locality; 2 (3) determine the cost and most appropriate 3 methods of making ESL instruction available to all 4 English language learners seeking instruction; and 5 (4) not later than 1 year after the date of en- 6 actment of this Act, issue a report to Congress that 7 assesses the information collected in paragraphs (1), 8 (2), and (3) and makes recommendations on steps 9 that should be taken to progressively realize the goal 10 of making ESL instruction available to all English 11 language learners seeking instruction. 12 (f) AUTHORIZATION OF APPROPRIATIONS.—There 13 are authorized to be appropriated to the Secretary of Edu- 14 cation $250,000,000 for each of fiscal years 2021 through 15 2024 to carry out this section. 16 SEC. 212. IMPLEMENTATION. 17 (a) GENERAL PROVISIONS.— 18 (1) IMMUNITY.—A State shall not be immune 19 under the 11th Amendment to the Constitution of 20 the United States from suit in Federal court for a 21 violation of this title (including an amendment made 22 by this title). 23 (2) REMEDIES.—In a suit against a State for 24 a violation of this title (including an amendment 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00135 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 136 •S 4819 IS made by this title), remedies (including remedies 1 both at law and in equity) are available for such a 2 violation to the same extent as such remedies are 3 available for such a violation in a suit against any 4 public or private entity other than a State. 5 (b) RULE OF CONSTRUCTION.—Nothing in this title 6 shall be construed to limit otherwise existing obligations 7 of recipients of Federal financial assistance under title VI 8 of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) 9 or any other Federal statute. 10 SEC. 213. LANGUAGE ACCESS SERVICES. 11 (a) ESSENTIAL BENEFITS.—Section 1302(b)(1) of 12 the Patient Protection and Affordable Care Act (42 13 U.S.C. 18022(b)(1)) is amended by adding at the end the 14 following: 15 ‘‘(K) Language access services, including 16 oral interpretation and written translations.’’. 17 (b) EMPLOYER-SPONSORED MINIMUM ESSENTIAL 18 COVERAGE.— 19 (1) IN GENERAL.—Section 36B(c)(2)(C) of the 20 Internal Revenue Code of 1986 is amended by redes- 21 ignating clauses (iii) and (iv) as clauses (iv) and (v), 22 respectively, and by inserting after clause (ii) the fol- 23 lowing new clause: 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00136 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 137 •S 4819 IS ‘‘(iii) COVERAGE MUST INCLUDE LAN- 1 GUAGE ACCESS AND SERVICES.—Except as 2 provided in clause (iv), an employee shall 3 not be treated as eligible for minimum es- 4 sential coverage if such coverage consists 5 of an eligible employer-sponsored plan (as 6 defined in section 5000A(f)(2)) and the 7 plan does not provide coverage for lan- 8 guage access services, including oral inter- 9 pretation and written translations.’’. 10 (2) CONFORMING AMENDMENTS.— 11 (A) Section 36B(c)(2)(C) of such Code is 12 amended by striking ‘‘clause (iii)’’ each place it 13 appears in clauses (i) and (ii) and inserting 14 ‘‘clause (iv)’’. 15 (B) Section 36B(c)(2)(C)(iv) of such Code, 16 as redesignated by this subsection, is amended 17 by striking ‘‘(i) and (ii)’’ and inserting ‘‘(i), (ii), 18 and (iii)’’. 19 (c) QUALITY REPORTING.—Section 2717(a)(1) of the 20 Public Health Service Act (42 U.S.C. 300gg–17(a)(1)) is 21 amended— 22 (1) by striking ‘‘and’’ at the end of subpara- 23 graph (C); 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00137 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 138 •S 4819 IS (2) by striking the period at the end of sub- 1 paragraph (D) and inserting ‘‘; and’’; and 2 (3) by adding at the end the following new sub- 3 paragraph: 4 ‘‘(E) reduce health disparities through the 5 provision of language access services, including 6 oral interpretation and written translations.’’. 7 (d) REGULATIONS REGARDING INTERNAL CLAIMS 8 AND APPEALS AND EXTERNAL REVIEW PROCESSES FOR 9 HEALTH PLANS AND HEALTH INSURANCE ISSUERS.— 10 The Secretary of the Treasury, the Secretary of Labor, 11 and the Secretary of Health and Human Services shall 12 amend the regulations in section 54.9815–2719(e) of title 13 26, Code of Federal Regulations, section 2590.715– 14 2719(e) of title 29, Code of Federal Regulations, and sec- 15 tion 147.136(e) of title 45, Code of Federal Regulations 16 (or a successor regulation), respectively, to require group 17 health plans and health insurance issuers offering group 18 or individual health insurance coverage to which such sec- 19 tions apply— 20 (1) to provide oral interpretation services with- 21 out any threshold requirements; 22 (2) to provide in the English versions of all no- 23 tices a statement prominently displayed in not less 24 than 15 non-English languages clearly indicating 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00138 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 139 •S 4819 IS how to access the language services provided by the 1 plan or issuer; and 2 (3) with respect to the requirements for pro- 3 viding relevant notices in a culturally and linguis- 4 tically appropriate manner in the applicable non- 5 English languages, to apply a threshold that 5 per- 6 cent of the population, or not less than 500 individ- 7 uals, in the county is literate only in the same non- 8 English language in order for the language to be 9 considered an applicable non-English language. 10 (e) DATA COLLECTION AND REPORTING.—The Sec- 11 retary of Health and Human Services shall— 12 (1) amend the single streamlined application 13 form developed pursuant to section 1413 of the Pa- 14 tient Protection and Affordable Care Act (42 U.S.C. 15 18083) to collect the preferred spoken and written 16 language for each household member applying for 17 coverage under a qualified health plan through an 18 Exchange under title I of such Act (42 U.S.C. 19 18001 et seq.); 20 (2) require navigators, certified application 21 counselors, and other individuals assisting with en- 22 rollment to collect and report requests for language 23 assistance; and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00139 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 140 •S 4819 IS (3) require the toll-free telephone hotlines es- 1 tablished pursuant to section 1311(d)(4)(B) of the 2 Patient Protection and Affordable Care Act (42 3 U.S.C. 18031(d)(4)(B)) to submit an annual report 4 documenting the number of language assistance re- 5 quests, the types of languages requested, the range 6 and average wait time for a consumer to speak with 7 an interpreter, and any steps the hotline, and any 8 entity contracting with the Secretary to provide lan- 9 guage services, have taken to actively address some 10 of the consumer complaints. 11 (f) EFFECTIVE DATE.—The amendments made by 12 this section shall not apply to plans beginning prior to the 13 date of the enactment of this Act. 14 SEC. 214. MEDICALLY UNDERSERVED POPULATIONS. 15 Section 330(b)(3)(A) of the Public Health Service 16 Act (42 U.S.C. 254b(b)(3)(A)) is amended to read as fol- 17 lows: 18 ‘‘(A) IN GENERAL.—The term ‘medically 19 underserved’, with respect to a population, 20 means— 21 ‘‘(i) the population of an urban or 22 rural area designated by the Secretary 23 as— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00140 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 141 •S 4819 IS ‘‘(I) an area with a shortage of 1 personal health services; or 2 ‘‘(II) a population group having a 3 shortage of such services; or 4 ‘‘(ii) a population of individuals, not 5 confined to a particular urban or rural 6 area, who are designated by the Secretary 7 as having a shortage of personal health 8 services due to a specific demographic 9 trait.’’. 10 TITLE III—HEALTH WORKFORCE 11 DIVERSITY 12 SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE 13 ACT. 14 Title XXXIV of the Public Health Service Act, as 15 added by section 204, is amended by adding at the end 16 the following: 17 ‘‘Subtitle B—Diversifying the 18 Health Care Workplace 19 ‘‘SEC. 3411. NATIONAL WORKING GROUP ON WORKFORCE 20 DIVERSITY. 21 ‘‘(a) IN GENERAL.—The Secretary, acting through 22 the Bureau of Health Workforce of the Health Resources 23 and Services Administration, shall award a grant to an 24 entity determined appropriate by the Secretary for the es- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00141 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 142 •S 4819 IS tablishment of a national working group on workforce di- 1 versity. 2 ‘‘(b) REPRESENTATION.—In establishing the national 3 working group under subsection (a): 4 ‘‘(1) The grantee shall ensure that the group 5 has representatives of each of the following: 6 ‘‘(A) The Health Resources and Services 7 Administration. 8 ‘‘(B) The Department of Health and 9 Human Services Data Council. 10 ‘‘(C) The Office of Minority Health of the 11 Department of Health and Human Services. 12 ‘‘(D) The Substance Abuse and Mental 13 Health Services Administration. 14 ‘‘(E) The Bureau of Labor Statistics of 15 the Department of Labor. 16 ‘‘(F) The National Institute on Minority 17 Health and Health Disparities. 18 ‘‘(G) The Agency for Healthcare Research 19 and Quality. 20 ‘‘(H) The Institute of Medicine Study 21 Committee for the 2004 workforce diversity re- 22 port. 23 ‘‘(I) The Indian Health Service. 24 ‘‘(J) The Department of Education. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00142 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 143 •S 4819 IS ‘‘(K) Minority-serving academic institu- 1 tions. 2 ‘‘(L) Consumer organizations. 3 ‘‘(M) Health professional associations, in- 4 cluding those that represent underrepresented 5 minority populations. 6 ‘‘(N) Researchers in the area of health 7 workforce. 8 ‘‘(O) Health workforce accreditation enti- 9 ties. 10 ‘‘(P) Private (including nonprofit) founda- 11 tions that have sponsored workforce diversity 12 initiatives. 13 ‘‘(Q) Local and State health departments. 14 ‘‘(R) Representatives of community mem- 15 bers to be included on admissions committees 16 for health profession schools pursuant to sub- 17 section (c)(9). 18 ‘‘(S) National community-based organiza- 19 tions that serve as a national intermediary to 20 their urban affiliate members and have dem- 21 onstrated capacity to train health care profes- 22 sionals. 23 ‘‘(T) The Veterans Health Administration. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00143 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 144 •S 4819 IS ‘‘(U) Other entities determined appropriate 1 by the Secretary. 2 ‘‘(2) The grantee shall ensure that, in addition 3 to the representatives under paragraph (1), the 4 working group has not less than 5 health professions 5 students representing various health profession fields 6 and levels of training. 7 ‘‘(c) ACTIVITIES.—The working group established 8 under subsection (a) shall convene at least twice each year 9 to complete the following activities: 10 ‘‘(1) Review public and private health workforce 11 diversity initiatives. 12 ‘‘(2) Identify successful health workforce diver- 13 sity programs and practices. 14 ‘‘(3) Examine challenges relating to the devel- 15 opment and implementation of health workforce di- 16 versity initiatives. 17 ‘‘(4) Draft a national strategic work plan for 18 health workforce diversity, including recommenda- 19 tions for public and private sector initiatives. 20 ‘‘(5) Develop a framework and methods for the 21 evaluation of current and future health workforce di- 22 versity initiatives. 23 ‘‘(6) Develop recommended standards for work- 24 force diversity that could be applicable to all health 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00144 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 145 •S 4819 IS professions programs and programs funded under 1 this Act. 2 ‘‘(7) Develop guidelines to train health profes- 3 sionals to care for a diverse population. 4 ‘‘(8) Develop a workforce data collection or 5 tracking system to identify where racial and ethnic 6 minority health professionals practice. 7 ‘‘(9) Develop a strategy for the inclusion of 8 community members on admissions committees for 9 health profession schools. 10 ‘‘(10) Help with monitoring and implementation 11 of standards for diversity, equity, and inclusion. 12 ‘‘(11) Other activities determined appropriate 13 by the Secretary. 14 ‘‘(d) ANNUAL REPORT.—Not later than 1 year after 15 the establishment of the working group under subsection 16 (a), and annually thereafter, the working group shall pre- 17 pare and make available to the general public for com- 18 ment, an annual report on the activities of the working 19 group. Such report shall include the recommendations of 20 the working group for improving health workforce diver- 21 sity. 22 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 23 is authorized to be appropriated to carry out this section 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00145 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 146 •S 4819 IS such sums as may be necessary for each of fiscal years 1 2021 through 2025. 2 ‘‘SEC. 3412. TECHNICAL CLEARINGHOUSE FOR HEALTH 3 WORKFORCE DIVERSITY. 4 ‘‘(a) IN GENERAL.—The Secretary, acting through 5 the Deputy Assistant Secretary for Minority Health, and 6 in collaboration with the Bureau of Health Workforce 7 within the Health Resources and Services Administration 8 and the National Institute on Minority Health and Health 9 Disparities, shall establish a technical clearinghouse on 10 health workforce diversity within the Office of Minority 11 Health and coordinate current and future clearinghouses 12 related to health workforce diversity. 13 ‘‘(b) INFORMATION AND SERVICES.—The clearing- 14 house established under subsection (a) shall offer the fol- 15 lowing information and services: 16 ‘‘(1) Information on the importance of health 17 workforce diversity. 18 ‘‘(2) Statistical information relating to under- 19 represented minority representation in health and al- 20 lied health professions and occupations. 21 ‘‘(3) Model health workforce diversity practices 22 and programs, including integrated models of care. 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00146 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 147 •S 4819 IS ‘‘(4) Admissions policies that promote health 1 workforce diversity and are in compliance with Fed- 2 eral and State laws. 3 ‘‘(5) Retainment policies that promote comple- 4 tion of health profession degrees for underserved 5 populations. 6 ‘‘(6) Lists of scholarship, loan repayment, and 7 loan cancellation grants as well as fellowship infor- 8 mation for underserved populations for health pro- 9 fessions schools. 10 ‘‘(7) Foundation and other large organizational 11 initiatives relating to health workforce diversity. 12 ‘‘(c) CONSULTATION.—In carrying out this section, 13 the Secretary shall consult with non-Federal entities which 14 may include minority health professional associations and 15 minority sections of major health professional associations 16 to ensure the adequacy and accuracy of information. 17 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 18 is authorized to be appropriated to carry out this section 19 such sums as may be necessary for each of fiscal years 20 2021 through 2025. 21 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00147 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 148 •S 4819 IS ‘‘SEC. 3413. SUPPORT FOR INSTITUTIONS COMMITTED TO 1 WORKFORCE DIVERSITY, EQUITY, AND IN- 2 CLUSION. 3 ‘‘(a) IN GENERAL.—The Secretary, acting through 4 the Administrator of the Health Resources and Services 5 Administration and the Director of the Centers for Dis- 6 ease Control and Prevention, shall award grants to eligible 7 entities that demonstrate a commitment to health work- 8 force diversity. 9 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 10 under subsection (a), an entity shall— 11 ‘‘(1) be an educational institution or entity that 12 historically produces or trains meaningful numbers 13 of underrepresented minority health professionals, 14 including— 15 ‘‘(A) part B institutions, as defined in sec- 16 tion 322 of the Higher Education Act of 1965; 17 ‘‘(B) Hispanic-serving health professions 18 schools; 19 ‘‘(C) Hispanic-serving institutions, as de- 20 fined in section 502 of such Act; 21 ‘‘(D) Tribal colleges or universities, as de- 22 fined in section 316 of such Act; 23 ‘‘(E) Asian American and Native American 24 Pacific Islander-serving institutions, as defined 25 in section 371(c) of such Act; 26 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00148 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 149 •S 4819 IS ‘‘(F) institutions that have programs to re- 1 cruit and retain underrepresented minority 2 health professionals, in which a significant 3 number of the enrolled participants are under- 4 represented minorities; 5 ‘‘(G) health professional associations, 6 which may include underrepresented minority 7 health professional associations; and 8 ‘‘(H) institutions, including national and 9 regional community-based organizations with 10 demonstrated commitment to a diversified 11 workforce— 12 ‘‘(i) located in communities with pre- 13 dominantly underrepresented minority pop- 14 ulations; 15 ‘‘(ii) with whom partnerships have 16 been formed for the purpose of increasing 17 workforce diversity; and 18 ‘‘(iii) in which at least 20 percent of 19 the enrolled participants are underrep- 20 resented minorities; and 21 ‘‘(2) submit to the Secretary an application at 22 such time, in such manner, and containing such in- 23 formation as the Secretary may require. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00149 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 150 •S 4819 IS ‘‘(c) USE OF FUNDS.—Amounts received under a 1 grant under subsection (a) shall be used to expand existing 2 workforce diversity programs, implement new workforce 3 diversity programs, or evaluate existing or new workforce 4 diversity programs, including with respect to mental 5 health care professions. Such programs shall enhance di- 6 versity by considering minority status as part of an indi- 7 vidualized consideration of qualifications. Possible activi- 8 ties may include— 9 ‘‘(1) educational outreach programs relating to 10 opportunities in the health professions; 11 ‘‘(2) scholarship, fellowship, grant, loan repay- 12 ment, and loan cancellation programs; 13 ‘‘(3) postbaccalaureate programs; 14 ‘‘(4) academic enrichment programs, particu- 15 larly targeting those who would not be competitive 16 for health professions schools; 17 ‘‘(5) supporting workforce diversity in kinder- 18 garten through 12th grade and other health pipeline 19 programs; 20 ‘‘(6) mentoring programs; 21 ‘‘(7) internship or rotation programs involving 22 hospitals, health systems, health plans, and other 23 health entities; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00150 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 151 •S 4819 IS ‘‘(8) community partnership development for 1 purposes relating to workforce diversity; or 2 ‘‘(9) leadership training. 3 ‘‘(d) REPORTS.—Not later than 1 year after receiving 4 a grant under this section, and annually for the term of 5 the grant, a grantee shall submit to the Secretary a report 6 that summarizes and evaluates all activities conducted 7 under the grant. 8 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 9 is authorized to be appropriated to carry out this section, 10 such sums as may be necessary for each of fiscal years 11 2021 through 2025. 12 ‘‘SEC. 3414. CAREER DEVELOPMENT FOR SCIENTISTS AND 13 RESEARCHERS. 14 ‘‘(a) IN GENERAL.—The Secretary, acting through 15 the Director of the National Institutes of Health, the Di- 16 rector of the Centers for Disease Control and Prevention, 17 the Commissioner of Food and Drugs, the Director of the 18 Agency for Healthcare Research and Quality, and the Ad- 19 ministrator of the Health Resources and Services Admin- 20 istration, shall award grants that expand existing opportu- 21 nities for scientists and researchers and promote the inclu- 22 sion of underrepresented minorities in the health profes- 23 sions. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00151 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 152 •S 4819 IS ‘‘(b) RESEARCH FUNDING.—The head of each agency 1 listed in subsection (a) shall establish or expand existing 2 programs to provide research funding to scientists and re- 3 searchers in training. Under such programs, the head of 4 each such entity shall give priority in allocating research 5 funding to support health research in traditionally under- 6 served communities, including underrepresented minority 7 communities, and research classified as community or 8 participatory. 9 ‘‘(c) DATA COLLECTION.—The head of each agency 10 listed in subsection (a) shall collect data on the number 11 (expressed as an absolute number and a percentage) of 12 underrepresented minority and nonminority applicants 13 who receive and are denied agency funding at every stage 14 of review. Such data shall be reported annually to the Sec- 15 retary and the appropriate committees of Congress. 16 ‘‘(d) STUDENT LOAN REIMBURSEMENT.—The Sec- 17 retary shall establish a student loan reimbursement pro- 18 gram to provide student loan reimbursement assistance to 19 researchers who focus on racial and ethnic disparities in 20 health. The Secretary shall promulgate regulations to de- 21 fine the scope and procedures for the program under this 22 subsection. 23 ‘‘(e) STUDENT LOAN CANCELLATION.—The Sec- 24 retary shall establish a student loan cancellation program 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00152 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 153 •S 4819 IS to provide student loan cancellation assistance to research- 1 ers who focus on racial and ethnic disparities in health. 2 Students participating in the program shall make a min- 3 imum 5-year commitment to work at an accredited health 4 profession school. The Secretary shall promulgate addi- 5 tional regulations to define the scope and procedures for 6 the program under this subsection. 7 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 8 is authorized to be appropriated to carry out this section, 9 such sums as may be necessary for each of fiscal years 10 2021 through 2025. 11 ‘‘SEC. 3415. CAREER SUPPORT FOR NONRESEARCH HEALTH 12 PROFESSIONALS. 13 ‘‘(a) IN GENERAL.—The Secretary, acting through 14 the Director of the Centers for Disease Control and Pre- 15 vention, the Assistant Secretary for Mental Health and 16 Substance Use, the Administrator of the Health Resources 17 and Services Administration, and the Administrator of the 18 Centers for Medicare & Medicaid Services, shall establish 19 a program to award grants to eligible individuals for ca- 20 reer support in nonresearch-related health and wellness 21 professions. 22 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 23 under subsection (a), an individual shall— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00153 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 154 •S 4819 IS ‘‘(1) be a student in a health professions school, 1 a graduate of such a school who is working in a 2 health profession, an individual working in a health 3 or wellness profession (including mental and behav- 4 ioral health), or a faculty member of such a school; 5 and 6 ‘‘(2) submit to the Secretary an application at 7 such time, in such manner, and containing such in- 8 formation as the Secretary may require. 9 ‘‘(c) USE OF FUNDS.—An individual shall use 10 amounts received under a grant under this section to— 11 ‘‘(1) support the individual’s health activities or 12 projects that involve underserved communities, in- 13 cluding racial and ethnic minority communities; 14 ‘‘(2) support health-related career advancement 15 activities; 16 ‘‘(3) pay, or as reimbursement for payments of, 17 student loans or training or credentialing costs for 18 individuals who are health professionals and are fo- 19 cused on health issues affecting underserved commu- 20 nities, including racial and ethnic minority commu- 21 nities; and 22 ‘‘(4) establish and promote leadership training 23 programs to decrease health disparities and to in- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00154 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 155 •S 4819 IS crease cultural competence with the goal of increas- 1 ing diversity in leadership positions. 2 ‘‘(d) DEFINITION.—In this section, the term ‘career 3 in nonresearch-related health and wellness professions’ 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 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 12 is authorized to be appropriated to carry out this section 13 such sums as may be necessary for each of fiscal years 14 2021 through 2025. 15 ‘‘SEC. 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 collaboration with 19 the Deputy Assistant Secretary for Minority Health and 20 the Director of the National Institute on Minority Health 21 and Health Disparities, shall award grants to eligible enti- 22 ties to expand research on the link between health work- 23 force diversity and quality health care. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00155 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 156 •S 4819 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 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00156 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 157 •S 4819 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 is authorized to be appropriated to carry out this section 9 such sums as may be necessary for each of fiscal years 10 2021 through 2025. 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 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00157 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 158 •S 4819 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 Institute of 11 Medicine Report entitled ‘Unequal Treatment: Con- 12 fronting Racial and Ethnic Disparities in Health 13 Care’, as well as the impact of disparities related to 14 age, disability status, socioeconomic status, sex, gen- 15 der identity, and sexual orientation on racial and 16 ethnic minorities; 17 ‘‘(2) disseminate new research findings to 18 health care providers and patients to assist them in 19 understanding, reducing, and eliminating health and 20 health care disparities; 21 ‘‘(3) disseminate information about the impact 22 of linguistic and cultural barriers on health care 23 quality and the obligation of health providers who 24 receive Federal financial assistance to ensure that 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00158 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 159 •S 4819 IS individuals with limited English proficiency have ac- 1 cess to language access services; 2 ‘‘(4) disseminate information about the impor- 3 tance and legality of racial, ethnic, disability status, 4 socioeconomic status, sex, gender identity, and sex- 5 ual orientation, and primary language data collec- 6 tion, analysis, and reporting; 7 ‘‘(5) design and implement specific educational 8 initiatives to health care providers relating to health 9 and health care disparities; 10 ‘‘(6) assess the impact of the programs estab- 11 lished under this section in raising awareness of 12 health and health care disparities and providing in- 13 formation on available resources; and 14 ‘‘(7) design and implement specific educational 15 initiatives to educate the health care workforce relat- 16 ing to unconscious bias. 17 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 18 is authorized to be appropriated to carry out this section 19 such sums as may be necessary for each of fiscal years 20 2021 through 2025.’’. 21 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00159 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 160 •S 4819 IS SEC. 302. HISPANIC-SERVING INSTITUTIONS, HISTORI- 1 CALLY BLACK COLLEGES AND UNIVERSITIES, 2 ASIAN AMERICAN AND NATIVE AMERICAN PA- 3 CIFIC ISLANDER-SERVING INSTITUTIONS, 4 TRIBAL COLLEGES, REGIONAL COMMUNITY- 5 BASED ORGANIZATIONS, AND NATIONAL MI- 6 NORITY MEDICAL ASSOCIATIONS. 7 (a) IN GENERAL.—Part B of title VII of the Public 8 Health Service Act (42 U.S.C. 293 et seq.) is amended 9 by adding at the end the following: 10 ‘‘SEC. 742. HISPANIC-SERVING INSTITUTIONS, HISTORI- 11 CALLY BLACK COLLEGES AND UNIVERSITIES, 12 ASIAN AMERICAN AND NATIVE AMERICAN PA- 13 CIFIC ISLANDER-SERVING INSTITUTIONS, 14 AND TRIBAL COLLEGES. 15 ‘‘(a) IN GENERAL.—The Secretary, acting through 16 the Administrator of the Health Resources and Services 17 Administration and in consultation with the Secretary of 18 Education, shall award grants to Hispanic-serving institu- 19 tions, historically black colleges and universities, Asian 20 American and Native American Pacific Islander-serving 21 institutions, Tribal Colleges or Universities, regional com- 22 munity-based organizations, and national minority med- 23 ical associations, for counseling, mentoring, and providing 24 information on financial assistance to prepare underrep- 25 resented minority individuals to enroll in and graduate 26 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00160 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 161 •S 4819 IS from health professional schools and to increase services 1 for underrepresented minority students including— 2 ‘‘(1) mentoring with underrepresented health 3 professionals; and 4 ‘‘(2) providing financial assistance information 5 for continued education and applications to health 6 professional schools. 7 ‘‘(b) DEFINITIONS.—In this section: 8 ‘‘(1) ASIAN AMERICAN AND NATIVE AMERICAN 9 PACIFIC ISLANDER-SERVING INSTITUTION.—The 10 term ‘Asian American and Native American Pacific 11 Islander-serving institution’ has the meaning given 12 such term in section 320(b) of the Higher Education 13 Act of 1965. 14 ‘‘(2) HISPANIC-SERVING INSTITUTION.—The 15 term ‘Hispanic-serving institution’ means an entity 16 that— 17 ‘‘(A) is a school or program for which 18 there is a definition under section 799B; 19 ‘‘(B) has an enrollment of full-time equiva- 20 lent students that is made up of at least 9 per- 21 cent Hispanic students; 22 ‘‘(C) has been effective in carrying out pro- 23 grams to recruit Hispanic individuals to enroll 24 in and graduate from the school; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00161 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 162 •S 4819 IS ‘‘(D) has been effective in recruiting and 1 retaining Hispanic faculty members; 2 ‘‘(E) has a significant number of graduates 3 who are providing health services to medically 4 underserved populations or to individuals in 5 health professional shortage areas; and 6 ‘‘(F) is a Hispanic Center of Excellence in 7 Health Professions Education designated under 8 section 736(d)(2) of the Public Health Service 9 Act (42 U.S.C. 293(d)(2)). 10 ‘‘(3) HISTORICALLY BLACK COLLEGES AND 11 UNIVERSITY.—The term ‘historically black college 12 and university’ has the meaning given the term ‘part 13 B institution’ as defined in section 322 of the High- 14 er Education Act of 1965. 15 ‘‘(4) TRIBAL COLLEGE OR UNIVERSITY.—The 16 term ‘Tribal College or University’ has the meaning 17 given such term in section 316(b) of the Higher 18 Education Act of 1965. 19 ‘‘(c) CERTAIN LOAN REPAYMENT PROGRAMS.—In 20 carrying out the National Health Service Corps Loan Re- 21 payment Program established under subpart III of part 22 D of title III and the loan repayment program under sec- 23 tion 317F, the Secretary shall ensure, notwithstanding 24 such subpart or section, that loan repayments of not less 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00162 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 163 •S 4819 IS than $50,000 per year per person are awarded for repay- 1 ment of loans incurred for enrollment or participation of 2 underrepresented minority individuals in health profes- 3 sional schools and other health programs described in this 4 section. 5 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 6 is authorized to be appropriated to carry out this section 7 such sums as may be necessary for each of fiscal years 8 2021 through 2026.’’. 9 SEC. 303. LOAN REPAYMENT PROGRAM OF CENTERS FOR 10 DISEASE CONTROL AND PREVENTION. 11 Section 317F(c)(1) of the Public Health Service Act 12 (42 U.S.C. 247b–7(c)(1)) is amended— 13 (1) by striking ‘‘and’’ after ‘‘1994,’’; and 14 (2) by inserting before the period at the end the 15 following: ‘‘, $750,000 for fiscal year 2021, and such 16 sums as may be necessary for each of the fiscal 17 years 2022 through 2026’’. 18 SEC. 304. COOPERATIVE AGREEMENTS FOR ONLINE DE- 19 GREE PROGRAMS AT SCHOOLS OF PUBLIC 20 HEALTH AND SCHOOLS OF ALLIED HEALTH. 21 Part B of title VII of the Public Health Service Act 22 (42 U.S.C. 293 et seq.), as amended by section 302, is 23 further amended by adding at the end the following: 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00163 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 164 •S 4819 IS ‘‘SEC. 743. COOPERATIVE AGREEMENTS FOR ONLINE DE- 1 GREE PROGRAMS. 2 ‘‘(a) COOPERATIVE AGREEMENTS.—The Secretary, 3 acting through the Administrator of the Health Resources 4 and Services Administration, in consultation with the Di- 5 rector of the Centers for Disease Control and Prevention, 6 the Director of the Agency for Healthcare Research and 7 Quality, and the Deputy Assistant Secretary for Minority 8 Health, shall enter into cooperative agreements with 9 schools of public health and schools of allied health to de- 10 sign and implement online degree programs. 11 ‘‘(b) PRIORITY.—In entering into cooperative agree- 12 ments under this section, the Secretary shall give priority 13 to any school of public health or school of allied health 14 that has an established track record of serving medically 15 underserved communities. 16 ‘‘(c) REQUIREMENTS.—As a condition of entering 17 into a cooperative agreement with the Secretary under this 18 section, a school of public health or school of allied health 19 shall agree to design and implement an online degree pro- 20 gram that meets the following restrictions: 21 ‘‘(1) Enrollment of individuals who have ob- 22 tained a secondary school diploma or its recognized 23 equivalent. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00164 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 165 •S 4819 IS ‘‘(2) Maintaining a significant enrollment of 1 underrepresented minority or disadvantaged stu- 2 dents. 3 ‘‘(3) Achieving a high completion rate of en- 4 rolled underrepresented minority or disadvantaged 5 students. 6 ‘‘(d) PERIOD OF COOPERATIVE AGREEMENTS.—The 7 period during which payments are made through a cooper- 8 ative agreement entered into under this section may not 9 exceed 3 years. 10 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 11 are authorized to be appropriated to carry out this section 12 such sums as may be necessary for each of fiscal years 13 2021 through 2025.’’. 14 SEC. 305. SENSE OF CONGRESS ON THE MISSION OF THE 15 NATIONAL HEALTH CARE WORKFORCE COM- 16 MISSION. 17 It is the sense of Congress that the National Health 18 Care Workforce Commission established by section 5101 19 of the Patient Protection and Affordable Care Act (42 20 U.S.C. 294q) should, in carrying out its assigned duties 21 under that section, give attention to the needs of racial 22 and ethnic minorities, individuals with lower socio- 23 economic status, individuals with mental, developmental, 24 and physical disabilities, lesbian, gay, bisexual, 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00165 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 166 •S 4819 IS transgender, queer, and questioning populations, and indi- 1 viduals who are members of multiple minority or special 2 population groups. 3 SEC. 306. SCHOLARSHIP AND FELLOWSHIP PROGRAMS. 4 Subtitle B of title XXXIV of the Public Health Serv- 5 ice Act, as added by section 301, is further amended by 6 inserting after section 3417 the following: 7 ‘‘SEC. 3418. DAVID SATCHER PUBLIC HEALTH AND HEALTH 8 SERVICES CORPS. 9 ‘‘(a) IN GENERAL.—The Director of the Centers for 10 Disease Control and Prevention, in collaboration with the 11 Administrator of the Health Resources and Services Ad- 12 ministration and the Deputy Assistant Secretary for Mi- 13 nority Health, shall award grants to eligible entities to in- 14 crease awareness among secondary and postsecondary stu- 15 dents of career opportunities in the health professions. 16 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 17 under subsection (a), an entity shall— 18 ‘‘(1) be a clinical, public health, or health serv- 19 ices organization, community-based or nonprofit en- 20 tity, or other entity determined appropriate by the 21 Director of the Centers for Disease Control and Pre- 22 vention; 23 ‘‘(2) serve a health professional shortage area, 24 as determined by the Secretary; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00166 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 167 •S 4819 IS ‘‘(3) work with students, including those from 1 racial and ethnic minority backgrounds, that have 2 expressed an interest in the health professions; and 3 ‘‘(4) submit to the Secretary an application at 4 such time, in such manner, and containing such in- 5 formation as the Secretary may require. 6 ‘‘(c) USE OF FUNDS.—Grant awards under sub- 7 section (a) shall be used to support internships that will 8 increase awareness among students of non-research-based, 9 career opportunities in the following health professions: 10 ‘‘(1) Medicine. 11 ‘‘(2) Nursing. 12 ‘‘(3) Public health. 13 ‘‘(4) Pharmacy. 14 ‘‘(5) Health administration and management. 15 ‘‘(6) Health policy. 16 ‘‘(7) Psychology. 17 ‘‘(8) Dentistry. 18 ‘‘(9) International health. 19 ‘‘(10) Social work. 20 ‘‘(11) Allied health. 21 ‘‘(12) Psychiatry. 22 ‘‘(13) Hospice care. 23 ‘‘(14) Community health, patient navigation, 24 and peer support. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00167 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 168 •S 4819 IS ‘‘(15) Other professions determined appropriate 1 by the Director of the Centers for Disease Control 2 and Prevention. 3 ‘‘(d) PRIORITY.—In awarding grants under sub- 4 section (a), the Director of the Centers for Disease Con- 5 trol and Prevention shall give priority to those entities 6 that— 7 ‘‘(1) serve a high proportion of individuals from 8 disadvantaged backgrounds; 9 ‘‘(2) have experience in health disparity elimi- 10 nation programs; 11 ‘‘(3) facilitate the entry of disadvantaged indi- 12 viduals into institutions of higher education; and 13 ‘‘(4) provide counseling or other services de- 14 signed to assist disadvantaged individuals in success- 15 fully completing their education at the postsecondary 16 level. 17 ‘‘(e) STIPENDS.— 18 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 19 an entity receiving a grant under this section may 20 use the funds made available through such grant to 21 award stipends for educational and living expenses 22 to students participating in the internship supported 23 by the grant. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00168 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 169 •S 4819 IS ‘‘(2) LIMITATIONS.—A stipend awarded under 1 paragraph (1) to an individual— 2 ‘‘(A) may not be provided for a period that 3 exceeds 6 months; and 4 ‘‘(B) may not exceed $20 per day for an 5 individual (notwithstanding any other provision 6 of law regarding the amount of a stipend). 7 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 8 is authorized to be appropriated to carry out this section 9 such sums as may be necessary for each of fiscal years 10 2021 through 2026. 11 ‘‘SEC. 3419. LOUIS STOKES PUBLIC HEALTH SCHOLARS 12 PROGRAM. 13 ‘‘(a) IN GENERAL.—The Director of the Centers for 14 Disease Control and Prevention, in collaboration with the 15 Deputy Assistant Secretary for Minority Health, shall 16 award scholarships to eligible individuals under subsection 17 (b) who seek a career in public health. 18 ‘‘(b) ELIGIBILITY.—To be eligible to receive a schol- 19 arship under subsection (a), an individual shall— 20 ‘‘(1) have interest, knowledge, or skill in public 21 health research or public health practice, or other 22 health professions as determined appropriate by the 23 Director of the Centers for Disease Control and Pre- 24 vention; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00169 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 170 •S 4819 IS ‘‘(2) reside in a health professional shortage 1 area as determined by the Secretary; 2 ‘‘(3) demonstrate promise for becoming a leader 3 in public health; 4 ‘‘(4) secure admission to a 4-year institution of 5 higher education; and 6 ‘‘(5) submit to the Secretary an application at 7 such time, in such manner, and containing such in- 8 formation as the Secretary may require. 9 ‘‘(c) USE OF FUNDS.—Amounts received under an 10 award under subsection (a) shall be used to support oppor- 11 tunities for students to become public health professionals. 12 ‘‘(d) PRIORITY.—In awarding grants under sub- 13 section (a), the Director shall give priority to those stu- 14 dents that— 15 ‘‘(1) are from disadvantaged backgrounds; 16 ‘‘(2) have secured admissions to a minority- 17 serving institution; and 18 ‘‘(3) have identified a health professional as a 19 mentor at their school or institution and an aca- 20 demic advisor to assist in the completion of their 21 baccalaureate degree. 22 ‘‘(e) SCHOLARSHIPS.—The Secretary may approve 23 payment of scholarships under this section for such indi- 24 viduals for any period of education in student under- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00170 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 171 •S 4819 IS graduate tenure, except that such a scholarship may not 1 be provided to an individual for more than 4 years, and 2 such a scholarship may not exceed $10,000 per academic 3 year for an individual (notwithstanding any other provi- 4 sion of law regarding the amount of a scholarship). 5 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 6 is authorized to be appropriated to carry out this section 7 such sums as may be necessary for each of fiscal years 8 2021 through 2025. 9 ‘‘SEC. 3420. PATSY MINK HEALTH AND GENDER RESEARCH 10 FELLOWSHIP PROGRAM. 11 ‘‘(a) IN GENERAL.—The Director of the Centers for 12 Disease Control and Prevention, in collaboration with the 13 Deputy Assistant Secretary for Minority Health, the As- 14 sistant Secretary for Mental Health and Substance Use, 15 and the Director of the Indian Health Services, shall 16 award research fellowships to eligible individuals under 17 subsection (b) to conduct research that will examine gen- 18 der and health disparities and to pursue a career in the 19 health professions. 20 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow- 21 ship under subsection (a), an individual shall— 22 ‘‘(1) have experience in health research or pub- 23 lic health practice; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00171 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 172 •S 4819 IS ‘‘(2) reside in a health professional shortage 1 area as designated by the Secretary under section 2 332; 3 ‘‘(3) have expressed an interest in the health 4 professions; 5 ‘‘(4) demonstrate promise for becoming a leader 6 in the field of women’s health; 7 ‘‘(5) secure admission to a health professions 8 school or graduate program with an emphasis in 9 gender studies; and 10 ‘‘(6) submit to the Secretary an application at 11 such time, in such manner, and containing such in- 12 formation as the Secretary may require. 13 ‘‘(c) USE OF FUNDS.—A fellowship awarded under 14 subsection (a) to an eligible individual shall be used to 15 support an opportunity for the individual to become a re- 16 searcher and advance the research base on the intersection 17 between gender and health. 18 ‘‘(d) PRIORITY.—In awarding fellowships under sub- 19 section (a), the Director of the Centers for Disease Con- 20 trol and Prevention shall give priority to those applicants 21 that— 22 ‘‘(1) are from disadvantaged backgrounds; and 23 ‘‘(2) have identified a mentor and academic ad- 24 visor who will assist in the completion of their grad- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00172 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 173 •S 4819 IS uate or professional degree and have secured a re- 1 search assistant position with a researcher working 2 in the area of gender and health. 3 ‘‘(e) FELLOWSHIPS.—The Director of the Centers for 4 Disease Control and Prevention may approve fellowships 5 for individuals under this section for any period of edu- 6 cation in the student’s graduate or health profession ten- 7 ure, except that such a fellowship may not be provided 8 to an individual for more than 3 years, and such a fellow- 9 ship may not exceed $18,000 per academic year for an 10 individual (notwithstanding any other provision of law re- 11 garding the amount of a fellowship). 12 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 13 is authorized to be appropriated to carry out this section 14 such sums as may be necessary for each of fiscal years 15 2021 through 2025. 16 ‘‘SEC. 3421. PAUL DAVID WELLSTONE INTERNATIONAL 17 HEALTH FELLOWSHIP PROGRAM. 18 ‘‘(a) IN GENERAL.—The Director of the Agency for 19 Healthcare Research and Quality, in collaboration with 20 the Deputy Assistant Secretary for Minority Health, shall 21 award research fellowships to eligible individuals under 22 subsection (b) to advance their understanding of inter- 23 national health. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00173 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 174 •S 4819 IS ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow- 1 ship under subsection (a), an individual shall— 2 ‘‘(1) have educational experience in the field of 3 international health; 4 ‘‘(2) reside in a health professional shortage 5 area as determined by the Secretary; 6 ‘‘(3) demonstrate promise for becoming a leader 7 in the field of international health; 8 ‘‘(4) be a college senior or recent graduate of 9 a 4-year institution of higher education; and 10 ‘‘(5) submit to the Secretary an application at 11 such time, in such manner, and containing such in- 12 formation as the Secretary may require. 13 ‘‘(c) USE OF FUNDS.—A fellowship awarded under 14 subsection (a) to an eligible individual shall be used to 15 support an opportunity for the individual to become a 16 health professional and to advance the knowledge of the 17 individual about international issues relating to health 18 care access and quality. 19 ‘‘(d) PRIORITY.—In awarding fellowships under sub- 20 section (a), the Director shall give priority to eligible indi- 21 viduals that— 22 ‘‘(1) are from a disadvantaged background; and 23 ‘‘(2) have identified a mentor at a health pro- 24 fessions school or institution, an academic advisor to 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00174 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 175 •S 4819 IS assist in the completion of their graduate or profes- 1 sional degree, and an advisor from an international 2 health non-governmental organization, private volun- 3 teer organization, or other international institution 4 or program that focuses on increasing health care 5 access and quality for residents in developing coun- 6 tries. 7 ‘‘(e) FELLOWSHIPS.—A fellowship awarded under 8 this section may not— 9 ‘‘(1) be provided to an eligible individual for 10 more than a period of 6 months; 11 ‘‘(2) be awarded to a graduate of a 4-year insti- 12 tution of higher education that has not been enrolled 13 in such institution for more than 1 year; and 14 ‘‘(3) exceed $4,000 per academic year (notwith- 15 standing any other provision of law regarding the 16 amount of a fellowship). 17 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 18 is authorized to be appropriated to carry out this section, 19 such sums as may be necessary for each of fiscal years 20 2021 through 2025. 21 ‘‘SEC. 3422. EDWARD R. ROYBAL HEALTH SCHOLAR PRO- 22 GRAM. 23 ‘‘(a) IN GENERAL.—The Director of the Agency for 24 Healthcare Research and Quality, the Director of the Cen- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00175 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 176 •S 4819 IS ters for Medicare & Medicaid Services, and the Adminis- 1 trator of the Health Resources and Services Administra- 2 tion, in collaboration with the Deputy Assistant Secretary 3 for Minority Health, shall award grants to eligible entities 4 to expose entering graduate students to the health profes- 5 sions. 6 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 7 under subsection (a), an entity shall— 8 ‘‘(1) be a clinical, public health, or health serv- 9 ices organization, community-based, academic, or 10 nonprofit entity, or other entity determined appro- 11 priate by the Director of the Agency for Healthcare 12 Research and Quality; 13 ‘‘(2) serve in a health professional shortage 14 area as designated by the Secretary under section 15 332; 16 ‘‘(3) work with students obtaining a degree in 17 the health professions; and 18 ‘‘(4) submit to the Secretary an application at 19 such time, in such manner, and containing such in- 20 formation as the Secretary may require. 21 ‘‘(c) USE OF FUNDS.—Amounts received under a 22 grant awarded under subsection (a) shall be used to sup- 23 port opportunities that expose students to non-research- 24 based health professions, including— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00176 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 177 •S 4819 IS ‘‘(1) public health policy; 1 ‘‘(2) health care and pharmaceutical policy; 2 ‘‘(3) health care administration and manage- 3 ment; 4 ‘‘(4) health economics; and 5 ‘‘(5) other professions determined appropriate 6 by the Director of the Agency for Healthcare Re- 7 search and Quality, the Director of the Centers for 8 Medicare & Medicaid Services, or the Administrator 9 of the Health Resources and Services Administra- 10 tion. 11 ‘‘(d) PRIORITY.—In awarding grants under sub- 12 section (a), the Director of the Agency for Healthcare Re- 13 search and Quality, the Director of the Centers for Medi- 14 care & Medicaid Services, and the Administrator of the 15 Health Resources and Services Administration, in collabo- 16 ration with the Deputy Assistant for Secretary for Minor- 17 ity Health, shall give priority to those entities that— 18 ‘‘(1) have experience with health disparity elimi- 19 nation programs; 20 ‘‘(2) facilitate training in the fields described in 21 subsection (c); and 22 ‘‘(3) provide counseling or other services de- 23 signed to assist students in successfully completing 24 their education at the postsecondary level. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00177 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 178 •S 4819 IS ‘‘(e) STIPENDS.— 1 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 2 an entity receiving a grant under this section may 3 use the funds made available through such grant to 4 award stipends for educational and living expenses 5 to students participating in the opportunities sup- 6 ported by the grant. 7 ‘‘(2) LIMITATIONS.—A stipend awarded under 8 paragraph (1) to an individual— 9 ‘‘(A) may not be provided for a period that 10 exceeds 2 months; and 11 ‘‘(B) may not exceed $100 per day (not- 12 withstanding any other provision of law regard- 13 ing the amount of a stipend). 14 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 15 are authorized to be appropriated to carry out this section 16 such sums as may be necessary for each of fiscal years 17 2021 through 2025. 18 ‘‘SEC. 3423. LEADERSHIP FELLOWSHIP PROGRAMS. 19 ‘‘(a) IN GENERAL.—The Secretary shall award 20 grants to national minority medical or health professional 21 associations to develop leadership fellowship programs for 22 underrepresented health professionals in order to— 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00178 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 179 •S 4819 IS ‘‘(1) assist such professionals in becoming fu- 1 ture leaders in public health and health care delivery 2 institutions; and 3 ‘‘(2) increase diversity in decision-making posi- 4 tions that can improve the health of underserved 5 communities. 6 ‘‘(b) USE OF FUNDS.—A leadership fellowship pro- 7 gram supported under this section shall— 8 ‘‘(1) focus on training mid-career physicians 9 and health care executives who have documented 10 leadership experience and a commitment to public 11 health services in underserved communities; and 12 ‘‘(2) support Federal public health policy and 13 budget programs, and priorities that impact health 14 equity, through activities such as didactic lectures 15 and leader site visits. 16 ‘‘(c) PERIOD OF GRANTS.—The period during which 17 payments are made under a grant awarded under sub- 18 section (a) may not exceed 3 years. 19 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 20 is authorized to be appropriated to carry out this section 21 such sums as may be necessary for each of fiscal years 22 2021 through 2026.’’. 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00179 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 180 •S 4819 IS SEC. 307. MCNAIR POSTBACCALAUREATE ACHIEVEMENT 1 PROGRAM. 2 Section 402E of the Higher Education Act of 1965 3 (20 U.S.C. 1070a–15) is amended by striking subsection 4 (g) and inserting the following: 5 ‘‘(g) COLLABORATION IN HEALTH PROFESSION DI- 6 VERSITY TRAINING PROGRAMS.—The Secretary shall co- 7 ordinate with the Secretary of Health and Human Serv- 8 ices to ensure that there is collaboration between the goals 9 of the program under this section and programs of the 10 Health Resources and Services Administration that pro- 11 mote health workforce diversity. The Secretary of Edu- 12 cation shall take such measures as may be necessary to 13 encourage students participating in projects assisted 14 under this section to consider health profession careers. 15 ‘‘(h) FUNDING.—From amounts appropriated pursu- 16 ant to the authority of section 402A(g), the Secretary 17 shall, to the extent practicable, allocate funds for projects 18 authorized by this section in an amount that is not less 19 than $31,000,000 for each of the fiscal years 2021 20 through 2026.’’. 21 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00180 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 181 •S 4819 IS SEC. 308. RULES FOR DETERMINATION OF FULL-TIME 1 EQUIVALENT RESIDENTS FOR COST-REPORT- 2 ING PERIODS. 3 (a) DGME DETERMINATIONS.—Section 1886(h)(4) 4 of the Social Security Act (42 U.S.C. 1395ww(h)(4)), as 5 amended by section 206(a), is amended— 6 (1) in subparagraph (E), by striking ‘‘Subject 7 to subparagraphs (J) and (K), such rules’’ and in- 8 serting ‘‘Subject to subparagraphs (J), (K), and 9 (M), such rules’’; 10 (2) in subparagraph (J), by striking ‘‘Such 11 rules’’ and inserting ‘‘Subject to subparagraph (M), 12 such rules’’; 13 (3) in subparagraph (K), by striking ‘‘In deter- 14 mining’’ and inserting ‘‘Subject to subparagraph 15 (M), in determining’’; and 16 (4) by adding at the end the following new sub- 17 paragraph: 18 ‘‘(M) TREATMENT OF CERTAIN RESIDENTS 19 AND INTERNS.—For purposes of cost-reporting 20 periods beginning on or after October 1, 2021, 21 in determining the hospital’s number of full- 22 time equivalent residents for purposes of this 23 paragraph, all the time spent by an intern or 24 resident in an approved medical residency train- 25 ing program shall be counted toward the deter- 26 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00181 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 182 •S 4819 IS mination of full-time equivalency if the hos- 1 pital— 2 ‘‘(i) is recognized as a subsection (d) 3 hospital; 4 ‘‘(ii) is recognized as a subsection (d) 5 Puerto Rico hospital; 6 ‘‘(iii) is reimbursed under a reim- 7 bursement system authorized under section 8 1814(b)(3); or 9 ‘‘(iv) is a provider-based hospital out- 10 patient department.’’. 11 (b) IME DETERMINATIONS.—Section 12 1886(d)(5)(B)(xi) of the Social Security Act (42 U.S.C. 13 1395ww(d)(5)(B)(xi)), as redesignated by section 206(b), 14 is amended— 15 (1) in subclause (II), by striking ‘‘In deter- 16 mining’’ and inserting ‘‘Subject to subclause (IV), in 17 determining’’; 18 (2) in subclause (III), by striking ‘‘In deter- 19 mining’’ and inserting ‘‘Subject to subclause (IV), in 20 determining’’; and 21 (3) by inserting after subclause (III) the fol- 22 lowing new subclause: 23 ‘‘(IV) For purposes of cost-reporting peri- 24 ods beginning on or after October 1, 2021, the 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00182 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 183 •S 4819 IS provisions of subparagraph (M) of subsection 1 (h)(4) shall apply under this subparagraph in 2 the same manner as they apply under such sub- 3 section.’’. 4 SEC. 309. DEVELOPING AND IMPLEMENTING STRATEGIES 5 FOR LOCAL HEALTH EQUITY. 6 (a) GRANTS.—The Secretary of Health and Human 7 Services, acting jointly with the Secretary of Education 8 and the Secretary of Labor, shall make grants to institu- 9 tions of higher education for the purposes of— 10 (1) in accordance with subsection (b), devel- 11 oping capacity— 12 (A) to build an evidence base for successful 13 strategies for increasing local health equity; and 14 (B) to serve as national models of driving 15 local health equity; 16 (2) in accordance with subsection (c), devel- 17 oping a strategic partnership with the community in 18 which the institution is located; and 19 (3) collecting data on, and periodically evalu- 20 ating, the effectiveness of the institution’s programs 21 funded through this section to enable the institution 22 to adapt accordingly for maximum efficiency and 23 success. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00183 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 184 •S 4819 IS (b) DEVELOPING CAPACITY FOR INCREASING LOCAL 1 HEALTH EQUITY.—As a condition on receipt of a grant 2 under subsection (a), an institution of higher education 3 shall agree to use the grant to build an evidence base for 4 successful strategies for increasing local health equity, and 5 to serve as a national model of driving local health equity, 6 by supporting— 7 (1) resources to strengthen institutional metrics 8 and capacity to execute institution-wide health work- 9 force goals that can serve as models for increasing 10 health equity in communities across the United 11 States; 12 (2) collaborations among a cohort of institu- 13 tions in implementing systemic change, partnership 14 development, and programmatic efforts supportive of 15 health equity goals across disciplines and popu- 16 lations; and 17 (3) enhanced or newly developed data systems 18 and research infrastructure capable of informing 19 current and future workforce efforts and building a 20 foundation for a broader research agenda targeting 21 urban health disparities. 22 (c) STRATEGIC PARTNERSHIPS.—As a condition on 23 receipt of a grant under subsection (a), an institution of 24 higher education shall agree to use the grant to develop 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00184 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 185 •S 4819 IS a strategic partnership with the community in which the 1 institution is located for the purposes of— 2 (1) strengthening connections between the insti- 3 tution and the community— 4 (A) to improve evaluation of and address 5 the community’s health and health workforce 6 needs; and 7 (B) to engage the community in health 8 workforce development; 9 (2) developing, enhancing, or accelerating inno- 10 vative undergraduate and graduate programs in the 11 biomedical sciences and health professions; and 12 (3) strengthening pipeline programs in the bio- 13 medical sciences and health professions, including by 14 developing partnerships between institutions of high- 15 er education and elementary schools and secondary 16 schools to recruit the next generation of health pro- 17 fessionals earlier in the pipeline to a health care ca- 18 reer. 19 (d) AUTHORIZATION OF APPROPRIATIONS.—There is 20 authorized to be appropriated to carry out this section 21 such sums as may be necessary for each of fiscal years 22 2021 through 2026. 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00185 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 186 •S 4819 IS SEC. 310. LOAN FORGIVENESS FOR MENTAL AND BEHAV- 1 IORAL HEALTH SOCIAL WORKERS. 2 Section 455 of the Higher Education Act of 1965 (20 3 U.S.C. 1087e) is amended by adding at the end the fol- 4 lowing: 5 ‘‘(r) REPAYMENT PLAN FOR MENTAL AND BEHAV- 6 IORAL HEALTH SOCIAL WORKERS.— 7 ‘‘(1) IN GENERAL.—The Secretary shall cancel 8 the balance of interest and principal due, in accord- 9 ance with paragraph (2), on any eligible Federal Di- 10 rect Loan not in default for a borrower who— 11 ‘‘(A) has made 120 monthly payments on 12 the eligible Federal Direct Loan after October 13 1, 2020, pursuant to any one or a combination 14 of the following— 15 ‘‘(i) payments under an income-based 16 repayment plan under section 493C; 17 ‘‘(ii) payments under a standard re- 18 payment plan under subsection (d)(1)(A), 19 based on a 10-year repayment period; 20 ‘‘(iii) monthly payments under a re- 21 payment plan under subsection (d)(1) or 22 (g) of not less than the monthly amount 23 calculated under subsection (d)(1)(A), 24 based on a 10-year repayment period; or 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00186 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 187 •S 4819 IS ‘‘(iv) payments under an income con- 1 tingent repayment plan under subsection 2 (d)(1)(D); and 3 ‘‘(B)(i) is employed as a mental health or 4 behavioral health social worker, as defined by 5 the Secretary by regulation, at the time of such 6 forgiveness; and 7 ‘‘(ii) has been employed as such a mental 8 health or behavioral health social worker during 9 the period in which the borrower makes each of 10 the 120 payments as described in subparagraph 11 (A). 12 ‘‘(2) LOAN CANCELLATION AMOUNT.—After the 13 conclusion of the employment period described in 14 paragraph (1), the Secretary shall cancel the obliga- 15 tion to repay the balance of principal and interest 16 due as of the time of such cancellation, on the eligi- 17 ble Federal Direct Loans made to the borrower 18 under this part. 19 ‘‘(3) INELIGIBILITY FOR DOUBLE BENEFITS.— 20 No borrower may, for the same employment as a 21 mental health or behavioral health social worker, re- 22 ceive a reduction of loan obligations under both this 23 subsection and subsection (m), 428J, 428K, 428L, 24 or 460. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00187 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 188 •S 4819 IS ‘‘(4) DEFINITION OF ELIGIBLE FEDERAL DI- 1 RECT LOAN.—In this subsection, the term ‘eligible 2 Federal Direct Loan’ means a Federal Direct Staf- 3 ford Loan, Federal Direct PLUS Loan, Federal Di- 4 rect Unsubsidized Stafford Loan, or a Federal Di- 5 rect Consolidation Loan.’’. 6 SEC. 311. HEALTH PROFESSIONS WORKFORCE FUND. 7 (a) ESTABLISHMENT.—There is established in the 8 Health Resources and Services Administration of the De- 9 partment of Health and Human Services a Health Profes- 10 sions Workforce Fund to provide for expanded and sus- 11 tained national investment in the health professions and 12 nursing workforce development programs under title VII 13 and title VIII of the Public Health Service Act (42 U.S.C. 14 292 et seq.; 42 U.S.C. 296 et seq.). 15 (b) FUNDING.— 16 (1) IN GENERAL.—There is authorized to be 17 appropriated, and there is appropriated, out of any 18 monies in the Treasury not otherwise appropriated, 19 to the Health Professions Workforce Fund— 20 (A) $355,000,000 for fiscal year 2021; 21 (B) $375,000,000 for fiscal year 2022; 22 (C) $392,000,000 for fiscal year 2023; 23 (D) $412,000,000 for fiscal year 2024; 24 (E) $432,000,000 for fiscal year 2025; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00188 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 189 •S 4819 IS (F) $454,000,000 for fiscal year 2026; 1 (G) $476,000,000 for fiscal year 2027; 2 (H) $500,000,000 for fiscal year 2028; 3 (I) $525,000,000 for fiscal year 2029; and 4 (J) $552,000,000 for fiscal year 2030. 5 (2) HEALTH PROFESSIONS EDUCATION PRO- 6 GRAMS.—For the purpose of carrying out health 7 professions education programs authorized under 8 title VII of the Public Health Service Act, in addi- 9 tion to any other amounts authorized to be appro- 10 priated for such purpose, there is authorized to be 11 appropriated out of any monies in the Health Pro- 12 fessions Workforce Fund, the following: 13 (A) $240,000,000 for fiscal year 2021. 14 (B) $253,000,000 for fiscal year 2022. 15 (C) $265,000,000 for fiscal year 2023. 16 (D) $278,000,000 for fiscal year 2024. 17 (E) $292,000,000 for fiscal year 2025. 18 (F) $307,000,000 for fiscal year 2026. 19 (G) $322,000,000 for fiscal year 2027. 20 (H) $338,000,000 for fiscal year 2028. 21 (I) $355,000,000 for fiscal year 2029. 22 (J) $373,000,000 for fiscal year 2030. 23 (3) NURSING WORKFORCE DEVELOPMENT PRO- 24 GRAMS.—For the purpose of carrying out nursing 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00189 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 190 •S 4819 IS workforce development programs authorized under 1 title VIII of the Public Health Service Act, in addi- 2 tion to any other amounts authorized to be appro- 3 priated for such purpose, there is authorized to be 4 appropriated out of any monies in the Health Pro- 5 fessions Workforce Fund, the following: 6 (A) $115,000,000 for fiscal year 2021. 7 (B) $122,000,000 for fiscal year 2022. 8 (C) $127,000,000 for fiscal year 2023. 9 (D) $134,000,000 for fiscal year 2024. 10 (E) $140,000,000 for fiscal year 2025. 11 (F) $147,000,000 for fiscal year 2026. 12 (G) $154,000,000 for fiscal year 2027. 13 (H) $162,000,000 for fiscal year 2028. 14 (I) $170,000,000 for fiscal year 2029. 15 (J) $179,000,000 for fiscal year 2030. 16 SEC. 312. FINDINGS; SENSE OF CONGRESS RELATING TO 17 GRADUATE MEDICAL EDUCATION. 18 (a) FINDINGS.—Congress finds the following: 19 (1) Projections by the Association of American 20 Medical Colleges and other expert entities, such as 21 the Health Resources and Services Administration, 22 have indicated a nationwide shortage of up to 23 121,900 physicians, split evenly between primary 24 care and specialists, by 2032. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00190 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 191 •S 4819 IS (2) Primarily due to the growing and aging 1 population, over the next decade, physician demand 2 is expected to grow up to 17 percent. 3 (3) The United States Census Bureau estimates 4 that the United States population will grow from 5 321,000,000 in 2015 to 347,000,000 in 2025. Fur- 6 ther, the number of Medicare beneficiaries is esti- 7 mated to increase from 47,800,000 in 2015 to ap- 8 proximately 66,000,000 in 2025. 9 (4) Approximately 36 percent of practicing phy- 10 sicians are over the age of 55 and are likely to retire 11 within the next decade. 12 (5) A nationwide physician shortage will result 13 in many people in the United States waiting longer 14 and traveling farther for health care; seeking non- 15 emergent care in emergency departments; and delay- 16 ing treatment until their health care needs become 17 more serious, complex, and costly. 18 (6) Changing demographics (such as an aging 19 population), new health care delivery models (such 20 as medical homes), and other factors (such as dis- 21 aster preparedness) are contributing to a shortage of 22 both generalist and specialist physicians. 23 (7) These shortages will have the most severe 24 impact on vulnerable and underserved populations, 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00191 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 192 •S 4819 IS including racial and ethnic minorities and the ap- 1 proximately 20 percent of people in the United 2 States who live in rural or inner-city locations des- 3 ignated as health professional shortage areas. 4 (8) The health care utilization equity model of 5 the Association of American Medical Colleges esti- 6 mates that if racial and ethnic minorities and indi- 7 viduals from rural areas utilized health care in a 8 similar way to their Caucasian counterparts living in 9 metropolitan areas, the physician shortage would re- 10 quire an additional 96,000 physicians. 11 (9) To address the physician shortage in rural 12 and medically underserved areas, medical education 13 and training need to be accessible to underrep- 14 resented minorities (including individuals who are 15 African American, Hispanic, Native American, or 16 Native Hawaiian), and need to increase pathway 17 programs for such underrepresented minorities who 18 make up less than 12 percent of individuals enrolled 19 in graduate medical education and for international 20 students who make up 25 percent of individuals en- 21 rolled in graduate medical education. Immigration 22 pathways like student, exchange-visitor, and employ- 23 ment visas, and programs like the National Interest 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00192 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 193 •S 4819 IS Waiver and Conrad 30 J–1 Visa Waiver, help im- 1 prove health access across the United States. 2 (10) United States medical school enrollment 3 was expected to grow by 30 percent from 2018 to 4 2019 to help reduce the shortage of quality physi- 5 cians in the United States. 6 (11) An increase in United States medical 7 school graduates must be accompanied by an in- 8 crease of 4,000 graduate medical education training 9 positions each year. 10 (12) Graduate medical education programs and 11 teaching hospitals provide venues in which the next 12 generation of physicians learns to work collabo- 13 ratively with other physicians and health profes- 14 sionals, adopt more efficient care delivery models 15 (such as care coordination and medical homes), in- 16 corporate health information technology and elec- 17 tronic health records in every aspect of their work, 18 apply new methods of assuring quality and safety, 19 and participate in groundbreaking clinical and public 20 health research. 21 (13) The Medicare program under title XVIII 22 of the Social Security Act (42 U.S.C. 1395 et seq.) 23 (having more beneficiaries than any other health 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00193 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 194 •S 4819 IS care program) supports its ‘‘fair share’’ of the costs 1 associated with graduate medical education. 2 (14) In general, the level of support of graduate 3 medical education by the Medicare program has 4 been capped since 1997 and has not been increased 5 to support the expansion of graduate medical edu- 6 cation programs needed to avert the projected physi- 7 cian shortage or to accommodate the increase in 8 United States medical school graduates. 9 (b) SENSE OF CONGRESS.—It is the sense of Con- 10 gress that eliminating the limit of the number of residency 11 positions that receive some level of Medicare support 12 under section 1886(h) of the Social Security Act (42 13 U.S.C. 1395ww(h)), also referred to as the Medical grad- 14 uate medical education cap, is critical to— 15 (1) ensuring an appropriate supply of physi- 16 cians to meet the health care needs in the United 17 States; 18 (2) facilitating equitable access for all who seek 19 health care; and 20 (3) mitigating disparities in health and health 21 care. 22 SEC. 313. CAREER SUPPORT FOR SKILLED, INTERNATION- 23 ALLY EDUCATED HEALTH PROFESSIONALS. 24 (a) FINDINGS.—Congress finds the following: 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00194 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 195 •S 4819 IS (1) According to a 2018 study, the State and 1 local public health workforce has shrunk by more 2 than 50,000 individuals since the beginning of the 3 2008 Great Recession and almost one quarter of in- 4 dividuals comprising the governmental public health 5 workforce plan to leave or retire in the coming years. 6 (2) Shortages are projected for other health 7 professions, including within the fields of nursing 8 (500,000 by 2025), dentistry (15,000 by 2025), 9 pharmacy (38,000 by 2030), mental and behavioral 10 health, primary care (46,000 by 2025), and commu- 11 nity and allied health. 12 (3) A nationwide health workforce shortage will 13 result in serious health threats and more severe and 14 costly health care needs, due to, in part, a delayed 15 response to food-borne outbreaks, emerging infec- 16 tious diseases, natural disasters, fewer cancer 17 screenings, and delayed treatment. 18 (4) Vulnerable and underserved populations and 19 health professional shortage areas will be most se- 20 verely impacted by the health workforce shortage. 21 (5) According to the Migration Policy Institute, 22 more than 2,000,000 college-educated immigrants in 23 the United States today are unemployed or under- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00195 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 196 •S 4819 IS employed in low- or semi-skilled jobs that fail to 1 draw on their education and expertise. 2 (6) Approximately 2 out of every 5 internation- 3 ally educated immigrants are unemployed or under- 4 employed. 5 (7) According to the Drexel University Center 6 for Labor Markets and Policy, underemployment for 7 internationally educated immigrant women is 28 per- 8 cent higher than for their male counterparts. 9 (8) According to the Drexel University Center 10 for Labor Markets and Policy, the mean annual 11 earnings of underemployed immigrants were 12 $32,000, or 43 percent less than United States born 13 college graduates employed in the college labor mar- 14 ket. 15 (9) According to Upwardly Global and the Wel- 16 come Back Initiative, with proper guidance and sup- 17 port, underemployed skilled immigrants typically in- 18 crease their income by 215 percent to 900 percent. 19 (10) According to the Brookings Institution and 20 the Partnership for a New American Economy, im- 21 migrants working in the health workforce are, on av- 22 erage, better educated than United States-born 23 workers in the health workforce. 24 (b) GRANTS TO ELIGIBLE ENTITIES.— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00196 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 197 •S 4819 IS (1) AUTHORITY TO PROVIDE GRANTS.—The 1 Secretary of Health and Human Services, acting 2 through the Bureau of Health Workforce within the 3 Health Resources and Services Administration, the 4 National Institute on Minority Health and Health 5 Disparities, or the Office of Minority Health (in this 6 section referred to as the ‘‘Secretary’’), may award 7 grants to eligible entities to carry out activities de- 8 scribed in subsection (c). 9 (2) ELIGIBILITY.—To be eligible to receive a 10 grant under this section, an entity shall— 11 (A) be a clinical, public health, or health 12 services organization, a community-based or 13 nonprofit entity, an academic institution, a 14 faith-based organization, a State, county, or 15 local government, an area health education cen- 16 ter, or another entity determined appropriate by 17 the Secretary; and 18 (B) submit to the Secretary an application 19 at such time, in such manner, and containing 20 such information as the Secretary may require. 21 (c) AUTHORIZED ACTIVITIES.—A grant awarded 22 under this section shall be used— 23 (1) to provide services to assist unemployed and 24 underemployed skilled immigrants, residing in the 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00197 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 198 •S 4819 IS United States, who have legal, permanent work au- 1 thorization and who are internationally educated 2 health professionals, enter into the health workforce 3 of the United States with employment matching 4 their health professional skills and education, and 5 advance in employment to positions that better 6 match their health professional education and exper- 7 tise; 8 (2) to provide training opportunities to reduce 9 barriers to entry and advancement in the health 10 workforce for skilled, internationally educated immi- 11 grants; 12 (3) to educate employers regarding the abilities 13 and capacities of internationally educated health 14 professionals; 15 (4) to assist in the evaluation of foreign creden- 16 tials; 17 (5) to support preceptorships for international 18 medical graduates in hospital primary care training; 19 and 20 (6) to facilitate access to contextualized and ac- 21 celerated courses on English as a second language. 22 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00198 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 199 •S 4819 IS SEC. 314. STUDY AND REPORT ON STRATEGIES FOR IN- 1 CREASING DIVERSITY. 2 (a) STUDY.—The Comptroller General of the United 3 States shall conduct a study on strategies for increasing 4 the diversity of the health professional workforce. Such 5 study shall include an analysis of strategies for increasing 6 the number of health professionals from rural, lower in- 7 come, and underrepresented minority communities, includ- 8 ing which strategies are most effective for achieving such 9 goal. 10 (b) REPORT.—Not later than 2 years after the date 11 of enactment of this Act, the Comptroller General shall 12 submit to Congress a report on the study conducted under 13 subsection (a), together with recommendations for such 14 legislation and administrative action as the Comptroller 15 General determines appropriate. 16 SEC. 315. CONRAD STATE 30 PROGRAM; PHYSICIAN RETEN- 17 TION. 18 (a) CONRAD STATE 30 PROGRAM EXTENSION.—Sec- 19 tion 220(c) of the Immigration and Nationality Technical 20 Corrections Act of 1994 (Public Law 103–416; 8 U.S.C. 21 1182 note) is amended by striking ‘‘September 30, 2015’’ 22 and inserting ‘‘September 30, 2021’’. 23 (b) RETAINING PHYSICIANS WHO HAVE PRACTICED 24 IN MEDICALLY UNDERSERVED COMMUNITIES.—Section 25 201(b)(1) of the Immigration and Nationality Act (8 26 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00199 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 200 •S 4819 IS U.S.C. 1151(b)(1)) is amended by adding at the end the 1 following: 2 ‘‘(F)(i) Alien physicians who have completed 3 service requirements for a national interest waiver 4 requested under section 203(b)(2)(B)(ii), includ- 5 ing— 6 ‘‘(I) alien physicians who completed such 7 service before the date of the enactment of the 8 Health Equity and Accountability Act of 2020; 9 and 10 ‘‘(II) the spouse or children of an alien 11 physician described in subclause (I). 12 ‘‘(ii) Nothing in this subparagraph may be con- 13 strued— 14 ‘‘(I) to prevent the filing of a petition with 15 the Secretary of Homeland Security for classi- 16 fication under section 204(a) or the filing of an 17 application for adjustment of status under sec- 18 tion 245 by an alien physician described in 19 clause (i) before the date on which such alien 20 physician completes the service described in sec- 21 tion 214(l) or worked full-time as a physician 22 for an aggregate of 5 years at the location iden- 23 tified in the waiver of the 2-year foreign resi- 24 dence requirement under section 214(l) or in an 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00200 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 201 •S 4819 IS area or areas designated by the Secretary of 1 Health and Human Services as having a short- 2 age of health care professionals; or 3 ‘‘(II) to permit the Secretary of Homeland 4 Security to grant a petition or application de- 5 scribed in subclause (I) until the alien has sat- 6 isfied all of the requirements of the waiver re- 7 ceived under section 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 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00201 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 202 •S 4819 IS ‘‘(i) the alien demonstrates a bona fide 1 offer of full-time employment at a health facil- 2 ity or health care organization, which employ- 3 ment has been determined by the Secretary of 4 Homeland Security to be in the public interest; 5 and 6 ‘‘(ii) the alien— 7 ‘‘(I) has accepted employment with 8 the health facility or health care organiza- 9 tion in a geographic area or areas which 10 are designated by the Secretary of Health 11 and Human Services as having a shortage 12 of health care professionals; 13 ‘‘(II) begins employment by the later 14 of the date that is— 15 ‘‘(aa) 120 days after receiving 16 such waiver; 17 ‘‘(bb) 120 days after completing 18 graduate medical education or train- 19 ing under a program approved pursu- 20 ant to section 212(j)(1); or 21 ‘‘(cc) 120 days after receiving 22 nonimmigrant status or employment 23 authorization, if the alien or the 24 alien’s employer petitions for such 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00202 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 203 •S 4819 IS nonimmigrant status or employment 1 authorization not later than 120 days 2 after the date on which the alien com- 3 pletes his or her graduate medical 4 education or training under a pro- 5 gram approved pursuant to section 6 212(j)(1); and 7 ‘‘(III) agrees to continue to work for 8 a total of not less than 3 years in the sta- 9 tus authorized for such employment under 10 this subsection, except as provided in para- 11 graph (8).’’; and 12 (E) in subparagraph (D), in the matter 13 preceding clause (i), by inserting ‘‘subject to 14 paragraph (8),’’ before ‘‘in the case’’. 15 (2) ALLOWABLE VISA STATUS FOR PHYSICIANS 16 FULFILLING WAIVER REQUIREMENTS IN MEDICALLY 17 UNDERSERVED AREAS.—Section 214(l)(2)(A) of 18 such Act (8 U.S.C. 1184(l)(2)(A)) is amended to 19 read as follows: 20 ‘‘(A) Upon the request of an interested Federal 21 agency or an interested State agency for rec- 22 ommendation of a waiver under this section by a 23 physician who is maintaining valid nonimmigrant 24 status under section 101(a)(15)(J) and received a 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00203 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 204 •S 4819 IS favorable recommendation by the Secretary of State, 1 the Secretary of Homeland Security may change the 2 status of such physician to any status authorized for 3 employment under this Act. The numerical limita- 4 tions set forth in subsection (g)(1)(A) shall not 5 apply to any alien whose status is changed under 6 this subparagraph.’’. 7 (3) VIOLATION OF AGREEMENTS.—Section 8 214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is 9 amended by inserting ‘‘substantial requirement of 10 an’’ before ‘‘agreement entered into’’. 11 (4) PHYSICIAN EMPLOYMENT IN UNDERSERVED 12 AREAS.—Section 214(l) of such Act (8 U.S.C. 13 1184(l)), as amended by this section, is further 14 amended by adding at the end the following: 15 ‘‘(4)(A) If an interested State agency denies the ap- 16 plication for a waiver under paragraph (1)(B) from a phy- 17 sician pursuing graduate medical education or training 18 pursuant to section 101(a)(15)(J) because the State has 19 requested the maximum number of waivers permitted for 20 that fiscal year, the physician’s nonimmigrant status shall 21 be extended for up to 6 months if the physician agrees 22 to seek a waiver under this subsection (except for para- 23 graph (1)(D)(ii)) to work for an employer described in 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00204 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 205 •S 4819 IS paragraph (1)(C) in a State that has not yet requested 1 the maximum number of waivers. 2 ‘‘(B) A physician described in subparagraph (A) may 3 only work for the employer referred to in subparagraph 4 (A) during the period beginning on the date on which a 5 new waiver application is filed with such State and ending 6 on the earlier of— 7 ‘‘(i) the date on which the Secretary of Home- 8 land Security denies such waiver; or 9 ‘‘(ii) the date on which the Secretary approves 10 an application for change of status under paragraph 11 (2)(A) pursuant to the approval of such waiver.’’. 12 (5) CONTRACT REQUIREMENTS.—Section 214(l) 13 of such Act, as amended by this section, is further 14 amended by adding at the end the following: 15 ‘‘(5) An alien granted a waiver under paragraph 16 (1)(C) shall enter into an employment agreement with the 17 contracting health facility or health care organization 18 that— 19 ‘‘(A) specifies the maximum number of on-call 20 hours per week (which may be a monthly average) 21 that the alien will be expected to be available and 22 the compensation the alien will receive for on-call 23 time; 24 ‘‘(B) specifies— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00205 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 206 •S 4819 IS ‘‘(i) whether the contracting facility or or- 1 ganization will pay the alien’s malpractice in- 2 surance premiums; 3 ‘‘(ii) whether the employer will provide 4 malpractice insurance; and 5 ‘‘(iii) the amount of such insurance that 6 will be provided; 7 ‘‘(C) describes all of the work locations that the 8 alien will work, including a statement that the con- 9 tracting facility or organization will not add addi- 10 tional work locations without the approval of the 11 Federal agency or State agency that requested the 12 waiver; and 13 ‘‘(D) does not include a non-compete provision. 14 ‘‘(6) An alien granted a waiver under this subsection 15 whose employment relationship with a health facility or 16 health care organization terminates under paragraph 17 (1)(C)(ii) during the 3-year service period required under 18 paragraph (1) shall be considered to be maintaining lawful 19 status in an authorized period of stay during the 120-day 20 period referred to in items (aa) and (bb) of subclause (III) 21 of paragraph (1)(C)(ii) or the 45-day period referred to 22 in subclause (III)(cc) of such paragraph.’’. 23 (6) RECAPTURING WAIVER SLOTS LOST TO 24 OTHER STATES.—Section 214(l) of such Act, as 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00206 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 207 •S 4819 IS amended by this section, is further amended by add- 1 ing at the end the following: 2 ‘‘(7) If a recipient of a waiver under this subsection 3 terminates the recipient’s employment with a health facil- 4 ity or health care organization pursuant to paragraph 5 (1)(C)(ii), including termination of employment because of 6 circumstances described in paragraph (1)(C)(ii)(III), and 7 accepts new employment with such a facility or organiza- 8 tion in a different State, the State from which the alien 9 is departing may be accorded an additional waiver by the 10 Secretary of State for use in the fiscal year in which the 11 alien’s employment was terminated.’’. 12 (7) EXCEPTION TO 3-YEAR WORK REQUIRE- 13 MENT.—Section 214(l) of such Act, as amended by 14 this section, is further amended by adding at the 15 end the following: 16 ‘‘(8) The 3-year work requirement set forth in sub- 17 paragraphs (C) and (D) of paragraph (1) shall not apply 18 if— 19 ‘‘(A)(i) the Secretary of Homeland Security de- 20 termines that extenuating circumstances, including 21 violations by the employer of the employment agree- 22 ment with the alien or of labor and employment 23 laws, exist that justify a lesser period of employment 24 at such facility or organization; and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00207 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 208 •S 4819 IS ‘‘(ii) not later than 120 days after the employ- 1 ment termination date (unless the Secretary deter- 2 mines that extenuating circumstances would justify 3 an extension), the alien demonstrates another bona 4 fide offer of employment at a health facility or 5 health care organization in a geographic area or 6 areas which are designated by the Secretary of 7 Health and Human Services as having a shortage of 8 health care professionals, for the remainder of such 9 3-year period; 10 ‘‘(B)(i) the interested State agency that re- 11 quested the waiver attests that extenuating cir- 12 cumstances, including violations by the employer of 13 the employment agreement with the alien or of labor 14 and employment laws, exist that justify a lesser pe- 15 riod of employment at such facility or organization; 16 and 17 ‘‘(ii) not later than 120 days after the employ- 18 ment termination date (unless the Secretary deter- 19 mines that extenuating circumstances would justify 20 an extension), the alien demonstrates another bona 21 fide offer of employment at a health facility or 22 health care organization in a geographic area or 23 areas which are designated by the Secretary of 24 Health and Human Services as having a shortage of 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00208 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 209 •S 4819 IS health care professionals, for the remainder of such 1 3-year period; or 2 ‘‘(C) the alien— 3 ‘‘(i) elects not to pursue a determination of 4 extenuating circumstances pursuant to sub- 5 clause (A) or (B); 6 ‘‘(ii) terminates the alien’s employment re- 7 lationship with the health facility or health care 8 organization at which the alien was employed; 9 ‘‘(iii) not later than 45 days after the em- 10 ployment termination date, demonstrates an- 11 other bona fide offer of employment at a health 12 facility or health care organization in a geo- 13 graphic area or areas, in the State that re- 14 quested the alien’s waiver, which are designated 15 by the Secretary of Health and Human Services 16 as having a shortage of health care profes- 17 sionals; and 18 ‘‘(iv) agrees to be employed for the remain- 19 der of such 3-year period, and 1 additional year 20 for each termination under clause (ii).’’. 21 (d) ALLOTMENT OF CONRAD 30 WAIVERS.— 22 (1) IN GENERAL.—Section 214(l) of the Immi- 23 gration and Nationality Act (8 U.S.C. 1184(l)), as 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00209 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 210 •S 4819 IS amended by subsection (c), is further amended by 1 adding at the end the following: 2 ‘‘(9)(A)(i) All States shall be allotted 35 waivers 3 under paragraph (1)(B) for each fiscal year if 90 percent 4 of the waivers available to the States receiving at least 5 5 waivers were used in the previous fiscal year. 6 ‘‘(ii) When an allotment occurs under clause (i), all 7 States shall be allotted an additional 5 waivers under 8 paragraph (1)(B) for each subsequent fiscal year if 90 9 percent of the waivers available to the States receiving at 10 least 5 waivers were used in the previous fiscal year. If 11 the States are allotted 45 or more waivers for a fiscal year, 12 the States will only receive an additional increase of 5 13 waivers the following fiscal year if 95 percent of the waiv- 14 ers available to the States receiving at least 1 waiver were 15 used in the previous fiscal year. 16 ‘‘(B) Any increase in allotments under subparagraph 17 (A) shall be maintained indefinitely, unless in a fiscal year, 18 the total number of such waivers granted is 5 percent 19 lower than in the last year in which there was an increase 20 in the number of waivers allotted pursuant to this para- 21 graph. In such case— 22 ‘‘(i) the number of waivers allotted beginning in 23 the next fiscal year shall be decreased by 5 for all 24 States; and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00210 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 211 •S 4819 IS ‘‘(ii) each additional 5 percent decrease in such 1 waivers granted from the last year in which there 2 was an increase in the allotment, shall result in an 3 additional decrease of 5 waivers allotted for all 4 States, provided that the number of waivers allotted 5 for all States shall not drop below 30.’’. 6 (2) ACADEMIC MEDICAL CENTERS.—Section 7 214(l)(1)(D) of such Act, as amended by subsection 8 (c)(1)(E), is further amended— 9 (A) in clause (ii), by striking ‘‘and’’ at the 10 end; 11 (B) in clause (iii), by striking the period at 12 the end and inserting ‘‘; and’’; and 13 (C) by adding at the end the following: 14 ‘‘(iv) in the case of a request by an inter- 15 ested State agency— 16 ‘‘(I) the head of such agency deter- 17 mines that the alien is to practice medicine 18 in, or be on the faculty of a residency pro- 19 gram at, an academic medical center (as 20 defined in section 411.355(e)(2) of title 42, 21 Code of Federal Regulations), without re- 22 gard to whether such facility is located 23 within an area designated by the Secretary 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00211 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 212 •S 4819 IS of Health and Human Services as having 1 a shortage of health care professionals; and 2 ‘‘(II) the head of such agency deter- 3 mines that— 4 ‘‘(aa) the alien physician’s work 5 is in the public interest; and 6 ‘‘(bb) subject to paragraph (6), 7 the grant of such waiver would not 8 cause the number of the waivers 9 granted on behalf of aliens for such 10 State for a fiscal year to exceed 3, 11 within the limitation under subpara- 12 graph (B).’’. 13 (e) AMENDMENTS TO THE PROCEDURES, DEFINI- 14 TIONS, AND OTHER PROVISIONS RELATED TO PHYSICIAN 15 IMMIGRATION.— 16 (1) DUAL INTENT FOR PHYSICIANS SEEKING 17 GRADUATE MEDICAL TRAINING.—Section 214(b) of 18 the Immigration and Nationality Act (8 U.S.C. 19 1184(b)) is amended by striking ‘‘and other than a 20 nonimmigrant described in any provision of section 21 101(a)(15)(H)(i) except subclause (b1) of such sec- 22 tion)’’ and inserting ‘‘a nonimmigrant described in 23 any provision of section 101(a)(15)(H)(i) (except 24 subclause (b1) of such section), and an alien coming 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00212 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 213 •S 4819 IS to the United States to receive graduate medical 1 education or training as described in section 212(j) 2 or to take examinations required to receive graduate 3 medical education or training as described in section 4 212(j))’’. 5 (2) PHYSICIAN NATIONAL INTEREST WAIVER 6 CLARIFICATIONS.— 7 (A) PRACTICE AND GEOGRAPHIC AREA.— 8 Section 203(b)(2)(B)(ii)(I) of the Immigration 9 and Nationality Act (8 U.S.C. 10 1153(b)(2)(B)(ii)(I)) is amended by striking 11 items (aa) and (bb) and inserting the following: 12 ‘‘(aa) the alien physician agrees to 13 work on a full-time basis practicing pri- 14 mary care, specialty medicine, or a com- 15 bination thereof, in an area or areas des- 16 ignated by the Secretary of Health and 17 Human Services as having a shortage of 18 health care professionals, or at a health 19 care facility under the jurisdiction of the 20 Secretary of Veterans Affairs; or 21 ‘‘(bb) the alien physician is pursuing 22 such waiver based upon service at a facility 23 or facilities that serve patients who reside 24 in a geographic area or areas designated 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00213 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 214 •S 4819 IS by the Secretary of Health and Human 1 Services as having a shortage of health 2 care professionals (without regard to 3 whether such facility or facilities are lo- 4 cated within such an area) and a Federal 5 agency, or a local, county, regional, or 6 State department of public health deter- 7 mines the alien physician’s work was or 8 will be in the public interest.’’. 9 (B) FIVE-YEAR SERVICE REQUIREMENT.— 10 Section 203(b)(2)(B)(ii) of such Act is amend- 11 ed— 12 (i) by moving subclauses (II), (III), 13 and (IV) 4 ems to the left; and 14 (ii) in subclause (II)— 15 (I) by inserting ‘‘(aa)’’ after 16 ‘‘(II)’’; and 17 (II) by adding at the end the fol- 18 lowing: 19 ‘‘(bb) The 5-year service requirement 20 described in item (aa) shall begin on the 21 date on which the alien physician begins 22 work in the shortage area in any legal sta- 23 tus and not on the date on which an immi- 24 grant visa petition is filed or approved. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00214 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 215 •S 4819 IS Such service shall be aggregated without 1 regard to when such service began and 2 without regard to whether such service 3 began during or in conjunction with a 4 course of graduate medical education. 5 ‘‘(cc) An alien physician shall not be 6 required to submit an employment contract 7 with a term exceeding the balance of the 5- 8 year commitment yet to be served or an 9 employment contract dated within a min- 10 imum time period before filing a visa peti- 11 tion under this subsection. 12 ‘‘(dd) An alien physician shall not be 13 required to file additional immigrant visa 14 petitions upon a change of work location 15 from the location approved in the original 16 national interest immigrant petition.’’. 17 (3) TECHNICAL CLARIFICATION REGARDING AD- 18 VANCED DEGREE FOR PHYSICIANS.—Section 19 203(b)(2)(A) of such Act (8 U.S.C. 1153(b)(2)(A)) 20 is amended by adding at the end the following: ‘‘An 21 alien physician holding a foreign medical degree that 22 has been deemed sufficient for acceptance by an ac- 23 credited United States medical residency or fellow- 24 ship program shall be considered a member of the 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00215 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 216 •S 4819 IS professions holding an advanced degree or its equiv- 1 alent for purposes of this paragraph.’’. 2 (4) SHORT-TERM WORK AUTHORIZATION FOR 3 PHYSICIANS COMPLETING THEIR RESIDENCIES.— 4 (A) IN GENERAL.—A physician completing 5 graduate medical education or training de- 6 scribed in section 212(j) of the Immigration 7 and Nationality Act (8 U.S.C. 1182(j)) as a 8 nonimmigrant described in section 9 101(a)(15)(H)(i) of such Act (8 U.S.C. 10 1101(a)(15)(H)(i))— 11 (i) shall have such nonimmigrant sta- 12 tus automatically extended until October 1 13 of the fiscal year for which a petition for 14 a continuation of such nonimmigrant sta- 15 tus has been submitted in a timely manner 16 and the employment start date for the ben- 17 eficiary of such petition is October 1 of 18 that fiscal year; and 19 (ii) shall be authorized to be employed 20 incident to status during the period be- 21 tween the filing of such petition and Octo- 22 ber 1 of such fiscal year. 23 (B) TERMINATION.—The status and em- 24 ployment authorization of a physician described 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00216 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 217 •S 4819 IS in subparagraph (A) shall terminate on the date 1 that is 30 days after the date on which a peti- 2 tion described in clause (i)(I) is rejected, denied 3 or revoked. 4 (C) AUTOMATIC EXTENSION.—The status 5 and employment authorization of a physician 6 described in subparagraph (A) will automati- 7 cally extend to October 1 of the next fiscal year 8 if all of the visas described in section 9 101(a)(15)(H)(i) of the Immigration and Na- 10 tionality Act (8 U.S.C. 1101(a)(15)(H)(i)) that 11 were authorized to be issued for the fiscal year 12 have been issued. 13 (5) APPLICABILITY OF SECTION 212(e) TO 14 SPOUSES AND CHILDREN OF J–1 EXCHANGE VISI- 15 TORS.—A spouse or child of an exchange visitor de- 16 scribed in section 101(a)(15)(J) of the Immigration 17 and Nationality Act (8 U.S.C. 1101(a)(15)(J)) shall 18 not be subject to the requirements under section 19 212(e) of such Act (8 U.S.C. 1182(e)). 20 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00217 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 218 •S 4819 IS TITLE IV—IMPROVING HEALTH 1 CARE ACCESS AND QUALITY 2 Subtitle A—Improvement of 3 Coverage 4 SEC. 401. REPEAL OF REQUIREMENT FOR DOCUMENTA- 5 TION EVIDENCING CITIZENSHIP OR NATION- 6 ALITY UNDER THE MEDICAID PROGRAM. 7 (a) REPEAL.—Subsections (i)(22) and (x) of section 8 1903 of the Social Security Act (42 U.S.C. 1396b) are 9 each repealed. 10 (b) CONFORMING AMENDMENTS.— 11 (1) STATE PAYMENTS FOR MEDICAL ASSIST- 12 ANCE.—Section 1902 of the Social Security Act (42 13 U.S.C. 1396a) is amended— 14 (A) by amending paragraph (46) of sub- 15 section (a) to read as follows: 16 ‘‘(46) provide that information is requested and 17 exchanged for purposes of income and eligibility 18 verification in accordance with a State system which 19 meets the requirements of section 1137 of this 20 Act;’’; 21 (B) in subsection (e)(13)(A)(i)— 22 (i) in the matter preceding subclause 23 (I), by striking ‘‘sections 1902(a)(46)(B) 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00218 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 219 •S 4819 IS and 1137(d)’’ and inserting ‘‘section 1 1137(d)’’; and 2 (ii) in subclause (IV), by striking 3 ‘‘1902(a)(46)(B) or’’; and 4 (C) by striking subsection (ee). 5 (2) PAYMENT TO STATES.—Section 1903 of the 6 Social Security Act (42 U.S.C. 1396b) is amended— 7 (A) in subsection (i), by redesignating 8 paragraphs (23) through (27) as paragraphs 9 (22) through (26), respectively; and 10 (B) by redesignating subsections (y), (z), 11 and (aa) as subsections (x), (y), and (z), respec- 12 tively. 13 (3) REPEAL.—Subsection (c) of section 6036 of 14 the Deficit Reduction Act of 2005 (42 U.S.C. 1396b 15 note) is repealed. 16 (c) EFFECTIVE DATE.—The amendments made by 17 this section shall take effect on the date of enactment of 18 this Act. 19 SEC. 402. REMOVING CITIZENSHIP AND IMMIGRATION BAR- 20 RIERS TO ACCESS TO AFFORDABLE HEALTH 21 CARE UNDER ACA. 22 (a) IN GENERAL.— 23 (1) PREMIUM TAX CREDITS.—Section 36B of 24 the Internal Revenue Code of 1986 is amended— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00219 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 220 •S 4819 IS (A) in subsection (c)(1)(B)— 1 (i) by amending the heading to read 2 as follows: ‘‘SPECIAL RULE FOR CERTAIN 3 INDIVIDUALS INELIGIBLE FOR MEDICAID 4 DUE TO STATUS’’; and 5 (ii) in clause (ii), by striking ‘‘lawfully 6 present in the United States, but’’ and in- 7 serting ‘‘who’’; and 8 (B) by striking subsection (e). 9 (2) COST-SHARING REDUCTIONS.—Section 1402 10 of the Patient Protection and Affordable Care Act 11 (42 U.S.C. 18071) is amended by striking sub- 12 section (e). 13 (3) BASIC HEALTH PROGRAM ELIGIBILITY.— 14 Section 1331(e)(1)(B) of the Patient Protection and 15 Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is 16 amended by striking ‘‘lawfully present in the United 17 States’’. 18 (4) RESTRICTIONS ON FEDERAL PAYMENTS.— 19 Section 1412 of the Patient Protection and Afford- 20 able Care Act (42 U.S.C. 18082) is amended by 21 striking subsection (d). 22 (5) REQUIREMENT TO MAINTAIN MINIMUM ES- 23 SENTIAL COVERAGE.—Section 5000A(d) of the In- 24 ternal Revenue Code of 1986 is amended by striking 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00220 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 221 •S 4819 IS paragraph (3) and by redesignating paragraph (4) 1 as paragraph (3). 2 (b) CONFORMING AMENDMENTS.— 3 (1) Section 1411(a) of the Patient Protection 4 and Affordable Care Act (42 U.S.C. 18081(a)) is 5 amended by striking paragraph (1) and redesig- 6 nating paragraphs (2), (3), and (4) as paragraphs 7 (1), (2), and (3), respectively. 8 (2) Section 1312(f) of the Patient Protection 9 and Affordable Care Act (42 U.S.C. 18032(f)) is 10 amended— 11 (A) in the heading, by striking ‘‘; ACCESS 12 LIMITED TO CITIZENS AND LAWFUL RESI- 13 DENTS’’; and 14 (B) by striking paragraph (3). 15 SEC. 403. STUDY ON THE UNINSURED. 16 (a) IN GENERAL.—The Secretary of Health and 17 Human Services (in this section referred to as the ‘‘Sec- 18 retary’’) shall— 19 (1) conduct a study, in accordance with the 20 standards under section 3101 of the Public Health 21 Service Act (42 U.S.C. 300kk), on the demographic 22 characteristics of the population of individuals who 23 do not have health insurance coverage or oral health 24 coverage; and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00221 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 222 •S 4819 IS (2) predict, based on such study, the demo- 1 graphic characteristics of the population of individ- 2 uals who would remain without health insurance cov- 3 erage after the end of any annual open enrollment 4 or any special enrollment period or upon enactment 5 and implementation of any legislative changes to the 6 Patient Protection and Affordable Care Act (Public 7 Law 111–148) that affect the number of persons eli- 8 gible for coverage. 9 (b) REPORTING REQUIREMENTS.— 10 (1) IN GENERAL.—Not later than 12 months 11 after the date of the enactment of this Act, the Sec- 12 retary shall submit to the Congress the results of 13 the study under subsection (a)(1) and the prediction 14 made under subsection (a)(2). 15 (2) REPORTING OF DEMOGRAPHIC CHARACTER- 16 ISTICS.—The Secretary shall— 17 (A) report the demographic characteristics 18 under paragraphs (1) and (2) of subsection (a) 19 on the basis of racial and ethnic group, and 20 shall stratify the reporting on each racial and 21 ethnic group by other demographic characteris- 22 tics that can impact access to health insurance 23 coverage, such as sexual orientation, gender 24 identity, primary language, disability status, 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00222 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 223 •S 4819 IS sex, socioeconomic status, age group, and citi- 1 zenship and immigration status, in a manner 2 consistent with title I of this Act, including the 3 amendments made by such title; and 4 (B) not use such report to engage in or an- 5 ticipate any deportation or immigration related 6 enforcement action by any entity, including the 7 Department of Homeland Security. 8 SEC. 404. MEDICAID IN THE TERRITORIES. 9 (a) ELIMINATION OF GENERAL MEDICAID FUNDING 10 LIMITATIONS (‘‘CAP’’) FOR TERRITORIES.— 11 (1) REPEAL OF PROVISIONS RELATED TO CAP 12 AFTER 2019.—Subsections (a), (b), and (d) of section 13 202 of subtitle B of title I of division N of the Fur- 14 ther Consolidated Appropriations Act, 2020 (Public 15 Law 116–94) and section 6009 of the Families First 16 Coronavirus Response Act (Public Law 116–127) 17 are repealed and the provisions of law amended by 18 such subsections and section are restored as if such 19 subsections and section had not been enacted. 20 (2) SUNSET OF MEDICAID FUNDING LIMITA- 21 TIONS FOR TERRITORIES.—Section 1108 of the So- 22 cial Security Act (42 U.S.C. 1308) (as restored by 23 paragraph (1)) is amended— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00223 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 224 •S 4819 IS (A) in subsection (f), in the matter pre- 1 ceding paragraph (1), by striking ‘‘subsection 2 (g)’’ and inserting ‘‘subsections (g) and (h)’’; 3 (B) in subsection (g)(2), in the matter pre- 4 ceding subparagraph (A), by inserting ‘‘and 5 subsection (h)’’ after ‘‘paragraphs (3) and (5)’’; 6 and 7 (C) by adding at the end the following new 8 subsection: 9 ‘‘(h) SUNSET OF MEDICAID FUNDING LIMITATIONS 10 FOR PUERTO RICO, THE VIRGIN ISLANDS OF THE 11 UNITED STATES, GUAM, THE NORTHERN MARIANA IS- 12 LANDS, AND AMERICAN SAMOA.—Subsections (f) and (g) 13 shall not apply to Puerto Rico, the Virgin Islands of the 14 United States, Guam, the Northern Mariana Islands, and 15 American Samoa beginning with fiscal year 2020.’’. 16 (3) CONFORMING AMENDMENTS.— 17 (A) Section 1902(j) of the Social Security 18 Act (42 U.S.C. 1396a(j)) is amended by strik- 19 ing ‘‘, the limitation in section 1108(f),’’. 20 (B) Section 1903(u) of the Social Security 21 Act (42 U.S.C. 1396b(u)) is amended by strik- 22 ing paragraph (4). 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00224 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 225 •S 4819 IS (4) EFFECTIVE DATE.—The amendments made 1 by this subsection shall apply beginning with fiscal 2 year 2020. 3 (b) ELIMINATION OF SPECIFIC FEDERAL MEDICAL 4 ASSISTANCE PERCENTAGE (FMAP) LIMITATION FOR 5 TERRITORIES.—Section 1905 of the Social Security Act 6 (42 U.S.C. 1396d) is amended— 7 (1) in clause (2) of subsection (b), by inserting 8 ‘‘for fiscal years before fiscal year 2020’’ after 9 ‘‘American Samoa’’; and 10 (2) in subsection (ff)— 11 (A) by striking ‘‘(z)(2)—’’ and all that fol- 12 lows through ‘‘beginning October 1, 2019’’ and 13 inserting ‘‘(z)(2), for the period beginning Octo- 14 ber 1, 2019’’; 15 (B) by striking ‘‘100 percent;’’ and insert- 16 ing ‘‘100 percent.’’; and 17 (C) by striking paragraphs (2) and (3). 18 (c) APPLICATION OF MEDICAID WAIVER AUTHORITY 19 TO ALL OF THE TERRITORIES.— 20 (1) IN GENERAL.—Section 1902(j) of the Social 21 Security Act (42 U.S.C. 1396a(j)), as amended by 22 subsection (a)(3)(A), is amended— 23 (A) by striking ‘‘American Samoa and the 24 Northern Mariana Islands’’ and inserting 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00225 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 226 •S 4819 IS ‘‘Puerto Rico, the Virgin Islands of the United 1 States, Guam, the Northern Mariana Islands, 2 and American Samoa’’; 3 (B) by striking ‘‘American Samoa or the 4 Northern Mariana Islands’’ and inserting 5 ‘‘Puerto Rico, the Virgin Islands of the United 6 States, Guam, the Northern Mariana Islands, 7 or American Samoa’’; 8 (C) by inserting ‘‘(1)’’ after ‘‘(j)’’; 9 (D) by inserting ‘‘except as otherwise pro- 10 vided in this subsection,’’ after ‘‘Notwith- 11 standing any other requirement of this title’’; 12 and 13 (E) by adding at the end the following: 14 ‘‘(2) The Secretary may not waive under this 15 subsection the requirement of subsection 16 (a)(10)(A)(i)(IX) (relating to coverage of adults for- 17 merly under foster care) with respect to any terri- 18 tory.’’. 19 (2) EFFECTIVE DATE.—The amendments made 20 by this subsection shall apply beginning October 1, 21 2021. 22 (d) PERMITTING MEDICAID DSH ALLOTMENTS FOR 23 TERRITORIES.—Section 1923(f) of the Social Security Act 24 (42 U.S.C. 1396r–4) is amended— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00226 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 227 •S 4819 IS (1) in paragraph (6), by adding at the end the 1 following new subparagraph: 2 ‘‘(C) TERRITORIES.— 3 ‘‘(i) FISCAL YEAR 2020.—For fiscal 4 year 2020, the DSH allotment for Puerto 5 Rico, the Virgin Islands of the United 6 States, Guam, the Northern Mariana Is- 7 lands, and American Samoa shall bear the 8 same ratio to $300,000,000 as the ratio of 9 the number of individuals who are low-in- 10 come or uninsured and residing in such re- 11 spective territory (as estimated from time 12 to time by the Secretary) bears to the 13 sums of the number of such individuals re- 14 siding in all of the territories. 15 ‘‘(ii) SUBSEQUENT FISCAL YEAR.— 16 For each subsequent fiscal year, the DSH 17 allotment for each such territory is subject 18 to an increase in accordance with para- 19 graph (2).’’; and 20 (2) in paragraph (9), by inserting before the pe- 21 riod at the end the following: ‘‘, and includes, begin- 22 ning with fiscal year 2020, Puerto Rico, the Virgin 23 Islands of the United States, Guam, the Northern 24 Mariana Islands, and American Samoa’’. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00227 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 228 •S 4819 IS SEC. 405. EXTENSION OF MEDICARE SECONDARY PAYER. 1 (a) IN GENERAL.—Section 1862(b)(1)(C) of the So- 2 cial Security Act (42 U.S.C. 1395y(b)(1)(C)) is amend- 3 ed— 4 (1) in the last sentence, by inserting ‘‘, and be- 5 fore January 1, 2021’’ after ‘‘prior to such date)’’; 6 and 7 (2) by adding at the end the following new sen- 8 tence: ‘‘Effective for items and services furnished on 9 or after January 1, 2021 (with respect to periods 10 beginning on or after the date that is 42 months 11 prior to such date), clauses (i) and (ii) shall be ap- 12 plied by substituting ‘42-month’ for ‘12-month’ each 13 place it appears.’’. 14 (b) EFFECTIVE DATE.—The amendments made by 15 this section shall take effect on the date of enactment of 16 this Act. For purposes of determining an individual’s sta- 17 tus under section 1862(b)(1)(C) of the Social Security Act 18 (42 U.S.C. 1395y(b)(1)(C)), as amended by subsection 19 (a), an individual who is within the coordinating period 20 as of the date of enactment of this Act shall have that 21 period extended to the full 42 months described in the last 22 sentence of such section, as added by the amendment 23 made by subsection (a)(2). 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00228 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 229 •S 4819 IS SEC. 406. INDIAN DEFINED IN TITLE I OF THE PATIENT 1 PROTECTION AND AFFORDABLE CARE ACT. 2 (a) DEFINITION OF INDIAN.—Section 1304 of the 3 Patient Protection and Affordable Care Act (42 U.S.C. 4 18024) is amended by adding at the end the following: 5 ‘‘(f) INDIAN.— 6 ‘‘(1) IN GENERAL.—In this title, the term ‘In- 7 dian’ means any individual— 8 ‘‘(A) described in paragraph (13) or (28) 9 of section 4 of the Indian Health Care Improve- 10 ment Act (25 U.S.C. 1603); 11 ‘‘(B) who is eligible for health services pro- 12 vided by the Indian Health Service under sec- 13 tion 809 of the Indian Health Care Improve- 14 ment Act (25 U.S.C. 1679); 15 ‘‘(C) who is of Indian descent and belongs 16 to an Indian community served by a local facil- 17 ity or program of the Indian Health Service; or 18 ‘‘(D) who is otherwise described in para- 19 graph (2). 20 ‘‘(2) INCLUSIONS.—An individual is described 21 in this paragraph if the individual is any of the fol- 22 lowing: 23 ‘‘(A) A member of a federally recognized 24 Indian Tribe. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00229 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 230 •S 4819 IS ‘‘(B) A resident of an urban center who 1 meets any of the following criteria: 2 ‘‘(i) Membership in a Tribe, band, or 3 other organized group of Indians, including 4 those Tribes, bands, or groups terminated 5 since 1940 and those recognized as of the 6 date of enactment of the Health Equity 7 and Accountability Act of 2018 or later by 8 the State in which they reside, or being a 9 descendant, in the first or second degree, 10 of any such member. 11 ‘‘(ii) Is an Eskimo or Aleut or other 12 Alaska Native. 13 ‘‘(iii) Is considered by the Secretary of 14 the Interior to be an Indian for any pur- 15 pose. 16 ‘‘(iv) Is determined to be an Indian 17 under regulations promulgated by the Sec- 18 retary. 19 ‘‘(C) An individual who is considered by 20 the Secretary of the Interior to be an Indian for 21 any purpose. 22 ‘‘(D) An individual who is considered by 23 the Secretary to be an Indian for purposes of 24 eligibility for Indian health care services, includ- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00230 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 231 •S 4819 IS ing as a California Indian, Eskimo, Aleut, or 1 other Alaska Native.’’. 2 (b) CONFORMING AMENDMENTS.— 3 (1) AFFORDABLE CHOICES HEALTH BENEFIT 4 PLANS.—Section 1311(c)(6)(D) of the Patient Pro- 5 tection and Affordable Care Act (42 U.S.C. 6 18031(c)(6)(D)) is amended by striking ‘‘(as defined 7 in section 4 of the Indian Health Care Improvement 8 Act)’’. 9 (2) REDUCED COST-SHARING FOR INDIVIDUALS 10 ENROLLING IN QUALIFIED HEALTH PLANS.—Section 11 1402(d) of the Patient Protection and Affordable 12 Care Act (42 U.S.C. 18071(d)) is amended— 13 (A) in paragraph (1), in the matter pre- 14 ceding subparagraph (A), by striking ‘‘(as de- 15 fined in section 4(d) of the Indian Self-Deter- 16 mination and Education Assistance Act (25 17 U.S.C. 450b(d))’’; and 18 (B) in paragraph (2), in the matter pre- 19 ceding subparagraph (A), by striking ‘‘(as so 20 defined)’’. 21 (3) EXEMPTION FROM PENALTY FOR NOT 22 MAINTAINING MINIMUM ESSENTIAL COVERAGE.— 23 Section 5000A(e) of the Internal Revenue Code of 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00231 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 232 •S 4819 IS 1986 is amended by striking paragraph (3) and in- 1 serting the following: 2 ‘‘(3) INDIANS.—Any applicable individual who 3 is an Indian (as defined in section 1304(f) of the 4 Patient Protection and Affordable Care Act).’’. 5 SEC. 407. REMOVING MEDICARE BARRIER TO HEALTH 6 CARE. 7 (a) PART A.—Section 1818(a)(3) of the Social Secu- 8 rity Act (42 U.S.C. 1395i–2(a)(3)) is amended by striking 9 ‘‘an alien’’ and all that follows through ‘‘under this sec- 10 tion’’ and inserting ‘‘an individual who is lawfully present 11 in the United States’’. 12 (b) PART B.—Section 1836(2) of the Social Security 13 Act (42 U.S.C. 1395o(2)) is amended by striking ‘‘an 14 alien’’ and all that follows through ‘‘under this part’’ and 15 inserting ‘‘an individual who is lawfully present in the 16 United States’’. 17 SEC. 408. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 18 PROVIDED BY URBAN INDIAN HEALTH CEN- 19 TERS. 20 (a) IN GENERAL.—The third sentence of section 21 1905(b) of the Social Security Act (42 U.S.C. 1396(b)) 22 is amended by inserting ‘‘or are received through a pro- 23 gram operated by an urban Indian organization through 24 a grant or contract under title V of the Indian Health 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00232 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 233 •S 4819 IS Care Improvement Act’’ after ‘‘(as defined in section 4 1 of the Indian Health Care Improvement Act)’’. 2 (b) EFFECTIVE DATE.—The amendment made by 3 this section shall apply to medical assistance provided on 4 or after the date of enactment of this Act. 5 SEC. 409. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 6 PROVIDED TO A NATIVE HAWAIIAN THROUGH 7 A FEDERALLY QUALIFIED HEALTH CENTER 8 OR A NATIVE HAWAIIAN HEALTH CARE SYS- 9 TEM UNDER THE MEDICAID PROGRAM. 10 (a) IN GENERAL.—The third sentence of section 11 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)), 12 as amended by section 408(a), is amended by inserting 13 before the period the following: ‘‘, and with respect to 14 medical assistance provided to a Native Hawaiian (as de- 15 fined in section 12(2) of the Native Hawaiian Health Care 16 Improvement Act) through a federally qualified health 17 center or a Native Hawaiian health care system (as de- 18 fined in section 12(6) of such Act), whether directly, by 19 referral, or under contract or other arrangement between 20 such federally qualified health center or Native Hawaiian 21 health care system and another health care provider’’. 22 (b) EFFECTIVE DATE.—The amendment made by 23 this section shall apply to medical assistance provided on 24 or after the date of enactment of this Act. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00233 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 234 •S 4819 IS SEC. 410. MEDICAID COVERAGE FOR CITIZENS OF FREELY 1 ASSOCIATED STATES. 2 (a) IN GENERAL.—Section 402(b)(2) of the Personal 3 Responsibility and Work Opportunity Reconciliation Act 4 of 1996 (8 U.S.C. 1612(b)(2)) is amended by adding at 5 the end the following new subparagraph: 6 ‘‘(G) MEDICAID EXCEPTION FOR CITIZENS 7 OF FREELY ASSOCIATED STATES.—With respect 8 to eligibility for benefits for the designated Fed- 9 eral program described in paragraph (3)(C), 10 section 401(a) and paragraph (1) shall not 11 apply to any individual who lawfully resides in 12 1 of the 50 States or the District of Columbia 13 in accordance with the Compacts of Free Asso- 14 ciation between the Government of the United 15 States and the Governments of the Federated 16 States of Micronesia, the Republic of the Mar- 17 shall Islands, and the Republic of Palau and 18 shall not apply, at the option of the Governors 19 of Puerto Rico, the Virgin Islands, Guam, the 20 Northern Mariana Islands, or American Samoa, 21 respectively, as communicated to the Secretary 22 of Health and Human Services in writing, to 23 any individual who lawfully resides in the re- 24 spective territory in accordance with such Com- 25 pacts.’’. 26 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00234 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 235 •S 4819 IS (b) EXCEPTION TO 5-YEAR LIMITED ELIGIBILITY.— 1 Section 403(d) of the Personal Responsibility and Work 2 Opportunity Reconciliation Act of 1996 (8 U.S.C. 3 1613(d)) is amended— 4 (1) in paragraph (1), by striking ‘‘or’’ at the 5 end; 6 (2) in paragraph (2), by striking the period at 7 the end and inserting ‘‘; or’’; and 8 (3) by adding at the end the following new 9 paragraph: 10 ‘‘(3) an individual described in section 11 402(b)(2)(G), but only with respect to the des- 12 ignated Federal program described in section 13 402(b)(3)(C).’’. 14 (c) DEFINITION OF QUALIFIED ALIEN.—Section 15 431(b) of the Personal Responsibility and Work Oppor- 16 tunity Reconciliation Act of 1996 (8 U.S.C. 1641(b)) is 17 amended— 18 (1) in paragraph (6), by striking ‘‘; or’’ at the 19 end and inserting a comma; 20 (2) in paragraph (7), by striking the period at 21 the end and inserting ‘‘, or’’; and 22 (3) by adding at the end the following new 23 paragraph: 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00235 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 236 •S 4819 IS ‘‘(8) an individual who lawfully resides in the 1 United States in accordance with a Compact of Free 2 Association referred to in section 402(b)(2)(G), but 3 only with respect to the designated Federal program 4 described in section 402(b)(3)(C) (relating to the 5 Medicaid program).’’. 6 (d) EFFECTIVE DATE.—The amendments made by 7 this section take effect on October 1, 2021. 8 Subtitle B—Expansion of Access 9 SEC. 412. AMENDMENT TO THE PUBLIC HEALTH SERVICE 10 ACT. 11 Title XXXIV of the Public Health Service Act, as 12 amended by titles I, II, III, and IX of this Act, is further 13 amended by inserting after subtitle D the following: 14 ‘‘Subtitle E—Reconstruction and 15 Improvement Grants for Public 16 Health Care Facilities Serving 17 Pacific Islanders and the Insu- 18 lar Areas 19 ‘‘SEC. 3451. 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 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00236 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 237 •S 4819 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, or other health en- 8 tity determined appropriate by the Secretary— 9 ‘‘(A) that, by legal mandate or explicitly 10 adopted mission, provides patients with access 11 to services regardless of their ability to pay; 12 ‘‘(B) that provides care or treatment for a 13 substantial number of patients who are unin- 14 sured, are receiving assistance under a State 15 plan under title XIX of the Social Security Act 16 (or under a waiver of such plan), or are mem- 17 bers of vulnerable populations, as determined 18 by the Secretary; and 19 ‘‘(C)(i) with respect to which, not less than 20 50 percent of the entity’s patient population is 21 made up of racial and ethnic minority groups; 22 or 23 ‘‘(ii) that— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00237 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 238 •S 4819 IS ‘‘(I) serves a disproportionate percent- 1 age of local patients that are from a racial 2 and ethnic minority group, or that has a 3 patient population, at least 50 percent of 4 which is composed of individuals with lim- 5 ited 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 applicants 17 meeting the criteria under subsection (b) 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 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00238 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 239 •S 4819 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; or 13 ‘‘(G) other activities determined appro- 14 priate by the Secretary. 15 ‘‘(d) USE OF FUNDS.—An entity shall use amounts 16 received under a grant under subsection (a) to support 17 the implementation and evaluation of health care quality 18 improvement activities or minority health and health care 19 disparity reduction activities that include— 20 ‘‘(1) with respect to health care systems, activi- 21 ties relating to improving— 22 ‘‘(A) patient safety; 23 ‘‘(B) timeliness of care; 24 ‘‘(C) effectiveness of care; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00239 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 240 •S 4819 IS ‘‘(D) efficiency of care; 1 ‘‘(E) patient centeredness; and 2 ‘‘(F) health information technology; and 3 ‘‘(2) with respect to patients, activities relating 4 to— 5 ‘‘(A) staying healthy; 6 ‘‘(B) getting well, mentally and physically; 7 ‘‘(C) living effectively with illness or dis- 8 ability; 9 ‘‘(D) coping with end-of-life issues; and 10 ‘‘(E) shared decision making. 11 ‘‘(e) COMMON DATA SYSTEMS.—The Secretary shall 12 provide financial and other technical assistance to grant- 13 ees under this section for the development of common data 14 systems. 15 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 16 are authorized to be appropriated to carry out this section 17 such sums as may be necessary for each of fiscal years 18 2021 through 2026. 19 ‘‘SEC. 3452. CENTERS OF EXCELLENCE. 20 ‘‘(a) IN GENERAL.—The Secretary, acting through 21 the Administrator of the Health Resources and Services 22 Administration, shall designate centers of excellence at 23 public hospitals, and other health systems serving large 24 numbers of minority patients, that— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00240 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 241 •S 4819 IS ‘‘(1) meet the requirements of section 1 3451(b)(1); 2 ‘‘(2) demonstrate excellence in providing care to 3 minority populations; and 4 ‘‘(3) demonstrate excellence in reducing dispari- 5 ties in health and health care. 6 ‘‘(b) REQUIREMENTS.—A hospital or health system 7 that serves as a center of excellence under subsection (a) 8 shall— 9 ‘‘(1) design, implement, and evaluate programs 10 and policies relating to the delivery of care in ra- 11 cially, ethnically, and linguistically diverse popu- 12 lations; 13 ‘‘(2) provide training and technical assistance 14 to other hospitals and health systems relating to the 15 provision of quality health care to minority popu- 16 lations; and 17 ‘‘(3) develop activities for graduate or con- 18 tinuing medical education that institutionalize a 19 focus on cultural competence training for health care 20 providers. 21 ‘‘(c) 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 2021 through 2026. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00241 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 242 •S 4819 IS ‘‘SEC. 3453. RECONSTRUCTION AND IMPROVEMENT GRANTS 1 FOR PUBLIC HEALTH CARE FACILITIES SERV- 2 ING PACIFIC ISLANDERS AND THE INSULAR 3 AREAS. 4 ‘‘(a) IN GENERAL.—The Secretary shall provide di- 5 rect financial assistance to designated health care pro- 6 viders and community health centers in American Samoa, 7 Guam, the Commonwealth of the Northern Mariana Is- 8 lands, the United States Virgin Islands, Puerto Rico, and 9 Hawaii for the purposes of reconstructing and improving 10 health care facilities and services in a culturally competent 11 and sustainable manner. 12 ‘‘(b) ELIGIBILITY.—To be eligible to receive direct fi- 13 nancial assistance under subsection (a), an entity shall be 14 a public health facility or community health center located 15 in American Samoa, Guam, the Commonwealth of the 16 Northern Mariana Islands, the United States Virgin Is- 17 lands, Puerto Rico, or Hawaii that— 18 ‘‘(1) is owned or operated by— 19 ‘‘(A) the Government of American Samoa, 20 Guam, the Commonwealth of the Northern 21 Mariana Islands, the United States Virgin Is- 22 lands, Puerto Rico, or Hawaii or a unit of local 23 government; or 24 ‘‘(B) a nonprofit organization; and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00242 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 243 •S 4819 IS ‘‘(2)(A) provides care or treatment for a sub- 1 stantial number of patients who are uninsured, re- 2 ceiving assistance under title XVIII of the Social Se- 3 curity Act, or a State plan under title XIX of such 4 Act (or under a waiver of such plan), or who are 5 members of a vulnerable population, as determined 6 by the Secretary; or 7 ‘‘(B) serves a disproportionate percentage of 8 local patients that are from a racial and ethnic mi- 9 nority group. 10 ‘‘(c) REPORT.—Not later than 180 days after the 11 date of enactment of this title and annually thereafter, the 12 Secretary shall submit to the Congress and the President 13 a report that includes an assessment of health resources 14 and facilities serving populations in American Samoa, 15 Guam, the Commonwealth of the Northern Mariana Is- 16 lands, the United States Virgin Islands, Puerto Rico, and 17 Hawaii. In preparing such report, the Secretary shall— 18 ‘‘(1) consult with and obtain information on all 19 health care facilities needs from the entities receiv- 20 ing direct financial assistance under subsection (a); 21 ‘‘(2) include all amounts of Federal assistance 22 received by each such entity in the preceding fiscal 23 year; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00243 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 244 •S 4819 IS ‘‘(3) review the total unmet needs of health care 1 facilities serving American Samoa, Guam, the Com- 2 monwealth of the Northern Mariana Islands, the 3 United States Virgin Islands, Puerto Rico, and Ha- 4 waii, including needs for renovation and expansion 5 of existing facilities; 6 ‘‘(4) include a strategic plan for addressing the 7 needs of each such population identified in the re- 8 port; and 9 ‘‘(5) evaluate the effectiveness of the care pro- 10 vided by measuring patient outcomes and cost meas- 11 ures. 12 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 13 are authorized to be appropriated such sums as necessary 14 to carry out this section.’’. 15 SEC. 413. PROTECTING SENSITIVE LOCATIONS. 16 Section 287 of the Immigration and Nationality Act 17 (8 U.S.C. 1357) is amended— 18 (1) by striking ‘‘Service’’ each place such term 19 appears and inserting ‘‘Department of Homeland 20 Security’’; 21 (2) by striking ‘‘Attorney General’’ each place 22 such term appears and inserting ‘‘Secretary of 23 Homeland Security’’; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00244 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 245 •S 4819 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, inter- 21 view, request for identification, search, or sur- 22 veillance for the purposes of immigration en- 23 forcement; and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00245 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 246 •S 4819 IS ‘‘(ii) includes an enforcement action at, or 1 focused on, a sensitive location that is part of 2 a joint case led by another law enforcement 3 agency. 4 ‘‘(C) The term ‘exigent circumstances’ means a 5 situation involving— 6 ‘‘(i) the imminent risk of death, violence, 7 or physical harm to any person or property, in- 8 cluding a situation implicating terrorism or the 9 national security of the United States; 10 ‘‘(ii) the immediate arrest or pursuit of a 11 dangerous felon, terrorist suspect, or other indi- 12 vidual presenting an imminent danger; or 13 ‘‘(iii) the imminent risk of destruction of 14 evidence that is material to an ongoing criminal 15 case. 16 ‘‘(D) The term ‘prior approval’ means— 17 ‘‘(i) in the case of officers and agents of 18 U.S. Immigration and Customs Enforcement, 19 prior written approval to carry out an enforce- 20 ment action involving a specific individual or in- 21 dividuals authorized by— 22 ‘‘(I) the Assistant Director of Oper- 23 ations, Homeland Security Investigations; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00246 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 247 •S 4819 IS ‘‘(II) the Executive Associate Direc- 1 tor, Homeland Security Investigations; 2 ‘‘(III) the Assistant Director for Field 3 Operations, Enforcement and Removal Op- 4 erations; or 5 ‘‘(IV) the Executive Associate Direc- 6 tor for Field Operations, Enforcement and 7 Removal Operations; 8 ‘‘(ii) in the case of officers and agents of 9 U.S. Customs and Border Protection, prior 10 written approval to carry out an enforcement 11 action involving a specific individual or individ- 12 uals authorized by— 13 ‘‘(I) a Chief Patrol Agent; 14 ‘‘(II) the Director of Field Operations; 15 ‘‘(III) the Director of Air and Marine 16 Operations; or 17 ‘‘(IV) the Internal Affairs Special 18 Agent in Charge; and 19 ‘‘(iii) in the case of other Federal, State, 20 or local law enforcement officers, to carry out 21 an enforcement action involving a specific indi- 22 vidual or individuals authorized by— 23 ‘‘(I) the head of the Federal agency 24 carrying out the enforcement action; or 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00247 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 248 •S 4819 IS ‘‘(II) the head of the State or local 1 law enforcement agency carrying out the 2 enforcement action. 3 ‘‘(E) The term ‘sensitive location’ includes all of 4 the physical space located within 1,000 feet of— 5 ‘‘(i) any medical treatment or health care 6 facility, including any hospital, doctor’s office, 7 accredited health clinic, alcohol or drug treat- 8 ment center, or emergent or urgent care facil- 9 ity; 10 ‘‘(ii) any public or private school, including 11 any known and licensed day care facility, pre- 12 school, other early learning program facility, 13 primary school, secondary school, postsecondary 14 school (including colleges and universities), or 15 other institution of learning (including voca- 16 tional or trade schools); 17 ‘‘(iii) any scholastic or education-related 18 activity or event, including field trips and inter- 19 scholastic events; 20 ‘‘(iv) any school bus or school bus stop 21 during periods when school children are present 22 on the bus or at the stop; 23 ‘‘(v) any organization or subdivision of 24 government that— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00248 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 249 •S 4819 IS ‘‘(I) assists children, pregnant women, 1 victims of crime or abuse, or individuals 2 with significant mental or physical disabil- 3 ities; or 4 ‘‘(II) provides social services and as- 5 sistance, including emergency and disaster 6 services or assistance with food and nutri- 7 tion, housing affordability and income or 8 other services funded by State or local gov- 9 ernment, charitable giving, the Special 10 Supplemental Nutrition Program for 11 Women, Infants, and Children (WIC), 12 Supplemental Nutrition Assistance Pro- 13 gram (SNAP), Temporary Assistance for 14 Needy Families (TANF), or the United 15 States Housing Act; 16 ‘‘(vi) any church, synagogue, mosque, or 17 other place of worship, including buildings 18 rented for the purpose of religious services, re- 19 treats, counseling, workshops, instruction, and 20 education; 21 ‘‘(vii) any Federal, State, or local court- 22 house, including the office of an individual’s 23 legal counsel or representative, and a probation, 24 parole, or supervised release office; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00249 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 250 •S 4819 IS ‘‘(viii) the site of a funeral, wedding, or 1 other religious ceremony or observance; 2 ‘‘(ix) any public demonstration, such as a 3 march, rally, or parade; 4 ‘‘(x) any domestic violence shelter, rape 5 crisis center, supervised visitation center, family 6 justice center, or victim services provider; or 7 ‘‘(xi) any other location specified by the 8 Secretary of Homeland Security for purposes of 9 this subsection. 10 ‘‘(2)(A) An enforcement action may not take place 11 at, or be focused on, a sensitive location unless— 12 ‘‘(i) the action involves exigent circumstances; 13 and 14 ‘‘(ii) prior approval for the enforcement action 15 was obtained from the appropriate official. 16 ‘‘(B) If an enforcement action is initiated pursuant 17 to subparagraph (A) and the exigent circumstances per- 18 mitting the enforcement action cease, the enforcement ac- 19 tion shall be discontinued until such exigent circumstances 20 reemerge. 21 ‘‘(C) If an enforcement action is carried out in viola- 22 tion of this subsection— 23 ‘‘(i) no information resulting from the enforce- 24 ment action may be entered into the record or re- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00250 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 251 •S 4819 IS ceived into evidence in a removal proceeding result- 1 ing from the enforcement action; and 2 ‘‘(ii) the alien who is the subject of such re- 3 moval proceeding may file a motion for the imme- 4 diate termination of the removal proceeding. 5 ‘‘(3)(A) This subsection shall apply to any enforce- 6 ment action by officers or agents of the Department of 7 Homeland Security, including— 8 ‘‘(i) officers or agents of U.S. Immigration and 9 Customs Enforcement; 10 ‘‘(ii) officers or agents of U.S. Customs and 11 Border Protection; and 12 ‘‘(iii) any individual designated to perform im- 13 migration enforcement functions pursuant to sub- 14 section (g). 15 ‘‘(B) While carrying out an enforcement action at a 16 sensitive location, officers and agents referred to in sub- 17 paragraph (A) shall make every effort— 18 ‘‘(i) to limit the time spent at the sensitive loca- 19 tion; 20 ‘‘(ii) to limit the enforcement action at the sen- 21 sitive location to the person or persons for whom 22 prior approval was obtained; and 23 ‘‘(iii) to conduct themselves discreetly. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00251 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 252 •S 4819 IS ‘‘(C) If, while carrying out an enforcement action 1 that is not initiated at or focused on a sensitive location, 2 officers or agents are led to a sensitive location, and no 3 exigent circumstance and prior approval with respect to 4 the sensitive location exists, such officers or agents shall— 5 ‘‘(i) cease before taking any further enforce- 6 ment action; 7 ‘‘(ii) conduct themselves in a discreet manner; 8 ‘‘(iii) maintain surveillance; and 9 ‘‘(iv) immediately consult their supervisor in 10 order to determine whether such enforcement action 11 should be discontinued. 12 ‘‘(D) The limitations under this paragraph shall not 13 apply to the transportation of an individual apprehended 14 at or near a land or sea border to a hospital or health 15 care provider for the purpose of providing medical care 16 to such individual. 17 ‘‘(4)(A) Each official specified in subparagraph (B) 18 shall ensure that the employees under his or her super- 19 vision receive annual training on compliance with— 20 ‘‘(i) the requirements under this subsection in 21 enforcement actions at or focused on sensitive loca- 22 tions and enforcement actions that lead officers or 23 agents to a sensitive location; and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00252 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 253 •S 4819 IS ‘‘(ii) the requirements under section 239 of this 1 Act and section 384 of the Illegal Immigration Re- 2 form and Immigrant Responsibility Act of 1996 (8 3 U.S.C. 1367). 4 ‘‘(B) The officials specified in this subparagraph 5 are— 6 ‘‘(i) the Chief Counsel of U.S. Immigration and 7 Customs Enforcement; 8 ‘‘(ii) the Field Office Directors of U.S. Immi- 9 gration and Customs Enforcement; 10 ‘‘(iii) each Special Agent in Charge of U.S. Im- 11 migration and Customs Enforcement; 12 ‘‘(iv) each Chief Patrol Agent of U.S. Customs 13 and Border Protection; 14 ‘‘(v) the Director of Field Operations of U.S. 15 Customs and Border Protection; 16 ‘‘(vi) the Director of Air and Marine Operations 17 of U.S. Customs and Border Protection; 18 ‘‘(vii) the Internal Affairs Special Agent in 19 Charge of U.S. Customs and Border Protection; and 20 ‘‘(viii) the chief law enforcement officer of each 21 State or local law enforcement agency that enters 22 into a written agreement with the Department of 23 Homeland Security pursuant to subsection (g). 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00253 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 254 •S 4819 IS ‘‘(5) The Secretary of Homeland Security shall mod- 1 ify the Notice to Appear form (I–862)— 2 ‘‘(A) to provide the subjects of an enforcement 3 action with information, written in plain language, 4 summarizing the restrictions against enforcement 5 actions at sensitive locations set forth in this sub- 6 section and the remedies available to the alien if 7 such action violates such restrictions; 8 ‘‘(B) to ensure that the information described 9 in subparagraph (A) is accessible to individuals with 10 limited English proficiency; and 11 ‘‘(C) to ensure that subjects of an enforcement 12 action are not permitted to verify that the officers 13 or agents that carried out such action complied with 14 the restrictions set forth in this subsection. 15 ‘‘(6)(A) The Director of U.S. Immigration and Cus- 16 toms Enforcement and the Commissioner of U.S. Customs 17 and Border Protection shall each submit an annual report 18 to the appropriate congressional committees that includes 19 the information set forth in subparagraph (B) with respect 20 to the respective agency. 21 ‘‘(B) Each report submitted under subparagraph (A) 22 shall include, with respect to the submitting agency during 23 the reporting period— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00254 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 255 •S 4819 IS ‘‘(i) the number of enforcement actions that 1 were carried out at, or focused on, a sensitive loca- 2 tion; 3 ‘‘(ii) the number of enforcement actions in 4 which officers or agents were subsequently led to a 5 sensitive location; and 6 ‘‘(iii) for each enforcement action described in 7 clause (i) or (ii)— 8 ‘‘(I) the date on which it occurred; 9 ‘‘(II) the specific site, city, county, and 10 State in which it occurred; 11 ‘‘(III) the components of the agency in- 12 volved in the enforcement action; 13 ‘‘(IV) a description of the enforcement ac- 14 tion, including the nature of the criminal activ- 15 ity of its intended target; 16 ‘‘(V) the number of individuals, if any, ar- 17 rested or taken into custody; 18 ‘‘(VI) the number of collateral arrests, if 19 any, and the reasons for each such arrest; 20 ‘‘(VII) a certification whether the location 21 administrator was contacted before, during, or 22 after the enforcement action; and 23 ‘‘(VIII) the percentage of all of the staff 24 members and supervisors reporting to the offi- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00255 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 256 •S 4819 IS cials listed in paragraph (4)(B) who completed 1 the training required under paragraph (4)(A). 2 ‘‘(7) Nothing in the subsection may be construed— 3 ‘‘(A) to affect the authority of Federal, State, 4 or local law enforcement agencies— 5 ‘‘(i) to enforce generally applicable Federal 6 or State criminal laws unrelated to immigra- 7 tion; or 8 ‘‘(ii) to protect residents from imminent 9 threats to public safety; or 10 ‘‘(B) to limit or override the protections pro- 11 vided in— 12 ‘‘(i) section 239; or 13 ‘‘(ii) section 384 of the Illegal Immigration 14 Reform and Immigrant Responsibility Act of 15 1996 (8 U.S.C. 1367).’’. 16 SEC. 414. GRANTS FOR RACIAL AND ETHNIC APPROACHES 17 TO COMMUNITY HEALTH. 18 (a) PURPOSE.—It is the purpose of this section to 19 award grants to assist communities in mobilizing and or- 20 ganizing resources in support of effective and sustainable 21 programs that will reduce or eliminate disparities in health 22 and health care experienced by racial and ethnic minority 23 individuals. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00256 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 257 •S 4819 IS (b) AUTHORITY TO AWARD GRANTS.—The Secretary 1 of Health and Human Services, acting through the Ad- 2 ministrator of the Health Resources and Services Admin- 3 istration (referred to in this section as the ‘‘Secretary’’), 4 shall award grants to eligible entities to assist in design- 5 ing, implementing, and evaluating culturally and linguis- 6 tically appropriate, science-based, and community-driven 7 sustainable strategies to eliminate racial and ethnic health 8 and health care disparities. 9 (c) ELIGIBLE ENTITIES.—To be eligible to receive a 10 grant under this section, an entity shall— 11 (1) represent a coalition— 12 (A) whose principal purpose is to develop 13 and implement interventions to reduce or elimi- 14 nate a health or health care disparity in a tar- 15 geted racial or ethnic minority group in the 16 community served by the coalition; and 17 (B) that includes— 18 (i) members selected from among— 19 (I) public health departments; 20 (II) community-based organiza- 21 tions; 22 (III) university and research or- 23 ganizations; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00257 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 258 •S 4819 IS (IV) Indian tribes or tribal orga- 1 nizations (as such terms are defined 2 in section 4 of the Indian Self-Deter- 3 mination and Education Assistance 4 Act (25 U.S.C. 5304)), the Indian 5 Health Service, or any other organiza- 6 tion that serves Alaska Natives; and 7 (V) interested public or private 8 health care providers or organizations 9 as determined appropriate by the Sec- 10 retary; and 11 (ii) at least 1 member from a commu- 12 nity-based organization that represents the 13 targeted racial or ethnic minority group; 14 and 15 (2) submit to the Secretary an application at 16 such time, in such manner, and containing such in- 17 formation as the Secretary may require, which shall 18 include— 19 (A) a description of the targeted racial or 20 ethnic populations in the community to be 21 served under the grant; 22 (B) a description of at least 1 health dis- 23 parity that exists in the racial or ethnic tar- 24 geted populations, including health issues such 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00258 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 259 •S 4819 IS as infant mortality, breast and cervical cancer 1 screening and management, musculoskeletal 2 diseases and obesity, prostate cancer screening 3 and management, cardiovascular disease, diabe- 4 tes, child and adult immunization levels, oral 5 disease, or other health priority areas as des- 6 ignated by the Secretary; and 7 (C) a demonstration of a proven record of 8 accomplishment of the coalition members in 9 serving and working with the targeted commu- 10 nity. 11 (d) SUSTAINABILITY.—The Secretary shall give pri- 12 ority to an eligible entity under this section if the entity 13 agrees that, with respect to the costs to be incurred by 14 the entity in carrying out the activities for which the grant 15 was awarded, the entity (and each of the participating 16 partners in the coalition represented by the entity) will 17 maintain its expenditures of non-Federal funds for such 18 activities at a level that is not less than the level of such 19 expenditures during the fiscal year immediately preceding 20 the first fiscal year for which the grant is awarded. 21 (e) NONDUPLICATION.—Any funds provided to an eli- 22 gible entity through a grant under this section shall— 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00259 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 260 •S 4819 IS (1) supplement, not supplant, any other Federal 1 funds made available to the entity for the purposes 2 of this section; and 3 (2) not be used to duplicate the activities of any 4 other health disparity grant program under this Act, 5 including an amendment made by this Act. 6 (f) TECHNICAL ASSISTANCE.—The Secretary may, 7 either directly or by grant or contract, provide any entity 8 that receives a grant under this section with technical and 9 other nonfinancial assistance necessary to meet the re- 10 quirements of this section. 11 (g) DISSEMINATION.—The Secretary shall encourage 12 and enable eligible entities receiving grants under this sec- 13 tion to share best practices, evaluation results, and reports 14 with communities not affiliated with such entities, by 15 using the internet, conferences, and other pertinent infor- 16 mation regarding the projects funded by this section, in- 17 cluding through using outreach efforts of the Office of Mi- 18 nority Health and the Centers for Disease Control and 19 Prevention. 20 (h) ADMINISTRATIVE BURDENS.—The Secretary 21 shall make every effort to minimize duplicative or unneces- 22 sary administrative burdens on eligible entities receiving 23 grants under this section. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00260 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 261 •S 4819 IS (i) AUTHORIZATION OF APPROPRIATIONS.—There 1 are authorized to be appropriated such sums as may be 2 necessary to carry out this section. 3 SEC. 415. BORDER HEALTH GRANTS. 4 (a) DEFINITIONS.—In this section: 5 (1) BORDER AREA.—The term ‘‘border area’’ 6 means the United States-Mexico Border Area, as de- 7 fined in section 8 of the United States-Mexico Bor- 8 der Health Commission Act (22 U.S.C. 290n–6). 9 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti- 10 ty’’ means an entity that is located in the border 11 area and is any of the following: 12 (A) A State, local government, or Tribal 13 government. 14 (B) A public institution of higher edu- 15 cation. 16 (C) A nonprofit health organization. 17 (D) A community health center. 18 (E) A community clinic that is a health 19 center receiving assistance under section 330 of 20 the Public Health Service Act (42 U.S.C. 21 254b). 22 (b) AUTHORIZATION.—From funds appropriated 23 under subsection (f), the Secretary of Health and Human 24 Services (in this section referred to as the ‘‘Secretary’’), 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00261 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 262 •S 4819 IS acting through the United States members of the United 1 States-Mexico Border Health Commission, shall award 2 grants to eligible entities to address priorities and rec- 3 ommendations to improve the health of border area resi- 4 dents that are established by— 5 (1) the United States members of the United 6 States-Mexico Border Health Commission; 7 (2) the State border health offices; and 8 (3) the Secretary. 9 (c) APPLICATION.—An eligible entity that desires a 10 grant under subsection (b) shall submit an application to 11 the Secretary at such time, in such manner, and con- 12 taining such information as the Secretary may require. 13 (d) USE OF FUNDS.—An eligible entity that receives 14 a grant under subsection (b) shall use the grant funds 15 for— 16 (1) programs relating to— 17 (A) maternal and child health; 18 (B) primary care and preventative health; 19 (C) public health and public health infra- 20 structure; 21 (D) musculoskeletal health and obesity; 22 (E) health education and promotion; 23 (F) oral health; 24 (G) mental and behavioral health; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00262 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 263 •S 4819 IS (H) substance use disorders; 1 (I) health conditions that have a high prev- 2 alence in the border area; 3 (J) medical and health services research; 4 (K) workforce training and development; 5 (L) community health workers, patient 6 navigators, and promotores; 7 (M) health care infrastructure problems in 8 the border area (including planning and con- 9 struction grants); 10 (N) health disparities in the border area; 11 (O) environmental health; and 12 (P) outreach and enrollment services with 13 respect to Federal programs (including pro- 14 grams authorized under titles XIX and XXI of 15 the Social Security Act (42 U.S.C. 1396 et seq.; 16 42 U.S.C. 1397aa et seq.)); and 17 (2) other programs determined appropriate by 18 the Secretary. 19 (e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro- 20 vided to an eligible entity awarded a grant under sub- 21 section (b) shall be used to supplement and not supplant 22 other funds available to the eligible entity to carry out the 23 activities described in subsection (d). 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00263 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 264 •S 4819 IS (f) AUTHORIZATION OF APPROPRIATIONS.—There 1 are authorized to be appropriated to carry out this section, 2 $200,000,000 for fiscal year 2021, and such sums as may 3 be necessary for each succeeding fiscal year. 4 SEC. 416. CRITICAL ACCESS HOSPITAL IMPROVEMENTS. 5 (a) ELIMINATION OF ISOLATION TEST FOR COST- 6 BASED AMBULANCE REIMBURSEMENT.— 7 (1) IN GENERAL.—Section 1834(l)(8) of the 8 Social Security Act (42 U.S.C. 1395m(l)(8)) is 9 amended— 10 (A) in subparagraph (B)— 11 (i) by striking ‘‘owned and’’; and 12 (ii) by inserting ‘‘(including when 13 such services are provided by the entity 14 under an arrangement with the hospital)’’ 15 after ‘‘hospital’’; and 16 (B) by striking the comma at the end of 17 subparagraph (B) and all that follows and in- 18 serting a period. 19 (2) EFFECTIVE DATE.—The amendments made 20 by this subsection shall apply to services furnished 21 on or after January 1, 2021. 22 (b) PROVISION OF A MORE FLEXIBLE ALTERNATIVE 23 TO THE CAH DESIGNATION 25 INPATIENT BED LIMIT 24 REQUIREMENT.— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00264 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 265 •S 4819 IS (1) IN GENERAL.—Section 1820(c)(2) of the 1 Social Security Act (42 U.S.C. 1395i–4(c)(2)) is 2 amended— 3 (A) in subparagraph (B)(iii), by striking 4 ‘‘provides not more than’’ and inserting ‘‘sub- 5 ject to subparagraph (F), provides not more 6 than’’; and 7 (B) by adding at the end the following new 8 subparagraph: 9 ‘‘(F) ALTERNATIVE TO 25 INPATIENT BED 10 LIMIT REQUIREMENT.— 11 ‘‘(i) IN GENERAL.—A State may elect 12 to treat a facility, with respect to the des- 13 ignation of the facility for a cost-reporting 14 period, as satisfying the requirement of 15 subparagraph (B)(iii) relating to a max- 16 imum number of acute care inpatient beds 17 if the facility elects, in accordance with a 18 method specified by the Secretary and be- 19 fore the beginning of the cost reporting pe- 20 riod, to meet the requirement under clause 21 (ii). 22 ‘‘(ii) ALTERNATE REQUIREMENT.— 23 The requirement under this clause, with 24 respect to a facility and a cost-reporting 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00265 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 266 •S 4819 IS period, is that the total number of inpa- 1 tient bed days described in subparagraph 2 (B)(iii) during such period will not exceed 3 7,300. For purposes of this subparagraph, 4 an individual who is an inpatient in a bed 5 in the facility for a single day shall be 6 counted as one inpatient bed day. 7 ‘‘(iii) WITHDRAWAL OF ELECTION.— 8 The option described in clause (i) shall not 9 apply to a facility for a cost-reporting pe- 10 riod if the facility (for any two consecutive 11 cost-reporting periods during the previous 12 5 cost-reporting periods) was treated under 13 such option and had a total number of in- 14 patient bed days for each of such two cost- 15 reporting periods that exceeded the num- 16 ber specified in such clause.’’. 17 (2) EFFECTIVE DATE.—The amendments made 18 by paragraph (1) shall apply to cost-reporting peri- 19 ods beginning on or after the date of the enactment 20 of this Act. 21 SEC. 417. ESTABLISHMENT OF RURAL COMMUNITY HOS- 22 PITAL (RCH) PROGRAM. 23 (a) IN GENERAL.—Section 1861 of the Social Secu- 24 rity Act (42 U.S.C. 1395x), as amended by section 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00266 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 267 •S 4819 IS 207(b)(1), is amended by adding at the end of the fol- 1 lowing new subsection: 2 ‘‘Rural Community Hospital; Rural Community Hospital 3 Services 4 ‘‘(lll)(1) The term ‘rural community hospital’ means 5 a hospital (as defined in subsection (e)) that— 6 ‘‘(A) is located in a rural area (as defined in 7 section 1886(d)(2)(D)) or treated as being so lo- 8 cated pursuant to section 1886(d)(8)(E); 9 ‘‘(B) subject to paragraph (2), has less than 51 10 acute care inpatient beds, as reported in its most re- 11 cent cost report; 12 ‘‘(C) makes available 24-hour emergency care 13 services; 14 ‘‘(D) subject to paragraph (3), has a provider 15 agreement in effect with the Secretary and is open 16 to the public as of January 1, 2010; and 17 ‘‘(E) applies to the Secretary for such designa- 18 tion. 19 ‘‘(2) For purposes of paragraph (1)(B), beds in a 20 psychiatric or rehabilitation unit of the hospital which is 21 a distinct part of the hospital shall not be counted. 22 ‘‘(3) Paragraph (1)(D) shall not be construed to pro- 23 hibit any of the following from qualifying as a rural com- 24 munity hospital: 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00267 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 268 •S 4819 IS ‘‘(A) A replacement facility (as defined by the 1 Secretary in regulations in effect on January 1, 2 2012) with the same service area (as defined by the 3 Secretary in regulations in effect on such date). 4 ‘‘(B) A facility obtaining a new provider num- 5 ber pursuant to a change of ownership. 6 ‘‘(C) A facility which has a binding written 7 agreement with an outside, unrelated party for the 8 construction, reconstruction, lease, rental, or financ- 9 ing of a building as of January 1, 2012. 10 ‘‘(4) Nothing in this subsection shall be construed as 11 prohibiting a critical access hospital from qualifying as a 12 rural community hospital if the critical access hospital 13 meets the conditions otherwise applicable to hospitals 14 under subsection (e) and section 1866. 15 ‘‘(5) Nothing in this subsection shall be construed as 16 prohibiting a rural community hospital participating in 17 the demonstration program under section 410A of the 18 Medicare Prescription Drug, Improvement, and Mod- 19 ernization Act of 2003 (Public Law 108–173; 117 Stat. 20 2313) from qualifying as a rural community hospital if 21 the rural community hospital meets the conditions other- 22 wise applicable to hospitals under subsection (e) and sec- 23 tion 1866.’’. 24 (b) PAYMENT.— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00268 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 269 •S 4819 IS (1) INPATIENT HOSPITAL SERVICES.—Section 1 1814 of the Social Security Act (42 U.S.C. 1395f) 2 is amended by adding at the end the following new 3 subsection: 4 ‘‘Payment for Inpatient Services Furnished in Rural 5 Community Hospitals 6 ‘‘(m) The amount of payment under this part for in- 7 patient hospital services furnished in a rural community 8 hospital, other than such services furnished in a psy- 9 chiatric or rehabilitation unit of the hospital which is a 10 distinct part, is, at the election of the hospital in the appli- 11 cation referred to in section 1861(lll)(1)(E)— 12 ‘‘(1) 101 percent of the reasonable costs of pro- 13 viding such services, without regard to the amount 14 of the customary or other charge, or 15 ‘‘(2) the amount of payment provided for under 16 the prospective payment system for inpatient hos- 17 pital services under section 1886(d).’’. 18 (2) OUTPATIENT SERVICES.—Section 1834 of 19 such Act (42 U.S.C. 1395m) is amended by adding 20 at the end the following new subsection: 21 ‘‘(x) PAYMENT FOR OUTPATIENT SERVICES FUR- 22 NISHED IN RURAL COMMUNITY HOSPITALS.—The 23 amount of payment under this part for outpatient services 24 furnished in a rural community hospital is, at the election 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00269 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 270 •S 4819 IS of the hospital in the application referred to in section 1 1861(lll)(1)(E)— 2 ‘‘(1) 101 percent of the reasonable costs of pro- 3 viding such services, without regard to the amount 4 of the customary or other charge and any limitation 5 under section 1861(v)(1)(U), or 6 ‘‘(2) the amount of payment provided for under 7 the prospective payment system for covered OPD 8 services under section 1833(t).’’. 9 (3) EXEMPTION FROM 30-PERCENT REDUCTION 10 IN REIMBURSEMENT FOR BAD DEBT.—Section 11 1861(v)(1)(T) of such Act (42 U.S.C. 12 1395x(v)(1)(T)) is amended by inserting ‘‘(other 13 than for a rural community hospital)’’ after ‘‘In de- 14 termining such reasonable costs for hospitals’’. 15 (c) BENEFICIARY COST-SHARING FOR OUTPATIENT 16 SERVICES.—Section 1834(x) of such Act (as added by 17 subsection (b)(2)) is amended— 18 (1) by redesignating paragraphs (1) and (2) as 19 subparagraphs (A) and (B), respectively; 20 (2) by inserting ‘‘(1)’’ after ‘‘(x)’’; and 21 (3) by adding at the end the following: 22 ‘‘(2) The amounts of beneficiary cost-sharing for out- 23 patient services furnished in a rural community hospital 24 under this part shall be as follows: 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00270 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 271 •S 4819 IS ‘‘(A) For items and services that would have 1 been paid under section 1833(t) if furnished by a 2 hospital, the amount of cost-sharing determined 3 under paragraph (8) of such section. 4 ‘‘(B) For items and services that would have 5 been paid under section 1833(h) if furnished by a 6 provider of services or supplier, no cost-sharing shall 7 apply. 8 ‘‘(C) For all other items and services, the 9 amount of cost-sharing that would apply to the item 10 or service under the methodology that would be used 11 to determine payment for such item or service if pro- 12 vided by a physician, provider of services, or sup- 13 plier, as the case may be.’’. 14 (d) CONFORMING AMENDMENTS.— 15 (1) PART A PAYMENT.—Section 1814(b) of 16 such Act (42 U.S.C. 1395f(b)) is amended in the 17 matter preceding paragraph (1) by inserting ‘‘other 18 than inpatient hospital services furnished by a rural 19 community hospital,’’ after ‘‘critical access hospital 20 services,’’. 21 (2) PART B PAYMENT.—Section 1833(a) of 22 such Act (42 U.S.C. 1395l(a)), as amended by sec- 23 tion 207(b)(3), is amended— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00271 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 272 •S 4819 IS (A) by striking ‘‘and’’ at the end of para- 1 graph (9); 2 (B) by striking the period at the end of 3 paragraph (10) and inserting ‘‘; and’’; and 4 (C) by adding at the end the following: 5 ‘‘(11) in the case of outpatient services fur- 6 nished by a rural community hospital, the amounts 7 described in section 1834(x).’’. 8 (3) TECHNICAL AMENDMENTS.— 9 (A) CONSULTATION WITH STATE AGEN- 10 CIES.—Section 1863 of such Act (42 U.S.C. 11 1395z) is amended by striking ‘‘and (dd)(2)’’ 12 and inserting ‘‘(dd)(2), and (lll)(1)’’. 13 (B) PROVIDER AGREEMENTS.—Section 14 1866(a)(2)(A) of such Act (42 U.S.C. 15 1395cc(a)(2)(A)) is amended by inserting ‘‘sec- 16 tion 1834(x)(2),’’ after ‘‘section 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, 2021. 20 SEC. 418. MEDICARE REMOTE MONITORING PILOT 21 PROJECTS. 22 (a) PILOT PROJECTS.— 23 (1) IN GENERAL.—Not later than 9 months 24 after the date of enactment of this Act, the Sec- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00272 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 273 •S 4819 IS retary of Health and Human Services (in this sec- 1 tion referred to as the ‘‘Secretary’’) shall conduct 2 pilot projects under title XVIII of the Social Secu- 3 rity Act (42 U.S.C. 1395 et seq.) for the purpose of 4 providing incentives to home health agencies to uti- 5 lize home monitoring and communications tech- 6 nologies that— 7 (A) enhance health outcomes for Medicare 8 beneficiaries; and 9 (B) reduce expenditures under such title. 10 (2) SITE REQUIREMENTS.— 11 (A) URBAN AND RURAL.—The Secretary 12 shall conduct the pilot projects under this sec- 13 tion in both urban and rural areas. 14 (B) SITE IN A SMALL STATE.—The Sec- 15 retary shall conduct at least 3 of the pilot 16 projects in a State with a population of less 17 than 1,000,000. 18 (3) DEFINITION OF HOME HEALTH AGENCY.— 19 In this section, the term ‘‘home health agency’’ has 20 the meaning given that term in section 1861(o) of 21 the Social Security Act (42 U.S.C. 1395x(o)). 22 (b) MEDICARE BENEFICIARIES WITHIN THE SCOPE 23 OF PROJECTS.—The Secretary shall specify the criteria 24 for identifying those Medicare beneficiaries who shall be 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00273 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 274 •S 4819 IS considered within the scope of the pilot projects under this 1 section for purposes of the application of subsection (c) 2 and for the assessment of the effectiveness of the home 3 health agency in achieving the objectives of this section. 4 Such criteria may provide for the inclusion in the projects 5 of Medicare beneficiaries who begin receiving home health 6 services under title XVIII of the Social Security Act (42 7 U.S.C. 1395 et seq.) after the date of the implementation 8 of the projects. 9 (c) INCENTIVES.— 10 (1) PERFORMANCE TARGETS.—The Secretary 11 shall establish for each home health agency partici- 12 pating in a pilot project under this section a per- 13 formance target using one of the following meth- 14 odologies, as determined appropriate by the Sec- 15 retary: 16 (A) ADJUSTED HISTORICAL PERFORMANCE 17 TARGET.—The Secretary shall establish for the 18 agency— 19 (i) a base expenditure amount equal 20 to the average total payments made to the 21 agency under parts A and B of title XVIII 22 of the Social Security Act (42 U.S.C. 1395 23 et seq.) for Medicare beneficiaries deter- 24 mined to be within the scope of the pilot 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00274 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 275 •S 4819 IS project in a base period determined by the 1 Secretary; and 2 (ii) an annual per capita expenditure 3 target for such beneficiaries, reflecting the 4 base expenditure amount adjusted for risk 5 and adjusted growth rates. 6 (B) COMPARATIVE PERFORMANCE TAR- 7 GET.—The Secretary shall establish for the 8 agency a comparative performance target equal 9 to the average total payments under such parts 10 A and B during the pilot project for comparable 11 individuals in the same geographic area that 12 are not determined to be within the scope of the 13 pilot project. 14 (2) INCENTIVE.—Subject to paragraph (3), the 15 Secretary shall pay to each participating home care 16 agency an incentive payment for each year under the 17 pilot project equal to a portion of the Medicare sav- 18 ings realized for such year relative to the perform- 19 ance target under paragraph (1). 20 (3) LIMITATION ON EXPENDITURES.—The Sec- 21 retary shall limit incentive payments under this sec- 22 tion in order to ensure that the aggregate expendi- 23 tures under title XVIII of the Social Security Act 24 (42 U.S.C. 1395 et seq.) (including incentive pay- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00275 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 276 •S 4819 IS ments under this subsection) do not exceed the 1 amount that the Secretary estimates would have 2 been expended if the pilot projects under this section 3 had not been implemented. 4 (d) WAIVER AUTHORITY.—The Secretary may waive 5 such provisions of titles XI and XVIII of the Social Secu- 6 rity Act (42 U.S.C. 1301 et seq.; 42 U.S.C. 1395 et seq.) 7 as the Secretary determines to be appropriate for the con- 8 duct of the pilot projects under this section. 9 (e) REPORT TO CONGRESS.—Not later than 5 years 10 after the date that the first pilot project under this section 11 is implemented, the Secretary shall submit to Congress a 12 report on the pilot projects. Such report shall contain a 13 detailed description of issues related to the expansion of 14 the projects under subsection (f) and recommendations for 15 such legislation and administrative actions as the Sec- 16 retary considers appropriate. 17 (f) EXPANSION.—If the Secretary determines that 18 any of the pilot projects under this section enhance health 19 outcomes for Medicare beneficiaries and reduce expendi- 20 tures under title XVIII of the Social Security Act (42 21 U.S.C. 1395 et seq.), the Secretary may initiate com- 22 parable projects in additional areas. 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00276 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 277 •S 4819 IS (g) INCENTIVE PAYMENTS HAVE NO EFFECT ON 1 OTHER MEDICARE PAYMENTS TO AGENCIES.—An incen- 2 tive payment under this section— 3 (1) shall be in addition to the payments that a 4 home health agency would otherwise receive under 5 title XVIII of the Social Security Act for the provi- 6 sion of home health services; and 7 (2) shall have no effect on the amount of such 8 payments. 9 SEC. 419. RURAL HEALTH QUALITY ADVISORY COMMISSION 10 AND DEMONSTRATION PROJECTS. 11 (a) RURAL HEALTH QUALITY ADVISORY COMMIS- 12 SION.— 13 (1) ESTABLISHMENT.—Not later than 6 14 months after the date of the enactment of this sec- 15 tion, the Secretary of Health and Human Services 16 (in this section referred to as the ‘‘Secretary’’) shall 17 establish a commission to be known as the Rural 18 Health Quality Advisory Commission (in this section 19 referred to as the ‘‘Commission’’). 20 (2) DUTIES OF COMMISSION.— 21 (A) NATIONAL PLAN.—The Commission 22 shall develop, coordinate, and facilitate imple- 23 mentation of a national plan for rural health 24 quality improvement. The national plan shall— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00277 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 278 •S 4819 IS (i) identify objectives for rural health 1 quality improvement; 2 (ii) identify strategies to eliminate 3 known gaps in rural health system capacity 4 and improve rural health quality; and 5 (iii) provide recommendations for 6 Federal programs to identify opportunities 7 for strengthening and aligning policies and 8 programs to improve rural health quality. 9 (B) DEMONSTRATION PROJECTS.—The 10 Commission shall design demonstration projects 11 to recommend to the Secretary to test alter- 12 native models for rural health quality improve- 13 ment, including with respect to both personal 14 and population health. 15 (C) MONITORING.—The Commission shall 16 monitor progress toward the objectives identi- 17 fied pursuant to subparagraph (A)(i). 18 (3) MEMBERSHIP.— 19 (A) NUMBER.—The Commission shall be 20 composed of 11 members appointed by the Sec- 21 retary. 22 (B) SELECTION.—The Secretary shall se- 23 lect the members of the Commission from 24 among individuals with significant rural health 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00278 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 279 •S 4819 IS care and health care quality expertise, including 1 expertise in clinical health care, health care 2 quality research, population or public health, or 3 purchaser organizations. 4 (4) CONTRACTING AUTHORITY.—Subject to the 5 availability of funds, the Commission may enter into 6 contracts and make other arrangements, as may be 7 necessary to carry out the duties described in para- 8 graph (2). 9 (5) STAFF.—Upon the request of the Commis- 10 sion, the Secretary may detail, on a reimbursable 11 basis, any of the personnel of the Office of Rural 12 Health Policy of the Health Resources and Services 13 Administration, the Agency for Healthcare Research 14 and Quality, or the Centers for Medicare & Medicaid 15 Services to the Commission to assist in carrying out 16 this subsection. 17 (6) REPORTS TO CONGRESS.—Not later than 1 18 year after the establishment of the Commission, and 19 annually thereafter, the Commission shall submit a 20 report to the Congress on rural health quality. Each 21 such report shall include the following: 22 (A) An inventory of relevant programs and 23 recommendations for improved coordination and 24 integration of policy and programs. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00279 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 280 •S 4819 IS (B) An assessment of achievement of the 1 objectives identified in the national plan devel- 2 oped under paragraph (2) and recommenda- 3 tions for realizing such objectives. 4 (C) Recommendations on Federal legisla- 5 tion, regulations, or administrative policies to 6 enhance rural health quality and outcomes. 7 (b) RURAL HEALTH QUALITY DEMONSTRATION 8 PROJECTS.— 9 (1) IN GENERAL.—Not later than 270 days 10 after the date of the enactment of this section, the 11 Secretary, in consultation with the Rural Health 12 Quality Advisory Commission, the Office of Rural 13 Health Policy of the Health Resources and Services 14 Administration, the Agency for Healthcare Research 15 and Quality, and the Centers for Medicare & Med- 16 icaid Services, shall make grants to eligible entities 17 for a total of 5 demonstration projects to implement 18 and evaluate methods for improving the quality of 19 health care in rural communities. Each such dem- 20 onstration project shall include— 21 (A) alternative community models that— 22 (i) will achieve greater integration of 23 personal and population health services; 24 and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00280 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 281 •S 4819 IS (ii) address safety, effectiveness, 1 patient- or community-centeredness, timeli- 2 ness, efficiency, and equity (the 6 aims 3 identified by the National Academy of 4 Medicine (formerly known as the ‘‘Institute 5 of Medicine’’) in its report entitled ‘‘Cross- 6 ing the Quality Chasm: A New Health Sys- 7 tem for the 21st Century’’ released on 8 March 1, 2001); 9 (B) innovative approaches to the financing 10 and delivery of health services to achieve rural 11 health quality goals; and 12 (C) development of quality improvement 13 support structures to assist rural health sys- 14 tems and professionals (such as workforce sup- 15 port structures, quality monitoring and report- 16 ing, clinical care protocols, and information 17 technology applications). 18 (2) ELIGIBLE ENTITIES.—In this subsection, 19 the term ‘‘eligible entity’’ means a consortium 20 that— 21 (A) shall include— 22 (i) at least one health care provider or 23 health care delivery system located in a 24 rural area; and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00281 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 282 •S 4819 IS (ii) at least one organization rep- 1 resenting multiple community stakeholders; 2 and 3 (B) may include other partners such as 4 rural research centers. 5 (3) CONSULTATION.—In developing the pro- 6 gram for awarding grants under this subsection, the 7 Secretary shall consult with the Administrator of the 8 Agency for Healthcare Research and Quality, rural 9 health care providers, rural health care researchers, 10 and private and nonprofit groups (including national 11 associations) which are undertaking similar efforts. 12 (4) EXPEDITED WAIVERS.—The Secretary shall 13 expedite the processing of any waiver that— 14 (A) is authorized under title XVIII or XIX 15 of the Social Security Act (42 U.S.C. 1395 et 16 seq.; 42 U.S.C. 1396 et seq.); and 17 (B) is necessary to carry out a demonstra- 18 tion project under this subsection. 19 (5) DEMONSTRATION PROJECT SITES.—The 20 Secretary shall ensure that the 5 demonstration 21 projects funded under this subsection are conducted 22 at a variety of sites representing the diversity of 23 rural communities in the United States. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00282 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 283 •S 4819 IS (6) DURATION.—Each demonstration project 1 under this subsection shall be for a period of 4 2 years. 3 (7) INDEPENDENT EVALUATION.—The Sec- 4 retary shall enter into an arrangement with an enti- 5 ty that has experience working directly with rural 6 health systems for the conduct of an independent 7 evaluation of the program carried out under this 8 subsection. 9 (8) REPORT.—Not later than 1 year after the 10 conclusion of all of the demonstration projects fund- 11 ed under this subsection, the Secretary shall submit 12 a report to the Congress on the results of such 13 projects. The report shall include— 14 (A) an evaluation of patient access to care, 15 patient outcomes, and an analysis of the cost 16 effectiveness of each such project; and 17 (B) recommendations on Federal legisla- 18 tion, regulations, or administrative policies to 19 enhance rural health quality and outcomes. 20 (c) APPROPRIATION.— 21 (1) IN GENERAL.—Out of funds in the Treas- 22 ury not otherwise appropriated, there are appro- 23 priated to the Secretary to carry out this section 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00283 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 284 •S 4819 IS $30,000,000 for the period of fiscal years 2021 1 through 2025. 2 (2) AVAILABILITY.— 3 (A) IN GENERAL.—Funds appropriated 4 under paragraph (1) shall remain available for 5 expenditure through fiscal year 2025. 6 (B) REPORT.—For purposes of carrying 7 out subsection (b)(8), funds appropriated under 8 paragraph (1) shall remain available for ex- 9 penditure through fiscal year 2026. 10 (3) RESERVATION.—Of the amount appro- 11 priated under paragraph (1), the Secretary shall re- 12 serve— 13 (A) $5,000,000 to carry out subsection (a); 14 and 15 (B) $25,000,000 to carry out subsection 16 (b), of which— 17 (i) 2 percent shall be for the provision 18 of technical assistance to grant recipients; 19 and 20 (ii) 5 percent shall be for independent 21 evaluation under subsection (b)(7). 22 SEC. 420. RURAL HEALTH CARE SERVICES. 23 Section 330A of the Public Health Service Act (42 24 U.S.C. 254c) is amended to read as follows: 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00284 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 285 •S 4819 IS ‘‘SEC. 330A. RURAL HEALTH CARE SERVICES OUTREACH, 1 RURAL HEALTH NETWORK DEVELOPMENT, 2 DELTA RURAL DISPARITIES AND HEALTH 3 SYSTEMS DEVELOPMENT, AND SMALL RURAL 4 HEALTH CARE PROVIDER QUALITY IMPROVE- 5 MENT GRANT PROGRAMS. 6 ‘‘(a) PURPOSE.—The purpose of this section is to 7 provide for grants— 8 ‘‘(1) under subsection (b), to promote rural 9 health care services outreach; 10 ‘‘(2) under subsection (c), to provide for the 11 planning and implementation of integrated health 12 care networks in rural areas; 13 ‘‘(3) under subsection (d), to assist rural com- 14 munities in the Delta Region to reduce health dis- 15 parities and to promote and enhance health system 16 development; and 17 ‘‘(4) under subsection (e), to provide for the 18 planning and implementation of small rural health 19 care provider quality improvement activities. 20 ‘‘(b) RURAL HEALTH CARE SERVICES OUTREACH 21 GRANTS.— 22 ‘‘(1) GRANTS.—The Director of the Office of 23 Rural Health Policy of the Health Resources and 24 Services Administration (referred to in this section 25 as the ‘Director’) may award grants to eligible enti- 26 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00285 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 286 •S 4819 IS ties to promote rural health care services outreach 1 by expanding the delivery of health care services to 2 include new and enhanced services in rural areas. 3 The Director may award the grants for periods of 4 not more than 3 years. 5 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 6 grant under this subsection for a project, an enti- 7 ty— 8 ‘‘(A) shall be a rural public or rural non- 9 profit private entity, a facility that qualifies as 10 a rural health clinic under title XVIII of the 11 Social Security Act, a public or nonprofit entity 12 existing exclusively to provide services to mi- 13 grant and seasonal farm workers in rural areas, 14 or a Tribal government whose grant-funded ac- 15 tivities will be conducted within federally recog- 16 nized Tribal areas; 17 ‘‘(B) shall represent a consortium com- 18 posed of members— 19 ‘‘(i) that include 3 or more independ- 20 ently owned health care entities; and 21 ‘‘(ii) that may be nonprofit or for- 22 profit entities; and 23 ‘‘(C) shall not previously have received a 24 grant under this subsection for the same or a 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00286 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 287 •S 4819 IS similar project, unless the entity is proposing to 1 expand the scope of the project or the area that 2 will be served through the project. 3 ‘‘(3) APPLICATIONS.—To be eligible to receive a 4 grant under this subsection, an eligible entity shall 5 prepare and submit to the Director an application at 6 such time, in such manner, and containing such in- 7 formation as the Director may require, including— 8 ‘‘(A) a description of the project that the 9 eligible entity will carry out using the funds 10 provided under the grant; 11 ‘‘(B) a description of the manner in which 12 the project funded under the grant will meet 13 the health care needs of rural populations in 14 the local community or region to be served; 15 ‘‘(C) a plan for quantifying how health 16 care needs will be met through identification of 17 the target population and benchmarks of service 18 delivery or health status, such as— 19 ‘‘(i) quantifiable measurements of 20 health status improvement for projects fo- 21 cusing on health promotion; or 22 ‘‘(ii) benchmarks of increased access 23 to primary care, including tracking factors 24 such as the number and type of primary 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00287 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 288 •S 4819 IS care visits, identification of a medical 1 home, or other general measures of such 2 access; 3 ‘‘(D) a description of how the local com- 4 munity or region to be served will be involved 5 in the development and ongoing operations of 6 the project; 7 ‘‘(E) a plan for sustaining the project after 8 Federal support for the project has ended; 9 ‘‘(F) a description of how the project will 10 be evaluated; 11 ‘‘(G) the administrative capacity to submit 12 annual performance data electronically as speci- 13 fied by the Director; and 14 ‘‘(H) other such information as the Direc- 15 tor determines to be appropriate. 16 ‘‘(c) RURAL HEALTH NETWORK DEVELOPMENT 17 GRANTS.— 18 ‘‘(1) GRANTS.— 19 ‘‘(A) IN GENERAL.—The Director may 20 award rural health network development grants 21 to eligible entities to promote, through planning 22 and implementation, the development of inte- 23 grated health care networks that have combined 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00288 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 289 •S 4819 IS the functions of the entities participating in the 1 networks in order to— 2 ‘‘(i) achieve efficiencies and economies 3 of scale; 4 ‘‘(ii) expand access to, coordinate, and 5 improve the quality of the health care de- 6 livery system through development of orga- 7 nizational efficiencies; 8 ‘‘(iii) implement health information 9 technology to achieve efficiencies, reduce 10 medical errors, and improve quality; 11 ‘‘(iv) coordinate care and manage 12 chronic illness; and 13 ‘‘(v) strengthen the rural health care 14 system as a whole in such a manner as to 15 show a quantifiable return on investment 16 to the participants in the network. 17 ‘‘(B) GRANT PERIODS.—The Director may 18 award such a rural health network development 19 grant— 20 ‘‘(i) for a period of 3 years for imple- 21 mentation activities; or 22 ‘‘(ii) for a period of 1 year for plan- 23 ning activities to assist in the initial devel- 24 opment of an integrated health care net- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00289 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 290 •S 4819 IS work, if the proposed participants in the 1 network do not have a history of collabo- 2 rative efforts and a 3-year grant would be 3 inappropriate. 4 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 5 grant under this subsection, an entity— 6 ‘‘(A) shall be a rural public or rural non- 7 profit private entity, a facility that qualifies as 8 a rural health clinic under title XVIII of the 9 Social Security Act, a public or nonprofit entity 10 existing exclusively to provide services to mi- 11 grant and seasonal farm workers in rural areas, 12 or a Tribal government whose grant-funded ac- 13 tivities will be conducted within federally recog- 14 nized Tribal areas; 15 ‘‘(B) shall represent a network composed 16 of participants— 17 ‘‘(i) that include 3 or more independ- 18 ently owned health care entities; and 19 ‘‘(ii) that may be nonprofit or for- 20 profit entities; and 21 ‘‘(C) shall not previously have received a 22 grant under this subsection (other than a 1- 23 year grant for planning activities) for the same 24 or a similar project. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00290 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 291 •S 4819 IS ‘‘(3) APPLICATIONS.—To be eligible to receive a 1 grant under this subsection, an eligible entity, in 2 consultation with the appropriate State office of 3 rural health or another appropriate State entity, 4 shall prepare and submit to the Director an applica- 5 tion at such time, in such manner, and containing 6 such information as the Director may require, in- 7 cluding— 8 ‘‘(A) a description of the project that the 9 eligible entity will carry out using the funds 10 provided under the grant; 11 ‘‘(B) an explanation of the reasons why 12 Federal assistance is required to carry out the 13 project; 14 ‘‘(C) a description of— 15 ‘‘(i) the history of collaborative activi- 16 ties carried out by the participants in the 17 network; 18 ‘‘(ii) the degree to which the partici- 19 pants are ready to integrate their func- 20 tions; and 21 ‘‘(iii) how the local community or re- 22 gion to be served will benefit from and be 23 involved in the activities carried out by the 24 network; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00291 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 292 •S 4819 IS ‘‘(D) a description of how the local com- 1 munity or region to be served will experience in- 2 creased access to quality health care services 3 across the continuum of care as a result of the 4 integration activities carried out by the net- 5 work, including a description of— 6 ‘‘(i) return on investment for the com- 7 munity and the network members; and 8 ‘‘(ii) other quantifiable performance 9 measures that show the benefit of the net- 10 work activities; 11 ‘‘(E) a plan for sustaining the project after 12 Federal support for the project has ended; 13 ‘‘(F) a description of how the project will 14 be evaluated; 15 ‘‘(G) the administrative capacity to submit 16 annual performance data electronically as speci- 17 fied by the Director; and 18 ‘‘(H) other such information as the Direc- 19 tor determines to be appropriate. 20 ‘‘(d) DELTA RURAL DISPARITIES AND HEALTH SYS- 21 TEMS DEVELOPMENT GRANTS.— 22 ‘‘(1) GRANTS.—The Director may award grants 23 to eligible entities to support reduction of health dis- 24 parities, improve access to health care, and enhance 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00292 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 293 •S 4819 IS rural health system development in the Delta Re- 1 gion. 2 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 3 grant under this subsection, an entity shall be a 4 rural public or rural nonprofit private entity, a facil- 5 ity that qualifies as a rural health clinic under title 6 XVIII of the Social Security Act, a public or non- 7 profit entity existing exclusively to provide services 8 to migrant and seasonal farm workers in rural 9 areas, or a Tribal government whose grant-funded 10 activities will be conducted within federally recog- 11 nized Tribal areas. 12 ‘‘(3) APPLICATIONS.—To be eligible to receive a 13 grant under this subsection, an eligible entity shall 14 prepare and submit to the Director an application at 15 such time, in such manner, and containing such in- 16 formation as the Director may require, including— 17 ‘‘(A) a description of the project that the 18 eligible entity will carry out using the funds 19 provided under the grant; 20 ‘‘(B) an explanation of the reasons why 21 Federal assistance is required to carry out the 22 project; 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00293 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 294 •S 4819 IS ‘‘(C) a description of the manner in which 1 the project funded under the grant will meet 2 the health care needs of the Delta Region; 3 ‘‘(D) a description of how the local com- 4 munity or region to be served will experience in- 5 creased access to quality health care services as 6 a result of the activities carried out by the enti- 7 ty; 8 ‘‘(E) a description of how health dispari- 9 ties will be reduced or the health system will be 10 improved; 11 ‘‘(F) a plan for sustaining the project after 12 Federal support for the project has ended; 13 ‘‘(G) a description of how the project will 14 be evaluated including process and outcome 15 measures related to the quality of care provided 16 or how the health care system improves its per- 17 formance; 18 ‘‘(H) a description of how the grantee will 19 develop an advisory group made up of rep- 20 resentatives of the communities to be served to 21 provide guidance to the grantee to best meet 22 community need; and 23 ‘‘(I) other such information as the Director 24 determines to be appropriate. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00294 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 295 •S 4819 IS ‘‘(e) SMALL RURAL HEALTH CARE PROVIDER QUAL- 1 ITY IMPROVEMENT GRANTS.— 2 ‘‘(1) GRANTS.—The Director may award grants 3 to provide for the planning and implementation of 4 small rural health care provider quality improvement 5 activities. The Director may award the grants for 6 periods of 1 to 3 years. 7 ‘‘(2) ELIGIBILITY.—To be eligible for a grant 8 under this subsection, an entity— 9 ‘‘(A) shall be— 10 ‘‘(i) a rural public or rural nonprofit 11 private health care provider or provider of 12 health care services, such as a rural health 13 clinic; or 14 ‘‘(ii) another rural provider or net- 15 work of small rural providers identified by 16 the Director as a key source of local care; 17 and 18 ‘‘(B) shall not previously have received a 19 grant under this subsection for the same or a 20 similar project. 21 ‘‘(3) PREFERENCE.—In awarding grants under 22 this subsection, the Director shall give preference to 23 facilities that qualify as rural health clinics under 24 title XVIII of the Social Security Act. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00295 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 296 •S 4819 IS ‘‘(4) APPLICATIONS.—To be eligible to receive a 1 grant under this subsection, an eligible entity shall 2 prepare and submit to the Director an application at 3 such time, in such manner, and containing such in- 4 formation as the Director may require, including— 5 ‘‘(A) a description of the project that the 6 eligible entity will carry out using the funds 7 provided under the grant; 8 ‘‘(B) an explanation of the reasons why 9 Federal assistance is required to carry out the 10 project; 11 ‘‘(C) a description of the manner in which 12 the project funded under the grant will assure 13 continuous quality improvement in the provision 14 of services by the entity; 15 ‘‘(D) a description of how the local com- 16 munity or region to be served will experience in- 17 creased access to quality health care services as 18 a result of the activities carried out by the enti- 19 ty; 20 ‘‘(E) a plan for sustaining the project after 21 Federal support for the project has ended; 22 ‘‘(F) a description of how the project will 23 be evaluated including process and outcome 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00296 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 297 •S 4819 IS measures related to the quality of care pro- 1 vided; and 2 ‘‘(G) other such information as the Direc- 3 tor determines to be appropriate. 4 ‘‘(f) GENERAL REQUIREMENTS.— 5 ‘‘(1) PROHIBITED USES OF FUNDS.—An entity 6 that receives a grant under this section may not use 7 funds provided through the grant— 8 ‘‘(A) to build or acquire real property; or 9 ‘‘(B) for construction. 10 ‘‘(2) COORDINATION WITH OTHER AGENCIES.— 11 The Director shall coordinate activities carried out 12 under grant programs described in this section, to 13 the extent practicable, with Federal and State agen- 14 cies and nonprofit organizations that are operating 15 similar grant programs, to maximize the effect of 16 public dollars in funding meritorious proposals. 17 ‘‘(g) REPORT.—Not later than September 30, 2022, 18 the Secretary shall prepare and submit to the appropriate 19 committees of Congress a report on the progress and ac- 20 complishments of the grant programs described in sub- 21 sections (b), (c), (d), and (e). 22 ‘‘(h) DEFINITION OF DELTA REGION.—In this sec- 23 tion, the term ‘Delta Region’ has the meaning given to 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00297 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 298 •S 4819 IS the term ‘region’ in section 382A of the Consolidated 1 Farm and Rural Development Act (7 U.S.C. 2009aa). 2 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There 3 are authorized to be appropriated to carry out this section 4 $40,000,000 for fiscal year 2021, and such sums as may 5 be necessary for each of fiscal years 2022 through 2025.’’. 6 SEC. 421. COMMUNITY HEALTH CENTER COLLABORATIVE 7 ACCESS EXPANSION. 8 Section 330(r)(4) of the Public Health Service Act 9 (42 U.S.C. 254b(r)(4)) is amended— 10 (1) in subparagraph (A), by striking ‘‘primary 11 health care services’’ each place it appears and in- 12 serting ‘‘primary health care and other mental, den- 13 tal, and physical health services’’; and 14 (2) in subparagraph (B)— 15 (A) in clause (i), by striking ‘‘and’’ at the 16 end; 17 (B) in clause (ii), by striking the period at 18 the end and inserting ‘‘; and’’; and 19 (C) by adding at the end the following: 20 ‘‘(iii) in the case of a rural health 21 clinic described in such subparagraph— 22 ‘‘(I) that such clinic provides, to 23 the extent possible, enabling services, 24 such as transportation and language 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00298 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 299 •S 4819 IS assistance (including translation and 1 interpretation); and 2 ‘‘(II) that the primary health 3 care and other services described in 4 such subparagraph are subject to full 5 reimbursement according to the pro- 6 spective payment system for Federally 7 qualified health center services under 8 section 1834(o) of the Social Security 9 Act.’’. 10 SEC. 422. FACILITATING THE PROVISION OF TELEHEALTH 11 SERVICES ACROSS STATE LINES. 12 (a) IN GENERAL.—For purposes of expediting the 13 provision of telehealth services, for which payment is made 14 under the Medicare Program, across State lines, the Sec- 15 retary of Health and Human Services shall, in consulta- 16 tion with representatives of States, physicians, health care 17 practitioners, and patient advocates, encourage and facili- 18 tate the adoption of provisions allowing for multistate 19 practitioner practice across State lines. 20 (b) DEFINITIONS.—In subsection (a): 21 (1) TELEHEALTH SERVICE.—The term ‘‘tele- 22 health service’’ has the meaning given that term in 23 subparagraph (F) of section 1834(m)(4) of the So- 24 cial Security Act (42 U.S.C. 1395m(m)(4)). 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00299 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 300 •S 4819 IS (2) PHYSICIAN, PRACTITIONER.—The terms 1 ‘‘physician’’ and ‘‘practitioner’’ have the meaning 2 given those terms in subparagraphs (D) and (E), re- 3 spectively, of such section. 4 (3) MEDICARE PROGRAM.—The term ‘‘Medicare 5 Program’’ means the program of health insurance 6 administered by the Secretary of Health and Human 7 Services under title XVIII of the Social Security Act 8 (42 U.S.C. 1395 et seq.). 9 SEC. 423. SCORING OF PREVENTIVE HEALTH SAVINGS. 10 Section 202 of the Congressional Budget and Im- 11 poundment Control Act of 1974 (2 U.S.C. 602) is amend- 12 ed by adding at the end the following: 13 ‘‘(h) SCORING OF PREVENTIVE HEALTH SAVINGS.— 14 ‘‘(1) DETERMINATION BY THE DIRECTOR.— 15 Upon a request by the chairman or ranking minority 16 member of the Committee on the Budget of the Sen- 17 ate, or by the chairman or ranking minority member 18 of the Committee on the Budget of the House of 19 Representatives, the Director shall determine if a 20 proposed measure would result in reductions in 21 budget outlays in budgetary outyears through the 22 use of preventive health and preventive health serv- 23 ices. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00300 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 301 •S 4819 IS ‘‘(2) PROJECTIONS.—If the Director determines 1 that a measure would result in substantial reduc- 2 tions in budget outlays as described in paragraph 3 (1), the Director— 4 ‘‘(A) shall include, in any projection pre- 5 pared by the Director, a description and esti- 6 mate of the reductions in budget outlays in the 7 budgetary outyears and a description of the 8 basis for such conclusions; and 9 ‘‘(B) may prepare a budget projection that 10 includes some or all of the budgetary outyears, 11 notwithstanding the time periods for projections 12 described in subsection (e) and sections 308, 13 402, and 424. 14 ‘‘(3) DEFINITIONS.—As used in this sub- 15 section— 16 ‘‘(A) the term ‘budgetary outyears’ means 17 the 2 consecutive 10-year periods beginning 18 with the first fiscal year that is 10 years after 19 the budget year provided for in the most re- 20 cently agreed to concurrent resolution on the 21 budget; and 22 ‘‘(B) the term ‘preventive health’ means an 23 action that focuses on the health of the public, 24 individuals, and defined populations in order to 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00301 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 302 •S 4819 IS protect, promote, and maintain health, wellness, 1 and functional ability, and prevent disease, dis- 2 ability, and premature death that is dem- 3 onstrated by credible and publicly available epi- 4 demiological projection models, incorporating 5 clinical trials or observational studies in hu- 6 mans, to avoid future health care costs.’’. 7 SEC. 424. SENSE OF CONGRESS ON MAINTENANCE OF EF- 8 FORT PROVISIONS REGARDING CHILDREN’S 9 HEALTH. 10 It is the sense of the Congress that— 11 (1) the maintenance of effort provisions added 12 to sections 1902 and 2105(d) of the Social Security 13 Act (42 U.S.C. 1396a; 42 U.S.C. 1397ee(d)) by sec- 14 tions 2001(b) and 2101(b) of the Patient Protection 15 and Affordable Care Act were intended to maintain 16 the eligibility standards for the Medicaid program 17 under title XIX of the Social Security Act (42 18 U.S.C. 1396 et seq.) and Children’s Health Insur- 19 ance Program under title XXI of such Act (42 20 U.S.C. 1397aa et seq.) until the American Health 21 Benefit Exchanges in the States are fully oper- 22 ational; 23 (2) it is imperative that the maintenance of ef- 24 fort provisions are enforced to the strict standard in- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00302 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 303 •S 4819 IS tended by the Congress through September 30, 1 2027; 2 (3) waiving the maintenance of effort provisions 3 should not be permitted; 4 (4) the maintenance of effort provisions ensure 5 the continued success of the Medicaid program and 6 Children’s Health Insurance Program and were in- 7 tended to specifically protect vulnerable and disabled 8 adults, children, and senior citizens, many of whom 9 are also members of communities of color; and 10 (5) the maintenance of effort provisions must 11 be strictly enforced and proposals to weaken the 12 maintenance of effort provisions must not be consid- 13 ered. 14 SEC. 425. PROTECTION OF THE HHS OFFICES OF MINORITY 15 HEALTH. 16 (a) IN GENERAL.—Pursuant to section 1707A of the 17 Public Health Service Act (42 U.S.C. 300u–6a), the Of- 18 fices of Minority Health established within the Centers for 19 Disease Control and Prevention, the Health Resources 20 and Services Administration, the Substance Abuse and 21 Mental Health Services Administration, the Agency for 22 Healthcare Research and Quality, the Food and Drug Ad- 23 ministration, and the Centers for Medicare & Medicaid 24 Services, are offices that, regardless of change in the 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00303 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 304 •S 4819 IS structure of the Department of Health and Human Serv- 1 ices, shall report to the Secretary of Health and Human 2 Services. 3 (b) SENSE OF CONGRESS.—It is the sense of the 4 Congress that any effort to eliminate or consolidate such 5 Offices of Minority Health undermines the progress 6 achieved so far. 7 SEC. 426. OFFICE OF MINORITY HEALTH IN VETERANS 8 HEALTH ADMINISTRATION OF DEPARTMENT 9 OF VETERANS AFFAIRS. 10 (a) ESTABLISHMENT AND FUNCTIONS.—Subchapter 11 I of chapter 73 of title 38, United States Code, is amended 12 by inserting after section 7308 the following new section: 13 ‘‘§ 7308A. Office of Minority Health 14 ‘‘(a) ESTABLISHMENT.—There is established in the 15 Department within the Office of the Under Secretary for 16 Health an office to be known as the ‘Office of Minority 17 Health’ (in this section referred to as the ‘Office’). 18 ‘‘(b) HEAD.—The Director of the Office of Minority 19 Health shall be the head of the Office. The Director of 20 the Office of Minority Health shall be appointed by the 21 Under Secretary for Health from among individuals quali- 22 fied to perform the duties of the position. 23 ‘‘(c) FUNCTIONS.—The functions of the Office are as 24 follows: 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00304 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 305 •S 4819 IS ‘‘(1) To establish short-range and long-range 1 goals and objectives and coordinate all other activi- 2 ties within the Veterans Health Administration that 3 relate to disease prevention, health promotion, health 4 care services delivery, and health care research con- 5 cerning veterans who are members of a racial or eth- 6 nic minority group. 7 ‘‘(2) To support research, demonstrations, and 8 evaluations to test new and innovative models for 9 the discharge of activities described in paragraph 10 (1). 11 ‘‘(3) To increase knowledge and understanding 12 of health risk factors for veterans who are members 13 of a racial or ethnic minority group. 14 ‘‘(4) To develop mechanisms that support bet- 15 ter health care information dissemination, education, 16 prevention, and services delivery to veterans from 17 disadvantaged backgrounds, including veterans who 18 are members of a racial or ethnic minority group. 19 ‘‘(5) To enter into contracts or agreements with 20 appropriate public and nonprofit private entities to 21 develop and carry out programs to provide bilingual 22 or interpretive services to assist veterans who are 23 members of a racial or ethnic minority group and 24 who lack proficiency in speaking the English lan- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00305 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 306 •S 4819 IS guage in accessing and receiving health care services 1 through the Veterans Health Administration. 2 ‘‘(6) To carry out programs to improve access 3 to health care services through the Veterans Health 4 Administration for veterans with limited proficiency 5 in speaking the English language, including the de- 6 velopment and evaluation of demonstration and pilot 7 projects for that purpose. 8 ‘‘(7) To advise the Under Secretary for Health 9 on matters relating to the development, implementa- 10 tion, and evaluation of health professions education 11 in decreasing disparities in health care outcomes be- 12 tween veterans who are members of a racial or eth- 13 nic minority group and other veterans, including cul- 14 tural competency as a method of eliminating such 15 health disparities. 16 ‘‘(8) To perform such other functions and du- 17 ties as the Secretary or the Under Secretary for 18 Health considers appropriate. 19 ‘‘(d) DEFINITIONS.—In this section: 20 ‘‘(1) The term ‘racial or ethnic minority group’ 21 means any of the following: 22 ‘‘(A) American Indians (including Alaska 23 Natives, Eskimos, and Aleuts). 24 ‘‘(B) Asian Americans. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00306 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 307 •S 4819 IS ‘‘(C) Native Hawaiians and other Pacific 1 Islanders. 2 ‘‘(D) Blacks. 3 ‘‘(E) Hispanics. 4 ‘‘(2) The term ‘Hispanic’ means individuals 5 whose origin is Mexican, Puerto Rican, Cuban, Cen- 6 tral or South American, or any other Spanish-speak- 7 ing country.’’. 8 (b) CLERICAL AMENDMENT.—The table of sections 9 at the beginning of such subchapter is amended by insert- 10 ing after the item relating to section 7308 the following 11 new item: 12 ‘‘7308A. Office of Minority Health.’’. SEC. 427. STUDY OF DSH PAYMENTS TO ENSURE HOSPITAL 13 ACCESS FOR LOW-INCOME PATIENTS. 14 (a) IN GENERAL.—Not later than January 1, 2021, 15 the Comptroller General of the United States shall con- 16 duct a study on how amendments made by the Patient 17 Protection and Affordable Care Act (Public Law 111– 18 148) and the Health Care and Education Reconciliation 19 Act of 2010 (Public Law 111–152) to titles XVIII and 20 XIX of the Social Security Act (42 U.S.C. 1395 et seq.; 21 42 U.S.C. 1396 et seq.) relating to disproportionate share 22 hospital adjustment payments under Medicare and Med- 23 icaid (and subsequent amendments made with respect to 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00307 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 308 •S 4819 IS such payments) affect the timely access to health care 1 services for low-income patients. Such study shall— 2 (1) evaluate and examine whether States elect- 3 ing to make medical assistance available under sec- 4 tion 1902(a)(10)(A)(i)(VIII) of the Social Security 5 Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)) (including 6 States making such an election through a waiver of 7 the State plan) to individuals described in such sec- 8 tion mitigate the need for payments to dispropor- 9 tionate share hospitals under section 1886(d)(5)(F) 10 of the Social Security Act (42 U.S.C. 11 1395ww(d)(5)(F)) and section 1923 of such Act (42 12 U.S.C. 1396r–4), including the impact of such 13 States electing to make medical assistance available 14 to such individuals on— 15 (A) the number of individuals in the 16 United States who are without health insurance 17 and the distribution of such individuals in rela- 18 tion to areas primarily served by dispropor- 19 tionate share hospitals; and 20 (B) the low-income utilization rate of such 21 hospitals and the resulting fiscal sustainability 22 of such hospitals; 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00308 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 309 •S 4819 IS (2) evaluate the appropriate level and distribu- 1 tion of such payments among such disproportionate 2 share hospitals for purposes of— 3 (A) sufficiently accounting for the level of 4 uncompensated care provided by such hospitals 5 to low-income patients; and 6 (B) providing timely access to health serv- 7 ices for individuals in medically underserved 8 areas; and 9 (3) assess, with respect to such disproportionate 10 share hospitals— 11 (A) the role played by such hospitals in 12 providing critical access to emergency, inpa- 13 tient, and outpatient health services, as well as 14 the location of such hospitals in relation to 15 medically underserved areas; and 16 (B) the extent to which such hospitals sat- 17 isfy the requirements established for charitable 18 hospital organizations under section 501(r) of 19 the Internal Revenue Code of 1986 with respect 20 to community health needs assessments, finan- 21 cial assistance policy requirements, limitations 22 on charges, and billing and collection require- 23 ments. 24 (b) REPORTS.— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00309 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 310 •S 4819 IS (1) REPORT TO CONGRESS.—Not later than 1 180 days after the date on which the study under 2 subsection (a) is completed, the Comptroller General 3 of the United States shall submit to the Committee 4 on Energy and Commerce of the House of Rep- 5 resentatives and the Committee on Finance of the 6 Senate a report that contains— 7 (A) the results of the study; 8 (B) recommendations to Congress for any 9 legislative changes to the payments to dis- 10 proportionate share hospitals under section 11 1886(d)(5)(F) of the Social Security Act (42 12 U.S.C. 1395ww(d)(5)(F)) and section 1923 of 13 such Act (42 U.S.C. 1396r–4) that are needed 14 to ensure access to health services for low-in- 15 come patients that— 16 (i) are based on the number of indi- 17 viduals without health insurance, the 18 amount of uncompensated care provided by 19 such hospitals, and the impact of reduced 20 payment levels on low-income communities; 21 and 22 (ii) takes into account any reports 23 submitted by the Secretary of the Treas- 24 ury, in consultation with the Secretary of 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00310 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 311 •S 4819 IS Health and Human Services, to congres- 1 sional committees regarding the costs in- 2 curred by charitable hospital organizations 3 for charity care, bad debt, nonreimbursed 4 expenses for services provided to individ- 5 uals under the Medicare program under 6 title XVIII of the Social Security Act and 7 the Medicaid program under title XIX of 8 such Act, and any community benefit ac- 9 tivities provided by such organizations. 10 (2) REPORT TO THE SECRETARY OF HEALTH 11 AND HUMAN SERVICES.—Not later than 180 days 12 after the date on which the study under subsection 13 (a) is completed, the Comptroller General of the 14 United States shall submit to the Secretary of 15 Health and Human Services a report that con- 16 tains— 17 (A) the results of the study; and 18 (B) any recommendations for purposes of 19 assisting in the development of the methodology 20 for the adjustment of payments to dispropor- 21 tionate share hospitals, as required under sec- 22 tion 1886(r) of the Social Security Act (42 23 U.S.C. 1395ww(r)) and the reduction of such 24 payments under section 1923(f)(7) of such Act 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00311 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 312 •S 4819 IS (42 U.S.C. 1396r–4(f)(7)), taking into account 1 the reports referred to in paragraph (1)(B)(ii). 2 SEC. 428. ASSISTANT SECRETARY OF THE INDIAN HEALTH 3 SERVICE. 4 (a) REFERENCES.—Any reference in a law, regula- 5 tion, document, paper, or other record of the United 6 States to the Director of the Indian Health Service shall 7 be deemed to be a reference to the Assistant Secretary 8 of the Indian Health Service. 9 (b) EXECUTIVE SCHEDULE.—Section 5315 of title 5, 10 United States Code, is amended in the matter relating to 11 the Assistant Secretaries of Health and Human Services 12 by striking ‘‘(6)’’ and inserting ‘‘(7), one of whom shall 13 be the Assistant Secretary of the Indian Health Service’’. 14 (c) CONFORMING AMENDMENT.—Section 5316 of 15 title 5, United States Code, is amended by striking ‘‘Direc- 16 tor, Indian Health Service, Department of Health and 17 Human Services.’’. 18 SEC. 429. REAUTHORIZATION OF THE NATIVE HAWAIIAN 19 HEALTH CARE IMPROVEMENT ACT. 20 (a) NATIVE HAWAIIAN HEALTH CARE SYSTEMS.— 21 Section 6(h)(1) of the Native Hawaiian Health Care Im- 22 provement Act (42 U.S.C. 11705(h)(1)) is amended by 23 striking ‘‘may be necessary for fiscal years 1993 through 24 2019’’ and inserting ‘‘are necessary’’. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00312 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 313 •S 4819 IS (b) ADMINISTRATIVE GRANT FOR PAPA OLA 1 LOKAHI.—Section 7(b) of the Native Hawaiian Health 2 Care Improvement Act (42 U.S.C. 11706(b)) is amended 3 by striking ‘‘may be necessary for fiscal years 1993 4 through 2019’’ and inserting ‘‘are necessary’’. 5 (c) NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.— 6 Section 10(c) of the Native Hawaiian Health Care Im- 7 provement Act (42 U.S.C. 11709(c)) is amended by strik- 8 ing ‘‘may be necessary for fiscal years 1993 through 9 2019’’ and inserting ‘‘are necessary’’. 10 SEC. 430. AVAILABILITY OF NON-ENGLISH LANGUAGE 11 SPEAKING PROVIDERS. 12 (a) IN GENERAL.—Section 1311(c)(1)(B) of the Pa- 13 tient Protection and Affordable Care Act (42 U.S.C. 14 18031(c)(1)(B)) is amended by inserting before the semi- 15 colon the following: ‘‘and the ability of such provider to 16 provide care in a language other than English either 17 through the provider speaking such language or by the 18 provider having a qualified interpreter for an individual 19 with limited English proficiency (as defined in section 20 3400 of such Act) who speaks such language available 21 during office hours’’. 22 (b) EFFECTIVE DATE.—The amendment made by 23 subsection (a) shall not apply to any plan beginning on 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00313 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 314 •S 4819 IS or prior to the date that is 1 year after the date of the 1 enactment of this Act. 2 SEC. 431. ACCESS TO ESSENTIAL COMMUNITY PROVIDERS. 3 (a) ESSENTIAL COMMUNITY PROVIDERS.—Section 4 1311(c)(1)(C) of the Patient Protection and Affordable 5 Care Act (42 U.S.C. 18031(c)(1)(C)) is amended— 6 (1) by inserting ‘‘(i)’’ after ‘‘(C)’’; and 7 (2) by adding at the end the following new 8 clauses: 9 ‘‘(ii) not later than January 1, 2021, in- 10 crease the percentage of essential community 11 providers as described in clause (i) included in 12 its network by 10 percent annually (based on 13 the level in the plan for 2016) until 90 percent 14 of all federally qualified health centers and 75 15 percent of all other such essential community 16 providers in the contract service area are in-net- 17 work; and 18 ‘‘(iii) include at least one essential commu- 19 nity provider in each of the essential community 20 provider categories described in section 21 156.235(a)(2)(ii)(B) of title 45, Code of Fed- 22 eral Regulations (as in effect on the date of en- 23 actment of the Health Equity and Account- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00314 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 315 •S 4819 IS ability Act of 2020), in each county in the serv- 1 ice area, where available;’’. 2 (b) REPORTING REQUIREMENTS.—Section 3 1311(e)(3) of the Patient Protection and Affordable Care 4 Act (42 U.S.C. 18031(e)(3)) is amended by adding at the 5 end the following new subparagraph: 6 ‘‘(E) DATA ON ESSENTIAL COMMUNITY 7 PROVIDERS.—The Secretary shall require quali- 8 fied health plans to submit annually to the Sec- 9 retary data on the percentage of essential com- 10 munity providers as described in clause (ii) of 11 subsection (c)(1)(C), by county, that contract 12 with each qualified health plan offered in that 13 county and the percentage of such essential 14 community providers, by category as described 15 in clause (iii) of such subsection, that contract 16 with each qualified health plan offered in that 17 county. Such data shall be made available to 18 the general public.’’. 19 (c) ESSENTIAL COMMUNITY PROVIDER PROVISIONS 20 APPLIED UNDER MEDICARE AND MEDICAID.— 21 (1) MEDICARE.—Section 1852(d)(1) of the So- 22 cial Security Act (42 U.S.C. 1395w–22(d)(1)) is 23 amended— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00315 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 316 •S 4819 IS (A) by striking ‘‘and’’ at the end of sub- 1 paragraph (D); 2 (B) by striking the period at the end of 3 subparagraph (E) and inserting ‘‘; and’’; and 4 (C) by adding at the end the following new 5 subparagraph: 6 ‘‘(F) the plan meets the requirements of 7 clauses (ii) and (iii) of section 1311(c)(1)(C) of 8 the Patient Protection and Affordable Care Act 9 (relating to inclusion in networks of essential 10 community providers).’’. 11 (2) MEDICAID.—Section 1932(b)(5) of the So- 12 cial Security Act (42 U.S.C. 1396u–2(b)(5)) is 13 amended— 14 (A) by striking ‘‘and’’ at the end of sub- 15 paragraph (A); 16 (B) by striking the period at the end of 17 subparagraph (B) and inserting ‘‘; and’’; and 18 (C) by adding at the end the following new 19 subparagraph: 20 ‘‘(C) meets the requirements of clauses (ii) 21 and (iii) of section 1311(c)(1)(C) of the Patient 22 Protection and Affordable Care Act (relating to 23 inclusion in networks of essential community 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00316 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 317 •S 4819 IS providers) with respect to services offered in the 1 service area involved.’’. 2 SEC. 432. PROVIDER NETWORK ADEQUACY IN COMMU- 3 NITIES OF COLOR. 4 (a) IN GENERAL.—Section 1311(c)(1)(B) of the Pa- 5 tient Protection and Affordable Care Act (42 U.S.C. 6 18031(c)(1)(B)), as amended by section 430(a), is further 7 amended— 8 (1) by inserting ‘‘(i)’’ after ‘‘(B)’’; and 9 (2) by adding at the end the following new 10 clauses: 11 ‘‘(ii) meet such network adequacy 12 standards as the Secretary may establish 13 with regard to— 14 ‘‘(I) appointment wait time; 15 ‘‘(II) travel time and distance to 16 health care provider facilities and pro- 17 viders by public and private transit; 18 ‘‘(III) hours of operation to ac- 19 commodate individuals who cannot 20 come to provider appointments during 21 standard business hours; and 22 ‘‘(IV) other network adequacy 23 standards to ensure that care through 24 these plans is accessible to diverse 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00317 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 318 •S 4819 IS communities, including individuals 1 with limited English proficiency as de- 2 fined in section 3400 of such Act; and 3 ‘‘(iii) provide coverage for services for 4 enrollees through out-of-network providers 5 at no additional cost to the enrollees in 6 cases where in-network providers are un- 7 able to comply with the standards estab- 8 lished under subclause (III) or (IV) of 9 clause (ii) for such services and the out-of- 10 network providers can deliver such services 11 in compliance with such standards. 12 ‘‘(b) EFFECTIVE DATE.—The amendments made by 13 subsection (a) shall not apply to plans beginning on or 14 prior to the date that is 1 year after the date of the enact- 15 ment of the Health Equity and Accountability Act of 16 2020.’’. 17 SEC. 433. IMPROVING ACCESS TO DENTAL CARE. 18 (a) REPORTS TO CONGRESS.— 19 (1) GAO REPORTS.—Not later than 1 year 20 after the date of the enactment of this Act, the 21 Comptroller General of the United States shall sub- 22 mit to Congress— 23 (A) a report on the Alaska Dental Health 24 Aide Therapists program and the Dental Ther- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00318 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 319 •S 4819 IS apist and Advanced Dental Therapist programs 1 in Minnesota, to assess the effectiveness of den- 2 tal therapists in— 3 (i) improving access to timely dental 4 care among communities of color; 5 (ii) providing high-quality care; 6 (iii) providing culturally competent 7 care; and 8 (iv) providing accessible care to people 9 with disabilities; 10 (B) a report on State variations in the use 11 of dental hygienists and the effectiveness of ex- 12 panding the scope of practice for dental hygien- 13 ists in— 14 (i) improving access to timely dental 15 care among communities of color; 16 (ii) providing high-quality care; 17 (iii) providing culturally competent 18 care; and 19 (iv) providing accessible care to people 20 with disabilities; and 21 (C) a report on the use of telehealth serv- 22 ices to enhance services provided by dental hy- 23 gienists and therapists, including recommenda- 24 tions for any modifications to the Medicare pro- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00319 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 320 •S 4819 IS gram under title XVIII of the Social Security 1 Act and the Medicaid program under title XIX 2 of such Act to better provide for telehealth con- 3 sultations in conjunction with therapists’ and 4 hygienists’ care. 5 (2) HRSA REPORT ON DENTAL SHORTAGE 6 AREAS.—Not later than 1 year after the date of the 7 enactment of this Act, the Secretary of Health and 8 Human Services, acting through the Administrator 9 of the Health Resources and Services Administra- 10 tion, shall submit to Congress a report which details 11 geographic dental access shortages and the pre- 12 paredness of dental providers to offer culturally and 13 linguistically appropriate, affordable, accessible, and 14 timely services. 15 (b) EXPANSION OF DENTAL HEALTH AID THERA- 16 PISTS IN TRIBAL COMMUNITIES.—Section 119(d) of the 17 Indian Health Care Improvement Act (25 U.S.C. 18 1616l(d)) is amended— 19 (1) in paragraph (2), by striking ‘‘Subject to’’ 20 and all that follows and inserting ‘‘Subject to para- 21 graph (3), in establishing a national program under 22 paragraph (1), the Secretary shall not reduce the 23 amounts provided for the Community Health Aide 24 Program described in subsections (a) and (b).’’; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00320 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 321 •S 4819 IS (2) by striking paragraph (3); and 1 (3) by redesignating paragraph (4) as para- 2 graph (3). 3 (c) COVERAGE OF DENTAL SERVICES UNDER THE 4 MEDICARE PROGRAM.— 5 (1) COVERAGE.—Section 1861(s)(2) of the So- 6 cial Security Act (42 U.S.C. 1395x(s)(2)) is amend- 7 ed— 8 (A) in subparagraph (GG), by striking 9 ‘‘and’’ at the end; 10 (B) in subparagraph (HH), by striking the 11 period and inserting ‘‘; and’’; and 12 (C) by adding at the end the following new 13 subparagraph: 14 ‘‘(II) oral health services (as defined in sub- 15 section (mmm));’’. 16 (2) ORAL HEALTH SERVICES DEFINED.—Sec- 17 tion 1861 of the Social Security Act (42 U.S.C. 18 1395x), as amended by sections 207(b)(1) and 19 417(a), is amended by adding at the end the fol- 20 lowing new subsection: 21 ‘‘Oral Health Services 22 ‘‘(mmm)(1) The term ‘oral health services’ means 23 services (as defined by the Secretary) that are necessary 24 to prevent disease and promote oral health, restore oral 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00321 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 322 •S 4819 IS structures to health and function, and treat emergency 1 conditions. 2 ‘‘(2) For purposes of paragraph (1), such term shall 3 include mobile and portable oral health services (as de- 4 fined by the Secretary) that— 5 ‘‘(A) are provided for the purpose of over- 6 coming mobility, transportation, and access barriers 7 for individuals; and 8 ‘‘(B) satisfy the standards and certification re- 9 quirements established under section 1902(a)(82)(B) 10 for the State in which the services are provided.’’. 11 (3) PAYMENT AND COINSURANCE.—Section 12 1833(a)(1) of the Social Security Act (42 U.S.C. 13 1395l(a)(1)) is amended— 14 (A) by striking ‘‘and’’ before ‘‘(DD)’’; and 15 (B) by inserting before the semicolon at 16 the end the following: ‘‘, and (EE) with respect 17 to oral health services (as defined in section 18 1861(mmm)), the amount paid shall be (i) in 19 the case of such services that are preventive, 20 100 percent of the lesser of the actual charge 21 for the services or the amount determined 22 under the payment basis determined under sec- 23 tion 1848, and (ii) in the case of all other such 24 services, 80 percent of the lesser of the actual 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00322 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 323 •S 4819 IS charge for the services or the amount deter- 1 mined under the payment basis determined 2 under section 1848’’. 3 (4) PAYMENT UNDER PHYSICIAN FEE SCHED- 4 ULE.—Section 1848(j)(3) of the Social Security Act 5 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 6 ‘‘(2)(II),’’ after ‘‘risk assessment),’’. 7 (5) DENTURES.—Section 1861(s)(8) of the So- 8 cial Security Act (42 U.S.C. 1395x(s)(8)) is amend- 9 ed— 10 (A) by striking ‘‘(other than dental)’’ and 11 inserting ‘‘(including dentures)’’; and 12 (B) by striking ‘‘internal body’’. 13 (6) REPEAL OF GROUND FOR EXCLUSION.— 14 Section 1862(a) of the Social Security Act (42 15 U.S.C. 1395y) is amended by striking paragraph 16 (12). 17 (7) EFFECTIVE DATE.—The amendments made 18 by this section shall apply to services furnished on 19 or after January 1, 2021. 20 (d) COVERAGE OF DENTAL SERVICES UNDER THE 21 MEDICAID PROGRAM.— 22 (1) IN GENERAL.—Section 1905 of the Social 23 Security Act (42 U.S.C. 1396d) is amended— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00323 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 324 •S 4819 IS (A) in subsection (a)(10), by striking ‘‘den- 1 tal services’’ and inserting ‘‘oral health services 2 (as defined in subsection (gg)(1))’’; and 3 (B) by adding at the end the following new 4 subsection: 5 ‘‘(gg)(1) Subject to paragraphs (2) and (3), for pur- 6 poses of this title, the term ‘oral health services’ means 7 services (as defined by the Secretary) that are necessary 8 to prevent disease and promote oral health, restore oral 9 structures to health and function, and treat emergency 10 conditions. 11 ‘‘(2) For purposes of paragraph (1), such term shall 12 include— 13 ‘‘(A) dentures; and 14 ‘‘(B) mobile and portable oral health services 15 (as defined by the Secretary) that— 16 ‘‘(i) are provided for the purpose of over- 17 coming mobility, transportation, and access bar- 18 riers for individuals; and 19 ‘‘(ii) satisfy the standards and certification 20 requirements established under section 21 1902(a)(87)(C) for the State in which the serv- 22 ices are provided. 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00324 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 325 •S 4819 IS ‘‘(3) For purposes of paragraph (1), such term shall 1 not include dental care or services provided to individuals 2 under the age of 21 under subsection (r)(3).’’. 3 (2) CONFORMING AMENDMENTS.— 4 (A) STATE PLAN REQUIREMENTS.—Section 5 1902(a) of the Social Security Act (42 U.S.C. 6 1396a(a)) is amended— 7 (i) in paragraph (10)(A), in the mat- 8 ter preceding clause (i), by inserting 9 ‘‘(10),’’ after ‘‘(5),’’; 10 (ii) in paragraph (85), by striking 11 ‘‘and’’ at the end; 12 (iii) in paragraph (86), by striking the 13 period at the end and inserting ‘‘; and’’; 14 and 15 (iv) by inserting after paragraph (86) 16 the following: 17 ‘‘(87) provide for— 18 ‘‘(A) informing, in writing, all individuals 19 who have been determined to be eligible for 20 medical assistance of the availability of oral 21 health services (as defined in section 1905(gg)); 22 ‘‘(B) conducting targeted outreach to preg- 23 nant women who have been determined to be el- 24 igible for medical assistance about the avail- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00325 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 326 •S 4819 IS ability of medical assistance for such dental 1 services and the importance of receiving dental 2 care while pregnant; and 3 ‘‘(C) establishing and maintaining stand- 4 ards for and certification of mobile and portable 5 oral health services (as described in subsections 6 (r)(3)(C) and (gg)(2)(B) of section 1905).’’. 7 (B) DEFINITION OF MEDICAL ASSIST- 8 ANCE.—Section 1905(a)(12) of the Social Secu- 9 rity Act (42 U.S.C. 1396d(a)(12)) is amended 10 by striking ‘‘, dentures,’’. 11 (3) MOBILE AND PORTABLE ORAL HEALTH 12 SERVICES UNDER EPSDT.—Section 1905(r)(3) of the 13 Social Security Act (42 U.S.C. 1396d(r)(3)) is 14 amended— 15 (A) in subparagraph (A)(ii), by striking ‘‘; 16 and’’ and inserting a semicolon; 17 (B) in subparagraph (B), by striking the 18 period at the end and inserting ‘‘; and’’; and 19 (C) by adding at the end the following new 20 subparagraph: 21 ‘‘(C) which shall include mobile and port- 22 able oral health services (as defined by the Sec- 23 retary) that— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00326 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 327 •S 4819 IS ‘‘(i) are provided for the purpose of 1 overcoming mobility, transportation, or ac- 2 cess barriers for children; and 3 ‘‘(ii) satisfy the standards and certifi- 4 cation requirements established under sec- 5 tion 1902(a)(87)(C) for the State in which 6 the services are provided.’’. 7 (e) ORAL HEALTH SERVICES AS AN ESSENTIAL 8 HEALTH BENEFIT.—Section 1302(b) of the Patient Pro- 9 tection and Affordable Care Act (42 U.S.C. 18022(b)) is 10 amended— 11 (1) in paragraph (1)— 12 (A) in subparagraph (J), by striking ‘‘oral 13 and’’; and 14 (B) by adding at the end the following: 15 ‘‘(K) Oral health services for children and 16 adults.’’; and 17 (2) by adding at the end the following: 18 ‘‘(6) ORAL HEALTH SERVICES.—For purposes 19 of paragraph (1)(K), the term ‘oral health services’ 20 means services (as defined by the Secretary) that 21 are necessary to prevent any oral disease and pro- 22 mote oral health, restore oral structures to health 23 and function, and treat emergency oral conditions.’’. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00327 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 328 •S 4819 IS (f) DEMONSTRATION PROGRAM ON TRAINING AND 1 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 2 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR 3 VETERANS IN RURAL AND OTHER UNDERSERVED COM- 4 MUNITIES.— 5 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 6 The Secretary of Veterans Affairs may carry out a 7 demonstration program to establish programs to 8 train and employ alternative dental health care pro- 9 viders in order to increase access to dental health 10 care services for veterans who are entitled to such 11 services from the Department of Veterans Affairs 12 and reside in rural and other underserved commu- 13 nities. 14 (2) TELEHEALTH.—For purposes of alternative 15 dental health care providers and other dental care 16 providers who are licensed to provide clinical care, 17 dental services provided under the demonstration 18 program under this subsection may be administered 19 by such providers through telehealth-enabled collabo- 20 ration and supervision when appropriate and fea- 21 sible. 22 (3) ALTERNATIVE DENTAL HEALTH CARE PRO- 23 VIDERS DEFINED.—In this subsection, the term ‘‘al- 24 ternative dental health care providers’’ has the 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00328 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 329 •S 4819 IS meaning given that term in section 340G–1(a)(2) of 1 the Public Health Service Act (42 U.S.C. 256g– 2 1(a)(2)). 3 (4) AUTHORIZATION OF APPROPRIATIONS.— 4 There are authorized to be appropriated such sums 5 as are necessary to carry out the demonstration pro- 6 gram under this subsection. 7 (g) DEMONSTRATION PROGRAM ON TRAINING AND 8 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 9 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR 10 MEMBERS OF THE ARMED FORCES AND DEPENDENTS 11 LACKING READY ACCESS TO SUCH SERVICES.— 12 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 13 The Secretary of Defense may carry out a dem- 14 onstration program to establish programs to train 15 and employ alternative dental health care providers 16 in order to increase access to dental health care 17 services for members of the Armed Forces and their 18 dependents who lack ready access to such services, 19 including the following: 20 (A) Members and dependents who reside in 21 rural areas or areas otherwise underserved by 22 dental health care providers. 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00329 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 330 •S 4819 IS (B) Members of a reserve component of 1 the Armed Forces in active status who are po- 2 tentially deployable. 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) DEFINITIONS.—In this subsection: 12 (A) ACTIVE STATUS.—The term ‘‘active 13 status’’ has the meaning given that term in sec- 14 tion 101(d) of title 10, United States Code. 15 (B) ALTERNATIVE DENTAL HEALTH CARE 16 PROVIDERS.—The term ‘‘alternative dental 17 health care providers’’ has the meaning given 18 that term in section 340G–1(a)(2) of the Public 19 Health Service Act (42 U.S.C. 256g–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 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00330 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 331 •S 4819 IS (h) DEMONSTRATION PROGRAM ON TRAINING AND 1 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 2 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR 3 PRISONERS WITHIN THE CUSTODY OF THE BUREAU OF 4 PRISONS.— 5 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 6 The Attorney General, acting through the Director 7 of the Bureau of Prisons, may carry out a dem- 8 onstration program to establish programs to train 9 and employ alternative dental health care providers 10 in order to increase access to dental health services 11 for prisoners within the custody of the Bureau of 12 Prisons. 13 (2) TELEHEALTH.—For purposes of alternative 14 dental health care providers and other dental care 15 providers who are licensed to provide clinical care, 16 dental services provided under the demonstration 17 program under this subsection may be administered 18 by such providers through telehealth-enabled collabo- 19 ration and supervision when appropriate and fea- 20 sible. 21 (3) ALTERNATIVE DENTAL HEALTH CARE PRO- 22 VIDERS DEFINED.—In this subsection and sub- 23 section (i), the term ‘‘alternative dental health care 24 providers’’ has the meaning given that term in sec- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00331 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 332 •S 4819 IS tion 340G–1(a)(2) of the Public Health Service Act 1 (42 U.S.C. 256g–1(a)(2)). 2 (4) AUTHORIZATION OF APPROPRIATIONS.— 3 There are authorized to be appropriated such sums 4 as are necessary to carry out the demonstration pro- 5 gram under this subsection. 6 (i) DEMONSTRATION PROGRAM ON TRAINING AND 7 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 8 PROVIDERS FOR DENTAL HEALTH CARE SERVICES 9 UNDER THE INDIAN HEALTH SERVICE.— 10 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 11 The Secretary of Health and Human Services, act- 12 ing through the Indian Health Service, may carry 13 out a demonstration program to establish programs 14 to train and employ alternative dental health care 15 providers in order to help eliminate oral health dis- 16 parities and increase access to dental services 17 through health programs operated by the Indian 18 Health Service, Indian tribes, tribal organizations, 19 and urban Indian organizations (as the preceding 3 20 terms are defined in section 4 of the Indian Health 21 Care Improvement Act (25 U.S.C. 1603)). 22 (2) TELEHEALTH.—For purposes of alternative 23 dental health care providers and other dental care 24 providers who are licensed to provide clinical care, 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00332 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 333 •S 4819 IS dental services provided under the demonstration 1 program under this subsection may be administered 2 by such providers through telehealth-enabled collabo- 3 ration and supervision when appropriate and fea- 4 sible. 5 (3) AUTHORIZATION OF APPROPRIATIONS.— 6 There are authorized to be appropriated such sums 7 as are necessary to carry out the demonstration pro- 8 gram under this subsection. 9 SEC. 434. PROVIDING FOR A SPECIAL ENROLLMENT PE- 10 RIOD FOR PREGNANT INDIVIDUALS. 11 (a) PUBLIC HEALTH SERVICE ACT.—Section 12 2702(b)(2) of the Public Health Service Act (42 U.S.C. 13 300gg–1(b)(2)) is amended by inserting ‘‘including a spe- 14 cial enrollment period for pregnant individuals, beginning 15 on the date on which the pregnancy is reported to the 16 health insurance issuer’’ before the period at the end. 17 (b) PATIENT PROTECTION AND AFFORDABLE CARE 18 ACT.—Section 1311(c)(6) of the Patient Protection and 19 Affordable Care Act (42 U.S.C. 18031(c)(6)) is amend- 20 ed— 21 (1) in subparagraph (C), by striking ‘‘and’’ at 22 the end; 23 (2) by redesignating subparagraph (D) as sub- 24 paragraph (E); and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00333 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 334 •S 4819 IS (3) by inserting after subparagraph (C) the fol- 1 lowing new subparagraph: 2 ‘‘(D) a special enrollment period for preg- 3 nant individuals, beginning on the date on 4 which the pregnancy is reported to the Ex- 5 change; and’’. 6 (c) SPECIAL ENROLLMENT PERIODS.— 7 (1) INTERNAL REVENUE CODE.—Section 8 9801(f) of the Internal Revenue Code of 1986 (26 9 U.S.C. 9801(f)) is amended by adding at the end 10 the following new paragraph: 11 ‘‘(4) FOR PREGNANT INDIVIDUALS.— 12 ‘‘(A) A group health plan shall permit an 13 employee who is eligible, but not enrolled, for 14 coverage under the terms of the plan (or a de- 15 pendent of such an employee if the dependent 16 is eligible, but not enrolled, for coverage under 17 such terms) to enroll for coverage under the 18 terms of the plan upon pregnancy, with the spe- 19 cial enrollment period beginning on the date on 20 which the pregnancy is reported to the group 21 health plan or the pregnancy is confirmed by a 22 health care provider. 23 ‘‘(B) The Secretary shall promulgate regu- 24 lations with respect to the special enrollment 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00334 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 335 •S 4819 IS period under subparagraph (A), including es- 1 tablishing a time period for pregnant individ- 2 uals to enroll in coverage and effective date of 3 such coverage.’’. 4 (2) ERISA.—Section 701(f) of the Employee 5 Retirement Income Security Act of 1974 (29 U.S.C. 6 1181(f)) is amended by adding at the end the fol- 7 lowing: 8 ‘‘(4) FOR PREGNANT INDIVIDUALS.— 9 ‘‘(A) A group health plan, and a health in- 10 surance issuer offering group health insurance 11 coverage in connection with a group health 12 plan, shall permit an employee who is eligible, 13 but not enrolled, for coverage under the terms 14 of the plan (or a dependent of such an employee 15 if the dependent is eligible, but not enrolled, for 16 coverage under such terms) to enroll for cov- 17 erage under the terms of the plan upon preg- 18 nancy, with the special enrollment period begin- 19 ning on the date on which the pregnancy is re- 20 ported to the group health plan or health insur- 21 ance issuer or the pregnancy is confirmed by a 22 health care provider. 23 ‘‘(B) The Secretary shall promulgate regu- 24 lations with respect to the special enrollment 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00335 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 336 •S 4819 IS period under subparagraph (A), including es- 1 tablishing a time period for pregnant individ- 2 uals to enroll in coverage and effective date of 3 such coverage.’’. 4 (d) EFFECTIVE DATE.—The amendments made by 5 this section shall apply with respect to plan years begin- 6 ning on or after January 1, 2022. 7 SEC. 435. COVERAGE OF MATERNITY CARE FOR DEPEND- 8 ENT CHILDREN. 9 Section 2719A of the Public Health Service Act (42 10 U.S.C. 300gg–19a) is amended by adding at the end the 11 following: 12 ‘‘(e) COVERAGE OF MATERNITY CARE.—A group 13 health plan, or health insurance issuer offering group or 14 individual health insurance coverage, that provides cov- 15 erage for dependants shall ensure that such plan or cov- 16 erage includes coverage for maternity care associated with 17 pregnancy, childbirth, and postpartum care for all partici- 18 pants, beneficiaries, or enrollees, including dependants, in- 19 cluding coverage of labor and delivery. Such coverage shall 20 be provided to all pregnant dependents regardless of age.’’. 21 SEC. 436. FEDERAL EMPLOYEE HEALTH BENEFIT PLANS. 22 (a) COVERAGE OF PREGNANCY.— 23 (1) IN GENERAL.—The Director of the Office of 24 Personnel Management shall issue such regulations 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00336 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 337 •S 4819 IS as are necessary to ensure that pregnancy is consid- 1 ered a change in family status and a qualifying life 2 event for an individual who is eligible to enroll, but 3 is not enrolled, in a health benefit plan under chap- 4 ter 89 of title 5, United States Code. 5 (2) EFFECTIVE DATE.—The requirement in 6 paragraph (1) shall apply with respect to any con- 7 tract entered into under section 8902 of such title 8 beginning 12 months after the date of enactment of 9 this Act. 10 (b) DESIGNATING CERTAIN FEHBP-RELATED 11 SERVICES AS EXCEPTED SERVICES UNDER THE ANTI- 12 DEFICIENCY ACT.— 13 (1) IN GENERAL.—Section 8905 of title 5, 14 United States Code, is amended by adding at the 15 end the following: 16 ‘‘(i) Any services by an officer or em- 17 ployee under this chapter relating to en- 18 rolling individuals in a health benefits plan 19 under this chapter, or changing the enroll- 20 ment of an individual already so enrolled 21 due to an event described in section 22 436(a)(1) of the Health Equity and Ac- 23 countability Act of 2020, shall be deemed, 24 for purposes of section 1342 of title 31, 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00337 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 338 •S 4819 IS services for emergencies involving the safe- 1 ty of human life or the protection of prop- 2 erty.’’. 3 (2) APPLICATION.—The amendment made by 4 paragraph (1) shall apply to any lapse in appropria- 5 tions beginning on or after the date of enactment of 6 this Act. 7 SEC. 437. CONTINUATION OF MEDICAID INCOME ELIGI- 8 BILITY STANDARD FOR PREGNANT INDIVID- 9 UALS AND INFANTS. 10 Section 1902(l)(2)(A) of the Social Security Act (42 11 U.S.C. 1396a(l)(2)(A)) is amended— 12 (1) in clause (i), by striking ‘‘and not more 13 than 185 percent’’; 14 (2) in clause (ii)— 15 (A) in subclause (I), by striking ‘‘and’’ 16 after the comma; 17 (B) in subclause (II), by striking the pe- 18 riod at the end and inserting ‘‘, and’’; and 19 (C) by adding at the end the following: 20 ‘‘(III) January 1, 2021, is the 21 percentage provided under clause 22 (v).’’; and 23 (3) by adding at the end the following new 24 clause: 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00338 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 339 •S 4819 IS ‘‘(v) The percentage provided under 1 clause (ii) for medical assistance provided 2 on or after January 1, 2021, with respect 3 to individuals described in subparagraph 4 (A) or (B) of paragraph (1) shall not be 5 less than— 6 ‘‘(I) the percentage specified for 7 such individuals by the State in an 8 amendment to its State plan (whether 9 approved or not) as of January 1, 10 2014; or 11 ‘‘(II) if no such percentage is 12 specified as of January 1, 2014, the 13 percentage established for such indi- 14 viduals under the State’s authorizing 15 legislation or provided for under the 16 State’s appropriations as of that 17 date.’’. 18 Subtitle C—Advancing Health Eq- 19 uity Through Payment and De- 20 livery Reform 21 SEC. 441. SENSE OF CONGRESS. 22 It is the sense of Congress that— 23 (1) the sustainability of the health care system 24 in the United States hinges on restructuring how 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00339 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 340 •S 4819 IS health care is paid for, shifting away from paying 1 for the volume of services provided to the value the 2 services provide; 3 (2) high value care is care that provides higher 4 quality care more efficiently, achieving greater 5 health improvement and better health outcomes at 6 lower cost (per patient and overall); 7 (3) a high value health care system must deliver 8 timely, accessible, well-coordinated, high-quality, cul- 9 turally centered, and language-appropriate care to 10 everyone; 11 (4) eliminating health disparities and achieving 12 health equity must be central to efforts to achieve a 13 high value health care system; 14 (5) eliminating such disparities and achieving 15 such equity will require tailored interventions and 16 targeted investments to address inequities in health 17 and health care to make sure that health care deliv- 18 ery and payment efforts are responsive to and inclu- 19 sive of the needs of communities of color and other 20 communities experiencing disparities; and 21 (6) new models of value-based payment and 22 care delivery should consider the holistic needs of 23 and other factors with respect to the patient popu- 24 lation, including with respect to behavioral health, 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00340 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 341 •S 4819 IS oral health, history of adverse childhood experiences 1 and adverse community environments, social deter- 2 minants of health, social risk factors, unmet social 3 needs, and the burden of intergenerational racial 4 and other inequities. 5 SEC. 442. CENTERS FOR MEDICARE & MEDICAID SERVICES 6 REPORTING AND VALUE BASED PROGRAMS. 7 (a) ADVANCING HEALTH EQUITY IN REPORTING AND 8 VALUE BASED PAYMENT PROGRAMS.— 9 (1) IN GENERAL.—The Administrator of the 10 Centers for Medicare & Medicaid Services (in this 11 section referred to as the ‘‘Administrator’’) shall re- 12 quire that a clinician or other professional partici- 13 pating in any pay-for-reporting or value based pay- 14 ment program stratify clinical quality measures by 15 disparity variables, including race, ethnicity, sex, pri- 16 mary language, disability status, sexual orientation, 17 gender identity, and socioeconomic status. A clini- 18 cian or other professional may use existing demo- 19 graphic data collection fields in certified electronic 20 health record technology (as defined in section 21 1848(o)(4) of the Social Security Act (42 U.S.C. 22 1395w–4(o)(4))) to carry out such data stratifica- 23 tion under the preceding sentence. Such stratified 24 data will assist clinicians and other professionals in 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00341 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 342 •S 4819 IS the identification of disparities obscured in aggre- 1 gated data and assist with the provision of interven- 2 tions that target reducing those disparities. 3 (2) CLINICIAN.—In assessing performance in 4 any value-based payment program, the Adminis- 5 trator shall incorporate a clinician or other profes- 6 sional’s performance in reducing disparities across 7 race, ethnicity, sex, primary language, disability sta- 8 tus, sexual orientation, gender identity, and socio- 9 economic status. Linking performance payments to 10 the reduction of health care disparities across such 11 variables will assist in holding clinicians and other 12 professionals accountable for providing quality care 13 that can lead to decreased health inequities. 14 (3) REQUIREMENT OF ADOPTION OF CERT.—All 15 entities, clinicians, or other professionals partici- 16 pating in the Quality Payment Program of the Cen- 17 ters for Medicare & Medicaid Services shall be re- 18 quired to adopt 2015 certified electronic health 19 record technology (as so defined) as a condition of 20 participating in such program. 21 (b) QUALITY IMPROVEMENT ACTIVITIES.—The Ad- 22 ministrator, upon yearly review of the Quality Payment 23 Program, shall add quality improvement activities that im- 24 plement the Culturally and Linguistically Accessible 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00342 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 343 •S 4819 IS Standards (CLAS) as Improvement Activities under the 1 Quality Payment Program. 2 SEC. 443. DEVELOPMENT AND TESTING OF DISPARITY RE- 3 DUCING DELIVERY AND PAYMENT MODELS. 4 (a) IN GENERAL.—The Center for Medicare and 5 Medicaid Innovation established under section 1115A of 6 the Social Security Act (42 U.S.C. 1315a) (in this section 7 referred to as the ‘‘CMI’’) shall establish a dedicated fund 8 to identify, test, evaluate, and scale delivery and payment 9 models under the applicable titles (as defined in subsection 10 (a)(4)(B) of such section) that target health disparities 11 among racial and ethnic minorities, including models that 12 support high-value non-medical services that address so- 13 cially determined barriers to health, including English pro- 14 ficiency status, low health literacy, case management, 15 transportation, enrollment assistance needs, stable and af- 16 fordable housing, utility assistance, employment and ca- 17 reer development, and nutrition and food security which 18 will help to reduce disparities and impact the overall cost 19 of care. 20 (b) AMENDMENT TO SOCIAL SECURITY ACT.—The 21 second sentence of section 1115A(a)(1) of the Social Secu- 22 rity Act (42 U.S.C. 1315a(a)(1)) is amended by inserting 23 ‘‘and improve health equity’’ after ‘‘expenditures’’. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00343 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 344 •S 4819 IS (c) PILOT PROGRAMS.—The CMI shall prioritize the 1 testing of models under such section 1115A that include 2 partnerships with entities, including community based or- 3 ganizations or other nonprofit entities, to help address so- 4 cially determined barriers to health and health care. 5 (d) ALTERNATIVES.—Any model tested by the CMI 6 under such 1115A shall include measures to assess and 7 track the impact of the model on health disparities, using 8 existing measures such as the Healthcare Disparities and 9 Cultural Competency Measures endorsed by the entity 10 with a contract under section 1890(a) of the Social Secu- 11 rity Act (42 U.S.C. 1395aaa(a)), and stratified by race, 12 ethnicity, English proficiency, gender identity, sexual ori- 13 entation, and disability status. 14 SEC. 444. DIVERSITY IN CENTERS FOR MEDICARE AND 15 MEDICAID CONSULTATION. 16 (a) IN GENERAL.—In carrying out the duties under 17 this section, the CMI shall consult representatives of rel- 18 evant Federal agencies, and clinical and analytical experts 19 with expertise in medicine and health care management, 20 specifically such experts with expertise in— 21 (1) the health care needs of minority, rural, and 22 underserved populations; and 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00344 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 345 •S 4819 IS (2) the financial needs of safety net, community 1 based, rural, and critical access providers, including 2 federally qualified health centers. 3 (b) OPEN DOOR FORUMS.—The CMI shall use open 4 door forums or other mechanisms to seek external feed- 5 back from interested parties and incorporate that feedback 6 into the development of models. 7 SEC. 445. SUPPORTING SAFETY NET AND COMMUNITY- 8 BASED PROVIDERS TO COMPETE IN VALUE- 9 BASED PAYMENT SYSTEMS. 10 (a) IN GENERAL.—Any pay-for-performance or alter- 11 native payment model that is developed and tested by the 12 Center for Medicare and Medicaid Innovation established 13 under section 1115A of the Social Security Act (42 U.S.C. 14 1315a), or any other agency of the Department of Health 15 and Human Services with respect to the programs under 16 titles XVIII, XIX, or XXI of such Act, shall be assessed 17 for potential impact on safety net, community based, and 18 critical access providers, including Federally qualified 19 health centers. 20 (b) NEW MODELS.—The rollout of any such models 21 shall include training and additional up front resources for 22 community based and safety net providers to enable those 23 providers to participate in the model. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00345 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 346 •S 4819 IS Subtitle D—Health Empowerment 1 Zones 2 SEC. 451. SHORT TITLE. 3 This subtitle may be cited as the ‘‘Health Empower- 4 ment Zone Act of 2020’’. 5 SEC. 452. FINDINGS. 6 Congress finds the following: 7 (1) Numerous studies and reports, including 8 the 2015 National Healthcare Quality and Dispari- 9 ties Report of the Agency for Healthcare Research 10 and Quality and the 2002 report of the Institute of 11 Medicine entitled ‘‘Unequal Treatment: Confronting 12 Racial and Ethnic Disparities in Health Care’’, doc- 13 ument the extensiveness to which health disparities 14 exist across the country. 15 (2) These studies have found that, on average, 16 racial and ethnic minorities are disproportionately 17 afflicted with chronic and acute conditions—such as 18 cancer, diabetes, musculoskeletal disease, obesity, 19 and hypertension—and suffer worse health out- 20 comes, worse health status, and higher mortality 21 rates than their White counterparts. 22 (3) Several recent studies also show that health 23 disparities are a function of not only access to health 24 care, but also the social determinants of health—in- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00346 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 347 •S 4819 IS cluding the environment, the physical structure of 1 communities, nutrition and food options, educational 2 attainment and health literacy, employment, race, 3 ethnicity, immigration status, geography, and lan- 4 guage preference—that directly and indirectly affect 5 the health, health care, and wellness of individuals 6 and communities. 7 (4) Integrally involving and fully supporting the 8 communities most affected by health inequities in 9 the assessment, planning, launch, and evaluation of 10 health disparity elimination efforts are among the 11 leading recommendations made to adequately ad- 12 dress and ultimately reduce health disparities. 13 (5) Recommendations also include supporting 14 the efforts of community stakeholders from a broad 15 cross section—including local businesses, local de- 16 partments of commerce, education, labor, urban 17 planning, and transportation, and community-based 18 and other nonprofit organizations, including national 19 and regional intermediaries with demonstrated ca- 20 pacity to serve low-income urban communities—to 21 find areas of common ground around health dis- 22 parity elimination and collaborate to improve the 23 overall health and wellness of a community and its 24 residents. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00347 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 348 •S 4819 IS SEC. 453. DESIGNATION OF HEALTH EMPOWERMENT 1 ZONES. 2 (a) IN GENERAL.—The Secretary may, at the request 3 of an eligible community partnership described in sub- 4 section (b)(1), designate an eligible area described in sub- 5 section (b)(2) as a health empowerment zone for the pur- 6 pose of eligibility for a grant under section 455. 7 (b) ELIGIBILITY CRITERIA.— 8 (1) ELIGIBLE COMMUNITY PARTNERSHIP.—A 9 community partnership is eligible to submit a re- 10 quest under this section if the partnership— 11 (A) demonstrates widespread public sup- 12 port from key individuals and entities in the eli- 13 gible area, including members of the target 14 community, State and local governments, non- 15 profit organizations including national and re- 16 gional intermediaries with demonstrated capac- 17 ity to serve low-income urban communities, and 18 community and industry leaders, for designa- 19 tion of the eligible area as a health empower- 20 ment zone; and 21 (B) includes representatives of— 22 (i) a broad cross section of stake- 23 holders and residents from communities in 24 the eligible area experiencing dispropor- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00348 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 349 •S 4819 IS tionate disparities in health status and 1 health care; and 2 (ii) organizations, facilities, and insti- 3 tutions that have a history of working 4 within and serving such communities. 5 (2) ELIGIBLE AREA.—An area is eligible to be 6 designated as a health empowerment zone under this 7 section if one or more communities in the area expe- 8 rience disproportionate disparities in health status 9 and health care. In determining whether a commu- 10 nity experiences such disparities, the Secretary shall 11 consider data collected by the Department of Health 12 and Human Services focusing on the following areas: 13 (A) Access to affordable, high-quality 14 health services. 15 (B) The prevalence of disproportionate 16 rates of certain illnesses or diseases including 17 the following: 18 (i) Arthritis, osteoporosis, chronic 19 back conditions, and other musculoskeletal 20 diseases. 21 (ii) Cancer. 22 (iii) Chronic kidney disease. 23 (iv) Diabetes. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00349 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 350 •S 4819 IS (v) Injury (intentional and uninten- 1 tional). 2 (vi) Violence (intimate and non- 3 intimate). 4 (vii) Maternal and paternal illnesses 5 and diseases. 6 (viii) Infant mortality. 7 (ix) Mental illness and other disabil- 8 ities. 9 (x) Substance use disorder treatment 10 and prevention, including underage drink- 11 ing. 12 (xi) Nutrition, obesity, and overweight 13 conditions. 14 (xii) Heart disease. 15 (xiii) Hypertension. 16 (xiv) Cerebrovascular disease or 17 stroke. 18 (xv) Tuberculosis. 19 (xvi) HIV/AIDS and other sexually 20 transmitted infections. 21 (xvii) Viral hepatitis. 22 (xviii) Asthma. 23 (xix) Tooth decay and other oral 24 health issues. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00350 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 351 •S 4819 IS (C) Within the community, the historical 1 and persistent presence of conditions that have 2 been found to contribute to health disparities 3 including any such conditions respecting any of 4 the following: 5 (i) Poverty. 6 (ii) Educational status and the quality 7 of community schools. 8 (iii) Income. 9 (iv) Access to high-quality affordable 10 health care. 11 (v) Work and work environment. 12 (vi) Environmental conditions in the 13 community, including with respect to clean 14 water, clean air, and the presence or ab- 15 sence of pollutants. 16 (vii) Language and English pro- 17 ficiency. 18 (viii) Access to affordable healthy 19 food. 20 (ix) Access to ethnically and culturally 21 diverse health and human service providers 22 and practitioners. 23 (x) Access to culturally and linguis- 24 tically competent health and human serv- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00351 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 352 •S 4819 IS ices and health and human service pro- 1 viders. 2 (xi) Health-supporting infrastructure. 3 (xii) Health insurance that is ade- 4 quate and affordable. 5 (xiii) Race, racism, and bigotry (con- 6 scious and unconscious). 7 (xiv) Sexual orientation. 8 (xv) Health literacy. 9 (xvi) Place of residence (such as 10 urban areas, rural areas, and reservations 11 of Indian tribes). 12 (xvii) Stress. 13 (c) PROCEDURE.— 14 (1) REQUEST.—A request under subsection (a) 15 shall— 16 (A) describe the bounds of the area to be 17 designated as a health empowerment zone and 18 the process used to select those bounds; 19 (B) demonstrate that the partnership sub- 20 mitting the request is an eligible community 21 partnership described in subsection (b)(1); 22 (C) demonstrate that the area is an eligible 23 area described in subsection (b)(2); 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00352 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 353 •S 4819 IS (D) include a comprehensive assessment of 1 disparities in health status and health care ex- 2 perience by one or more communities in the 3 area; 4 (E) set forth— 5 (i) a vision and a set of values for the 6 area; and 7 (ii) a comprehensive and holistic set of 8 goals to be achieved in the area through 9 designation as a health empowerment zone; 10 and 11 (F) include a strategic plan and an action 12 plan for achieving the goals described in sub- 13 paragraph (E)(ii). 14 (2) APPROVAL.—Not later than 60 days after 15 the receipt of a request for designation of an area 16 as a health empowerment zone under this section, 17 the Secretary shall approve or disapprove the re- 18 quest. 19 (d) MINIMUM NUMBER.—The Secretary— 20 (1) shall designate not more than 110 health 21 empowerment zones under this section; and 22 (2) of such zones designated under paragraph 23 (1), shall designate at least one health empowerment 24 zone in each of the several States, the District of 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00353 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 354 •S 4819 IS Columbia, and each territory or possession of the 1 United States. 2 SEC. 454. ASSISTANCE TO THOSE SEEKING DESIGNATION. 3 At the request of any organization or entity seeking 4 to submit a request under section 453(a), the Secretary 5 shall provide technical assistance, and may award a grant, 6 to assist such organization or entity— 7 (1) to form an eligible community partnership 8 described in section 453(b)(1); 9 (2) to complete a health assessment, including 10 an assessment of health disparities under section 11 453(c)(1)(D); or 12 (3) to prepare and submit a request, including 13 a strategic plan, in accordance with section 453. 14 SEC. 455. BENEFITS OF DESIGNATION. 15 (a) PRIORITY.—In awarding a grant under sub- 16 section (b), a Federal official shall give priority to any ap- 17 plicant that— 18 (1) meets the eligibility criteria for the grant; 19 (2) proposes to use the grant for activities in a 20 health empowerment zone; and 21 (3) demonstrates that such activities will di- 22 rectly and significantly further the goals of the stra- 23 tegic plan approved for such zone under section 453. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00354 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 355 •S 4819 IS (b) GRANTS FOR INITIAL IMPLEMENTATION OF 1 STRATEGIC PLAN.— 2 (1) IN GENERAL.—Upon designating an eligible 3 area as a health empowerment zone at the request 4 of an eligible community partnership, the Secretary 5 shall, subject to the availability of appropriations, 6 make a grant to the community partnership for im- 7 plementation of the strategic plan for such zone. 8 (2) GRANT PERIOD.—A grant under paragraph 9 (1) for a health empowerment zone shall be for a pe- 10 riod of 2 years and may be renewed, except that the 11 total period of grants under paragraph (1) for such 12 zone may not exceed 10 years. 13 (3) LIMITATION.—In awarding grants under 14 this subsection, the Secretary shall not give less pri- 15 ority to an applicant or reduce the amount of a 16 grant because the Secretary rendered technical as- 17 sistance or made a grant to the same applicant 18 under section 454. 19 (4) REPORTING.—The Secretary shall establish 20 metrics for measuring the progress of grantees 21 under this subsection and, based on such metrics, 22 require each such grantee to report to the Secretary 23 not less than every 6 months on the progress in im- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00355 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 356 •S 4819 IS plementing the strategic plan for the health em- 1 powerment zone. 2 SEC. 456. DEFINITION OF SECRETARY. 3 In this subtitle, the term ‘‘Secretary’’ means the Sec- 4 retary of Health and Human Services, acting through the 5 Administrator of the Health Resources and Services Ad- 6 ministration and the Deputy Assistant Secretary for Mi- 7 nority Health, and in cooperation with the Director of the 8 Office of Community Services and the Director of the Na- 9 tional Institute on Minority Health and Health Dispari- 10 ties. 11 SEC. 457. AUTHORIZATION OF APPROPRIATIONS. 12 To carry out this subtitle, there is authorized to be 13 appropriated $100,000,000 for fiscal year 2021. 14 TITLE V—IMPROVING HEALTH 15 OUTCOMES FOR WOMEN, 16 CHILDREN, AND FAMILIES 17 Subtitle A—In General 18 SEC. 501. GRANTS TO PROMOTE HEALTH FOR UNDER- 19 SERVED COMMUNITIES. 20 Part Q of title III of the Public Health Service Act 21 (42 U.S.C. 280h et seq.) is amended by adding at the end 22 the following: 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00356 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 357 •S 4819 IS ‘‘SEC. 399Z–3. GRANTS TO PROMOTE HEALTH FOR UNDER- 1 SERVED COMMUNITIES. 2 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col- 3 laboration with the Administrator of the Health Resources 4 and Services Administration and other Federal officials 5 determined appropriate by the Secretary, is authorized to 6 award grants to eligible entities— 7 ‘‘(1) to promote health for underserved commu- 8 nities, with preference given to projects that benefit 9 racial and ethnic minority women, racial and ethnic 10 minority children, adolescents, and lesbian, gay, bi- 11 sexual, transgender, queer, or questioning commu- 12 nities; and 13 ‘‘(2) to strengthen health outreach initiatives in 14 medically underserved communities, including lin- 15 guistically isolated populations. 16 ‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 17 subsection (a) may be used to support the activities of 18 community health workers, including such activities— 19 ‘‘(1) to educate and provide outreach regarding 20 enrollment in health insurance including the State 21 Children’s Health Insurance Program under title 22 XXI of the Social Security Act, Medicare under title 23 XVIII of such Act, and Medicaid under title XIX of 24 such Act; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00357 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 358 •S 4819 IS ‘‘(2) to educate and provide outreach in a com- 1 munity setting regarding health problems prevalent 2 among underserved communities, and especially 3 among racial and ethnic minority women, racial and 4 ethnic minority children, adolescents, and lesbian, 5 gay, bisexual, transgender, queer, or questioning 6 communities; 7 ‘‘(3) to educate and provide experiential learn- 8 ing opportunities and target risk factors and healthy 9 behaviors that impede or contribute to achieving 10 positive health outcomes, including— 11 ‘‘(A) healthy nutrition; 12 ‘‘(B) physical activity; 13 ‘‘(C) overweight or obesity; 14 ‘‘(D) tobacco use, including the use of e- 15 cigarettes and vaping; 16 ‘‘(E) alcohol and substance use; 17 ‘‘(F) injury and violence; 18 ‘‘(G) sexual health; 19 ‘‘(H) mental health; 20 ‘‘(I) musculoskeletal health and arthritis; 21 ‘‘(J) prenatal and postnatal care; 22 ‘‘(K) dental and oral health; 23 ‘‘(L) understanding informed consent; 24 ‘‘(M) stigma; and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00358 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 359 •S 4819 IS ‘‘(N) environmental hazards; 1 ‘‘(4) to promote community wellness and aware- 2 ness; and 3 ‘‘(5) to educate and refer target populations to 4 appropriate health care agencies and community- 5 based programs and organizations in order to in- 6 crease access to quality health care services, includ- 7 ing preventive health services. 8 ‘‘(c) APPLICATION.— 9 ‘‘(1) IN GENERAL.—Each eligible entity that 10 desires to receive a grant under subsection (a) shall 11 submit an application to the Secretary, at such time, 12 in such manner, and accompanied by such additional 13 information as the Secretary may require. 14 ‘‘(2) CONTENTS.—Each application submitted 15 pursuant to paragraph (1) shall— 16 ‘‘(A) describe the activities for which as- 17 sistance under this section is sought; 18 ‘‘(B) contain an assurance that, with re- 19 spect to each community health worker pro- 20 gram receiving funds under the grant awarded, 21 such program provides in-language training and 22 supervision to community health workers to en- 23 able such workers to provide authorized pro- 24 gram activities in (at least) the most commonly 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00359 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 360 •S 4819 IS used languages within a particular geographic 1 region; 2 ‘‘(C) contain an assurance that the appli- 3 cant will evaluate the effectiveness of commu- 4 nity health worker programs receiving funds 5 under the grant; 6 ‘‘(D) contain an assurance that each com- 7 munity health worker program receiving funds 8 under the grant will provide culturally com- 9 petent services in the linguistic context most 10 appropriate for the individuals served by the 11 program; 12 ‘‘(E) contain a plan to document and dis- 13 seminate project descriptions and results to 14 other States and organizations as identified by 15 the Secretary; and 16 ‘‘(F) describe plans to enhance the capac- 17 ity of individuals to utilize health services and 18 health-related social services under Federal, 19 State, and local programs by— 20 ‘‘(i) assisting individuals in estab- 21 lishing eligibility under the programs and 22 in receiving the services or other benefits 23 of the programs; and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00360 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 361 •S 4819 IS ‘‘(ii) providing other services, as the 1 Secretary determines to be appropriate, 2 which may include transportation and 3 translation services. 4 ‘‘(d) PRIORITY.—In awarding grants under sub- 5 section (a), the Secretary shall give priority to those appli- 6 cants— 7 ‘‘(1) who propose to target geographic areas 8 that— 9 ‘‘(A)(i) have a high percentage of residents 10 who are uninsured or underinsured (if the tar- 11 geted geographic area is located in a State that 12 has elected to make medical assistance available 13 under section 1902(a)(10)(A)(i)(VIII) of the 14 Social Security Act to individuals described in 15 such section); 16 ‘‘(ii) have a high percentage of under- 17 insured residents in a particular geographic 18 area (if the targeted geographic area is located 19 in a State that has not so elected); or 20 ‘‘(iii) have a high number of households ex- 21 periencing extreme poverty; and 22 ‘‘(B) have a high percentage of families for 23 whom English is not their primary language or 24 including smaller limited English-proficient 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00361 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 362 •S 4819 IS communities within the region that are not oth- 1 erwise reached by linguistically appropriate 2 health services; 3 ‘‘(2) with experience in providing health or 4 health-related social services to individuals who are 5 underserved with respect to such services; and 6 ‘‘(3) with documented community activity and 7 experience with community health workers. 8 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU- 9 TIONS.—The Secretary shall encourage community health 10 worker programs receiving funds under this section to col- 11 laborate with academic institutions, including minority- 12 serving institutions. Nothing in this section shall be con- 13 strued to require such collaboration. 14 ‘‘(f) QUALITY ASSURANCE AND COST EFFECTIVE- 15 NESS.—The Secretary shall establish guidelines for ensur- 16 ing the quality of the training and supervision of commu- 17 nity health workers under the programs funded under this 18 section and for ensuring the cost effectiveness of such pro- 19 grams. 20 ‘‘(g) MONITORING.—The Secretary shall monitor 21 community health worker programs identified in approved 22 applications and shall determine whether such programs 23 are in compliance with the guidelines established under 24 subsection (f). 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00362 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 363 •S 4819 IS ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 1 provide technical assistance to community health worker 2 programs identified in approved applications with respect 3 to planning, developing, and operating programs under the 4 grant. 5 ‘‘(i) REPORT TO CONGRESS.— 6 ‘‘(1) IN GENERAL.—Not later than 4 years 7 after the date on which the Secretary first awards 8 grants under subsection (a), the Secretary shall sub- 9 mit to Congress a report regarding the grant 10 project. 11 ‘‘(2) CONTENTS.—The report required under 12 paragraph (1) shall include the following: 13 ‘‘(A) A description of the programs for 14 which grant funds were used. 15 ‘‘(B) The number of individuals served. 16 ‘‘(C) An evaluation of— 17 ‘‘(i) the effectiveness of these pro- 18 grams; 19 ‘‘(ii) the cost of these programs; and 20 ‘‘(iii) the impact of these programs on 21 the health outcomes of the community resi- 22 dents. 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00363 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 364 •S 4819 IS ‘‘(D) Recommendations for sustaining the 1 community health worker programs developed 2 or assisted under this section. 3 ‘‘(E) Recommendations regarding training 4 to enhance career opportunities for community 5 health workers. 6 ‘‘(j) DEFINITIONS.—In this section: 7 ‘‘(1) COMMUNITY HEALTH WORKER.—The term 8 ‘community health worker’ means an individual who 9 promotes health or nutrition within the community 10 in which the individual resides— 11 ‘‘(A) by serving as a liaison between com- 12 munities and health care agencies; 13 ‘‘(B) by providing guidance and social as- 14 sistance to community residents; 15 ‘‘(C) by enhancing community residents’ 16 ability to effectively communicate with health 17 care providers; 18 ‘‘(D) by providing culturally and linguis- 19 tically appropriate health or nutrition edu- 20 cation; 21 ‘‘(E) by advocating for individual and com- 22 munity health, including dental, oral, mental, 23 and environmental health, or nutrition needs; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00364 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 365 •S 4819 IS ‘‘(F) by taking into consideration the 1 needs of the communities served, including the 2 prevalence rates of risk factors that impede 3 achieving positive healthy outcomes among 4 women and children, especially among racial 5 and ethnic minority women and children; and 6 ‘‘(G) by providing referral and followup 7 services. 8 ‘‘(2) COMMUNITY SETTING.—The term ‘commu- 9 nity setting’ means a home or a community organi- 10 zation that serves a population. 11 ‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en- 12 tity’ means— 13 ‘‘(A) a unit of State, territorial, local, or 14 Tribal government (including a federally recog- 15 nized Tribe or Alaska Native village); or 16 ‘‘(B) a community-based organization. 17 ‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 18 The term ‘medically underserved community’ means 19 a community— 20 ‘‘(A) that has a substantial number of in- 21 dividuals who are members of a medically un- 22 derserved population, as defined by section 23 330(b)(3); 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00365 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 366 •S 4819 IS ‘‘(B) a significant portion of which is a 1 health professional shortage area as designated 2 under section 332; and 3 ‘‘(C) that includes populations that are lin- 4 guistically isolated, such as geographic areas 5 with a shortage of health professionals able to 6 provide linguistically appropriate services. 7 ‘‘(5) SUPPORT.—The term ‘support’ means the 8 provision of training, supervision, and materials 9 needed to effectively deliver the services described in 10 subsection (b), reimbursement for services, and 11 other benefits. 12 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 13 are authorized to be appropriated to carry out this section 14 $15,000,000 for each of fiscal years 2021 through 2025.’’. 15 SEC. 502. REMOVING BARRIERS TO HEALTH CARE AND NU- 16 TRITION ASSISTANCE FOR CHILDREN, PREG- 17 NANT PERSONS, AND LAWFULLY PRESENT IN- 18 DIVIDUALS. 19 (a) MEDICAID.—Section 1903(v) of the Social Secu- 20 rity Act (42 U.S.C. 1396b(v)) is amended by striking 21 paragraph (4) and inserting the following new paragraph: 22 ‘‘(4)(A) Notwithstanding sections 401(a), 402(b), 23 403, and 421 of the Personal Responsibility and Work Op- 24 portunity Reconciliation Act of 1996 and paragraph (1), 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00366 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 367 •S 4819 IS payment shall be made to a State under this section for 1 medical assistance furnished to an alien under this title 2 (including an alien described in such paragraph) who 3 meets any of the following conditions: 4 ‘‘(i) The alien is otherwise eligible for such as- 5 sistance under the State plan approved under this 6 title (other than the requirement of the receipt of 7 aid or assistance under title IV, supplemental secu- 8 rity income benefits under title XVI, or a State sup- 9 plementary payment) within either or both of the 10 following eligibility categories: 11 ‘‘(I) Children under 21 years of age, in- 12 cluding any optional targeted low-income child 13 (as such term is defined in section 14 1905(u)(2)(B)). 15 ‘‘(II) Pregnant persons during pregnancy 16 and during the 12-month period beginning on 17 the last day of the pregnancy. 18 ‘‘(ii) The alien is lawfully present in the United 19 States. 20 ‘‘(B) No debt shall accrue under an affidavit of sup- 21 port against any sponsor of an alien who meets the condi- 22 tions specified in subparagraph (A) on the basis of the 23 provision of medical assistance to such alien under this 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00367 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 368 •S 4819 IS paragraph and the cost of such assistance shall not be con- 1 sidered as an unreimbursed cost.’’. 2 (b) CHIP.—Subparagraph (N) of section 2107(e)(1) 3 of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 4 amended to read as follows: 5 ‘‘(N) Paragraph (4) of section 1903(v) (re- 6 lating to coverage of categories of children, 7 pregnant persons, and other lawfully present in- 8 dividuals).’’. 9 (c) SUPPLEMENTAL NUTRITION ASSISTANCE FOR 10 LAWFULLY PRESENT INDIVIDUALS.— 11 (1) IN GENERAL.—Section 402(a)(2)(J) of the 12 Personal Responsibility and Work Opportunity Rec- 13 onciliation Act of 1996 (8 U.S.C. 1612(a)(2)(J)) is 14 amended— 15 (A) in the subparagraph heading, by strik- 16 ing ‘‘CERTAIN CHILDREN’’ inserting ‘‘CHILDREN 17 AND LAWFULLY PRESENT INDIVIDUALS’’; and 18 (B) by striking ‘‘who is under 18 years of 19 age.’’ and inserting ‘‘who is— 20 ‘‘(i) under 21 years of age; or 21 ‘‘(ii) lawfully present in the United 22 States.’’. 23 (2) CONFORMING AMENDMENTS.— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00368 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 369 •S 4819 IS (A) Section 402(a)(3) of such Act (8 1 U.S.C. 1612(a)(3)) is amended by striking sub- 2 paragraph (B) and inserting the following: 3 ‘‘(B) SNAP (FOOD STAMP PROGRAM).— 4 The supplemental nutrition assistance program 5 established under the Food and Nutrition Act 6 of 2008 (7 U.S.C. 2011 et seq.) (referred to in 7 this title as ‘SNAP’ or the ‘food stamp pro- 8 gram’).’’. 9 (B) Section 403(c)(2)(L) of such Act (42 10 U.S.C. 1613(c)(2)(L)) is amended by striking 11 ‘‘18’’ and all that follows through the period 12 and inserting ‘‘21, or to individuals who are 13 lawfully present in the United States, under the 14 supplemental nutrition assistance program es- 15 tablished under the Food and Nutrition Act of 16 2008 (7 U.S.C. 2011 et seq.).’’. 17 (C) Section 5(i)(2)(E) of the Food and 18 Nutrition Act of 2008 (7 U.S.C. 2014(i)(2)(E)) 19 is amended by striking ‘‘18 years of age.’’ and 20 inserting ‘‘21 years of age, or who is lawfully 21 present in the United States.’’. 22 (d) NONAPPLICATION OF SPONSOR DEEMING; AS- 23 SURING ELIGIBILITY FOR FAMILIES.—Section 421(d) of 24 the Personal Responsibility and Work Opportunity Rec- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00369 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 370 •S 4819 IS onciliation Act of 1996 (8 U.S.C. 1631(d)) is amended 1 by striking paragraph (3) and inserting the following: 2 ‘‘(3) This section shall not apply to assistance 3 or benefits under the supplemental nutrition assist- 4 ance program established under the Food and Nutri- 5 tion Act of 2008 (7 U.S.C. 2011 et seq.) for a quali- 6 fied alien who is eligible under section 402(a)(2)(J) 7 and for any member of the household of such quali- 8 fied alien.’’. 9 (e) ENSURING PROPER SCREENING.—Section 10 11(e)(2)(B) of the Food and Nutrition Act of 2008 (7 11 U.S.C. 2020(e)(2)(B)) is amended— 12 (1) by redesignating clauses (vi) and (vii) as 13 clauses (vii) and (viii), respectively; and 14 (2) by inserting after clause (v) the following: 15 ‘‘(vi) shall provide a method for imple- 16 menting section 421 of the Personal Re- 17 sponsibility and Work Opportunity Rec- 18 onciliation Act of 1996 (8 U.S.C. 1631) 19 that does not require any unnecessary in- 20 formation from applicants who may be ex- 21 empt from that provision;’’. 22 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00370 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 371 •S 4819 IS SEC. 503. REPEAL OF DENIAL OF SNAP BENEFITS. 1 Section 115 of the Personal Responsibility and Work 2 Opportunity Reconciliation Act of 1996 (21 U.S.C. 862a) 3 is amended— 4 (1) in subsection (a), by striking ‘‘for—’’ and 5 all that follows and inserting ‘‘for assistance under 6 any State program funded under part A of title IV 7 of the Social Security Act (42 U.S.C. 601 et seq.).’’; 8 (2) in subsection (b)— 9 (A) by striking ‘‘(1) PROGRAM OF TEM- 10 PORARY ASSISTANCE FOR NEEDY FAMILIES.—’’; 11 and 12 (B) by striking paragraph (2); and 13 (3) in subsection (e), by striking ‘‘it—’’ and all 14 that follows and inserting ‘‘the term in section 15 419(5) of the Social Security Act (42 U.S.C. 16 619(5)) when referring to assistance provided under 17 a State program funded under paragraph A of title 18 IV of the Social Security Act (42 U.S.C. 601 et 19 seq.).’’. 20 SEC. 504. BIRTH DEFECTS PREVENTION, RISK REDUCTION, 21 AND AWARENESS. 22 (a) IN GENERAL.—The Secretary shall establish and 23 implement a birth defects prevention and public awareness 24 program, consisting of the activities described in sub- 25 sections (c) and (d). 26 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00371 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 372 •S 4819 IS (b) DEFINITIONS.—In this section: 1 (1) MATERNAL.—The term ‘‘maternal’’ refers 2 to persons who are pregnant or breastfeeding of all 3 gender identities. 4 (2) PREGNANCY AND BREASTFEEDING INFOR- 5 MATION SERVICES.—The term ‘‘pregnancy and 6 breastfeeding information services’’ includes only— 7 (A) information services to provide accu- 8 rate, evidence-based, clinical information re- 9 garding maternal exposures during pregnancy 10 that may be associated with birth defects or 11 other health risks, such as exposures to medica- 12 tions, chemicals, infections, foodborne patho- 13 gens, illnesses, nutrition, or lifestyle factors; 14 (B) information services to provide accu- 15 rate, evidence-based, clinical information re- 16 garding maternal exposures during breast- 17 feeding that may be associated with health risks 18 to a breast-fed infant, such as exposures to 19 medications, chemicals, infections, foodborne 20 pathogens, illnesses, nutrition, lifestyle, or 21 climate- and weather-related factors; 22 (C) the provision of accurate, evidence- 23 based information weighing risks of exposures 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00372 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 373 •S 4819 IS during breastfeeding against the benefits of 1 breastfeeding; and 2 (D) the provision of information described 3 in subparagraph (A), (B), or (C) through coun- 4 selors, websites, fact sheets, telephonic or elec- 5 tronic communication, community outreach ef- 6 forts, or other appropriate means. 7 (3) SECRETARY.—The term ‘‘Secretary’’ means 8 the Secretary of Health and Human Services, acting 9 through the Director of the Centers for Disease 10 Control and Prevention. 11 (c) NATIONWIDE MEDIA CAMPAIGN.—In carrying out 12 subsection (a), the Secretary shall conduct or support a 13 nationwide media campaign to increase awareness among 14 health care providers and at-risk populations about preg- 15 nancy and breastfeeding information services. 16 (d) GRANTS FOR PREGNANCY AND BREASTFEEDING 17 INFORMATION SERVICES.— 18 (1) IN GENERAL.—In carrying out subsection 19 (a), the Secretary shall award grants to State or re- 20 gional agencies or organizations for any of the fol- 21 lowing: 22 (A) INFORMATION SERVICES.—The provi- 23 sion of, or campaigns to increase awareness 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00373 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 374 •S 4819 IS about, pregnancy and breastfeeding information 1 services. 2 (B) SURVEILLANCE AND RESEARCH.—The 3 conduct or support of— 4 (i) surveillance of or research on— 5 (I) maternal exposures and ma- 6 ternal health conditions that may in- 7 fluence the risk of birth defects, pre- 8 maturity, or other adverse pregnancy 9 outcomes; and 10 (II) maternal exposures that may 11 influence health risks to a breastfed 12 infant; or 13 (ii) networking to facilitate surveil- 14 lance or research described in this sub- 15 paragraph. 16 (2) PREFERENCE FOR CERTAIN STATES.—The 17 Secretary, in making any grant under this sub- 18 section, shall give preference to States, otherwise 19 equally qualified, that have a pregnancy and 20 breastfeeding information service in place. 21 (3) MATCHING FUNDS.—The Secretary may 22 only award a grant under this subsection to a State 23 or regional agency or organization that agrees, with 24 respect to the costs to be incurred in carrying out 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00374 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 375 •S 4819 IS the grant activities, to make available (directly or 1 through donations from public or private entities) 2 non-Federal funds toward such costs in an amount 3 equal to not less than 25 percent of the amount of 4 the grant. 5 (4) COORDINATION.—The Secretary shall en- 6 sure that activities funded through a grant under 7 this subsection are coordinated, to the maximum ex- 8 tent practicable, with other birth defects prevention 9 and environmental health activities of the Federal 10 Government, including with respect to pediatric envi- 11 ronmental health specialty units and children’s envi- 12 ronmental health centers. 13 (e) EVALUATION.—In furtherance of the program 14 under subsection (a), the Secretary shall provide for an 15 evaluation of pregnancy and breastfeeding information 16 services to identify efficient and effective models of— 17 (1) providing information; 18 (2) raising awareness and increasing knowledge 19 about birth defects prevention measures and tar- 20 geting education to at-risk groups; 21 (3) modifying risk behaviors; or 22 (4) other outcome measures as determined ap- 23 propriate by the Secretary. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00375 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 376 •S 4819 IS (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 1 out this section, there are authorized to be appropriated 2 $5,000,000 for fiscal year 2021, $6,000,000 for fiscal year 3 2022, $7,000,000 for fiscal year 2023, $8,000,000 for fis- 4 cal year 2024, and $9,000,000 for fiscal year 2025. 5 SEC. 505. MOMMA’S ACT. 6 (a) SHORT TITLE.—This section may be cited as the 7 ‘‘Mothers and Offspring Mortality and Morbidity Aware- 8 ness Act’’ or the ‘‘MOMMA’s Act’’. 9 (b) FINDINGS.—Congress finds the following: 10 (1) Every year, across the United States, 11 4,000,000 women give birth, about 700 women suf- 12 fer fatal complications during pregnancy, while giv- 13 ing birth or during the postpartum period, and 14 70,000 women suffer near-fatal, partum-related 15 complications. 16 (2) The maternal mortality rate is often used as 17 a proxy to measure the overall health of a popu- 18 lation. While the infant mortality rate in the United 19 States has reached its lowest point, the risk of death 20 for women in the United States during pregnancy, 21 childbirth, or the postpartum period is higher than 22 such risk in many other developed nations. The esti- 23 mated maternal mortality rate (per 100,000 live 24 births) for the 48 contiguous States and Wash- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00376 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 377 •S 4819 IS ington, DC, increased from 18.8 percent in 2000, to 1 23.8 percent in 2014, to 26.6 percent in 2018. This 2 estimated rate is on par with such rate for under- 3 developed nations such as Iraq and Afghanistan. 4 (3) It is estimated that more than 60 percent 5 of maternal deaths in the United States are prevent- 6 able. 7 (4) According to the Centers for Disease Con- 8 trol and Prevention, the maternal mortality rate var- 9 ies drastically for women by race and ethnicity. 10 There are 12.7 deaths per 100,000 live births for 11 White women, 43.5 deaths per 100,000 live births 12 for African-American women, and 14.4 deaths per 13 100,000 live births for women of other ethnicities. 14 While maternal mortality disparately impacts Afri- 15 can-American women, this urgent public health crisis 16 traverses race, ethnicity, socioeconomic status, edu- 17 cational background, and geography. 18 (5) African-American women are 3 to 4 times 19 more likely to die from causes related to pregnancy 20 and childbirth compared to non-Hispanic White 21 women. 22 (6) The findings described in paragraphs (1) 23 through (6) are of major concern to researchers, 24 academics, members of the business community, and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00377 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 378 •S 4819 IS providers across the obstetrical continuum rep- 1 resented by organizations such as March of Dimes; 2 the Preeclampsia Foundation; the American College 3 of Obstetricians and Gynecologists; the Society for 4 Maternal-Fetal Medicine; the Association of Wom- 5 en’s Health, Obstetric, and Neonatal Nurses; the 6 California Maternal Quality Care Collaborative; 7 Black Women’s Health Imperative; the National 8 Birth Equity Collaborative; Black Mamas Matter Al- 9 liance; EverThrive Illinois; the National Association 10 of Certified Professional Midwives; PCOS Challenge: 11 The National Polycystic Ovary Syndrome Associa- 12 tion; and the American College of Nurse Midwives. 13 (7) Hemorrhage, cardiovascular and coronary 14 conditions, cardiomyopathy, infection, embolism, 15 mental health conditions, preeclampsia and eclamp- 16 sia, polycystic ovary syndrome, infection and sepsis, 17 and anesthesia complications are the predominant 18 medical causes of maternal-related deaths and com- 19 plications. Most of these conditions are largely pre- 20 ventable or manageable. 21 (8) Oral health is an important part of 22 perinatal health. Reducing bacteria in a woman’s 23 mouth during pregnancy can significantly reduce her 24 risk of developing oral diseases and spreading decay- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00378 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 379 •S 4819 IS causing bacteria to her baby. Moreover, some evi- 1 dence suggests that women with periodontal disease 2 during pregnancy could be at greater risk for poor 3 birth outcomes, such as preeclampsia, pre-term 4 birth, and low-birth weight. Furthermore, a woman’s 5 oral health during pregnancy is a good predictor of 6 her newborn’s oral health, and since mothers can 7 unintentionally spread oral bacteria to their babies, 8 putting their children at higher risk for tooth decay, 9 prevention efforts should happen even before chil- 10 dren are born, as a matter of pre-pregnancy health 11 and prenatal care during pregnancy. 12 (9) The United States has not been able to sub- 13 mit a formal maternal mortality rate to international 14 data repositories since 2007. Thus, no official ma- 15 ternal mortality rate exists for the United States. 16 There can be no maternal mortality rate without 17 streamlining maternal mortality-related data from 18 the State level and extrapolating such data to the 19 Federal level. 20 (10) In the United States, death reporting and 21 analysis is a State function rather than a Federal 22 process. States report all deaths—including mater- 23 nal deaths—on a semi-voluntary basis, without 24 standardization across States. While the Centers for 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00379 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 380 •S 4819 IS Disease Control and Prevention has the capacity and 1 system for collecting death-related data based on 2 death certificates, these data are not sufficiently re- 3 ported by States in an organized and standard for- 4 mat across States such that the Centers for Disease 5 Control and Prevention is able to identify causes of 6 maternal death and best practices for the prevention 7 of such death. 8 (11) Vital statistics systems often underesti- 9 mate maternal mortality and are insufficient data 10 sources from which to derive a full scope of medical 11 and social determinant factors contributing to ma- 12 ternal deaths. While the addition of pregnancy 13 checkboxes on death certificates since 2003 have 14 likely improved States’ abilities to identify preg- 15 nancy-related deaths, they are not generally com- 16 pleted by obstetrical providers or persons trained to 17 recognize pregnancy-related mortality. Thus, these 18 vital forms may be missing information or may cap- 19 ture inconsistent data. Due to varying maternal 20 mortality-related analyses, lack of reliability, and 21 granularity in data, current maternal mortality 22 informatics do not fully encapsulate the myriad med- 23 ical and socially determinant factors that contribute 24 to such high maternal mortality rates within the 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00380 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 381 •S 4819 IS United States compared to other developed nations. 1 Lack of standardization of data and data sharing 2 across States and between Federal entities, health 3 networks, and research institutions keep the Nation 4 in the dark about ways to prevent maternal deaths. 5 (12) Having reliable and valid State data ag- 6 gregated at the Federal level are critical to the Na- 7 tion’s ability to quell surges in maternal death and 8 imperative for researchers to identify long-lasting 9 interventions. 10 (13) Leaders in maternal wellness highly rec- 11 ommend that maternal deaths be investigated at the 12 State level first, and that standardized, streamlined, 13 de-identified data regarding maternal deaths be sent 14 annually to the Centers for Disease Control and Pre- 15 vention. Such data standardization and collection 16 would be similar in operation and effect to the Na- 17 tional Program of Cancer Registries of the Centers 18 for Disease Control and Prevention and akin to the 19 Confidential Enquiry in Maternal Deaths Pro- 20 gramme in the United Kingdom. Such a maternal 21 mortalities and morbidities registry and surveillance 22 system would help providers, academicians, law- 23 makers, and the public to address questions con- 24 cerning the types of, causes of, and best practices to 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00381 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 382 •S 4819 IS thwart, pregnancy-related or pregnancy-associated 1 mortality and morbidity. 2 (14) The United Nations Millennium Develop- 3 ment Goal 5a aimed to reduce by 75 percent, be- 4 tween 1990 and 2015, the maternal mortality rate, 5 yet this metric has not been achieved. In fact, the 6 maternal mortality rate in the United States has 7 been estimated to have more than doubled between 8 2000 and 2014. Yet, because national data are not 9 fully available, the United States does not have an 10 official maternal mortality rate. 11 (15) Many States have struggled to establish or 12 maintain Maternal Mortality Review Committees 13 (referred to in this section as ‘‘MMRC’’). On the 14 State level, MMRCs have lagged because States have 15 not had the resources to mount local reviews. State- 16 level reviews are necessary as only the State depart- 17 ments of health have the authority to request med- 18 ical records, autopsy reports, and police reports crit- 19 ical to the function of the MMRC. 20 (16) The United Kingdom regards maternal 21 deaths as a health systems failure and a national 22 committee of obstetrics experts review each maternal 23 death or near-fatal childbirth complication. Such 24 committee also establishes the predominant course of 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00382 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 383 •S 4819 IS maternal-related deaths from conditions such as 1 preeclampsia. Consequently, the United Kingdom 2 has been able to reduce its incidence of preeclampsia 3 to less than one in 10,000 women—its lowest rate 4 since 1952. 5 (17) The United States has no comparable, co- 6 ordinated Federal process by which to review cases 7 of maternal mortality, systems failures, or best prac- 8 tices. Many States have active MMRCs and leverage 9 their work to impact maternal wellness. For exam- 10 ple, the State of California has worked extensively 11 with their State health departments, health and hos- 12 pital systems, and research collaborative organiza- 13 tions, including the California Maternal Quality Care 14 Collaborative and the Alliance for Innovation on Ma- 15 ternal Health, to establish MMRCs, wherein such 16 State has determined the most prevalent causes of 17 maternal mortality and recorded and shared data 18 with providers and researchers, who have developed 19 and implemented safety bundles and care protocols 20 related to preeclampsia, maternal hemorrhage, and 21 the like. In this way, the State of California has 22 been able to leverage its maternal mortality review 23 board system, generate data, and apply those data 24 to effect changes in maternal care-related protocol. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00383 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 384 •S 4819 IS To date, the State of California has reduced its ma- 1 ternal mortality rate, which is now comparable to 2 the low rates of the United Kingdom. 3 (18) Hospitals and health systems across the 4 United States lack standardization of emergency ob- 5 stetrical protocols before, during, and after delivery. 6 Consequently, many providers are delayed in recog- 7 nizing critical signs indicating maternal distress that 8 quickly escalate into fatal or near-fatal incidences. 9 Moreover, any attempt to address an obstetrical 10 emergency that does not consider both clinical and 11 public health approaches falls woefully under the 12 mark of excellent care delivery. State-based maternal 13 quality collaborative organizations, such as the Cali- 14 fornia Maternal Quality Care Collaborative or enti- 15 ties participating in the Alliance for Innovation on 16 Maternal Health (AIM), have formed obstetrical pro- 17 tocols, tool kits, and other resources to improve sys- 18 tem care and response as they relate to maternal 19 complications and warning signs for such conditions 20 as maternal hemorrhage, hypertension, and 21 preeclampsia. 22 (19) The Centers for Disease Control and Pre- 23 vention reports that nearly half of all maternal 24 deaths occur in the immediate postpartum period— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00384 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 385 •S 4819 IS the 42 days following a pregnancy—whereas more 1 than one-third of pregnancy-related or pregnancy-as- 2 sociated deaths occur while a person is still preg- 3 nant. Yet, for women eligible for the Medicaid pro- 4 gram on the basis of pregnancy, such Medicaid cov- 5 erage lapses at the end of the month on which the 6 60th postpartum day lands. 7 (20) The experience of serious traumatic 8 events, such as being exposed to domestic violence, 9 substance use disorder, or pervasive racism, can 10 over-activate the body’s stress-response system. 11 Known as toxic stress, the repetition of high doses 12 of cortisol to the brain, can harm healthy neuro- 13 logical development, which can have cascading phys- 14 ical and mental health consequences, as documented 15 in the Adverse Childhood Experiences study of the 16 Centers for Disease Control and Prevention. 17 (21) A growing body of evidence-based research 18 has shown the correlation between the stress associ- 19 ated with one’s race—the stress of racism—and 20 one’s birthing outcomes. The stress of sex and race 21 discrimination and institutional racism has been 22 demonstrated to contribute to a higher risk of ma- 23 ternal mortality, irrespective of one’s gestational 24 age, maternal age, socioeconomic status, or indi- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00385 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 386 •S 4819 IS vidual-level health risk factors, including poverty, 1 limited access to prenatal care, and poor physical 2 and mental health (although these are not nominal 3 factors). African-American women remain the most 4 at risk for pregnancy-associated or pregnancy-re- 5 lated causes of death. When it comes to 6 preeclampsia, for example, which is related to obe- 7 sity, African-American women of normal weight re- 8 main the most at risk of dying during the perinatal 9 period compared to non-African-American obese 10 women. 11 (22) The rising maternal mortality rate in the 12 United States is driven predominantly by the dis- 13 proportionately high rates of African-American ma- 14 ternal mortality. 15 (23) Compared to women from other racial and 16 ethnic demographics, African-American women 17 across the socioeconomic spectrum experience pro- 18 longed, unrelenting stress related to racial and gen- 19 der discrimination, contributing to higher rates of 20 maternal mortality, giving birth to low-weight ba- 21 bies, and experiencing pre-term birth. Racism is a 22 risk factor for these aforementioned experiences. 23 This cumulative stress often extends across the life 24 course and is situated in everyday spaces where Afri- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00386 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 387 •S 4819 IS can-American women establish livelihood. Structural 1 barriers, lack of access to care, and genetic pre- 2 dispositions to health vulnerabilities exacerbate Afri- 3 can-American women’s likelihood to experience poor 4 or fatal birthing outcomes, but do not fully account 5 for the great disparity. 6 (24) African-American women are twice as like- 7 ly to experience postpartum depression, and dis- 8 proportionately higher rates of preeclampsia com- 9 pared to White women. 10 (25) Racism is deeply ingrained in United 11 States systems, including in health care delivery sys- 12 tems between patients and providers, often resulting 13 in disparate treatment for pain, irreverence for cul- 14 tural norms with respect to health, and 15 dismissiveness. Research has demonstrated that pa- 16 tients respond more warmly and adhere to medical 17 treatment plans at a higher degree with providers of 18 the same race or ethnicity or with providers with 19 great ability to exercise empathy. However, the pro- 20 vider pool is not primed with many people of color, 21 nor are providers (whether student-doctors in train- 22 ing or licensed practitioners) consistently required to 23 undergo implicit bias, cultural competency, or empa- 24 thy training on a consistent, ongoing basis. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00387 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 388 •S 4819 IS (c) IMPROVING FEDERAL EFFORTS WITH RESPECT 1 TO PREVENTION OF MATERNAL MORTALITY.— 2 (1) TECHNICAL ASSISTANCE FOR STATES WITH 3 RESPECT TO REPORTING MATERNAL MORTALITY.— 4 Not later than one year after the date of enactment 5 of this Act, the Director of the Centers for Disease 6 Control and Prevention (referred to in this sub- 7 section as the ‘‘Director’’), in consultation with the 8 Administrator of the Health Resources and Services 9 Administration, shall provide technical assistance to 10 States that elect to report comprehensive data on 11 maternal mortality, including oral, mental, and 12 breastfeeding health information, for the purpose of 13 encouraging uniformity in the reporting of such data 14 and to encourage the sharing of such data among 15 the respective States. 16 (2) BEST PRACTICES RELATING TO PREVEN- 17 TION OF MATERNAL MORTALITY.— 18 (A) IN GENERAL.—Not later than one year 19 after the date of enactment of this Act— 20 (i) the Director, in consultation with 21 relevant patient and provider groups, shall 22 issue best practices to State maternal mor- 23 tality review committees on how best to 24 identify and review maternal mortality 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00388 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 389 •S 4819 IS cases, taking into account any data made 1 available by States relating to maternal 2 mortality, including data on oral, mental, 3 and breastfeeding health, and utilization of 4 any emergency services; and 5 (ii) the Director, working in collabora- 6 tion with the Health Resources and Serv- 7 ices Administration, shall issue best prac- 8 tices to hospitals, State professional society 9 groups, and perinatal quality collaboratives 10 on how best to prevent maternal mortality. 11 (B) AUTHORIZATION OF APPROPRIA- 12 TIONS.—For purposes of carrying out this 13 paragraph, there is authorized to be appro- 14 priated $5,000,000 for each of fiscal years 15 2021 through 2025. 16 (3) ALLIANCE FOR INNOVATION ON MATERNAL 17 HEALTH GRANT PROGRAM.— 18 (A) IN GENERAL.—Not later than one year 19 after the date of enactment of this Act, the Sec- 20 retary of Health and Human Services (referred 21 to in this paragraph as the ‘‘Secretary’’), acting 22 through the Associate Administrator of the Ma- 23 ternal and Child Health Bureau of the Health 24 Resources and Services Administration, shall 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00389 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 390 •S 4819 IS establish a grant program to be known as the 1 Alliance for Innovation on Maternal Health 2 Grant Program (referred to in this subsection 3 as ‘‘AIM’’) under which the Secretary shall 4 award grants to eligible entities for the purpose 5 of— 6 (i) directing widespread adoption and 7 implementation of maternal safety bundles 8 through collaborative State-based teams; 9 and 10 (ii) collecting and analyzing process, 11 structure, and outcome data to drive con- 12 tinuous improvement in the implementa- 13 tion of such safety bundles by such State- 14 based teams with the ultimate goal of 15 eliminating preventable maternal mortality 16 and severe maternal morbidity in the 17 United States. 18 (B) ELIGIBLE ENTITIES.—In order to be 19 eligible for a grant under subparagraph (A), an 20 entity shall— 21 (i) submit to the Secretary an applica- 22 tion at such time, in such manner, and 23 containing such information as the Sec- 24 retary may require; and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00390 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 391 •S 4819 IS (ii) demonstrate in such application 1 that the entity is an interdisciplinary, 2 multi-stakeholder, national organization 3 with a national data-driven maternal safety 4 and quality improvement initiative based 5 on implementation approaches that have 6 been proven to improve maternal safety 7 and outcomes in the United States. 8 (C) USE OF FUNDS.—An eligible entity 9 that receives a grant under subparagraph (A) 10 shall use such grant funds— 11 (i) to develop and implement, through 12 a robust, multi-stakeholder process, mater- 13 nal safety bundles to assist States and 14 health care systems in aligning national, 15 State, and hospital-level quality improve- 16 ment efforts to improve maternal health 17 outcomes, specifically the reduction of ma- 18 ternal mortality and severe maternal mor- 19 bidity; 20 (ii) to ensure, in developing and im- 21 plementing maternal safety bundles under 22 clause (i), that such maternal safety bun- 23 dles— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00391 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 392 •S 4819 IS (I) satisfy the quality improve- 1 ment needs of a State or health care 2 system by factoring in the results and 3 findings of relevant data reviews, such 4 as reviews conducted by a State ma- 5 ternal mortality review committee; 6 and 7 (II) address topics such as— 8 (aa) obstetric hemorrhage; 9 (bb) maternal mental health; 10 (cc) the maternal venous 11 system; 12 (dd) obstetric care for 13 women with substance use dis- 14 orders, including opioid use dis- 15 order; 16 (ee) postpartum care basics 17 for maternal safety; 18 (ff) reduction of peripartum 19 racial and ethnic disparities; 20 (gg) reduction of primary 21 caesarean birth; 22 (hh) severe hypertension in 23 pregnancy; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00392 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 393 •S 4819 IS (ii) severe maternal mor- 1 bidity reviews; 2 (jj) support after a severe 3 maternal morbidity event; 4 (kk) thromboembolism; 5 (ll) optimization of support 6 for breastfeeding; and 7 (mm) maternal oral health; 8 and 9 (iii) to provide ongoing technical as- 10 sistance at the national and State levels to 11 support implementation of maternal safety 12 bundles under clause (i). 13 (D) MATERNAL SAFETY BUNDLE DE- 14 FINED.—For purposes of this paragraph, the 15 term ‘‘maternal safety bundle’’ means standard- 16 ized, evidence-informed processes for maternal 17 health care. 18 (E) AUTHORIZATION OF APPROPRIA- 19 TIONS.—For purposes of carrying out this 20 paragraph, there is authorized to be appro- 21 priated $10,000,000 for each of fiscal years 22 2021 through 2025. 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00393 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 394 •S 4819 IS (4) FUNDING FOR STATE-BASED PERINATAL 1 QUALITY COLLABORATIVES DEVELOPMENT AND SUS- 2 TAINABILITY.— 3 (A) IN GENERAL.—Not later than one year 4 after the date of enactment of this Act, the Sec- 5 retary of Health and Human Services (referred 6 to in this paragraph as the ‘‘Secretary’’), acting 7 through the Division of Reproductive Health of 8 the Centers for Disease Control and Prevention, 9 shall establish a grant program to be known as 10 the State-Based Perinatal Quality Collaborative 11 grant program under which the Secretary 12 awards grants to eligible entities for the pur- 13 pose of development and sustainability of 14 perinatal quality collaboratives in every State, 15 the District of Columbia, and eligible terri- 16 tories, in order to measurably improve perinatal 17 care and perinatal health outcomes for preg- 18 nant and postpartum women and their infants. 19 (B) GRANT AMOUNTS.—Grants awarded 20 under this paragraph shall be in amounts not to 21 exceed $250,000 per year, for the duration of 22 the grant period. 23 (C) STATE-BASED PERINATAL QUALITY 24 COLLABORATIVE DEFINED.—For purposes of 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00394 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 395 •S 4819 IS this paragraph, the term ‘‘State-based perinatal 1 quality collaborative’’ means a network of mul- 2 tidisciplinary teams that— 3 (i) work 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 (ii) work 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 (iii) employ strategies that include the 14 use of the collaborative learning model to 15 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; and 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00395 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 396 •S 4819 IS (iv) have the goal of improving popu- 1 lation-level outcomes in maternal and in- 2 fant health. 3 (D) AUTHORIZATION OF APPROPRIA- 4 TIONS.—For purposes of carrying out this 5 paragraph, there is authorized to be appro- 6 priated $14,000,000 per year for each of fiscal 7 years 2021 through 2025. 8 (5) EXPANSION OF MEDICAID AND CHIP COV- 9 ERAGE FOR PREGNANT AND POSTPARTUM WOMEN.— 10 (A) REQUIRING COVERAGE OF CERTAIN 11 ORAL HEALTH SERVICES FOR PREGNANT AND 12 POSTPARTUM WOMEN.— 13 (i) MEDICAID.—Subsection (gg) of 14 section 1905 of the Social Security Act (42 15 U.S.C. 1396d), as added by section 16 433(d), is amended— 17 (I) in paragraph (1), by striking 18 ‘‘paragraphs (2) and (3)’’ and insert- 19 ing ‘‘paragraphs (2), (3), and (4)’’; 20 and 21 (II) by adding at the end the fol- 22 lowing new paragraph: 23 ‘‘(4) Such term shall include, in the case of a 24 woman who is pregnant (or during the 1-year period 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00396 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 397 •S 4819 IS beginning on the last day of her pregnancy) preven- 1 tive, diagnostic, periodontal, and restorative services 2 recommended for perinatal oral health care and den- 3 tal care during pregnancy by the American Academy 4 of Pediatric Dentistry and the American College of 5 Obstetricians and Gynecologists.’’. 6 (ii) CHIP.—Section 2103(c)(5)(A) of 7 the Social Security Act (42 U.S.C. 8 1397cc(c)(5)(A)) is amended by inserting 9 ‘‘or a targeted low-income pregnant 10 woman’’ after ‘‘targeted low-income child’’. 11 (B) EXTENDING MEDICAID COVERAGE FOR 12 PREGNANT AND POSTPARTUM WOMEN.—Section 13 1902 of the Social Security Act (42 U.S.C. 14 1396a) is amended— 15 (i) in subsection (e)— 16 (I) in paragraph (5)— 17 (aa) by inserting ‘‘(including 18 oral health services (as defined in 19 section 1905(gg) and including 20 services for pregnant and 21 postpartum women described in 22 paragraph (4) of such section)’’ 23 after ‘‘postpartum medical assist- 24 ance under the plan’’; and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00397 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 398 •S 4819 IS (bb) by striking ‘‘60-day’’ 1 and inserting ‘‘1-year’’; and 2 (II) in paragraph (6), by striking 3 ‘‘60-day’’ and inserting ‘‘1-year’’; and 4 (ii) in subsection (l)(1)(A), by striking 5 ‘‘60-day’’ and inserting ‘‘1-year’’. 6 (C) EXTENDING MEDICAID COVERAGE FOR 7 LAWFUL RESIDENTS.—Section 1903(v)(4)(A) of 8 the Social Security Act (42 U.S.C. 9 1396b(v)(4)(A)) is amended by striking ‘‘60- 10 day’’ and inserting ‘‘1-year’’. 11 (D) EXTENDING CHIP COVERAGE FOR 12 PREGNANT AND POSTPARTUM WOMEN.—Section 13 2112(d)(2)(A) of the Social Security Act (42 14 U.S.C. 1397ll(d)(2)(A)) is amended by striking 15 ‘‘60-day’’ and inserting ‘‘1-year’’. 16 (E) MAINTENANCE OF EFFORT.— 17 (i) MEDICAID.—Section 1902(l) of the 18 Social Security Act (42 U.S.C. 1396a(l)) is 19 amended by adding at the end the fol- 20 lowing new paragraph: 21 ‘‘(5) During the period that begins on the date of 22 enactment of this paragraph and ends on the date that 23 is 5 years after such date of enactment, as a condition 24 for receiving any Federal payments under section 1903(a) 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00398 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 399 •S 4819 IS for calendar quarters occurring during such period, a 1 State shall not have in effect, with respect to women who 2 are eligible for medical assistance under the State plan 3 or under a waiver of such plan on the basis of being preg- 4 nant or having been pregnant, eligibility standards, meth- 5 odologies, or procedures under the State plan or waiver 6 that are more restrictive than the eligibility standards, 7 methodologies, or procedures, respectively, under such 8 plan or waiver that are in effect on the date of enactment 9 of this paragraph.’’. 10 (ii) CHIP.—Section 2105(d) of the 11 Social Security Act (42 U.S.C. 1397ee(d)) 12 is amended by adding at the end the fol- 13 lowing new paragraph: 14 ‘‘(4) INELIGIBILITY STANDARDS FOR TARGETED 15 LOW-INCOME PREGNANT WOMEN.—During the pe- 16 riod that begins on the date of enactment of this 17 paragraph and ends on the date that is 5 years after 18 such date of enactment, as a condition of receiving 19 payments under subsection (a) and section 1903(a), 20 a State that elects to provide assistance to women 21 on the basis of being pregnant (including pregnancy- 22 related assistance provided to targeted low-income 23 pregnant women (as defined in section 2112(d)), 24 pregnancy-related assistance provided to women who 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00399 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 400 •S 4819 IS are eligible for such assistance through application 1 of section 1902(v)(4)(A)(i) under section 2107(e)(1), 2 or any other assistance under the State child health 3 plan (or a waiver of such plan) which is provided to 4 women on the basis of being pregnant) shall not 5 have in effect, with respect to such women, eligibility 6 standards, methodologies, or procedures under such 7 plan (or waiver) that are more restrictive than the 8 eligibility standards, methodologies, or procedures, 9 respectively, under such plan (or waiver) that are in 10 effect on the date of enactment of this paragraph.’’. 11 (F) INFORMATION ON BENEFITS.—The 12 Secretary of Health and Human Services shall 13 make publicly available on the internet website 14 of the Department of Health and Human Serv- 15 ices, information regarding benefits available to 16 pregnant and postpartum women and under the 17 Medicaid program and the Children’s Health 18 Insurance Program, including information on— 19 (i) benefits that States are required to 20 provide to pregnant and postpartum 21 women under such programs; 22 (ii) optional benefits that States may 23 provide to pregnant and postpartum 24 women under such programs; and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00400 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 401 •S 4819 IS (iii) the availability of different kinds 1 of benefits for pregnant and postpartum 2 women, including oral health and mental 3 health benefits, under such programs. 4 (G) FEDERAL FUNDING FOR COST OF EX- 5 TENDED MEDICAID AND CHIP COVERAGE FOR 6 POSTPARTUM WOMEN.— 7 (i) MEDICAID.—Section 1905 of the 8 Social Security Act (42 U.S.C. 1396d), as 9 amended by section 433(d), is further 10 amended— 11 (I) in subsection (b), by striking 12 ‘‘and (ff)’’ and inserting ‘‘(ff), and 13 (hh)’’; and 14 (II) by adding at the end the fol- 15 lowing: 16 ‘‘(hh) INCREASED FMAP FOR EXTENDED MEDICAL 17 ASSISTANCE FOR POSTPARTUM WOMEN.—Notwith- 18 standing subsection (b), the Federal medical assistance 19 percentage for a State, with respect to amounts expended 20 by such State for medical assistance for a woman who is 21 eligible for such assistance on the basis of being pregnant 22 or having been pregnant that is provided during the 305- 23 day period that begins on the 60th day after the last day 24 of her pregnancy (including any such assistance provided 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00401 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 402 •S 4819 IS during the month in which such period ends), shall be 1 equal to— 2 ‘‘(1) 100 percent for the first 20 calendar quar- 3 ters during which this subsection is in effect; and 4 ‘‘(2) 90 percent for calendar quarters there- 5 after.’’. 6 (ii) CHIP.—Section 2105(c) of the 7 Social Security Act (42 U.S.C. 1397ee(c)) 8 is amended by adding at the end the fol- 9 lowing new paragraph: 10 ‘‘(12) ENHANCED PAYMENT FOR EXTENDED 11 ASSISTANCE PROVIDED TO PREGNANT WOMEN.— 12 Notwithstanding subsection (b), the enhanced 13 FMAP, with respect to payments under subsection 14 (a) for expenditures under the State child health 15 plan (or a waiver of such plan) for assistance pro- 16 vided under the plan (or waiver) to a woman who is 17 eligible for such assistance on the basis of being 18 pregnant (including pregnancy-related assistance 19 provided to a targeted low-income pregnant woman 20 (as defined in section 2112(d)), pregnancy-related 21 assistance provided to a woman who is eligible for 22 such assistance through application of section 23 1902(v)(4)(A)(i) under section 2107(e)(1), or any 24 other assistance under the plan (or waiver) provided 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00402 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 403 •S 4819 IS to a woman who is eligible for such assistance on the 1 basis of being pregnant) during the 305-day period 2 that begins on the 60th day after the last day of her 3 pregnancy (including any such assistance provided 4 during the month in which such period ends), shall 5 be equal to— 6 ‘‘(A) 100 percent for the first 20 calendar 7 quarters during which this paragraph is in ef- 8 fect; and 9 ‘‘(B) 90 percent for calendar quarters 10 thereafter.’’. 11 (H) EFFECTIVE DATE.— 12 (i) IN GENERAL.—Subject to subpara- 13 graph (B), the amendments made by this 14 subsection shall take effect on the first day 15 of the first calendar quarter that begins on 16 or after the date that is one year after the 17 date of enactment of this Act. 18 (ii) EXCEPTION FOR STATE LEGISLA- 19 TION.—In the case of a State plan under 20 title XIX of the Social Security Act or a 21 State child health plan under title XXI of 22 such Act that the Secretary of Health and 23 Human Services determines requires State 24 legislation in order for the respective plan 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00403 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 404 •S 4819 IS to meet any requirement imposed by 1 amendments made by this subsection, the 2 respective plan shall not be regarded as 3 failing to comply with the requirements of 4 such title solely on the basis of its failure 5 to meet such an additional requirement be- 6 fore the first day of the first calendar 7 quarter beginning after the close of the 8 first regular session of the State legislature 9 that begins after the date of enactment of 10 this Act. For purposes of the previous sen- 11 tence, in the case of a State that has a 2- 12 year legislative session, each year of the 13 session shall be considered to be a separate 14 regular session of the State legislature. 15 (6) REGIONAL CENTERS OF EXCELLENCE.— 16 Part P of title III of the Public Health Service Act 17 (42 U.S.C. 280g et seq.) is amended by adding at 18 the end the following new section: 19 ‘‘SEC. 399V–7. REGIONAL CENTERS OF EXCELLENCE AD- 20 DRESSING IMPLICIT BIAS AND CULTURAL 21 COMPETENCY IN PATIENT-PROVIDER INTER- 22 ACTIONS EDUCATION. 23 ‘‘(a) IN GENERAL.—Not later than one year after the 24 date of enactment of this section, the Secretary, in con- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00404 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 405 •S 4819 IS sultation with such other agency heads as the Secretary 1 determines appropriate, shall award cooperative agree- 2 ments for the establishment or support of regional centers 3 of excellence addressing implicit bias and cultural com- 4 petency in patient-provider interactions education for the 5 purpose of enhancing and improving how health care pro- 6 fessionals are educated in implicit bias and delivering cul- 7 turally competent health care. 8 ‘‘(b) ELIGIBILITY.—To be eligible to receive a cooper- 9 ative agreement under subsection (a), an entity shall— 10 ‘‘(1) be a public or other nonprofit entity speci- 11 fied by the Secretary that provides educational and 12 training opportunities for students and health care 13 professionals, which may be a health system, teach- 14 ing hospital, community health center, medical 15 school, school of public health, dental school, social 16 work school, school of professional psychology, or 17 any other health professional school or program at 18 an institution of higher education (as defined in sec- 19 tion 101 of the Higher Education Act of 1965) fo- 20 cused on the prevention, treatment, or recovery of 21 health conditions that contribute to maternal mor- 22 tality and the prevention of maternal mortality and 23 severe maternal morbidity; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00405 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 406 •S 4819 IS ‘‘(2) demonstrate community engagement and 1 participation, such as through partnerships with 2 home visiting and case management programs; and 3 ‘‘(3) provide to the Secretary such information, 4 at such time and in such manner, as the Secretary 5 may require. 6 ‘‘(c) DIVERSITY.—In awarding a cooperative agree- 7 ment under subsection (a), the Secretary shall take into 8 account any regional differences among eligible entities 9 and make an effort to ensure geographic diversity among 10 award recipients. 11 ‘‘(d) DISSEMINATION OF INFORMATION.— 12 ‘‘(1) PUBLIC AVAILABILITY.—The Secretary 13 shall make publicly available on the internet website 14 of the Department of Health and Human Services 15 information submitted to the Secretary under sub- 16 section (b)(3). 17 ‘‘(2) EVALUATION.—The Secretary shall evalu- 18 ate each regional center of excellence established or 19 supported pursuant to subsection (a) and dissemi- 20 nate the findings resulting from each such evalua- 21 tion to the appropriate public and private entities. 22 ‘‘(3) DISTRIBUTION.—The Secretary shall share 23 evaluations and overall findings with State depart- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00406 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 407 •S 4819 IS ments of health and other relevant State level offices 1 to inform State and local best practices. 2 ‘‘(e) MATERNAL MORTALITY DEFINED.—In this sec- 3 tion, the term ‘maternal mortality’ means death of a 4 woman that occurs during pregnancy or within the one- 5 year period following the end of such pregnancy. 6 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—For 7 purposes of carrying out this section, there is authorized 8 to be appropriated $5,000,000 for each of fiscal years 9 2021 through 2025.’’. 10 (7) SPECIAL SUPPLEMENTAL NUTRITION PRO- 11 GRAM FOR WOMEN, INFANTS, AND CHILDREN.— 12 (A) DEFINITION OF BREASTFEEDING 13 WOMAN.—Section 17(b) of the Child Nutrition 14 Act of 1966 (42 U.S.C. 1786(b)) is amended by 15 striking paragraph (1) and inserting the fol- 16 lowing: 17 ‘‘(1) BREASTFEEDING WOMAN.—The term 18 ‘breastfeeding woman’ means a woman who is not 19 more than 2 years postpartum and is breastfeeding 20 the infant of the woman.’’. 21 (B) CERTIFICATION.—Section 22 17(d)(3)(A)(ii) of the Child Nutrition Act of 23 1966 (42 U.S.C. 1786(d)(3)(A)(ii)) is amend- 24 ed— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00407 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 408 •S 4819 IS (i) by striking the clause designation 1 and heading and all that follows through 2 ‘‘A State’’ and inserting the following: 3 ‘‘(ii) WOMEN.— 4 ‘‘(I) BREASTFEEDING WOMEN.— 5 A State’’; 6 (ii) in subclause (I) (as so des- 7 ignated), by striking ‘‘1 year’’ and all that 8 follows through ‘‘earlier’’ and inserting ‘‘2 9 years postpartum’’; and 10 (iii) by adding at the end the fol- 11 lowing: 12 ‘‘(II) POSTPARTUM WOMEN.—A 13 State may elect to certify a 14 postpartum woman for a period of 2 15 years.’’. 16 (8) DEFINITIONS.—In this section: 17 (A) MATERNAL MORTALITY.—The term 18 ‘‘maternal mortality’’ means death of a woman 19 that occurs during pregnancy or within the one- 20 year period following the end of such preg- 21 nancy. 22 (B) SEVERE MATERNAL MORBIDITY.—The 23 term ‘‘severe maternal morbidity’’ includes un- 24 expected outcomes of labor and delivery that re- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00408 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 409 •S 4819 IS sult in significant short-term or long-term con- 1 sequences to a woman’s health. 2 (d) INCREASING EXCISE TAXES ON CIGARETTES AND 3 ESTABLISHING EXCISE TAX EQUITY AMONG ALL TO- 4 BACCO PRODUCT TAX RATES.— 5 (1) TAX PARITY FOR ROLL-YOUR-OWN TO- 6 BACCO.—Section 5701(g) of the Internal Revenue 7 Code of 1986 is amended by striking ‘‘$24.78’’ and 8 inserting ‘‘$49.56’’. 9 (2) TAX PARITY FOR PIPE TOBACCO.—Section 10 5701(f) of the Internal Revenue Code of 1986 is 11 amended by striking ‘‘$2.8311 cents’’ and inserting 12 ‘‘$49.56’’. 13 (3) TAX PARITY FOR SMOKELESS TOBACCO.— 14 (A) Section 5701(e) of the Internal Rev- 15 enue Code of 1986 is amended— 16 (i) in paragraph (1), by striking 17 ‘‘$1.51’’ and inserting ‘‘$26.84’’; 18 (ii) in paragraph (2), by striking 19 ‘‘50.33 cents’’ and inserting ‘‘$10.74’’; and 20 (iii) by adding at the end the fol- 21 lowing: 22 ‘‘(3) SMOKELESS TOBACCO SOLD IN DISCRETE 23 SINGLE-USE UNITS.—On discrete single-use units, 24 $100.66 per thousand.’’. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00409 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 410 •S 4819 IS (B) Section 5702(m) of such Code is 1 amended— 2 (i) in paragraph (1), by striking ‘‘or 3 chewing tobacco’’ and inserting ‘‘, chewing 4 tobacco, or discrete single-use unit’’; 5 (ii) in paragraphs (2) and (3), by in- 6 serting ‘‘that is not a discrete single-use 7 unit’’ before the period in each such para- 8 graph; and 9 (iii) by adding at the end the fol- 10 lowing: 11 ‘‘(4) DISCRETE SINGLE-USE UNIT.—The term 12 ‘discrete single-use unit’ means any product con- 13 taining tobacco that— 14 ‘‘(A) is not intended to be smoked; and 15 ‘‘(B) is in the form of a lozenge, tablet, 16 pill, pouch, dissolvable strip, or other discrete 17 single-use or single-dose unit.’’. 18 (4) TAX PARITY FOR SMALL CIGARS.—Para- 19 graph (1) of section 5701(a) of the Internal Revenue 20 Code of 1986 is amended by striking ‘‘$50.33’’ and 21 inserting ‘‘$100.66’’. 22 (5) TAX PARITY FOR LARGE CIGARS.— 23 (A) IN GENERAL.—Paragraph (2) of sec- 24 tion 5701(a) of the Internal Revenue Code of 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00410 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 411 •S 4819 IS 1986 is amended by striking ‘‘52.75 percent’’ 1 and all that follows through the period and in- 2 serting the following: ‘‘$49.56 per pound and a 3 proportionate tax at the like rate on all frac- 4 tional parts of a pound but not less than 5 10.066 cents per cigar.’’. 6 (B) GUIDANCE.—The Secretary of the 7 Treasury, or the Secretary’s delegate, may issue 8 guidance regarding the appropriate method for 9 determining the weight of large cigars for pur- 10 poses of calculating the applicable tax under 11 section 5701(a)(2) of the Internal Revenue 12 Code of 1986. 13 (6) TAX PARITY FOR ROLL-YOUR-OWN TOBACCO 14 AND CERTAIN PROCESSED TOBACCO.—Subsection (o) 15 of section 5702 of the Internal Revenue Code of 16 1986 is amended by inserting ‘‘, and includes proc- 17 essed tobacco that is removed for delivery or deliv- 18 ered to a person other than a person with a permit 19 provided under section 5713, but does not include 20 removals of processed tobacco for exportation’’ after 21 ‘‘wrappers thereof’’. 22 (7) CLARIFYING TAX RATE FOR OTHER TO- 23 BACCO PRODUCTS.— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00411 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 412 •S 4819 IS (A) IN GENERAL.—Section 5701 of the In- 1 ternal Revenue Code of 1986 is amended by 2 adding at the end the following new subsection: 3 ‘‘(i) OTHER TOBACCO PRODUCTS.—Any product not 4 otherwise described under this section that has been deter- 5 mined to be a tobacco product by the Food and Drug Ad- 6 ministration through its authorities under the Family 7 Smoking Prevention and Tobacco Control Act shall be 8 taxed at a level of tax equivalent to the tax rate for ciga- 9 rettes on an estimated per use basis as determined by the 10 Secretary.’’. 11 (B) ESTABLISHING PER USE BASIS.—For 12 purposes of section 5701(i) of the Internal Rev- 13 enue Code of 1986, not later than 12 months 14 after the later of the date of the enactment of 15 this Act or the date that a product has been de- 16 termined to be a tobacco product by the Food 17 and Drug Administration, the Secretary of the 18 Treasury (or the Secretary of the Treasury’s 19 delegate) shall issue final regulations estab- 20 lishing the level of tax for such product that is 21 equivalent to the tax rate for cigarettes on an 22 estimated per use basis. 23 (8) CLARIFYING DEFINITION OF TOBACCO 24 PRODUCTS.— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00412 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 413 •S 4819 IS (A) IN GENERAL.—Subsection (c) of sec- 1 tion 5702 of the Internal Revenue Code of 1986 2 is amended to read as follows: 3 ‘‘(c) TOBACCO PRODUCTS.—The term ‘tobacco prod- 4 ucts’ means— 5 ‘‘(1) cigars, cigarettes, smokeless tobacco, pipe 6 tobacco, and roll-your-own tobacco, and 7 ‘‘(2) any other product subject to tax pursuant 8 to section 5701(i).’’. 9 (B) CONFORMING AMENDMENTS.—Sub- 10 section (d) of section 5702 of such Code is 11 amended by striking ‘‘cigars, cigarettes, smoke- 12 less tobacco, pipe tobacco, or roll-your-own to- 13 bacco’’ each place it appears and inserting ‘‘to- 14 bacco products’’. 15 (9) INCREASING TAX ON CIGARETTES.— 16 (A) SMALL CIGARETTES.—Section 17 5701(b)(1) of such Code is amended by striking 18 ‘‘$50.33’’ and inserting ‘‘$100.66’’. 19 (B) LARGE CIGARETTES.—Section 20 5701(b)(2) of such Code is amended by striking 21 ‘‘$105.69’’ and inserting ‘‘$211.38’’. 22 (10) TAX RATES ADJUSTED FOR INFLATION.— 23 Section 5701 of such Code, as amended by sub- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00413 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 414 •S 4819 IS section (g), is amended by adding at the end the fol- 1 lowing new subsection: 2 ‘‘(j) INFLATION ADJUSTMENT.— 3 ‘‘(1) IN GENERAL.—In the case of any calendar 4 year beginning after 2018, the dollar amounts pro- 5 vided under this chapter shall each be increased by 6 an amount equal to— 7 ‘‘(A) such dollar amount, multiplied by 8 ‘‘(B) the cost-of-living adjustment deter- 9 mined under section 1(f)(3) for the calendar 10 year, determined by substituting ‘calendar year 11 2017’ for ‘calendar year 2016’ in subparagraph 12 (A)(ii) thereof. 13 ‘‘(2) ROUNDING.—If any amount as adjusted 14 under paragraph (1) is not a multiple of $0.01, such 15 amount shall be rounded to the next highest multiple 16 of $0.01.’’. 17 (11) FLOOR STOCKS TAXES.— 18 (A) IMPOSITION OF TAX.—On tobacco 19 products manufactured in or imported into the 20 United States which are removed before any tax 21 increase date and held on such date for sale by 22 any person, there is hereby imposed a tax in an 23 amount equal to the excess of— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00414 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 415 •S 4819 IS (i) the tax which would be imposed 1 under section 5701 of the Internal Rev- 2 enue Code of 1986 on the article if the ar- 3 ticle had been removed on such date, over 4 (ii) the prior tax (if any) imposed 5 under section 5701 of such Code on such 6 article. 7 (B) CREDIT AGAINST TAX.—Each person 8 shall be allowed as a credit against the taxes 9 imposed by paragraph (1) an amount equal to 10 $500. Such credit shall not exceed the amount 11 of taxes imposed by paragraph (1) on such date 12 for which such person is liable. 13 (C) LIABILITY FOR TAX AND METHOD OF 14 PAYMENT.— 15 (i) LIABILITY FOR TAX.—A person 16 holding tobacco products on any tax in- 17 crease date to which any tax imposed by 18 paragraph (1) applies shall be liable for 19 such tax. 20 (ii) METHOD OF PAYMENT.—The tax 21 imposed by paragraph (1) shall be paid in 22 such manner as the Secretary shall pre- 23 scribe by regulations. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00415 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 416 •S 4819 IS (iii) TIME FOR PAYMENT.—The tax 1 imposed by paragraph (1) shall be paid on 2 or before the date that is 120 days after 3 the effective date of the tax rate increase. 4 (D) ARTICLES IN FOREIGN TRADE 5 ZONES.—Notwithstanding the Act of June 18, 6 1934 (commonly known as the Foreign Trade 7 Zone Act, 48 Stat. 998, 19 U.S.C. 81a et seq.), 8 or any other provision of law, any article which 9 is located in a foreign trade zone on any tax in- 10 crease date shall be subject to the tax imposed 11 by paragraph (1) if— 12 (i) internal revenue taxes have been 13 determined, or customs duties liquidated, 14 with respect to such article before such 15 date pursuant to a request made under the 16 1st proviso of section 3(a) of such Act; or 17 (ii) such article is held on such date 18 under the supervision of an officer of the 19 United States Customs and Border Protec- 20 tion of the Department of Homeland Secu- 21 rity pursuant to the 2d proviso of such sec- 22 tion 3(a). 23 (E) DEFINITIONS.—For purposes of this 24 subsection— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00416 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 417 •S 4819 IS (i) IN GENERAL.—Any term used in 1 this subsection which is also used in sec- 2 tion 5702 of such Code shall have the 3 same meaning as such term has in such 4 section. 5 (ii) TAX INCREASE DATE.—The term 6 ‘‘tax increase date’’ means the effective 7 date of any increase in any tobacco prod- 8 uct excise tax rate pursuant to the amend- 9 ments made by this section (other than 10 subsection (j) thereof). 11 (iii) SECRETARY.—The term ‘‘Sec- 12 retary’’ means the Secretary of the Treas- 13 ury or the Secretary’s delegate. 14 (F) CONTROLLED GROUPS.—Rules similar 15 to the rules of section 5061(e)(3) of such Code 16 shall apply for purposes of this subsection. 17 (G) OTHER LAWS APPLICABLE.—All provi- 18 sions of law, including penalties, applicable with 19 respect to the taxes imposed by section 5701 of 20 such Code shall, insofar as applicable and not 21 inconsistent with the provisions of this sub- 22 section, apply to the floor stocks taxes imposed 23 by paragraph (1), to the same extent as if such 24 taxes were imposed by such section 5701. The 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00417 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 418 •S 4819 IS Secretary may treat any person who bore the 1 ultimate burden of the tax imposed by para- 2 graph (1) as the person to whom a credit or re- 3 fund under such provisions may be allowed or 4 made. 5 (12) EFFECTIVE DATES.— 6 (A) IN GENERAL.—Except as provided in 7 paragraphs (2) through (4), the amendments 8 made by this section shall apply to articles re- 9 moved (as defined in section 5702(j) of the In- 10 ternal Revenue Code of 1986) after the last day 11 of the month which includes the date of the en- 12 actment of this Act. 13 (B) DISCRETE SINGLE-USE UNITS AND 14 PROCESSED TOBACCO.—The amendments made 15 by subsections (c)(1)(C), (c)(2), and (f) shall 16 apply to articles removed (as defined in section 17 5702(j) of the Internal Revenue Code of 1986) 18 after the date that is 6 months after the date 19 of the enactment of this Act. 20 (C) LARGE CIGARS.—The amendments 21 made by subsection (e) shall apply to articles 22 removed after December 31, 2021. 23 (D) OTHER TOBACCO PRODUCTS.—The 24 amendments made by subsection (g)(1) shall 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00418 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 419 •S 4819 IS apply to products removed after the last day of 1 the month which includes the date that the Sec- 2 retary of the Treasury (or the Secretary of the 3 Treasury’s delegate) issues final regulations es- 4 tablishing the level of tax for such product. 5 SEC. 506. RURAL MATERNAL AND OBSTETRIC MODERNIZA- 6 TION OF SERVICES. 7 (a) SHORT TITLE.—This section may be cited as the 8 ‘‘Rural Maternal and Obstetric Modernization of Services 9 Act’’ or the ‘‘Rural MOMS Act’’. 10 (b) IMPROVING RURAL MATERNAL AND OBSTETRIC 11 CARE DATA.— 12 (1) MATERNAL MORTALITY AND MORBIDITY AC- 13 TIVITIES.—Section 301 of the Public Health Service 14 Act (42 U.S.C. 241) is amended— 15 (A) by redesignating subsections (e) 16 through (h) as subsections (f) through (i), re- 17 spectively; and 18 (B) by inserting after subsection (d), the 19 following: 20 ‘‘(e) The Secretary, acting through the Director of 21 the Centers for Disease Control and Prevention, shall ex- 22 pand, intensify, and coordinate the activities of the Cen- 23 ters for Disease Control and Prevention with respect to 24 maternal mortality and morbidity.’’. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00419 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 420 •S 4819 IS (2) OFFICE OF WOMEN’S HEALTH.—Section 1 310A(b)(1) of the Public Health Service Act (42 2 U.S.C. 242s(b)(1)) is amended by striking ‘‘and 3 sociocultural contexts’’ and inserting ‘‘sociocultural 4 (including race, ethnicity, language, class, and in- 5 come) contexts, including among Indians (as defined 6 in section 4 of the Indian Health Care Improvement 7 Act), and geographic contexts,’’ after ‘‘biological,’’. 8 (3) SAFE MOTHERHOOD.—Section 317K(b)(2) 9 of the Public Health Service Act (42 U.S.C. 247b– 10 12(b)(2)) is amended— 11 (A) in subparagraph (L), by striking 12 ‘‘and’’ at the end; 13 (B) by redesignating subparagraph (M) as 14 subparagraph (N); and 15 (C) by inserting after subparagraph (L), 16 the following: 17 ‘‘(M) an examination of the relationship 18 between maternal health services in rural areas 19 and outcomes in delivery and postpartum care; 20 and’’. 21 (4) OFFICE OF RESEARCH ON WOMEN’S 22 HEALTH.—Section 486 of the Public Health Service 23 Act (42 U.S.C. 287d) is amended— 24 (A) in subsection (b)— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00420 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 421 •S 4819 IS (i) by redesignating paragraphs (4) 1 through (9) as paragraphs (5) through 2 (10), respectively; 3 (ii) by inserting after paragraph (3) 4 the following: 5 ‘‘(4) carry out paragraphs (1) and (2) with re- 6 spect to pregnancy, with priority given to deaths re- 7 lated to pregnancy;’’; and 8 (iii) in paragraph (5) (as so redesig- 9 nated), by striking ‘‘through (3)’’ and in- 10 serting ‘‘through (4)’’; and 11 (B) in subsection (d)(4)(A)(iv), by insert- 12 ing ‘‘, including maternal mortality and other 13 maternal morbidity outcomes’’ before the semi- 14 colon. 15 (c) RURAL OBSTETRIC NETWORK GRANTS.—The 16 Public Health Service Act is amended by inserting after 17 section 317L–1 (42 U.S.C. 247b–13a) the following: 18 ‘‘SEC. 317L–2. RURAL OBSTETRIC NETWORK GRANTS. 19 ‘‘(a) IN GENERAL.—For the purpose of enabling the 20 Secretary (through grants, contracts, or otherwise), acting 21 through the Administrator of the Health Resources and 22 Services Administration, to establish collaborative im- 23 provement and innovation networks (referred to in this 24 section as ‘rural obstetric networks’) to improve outcomes 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00421 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 422 •S 4819 IS in birth and maternal morbidity and mortality, there is 1 appropriated to the Secretary, out of any money in the 2 Treasury not otherwise appropriated, $3,000,000 for each 3 of fiscal years 2021 through 2025. Such amounts shall 4 remain available until expended. 5 ‘‘(b) USE OF FUNDS.—Amounts appropriated under 6 subsection (a) shall be used for the establishment of col- 7 laborative improvement and innovation networks to im- 8 prove maternal health in rural areas by improving out- 9 comes in birth and maternal morbidity and mortality. 10 Rural obstetric networks established in accordance with 11 this section shall— 12 ‘‘(1) assist pregnant women and other individ- 13 uals in rural areas in connecting with prenatal, labor 14 and birth, and postpartum care to improve outcomes 15 in birth and maternal mortality and morbidity; 16 ‘‘(2) identify successful prenatal, labor and 17 birth, and postpartum health delivery models for in- 18 dividuals in rural areas, including evidence-based 19 home visiting programs and successful, culturally 20 competent models with positive maternal health out- 21 comes that advance health equity; 22 ‘‘(3) develop a model for collaboration between 23 health facilities that have an obstetric health unit 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00422 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 423 •S 4819 IS and health facilities that do not have an obstetric 1 health unit; 2 ‘‘(4) provide training and guidance for health 3 facilities that do not have obstetric health units; 4 ‘‘(5) collaborate with academic institutions that 5 can provide regional expertise and research on ac- 6 cess, outcomes, needs assessments, and other identi- 7 fied data; and 8 ‘‘(6) measure and address inequities in birth 9 outcomes among rural residents, with an emphasis 10 on Black residents and residents who are Indians 11 (as defined in section 4 of the Indian Health Care 12 Improvement Act). 13 ‘‘(c) REQUIREMENTS FOR ESTABLISHMENT.—Not 14 later than 6 months after the date of enactment of this 15 section, the Secretary shall establish rural obstetric health 16 networks in at least 5 regions. 17 ‘‘(d) DEFINITIONS.—In this section: 18 ‘‘(1) FRONTIER AREA.—The term ‘frontier 19 area’ means a frontier county, as defined in section 20 1886(d)(3)(E)(iii)(III) of the Social Security Act. 21 ‘‘(2) INDIAN; INDIAN TRIBE.—The terms ‘In- 22 dian’ and ‘Indian tribe’ have the meanings given 23 such terms in section 4 of the Indian Health Care 24 Improvement Act. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00423 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 424 •S 4819 IS ‘‘(3) REGION.—The term ‘region’ means a 1 State, Indian tribe, rural area, or frontier area. 2 ‘‘(4) RURAL AREA.—The term ‘rural area’ has 3 the meaning given that term in section 4 1886(d)(2)(D) of the Social Security Act. 5 ‘‘(5) STATE.—The term ‘State’ has the mean- 6 ing given that term for purposes of title V of the So- 7 cial Security Act.’’. 8 (d) TELEHEALTH NETWORK AND TELEHEALTH RE- 9 SOURCE CENTERS GRANT PROGRAMS.—Section 330I of 10 the Public Health Service Act (42 U.S.C. 254c–14) is 11 amended— 12 (1) in subsection (f)(3), by adding at the end 13 the following: 14 ‘‘(M) Providers of maternal care services, 15 including prenatal, labor and birth, and 16 postpartum care services, and entities operating 17 obstetric care units.’’; 18 (2) in subsection (h)(1)(B), by striking ‘‘or pre- 19 natal’’ and inserting ‘‘or prenatal, labor and birth, 20 or postpartum’’; and 21 (3) in subsection (j)(1)(B), by inserting ‘‘equip- 22 ment useful for caring for pregnant individuals, in- 23 cluding ultrasound machines and fetal monitoring 24 equipment, and other’’ before ‘‘equipment’’. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00424 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 425 •S 4819 IS (e) RURAL MATERNAL AND OBSTETRIC CARE TRAIN- 1 ING DEMONSTRATION.—Part D of title VII of the Public 2 Health Service Act is amended by inserting after section 3 760 (42 U.S.C. 294k) the following: 4 ‘‘SEC. 760A. RURAL MATERNAL AND OBSTETRIC CARE 5 TRAINING DEMONSTRATION. 6 ‘‘(a) IN GENERAL.—The Secretary shall establish a 7 training demonstration program to award to eligible enti- 8 ties— 9 ‘‘(1) grants to support training for physicians, 10 medical residents, and fellows (including physicians, 11 residents, and fellows in family medicine and obstet- 12 rics and gynecology) to practice maternal and ob- 13 stetric medicine in rural community-based settings; 14 ‘‘(2) grants to support training for licensed and 15 accredited nurse practitioners, physician assistants, 16 certified nurse midwives, certified midwives, certified 17 professional midwives, home visiting nurses, or non- 18 clinical professionals such as doulas and community 19 health workers, to provide maternal care services in 20 rural community-based settings; and 21 ‘‘(3) grants to— 22 ‘‘(A) support establishing, maintaining, or 23 improving academic units or programs that pro- 24 vide training for students or faculty, including 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00425 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 426 •S 4819 IS through clinical experiences and research, to 1 improve maternal care in rural areas; or 2 ‘‘(B) develop evidence-based practices or 3 recommendations for the design of the units or 4 programs described in subparagraph (A), in- 5 cluding curriculum content standards. 6 ‘‘(b) ACTIVITIES.— 7 ‘‘(1) TRAINING FOR PHYSICIANS, MEDICAL 8 RESIDENTS, AND FELLOWS.—A recipient of a grant 9 under subsection (a)(1)— 10 ‘‘(A) shall use the grant funds to plan, de- 11 velop, and operate a training program for the 12 physicians, medical residents, and fellows de- 13 scribed in subsection (a)(1) to provide maternal 14 and obstetric health care services in rural com- 15 munity-based settings; and 16 ‘‘(B) may use the grant funds to provide 17 additional support for the administration of the 18 program or to meet the costs of projects to es- 19 tablish, maintain, or improve faculty develop- 20 ment, or departments, divisions, or other units 21 necessary to implement such training. 22 ‘‘(2) TRAINING FOR OTHER PROVIDERS.—A re- 23 cipient of a grant under subsection (a)(2)— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00426 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 427 •S 4819 IS ‘‘(A) shall use the grant funds to plan, de- 1 velop, or operate a training program for the in- 2 dividuals described in subsection (a)(2) to pro- 3 vide maternal health care services in rural, com- 4 munity-based settings; and 5 ‘‘(B) may use the grant funds to provide 6 additional support for the administration of the 7 program or to meet the costs of projects to es- 8 tablish, maintain, or improve faculty develop- 9 ment, or departments, divisions, or other units 10 necessary to implement such program. 11 ‘‘(3) ACADEMIC UNITS OR PROGRAMS.—A re- 12 cipient of a grant under subsection (a)(3) shall enter 13 into a partnership with organizations such as an 14 education accrediting organization (such as the Liai- 15 son Committee on Medical Education, the Accredita- 16 tion Council for Graduate Medical Education, the 17 Commission on Osteopathic College Accreditation, 18 the Accreditation Commission for Education in 19 Nursing, the Commission on Collegiate Nursing 20 Education, the Accreditation Commission for Mid- 21 wifery Education, or the Accreditation Review Com- 22 mission on Education for the Physician Assistant) to 23 carry out activities under subsection (a)(3). 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00427 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 428 •S 4819 IS ‘‘(4) TRAINING PROGRAM REQUIREMENTS.— 1 The recipient of a grant under subsection (a)(1) or 2 (a)(2) shall ensure that training programs carried 3 out under the grant include instruction on— 4 ‘‘(A) maternal mental health, including 5 perinatal depression and anxiety and 6 postpartum depression; 7 ‘‘(B) maternal substance use disorder; 8 ‘‘(C) social determinants of health that im- 9 pact individuals living in rural communities, in- 10 cluding poverty, social isolation, access to nutri- 11 tion, education, transportation, and housing; 12 and 13 ‘‘(D) implicit bias. 14 ‘‘(c) ELIGIBLE ENTITIES.— 15 ‘‘(1) TRAINING FOR PHYSICIANS, MEDICAL 16 RESIDENTS, AND FELLOWS.—To be eligible to re- 17 ceive a grant under subsection (a)(1), an entity 18 shall— 19 ‘‘(A) be a consortium consisting of— 20 ‘‘(i) at least one teaching health cen- 21 ter (as defined in section 749A(f)); or 22 ‘‘(ii) the sponsoring institution (or 23 parent institution of the sponsoring insti- 24 tution) of— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00428 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 429 •S 4819 IS ‘‘(I) an obstetrics and gynecology 1 or family medicine residency program 2 that is accredited by the Accreditation 3 Council for Graduate Medical Edu- 4 cation (or the parent institution of 5 such a program); or 6 ‘‘(II) a fellowship in maternal or 7 obstetric medicine, as determined ap- 8 propriate by the Secretary; or 9 ‘‘(B) be an entity described in subpara- 10 graph (A)(ii) that provides opportunities for 11 medical residents or fellows to train in rural 12 community-based settings. 13 ‘‘(2) TRAINING FOR OTHER PROVIDERS.—To be 14 eligible to receive a grant under subsection (a)(2), 15 an entity shall be— 16 ‘‘(A) a teaching health center (as defined 17 in section 749A(f)); 18 ‘‘(B) a federally qualified health center (as 19 defined in section 1905(l)(2)(B) of the Social 20 Security Act); 21 ‘‘(C) a community mental health center (as 22 defined in section 1861(ff)(3)(B) of the Social 23 Security Act); 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00429 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 430 •S 4819 IS ‘‘(D) a rural health clinic (as defined in 1 section 1861(aa) of the Social Security Act); 2 ‘‘(E) a freestanding birth center (as de- 3 fined in section 1905(l)(3) of the Social Secu- 4 rity Act); 5 ‘‘(F) a health center operated by— 6 ‘‘(i) the Indian Health Service, an In- 7 dian tribe, or a tribal organization (as such 8 terms are defined in section 4 of the In- 9 dian Health Care Improvement Act); or 10 ‘‘(ii) a Native Hawaiian Health Care 11 System (as defined in section 12 of the 12 Native Hawaiian Health Care Improve- 13 ment Act); or 14 ‘‘(G) an entity with a demonstrated record 15 of success in providing academic training for 16 nurse practitioners, physician assistants, cer- 17 tified nurse-midwives, certified midwives, cer- 18 tified professional midwives, home visiting 19 nurses, or non-clinical professionals, such as 20 doulas and community health workers. 21 ‘‘(3) ACADEMIC UNITS OR PROGRAMS.—To be 22 eligible to receive a grant under subsection (a)(3), 23 an entity shall be a school of medicine or osteopathic 24 medicine, a nursing school, a physician assistant 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00430 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 431 •S 4819 IS training program, an accredited public or nonprofit 1 private hospital, an accredited medical residency pro- 2 gram, a school accredited by the Midwifery Edu- 3 cation and Accreditation Council, or a public or pri- 4 vate nonprofit entity which the Secretary has deter- 5 mined is capable of carrying out activities supported 6 by such grant. 7 ‘‘(4) APPLICATION.—To be eligible to receive a 8 grant under subsection (a), an entity shall submit to 9 the Secretary an application at such time, in such 10 manner, and containing such information as the Sec- 11 retary may require, including an estimate of the 12 amount to be expended to conduct training activities 13 under the grant (including ancillary and administra- 14 tive costs). 15 ‘‘(d) DURATION.—Grants awarded under this section 16 shall be for a minimum of 5 years. 17 ‘‘(e) STUDY AND REPORT.— 18 ‘‘(1) STUDY.— 19 ‘‘(A) IN GENERAL.—The Secretary, acting 20 through the Administrator of the Health Re- 21 sources and Services Administration, shall con- 22 duct a study on the results of the demonstra- 23 tion program under this section. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00431 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 432 •S 4819 IS ‘‘(B) DATA SUBMISSION.—Not later than 1 90 days after the completion of the first year 2 of the training program, and each subsequent 3 year for the duration of the grant, that the pro- 4 gram is in effect, each recipient of a grant 5 under subsection (a) shall submit to the Sec- 6 retary such data as the Secretary may require 7 for analysis for the report described in para- 8 graph (2). 9 ‘‘(2) REPORT TO CONGRESS.—Not later than 1 10 year after receipt of the data described in paragraph 11 (1)(B), the Secretary shall submit to Congress a re- 12 port that includes— 13 ‘‘(A) an analysis of the effect of the dem- 14 onstration program under this section on the 15 quality, quantity, and distribution of maternal, 16 including prenatal, labor and birth, and 17 postpartum care services and the demographics 18 of the recipients of those services; 19 ‘‘(B) an analysis of maternal and infant 20 health outcomes (including quality of care, mor- 21 bidity, and mortality) before and after imple- 22 mentation of the program in the communities 23 served by entities participating in the dem- 24 onstration; and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00432 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 433 •S 4819 IS ‘‘(C) recommendations on whether the 1 demonstration program under this section 2 should be expanded. 3 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 4 are authorized to be appropriated to carry out this section, 5 $5,000,000 for each of fiscal years 2021 through 2025.’’. 6 (f) GAO REPORT.—Not later than 1 year after the 7 date of enactment of this Act, the Comptroller General 8 of the United States shall submit to the appropriate com- 9 mittees of Congress a report on the maternal, including 10 prenatal, labor and birth, and postpartum, care in rural 11 areas. Such report shall include the following: 12 (1) The location of gaps in maternal and ob- 13 stetric clinicians and health professionals, including 14 non-clinical professionals such as doulas and com- 15 munity health workers. 16 (2) The location of gaps in facilities able to pro- 17 vide maternal, including prenatal, labor and birth, 18 and postpartum, care in rural areas, including care 19 for high-risk pregnancies. 20 (3) The gaps in data on maternal mortality and 21 recommendations to standardize the format on col- 22 lecting data related to maternal mortality and mor- 23 bidity. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00433 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 434 •S 4819 IS (4) The gaps in maternal health by race and 1 ethnicity in rural communities, with a focus on ra- 2 cial inequities for Black residents and among Indian 3 Tribes and residents who are Indian (as such terms 4 are defined in section 4 of the Indian Health Care 5 Improvement Act). 6 (5) A list of specific activities that the Sec- 7 retary of Health and Human Services plans to con- 8 duct on maternal, including prenatal, labor and 9 birth, and postpartum, care. 10 (6) A plan for completing such activities. 11 (7) An explanation of Federal agency involve- 12 ment and coordination needed to conduct such ac- 13 tivities. 14 (8) A budget for conducting such activities. 15 (9) Other information that the Comptroller 16 General determines appropriate. 17 SEC. 507. DECREASING THE RISK FACTORS FOR SUDDEN 18 UNEXPECTED INFANT DEATH AND SUDDEN 19 UNEXPLAINED DEATH IN CHILDHOOD. 20 (a) ESTABLISHMENT.—The Secretary of Health and 21 Human Services, acting through the Administrator of the 22 Health Resources and Services Administration and in con- 23 sultation with the Director of the Centers for Disease Con- 24 trol and Prevention and the Director of the National Insti- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00434 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 435 •S 4819 IS tutes of Health (in this section referred to as the ‘‘Sec- 1 retary’’), shall establish and implement a culturally and 2 linguistically competent public health awareness and edu- 3 cation campaign to provide information that is focused on 4 decreasing the risk factors for sudden unexpected infant 5 death and sudden unexplained death in childhood, includ- 6 ing educating individuals about safe sleep environments, 7 sleep positions, and reducing exposure to smoking during 8 pregnancy and after birth. 9 (b) TARGETED POPULATIONS.—The campaign under 10 subsection (a) shall be designed to reduce health dispari- 11 ties through the targeting of populations with high rates 12 of sudden unexpected infant death and sudden unex- 13 plained death in childhood. 14 (c) CONSULTATION.—In establishing and imple- 15 menting the campaign under subsection (a), the Secretary 16 shall consult with national organizations representing 17 health care providers, including nurses and physicians, 18 parents, child care providers, children’s advocacy and safe- 19 ty organizations, maternal and child health programs, nu- 20 trition professionals focusing on women, infants, and chil- 21 dren, and other individuals and groups determined nec- 22 essary by the Secretary for such establishment and imple- 23 mentation. 24 (d) GRANTS.— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00435 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 436 •S 4819 IS (1) IN GENERAL.—In carrying out the cam- 1 paign under subsection (a), the Secretary shall 2 award grants to national organizations, State and 3 local health departments, and community-based or- 4 ganizations for the conduct of education and out- 5 reach programs for nurses, parents, child care pro- 6 viders, public health agencies, and community orga- 7 nizations. 8 (2) APPLICATION.—To be eligible to receive a 9 grant under paragraph (1), an entity shall submit to 10 the Secretary an application at such time, in such 11 manner, and containing such information as the Sec- 12 retary may require. 13 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 14 authorized to be appropriated to carry out this section 15 such sums as may be necessary for each of fiscal years 16 2021 through 2025. 17 SEC. 508. REDUCING UNINTENDED TEENAGE PREG- 18 NANCIES. 19 Title III of the Public Health Service Act (42 U.S.C. 20 241 et seq.) is amended by adding at the end the fol- 21 lowing: 22 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00436 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 437 •S 4819 IS ‘‘PART W—YOUTH ACCESS TO SEXUAL HEALTH 1 SERVICES 2 ‘‘SEC. 399OO. AUTHORIZATION OF GRANTS TO SUPPORT 3 THE ACCESS OF MARGINALIZED YOUTH TO 4 SEXUAL HEALTH SERVICES. 5 ‘‘(a) GRANTS.—The Secretary may award grants on 6 a competitive basis to eligible entities to support the access 7 of marginalized youth to sexual health services. 8 ‘‘(b) USE OF FUNDS.—An eligible entity that is 9 awarded a grant under subsection (a) may use the funds 10 to— 11 ‘‘(1) provide medically accurate and complete 12 and age-, developmentally, and culturally appro- 13 priate sexual health information to marginalized 14 youth, including information on how to access sexual 15 health services; 16 ‘‘(2) promote effective communication regarding 17 sexual health among marginalized youth; 18 ‘‘(3) promote and support better health, edu- 19 cation, and economic opportunities for school-age 20 parents; and 21 ‘‘(4) train individuals who work with 22 marginalized youth to promote— 23 ‘‘(A) the prevention of unintended preg- 24 nancy; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00437 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 438 •S 4819 IS ‘‘(B) the prevention of sexually transmitted 1 infections, including the human immuno- 2 deficiency virus (HIV); 3 ‘‘(C) healthy relationships; and 4 ‘‘(D) the development of safe and sup- 5 portive environments. 6 ‘‘(c) APPLICATION.—To be awarded a grant under 7 subsection (a), an eligible entity shall submit an applica- 8 tion to the Secretary at such time, in such manner, and 9 containing such information as the Secretary may require. 10 ‘‘(d) PRIORITY.—In awarding grants under sub- 11 section (a), the Secretary shall give priority to eligible enti- 12 ties— 13 ‘‘(1) with a history of supporting the access of 14 marginalized youth to sexuality education or sexual 15 health services; and 16 ‘‘(2) that plan to serve marginalized youth that 17 are not served by Federal adolescent programs for 18 the prevention of pregnancy, HIV, and other sexu- 19 ally transmitted infections. 20 ‘‘(e) REQUIREMENTS.—The Secretary may not award 21 a grant under subsection (a) to an eligible entity unless— 22 ‘‘(1) such eligible entity has formed a partner- 23 ship with a community organization; and 24 ‘‘(2) such eligible entity agrees— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00438 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 439 •S 4819 IS ‘‘(A) to employ a scientifically effective 1 strategy; 2 ‘‘(B) that all information provided to 3 marginalized youth will be— 4 ‘‘(i) age- and developmentally appro- 5 priate; 6 ‘‘(ii) medically accurate and complete; 7 ‘‘(iii) scientifically based; and 8 ‘‘(iv) provided in the language and 9 cultural context that is most appropriate 10 for the individuals served by the eligible 11 entity; and 12 ‘‘(C) that for each year the eligible entity 13 receives grant funds under subsection (a), the 14 eligible entity will submit to the Secretary an 15 annual report that includes— 16 ‘‘(i) the use of grant funds by the eli- 17 gible entity; 18 ‘‘(ii) how the use of grant funds has 19 increased the access of marginalized youth 20 to sexual health services; and 21 ‘‘(iii) such other information as the 22 Secretary may require. 23 ‘‘(f) PUBLICATION AND EVALUATIONS.— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00439 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 440 •S 4819 IS ‘‘(1) EVALUATIONS.—Not less than once every 1 two years after the date of the enactment of this 2 part, the Secretary shall evaluate the effectiveness of 3 whichever of the following is greater: 4 ‘‘(A) Eight grants awarded under sub- 5 section (a). 6 ‘‘(B) Ten percent of the grants awarded 7 under subsection (a). 8 ‘‘(2) PUBLICATION.—The Secretary shall make 9 available to the public— 10 ‘‘(A) the evaluations required under para- 11 graph (1); and 12 ‘‘(B) the reports required under subsection 13 (e)(2)(C). 14 ‘‘(g) LIMITATIONS.—No funds made available to an 15 eligible entity under this section may be used by such enti- 16 ty to provide access to sexual health services that— 17 ‘‘(1) withhold sexual health-promoting or life- 18 saving information; 19 ‘‘(2) are medically inaccurate or have been sci- 20 entifically shown to be ineffective; 21 ‘‘(3) promote gender stereotypes; 22 ‘‘(4) are insensitive or unresponsive to the 23 needs of young people, including— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00440 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 441 •S 4819 IS ‘‘(A) youth with varying gender identities, 1 gender expressions, and sexual orientations; 2 ‘‘(B) sexually active youth; 3 ‘‘(C) pregnant or parenting youth; 4 ‘‘(D) survivors of sexual abuse or assault; 5 and 6 ‘‘(E) youth of all physical, developmental, 7 and mental abilities; or 8 ‘‘(5) are inconsistent with the ethical impera- 9 tives of medicine and public health. 10 ‘‘(h) TRANSFER OF FUNDS.—Any unobligated bal- 11 ance of funds made available under section 510(f) of the 12 Social Security Act (as in effect on the day before the date 13 of the enactment of this part) are hereby transferred and 14 made available to the Secretary to carry out this section. 15 The amounts transferred and made available to carry out 16 this section shall remain available until expended. 17 ‘‘(i) DEFINITIONS.—In this section: 18 ‘‘(1) COMMUNITY ORGANIZATION.—The term 19 ‘community organization’ includes a State or local 20 health or education agency, public school, youth-fo- 21 cused organization that is faith-based and commu- 22 nity-based, juvenile justice entity, or other organiza- 23 tion that provides confidential and appropriate sexu- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00441 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 442 •S 4819 IS ality education or sexual health services to 1 marginalized youth. 2 ‘‘(2) ELIGIBLE ENTITY.—The term ‘eligible en- 3 tity’ includes a State or local health or education 4 agency, public school, nonprofit organization, hos- 5 pital, or an Indian Tribe or Tribal organization (as 6 such terms are defined in section 4 of the Indian 7 Self-Determination and Education Assistance Act 8 (25 U.S.C. 5304)). 9 ‘‘(3) MARGINALIZED YOUTH.—The term 10 ‘marginalized youth’ means a person under the age 11 of 26 that is disadvantaged by underlying structural 12 barriers and social inequity. 13 ‘‘(4) MEDICALLY ACCURATE AND COMPLETE.— 14 The term ‘medically accurate and complete’, when 15 used with respect to information, means information 16 that— 17 ‘‘(A) is supported by research and recog- 18 nized as accurate, objective, and complete by 19 leading medical, psychological, psychiatric, or 20 public health organizations and agencies; and 21 ‘‘(B) does not withhold any information re- 22 lating to the effectiveness and benefits of cor- 23 rect and consistent use of condoms or other 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00442 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 443 •S 4819 IS contraceptives and pregnancy prevention meth- 1 ods. 2 ‘‘(5) SCIENTIFICALLY EFFECTIVE STRATEGY.— 3 The term ‘scientifically effective strategy’ means a 4 strategy that— 5 ‘‘(A) is widely recognized by leading med- 6 ical and public health agencies as effective in 7 promoting sexual health awareness and healthy 8 behavior; and 9 ‘‘(B) either— 10 ‘‘(i) has been demonstrated to be ef- 11 fective on the basis of rigorous scientific 12 research; or 13 ‘‘(ii) incorporates characteristics of ef- 14 fective programs. 15 ‘‘(6) SEXUAL HEALTH SERVICES.—The term 16 ‘sexual health services’ includes— 17 ‘‘(A) sexual health information, education, 18 and counseling; 19 ‘‘(B) contraception; 20 ‘‘(C) emergency contraception; 21 ‘‘(D) condoms and other barrier methods 22 to prevent pregnancy or sexually transmitted in- 23 fections; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00443 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 444 •S 4819 IS ‘‘(E) routine gynecological care, including 1 human papillomavirus (HPV) vaccines and can- 2 cer screenings; 3 ‘‘(F) pre-exposure prophylaxis or post-ex- 4 posure prophylaxis; 5 ‘‘(G) mental health services; 6 ‘‘(H) sexual assault survivor services; and 7 ‘‘(I) other prevention, care, or treatment.’’. 8 SEC. 509. GESTATIONAL DIABETES. 9 Part B of title III of the Public Health Service Act 10 (42 U.S.C. 243 et seq.) is amended by adding after section 11 317H the following: 12 ‘‘SEC. 317H–1. GESTATIONAL DIABETES. 13 ‘‘(a) UNDERSTANDING AND MONITORING GESTA- 14 TIONAL DIABETES.— 15 ‘‘(1) IN GENERAL.—The Secretary, acting 16 through the Director of the Centers for Disease 17 Control and Prevention, in consultation with the Di- 18 abetes Mellitus Interagency Coordinating Committee 19 established under section 429 and representatives of 20 appropriate national health organizations, shall de- 21 velop a multisite gestational diabetes research 22 project within the diabetes program of the Centers 23 for Disease Control and Prevention to expand and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00444 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 445 •S 4819 IS enhance surveillance data and public health research 1 on gestational diabetes. 2 ‘‘(2) AREAS TO BE ADDRESSED.—The research 3 project developed under paragraph (1) shall ad- 4 dress— 5 ‘‘(A) procedures to establish accurate and 6 efficient systems for the collection of gestational 7 diabetes data within each State and common- 8 wealth, territory, or possession of the United 9 States; 10 ‘‘(B) the progress of collaborative activities 11 with the National Vital Statistics System, the 12 National Center for Health Statistics, and 13 State health departments with respect to the 14 standard birth certificate, in order to improve 15 surveillance of gestational diabetes; 16 ‘‘(C) postpartum methods of tracking indi- 17 viduals with gestational diabetes after delivery 18 as well as targeted interventions proven to 19 lower the incidence of type 2 diabetes in that 20 population; 21 ‘‘(D) variations in the distribution of diag- 22 nosed and undiagnosed gestational diabetes, 23 and of impaired fasting glucose tolerance and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00445 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 446 •S 4819 IS impaired fasting glucose, within and among 1 groups of pregnant individuals; and 2 ‘‘(E) factors and culturally sensitive inter- 3 ventions that influence risks and reduce the in- 4 cidence of gestational diabetes and related com- 5 plications during childbirth, including cultural, 6 behavioral, racial, ethnic, geographic, demo- 7 graphic, socioeconomic, and genetic factors. 8 ‘‘(3) REPORT.—Not later than 2 years after the 9 date of the enactment of this section, and annually 10 thereafter, the Secretary shall generate a report on 11 the findings and recommendations of the research 12 project including prevalence of gestational diabetes 13 in the multisite area and disseminate the report to 14 the appropriate Federal and non-Federal agencies. 15 ‘‘(b) EXPANSION OF GESTATIONAL DIABETES RE- 16 SEARCH.— 17 ‘‘(1) IN GENERAL.—The Secretary shall expand 18 and intensify public health research regarding gesta- 19 tional diabetes. Such research may include— 20 ‘‘(A) developing and testing novel ap- 21 proaches for improving postpartum diabetes 22 testing or screening and for preventing type 2 23 diabetes in individuals who can become preg- 24 nant with a history of gestational diabetes; and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00446 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 447 •S 4819 IS ‘‘(B) conducting public health research to 1 further understanding of the epidemiologic, 2 socioenvironmental, behavioral, translation, and 3 biomedical factors and health systems that in- 4 fluence the risk of gestational diabetes and the 5 development of type 2 diabetes in individuals 6 who can become pregnant with a history of ges- 7 tational diabetes. 8 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 9 There is authorized to be appropriated to carry out 10 this subsection $5,000,000 for each of fiscal years 11 2021 through 2025. 12 ‘‘(c) DEMONSTRATION GRANTS TO LOWER THE 13 RATE OF GESTATIONAL DIABETES.— 14 ‘‘(1) IN GENERAL.—The Secretary, acting 15 through the Director of the Centers for Disease 16 Control and Prevention, shall award grants, on a 17 competitive basis, to eligible entities for demonstra- 18 tion projects that implement evidence-based inter- 19 ventions to reduce the incidence of gestational diabe- 20 tes, the recurrence of gestational diabetes in subse- 21 quent pregnancies, and the development of type 2 di- 22 abetes in individuals who can become pregnant with 23 a history of gestational diabetes. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00447 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 448 •S 4819 IS ‘‘(2) PRIORITY.—In making grants under this 1 subsection, the Secretary shall give priority to 2 projects focusing on— 3 ‘‘(A) helping individuals who can become 4 pregnant who have 1 or more risk factors for 5 developing gestational diabetes; 6 ‘‘(B) working with individuals who can be- 7 come pregnant with a history of gestational dia- 8 betes during a previous pregnancy; 9 ‘‘(C) providing postpartum care for indi- 10 viduals who can become pregnant with gesta- 11 tional diabetes; 12 ‘‘(D) tracking cases where individuals who 13 can become pregnant with a history of gesta- 14 tional diabetes developed type 2 diabetes; 15 ‘‘(E) educating mothers with a history of 16 gestational diabetes about the increased risk of 17 their child developing diabetes; 18 ‘‘(F) working to prevent gestational diabe- 19 tes and prevent or delay the development of 20 type 2 diabetes in individuals who can become 21 pregnant with a history of gestational diabetes; 22 and 23 ‘‘(G) achieving outcomes designed to assess 24 the efficacy and cost-effectiveness of interven- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00448 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 449 •S 4819 IS tions that can inform decisions on long-term 1 sustainability, including third-party reimburse- 2 ment. 3 ‘‘(3) APPLICATION.—An eligible entity desiring 4 to receive a grant under this subsection shall submit 5 to the Secretary— 6 ‘‘(A) an application at such time, in such 7 manner, and containing such information as the 8 Secretary may require; and 9 ‘‘(B) a plan to— 10 ‘‘(i) lower the rate of gestational dia- 11 betes during pregnancy; or 12 ‘‘(ii) develop methods of tracking indi- 13 viduals who can become pregnant with a 14 history of gestational diabetes and develop 15 effective interventions to lower the inci- 16 dence of the recurrence of gestational dia- 17 betes in subsequent pregnancies and the 18 development of type 2 diabetes. 19 ‘‘(4) USES OF FUNDS.—An eligible entity re- 20 ceiving a grant under this subsection shall use the 21 grant funds to carry out demonstration projects de- 22 scribed in paragraph (1), including— 23 ‘‘(A) expanding community-based health 24 promotion education, activities, and incentives 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00449 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 450 •S 4819 IS focused on the prevention of gestational diabe- 1 tes and development of type 2 diabetes in indi- 2 viduals who can become pregnant with a history 3 of gestational diabetes; 4 ‘‘(B) aiding State- and Tribal-based diabe- 5 tes prevention and control programs to collect, 6 analyze, disseminate, and report surveillance 7 data on individuals who can become pregnant 8 with, and at risk for, gestational diabetes, the 9 recurrence of gestational diabetes in subsequent 10 pregnancies, and, for individuals who can be- 11 come pregnant with a history of gestational dia- 12 betes, the development of type 2 diabetes; and 13 ‘‘(C) training and encouraging health care 14 providers— 15 ‘‘(i) to promote risk assessment, high- 16 quality care, and self-management for ges- 17 tational diabetes and the recurrence of ges- 18 tational diabetes in subsequent preg- 19 nancies; and 20 ‘‘(ii) to prevent the development of 21 type 2 diabetes in individuals who can be- 22 come pregnant with a history of gesta- 23 tional diabetes, and its complications in the 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00450 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 451 •S 4819 IS practice settings of the health care pro- 1 viders. 2 ‘‘(5) REPORT.—Not later than 4 years after the 3 date of the enactment of this section, the Secretary 4 shall prepare and submit to the Congress a report 5 concerning the results of the demonstration projects 6 conducted through the grants awarded under this 7 subsection. 8 ‘‘(6) DEFINITION OF ELIGIBLE ENTITY.—In 9 this subsection, the term ‘eligible entity’ means a 10 nonprofit organization (such as a nonprofit academic 11 center or community health center) or a State, Trib- 12 al, or local health agency. 13 ‘‘(7) AUTHORIZATION OF APPROPRIATIONS.— 14 There is authorized to be appropriated to carry out 15 this subsection $5,000,000 for each of fiscal years 16 2021 through 2025. 17 ‘‘(d) POSTPARTUM FOLLOWUP REGARDING GESTA- 18 TIONAL DIABETES.—The Secretary, acting through the 19 Director of the Centers for Disease Control and Preven- 20 tion, shall work with the State- and Tribal-based diabetes 21 prevention and control programs assisted by the Centers 22 to encourage postpartum followup after gestational diabe- 23 tes, as medically appropriate, for the purpose of reducing 24 the incidence of gestational diabetes, the recurrence of 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00451 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 452 •S 4819 IS gestational diabetes in subsequent pregnancies, the devel- 1 opment of type 2 diabetes in individuals with a history 2 of gestational diabetes, and related complications.’’. 3 SEC. 510. EMERGENCY CONTRACEPTION EDUCATION AND 4 INFORMATION PROGRAMS. 5 (a) EMERGENCY CONTRACEPTION PUBLIC EDU- 6 CATION PROGRAM.— 7 (1) IN GENERAL.—The Secretary, acting 8 through the Director of the Centers for Disease 9 Control and Prevention, shall develop and dissemi- 10 nate to the public medically accurate and complete 11 information on emergency contraceptives. 12 (2) DISSEMINATION.—The Secretary may dis- 13 seminate medically accurate and complete informa- 14 tion under paragraph (1) directly or through ar- 15 rangements with nonprofit organizations, community 16 health workers including promotores, consumer 17 groups, institutions of higher education, clinics, the 18 media, and Federal, State, and local agencies. 19 (3) INFORMATION.—The information dissemi- 20 nated under paragraph (1) shall— 21 (A) include, at a minimum, a description 22 of emergency contraceptives and an explanation 23 of the use, safety, efficacy, affordability, and 24 availability, including over-the-counter access, 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00452 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 453 •S 4819 IS of such contraceptives and options for access 1 without cost-sharing through insurance and 2 other programs; and 3 (B) be pilot tested for consumer com- 4 prehension, cultural and linguistic appropriate- 5 ness, and acceptance of the messages across 6 geographically, racially, ethnically, and linguis- 7 tically diverse populations. 8 (b) EMERGENCY CONTRACEPTION INFORMATION 9 PROGRAM FOR HEALTH CARE PROVIDERS.— 10 (1) IN GENERAL.—The Secretary, acting 11 through the Administrator of the Health Resources 12 and Services Administration and in consultation 13 with major medical and public health organizations, 14 shall develop and disseminate to health care pro- 15 viders, including pharmacists, information on emer- 16 gency contraceptives. 17 (2) INFORMATION.—The information dissemi- 18 nated under paragraph (1) shall include, at a min- 19 imum— 20 (A) information describing the use, safety, 21 efficacy, and availability of emergency contra- 22 ceptives, and options for access without cost- 23 sharing through insurance and other programs; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00453 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 454 •S 4819 IS (B) a recommendation regarding the use of 1 such contraceptives; and 2 (C) information explaining how to obtain 3 copies of the information developed under sub- 4 section (a) for distribution to the patients of 5 the providers. 6 (c) DEFINITIONS.—In this section: 7 (1) HEALTH CARE PROVIDER.—The term 8 ‘‘health care provider’’ means an individual who is li- 9 censed or certified under State law to provide health 10 care services and who is operating within the scope 11 of such license. Such term shall include a phar- 12 macist. 13 (2) INSTITUTION OF HIGHER EDUCATION.—The 14 term ‘‘institution of higher education’’ has the same 15 meaning given such term in section 101(a) of the 16 Higher Education Act of 1965 (20 U.S.C. 1001(a)). 17 (3) SECRETARY.—The term ‘‘Secretary’’ means 18 the Secretary of Health and Human Services. 19 (d) AUTHORIZATION OF APPROPRIATIONS.—There 20 are authorized to be appropriated to carry out this section 21 such sums as may be necessary for each of the fiscal years 22 2021 through 2025. 23 SEC. 511. COMPREHENSIVE SEX EDUCATION PROGRAMS. 24 (a) PURPOSES; FINDING; SENSE OF CONGRESS.— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00454 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 455 •S 4819 IS (1) PURPOSES.—The purposes of this section 1 are to provide young people with comprehensive sex 2 education programs that— 3 (A) promote and uphold the rights of 4 young people to information in order to make 5 healthy decisions about their sexual health; 6 (B) provide the information and skills all 7 young people need to make informed, respon- 8 sible, and healthy decisions in order to become 9 sexually healthy adults and have healthy rela- 10 tionships; 11 (C) provide information about the preven- 12 tion of unintended pregnancy, sexually trans- 13 mitted infections, including HIV, dating vio- 14 lence, sexual assault, bullying, and harassment; 15 and 16 (D) provide resources and information on 17 topics ranging from gender stereotyping and 18 gender roles and stigma and socio-cultural in- 19 fluences surrounding sex and sexuality. 20 (2) FINDING ON REQUIRED RESOURCES.—In 21 order to provide the comprehensive sex education de- 22 scribed in paragraph (1), Congress finds that in- 23 creased resources are required for sex education pro- 24 grams that— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00455 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 456 •S 4819 IS (A) substantially incorporate elements of 1 evidence-based programs or characteristics of 2 effective programs; 3 (B) cover a broad range of topics, includ- 4 ing medically accurate and complete informa- 5 tion that is age and developmentally appro- 6 priate about all the aspects of sex, sexual 7 health, and sexuality; 8 (C) are gender and gender identity-sen- 9 sitive, emphasizing the importance of equality 10 and the social environment for achieving sexual 11 and reproductive health and overall well-being; 12 (D) promote educational achievement, crit- 13 ical thinking, decision making, self-esteem, and 14 self-efficacy; 15 (E) help develop healthy attitudes and in- 16 sights necessary for understanding relationships 17 between oneself and others and society; 18 (F) foster leadership skills and community 19 engagement by— 20 (i) promoting principles of fairness, 21 human dignity, and respect; and 22 (ii) engaging young people as partners 23 in their communities; and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00456 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 457 •S 4819 IS (G) are culturally and linguistically appro- 1 priate, reflecting the diverse circumstances and 2 realities of young people. 3 (3) SENSE OF CONGRESS.—It is the sense of 4 Congress that— 5 (A) federally funded sex education pro- 6 grams should aim to— 7 (i) provide information about a range 8 of human sexuality topics, including— 9 (I) human development, healthy 10 relationships, personal skills; 11 (II) sexual behavior including ab- 12 stinence; 13 (III) sexual health including pre- 14 venting unintended pregnancy; 15 (IV) sexually transmitted infec- 16 tions including HIV; and 17 (V) society and culture; 18 (ii) promote safe and healthy relation- 19 ships; 20 (iii) promote gender equity; 21 (iv) use, and be informed by, the best 22 scientific information available; 23 (v) be culturally appropriate and in- 24 clusive of youth with varying gender identi- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00457 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 458 •S 4819 IS ties, gender expressions, and sexual ori- 1 entations; 2 (vi) be built on characteristics of ef- 3 fective programs; 4 (vii) expand the existing body of re- 5 search on comprehensive sex education 6 programs through program evaluation; 7 (viii) expand training programs for 8 teachers of comprehensive sex education; 9 (ix) build on programs funded under 10 section 513 of the Social Security Act (42 11 U.S.C. 713) and the Office of Adolescent 12 Health’s Teen Pregnancy Prevention Pro- 13 gram, funded under title II of the Consoli- 14 dated Appropriations Act, 2010 (Public 15 Law 111–117; 123 Stat. 3253), and on 16 programs supported through the Centers 17 for Disease Control and Prevention (CDC); 18 and 19 (x) promote and uphold the rights of 20 young people to information in order to 21 make healthy and autonomous decisions 22 about their sexual health; and 23 (B) no Federal funds should be used for 24 health education programs that— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00458 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 459 •S 4819 IS (i) withhold health-promoting or life- 1 saving information about sexuality-related 2 topics, including HIV; 3 (ii) are medically inaccurate or have 4 been scientifically shown to be ineffective; 5 (iii) promote gender or racial stereo- 6 types; 7 (iv) are insensitive and unresponsive 8 to the needs of sexually active young peo- 9 ple; 10 (v) are insensitive and unresponsive to 11 the needs of survivors of sexual violence; 12 (vi) are insensitive and unresponsive 13 to the needs of youth of all physical, devel- 14 opmental, and mental abilities; 15 (vii) are insensitive and unresponsive 16 to the needs of youth with varying gender 17 identities, gender expressions, and sexual 18 orientations; or 19 (viii) are inconsistent with the ethical 20 imperatives of medicine and public health. 21 (b) GRANTS FOR COMPREHENSIVE SEX EDUCATION 22 FOR ADOLESCENTS.— 23 (1) PROGRAM AUTHORIZED.—The Secretary of 24 Health and Human Services, in coordination with 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00459 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 460 •S 4819 IS the Associate Commissioner of the Family and 1 Youth Services Bureau of the Administration on 2 Children, Youth, and Families of the Department of 3 Health and Human Services, the Director of the Of- 4 fice of Adolescent Health, the Director of the Divi- 5 sion of Adolescent and School Health within the 6 Centers for Disease Control and Prevention and the 7 Secretary of Education, shall award grants, on a 8 competitive basis, to eligible entities to enable such 9 eligible entities to carry out programs that provide 10 adolescents with comprehensive sex education, as de- 11 scribed in paragraph (6). 12 (2) DURATION.—Grants awarded under this 13 section shall be for a period of 5 years. 14 (3) ELIGIBLE ENTITY.—In this section, the 15 term ‘‘eligible entity’’ means a public or private enti- 16 ty that focuses on adolescent health and education 17 or has experience working with adolescents. 18 (4) APPLICATIONS.—An eligible entity desiring 19 a grant under this subsection shall submit an appli- 20 cation to the Secretary at such time, in such man- 21 ner, and containing such information as the Sec- 22 retary may require, including an assurance to par- 23 ticipate in the evaluation described in subsection (e). 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00460 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 461 •S 4819 IS (5) PRIORITY.—In awarding grants under this 1 section, the Secretary shall give priority to eligible 2 entities that— 3 (A) are State or local public entities; 4 (B) are entities not currently receiving 5 funds under— 6 (i) section 513 of the Social Security 7 Act (42 U.S.C. 713); 8 (ii) the Office of Adolescent Health’s 9 Teen Pregnancy Prevention Program, 10 funded under title II of the Consolidated 11 Appropriations Act, 2010 (Public Law 12 111–117; 123 Stat. 3253), or any substan- 13 tially similar successive program; or 14 (iii) the Centers for Disease Control 15 and Prevention’s Division of Adolescent 16 and School Health; and 17 (C) address health inequities among young 18 people that face systemic barriers resulting in 19 disproportionate rates of not less than one of 20 the following: 21 (i) Unintended pregnancies. 22 (ii) Sexually transmitted infections, 23 including HIV. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00461 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 462 •S 4819 IS (iii) Dating violence and sexual vio- 1 lence. 2 (6) USE OF FUNDS.— 3 (A) IN GENERAL.—Each eligible entity 4 that receives a grant under this section shall 5 use the grant funds to carry out an education 6 program that provides adolescents with com- 7 prehensive sex education that— 8 (i) is age and developmentally appro- 9 priate; 10 (ii) is medically accurate and com- 11 plete; 12 (iii) substantially incorporates ele- 13 ments of evidence-based sex education in- 14 struction; or 15 (iv) creates a demonstration project 16 based on characteristics of effective pro- 17 grams. 18 (B) CONTENTS OF COMPREHENSIVE SEX 19 EDUCATION PROGRAMS.—The comprehensive 20 sex education programs funded under this sec- 21 tion shall include instruction and materials that 22 address— 23 (i) the physical, social, and emotional 24 changes of human development including, 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00462 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 463 •S 4819 IS human anatomy, reproduction, and sexual 1 development; 2 (ii) healthy relationships, including 3 friendships, within families, and society, 4 that are based on mutual respect, and the 5 ability to distinguish between healthy and 6 unhealthy relationships, including— 7 (I) effective communication, ne- 8 gotiation and refusal skills, including 9 the skills to recognize and report in- 10 appropriate or abusive sexual ad- 11 vances; 12 (II) bodily autonomy, setting and 13 respecting personal boundaries, prac- 14 ticing personal safety, and consent; 15 and 16 (III) the limitations and harm of 17 gender- role stereotypes, violence, co- 18 ercion, bullying, harassment, and in- 19 timidation in relationships; 20 (iii) healthy decision-making skills 21 about sexuality and relationships that in- 22 clude— 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00463 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 464 •S 4819 IS (I) critical thinking, problem 1 solving, self-efficacy, stress-manage- 2 ment, self-care, and decision making; 3 (II) individual values and atti- 4 tudes; 5 (III) the promotion of positive 6 body images; 7 (IV) developing an understanding 8 that there are a range of body types 9 and encouraging positive feeling about 10 students’ own body types; 11 (V) information on how to re- 12 spect others and ensure safety on the 13 internet and when using other forms 14 of digital communication; 15 (VI) information on local services 16 and resources where students can ob- 17 tain additional information related to 18 bullying, harassment, dating violence 19 and sexual assault, suicide prevention, 20 and other related care; 21 (VII) encouragement for youth to 22 communicate with their parents or 23 guardians, health and social service 24 professionals, and other trusted adults 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00464 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 465 •S 4819 IS about sexuality and intimate relation- 1 ships; 2 (VIII) information on how to cre- 3 ate a safe environment for all stu- 4 dents and others in society; 5 (IX) examples of varying types of 6 relationships, couples, and family 7 structures; and 8 (X) affirmative representation of 9 varying gender identities, gender ex- 10 pressions, and sexual orientations, in- 11 cluding individuals and relationships 12 between same sex couples and their 13 families; 14 (iv) abstinence, delaying age of first 15 sexual activity, the use of condoms, preven- 16 tive medication, vaccination, birth control, 17 and other sexually transmitted infection 18 prevention measures, and the options for 19 pregnancy, including parenting, adoption, 20 and abortion, including— 21 (I) the importance of effectively 22 using condoms, preventive medication, 23 and applicable vaccinations to protect 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00465 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 466 •S 4819 IS against sexually transmitted infec- 1 tions, including HIV; 2 (II) the benefits of effective con- 3 traceptive and condom use in avoiding 4 unintended pregnancy; 5 (III) the relationship between 6 substance use and sexual health and 7 behaviors; and 8 (IV) information about local 9 health services where students can ob- 10 tain additional information and serv- 11 ices related to sexual and reproductive 12 health and other related care; 13 (v) through affirmative recognition, 14 the roles that traditions, values, religion, 15 norms, gender roles, acculturation, family 16 structure, health beliefs, and political 17 power play in how students make decisions 18 that affect their sexual health, using exam- 19 ples of various types of races, ethnicities, 20 cultures, and families, including single-par- 21 ent households and young families; 22 (vi) information about gender identity, 23 gender expression, and sexual orientation 24 for all students, including— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00466 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 467 •S 4819 IS (I) affirmative recognition that 1 people have different gender identi- 2 ties, gender expressions, and sexual 3 orientations; and 4 (II) community resources that 5 can provide additional support for in- 6 dividuals with varying gender identi- 7 ties, gender expressions, and sexual 8 orientations; and 9 (vii) opportunities to explore the roles 10 that race, ethnicity, immigration status, 11 disability status, economic status, home- 12 lessness, foster care status, and language 13 within different communities affect sexual 14 attitudes in society and culture and how 15 this may impact student sexual health. 16 (c) GRANTS FOR COMPREHENSIVE SEX EDUCATION 17 AT INSTITUTIONS OF HIGHER EDUCATION.— 18 (1) PROGRAM AUTHORIZED.—The Secretary, in 19 coordination with the Secretary of Education, shall 20 award grants, on a competitive basis, to institutions 21 of higher education or consortia of such institutions 22 to enable such institutions to provide young people 23 with comprehensive sex education, as described in 24 paragraph (5)(B). 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00467 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 468 •S 4819 IS (2) DURATION.—Grants awarded under this 1 subsection shall be for a period of 5 years. 2 (3) APPLICATIONS.—An institution of higher 3 education or consortium of such institutions desiring 4 a grant under this subsection shall submit an appli- 5 cation to the Secretary at such time, in such man- 6 ner, and containing such information as the Sec- 7 retary may require, including an assurance to par- 8 ticipate in the evaluation described in subsection (e). 9 (4) PRIORITY.—In awarding grants under this 10 subsection, the Secretary shall give priority to an in- 11 stitution of higher education that— 12 (A) has an enrollment of needy students, 13 as defined in section 318(b) of the Higher Edu- 14 cation Act of 1965 (20 U.S.C. 1059e(b)); 15 (B) is a Hispanic-serving institution, as 16 defined in section 502(a) of such Act (20 17 U.S.C. 1101a(a)); 18 (C) is a Tribal College or University, as 19 defined in section 316(b) of such Act (20 20 U.S.C. 1059c(b)); 21 (D) is an Alaska Native-serving institution, 22 as defined in section 317(b) of such Act (20 23 U.S.C. 1059d(b)); 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00468 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 469 •S 4819 IS (E) is a Native Hawaiian-serving institu- 1 tion, as defined in section 317(b) of such Act 2 (20 U.S.C. 1059d(b)); 3 (F) is a Predominately Black Institution, 4 as defined in section 318(b) of such Act (20 5 U.S.C. 1059e(b)); 6 (G) is a Native American-serving, non- 7 tribal institution, as defined in section 319(b) 8 of such Act (20 U.S.C. 1059f(b)); 9 (H) is an Asian American and Native 10 American Pacific Islander-serving institution, as 11 defined in section 320(b) of such Act (20 12 U.S.C. 1059g(b)); or 13 (I) is a minority institution, as defined in 14 section 365 of such Act (20 U.S.C. 1067k), 15 with an enrollment of needy students, as de- 16 fined in section 312 of such Act (20 U.S.C. 17 1058). 18 (5) USES OF FUNDS.— 19 (A) IN GENERAL.—An institution of higher 20 education, or a consortium, receiving a grant 21 under this subsection shall use grant funds to 22 integrate issues relating to comprehensive sex 23 education into the institution of higher edu- 24 cation, or consortium, in order to reach a large 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00469 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 470 •S 4819 IS number of students, by carrying out 1 or more 1 of the following activities: 2 (i) Developing or adopting educational 3 content for issues relating to comprehen- 4 sive sex education that will be incorporated 5 into student orientation, general education, 6 or core courses. 7 (ii) Developing or adopting, and im- 8 plementing schoolwide educational pro- 9 gramming outside of class that delivers ele- 10 ments of comprehensive sex education pro- 11 grams to students, faculty, and staff. 12 (iii) Developing or adopting innovative 13 technology-based approaches to deliver sex 14 education to students, faculty, and staff. 15 (iv) Developing or adopting, and im- 16 plementing peer-outreach and education 17 programs to generate discussion, educate, 18 and raise awareness among students about 19 issues relating to comprehensive sex edu- 20 cation. 21 (B) CONTENTS OF SEX EDUCATION PRO- 22 GRAMS.—Each institution of higher education’s 23 program of comprehensive sex education funded 24 under this section shall include instruction and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00470 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 471 •S 4819 IS materials that address the contents required 1 under subsection (b)(6). 2 (d) GRANTS FOR PRE-SERVICE AND IN-SERVICE 3 TEACHER TRAINING.— 4 (1) PROGRAM AUTHORIZED.—The Secretary, in 5 coordination with the Director of the Centers for 6 Disease Control and Prevention and the Secretary of 7 Education, shall award grants, on a competitive 8 basis, to eligible entities to enable such eligible enti- 9 ties to carry out the activities described in para- 10 graph (5). 11 (2) DURATION.—Grants awarded under this 12 section shall be for a period of 5 years. 13 (3) ELIGIBLE ENTITY.—In this section, the 14 term ‘‘eligible entity’’ means— 15 (A) a State educational agency, as defined 16 in section 8101 of the Elementary and Sec- 17 ondary Education of 1965 (20 U.S.C. 7801); 18 (B) a local educational agency, as defined 19 in section 8101 of the Elementary and Sec- 20 ondary Education of 1965 (20 U.S.C. 7801); 21 (C) an Indian Tribe or Tribal organization, 22 as defined in section 4 of the Indian Self-Deter- 23 mination and Education Assistance Act (25 24 U.S.C. 5304); 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00471 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 472 •S 4819 IS (D) a State or local department of health; 1 (E) a State or local department of edu- 2 cation; 3 (F) an educational service agency, as de- 4 fined in section 8101 of the Elementary and 5 Secondary Education of 1965 (20 U.S.C. 6 7801); 7 (G) a nonprofit institution of higher edu- 8 cation, as defined in section 101 of the Higher 9 Education Act of 1965 (20 U.S.C. 1001); 10 (H) a national or statewide nonprofit orga- 11 nization that has as its primary purpose the im- 12 provement of provision of comprehensive sex 13 education through training and effective teach- 14 ing of comprehensive sex education; or 15 (I) a consortium of nonprofit organizations 16 that has as its primary purpose the improve- 17 ment of provision of comprehensive sex edu- 18 cation through training and effective teaching 19 of comprehensive sex education. 20 (4) APPLICATION.—An eligible entity desiring a 21 grant under this subsection shall submit an applica- 22 tion to the Secretary at such time, in such manner, 23 and containing such information as the Secretary 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00472 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 473 •S 4819 IS may require, including an assurance to participate in 1 the evaluation described in subsection (e). 2 (5) AUTHORIZED ACTIVITIES.— 3 (A) REQUIRED ACTIVITY.—Each eligible 4 entity receiving a grant under this section shall 5 use grant funds for professional development 6 and training of relevant faculty, school adminis- 7 trators, teachers, and staff, in order to increase 8 effective teaching of comprehensive sex edu- 9 cation students. 10 (B) PERMISSIBLE ACTIVITIES.—Each eligi- 11 ble entity receiving a grant under this section 12 may use grant funds to— 13 (i) provide research-based training of 14 teachers for comprehensive sex education 15 for adolescents as a means of broadening 16 student knowledge about issues related to 17 human development, healthy relationships, 18 personal skills, and sexual behavior, includ- 19 ing abstinence, sexual health, and society 20 and culture; 21 (ii) support the dissemination of infor- 22 mation on effective practices and research 23 findings concerning the teaching of com- 24 prehensive sex education; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00473 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 474 •S 4819 IS (iii) support research on— 1 (I) effective comprehensive sex 2 education teaching practices; and 3 (II) the development of assess- 4 ment instruments and strategies to 5 document— 6 (aa) student understanding 7 of comprehensive sex education; 8 and 9 (bb) the effects of com- 10 prehensive sex education; 11 (iv) convene national conferences on 12 comprehensive sex education, in order to 13 effectively train teachers in the provision of 14 comprehensive sex education; and 15 (v) develop and disseminate appro- 16 priate research-based materials to foster 17 comprehensive sex education. 18 (C) SUBGRANTS.—Each eligible entity re- 19 ceiving a grant under this subsection may 20 award subgrants to nonprofit organizations that 21 possess a demonstrated record of providing 22 training to faculty, school administrators, 23 teachers, and staff on comprehensive sex edu- 24 cation to— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00474 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 475 •S 4819 IS (i) train teachers in comprehensive 1 sex education; 2 (ii) support internet or distance learn- 3 ing related to comprehensive sex education; 4 (iii) promote rigorous academic stand- 5 ards and assessment techniques to guide 6 and measure student performance in com- 7 prehensive sex education; 8 (iv) encourage replication of best 9 practices and model programs to promote 10 comprehensive sex education; 11 (v) develop and disseminate effective, 12 research-based comprehensive sex edu- 13 cation learning materials; 14 (vi) develop academic courses on the 15 pedagogy of sex education at institutions 16 of higher education; or 17 (vii) convene State-based conferences 18 to train teachers in comprehensive sex edu- 19 cation and to identify strategies for im- 20 provement. 21 (e) IMPACT EVALUATION AND REPORTING.— 22 (1) MULTI-YEAR EVALUATION.— 23 (A) IN GENERAL.—Not later than 6 24 months after the date of the enactment of this 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00475 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 476 •S 4819 IS Act, the Secretary shall enter into a contract 1 with a nonprofit organization with experience in 2 conducting impact evaluations, to conduct a 3 multi-year evaluation on the impact of the 4 grants under subsections (b), (c), and (d), and 5 to report to Congress and the Secretary on the 6 findings of such evaluation. 7 (B) EVALUATION.—The evaluation con- 8 ducted under this subsection shall— 9 (i) be conducted in a manner con- 10 sistent with relevant, nationally recognized 11 professional and technical evaluation 12 standards; 13 (ii) use sound statistical methods and 14 techniques relating to the behavioral 15 sciences, including quasi-experimental de- 16 signs, inferential statistics, and other 17 methodologies and techniques that allow 18 for conclusions to be reached; 19 (iii) be carried out by an independent 20 organization that has not received a grant 21 under subsection (b), (c), or (d); and 22 (iv) be designed to provide informa- 23 tion on— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00476 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 477 •S 4819 IS (I) output measures, such as the 1 number of individuals served under 2 the grant and the number of hours of 3 instruction; 4 (II) outcome measures, including 5 measures relating to— 6 (aa) the knowledge that in- 7 dividuals participating in the 8 grant program have gained in 9 each of the following age and de- 10 velopmentally appropriate 11 areas— 12 (AA) growth and devel- 13 opment; 14 (BB) relationship dy- 15 namics; 16 (CC) ways to prevent 17 unintended pregnancy and 18 sexually transmitted infec- 19 tions, including HIV; and 20 (DD) sexual health; 21 (bb) the age and develop- 22 mentally appropriate skills that 23 individuals participating in the 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00477 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 478 •S 4819 IS grant program have gained re- 1 garding— 2 (AA) negotiation and 3 communication; 4 (BB) decision making 5 and goal setting; 6 (CC) interpersonal 7 skills and healthy relation- 8 ships; and 9 (DD) condom use; and 10 (cc) the behaviors of adoles- 11 cents participating in the grant 12 program, including data about— 13 (AA) age of first inter- 14 course; 15 (BB) condom and con- 16 traceptive use at first inter- 17 course; 18 (CC) recent condom 19 and contraceptive use; 20 (DD) substance use; 21 (EE) dating abuse and 22 lifetime history of sexual as- 23 sault, dating violence, bul- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00478 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 479 •S 4819 IS lying, harassment, stalking; 1 and 2 (FF) academic per- 3 formance; and 4 (III) other measures necessary to 5 evaluate the impact of the grant pro- 6 gram. 7 (C) REPORT.—Not later than 6 years after 8 the date of enactment of this Act, the organiza- 9 tion conducting the evaluation under this sub- 10 section shall prepare and submit to the appro- 11 priate committees of Congress and the Sec- 12 retary an evaluation report. Such report shall 13 be made publicly available, including on the 14 website of the Department of Health and 15 Human Services. 16 (2) SECRETARY’S REPORT TO CONGRESS.—Not 17 later than 1 year after the date of the enactment of 18 this Act, and annually thereafter for a period of 5 19 years, the Secretary shall prepare and submit to the 20 appropriate committees of Congress a report on the 21 activities to provide adolescents and young people 22 with comprehensive sex education and pre-service 23 and in-service teacher training funded under this 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00479 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 480 •S 4819 IS section. The Secretary’s report to Congress shall in- 1 clude— 2 (A) a statement of how grants awarded by 3 the Secretary meet the purposes described in 4 subsection (a)(1); and 5 (B) information about— 6 (i) the number of eligible entities and 7 institutions of higher education that are 8 receiving grant funds under subsections 9 (b), (c), and (d); 10 (ii) the specific activities supported by 11 grant funds awarded under subsections 12 (b), (c), and (d); 13 (iii) the number of adolescents served 14 by grant programs funded under sub- 15 section (b); 16 (iv) the number of young people 17 served by grant programs funded under 18 subsection (c); 19 (v) the number of faculty, school ad- 20 ministrators, teachers, and staff trained 21 under subsection (d); and 22 (vi) the status of the evaluation re- 23 quired under paragraph (1). 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00480 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 481 •S 4819 IS (f) NONDISCRIMINATION.—Programs funded under 1 this section shall not discriminate on the basis of actual 2 or perceived sex, race, color, ethnicity, national origin, dis- 3 ability, sexual orientation, gender identity, or religion. 4 Nothing in this section shall be construed to invalidate or 5 limit rights, remedies, procedures, or legal standards avail- 6 able under any other Federal law or any law of a State 7 or a political subdivision of a State, including the Civil 8 Rights Act of 1964 (42 U.S.C. 2000a et seq.), title IX 9 of the Education Amendments of 1972 (20 U.S.C. 1681 10 et seq.), section 504 of the Rehabilitation Act of 1973 (29 11 U.S.C. 794), the Americans with Disabilities Act of 1990 12 (42 U.S.C. 12101 et seq.), and section 1557 of the Patient 13 Protection and Affordable Care Act (42 U.S.C. 18116). 14 (g) LIMITATION.—No Federal funds provided under 15 this section may be used for health education programs 16 that— 17 (1) withhold health-promoting or life-saving in- 18 formation about sexuality-related topics, including 19 HIV; 20 (2) are medically inaccurate or have been sci- 21 entifically shown to be ineffective; 22 (3) promote gender or racial stereotypes; 23 (4) are insensitive and unresponsive to the 24 needs of sexually active young people; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00481 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 482 •S 4819 IS (5) are insensitive and unresponsive to the 1 needs of pregnant or parenting young people; 2 (6) are insensitive and unresponsive to the 3 needs of survivors of sexual abuse or assault; 4 (7) are insensitive and unresponsive to the 5 needs of youth of all physical, developmental, or 6 mental abilities; 7 (8) are insensitive and unresponsive to individ- 8 uals with varying gender identities, gender expres- 9 sions, and sexual orientations; or 10 (9) are inconsistent with the ethical imperatives 11 of medicine and public health. 12 (h) AMENDMENTS TO OTHER LAWS.— 13 (1) AMENDMENT TO THE PUBLIC HEALTH 14 SERVICE ACT.—Section 2500 of the Public Health 15 Service Act (42 U.S.C. 300ee) is amended by strik- 16 ing subsections (b) through (d) and inserting the fol- 17 lowing: 18 ‘‘(b) CONTENTS OF PROGRAMS.—All programs of 19 education and information receiving funds under this title 20 shall include information about the potential effects of in- 21 travenous substance abuse.’’. 22 (2) AMENDMENTS TO THE ELEMENTARY AND 23 SECONDARY EDUCATION ACT OF 1965.—Section 8526 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00482 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 483 •S 4819 IS of the Elementary and Secondary Education Act of 1 1965 (20 U.S.C. 7906) is amended— 2 (A) by striking paragraph (3); 3 (B) by redesignating paragraphs (4) and 4 (5) as paragraphs (3) and (4), respectively; 5 (C) in paragraph (3), as redesignated by 6 subparagraph (B), by inserting ‘‘or’’ after the 7 semicolon; 8 (D) in paragraph (4), as redesignated by 9 subparagraph (B), by striking ‘‘; or’’ and in- 10 serting a period; and 11 (E) by striking paragraph (6). 12 (i) DEFINITIONS.—In this section: 13 (1) ADOLESCENTS.—The term ‘‘adolescents’’ 14 means individuals who are ages 10 through 19 at 15 the time of commencement of participation in a pro- 16 gram supported under this section. 17 (2) AGE AND DEVELOPMENTALLY APPRO- 18 PRIATE.—The term ‘‘age and developmentally appro- 19 priate’’ means topics, messages, and teaching meth- 20 ods suitable to particular age, age group of children 21 and adolescents, or developmental levels, based on 22 cognitive, emotional, social, and behavioral capacity 23 of most students at that age level. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00483 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 484 •S 4819 IS (3) APPROPRIATE COMMITTEES OF CON- 1 GRESS.—The term ‘‘appropriate committees of Con- 2 gress’’ means the Committee on Health, Education, 3 Labor, and Pensions of the Senate, the Committee 4 on Appropriations of the Senate, the Committee on 5 Energy and Commerce of the House of Representa- 6 tives, the Committee on Education and Labor of the 7 House of Representatives, and the Committee on 8 Appropriations of the House of Representatives. 9 (4) CHARACTERISTICS OF EFFECTIVE PRO- 10 GRAMS.—The term ‘‘characteristics of effective pro- 11 grams’’ means the aspects of evidence-based pro- 12 grams, including development, content, and imple- 13 mentation of such programs, that— 14 (A) have been shown to be effective in 15 terms of increasing knowledge, clarifying values 16 and attitudes, increasing skills, and impacting 17 upon behavior; and 18 (B) are widely recognized by leading med- 19 ical and public health agencies to be effective in 20 changing sexual behaviors that lead to sexually 21 transmitted infections, including HIV, unin- 22 tended pregnancy, and dating violence and sex- 23 ual assault among young people. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00484 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 485 •S 4819 IS (5) COMPREHENSIVE SEX EDUCATION.—The 1 term ‘‘comprehensive sex education’’ means instruc- 2 tional part of a comprehensive school health edu- 3 cation approach which addresses the physical, men- 4 tal, emotional, and social dimensions of human sexu- 5 ality; designed to motivate and assist students to 6 maintain and improve their sexual health, prevent 7 disease and reduce sexual health-related risk behav- 8 iors; and enable and empower students to develop 9 and demonstrate age and developmentally appro- 10 priate sexuality and sexual health-related knowledge, 11 attitudes, skills, and practices. 12 (6) CONSENT.—The term ‘‘consent’’ means af- 13 firmative, conscious, and voluntary agreement to en- 14 gage in interpersonal, physical, or sexual activity. 15 (7) CULTURALLY APPROPRIATE.—The term 16 ‘‘culturally appropriate’’ means materials and in- 17 struction that respond to culturally diverse individ- 18 uals, families and communities in an inclusive, re- 19 spectful and effective manner; including materials 20 and instruction that are inclusive of race, ethnicity, 21 languages, cultural background, religion, sex, gender 22 identity, sexual orientation, and different abilities. 23 (8) EVIDENCE-BASED.—The term ‘‘evidence- 24 based’’, when used with respect to sex education in- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00485 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 486 •S 4819 IS struction, means a sex education program that has 1 been proven through rigorous evaluation to be effec- 2 tive in changing sexual behavior or incorporates ele- 3 ments of other programs that have been proven to 4 be effective in changing sexual behavior. 5 (9) GENDER EXPRESSION.—The term ‘‘gender 6 expression’’, when used with respect to a sex edu- 7 cation program, means the expression of one’s gen- 8 der, such as through behavior, clothing, haircut, or 9 voice, and which may or may not conform to socially 10 defined behaviors and characteristics typically asso- 11 ciated with being either masculine or feminine. 12 (10) GENDER IDENTITY.—Except with respect 13 to subsection (f), the term ‘‘gender identity’’, when 14 used with respect to a sex education program, means 15 the gender-related identity, appearance, mannerisms, 16 or other gender-related characteristics of an indi- 17 vidual, regardless of the individual’s designated sex 18 at birth including a person’s deeply held sense or 19 knowledge of their own gender; such as male, fe- 20 male, both or neither. 21 (11) INCLUSIVE.—The term ‘‘inclusive’’, when 22 used with respect to a sex education program, means 23 curriculum that ensures that students from histori- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00486 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 487 •S 4819 IS cally marginalized communities are reflected in 1 classroom materials and lessons. 2 (12) INSTITUTION OF HIGHER EDUCATION.— 3 The term ‘‘institution of higher education’’ has the 4 meaning given the term in section 101 of the Higher 5 Education Act of 1965 (20 U.S.C. 1001). 6 (13) MEDICALLY ACCURATE AND COMPLETE.— 7 The term ‘‘medically accurate and complete’’, when 8 used with respect to a sex education program, means 9 that— 10 (A) the information provided through the 11 program is verified or supported by the weight 12 of research conducted in compliance with ac- 13 cepted scientific methods and is published in 14 peer-reviewed journals, where applicable; or 15 (B)(i) the program contains information 16 that leading professional organizations and 17 agencies with relevant expertise in the field rec- 18 ognize as accurate, objective, and complete; and 19 (ii) the program does not withhold infor- 20 mation about the effectiveness and benefits of 21 correct and consistent use of condoms and 22 other contraceptives. 23 (14) SECRETARY.—The term ‘‘Secretary’’ 24 means the Secretary of Health and Human Services. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00487 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 488 •S 4819 IS (15) SEXUAL DEVELOPMENT.—The term ‘‘sex- 1 ual development’’ means the lifelong process of phys- 2 ical, behavioral, cognitive, and emotional growth and 3 change as it relates to an individual’s sexuality and 4 sexual maturation, including puberty, identity devel- 5 opment, socio-cultural influences, and sexual behav- 6 iors. 7 (16) SEXUAL ORIENTATION.—Except with re- 8 spect to subsection (f), the term ‘‘sexual orienta- 9 tion’’, when used with respect to a sex education 10 program, means an individual’s attraction, including 11 physical or emotional, to the same or different gen- 12 der. 13 (17) YOUNG PEOPLE.—The term ‘‘young peo- 14 ple’’ means individuals who are ages 10 through 24 15 at the time of commencement of participation in a 16 program supported under this section. 17 (j) FUNDING.— 18 (1) APPROPRIATION.—For the purpose of car- 19 rying out this section, there is appropriated 20 $75,000,000 for each of fiscal years 2021 through 21 2026. Amounts appropriated under this subsection 22 shall remain available until expended. 23 (2) RESERVATIONS OF FUNDS.— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00488 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 489 •S 4819 IS (A) The Secretary shall reserve 50 percent 1 of the amount appropriated under paragraph 2 (1) for the purposes of awarding grants for 3 comprehensive sex education for adolescents 4 under subsection (c). 5 (B) The Secretary shall reserve 25 percent 6 of the amount appropriated under paragraph 7 (1) for the purposes of awarding grants for 8 comprehensive sex education at institutes of 9 higher education under subsection (d). 10 (C) The Secretary shall reserve 20 percent 11 of the amount appropriated under paragraph 12 (1) for the purposes of awarding grants for pre- 13 service and in-service teacher training under 14 subsection (e). 15 (D) The Secretary shall reserve 2 percent 16 of the amount appropriated under paragraph 17 (1) for the purpose of carrying out the impact 18 evaluation and reporting required under sub- 19 section (a). 20 (3) SECRETARIAL RESPONSIBILITIES.—The 21 Secretary shall reserve 3 percent of the amount ap- 22 propriated under paragraph (1) for each fiscal year 23 for expenditures by the Secretary to provide, directly 24 or through a competitive grant process, research, 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00489 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 490 •S 4819 IS training, and technical assistance, including dissemi- 1 nation of research and information regarding effec- 2 tive and promising practices, providing consultation 3 and resources, and developing resources and mate- 4 rials to support the activities of recipients of grants. 5 In carrying out such functions, the Secretary shall 6 collaborate with a variety of entities that have exper- 7 tise in adolescent sexual health development, edu- 8 cation, and promotion. 9 (4) 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 (5) REPEAL OF ABSTINENCE ONLY UNTIL MAR- 20 RIAGE PROGRAM.—Section 510 of the Social Secu- 21 rity Act (42 U.S.C. 710) is repealed. 22 SEC. 512. COMPASSIONATE ASSISTANCE FOR RAPE EMER- 23 GENCIES. 24 (a) MEDICARE.— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00490 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 491 •S 4819 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 section 24 1866(a)(1)(Z), a hospital meets the requirements of 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00491 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 492 •S 4819 IS this subsection if the hospital provides each of the 1 services described in paragraph (2) to each indi- 2 vidual, whether or not eligible for benefits under this 3 title or under any other form of health insurance, 4 who comes to the hospital on or after January 1, 5 2021, 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 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00492 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 493 •S 4819 IS ‘‘(iii) includes an explanation that 1 emergency contraceptives— 2 ‘‘(I) has been approved by the 3 Food and Drug Administration for in- 4 dividuals and is 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) is more effective the sooner 9 it is taken; and 10 ‘‘(III) does not cause an abortion 11 and cannot interrupt an established 12 pregnancy; 13 ‘‘(iv) meets 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) is provided without regard to the 18 ability of the individual or their family to 19 pay costs associated with the provision of 20 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 the individual accepts such 24 offer, immediate provision to the individual of 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00493 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 494 •S 4819 IS such contraception on the same day it is re- 1 quested without regard to the inability of the 2 individual or their family to pay costs associ- 3 ated 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) Immediately offer to begin PEP to 22 the individual at the hospital except in cases 23 where the medical professional’s best judgement 24 is that further evaluation is required or that 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00494 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 495 •S 4819 IS such a regimen will be substantially detrimental 1 to the individual’s health. Such provision shall 2 be offered regardless of the individual’s ability 3 to pay. Hospitals shall be responsible for ensur- 4 ing adequate supply of PEP medications to pro- 5 vide 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)) is amended by inserting after paragraph (8) the 13 following new paragraph: 14 ‘‘(9) with respect to any amount expended for 15 care or services furnished under the plan by a hos- 16 pital on or after January 1, 2021, unless such hos- 17 pital meets the requirements specified in section 18 1866(l) for purposes of title XVIII;’’. 19 SEC. 513. ACCESS TO BIRTH CONTROL DUTIES OF PHAR- 20 MACIES TO ENSURE PROVISION OF FDA-AP- 21 PROVED CONTRACEPTION. 22 Part B of title II of the Public Health Service Act 23 (42 U.S.C. 238 et seq.) is amended by adding at the end 24 the following: 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00495 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 496 •S 4819 IS ‘‘SEC. 249. DUTIES OF PHARMACIES TO ENSURE PROVISION 1 OF FDA-APPROVED CONTRACEPTION. 2 ‘‘(a) IN GENERAL.—Subject to subsection (c), a 3 pharmacy that receives Food and Drug Administration- 4 approved drugs or devices in interstate commerce shall 5 maintain compliance with the following: 6 ‘‘(1) If a customer requests a contraceptive or 7 a medication related to a contraceptive, including 8 emergency contraception, that is in stock, the phar- 9 macy shall ensure that the contraceptive is provided 10 to the customer without delay. 11 ‘‘(2) If a customer requests a contraceptive or 12 a medication related to a contraceptive that is not 13 in stock and the pharmacy in the normal course of 14 business stocks contraception, the pharmacy shall 15 immediately inform the customer that the contracep- 16 tive is not in stock and without delay offer the cus- 17 tomer the following options: 18 ‘‘(A) If the customer prefers to obtain the 19 contraceptive or a medication related to a con- 20 traceptive through a referral or transfer, the 21 pharmacy shall— 22 ‘‘(i) locate a pharmacy of the cus- 23 tomer’s choice or the closest pharmacy 24 confirmed to have the contraceptive or a 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00496 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 497 •S 4819 IS medication related to a contraceptive in 1 stock; and 2 ‘‘(ii) refer the customer or transfer 3 the prescription to that pharmacy. 4 ‘‘(B) If the customer prefers for the phar- 5 macy to order the contraceptive or a medication 6 related to a contraceptive, the pharmacy shall 7 obtain the contraceptive or medication under 8 the pharmacy’s standard procedure for expe- 9 dited ordering of medication and notify the cus- 10 tomer when the contraceptive or medication ar- 11 rives. 12 ‘‘(3) The pharmacy shall ensure that— 13 ‘‘(A) the pharmacy does not operate an en- 14 vironment in which customers are intimidated, 15 threatened, or harassed in the delivery of serv- 16 ices relating to a request for contraception or a 17 medication related to a contraceptive; 18 ‘‘(B) the pharmacy’s employees do not 19 interfere with or obstruct the delivery of serv- 20 ices relating to a request for contraception or a 21 medication related to a contraceptive; 22 ‘‘(C) the pharmacy’s employees do not in- 23 tentionally misrepresent or deceive customers 24 about the availability of a contraceptive or a 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00497 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 498 •S 4819 IS medication related to a contraceptive, or the 1 mechanism of action of such contraceptive or 2 medication; 3 ‘‘(D) the pharmacy’s employees do not 4 breach medical confidentiality with respect to a 5 request for a contraceptive or a medication re- 6 lated to a contraceptive or threaten to breach 7 such confidentiality; or 8 ‘‘(E) the pharmacy’s employees do not 9 refuse to return a valid, lawful prescription for 10 a contraceptive or a medication related to a 11 contraceptive upon customer request. 12 ‘‘(b) CONTRACEPTIVES NOT ORDINARILY 13 STOCKED.—Nothing in subsection (a)(2) shall be con- 14 strued to require any pharmacy to comply with such sub- 15 section if the pharmacy does not ordinarily stock contra- 16 ceptives or a medication related to a contraceptive in the 17 normal course of business. 18 ‘‘(c) REFUSALS PURSUANT TO STANDARD PHAR- 19 MACY PRACTICE.—This section does not prohibit a phar- 20 macy from refusing to provide a contraceptive or a medi- 21 cation related to a contraceptive to a customer in accord- 22 ance with any of the following: 23 ‘‘(1) If it is unlawful to dispense the contracep- 24 tive or a medication related to a contraceptive to the 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00498 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 499 •S 4819 IS customer without a valid, lawful prescription and no 1 such prescription is presented. 2 ‘‘(2) If the customer is unable to pay for the 3 contraceptive or the medication related to a contra- 4 ceptive. 5 ‘‘(3) If the employee of the pharmacy refuses to 6 provide the contraceptive or a medication related to 7 a contraceptive on the basis of a professional clinical 8 judgment. 9 ‘‘(d) RELATION TO OTHER LAW.— 10 ‘‘(1) RULE OF CONSTRUCTION.—Nothing in 11 this section shall be construed to invalidate or limit 12 rights, remedies, procedures, or legal standards 13 under title VII of the Civil Rights Act of 1964. 14 ‘‘(2) CERTAIN CLAIMS.—The Religious Free- 15 dom Restoration Act of 1993 shall not provide a 16 basis for a claim concerning, or a defense to a claim 17 under, this section, or provide a basis for challenging 18 the application or enforcement of this section. 19 ‘‘(e) PREEMPTION.—This section does not preempt 20 any provision of State law or any professional obligation 21 made applicable by a State board or other entity respon- 22 sible for licensing or discipline of pharmacies or phar- 23 macists, to the extent that such State law or professional 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00499 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 500 •S 4819 IS obligation provides protections for customers that are 1 greater than the protections provided by this section. 2 ‘‘(f) ENFORCEMENT.— 3 ‘‘(1) CIVIL PENALTY.—A pharmacy that vio- 4 lates a requirement of subsection (a) is liable to the 5 United States for a civil penalty in an amount not 6 exceeding $1,000 per day of violation, not to exceed 7 $100,000 for all violations adjudicated in a single 8 proceeding. 9 ‘‘(2) PRIVATE CAUSE OF ACTION.—Any person 10 aggrieved as a result of a violation of a requirement 11 of subsection (a) may, in any court of competent ju- 12 risdiction, commence a civil action against the phar- 13 macy involved to obtain appropriate relief, including 14 actual and punitive damages, injunctive relief, and a 15 reasonable attorney’s fee and cost. 16 ‘‘(3) LIMITATIONS.—A civil action under para- 17 graph (1) or (2) may not be commenced against a 18 pharmacy after the expiration of the 5-year period 19 beginning on the date on which the pharmacy alleg- 20 edly engaged in the violation involved. 21 ‘‘(g) DEFINITIONS.—In this section: 22 ‘‘(1) CONTRACEPTION.—The term ‘contracep- 23 tion’ or ‘contraceptive’ means any drug or device ap- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00500 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 501 •S 4819 IS proved by the Food and Drug Administration to pre- 1 vent pregnancy. 2 ‘‘(2) EMPLOYEE.—The term ‘employee’ means 3 a person hired, by contract or any other form of an 4 agreement, by a pharmacy. 5 ‘‘(3) MEDICATION RELATED TO A CONTRACEP- 6 TIVE.—The term ‘medication related to a contracep- 7 tive’ means any drug or device approved by the Food 8 and Drug Administration that a medical professional 9 determines necessary to use before or in conjunction 10 with a contraceptive. 11 ‘‘(4) PHARMACY.—The term ‘pharmacy’ means 12 an entity that— 13 ‘‘(A) is authorized by a State to engage in 14 the business of selling prescription drugs at re- 15 tail; and 16 ‘‘(B) employs one or more employees. 17 ‘‘(5) PRODUCT.—The term ‘product’ means a 18 Food and Drug Administration-approved drug or de- 19 vice. 20 ‘‘(6) PROFESSIONAL CLINICAL JUDGMENT.— 21 The term ‘professional clinical judgment’ means the 22 use of professional knowledge and skills to form a 23 clinical judgment, in accordance with prevailing 24 medical standards. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00501 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 502 •S 4819 IS ‘‘(7) WITHOUT DELAY.—The term ‘without 1 delay’, with respect to a pharmacy providing, pro- 2 viding a referral for, or ordering contraception, or 3 transferring the prescription for contraception, 4 means within the usual and customary timeframe at 5 the pharmacy for providing, providing a referral for, 6 or ordering other products, or transferring the pre- 7 scription for other products, respectively. 8 ‘‘(h) EFFECTIVE DATE.—This section shall take ef- 9 fect on the 31st day after the date of the enactment of 10 this section, without regard to whether the Secretary has 11 issued any guidance or final rule regarding this section.’’. 12 SEC. 514. 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)) is amended— 16 (1) in paragraph (6), at the end, by striking 17 ‘‘and’’; 18 (2) in paragraph (7), at the end, by striking the 19 period and inserting a semicolon; and 20 (3) by adding at the end the following new 21 paragraph: 22 ‘‘(8) facilitate policymakers, health system lead- 23 ers and providers, consumers, and other stake- 24 holders in understanding optimal maternity care and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00502 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 503 •S 4819 IS support for the provision of such care, including the 1 priorities of— 2 ‘‘(A) protecting, promoting, and supporting 3 the innate capacities of childbearing individuals 4 and their newborns for childbirth, breastfeed- 5 ing, and attachment; 6 ‘‘(B) using obstetric interventions only 7 when such interventions are supported by 8 strong, high-quality evidence, and minimizing 9 overuse of maternity practices that have been 10 shown to have benefit in limited situations and 11 that can expose women, infants, or both to risk 12 of harm if used routinely and indiscriminately, 13 including continuous electronic fetal monitoring, 14 labor induction, epidural analgesia, primary ce- 15 sarean section, and routine repeat cesarean 16 birth; 17 ‘‘(C) reliably incorporating noninvasive, 18 evidence-based practices that have documented 19 correlation with considerable improvement in 20 outcomes with no detrimental side effects, such 21 as smoking cessation programs in pregnancy 22 and proven models of group prenatal care that 23 integrate health assessment, education, and 24 support into a unified program and supporting 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00503 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 504 •S 4819 IS evidence-based breastfeeding promotion efforts 1 with respect for a breastfeeding individual’s 2 personal decision making; 3 ‘‘(D) a shared understanding of the quali- 4 fications of licensed providers of maternity care 5 and the best evidence about the safety, satisfac- 6 tion, outcomes, and costs of their care, and ap- 7 propriate deployment of such caregivers within 8 the maternity care workforce to address the 9 needs of childbearing individuals and newborns 10 and the growing shortage of maternity care- 11 givers; 12 ‘‘(E) a shared understanding of the results 13 of the best available research comparing hos- 14 pital, birth center, and planned home births, in- 15 cluding information about each setting’s safety, 16 satisfaction, outcomes, and costs; 17 ‘‘(F) high-quality, evidence-based child- 18 birth education that promotes a natural, 19 healthy, and safe approach to pregnancy, child- 20 birth, and early parenting; is taught by certified 21 educators, peer counselors, and health profes- 22 sionals; and promotes informed decision making 23 by childbearing individuals; and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00504 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 505 •S 4819 IS ‘‘(G) developing measures that enable a 1 more robust, balanced set of standardized ma- 2 ternity care measures, including performance 3 and quality measures;’’. 4 SEC. 515. INTERAGENCY COORDINATING COMMITTEE ON 5 THE PROMOTION OF OPTIMAL MATERNITY 6 OUTCOMES. 7 (a) IN GENERAL.—Part A of title II of the Public 8 Health Service Act (42 U.S.C. 202 et seq.) is amended 9 by adding at the end the following: 10 ‘‘SEC. 229A. INTERAGENCY COORDINATING COMMITTEE ON 11 THE PROMOTION OF OPTIMAL MATERNITY 12 OUTCOMES. 13 ‘‘(a) IN GENERAL.—The Secretary, acting through 14 the Deputy Assistant Secretary for Women’s Health under 15 section 229 and in collaboration with the Federal officials 16 specified in subsection (b), shall establish the Interagency 17 Coordinating Committee on the Promotion of Optimal Ma- 18 ternity Outcomes (referred to in this section as the 19 ‘ICCPOM’). 20 ‘‘(b) OTHER AGENCIES.—The officials specified in 21 this subsection are the Secretary of Labor, the Secretary 22 of Defense, the Secretary of Veterans Affairs, the Surgeon 23 General, the Director of the Centers for Disease Control 24 and Prevention, the Administrator of the Health Re- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00505 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 506 •S 4819 IS sources and Services Administration, the Administrator of 1 the Centers for Medicare & Medicaid Services, the Direc- 2 tor of the Indian Health Service, the Administrator of the 3 Substance Abuse and Mental Health Services Administra- 4 tion, the Director of the National Institute of Child Health 5 and Human Development, the Director of the Agency for 6 Healthcare Research and Quality, the Assistant Secretary 7 for Children and Families, the Deputy Assistant Secretary 8 for Minority Health, the Director of the Office of Per- 9 sonnel Management, and such other Federal officials as 10 the Secretary of Health and Human Services determines 11 to be appropriate. 12 ‘‘(c) CHAIR.—The Deputy Assistant Secretary for 13 Women’s Health shall serve as the chair of the ICCPOM. 14 ‘‘(d) DUTIES.—The ICCPOM shall guide policy and 15 program development across the Federal Government with 16 respect to promotion of optimal maternity care, provided, 17 however, that nothing in this section shall be construed 18 as transferring regulatory or program authority from an 19 agency to the ICCPOM. 20 ‘‘(e) CONSULTATIONS.—The ICCPOM shall actively 21 seek the input of, and shall consult with, all appropriate 22 and interested stakeholders, including State health depart- 23 ments, public health research and interest groups, founda- 24 tions, childbearing individuals and their advocates, and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00506 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 507 •S 4819 IS maternity care professional associations and organiza- 1 tions, reflecting racially, ethnically, demographically, and 2 geographically diverse communities. 3 ‘‘(f) ANNUAL REPORT.— 4 ‘‘(1) IN GENERAL.—The Secretary, on behalf of 5 the ICCPOM, shall annually submit to Congress a 6 report that summarizes— 7 ‘‘(A) all programs and policies of Federal 8 agencies (including the Medicare Program 9 under title XVIII of the Social Security Act and 10 the Medicaid program under title XIX of such 11 Act) designed to promote optimal maternity 12 care, focusing particularly on programs and 13 policies that support the adoption of evidence 14 based maternity care, as defined by timely, sci- 15 entifically sound systematic reviews; 16 ‘‘(B) all programs and policies of Federal 17 agencies (including the Medicare Program 18 under title XVIII of the Social Security Act and 19 the Medicaid program under title XIX of such 20 Act) designed to address the problems of mater- 21 nal mortality and morbidity, infant mortality, 22 prematurity, and low birth weight, including 23 such programs and policies designed to address 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00507 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 508 •S 4819 IS racial and ethnic disparities with respect to 1 each of such problems; 2 ‘‘(C) the extent of progress in reducing 3 maternal mortality and infant mortality, low 4 birth weight, and prematurity at State and na- 5 tional levels; and 6 ‘‘(D) such other information regarding op- 7 timal maternity care (such as quality and per- 8 formance measures) as the Secretary deter- 9 mines to be appropriate. 10 The information specified in subparagraph (C) shall 11 be included in each such report in a manner that 12 disaggregates such information by race, ethnicity, 13 and indigenous status in order to determine the ex- 14 tent of progress in reducing racial and ethnic dis- 15 parities and disparities related to indigenous status. 16 ‘‘(2) CERTAIN INFORMATION.—Each report 17 under paragraph (1) shall include information 18 (disaggregated by race, ethnicity, and indigenous 19 status, as applicable) on the following rates and 20 costs by State: 21 ‘‘(A) The rate of primary cesarean deliv- 22 eries and repeat cesarean deliveries. 23 ‘‘(B) The rate of vaginal births after cesar- 24 ean. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00508 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 509 •S 4819 IS ‘‘(C) The rate of vaginal breech births. 1 ‘‘(D) The rate of induction of labor. 2 ‘‘(E) The rate of freestanding birth center 3 births. 4 ‘‘(F) The rate of planned and unplanned 5 home birth. 6 ‘‘(G) The rate of attended births by pro- 7 vider, including by an obstetrician-gynecologist, 8 family practice physician, obstetrician-gyne- 9 cologist physician assistant, certified nurse-mid- 10 wife, certified midwife, and certified profes- 11 sional midwife. 12 ‘‘(H) The cost of maternity care 13 disaggregated by place of birth and provider of 14 care, including— 15 ‘‘(i) uncomplicated vaginal birth; 16 ‘‘(ii) complicated vaginal birth; 17 ‘‘(iii) uncomplicated cesarean birth; 18 and 19 ‘‘(iv) complicated cesarean birth. 20 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 21 is authorized to be appropriated, in addition to amounts 22 authorized to be appropriated under section 229(e), to 23 carry out this section $1,000,000 for each of the fiscal 24 years 2021 through 2025.’’. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00509 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 510 •S 4819 IS (b) CONFORMING AMENDMENTS.— 1 (1) INCLUSION AS DUTY OF HHS OFFICE ON 2 WOMEN’S HEALTH.—Section 229(b) of such Act (42 3 U.S.C. 237a(b)), as amended by section 514, is fur- 4 ther amended by adding at the end the following 5 new paragraph: 6 ‘‘(9) establish the Interagency Coordinating 7 Committee on the Promotion of Optimal Maternity 8 Outcomes in accordance with section 229A; and’’. 9 (2) TREATMENT OF BIENNIAL REPORTS.—Sec- 10 tion 229(d) of such Act (42 U.S.C. 237a(d)) is 11 amended by inserting ‘‘(other than under subsection 12 (b)(9))’’ after ‘‘under this section’’. 13 SEC. 516. CONSUMER EDUCATION CAMPAIGN. 14 Section 229(b) of the Public Health Service Act (42 15 U.S.C. 237a(b)), as amended by sections 514 and 515, 16 is further amended by adding at the end the following: 17 ‘‘(10) not later than one year after the date of 18 the enactment of the Health Equity and Account- 19 ability Act of 2020, develop and implement a 4-year 20 culturally and linguistically appropriate multimedia 21 consumer education campaign that is designed to 22 promote understanding and acceptance of evidence- 23 based maternity practices and models of care for op- 24 timal maternity outcomes among individuals of 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00510 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 511 •S 4819 IS childbearing ages and families of such individuals 1 and that— 2 ‘‘(A) highlights the importance of pro- 3 tecting, promoting, and supporting the innate 4 capacities of childbearing individuals and their 5 newborns for childbirth, breastfeeding, and at- 6 tachment; 7 ‘‘(B) promotes understanding of the impor- 8 tance of using obstetric interventions when 9 medically necessary and when supported by 10 strong, high-quality evidence; 11 ‘‘(C) highlights the widespread overuse of 12 maternity practices that have been shown to 13 have benefit when used appropriately in situa- 14 tions of medical necessity, but which can expose 15 pregnant individuals, infants, or both to risk of 16 harm if used routinely and indiscriminately, in- 17 cluding continuous fetal monitoring, labor in- 18 duction, epidural anesthesia, elective primary 19 cesarean section, and repeat cesarean delivery; 20 ‘‘(D) emphasizes the noninvasive maternity 21 practices that have strong proven correlation or 22 may be associated with considerable improve- 23 ment in outcomes with no detrimental side ef- 24 fects, and are significantly underused in the 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00511 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 512 •S 4819 IS United States, including smoking cessation pro- 1 grams in pregnancy, group model prenatal care, 2 continuous labor support, nonsupine positions 3 for birth, and external version to turn breech 4 babies at term; 5 ‘‘(E) educates consumers about the quali- 6 fications of licensed providers of maternity care 7 and the best evidence about their safety, satis- 8 faction, outcomes, and costs; 9 ‘‘(F) informs consumers about the best 10 available research comparing birth center 11 births, planned home births, and hospital 12 births, including information about each set- 13 ting’s safety, satisfaction, outcomes, and costs; 14 ‘‘(G) fosters participation in high-quality, 15 evidence-based childbirth education that pro- 16 motes a natural, healthy, and safe approach to 17 pregnancy, childbirth, and early parenting; is 18 taught by certified educators, peer counselors, 19 and health professionals; and promotes in- 20 formed decision making by childbearing individ- 21 uals; and 22 ‘‘(H) is pilot tested for consumer com- 23 prehension, cultural sensitivity, and acceptance 24 of the messages across geographically, racially, 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00512 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 513 •S 4819 IS ethnically, and linguistically diverse popu- 1 lations.’’. 2 SEC. 517. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC RE- 3 VIEWS FOR CARE OF CHILDBEARING INDI- 4 VIDUALS AND NEWBORNS. 5 (a) IN GENERAL.—Not later than one year after the 6 date of the enactment of this Act, the Secretary of Health 7 and Human Services, through the Agency for Healthcare 8 Research and Quality, shall— 9 (1) make publicly available an online biblio- 10 graphic database identifying systematic reviews, in- 11 cluding an explanation of the level and quality of 12 evidence, for care of childbearing individuals and 13 newborns; and 14 (2) initiate regular updates that incorporate 15 newly issued and updated systematic reviews. 16 (b) SOURCES.—To aim for a comprehensive inventory 17 of systematic reviews relevant to maternal and newborn 18 care, the database shall identify reviews from diverse 19 sources, including— 20 (1) scientific peer-reviewed journals; 21 (2) databases, including Cochrane Database of 22 Systematic Reviews, Clinical Evidence, and Data- 23 base of Abstracts of Reviews of Effects; and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00513 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 514 •S 4819 IS (3) internet websites of agencies and organiza- 1 tions throughout the world that produce such sys- 2 tematic reviews. 3 (c) FEATURES.—The database shall— 4 (1) provide bibliographic citations for each 5 record within the database, and for each such cita- 6 tion include an explanation of the level and quality 7 of evidence; 8 (2) include abstracts, as available; 9 (3) provide reference to companion documents 10 as may exist for each review, such as evidence tables 11 and guidelines or consumer educational materials de- 12 veloped from the review; 13 (4) provide links to the source of the full review 14 and to any companion documents; 15 (5) provide links to the source of a previous 16 version or update of the review; 17 (6) be searchable by intervention or other topic 18 of the review, reported outcomes, author, title, and 19 source; and 20 (7) offer to users periodic electronic notification 21 of database updates relating to users’ topics of inter- 22 est. 23 (d) OUTREACH.—Not later than the first date the 24 database is made publicly available and periodically there- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00514 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 515 •S 4819 IS after, the Secretary of Health and Human Services shall 1 publicize the availability, features, and uses of the data- 2 base under this section to the stakeholders described in 3 subsection (e). 4 (e) CONSULTATION.—For purposes of developing the 5 database under this section and maintaining and updating 6 such database, the Secretary of Health and Human Serv- 7 ices shall convene and consult with an advisory committee 8 composed of relevant stakeholders, including— 9 (1) Federal Medicaid administrators and State 10 agencies administrating State plans under title XIX 11 of the Social Security Act pursuant to section 12 1902(a)(5) of such Act (42 U.S.C. 1396a(a)(5)); 13 (2) providers of maternity and newborn care 14 from both academic and community-based settings, 15 including obstetrician-gynecologists, family physi- 16 cians, certified nurse midwives, certified midwives, 17 certified professional midwives, physician assistants, 18 perinatal nurses, pediatricians, and nurse practi- 19 tioners; 20 (3) maternal-fetal medicine specialists; 21 (4) neonatologists; 22 (5) childbearing individuals and advocates for 23 such individuals, including childbirth educators cer- 24 tified by a nationally accredited program, rep- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00515 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 516 •S 4819 IS resenting communities that are diverse in terms of 1 race, ethnicity, indigenous status, and geographic 2 area; 3 (6) employers and purchasers; 4 (7) health facility and system leaders, including 5 both hospital and birth center facilities; 6 (8) journalists; and 7 (9) bibliographic informatics specialists. 8 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 9 authorized to be appropriated $2,500,000 for each of the 10 fiscal years 2021 through 2023 for the purpose of devel- 11 oping the database and such sums as may be necessary 12 for each subsequent fiscal year for updating the database 13 and providing outreach and notification to users, as de- 14 scribed in this section. 15 SEC. 518. EXPANSION OF CDC PREVENTION RESEARCH 16 CENTERS PROGRAM TO INCLUDE CENTERS 17 ON OPTIMAL MATERNITY OUTCOMES. 18 (a) IN GENERAL.—Not later than one year after the 19 date of the enactment of this Act, the Secretary of Health 20 and Human Services, shall support the establishment of 21 additional Prevention Research Centers under the Preven- 22 tion Research Center Program administered by the Cen- 23 ters for Disease Control and Prevention. Such additional 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00516 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 517 •S 4819 IS centers shall each be known as a Center for Excellence 1 on Optimal Maternity Outcomes. 2 (b) RESEARCH.—Each Center for Excellence on Opti- 3 mal Maternity Outcomes shall— 4 (1) conduct at least one focused program of re- 5 search to improve maternity outcomes, including the 6 reduction of cesarean birth rates, elective inductions, 7 prematurity rates, and low birth weight rates within 8 an underserved population that has a disproportion- 9 ately large burden of suboptimal maternity out- 10 comes, including maternal mortality and morbidity, 11 infant mortality, prematurity, or low birth weight, 12 which such program shall include developing per- 13 formance and quality measures for accountability; 14 (2) work with partners on special interest 15 projects, as specified by the Centers for Disease 16 Control and Prevention and other relevant agencies 17 within the Department of Health and Human Serv- 18 ices, and on projects funded by other sources; and 19 (3) involve a minimum of two distinct birth set- 20 ting models, such as— 21 (A) a hospital labor and delivery model 22 and freestanding birth center model; or 23 (B) a hospital labor and delivery model 24 and planned home birth model. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00517 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 518 •S 4819 IS (c) INTERDISCIPLINARY PROVIDERS.—Each Center 1 for Excellence on Optimal Maternity Outcomes shall in- 2 clude the following interdisciplinary providers of maternity 3 care: 4 (1) Obstetrician-gynecologists. 5 (2) At least two of the following providers: 6 (A) Family practice physicians. 7 (B) Nurse practitioners. 8 (C) Physician assistants. 9 (D) Certified professional midwives. 10 (d) SERVICES.—Research conducted by each Center 11 for Excellence on Optimal Maternity Outcomes shall in- 12 clude at least 2 (and preferably more) of the following sup- 13 portive provider services: 14 (1) Mental health. 15 (2) Doula labor support. 16 (3) Nutrition education. 17 (4) Childbirth education. 18 (5) Social work. 19 (6) Physical therapy or occupation therapy. 20 (7) Substance abuse services. 21 (8) Home visiting. 22 (e) COORDINATION.—The programs of research at 23 each of the Centers of Excellence on Optimal Maternity 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00518 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 519 •S 4819 IS Outcomes shall complement and not replicate the work of 1 the other. 2 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 3 authorized to be appropriated to carry out this section 4 $2,000,000 for each of the fiscal years 2021 through 5 2025. 6 SEC. 519. EXPANDING MODELS ALLOWED TO BE TESTED BY 7 CENTER FOR MEDICARE & MEDICAID INNO- 8 VATION TO INCLUDE MATERNITY CARE MOD- 9 ELS. 10 Section 1115A(b)(2)(B) of the Social Security Act 11 (42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the 12 end the following new clause: 13 ‘‘(xxviii) Promoting evidence-based 14 models of care that have been associated 15 with reductions in maternal and infant 16 health disparities, including incorporating 17 the use of doula and promotoras support 18 for pregnant and childbearing individuals 19 into evidence-based models of prenatal 20 care, labor and delivery, and postpartum 21 care, and supporting the appropriate use of 22 out-of-hospital birth models, including 23 births at home and in freestanding birth 24 centers.’’. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00519 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 520 •S 4819 IS SEC. 520. DEVELOPMENT OF INTERPROFESSIONAL MATER- 1 NITY CARE EDUCATIONAL MODELS AND 2 TOOLS. 3 (a) IN GENERAL.—Not later than 6 months after the 4 date of the enactment of this Act, the Secretary of Health 5 and Human Services, acting in conjunction with the Ad- 6 ministrator of Health Resources and Services Administra- 7 tion, shall convene, for a 1-year period, an Interprofes- 8 sional Maternity Provider Education Commission to dis- 9 cuss and make recommendations for— 10 (1) a consensus standard physiologic maternity 11 care curriculum that takes into account the core 12 competencies for basic midwifery practice such as 13 those developed by the American College of Nurse 14 Midwives and the North American Registry of Mid- 15 wives, and the educational objectives for physicians 16 practicing in obstetrics and gynecology as deter- 17 mined by the Council on Resident Education in Ob- 18 stetrics and Gynecology; 19 (2) suggestions for multidisciplinary use of the 20 consensus physiologic curriculum; 21 (3) strategies to integrate and coordinate edu- 22 cation across maternity care disciplines, including 23 recommendations to increase medical and midwifery 24 student exposure to out-of-hospital birth; and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00520 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 521 •S 4819 IS (4) pilot demonstrations of interprofessional 1 educational models. 2 (b) PARTICIPANTS.—The Commission shall include 3 maternity care educators, curriculum developers, service 4 leaders, certification leaders, and accreditation leaders 5 from the various professions that provide maternity care 6 in the United States. Such professions shall include obste- 7 trician gynecologists, certified nurse midwives or certified 8 midwives, family practice physicians, nurse practitioners, 9 physician assistants, certified professional midwives, and 10 perinatal nurses. Additionally, the Commission shall in- 11 clude representation from maternity care consumer advo- 12 cates. 13 (c) CURRICULUM.—The consensus standard physio- 14 logic maternity care curriculum described in subsection 15 (a)(1) shall— 16 (1) have a public health focus with a foundation 17 in health promotion and disease prevention; 18 (2) foster physiologic childbearing and woman 19 and family centered care; 20 (3) integrate strategies to reduce maternal and 21 infant morbidity and mortality; 22 (4) incorporate recommendations to ensure re- 23 spectful, safe, and seamless consultation, referral, 24 transport, and transfer of care when necessary; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00521 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 522 •S 4819 IS (5) include cultural sensitivity and strategies to 1 decrease disparities in maternity outcomes; and 2 (6) include implicit bias training. 3 (d) REPORT.—Not later than 6 months after the final 4 meeting of the Commission, the Secretary of Health and 5 Human Services shall— 6 (1) submit to Congress a report containing the 7 recommendations made by the Commission under 8 this section; and 9 (2) make such report publicly available. 10 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 11 authorized to be appropriated to carry out this section 12 $1,000,000 for each of the fiscal years 2021 and 2022, 13 and such sums as are necessary for each of the fiscal years 14 2023 through 2025. 15 SEC. 521. INCLUDING SERVICES FURNISHED BY CERTAIN 16 STUDENTS, INTERNS, AND RESIDENTS SU- 17 PERVISED BY CERTIFIED NURSE MIDWIVES 18 WITHIN INPATIENT HOSPITAL SERVICES 19 UNDER MEDICARE. 20 (a) IN GENERAL.—Section 1861(b) of the Social Se- 21 curity Act (42 U.S.C. 1395x(b)) is amended— 22 (1) in paragraph (6), by striking ‘‘; or’’ at the 23 end and inserting ‘‘, or in the case of services in a 24 hospital or osteopathic hospital by a student midwife 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00522 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 523 •S 4819 IS or an intern or resident-in-training under a teaching 1 program previously described in this paragraph who 2 is in the field of obstetrics and gynecology, if such 3 student midwife, intern, or resident-in-training is su- 4 pervised by a certified nurse-midwife to the extent 5 permitted under applicable State law and as may be 6 authorized by the hospital;’’; 7 (2) in paragraph (7), by striking the period at 8 the end and inserting ‘‘; or’’; and 9 (3) by adding at the end the following new 10 paragraph: 11 ‘‘(8) a certified nurse-midwife where the hos- 12 pital has a teaching program approved as specified 13 in paragraph (6), if— 14 ‘‘(A) the hospital elects to receive any pay- 15 ment due under this title for reasonable costs of 16 such services; and 17 ‘‘(B) all certified nurse-midwives in such 18 hospital agree not to bill charges for profes- 19 sional services rendered in such hospital to indi- 20 viduals covered under the insurance program 21 established by this title.’’. 22 (b) EFFECTIVE DATE.—The amendments made by 23 subsection (a) shall apply to services furnished on or after 24 the date of the enactment of this Act. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00523 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 524 •S 4819 IS SEC. 522. GRANTS TO PROFESSIONAL ORGANIZATIONS TO 1 INCREASE DIVERSITY IN MATERNAL, REPRO- 2 DUCTIVE, AND SEXUAL HEALTH PROFES- 3 SIONALS. 4 (a) IN GENERAL.—The Secretary of Health and 5 Human Services, through the Administrator of the Health 6 Resources and Services Administration, shall carry out a 7 grant program under which the Secretary may make to 8 eligible organizations— 9 (1) for fiscal year 2021, planning grants de- 10 scribed in subsection (b); and 11 (2) for the subsequent 4-year period, implemen- 12 tation grants described in subsection (c). 13 (b) PLANNING GRANTS.— 14 (1) IN GENERAL.—Planning grants described in 15 this subsection are grants for the following purposes: 16 (A) To collect data and identify any work- 17 force disparities, with respect to a health pro- 18 fession, at each of the following areas along the 19 health professional continuum: 20 (i) Pipeline availability with respect to 21 students at the high school and college or 22 university levels considering and working 23 toward entrance in the profession, includ- 24 ing barriers triggered by criminal records. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00524 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 525 •S 4819 IS (ii) Entrance into the training pro- 1 gram for the profession. 2 (iii) Graduation from such training 3 program. 4 (iv) Entrance into practice, including 5 barriers triggered by criminal records. 6 (v) Retention in practice for more 7 than a 5-year period. 8 (B) To develop one or more strategies to 9 address the workforce disparities within the 10 health profession, as identified under (and in 11 response to the findings pursuant to) subpara- 12 graph (A). 13 (2) APPLICATION.—To be eligible to receive a 14 grant under this subsection, an eligible health pro- 15 fessional organization shall submit to the Secretary 16 of Health and Human Services an application in 17 such form and manner and containing such informa- 18 tion as specified by the Secretary. 19 (3) AMOUNT.—Each grant awarded under this 20 subsection shall be for an amount not to exceed 21 $300,000. 22 (4) REPORT.—Each recipient of a grant under 23 this subsection shall submit to the Secretary of 24 Health and Human Services a report containing— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00525 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 526 •S 4819 IS (A) information on the extent and distribu- 1 tion of workforce disparities identified through 2 the grant; and 3 (B) reasonable objectives and strategies 4 developed to address such disparities within a 5 5-, 10-, and 25-year period. 6 (c) IMPLEMENTATION GRANTS.— 7 (1) IN GENERAL.—Implementation grants de- 8 scribed in this subsection are grants to implement 9 one or more of the strategies developed pursuant to 10 a planning grant awarded under subsection (b). 11 (2) APPLICATION.—To be eligible to receive a 12 grant under this subsection, an eligible health pro- 13 fessional organization shall submit to the Secretary 14 of Health and Human Services an application in 15 such form and manner as specified by the Secretary. 16 Each such application shall contain information on 17 the capability of the organization to carry out a 18 strategy described in paragraph (1), involvement of 19 partners or coalitions, plans for developing sustain- 20 ability of the efforts after the culmination of the 21 grant cycle, and any other information specified by 22 the Secretary. 23 (3) AMOUNT.—Each grant awarded under this 24 subsection shall be for an amount not to exceed 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00526 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 527 •S 4819 IS $500,000 each year during the 4-year period of the 1 grant. 2 (4) REPORTS.—For each of the first 3 years for 3 which an eligible health professional organization is 4 awarded a grant under this subsection, the organiza- 5 tion shall submit to the Secretary of Health and 6 Human Services a report on the activities carried 7 out by such organization through the grant during 8 such year and objectives for the subsequent year. 9 For the fourth year for which an eligible health pro- 10 fessional organization is awarded a grant under this 11 subsection, the organization shall submit to the Sec- 12 retary a report that includes an analysis of all the 13 activities carried out by the organization through the 14 grant and a detailed plan for continuation of out- 15 reach efforts. 16 (d) ELIGIBLE HEALTH PROFESSIONAL ORGANIZA- 17 TION DEFINED.—For purposes of this section, the term 18 ‘‘eligible health professional organization’’ means a profes- 19 sional organization representing obstetrician-gyne- 20 cologists, certified nurse midwives, certified midwives, 21 family practice physicians, nurse practitioners whose scope 22 of practice includes maternity or sexual and reproductive 23 health care, physician assistants whose scope of practice 24 includes obstetrical or sexual and reproductive health care, 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00527 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 528 •S 4819 IS or certified professional midwives, adolescent medicine 1 specialists, and pediatricians who provide sexual and re- 2 productive health care. 3 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 4 authorized to be appropriated to carry out this section 5 $2,000,000 for fiscal year 2021 and $3,000,000 for each 6 of the fiscal years 2022 through 2025. 7 SEC. 523. INTERAGENCY UPDATE TO THE QUALITY FAMILY 8 PLANNING GUIDELINES. 9 (a) IN GENERAL.—Not later than six months after 10 the date of enactment of this Act, the Director of the Cen- 11 ters for Disease Control and Prevention and the Office 12 of Population Affairs shall review and expand the 2014 13 Quality Family Planning Guidelines to address— 14 (1) health disparities; and 15 (2) the importance of patient-directed contra- 16 ceptive decision making. 17 (b) CONSULTATION.—In carrying out subsection (a), 18 the Director of the Centers for Disease Control and Pre- 19 vention and the Office of Population Affairs shall convene 20 a meeting, and solicit the views of, stakeholders including 21 experts on health disparities, experts on reproductive coer- 22 cion, representatives of provider organizations, patient ad- 23 vocates, reproductive justice organizations, organizations 24 that represent racial and ethnic minority communities, or- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00528 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 529 •S 4819 IS ganizations that represent people with disabilities, organi- 1 zations that represent LGBTQ persons, and organizations 2 that represent people with limited English proficiency. 3 SEC. 524. DISSEMINATION OF THE QUALITY FAMILY PLAN- 4 NING GUIDELINES. 5 (a) IN GENERAL.—Not later than six months after 6 the date of enactment of this Act, the Secretary of Health 7 and Human Services and the Director of the Centers for 8 Disease Control and Prevention shall— 9 (1) develop a plan for outreach to publicly fund- 10 ed health care providers, including federally qualified 11 health centers and branches of the Indian Health 12 Service, about the quality family planning guidelines 13 referred to in section 523; and 14 (2) award grants to eligible entities to imple- 15 ment these guidelines for all patients seeking family 16 planning services. 17 (b) DEFINITION.—In this section, the term ‘‘eligible 18 entity’’ means a publicly funded health care provider that 19 serves persons of reproductive age. 20 Subtitle B—Pregnancy Screening 21 SEC. 531. PREGNANCY INTENTION SCREENING INITIATIVE 22 DEMONSTRATION PROGRAM. 23 Part P of title III of the Public Health Service Act 24 (42 U.S.C. 280g et seq.), as amended by section 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00529 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 530 •S 4819 IS 505(c)(6), is further amended by adding at the end the 1 following: 2 ‘‘SEC. 399V–8. PREGNANCY INTENTION SCREENING INITIA- 3 TIVE DEMONSTRATION PROGRAM. 4 ‘‘(a) PROGRAM ESTABLISHMENT.—The Secretary, 5 acting through the Director of the Centers for Disease 6 Control and Prevention, shall establish a demonstration 7 program to facilitate the clinical adoption of pregnancy in- 8 tention screening initiatives by health care and social serv- 9 ices providers. 10 ‘‘(b) GRANTS.—The Secretary may carry out the 11 demonstration program through awarding grants to eligi- 12 ble entities to implement pregnancy intention screening 13 initiatives, collect data, and evaluate such initiatives. 14 ‘‘(c) ELIGIBLE ENTITIES.— 15 ‘‘(1) IN GENERAL.—An eligible entity under 16 this section is an entity described in paragraph (2) 17 that provides non-directive, comprehensive, medically 18 accurate information. 19 ‘‘(2) ENTITIES DESCRIBED.—For purposes of 20 paragraph (1), an entity described in this paragraph 21 is a community-based organization, voluntary health 22 organization, public health department, community 23 health center, or other interested public or private 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00530 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 531 •S 4819 IS primary, behavioral, or other health care or social 1 service provider or organization. 2 ‘‘(d) PREGNANCY INTENTION SCREENING INITIA- 3 TIVE.—For purposes of this section, the term ‘pregnancy 4 intention screening initiative’ means any initiative by an 5 eligible entity to routinely screen women with respect to 6 their pregnancy intentions and goals to either prevent un- 7 intended pregnancies or improve the likelihood of healthy 8 pregnancies, in order to better provide health care that 9 meets the contraceptive or pre-pregnancy needs and goals 10 of such women. 11 ‘‘(e) EVALUATION.— 12 ‘‘(1) IN GENERAL.—The Secretary, acting 13 through the Director of the Centers for Disease 14 Control and Prevention, shall, by grant or contract, 15 and after consultation as described in paragraph (2), 16 conduct an evaluation of the demonstration pro- 17 gram, with respect to pregnancy intention screening 18 initiatives, conducted under this section. Such eval- 19 uation shall include: 20 ‘‘(A) Assessment of the implementation of 21 pregnancy intention screening protocols among 22 a diverse group of patients and providers, in- 23 cluding collecting data on the experiences and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00531 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 532 •S 4819 IS outcomes for diverse patient populations in a 1 variety of clinical settings. 2 ‘‘(B) Analysis of outcome measures that 3 will facilitate effective and widespread adoption 4 of such protocols by health care providers for 5 inquiring about and responding to pregnancy 6 goals of women with both contraceptive and 7 pre-pregnancy care. 8 ‘‘(C) Consideration of health disparities 9 among the population served. 10 ‘‘(D) Assessment of the equitable and vol- 11 untary application of such initiatives to minor- 12 ity and medically underserved communities. 13 ‘‘(E) Assessment of the training, capacity, 14 and ongoing technical assistance needed for 15 providers to effectively implement such preg- 16 nancy intention screening protocols. 17 ‘‘(F) Assessment of whether referral sys- 18 tems for selected protocols follow evidence-based 19 standards that ensure access to comprehensive 20 health services and appropriate follow-up care. 21 ‘‘(G) Measuring through rigorous methods 22 the effect of such initiatives on key health out- 23 comes. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00532 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 533 •S 4819 IS ‘‘(2) CONSULTATION WITH INDEPENDENT, EX- 1 PERT ADVISORY PANEL.—In conducting the evalua- 2 tion under paragraph (1), the Director of the Cen- 3 ters for Disease Control and Prevention shall consult 4 with physicians, physician assistants, advanced prac- 5 tice registered nurses, nurse midwives, and other 6 health care providers who specialize in women’s 7 health, and other experts in public health, clinical 8 practice, program evaluation, and research. 9 ‘‘(3) REPORT.—Not later than one year after 10 the last day of the demonstration program under 11 this section, the Director of the Centers for Disease 12 Control and Prevention shall submit to Congress a 13 report on the results of the evaluation conducted 14 under paragraph (1) and shall make the report pub- 15 licly available. 16 ‘‘(f) FUNDING.— 17 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 18 To carry out this section, there is authorized to be 19 appropriated $10,000,000 for each of fiscal years 20 2021 through 2025. 21 ‘‘(2) LIMITATION.—Not more than 20 percent 22 of funds appropriated to carry out this section pur- 23 suant to paragraph (1) for a fiscal year may be used 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00533 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 534 •S 4819 IS for purposes of the evaluation under subsection 1 (e).’’. 2 TITLE VI—MENTAL HEALTH 3 SEC. 601. MENTAL HEALTH FINDINGS. 4 Congress finds the following: 5 (1) Despite the existence of effective treat- 6 ments, inequities lie in the availability, accessibility, 7 and quality of mental health services for racial and 8 ethnic minorities and people with disabilities. 9 (2) These inequities have powerful significance 10 for minority groups and for society as a whole. 11 (3) Racial and ethnic minorities and people 12 with disabilities bear a greater burden from unmet 13 mental health needs and thus suffer a greater loss 14 to their overall health and productivity. 15 (4) Improving community conditions and one’s 16 home environment, paired with high-quality, acces- 17 sible, and culturally tailored mental health services, 18 can reduce the likelihood, frequency, and intensity of 19 challenges to one’s mental health. 20 (5) The presence of strong social connections 21 and trust, opportunities to experience and share cul- 22 tural identity, safe gathering places, and economic 23 opportunity are community factors that benefit men- 24 tal health. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00534 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 535 •S 4819 IS (6) The social, physical, and economic condi- 1 tions in communities can have tremendous influence 2 on daily stressors that shape mental health out- 3 comes. 4 (7) The foremost barriers include the cost of 5 care, societal stigma, and the fragmented organiza- 6 tion of services. 7 (8) People with disabilities who are racial or 8 ethnic minorities may have co-occurring mental 9 health conditions which, without proper accommoda- 10 tions and support, further stigmatize them and limit 11 their participation in society. 12 (9) African-American, Latinx, Asian American, 13 Pacific Islander, Native, and other people of color 14 have attitudes toward mental health challenges that 15 are another barrier to seeking mental health care. 16 (10) Mental illness retains considerable stigma 17 in many communities of color, including those of 18 Asian Americans and Pacific Islanders, and seeking 19 treatment is not always encouraged. 20 (11) Addressing mental health stigma and in- 21 creasing culturally appropriate treatment modalities 22 in communities will help to increase utilization of 23 mental health services for people who have trouble 24 functioning because of mental health challenges. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00535 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 536 •S 4819 IS (12) There is a link between mental health di- 1 agnosis and the likelihood of an individual commit- 2 ting suicide. 3 (13) A comprehensive public health approach to 4 behavioral health fosters protective factors in racial 5 and ethnic communities that support mental health. 6 (14) Approaches to mental health and address- 7 ing trauma must keep in mind the historical and 8 cultural trauma that has impacted many commu- 9 nities of color. 10 (15) Treatment modalities must keep ap- 11 proaches of individual communities to mental health 12 in mind, including by considering— 13 (A) approaches to cultural healing prac- 14 tices; and 15 (B) the mental health professionals needed 16 for such practices, such as peer support special- 17 ists. 18 (16) Approaches to mental health and address- 19 ing trauma must keep in mind the concept of 20 intersectionality of individuals; that individuals may 21 have many inequities that shape the way they proc- 22 ess and experience everyday life. 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00536 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 537 •S 4819 IS SEC. 602. COVERAGE OF MARRIAGE AND FAMILY THERA- 1 PIST SERVICES, MENTAL HEALTH COUN- 2 SELOR SERVICES, SUBSTANCE ABUSE COUN- 3 SELOR SERVICES, AND PEER SUPPORT SPE- 4 CIALIST SERVICES UNDER PART B OF THE 5 MEDICARE PROGRAM. 6 (a) COVERAGE OF SERVICES.— 7 (1) IN GENERAL.—Section 1861(s)(2) of the 8 Social Security Act (42 U.S.C. 1395x(s)(2)), as 9 amended by section 431(c), is amended— 10 (A) in subparagraph (HH), by striking 11 ‘‘and’’ at the end; 12 (B) in subparagraph (II), by adding ‘‘and’’ 13 after the semicolon at the end; and 14 (C) by adding at the end the following new 15 subparagraph: 16 ‘‘(JJ) marriage and family therapist services 17 (as defined in subsection (nnn)(1)), mental health 18 counselor services (as defined in subsection 19 (nnn)(3)), substance abuse counselor services (as de- 20 fined in subsection (nnn)(5)), and peer support spe- 21 cialist services (as defined in subsection (nnn)(7));’’. 22 (2) DEFINITIONS.—Section 1861 of the Social 23 Security Act (42 U.S.C. 1395x), as amended by sec- 24 tions 207(b)(1), 417(a), and 433(c), is amended by 25 adding at the end the following new subsection: 26 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00537 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 538 •S 4819 IS ‘‘Marriage and Family Therapist Services; Marriage and 1 Family Therapist; Mental Health Counselor Serv- 2 ices; Mental Health Counselor; Substance Abuse 3 Counselor Services; Substance Abuse Counselor; 4 Peer Support Specialist Services; Peer Support Spe- 5 cialist 6 ‘‘(nnn)(1) The term ‘marriage and family therapist 7 services’ means services performed by a marriage and 8 family therapist (as defined in paragraph (2)) for the diag- 9 nosis and treatment of mental illnesses, which the mar- 10 riage and family therapist is legally authorized to perform 11 under State law (or the State regulatory mechanism pro- 12 vided by State law) of the State in which such services 13 are performed, as would otherwise be covered if furnished 14 by a physician or as an incident to a physician’s profes- 15 sional service, but only if no facility or other provider 16 charges or is paid any amounts with respect to the fur- 17 nishing of such services. 18 ‘‘(2) The term ‘marriage and family therapist’ means 19 an individual who— 20 ‘‘(A) possesses a master’s or doctoral degree 21 that qualifies for licensure or certification as a mar- 22 riage and family therapist pursuant to State law, in- 23 cluding but not limited to, clinical social workers and 24 occupational therapists; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00538 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 539 •S 4819 IS ‘‘(B) after obtaining such degree has performed 1 at least 2 years of clinical supervised experience in 2 marriage and family therapy; and 3 ‘‘(C) in the case of an individual performing 4 services in a State that provides for licensure or cer- 5 tification of marriage and family therapists, is li- 6 censed or certified as a marriage and family thera- 7 pist in such State. 8 ‘‘(3) The term ‘mental health counselor services’ 9 means services performed by a mental health counselor (as 10 defined in paragraph (4)) for the diagnosis and treatment 11 of mental illnesses that the mental health counselor is le- 12 gally authorized to perform under State law (or the State 13 regulatory mechanism provided by the State law) of the 14 State in which such services are performed, as would oth- 15 erwise be covered if furnished by a physician or as incident 16 to a physician’s professional service, but only if no facility 17 or other provider charges or is paid any amounts with re- 18 spect to the furnishing of such services. 19 ‘‘(4) The term ‘mental health counselor’ means an 20 individual who— 21 ‘‘(A) possesses a master’s or doctor’s degree in 22 mental health counseling or a related field, including 23 clinical social workers and occupational therapists; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00539 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 540 •S 4819 IS ‘‘(B) after obtaining such a degree has per- 1 formed at least 2 years of supervised mental health 2 counselor practice; and 3 ‘‘(C) in the case of an individual performing 4 services in a State that provides for licensure or cer- 5 tification of mental health counselors or professional 6 counselors, is licensed or certified as a mental health 7 counselor or professional counselor in such State. 8 ‘‘(5) The term ‘substance abuse counselor services’ 9 means services performed by a substance abuse counselor 10 (as defined in paragraph (6)) for the diagnosis and treat- 11 ment of substance abuse and addiction that the substance 12 abuse counselor is legally authorized to perform under 13 State law (or the State regulatory mechanism provided by 14 the State law) of the State in which such services are per- 15 formed, as would otherwise be covered if furnished by a 16 physician or as incident to a physician’s professional serv- 17 ice, but only if no facility or other provider charges or is 18 paid any amounts with respect to the furnishing of such 19 services. 20 ‘‘(6) The term ‘substance abuse counselor’ means an 21 individual who— 22 ‘‘(A) has performed at least 2 years of super- 23 vised substance abuse counselor practice; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00540 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 541 •S 4819 IS ‘‘(B) in the case of an individual performing 1 services in a State that provides for licensure or cer- 2 tification of substance abuse counselors or profes- 3 sional counselors, is licensed or certified as a sub- 4 stance abuse counselor or professional counselor in 5 such State; or 6 ‘‘(C) is a drug and alcohol counselor as defined 7 in section 40.281 of title 49, Code of Federal Regu- 8 lations. 9 ‘‘(7) The term ‘peer support specialist services’ 10 means services performed by a peer support specialist (as 11 defined in paragraph (8)) for the well-being of individuals 12 needing mental health support that the peer support spe- 13 cialist is legally authorized to perform under State law (or 14 the State regulatory mechanism provided by the State 15 law) of the State in which such services are performed, 16 as would otherwise be covered if furnished by a physician 17 or as incident to a physician’s professional service, but 18 only if no facility or other provider charges or is paid any 19 amounts with respect to the furnishing of such services. 20 ‘‘(8) The term ‘peer support specialist’ means an in- 21 dividual who— 22 ‘‘(A) is an individual living in recovery with 23 mental illness, addiction, or systems involvement; 24 ‘‘(B) has skills learned in formal training; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00541 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 542 •S 4819 IS ‘‘(C) uses assets-based framing in speaking 1 about mental health, recovery, and well-being; and 2 ‘‘(D) delivers services in behavioral health set- 3 tings to promote mind-body recovery and resil- 4 iency.’’. 5 (3) PROVISION FOR PAYMENT UNDER PART 6 B.—Section 1832(a)(2)(B) of the Social Security 7 Act (42 U.S.C. 1395k(a)(2)(B)) is amended— 8 (A) by striking ‘‘and’’ at the end of clause 9 (iv); and 10 (B) by adding at the end the following new 11 clause: 12 ‘‘(v) marriage and family therapist 13 services, mental health counselor services, 14 substance abuse counselor services, and 15 peer support specialist services; and’’. 16 (4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 17 of the Social Security Act (42 U.S.C. 1395l(a)(1)), 18 as amended by section 431(c)(3), 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 marriage and family therapist services, men- 23 tal health counselor services, substance abuse 24 counselor services, and peer support specialist 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00542 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 543 •S 4819 IS services under section 1861(s)(2)(JJ), the 1 amounts paid shall be 80 percent of the lesser 2 of the actual charge for the services or 75 per- 3 cent of the amount determined for payment of 4 a psychologist under subparagraph (L)’’. 5 (5) EXCLUSION OF MARRIAGE AND FAMILY 6 THERAPIST SERVICES, MENTAL HEALTH COUNSELOR 7 SERVICES, AND PEER SUPPORT SPECIALIST SERV- 8 ICES FROM SKILLED NURSING FACILITY PROSPEC- 9 TIVE PAYMENT SYSTEM.—Section 1888(e)(2)(A)(ii) 10 of the Social Security Act (42 U.S.C. 11 1395yy(e)(2)(A)(ii)) is amended by inserting ‘‘mar- 12 riage and family therapist services (as defined in 13 section 1861(nnn)(1)), mental health counselor serv- 14 ices (as defined in section 1861(nnn)(3)), and peer 15 support specialist services (as defined in section 16 1861(nnn)(7))’’ after ‘‘qualified psychologist serv- 17 ices,’’. 18 (6) INCLUSION OF MARRIAGE AND FAMILY 19 THERAPISTS, MENTAL HEALTH COUNSELORS, AND 20 SUBSTANCE ABUSE COUNSELORS AS PRACTITIONERS 21 FOR ASSIGNMENT OF CLAIMS.—Section 22 1842(b)(18)(C) of the Social Security Act (42 23 U.S.C. 1395u(b)(18)(C)) is amended by adding at 24 the end the following new clauses: 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00543 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 544 •S 4819 IS ‘‘(vii) A marriage and family therapist (as de- 1 fined in section 1861(nnn)(2)). 2 ‘‘(viii) A mental health counselor (as defined in 3 section 1861(nnn)(4)). 4 ‘‘(ix) A substance abuse counselor (as defined 5 in section 1861(nnn)(6)). 6 ‘‘(x) A peer support specialist (as defined in 7 section 1861(nnn)(8)).’’. 8 (b) COVERAGE OF CERTAIN MENTAL HEALTH SERV- 9 ICES PROVIDED IN CERTAIN SETTINGS.— 10 (1) RURAL HEALTH CLINICS AND FEDERALLY 11 QUALIFIED HEALTH CENTERS.—Section 12 1861(aa)(1)(B) of the Social Security Act (42 13 U.S.C. 1395x(aa)(1)(B)) is amended by striking ‘‘or 14 by a clinical social worker (as defined in subsection 15 (hh)(1)),’’ and inserting ‘‘, by a clinical social worker 16 (as defined in subsection (hh)(1)), by a marriage 17 and family therapist (as defined in subsection 18 (nnn)(2)), or by a mental health counselor (as de- 19 fined in subsection (nnn)(4)), or by a substance 20 abuse counselor (as defined in section 1861 21 (nnn)(6)), or by a peer support specialist (as defined 22 in section 1861(nnn)(8)).’’. 23 (2) HOSPICE PROGRAMS.—Section 24 1861(dd)(2)(B)(i)(III) of the Social Security Act (42 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00544 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 545 •S 4819 IS U.S.C. 1395x(dd)(2)(B)(i)(III)) is amended by in- 1 serting ‘‘or one marriage and family therapist (as 2 defined in subsection (nnn)(2))’’ after ‘‘social work- 3 er’’. 4 (c) AUTHORIZATION OF MARRIAGE AND FAMILY 5 THERAPISTS TO DEVELOP DISCHARGE PLANS FOR 6 POSTHOSPITAL SERVICES.—Section 1861(ee)(2)(G) of 7 the Social Security Act (42 U.S.C. 1395x(ee)(2)(G)) is 8 amended by inserting ‘‘marriage and family therapist (as 9 defined in subsection (nnn)(2)),’’ after ‘‘social worker,’’. 10 (d) EFFECTIVE DATE.—The amendments made by 11 this section shall apply with respect to services furnished 12 on or after January 1, 2021. 13 SEC. 603. INTEGRATED HEALTH CARE DEMONSTRATION 14 PROGRAM. 15 Part D of title V of the Public Health Service Act 16 (42 U.S.C. 290dd et seq.) is amended by adding at the 17 end the following: 18 ‘‘SEC. 553. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 19 PROVISION OF BEHAVIORAL HEALTH CARE 20 IN PRIMARY CARE SETTINGS. 21 ‘‘(a) GRANTS.—The Secretary, acting through the 22 Assistant Secretary for Mental Health and Substance Use, 23 shall award grants to eligible entities for the purpose of 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00545 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 546 •S 4819 IS establishing interprofessional health care teams that pro- 1 vide behavioral health care. 2 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 3 a grant under this section, an entity shall be a Federally 4 qualified health center (as defined in section 1861(aa) of 5 the Social Security Act), rural health clinic, women’s 6 health clinic, or behavioral health program (including any 7 such program operated by a community-based organiza- 8 tion) serving a high proportion of individuals from racial 9 and ethnic minority groups (as defined in section 10 1707(g)). 11 ‘‘(c) LOAN FORGIVENESS.—To encourage qualified 12 allied health professionals to enter the mental health field, 13 an eligible entity receiving a grant under this section shall 14 agree to use not less than $10,000 of the grant funds on 15 a loan forgiveness program for practitioners who commit 16 to working in the mental health field for a period of 2 17 years. 18 ‘‘(d) SCIENTIFICALLY AND CULTURALLY BASED.— 19 Integrated health care funded through this section shall 20 be scientifically and culturally based, taking into consider- 21 ation the results of the most recent peer-reviewed research 22 available. 23 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—To 24 carry out this section, there is authorized to be appro- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00546 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 547 •S 4819 IS priated $20,000,000 for each of fiscal years 2021 through 1 2025.’’. 2 SEC. 604. ADDRESSING RACIAL AND ETHNIC MENTAL 3 HEALTH DISPARITIES RESEARCH GAPS. 4 (a) IN GENERAL.—Not later than 6 months after the 5 date of the enactment of this Act, the Director of the Na- 6 tional Institute on Minority Health and Health Disparities 7 shall enter into an arrangement with the National Acad- 8 emy of Sciences to carry out the activities under sub- 9 section (b), or, if the National Academy of Sciences de- 10 clines to enter into such an arrangement, the Director of 11 the National Institute on Minority Health and Health Dis- 12 parities, in cooperation with the Agency for Healthcare 13 Research and Quality, shall carry out the activities under 14 subsection (b). 15 (b) ACTIVITIES.—The applicable entity under sub- 16 section (a) shall— 17 (1) conduct a study with respect to mental 18 health disparities in racial and ethnic minority 19 groups (as defined in section 1707(g) of the Public 20 Health Service Act (42 U.S.C. 300u–6(g))); and 21 (2) submit to Congress a report on the results 22 of such study, including— 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00547 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 548 •S 4819 IS (A) a compilation of information on the dy- 1 namics of mental health outcomes in such racial 2 and ethnic minority groups; 3 (B) the degree of the co-occurrence of 4 mental conditions with other disabilities in such 5 racial and ethnic groups, including physical dis- 6 abilities, mental disabilities, and mental dis- 7 orders or mental health conditions which co- 8 occur with one another; 9 (C) a compilation of information on the 10 impact of exposure to community violence, com- 11 munity trauma, adverse childhood experiences, 12 weather extremes worsened by climate change 13 (such as heat waves, hurricanes, and wildfires), 14 substance use, and other psychological traumas, 15 on mental disorders in such racial and minority 16 groups, stratified by household income level; 17 (D) a compilation of information on the 18 impact of the intersectionality of transgender 19 individuals in racial and ethnic minority groups; 20 and 21 (E) a description of how protective factors 22 contrast and compare among different commu- 23 nities of color, identifying cultural strengths. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00548 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 549 •S 4819 IS SEC. 605. HEALTH PROFESSIONS COMPETENCIES TO AD- 1 DRESS RACIAL AND ETHNIC MENTAL HEALTH 2 DISPARITIES. 3 (a) IN GENERAL.—The Secretary of Health and 4 Human Services, acting through the Assistant Secretary 5 for Mental Health and Substance Use, shall award grants 6 to qualified national organizations for the purposes of— 7 (1) developing, and disseminating to health pro- 8 fessional educational programs curricula or core 9 competencies addressing mental health inequities 10 among racial and ethnic minority groups for use in 11 the training of students in the professions of social 12 work, psychology, psychiatry, marriage and family 13 therapy, mental health counseling, peer support, and 14 substance abuse counseling; and 15 (2) certifying community health workers and 16 peer wellness specialists with respect to such cur- 17 ricula and core competencies and integrating and ex- 18 panding the use of such workers and specialists into 19 health care and community-based settings to address 20 mental health disparities among racial and ethnic 21 minority groups. 22 (b) CURRICULA; CORE COMPETENCIES.—Organiza- 23 tions receiving funds under subsection (a) may use the 24 funds to engage in the following activities related to the 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00549 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 550 •S 4819 IS development and dissemination of curricula or core com- 1 petencies described in subsection (a)(1): 2 (1) Formation of committees or working groups 3 comprised of experts from accredited health profes- 4 sions schools to identify core competencies relating 5 to mental health disparities among racial and ethnic 6 minority groups. 7 (2) Planning of workshops in national fora to 8 allow for public input, including input from commu- 9 nities of color with lived experience, into the edu- 10 cational needs associated with mental health dispari- 11 ties among racial and ethnic minority groups. 12 (3) Dissemination and promotion of the use of 13 curricula or core competencies in undergraduate and 14 graduate health professions training programs na- 15 tionwide. 16 (4) Establishing external stakeholder advisory 17 boards to provide meaningful input into policy and 18 program development and best practices to reduce 19 mental health inequities among racial and ethnic 20 groups, including participation from communities of 21 color with lived experience of the impacts of mental 22 health disparities. 23 (c) DEFINITIONS.—In this section: 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00550 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 551 •S 4819 IS (1) QUALIFIED NATIONAL ORGANIZATION.—The 1 term ‘‘qualified national organization’’ means a na- 2 tional organization that focuses on the education of 3 students in programs of social work, occupational 4 therapy, psychology, psychiatry, and marriage and 5 family therapy. 6 (2) RACIAL AND ETHNIC MINORITY GROUP.— 7 The term ‘‘racial and ethnic minority group’’ has the 8 meaning given to such term in section 1707(g) of 9 the Public Health Service Act (42 U.S.C. 300u– 10 6(g)). 11 (d) 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 2021 through 2025. 15 SEC. 606. GEOACCESS STUDY. 16 The Assistant Secretary for Mental Health and Sub- 17 stance Use shall— 18 (1) conduct a study to— 19 (A) determine which geographic areas of 20 the United States have shortages of specialty 21 mental health providers; and 22 (B) assess the preparedness of speciality 23 mental health providers to deliver culturally and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00551 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 552 •S 4819 IS linguistically appropriate, affordable, and acces- 1 sible services; and 2 (2) submit a report to Congress on the results 3 of such study. 4 SEC. 607. ASIAN AMERICAN, NATIVE HAWAIIAN, PACIFIC IS- 5 LANDER, AND HISPANIC AND LATINO BEHAV- 6 IORAL AND MENTAL HEALTH OUTREACH AND 7 EDUCATION STRATEGIES. 8 Part D of title V of the Public Health Service Act 9 (42 U.S.C. 290dd et seq.), as amended by section 603, 10 is further amended by adding at the end the following new 11 section: 12 ‘‘SEC. 554. BEHAVIORAL AND MENTAL HEALTH OUTREACH 13 AND EDUCATION STRATEGIES. 14 ‘‘(a) IN GENERAL.—The Secretary, acting through 15 the Assistant Secretary for Mental Health and Substance 16 Use, shall, in coordination with advocacy and behavioral 17 and mental health organizations serving populations of 18 Asian American, Native Hawaiian, Pacific Islander, and 19 Hispanic and Latino individuals or communities, develop 20 and implement an outreach and education strategy to pro- 21 mote behavioral and mental health, clarify that behavioral 22 and mental health conditions are treatable and that rea- 23 sonable accommodations are required under section 504 24 of the Rehabilitation Act of 1973 (29 U.S.C. 794) and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00552 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 553 •S 4819 IS titles II and III of the Americans with Disabilities Act 1 of 1990 (42 U.S.C. 12131 et seq.), and reduce stigma as- 2 sociated with mental health conditions and substance 3 abuse among the Asian American, Native Hawaiian, Pa- 4 cific Islander, and Hispanic and Latino populations. Such 5 strategy shall— 6 ‘‘(1) be designed to— 7 ‘‘(A) meet the diverse cultural and lan- 8 guage needs of the various Asian American, 9 Native Hawaiian, Pacific Islander, and His- 10 panic and Latino populations; and 11 ‘‘(B) ensure such strategies are develop- 12 mentally (with respect to the beneficiary’s rel- 13 ative age and experience) and age appropriate, 14 as well as cognitively accessible to persons with 15 cognitive disabilities; 16 ‘‘(2) increase awareness of symptoms of mental 17 illnesses common among such populations, taking 18 into account differences within subgroups (such as 19 gender, gender identity, age, sexual orientation, dis- 20 ability, and ethnicity) of such populations; 21 ‘‘(3) provide information on evidence-based, cul- 22 turally and linguistically appropriate and adapted 23 interventions and treatments; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00553 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 554 •S 4819 IS ‘‘(4) ensure full participation of, and engage, 1 both consumers and community members in the de- 2 velopment and implementation of materials; and 3 ‘‘(5) seek to broaden the perspective among 4 both individuals in such communities and stake- 5 holders serving such communities to use a com- 6 prehensive public health approach to promoting be- 7 havioral health that addresses a holistic view of 8 health by focusing on the intersection between be- 9 havioral and physical health. 10 ‘‘(b) REPORTS.—Beginning not later than 1 year 11 after the date of the enactment of this section and annu- 12 ally thereafter, the Secretary, acting through the Assistant 13 Secretary, shall submit to Congress, and make publicly 14 available, a report on the extent to which the strategy de- 15 veloped and implemented under subsection (a) increased 16 behavioral and mental health outcomes associated with 17 mental health conditions and substance abuse among 18 Asian American, Native Hawaiian, Pacific Islander, and 19 Hispanic and Latino populations. 20 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 21 is authorized to be appropriated to carry out this section 22 $300,000 for fiscal year 2021.’’. 23 SEC. 608. MENTAL HEALTH IN SCHOOLS. 24 (a) PURPOSE.—It is the purpose of this section to— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00554 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 555 •S 4819 IS (1) revise, increase funding for, and expand the 1 scope of the Project AWARE State Educational 2 Agency Grant Program carried out by the Secretary 3 of Health and Human Services, in order to provide 4 access to more comprehensive school-based mental 5 health services and supports; 6 (2) provide for comprehensive staff development 7 for school and community service personnel working 8 in the school; 9 (3) provide for comprehensive training to im- 10 prove health and academic outcomes for children 11 with, or at risk for, mental health conditions, for 12 parents or guardians, siblings, and other family 13 members of such children, and for concerned mem- 14 bers of the community; 15 (4) provide for comprehensive, universal, evi- 16 dence-based screening to identify children and ado- 17 lescents with potential mental health conditions or 18 unmet emotional health needs; 19 (5) recognize best practices for the delivery of 20 mental health care in school-based settings, includ- 21 ing school-based health centers; 22 (6) provide for comprehensive training for par- 23 ents or guardians, siblings, other family members, 24 and concerned members of the community on behalf 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00555 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 556 •S 4819 IS of children and adolescents experiencing mental 1 health trauma, disorder, or disability; and 2 (7) establish formal working relationships be- 3 tween health, human service, and educational enti- 4 ties that support the mental and emotional health of 5 children and adolescents in the school setting. 6 (b) TECHNICAL AMENDMENTS.—The second part G 7 (relating to services provided through religious organiza- 8 tions) of title V of the Public Health Service Act (42 9 U.S.C. 290kk et seq.) is amended— 10 (1) by redesignating such part as part J; and 11 (2) by redesignating sections 581 through 584 12 as sections 596 through 596C, respectively. 13 (c) SCHOOL-BASED MENTAL HEALTH AND CHIL- 14 DREN AND VIOLENCE.—Section 581 of the Public Health 15 Service Act (42 U.S.C. 290hh) (relating to children and 16 violence) is amended to read as follows: 17 ‘‘SEC. 581. SCHOOL-BASED MENTAL HEALTH; CHILDREN 18 AND ADOLESCENTS. 19 ‘‘(a) IN GENERAL.—The Secretary, in consultation 20 with the Secretary of Education, shall, through grants, 21 contracts, or cooperative agreements awarded to eligible 22 entities described in subsection (c), provide comprehensive 23 school-based mental health services and supports to assist 24 children in local communities and schools (including 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00556 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 557 •S 4819 IS schools funded by the Bureau of Indian Education) deal- 1 ing with traumatic experiences, grief, bereavement, risk of 2 suicide, and violence. Such services and supports shall 3 be— 4 ‘‘(1) developmentally, linguistically, and cul- 5 turally appropriate; 6 ‘‘(2) trauma-informed; and 7 ‘‘(3) incorporate positive behavioral interven- 8 tions and supports. 9 ‘‘(b) ACTIVITIES.—Grants, contracts, or cooperative 10 agreements awarded under subsection (a), shall, as appro- 11 priate, be used for— 12 ‘‘(1) implementation of school and community- 13 based mental health programs that— 14 ‘‘(A) build awareness of individual trauma 15 and the intergenerational, continuum of impacts 16 of trauma on populations; 17 ‘‘(B) train appropriate staff to identify, 18 and screen for, signs of trauma exposure, men- 19 tal health disorders, or risk of suicide; and 20 ‘‘(C) incorporate positive behavioral inter- 21 ventions, family engagement, student treatment, 22 and multigenerational supports to foster the 23 health and development of children, prevent 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00557 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 558 •S 4819 IS mental health disorders, and ameliorate the im- 1 pact of trauma; 2 ‘‘(2) technical assistance to local communities 3 with respect to the development of programs de- 4 scribed in paragraph (1); 5 ‘‘(3) facilitating community partnerships among 6 families, students, law enforcement agencies, edu- 7 cation agencies, mental health and substance use 8 disorder service systems, family-based mental health 9 service systems, child welfare agencies, health care 10 providers (including primary care physicians, mental 11 health professionals, and other professionals who 12 specialize in children’s mental health such as child 13 and adolescent psychiatrists), institutions of higher 14 education, faith-based programs, trauma networks, 15 and other community-based systems to address child 16 and adolescent trauma, mental health issues, and vi- 17 olence; and 18 ‘‘(4) establishing and promoting best practices 19 that are either evidence- or culturally-based for chil- 20 dren and adolescents to share their experiences of 21 individual and community trauma, including their 22 exposure to violence, with trusted adults. 23 ‘‘(c) REQUIREMENTS.— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00558 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 559 •S 4819 IS ‘‘(1) IN GENERAL.—To be eligible for a grant, 1 contract, or cooperative agreement under subsection 2 (a), an entity shall be a partnership that includes— 3 ‘‘(A) a State educational agency, as de- 4 fined in section 8101 of the Elementary and 5 Secondary Education Act of 1965, in coordina- 6 tion with one or more local educational agen- 7 cies, as defined in section 8101 of the Elemen- 8 tary and Secondary Education Act of 1965, or 9 a consortium of any entities described in sub- 10 paragraph (B), (C), (D), or (E) of section 11 8101(30) of such Act; and 12 ‘‘(B) at least 1 community-based mental 13 health provider, including a public or private 14 mental health entity, health care entity, family- 15 based mental health entity, trauma network, or 16 other community-based entity, as determined by 17 the Secretary (and which may include addi- 18 tional entities such as a human services agency, 19 law enforcement or juvenile justice entity, child 20 welfare agency, an institution of higher edu- 21 cation, or another entity, as determined by the 22 Secretary). 23 ‘‘(2) COMPLIANCE WITH HIPAA.—Any patient 24 records developed by covered entities through activi- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00559 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 560 •S 4819 IS ties under the grant shall meet the regulations pro- 1 mulgated under section 264(c) of the Health Insur- 2 ance Portability and Accountability Act of 1996. 3 ‘‘(3) COMPLIANCE WITH FERPA.—Section 444 4 of the General Education Provisions Act (commonly 5 known as the ‘Family Educational Rights and Pri- 6 vacy Act of 1974’) shall apply to any entity that is 7 a member of the partnership in the same manner 8 that such section applies to an educational agency or 9 institution (as that term is defined in such section). 10 ‘‘(d) GEOGRAPHICAL DISTRIBUTION.—The Secretary 11 shall ensure that grants, contracts, or cooperative agree- 12 ments under subsection (a) will be distributed equitably 13 among the regions of the country and among urban and 14 rural areas. 15 ‘‘(e) DURATION OF AWARDS.—With respect to a 16 grant, contract, or cooperative agreement under sub- 17 section (a), the period during which payments under such 18 an award will be made to the recipient shall be 5 years, 19 with options for renewal. 20 ‘‘(f) EVALUATION AND MEASURES OF OUTCOMES.— 21 ‘‘(1) DEVELOPMENT OF PROCESS.—The Assist- 22 ant Secretary shall develop a fiscally appropriate 23 process for evaluating activities carried out under 24 this section. Such process shall include— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00560 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 561 •S 4819 IS ‘‘(A) the development of guidelines for the 1 submission of program data by grant, contract, 2 or cooperative agreement recipients; 3 ‘‘(B) the development of measures of out- 4 comes (in accordance with paragraph (2)) to be 5 applied by such recipients in evaluating pro- 6 grams carried out under this section; and 7 ‘‘(C) the submission of annual reports by 8 such recipients concerning the effectiveness of 9 programs carried out under this section. 10 ‘‘(2) MEASURES OF OUTCOMES.—The Assistant 11 Secretary shall develop measures of outcomes to be 12 applied by recipients of assistance under this section 13 to evaluate the effectiveness of programs carried out 14 under this section, including outcomes related to the 15 student, family, and local educational systems sup- 16 ported by this Act. 17 ‘‘(3) SUBMISSION OF ANNUAL DATA.—An eligi- 18 ble entity described in subsection (c) that receives a 19 grant, contract, or cooperative agreement under this 20 section shall annually submit to the Assistant Sec- 21 retary a report that includes data to evaluate the 22 success of the program carried out by the entity 23 based on whether such program is achieving the pur- 24 poses of the program. Such reports shall utilize the 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00561 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 562 •S 4819 IS measures of outcomes under paragraph (2) in a rea- 1 sonable manner to demonstrate the progress of the 2 program in achieving such purposes. 3 ‘‘(4) EVALUATION BY ASSISTANT SECRETARY.— 4 Based on the data submitted under paragraph (3), 5 the Assistant Secretary shall annually submit to 6 Congress a report concerning the results and effec- 7 tiveness of the programs carried out with assistance 8 received under this section. 9 ‘‘(5) LIMITATION.—An eligible entity shall use 10 not more than 20 percent of amounts received under 11 a grant under this section to carry out evaluation 12 activities under this subsection. 13 ‘‘(g) INFORMATION AND EDUCATION.—The Sec- 14 retary shall disseminate best practices based on the find- 15 ings of the knowledge development and application under 16 this section. 17 ‘‘(h) AMOUNT OF GRANTS AND AUTHORIZATION OF 18 APPROPRIATIONS.— 19 ‘‘(1) AMOUNT OF GRANTS.—A grant under this 20 section shall be in an amount that is not more than 21 $2,000,000 for each of the first 5 fiscal years fol- 22 lowing the date of enactment of this section. The 23 Secretary shall determine the amount of each such 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00562 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 563 •S 4819 IS grant based on the population of children up to age 1 21 of the area to be served under the grant. 2 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 3 There is authorized to be appropriated to carry out 4 this section, $130,000,000 for each of fiscal years 5 2021 through 2024.’’. 6 (d) CONFORMING AMENDMENT.—Part G of title V 7 of the Public Health Service Act (42 U.S.C. 290hh et 8 seq.), as amended by this section, is further amended by 9 striking the part heading and inserting the following: 10 ‘‘PART G—SCHOOL-BASED MENTAL HEALTH’’. 11 SEC. 609. BUILDING AN EFFECTIVE WORKFORCE IN MEN- 12 TAL HEALTH. 13 (a) IN GENERAL.—The Secretary of Health and 14 Human Services, in coordination with the Assistant Sec- 15 retary for Mental Health and Substance Use, the Adminis- 16 trator of the Health Resources and Services Administra- 17 tion, and the Secretary of Labor, shall, in coordination 18 with advocacy and behavioral and mental health organiza- 19 tions serving people of color— 20 (1) develop, strengthen, and implement strate- 21 gies to bolster career pathways for mental health 22 professionals; and 23 (2) identify the breadth of settings where men- 24 tal and behavioral health care can take place. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00563 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 564 •S 4819 IS (b) CONTENTS.—Strategies under subsection (a) 1 shall include— 2 (1) the variety of settings where mental health 3 professionals are needed, including community-based 4 organizations, women’s centers, shelters, organiza- 5 tions focused on youth development, workforce agen- 6 cies, job placement and development centers, emer- 7 gency rooms, the special supplemental nutrition pro- 8 gram for women, infants, and children under section 9 17 of the Child Nutrition Act of 1966 (42 U.S.C. 10 1786), food banks, legal aid, and benefit issuers as 11 defined in section 3 of the Food and Nutrition Act 12 of 2008 (7 U.S.C. 2012); 13 (2) defining career pathways in mental and be- 14 havioral health, to help communities understand the 15 variety of careers in mental and behavioral health 16 that are available; 17 (3) building career pathways in mental and be- 18 havioral health as part of the curriculum at the 19 postsecondary education level; 20 (4) providing accessible training and certifi- 21 cation pathways for lay health workers such as com- 22 munity health workers and other peer support indi- 23 viduals to ensure that careers pay a living wage; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00564 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 565 •S 4819 IS (5) creating incentives for students in the fields 1 of occupational therapy, social work, medicine, and 2 nursing to learn more about mental health, and to 3 include a mental health rotation as a part of the 4 health professional curricula; 5 (6) including training and education for teach- 6 ers about the basics of section 504 of the Rehabilita- 7 tion Act of 1973 (29 U.S.C. 794) and individualized 8 education programs (as defined in section 614(d) of 9 the Individuals with Disabilities Education Act (20 10 U.S.C. 1414(d))); 11 (7) researching, developing, and implementing 12 programs for mental and behavioral health profes- 13 sionals to prevent burnout; and 14 (8) finding better and increased avenues to en- 15 sure equity by providing better loan forgiveness pro- 16 grams, including a focus area within the National 17 Health Service Corps focused on community trauma. 18 SEC. 610. MENTAL HEALTH AT THE BORDER. 19 (a) SHORT TITLE.—This section may be cited as the 20 ‘‘Immigrants’ Mental Health Act of 2020’’. 21 (b) DEFINITIONS.—In this section: 22 (1) FORWARD OPERATING BASE.—The term 23 ‘‘forward operating base’’ means a permanent facil- 24 ity established by U.S. Customs and Border Protec- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00565 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 566 •S 4819 IS tion in forward or remote locations, and designated 1 as such by U.S. Customs and Border Protection. 2 (2) U.S. CUSTOMS AND BORDER PROTECTION 3 FACILITY.—The term ‘‘U.S. Customs and Border 4 Protection facility’’ means any of the following facili- 5 ties at which migrants are typically detained on be- 6 half of U.S. Customs and Border Protection: 7 (A) U.S. Border Patrol stations. 8 (B) Ports of entry. 9 (C) Checkpoints. 10 (D) Forward operating bases. 11 (E) Secondary inspection areas. 12 (F) Short-term custody facilities. 13 (c) TRAINING FOR CERTAIN CBP PERSONNEL IN 14 MENTAL HEALTH ISSUES.— 15 (1) TRAINING TO IDENTIFY RISK FACTORS AND 16 WARNING SIGNS IN IMMIGRANTS AND REFUGEES.— 17 (A) IN GENERAL.—The Commissioner of 18 U.S. Customs and Border Protection, in con- 19 sultation with the Assistant Secretary for Men- 20 tal Health and Substance Use, the Adminis- 21 trator of the Health Resources and Services Ad- 22 ministration, and nongovernmental experts in 23 the delivery of health care in humanitarian cri- 24 ses and in the delivery of health care to chil- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00566 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 567 •S 4819 IS dren, shall develop and implement a training 1 curriculum for U.S. Customs and Border Pro- 2 tection agents and officers assigned to U.S. 3 Customs and Border Protection facilities to en- 4 able such agents and officers to identify the 5 risk factors and warning signs in immigrants 6 and refugees of mental health issues relating to 7 trauma. 8 (B) REQUIREMENTS.—The training cur- 9 riculum described in subparagraph (A) shall— 10 (i) apply to all U.S. Customs and 11 Border Protection agents and officers 12 working at U.S. Customs and Border Pro- 13 tection facilities; 14 (ii) provide for crisis intervention 15 using a trauma-informed approach; and 16 (iii) provide for mental health 17 screenings for immigrants and refugees ar- 18 riving at the border in their preferred lan- 19 guage or with appropriate language assist- 20 ance. 21 (2) TRAINING TO ADDRESS MENTAL HEALTH 22 AND WELLNESS OF CBP AGENTS AND OFFICERS.— 23 (A) IN GENERAL.—The Commissioner of 24 U.S. Customs and Border Protection, in con- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00567 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 568 •S 4819 IS sultation with the Assistant Secretary for Men- 1 tal Health and Substance Use, the Adminis- 2 trator of the Health Resources and Services Ad- 3 ministration, and nongovernmental experts in 4 the delivery of mental health care, shall develop 5 and implement a training curriculum for U.S. 6 Customs and Border Protection agents and offi- 7 cers assigned to U.S. Customs and Border Pro- 8 tection facilities to address the mental health 9 and wellness of individuals working at such fa- 10 cilities. 11 (B) REQUIREMENTS.—The training cur- 12 riculum described in subparagraph (A) shall be 13 designed to help U.S. Customs and Border Pro- 14 tection agents and officers working at U.S. 15 Customs and Border Protection facilities— 16 (i) to better manage their own stress 17 and the stress of their coworkers; and 18 (ii) to be more aware of the psycho- 19 logical pressures experienced during their 20 jobs. 21 (3) ANNUAL REVIEW OF TRAINING.—Beginning 22 with respect to fiscal year 2022, the Assistant Sec- 23 retary for Mental Health and Substance Use shall— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00568 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 569 •S 4819 IS (A) conduct an annual review of the train- 1 ing implemented pursuant to paragraphs (1) 2 and (2); and 3 (B) submit the results of each such review, 4 including any recommendations for improve- 5 ment of such training, to— 6 (i) the Commissioner of U.S. Customs 7 and Border Protection; 8 (ii) the Committee on Appropriations 9 of the Senate; 10 (iii) the Committee on Health, Edu- 11 cation, Labor, and Pensions of the Senate; 12 (iv) the Committee on Homeland Se- 13 curity and Governmental Affairs of the 14 Senate; 15 (v) the Committee on Appropriations 16 of the House of Representatives; 17 (vi) the Committee on Energy and 18 Commerce of the House of Representa- 19 tives; 20 (vii) the Committee on Homeland Se- 21 curity of the House of Representatives; 22 and 23 (viii) the Committee on the Judiciary 24 of the House of Representatives. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00569 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 570 •S 4819 IS (4) AUTHORIZATION OF APPROPRIATIONS.— 1 There is authorized to be appropriated, to carry out 2 this subsection— 3 (A) for fiscal year 2021, $50,000 to de- 4 velop the training required under paragraphs 5 (1) and (2); and 6 (B) for each of the fiscal years 2022 7 through 2026— 8 (i) $20,000 to implement the training 9 required under paragraphs (1) and (2); 10 and 11 (ii) such sums as may be necessary to 12 review and make recommendations for 13 such training pursuant 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 adequately 18 evaluate the mental health needs of immigrants, ref- 19 ugees, border patrol agents, and staff by assigning 20 not fewer than 1 qualified mental or behavioral 21 health expert to each U.S. Customs and Border Pro- 22 tection facility. 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00570 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 571 •S 4819 IS (2) QUALIFICATIONS.—A mental or behavioral 1 health expert is qualified for an assignment de- 2 scribed in paragraph (1) if the expert— 3 (A) is bilingual; 4 (B) is well-versed in culturally appropriate 5 and trauma-informed interventions; and 6 (C) has particular expertise in child or ad- 7 olescent mental health or family mental health. 8 (3) AUTHORIZATION OF APPROPRIATIONS.— 9 There is authorized to be appropriated $3,000,000 10 for each of the fiscal years 2021 through 2025 to 11 carry out this subsection. 12 (e) PROHIBITION AGAINST SHARING DEPARTMENT 13 OF HEALTH AND HUMAN SERVICES MENTAL HEALTH IN- 14 FORMATION FOR ASYLUM DETERMINATIONS, IMMIGRA- 15 TION HEARINGS, OR DEPORTATION PROCEEDINGS.—The 16 officers, employees, and agents of the Department of 17 Health and Human Services, including the Office of Ref- 18 ugee Resettlement, may not share with the Department 19 of Homeland Security, and the officers, employees, and 20 agents of the Department of Homeland Security may not 21 request or receive from the Department of Health and 22 Human Services, for the purposes of an asylum deter- 23 mination, immigration hearing, or deportation proceeding, 24 any information or record that— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00571 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 572 •S 4819 IS (1) concerns the mental health of an alien; and 1 (2) was obtained or produced by a mental or 2 behavioral health professional while the alien was in 3 a shelter or otherwise in the custody of the Federal 4 Government. 5 TITLE VII—ADDRESSING HIGH 6 IMPACT MINORITY DISEASES 7 Subtitle A—Cancer 8 SEC. 701. LUNG CANCER MORTALITY REDUCTION. 9 (a) SHORT TITLE.—This section may be cited as the 10 ‘‘Lung Cancer Mortality Reduction Act of 2020’’. 11 (b) FINDINGS.—Congress makes the following find- 12 ings: 13 (1) Lung cancer is the leading cause of cancer 14 death for both men and women, accounting for 25 15 percent of all cancer deaths. 16 (2) Lung cancer kills more people annually 17 than breast cancer, prostate cancer, colon cancer, 18 liver cancer, melanoma, and kidney cancer combined. 19 (3) Since the National Cancer Act of 1971 20 (Public Law 92–218; 85 Stat. 778), coordinated and 21 comprehensive research has raised the 5-year sur- 22 vival rates for breast cancer to 90 percent, for pros- 23 tate cancer to 99 percent, and for colon cancer to 24 64 percent. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00572 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 573 •S 4819 IS (4) The 5-year survival rate for lung cancer is 1 still only 18 percent, and a similar coordinated and 2 comprehensive research effort is required to achieve 3 increases in lung cancer survivability rates. 4 (5) Sixty percent of lung cancer cases are now 5 diagnosed in nonsmokers or former smokers. 6 (6) Two-thirds of nonsmokers diagnosed with 7 lung cancer are women. 8 (7) Certain minority populations, such as Afri- 9 can-American males, have disproportionately high 10 rates of lung cancer incidence and mortality, despite 11 their smoking rate being similar to other racial 12 groups. 13 (8) Members of the Baby Boomer Generation 14 are entering their 60s, the most common age at 15 which people develop lung cancer. 16 (9) Tobacco addiction and exposure to other 17 lung cancer carcinogens such as Agent Orange and 18 other herbicides and battlefield emissions are serious 19 problems among military personnel and war vet- 20 erans. 21 (10) Significant and rapid improvements in 22 lung cancer mortality can be expected through great- 23 er use and access to lung cancer screening tests for 24 at-risk individuals. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00573 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 574 •S 4819 IS (11) Recent research has shown that screening 1 with low-dose computed tomography scan reduced 2 lung cancer death mortality by 20 percent for those 3 with a high risk of lung cancer through early detec- 4 tion. The Centers for Medicare & Medicaid Services 5 supports annual lung cancer screening for high-risk 6 patients with low-dose computed tomography. 7 (12) Additional strategies are necessary to fur- 8 ther enhance the existing tests and therapies avail- 9 able to diagnose and treat lung cancer in the future. 10 (13) The August 2001 Report of the Lung 11 Cancer Progress Review Group of the National Can- 12 cer Institute stated that funding for lung cancer re- 13 search was ‘‘far below the levels characterized for 14 other common malignancies and far out of propor- 15 tion to its massive health impact’’. 16 (14) The Report of the Lung Cancer Progress 17 Review Group identified as its ‘‘highest priority’’ the 18 creation of integrated, multidisciplinary, multi-insti- 19 tutional research consortia organized around the 20 problem of lung cancer rather than around specific 21 research disciplines. 22 (15) The United States must enhance its re- 23 sponse to the issues raised in the Report of the 24 Lung Cancer Progress Review Group, and this can 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00574 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 575 •S 4819 IS be accomplished through the establishment of a co- 1 ordinated effort designed to reduce the lung cancer 2 mortality rate by 50 percent by 2020 and targeted 3 funding to support this coordinated effort. 4 (c) SENSE OF CONGRESS CONCERNING INVESTMENT 5 IN LUNG CANCER RESEARCH.—It is the sense of the Con- 6 gress that— 7 (1) lung cancer mortality reduction should be 8 made a national public health priority; and 9 (2) a comprehensive mortality reduction pro- 10 gram coordinated by the Secretary of Health and 11 Human Services is justified and necessary to ade- 12 quately address and reduce lung cancer mortality. 13 (d) LUNG CANCER MORTALITY REDUCTION PRO- 14 GRAM.— 15 (1) IN GENERAL.—Subpart 1 of part C of title 16 IV of the Public Health Service Act (42 U.S.C. 285 17 et seq.) is amended by adding at the end the fol- 18 lowing: 19 ‘‘SEC. 417H. LUNG CANCER MORTALITY REDUCTION PRO- 20 GRAM. 21 ‘‘(a) IN GENERAL.—Not later than 6 months after 22 the date of the enactment of the Health Equity and Ac- 23 countability Act of 2020, the Secretary, in consultation 24 with the Secretary of Defense, the Secretary of Veterans 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00575 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 576 •S 4819 IS Affairs, the Director of the National Institutes of Health, 1 the Director of the Centers for Disease Control and Pre- 2 vention, the Commissioner of Food and Drugs, the Admin- 3 istrator of the Centers for Medicare & Medicaid Services, 4 the Director of the National Institute on Minority Health 5 and Health Disparities, and other members of the Lung 6 Cancer Advisory Board established under section 701 of 7 the Health Equity and Accountability Act of 2020, shall 8 implement a comprehensive program, to be known as the 9 Lung Cancer Mortality Reduction Program, to achieve a 10 reduction of at least 25 percent in the mortality rate of 11 lung cancer by 2020. 12 ‘‘(b) REQUIREMENTS.—The Program shall include at 13 least the following: 14 ‘‘(1) With respect to the National Institutes of 15 Health— 16 ‘‘(A) a strategic review and prioritization 17 by the National Cancer Institute of research 18 grants to achieve the goal of the Lung Cancer 19 Mortality Reduction Program in reducing lung 20 cancer mortality; 21 ‘‘(B) the provision of funds to enable the 22 Airway Biology and Disease Branch of the Na- 23 tional Heart, Lung, and Blood Institute to ex- 24 pand its research programs to include pre- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00576 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 577 •S 4819 IS dispositions to lung cancer, the interrelationship 1 between lung cancer and other pulmonary and 2 cardiac disease, and the diagnosis and treat- 3 ment of those interrelationships; 4 ‘‘(C) the provision of funds to enable the 5 National Institute of Biomedical Imaging and 6 Bioengineering to expedite the development of 7 computer-assisted diagnostic, surgical, treat- 8 ment, and drug-testing innovations to reduce 9 lung cancer mortality, such as through expan- 10 sion of the Institute’s Quantum Grant Program 11 and Image-Guided Interventions programs; and 12 ‘‘(D) the provision of funds to enable the 13 National Institute of Environmental Health 14 Sciences to implement research programs rel- 15 ative to the lung cancer incidence. 16 ‘‘(2) With respect to the Food and Drug Ad- 17 ministration— 18 ‘‘(A) activities under section 529B of the 19 Federal Food, Drug, and Cosmetic Act; and 20 ‘‘(B) activities under section 561 of the 21 Federal Food, Drug, and Cosmetic Act to ex- 22 pand access to investigational drugs and devices 23 for the diagnosis, monitoring, or treatment of 24 lung cancer. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00577 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 578 •S 4819 IS ‘‘(3) With respect to the Centers for Disease 1 Control and Prevention, the establishment of an 2 early disease research and management program 3 under section 1511. 4 ‘‘(4) With respect to the Agency for Healthcare 5 Research and Quality, the conduct of a biannual re- 6 view of lung cancer screening, diagnostic, and treat- 7 ment protocols, and the issuance of updated guide- 8 lines. 9 ‘‘(5) The promotion (including education) of 10 lung cancer screening within minority and rural pop- 11 ulations and the study of the effectiveness of efforts 12 to increase such screening. 13 ‘‘(6) The cooperation and coordination of all 14 minority and health disparity programs within the 15 Department of Health and Human Services to en- 16 sure that all aspects of the Lung Cancer Mortality 17 Reduction Program under this section adequately 18 address the burden of lung cancer on minority and 19 rural populations. 20 ‘‘(7) The cooperation and coordination of all to- 21 bacco control and cessation programs within agen- 22 cies of the Department of Health and Human Serv- 23 ices to achieve the goals of the Lung Cancer Mor- 24 tality Reduction Program under this section with 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00578 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 579 •S 4819 IS particular emphasis on the coordination of drug and 1 other cessation treatments with early detection pro- 2 tocols.’’. 3 (2) FEDERAL FOOD, DRUG, AND COSMETIC 4 ACT.—Subchapter B of chapter V of the Federal 5 Food, Drug, and Cosmetic Act (21 U.S.C. 360aaa et 6 seq.) is amended by adding at the end the following: 7 ‘‘SEC. 529B. DRUGS RELATING TO LUNG CANCER. 8 ‘‘(a) IN GENERAL.—The provisions of this sub- 9 chapter shall apply to a drug described in subsection (b) 10 to the same extent and in the same manner as such provi- 11 sions apply to a drug for a rare disease or condition. 12 ‘‘(b) QUALIFIED DRUGS.—A drug described in this 13 subsection is— 14 ‘‘(1) a chemoprevention drug for precancerous 15 conditions of the lung; 16 ‘‘(2) a drug for targeted therapeutic treat- 17 ments, including any vaccine, for lung cancer; or 18 ‘‘(3) a drug to curtail or prevent nicotine addic- 19 tion. 20 ‘‘(c) BOARD.—The Board established under section 21 701 of the Health Equity and Accountability Act of 2020 22 shall monitor the program implemented under this sec- 23 tion.’’. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00579 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 580 •S 4819 IS (3) ACCESS TO UNAPPROVED THERAPIES.—Sec- 1 tion 561(e) of the Federal Food, Drug, and Cos- 2 metic Act (21 U.S.C. 360bbb(e)) is amended by in- 3 serting before the period the following: ‘‘and shall 4 include expanding access to drugs under section 5 529B, with substantial consideration being given to 6 whether the totality of information available to the 7 Secretary regarding the safety and effectiveness of 8 an investigational drug, as compared to the risk of 9 morbidity and death from the disease, indicates that 10 a patient may obtain more benefit than risk if treat- 11 ed with the drug’’. 12 (4) CDC.—Title XV of the Public Health Serv- 13 ice Act (42 U.S.C. 300k et seq.) is amended by add- 14 ing at the end the following: 15 ‘‘SEC. 1511. EARLY DISEASE RESEARCH AND MANAGEMENT 16 PROGRAM. 17 ‘‘The Secretary shall establish and implement an 18 early disease research and management program targeted 19 at the high incidence and mortality rates of lung cancer 20 among minority and low-income populations.’’. 21 (e) DEPARTMENT OF DEFENSE AND THE DEPART- 22 MENT OF VETERANS AFFAIRS.—The Secretary of Defense 23 and the Secretary of Veterans Affairs, each in coordina- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00580 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 581 •S 4819 IS tion with the Secretary of Health and Human Services, 1 shall engage— 2 (1) in the implementation within the Depart- 3 ment of Defense and the Department of Veterans 4 Affairs of an early detection and disease manage- 5 ment research program for military personnel and 6 veterans whose smoking history and exposure to car- 7 cinogens during active duty service has increased 8 their risk for lung cancer; and 9 (2) in the implementation of coordinated care 10 programs for military personnel and veterans diag- 11 nosed with lung cancer. 12 (f) LUNG CANCER ADVISORY BOARD.— 13 (1) IN GENERAL.—The Secretary of Health and 14 Human Services shall convene a Lung Cancer Advi- 15 sory Board (referred to in this section as the 16 ‘‘Board’’)— 17 (A) to monitor the programs established 18 under this section (and the amendments made 19 by this section); and 20 (B) to provide annual reports to the Con- 21 gress concerning benchmarks, expenditures, 22 lung cancer statistics, and the public health im- 23 pact of such programs. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00581 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 582 •S 4819 IS (2) COMPOSITION.—The Board shall be com- 1 prised of— 2 (A) the Secretary of Health and Human 3 Services; 4 (B) the Secretary of Defense; 5 (C) the Secretary of Veterans Affairs; and 6 (D) 2 representatives each from the fields 7 of clinical medicine focused on lung cancer, 8 lung cancer research, imaging, drug develop- 9 ment, and lung cancer advocacy, to be ap- 10 pointed by the Secretary of Health and Human 11 Services. 12 (g) AUTHORIZATION OF APPROPRIATIONS.— 13 (1) IN GENERAL.—To carry out this section 14 (and the amendments made by this section), there 15 are authorized to be appropriated $75,000,000 for 16 fiscal year 2021 and such sums as may be necessary 17 for each of fiscal years 2022 through 2025. 18 (2) LUNG CANCER MORTALITY REDUCTION PRO- 19 GRAM.—The amounts appropriated under paragraph 20 (1) shall be allocated as follows: 21 (A) $25,000,000 for fiscal year 2021, and 22 such sums as may be necessary for each of fis- 23 cal years 2022 through 2025, for the activities 24 described in section 417H(b)(1)(B) of the Pub- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00582 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 583 •S 4819 IS lic Health Service Act, as added by subsection 1 (d); 2 (B) $25,000,000 for fiscal year 2021, and 3 such sums as may be necessary for each of fis- 4 cal years 2022 through 2025, for the activities 5 described in section 417H(b)(1)(C) of the Pub- 6 lic Health Service Act; 7 (C) $10,000,000 for fiscal year 2021, and 8 such sums as may be necessary for each of fis- 9 cal years 2022 through 2025, for the activities 10 described in section 417H(b)(1)(D) of the Pub- 11 lic Health Service Act; and 12 (D) $15,000,000 for fiscal year 2021, and 13 such sums as may be necessary for each of fis- 14 cal years 2022 through 2025, for the activities 15 described in section 417H(b)(3) of the Public 16 Health Service Act. 17 SEC. 702. EXPANDING PROSTATE CANCER RESEARCH, OUT- 18 REACH, SCREENING, TESTING, ACCESS, AND 19 TREATMENT EFFECTIVENESS. 20 (a) SHORT TITLE.—This section may be cited as the 21 ‘‘Prostate Research, Outreach, Screening, Testing, Access, 22 and Treatment Effectiveness Act of 2020’’ or the ‘‘PROS- 23 TATE Act’’. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00583 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 584 •S 4819 IS (b) FINDINGS.—Congress makes the following find- 1 ings: 2 (1) Prostate cancer is the second leading cause 3 of cancer death among men. 4 (2) In 2020, an estimated 191,930 individuals 5 in the United States will be diagnosed with prostate 6 cancer and approximately 33,330 will die from the 7 disease. 8 (3) Roughly 2,000,000 to 3,000,000 people in 9 the United States are living with a diagnosis of pros- 10 tate cancer and its consequences. 11 (4) Although prostate cancer generally affects 12 older individuals, younger men are also at risk for 13 the disease, and when prostate cancer appears in 14 early middle age, it frequently takes on a more ag- 15 gressive form. 16 (5) There are significant racial and ethnic dis- 17 parities that demand attention, for example, African 18 Americans have prostate cancer mortality rates that 19 are more than double those in the White population. 20 (6) Underserved rural populations have higher 21 rates of mortality compared to their urban counter- 22 parts, and innovative and cost-efficient methods to 23 improve rural access to high-quality care should take 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00584 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 585 •S 4819 IS advantage of advances in telehealth to diagnose and 1 treat prostate cancer when appropriate. 2 (7) Certain populations of veterans may have 3 nearly twice the incidence of prostate cancer as the 4 general population of the United States. 5 (8) Urologists may constitute the specialists 6 who diagnose and treat the vast majority of prostate 7 cancer patients. 8 (9) Although much basic and translational re- 9 search has been completed and much is currently 10 known, there are still many unanswered questions, 11 such as the extent to which known disparities are at- 12 tributable to disease etiology, access to care, or edu- 13 cation and awareness in the community. 14 (10) Causes of prostate cancer are not known. 15 There is not good information regarding how to dif- 16 ferentiate accurately, early on, between aggressive 17 and indolent forms of the disease. As a result, there 18 is significant overtreatment in prostate cancer. 19 There are no treatments that can durably arrest 20 growth or cure prostate cancer once it has metasta- 21 sized. 22 (11) A significant proportion of cases may be 23 clinically indolent and ‘‘overdiagnosed’’, resulting in 24 significant overtreatment. More accurate tests will 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00585 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 586 •S 4819 IS allow men and their families to face less physical, 1 psychological, financial, and emotional trauma, and 2 billions of dollars could be saved in private and pub- 3 lic health care systems. 4 (12) Prostate cancer research and health care 5 programs across Federal agencies should be coordi- 6 nated to improve accountability and actively encour- 7 age the translation of research into practice and to 8 identify and implement best practices in order to 9 foster an integrated and consistent focus on effective 10 prevention, diagnosis, and treatment of the disease. 11 (c) PROSTATE CANCER COORDINATION AND EDU- 12 CATION.— 13 (1) INTERAGENCY PROSTATE CANCER COORDI- 14 NATION AND EDUCATION TASK FORCE.—Not later 15 than 180 days after the date of the enactment of 16 this Act, the Secretary of Veterans Affairs, in co- 17 operation with the Secretary of Defense and the Sec- 18 retary of Health and Human Services, shall estab- 19 lish an Interagency Prostate Cancer Coordination 20 and Education Task Force (in this section referred 21 to as the ‘‘Prostate Cancer Task Force’’). 22 (2) DUTIES.—The Prostate Cancer Task Force 23 shall— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00586 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 587 •S 4819 IS (A) develop a summary of advances in 1 prostate cancer research supported or con- 2 ducted by Federal agencies relevant to the diag- 3 nosis, prevention, and treatment of prostate 4 cancer, including psychosocial impairments re- 5 lated to prostate cancer treatment, and compile 6 a list of best practices that warrant broader 7 adoption in health care programs; 8 (B) consider establishing, and advocating 9 for, a guidance to enable physicians to allow 10 screening of men who are age 74 or older, on 11 a case-by-case basis, taking into account quality 12 of life and family history of prostate cancer; 13 (C) share and coordinate information on 14 research and health care program activities by 15 the Federal Government, including activities re- 16 lated to— 17 (i) determining how to improve re- 18 search and health care programs, including 19 psychosocial impairments related to pros- 20 tate cancer treatment; 21 (ii) identifying any gaps in the overall 22 research inventory and in health care pro- 23 grams; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00587 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 588 •S 4819 IS (iii) identifying opportunities to pro- 1 mote translation of research into practice; 2 and 3 (iv) maximizing the effects of Federal 4 Government efforts by identifying opportu- 5 nities for collaboration and leveraging of 6 resources in research and health care pro- 7 grams that serve individuals who are sus- 8 ceptible to or diagnosed with prostate can- 9 cer; 10 (D) develop a comprehensive interagency 11 strategy and advise relevant Federal agencies in 12 the solicitation of proposals for collaborative, 13 multidisciplinary research and health care pro- 14 grams, including proposals to evaluate factors 15 that may be related to the etiology of prostate 16 cancer, that would— 17 (i) result in innovative approaches to 18 study emerging scientific opportunities or 19 eliminate knowledge gaps in research to 20 improve the prostate cancer research port- 21 folio of the Federal Government; and 22 (ii) outline key research questions, 23 methodologies, and knowledge gaps; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00588 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 589 •S 4819 IS (E) develop a coordinated message related 1 to screening and treatment for prostate cancer 2 to be reflected in educational and beneficiary 3 materials for Federal health programs as such 4 documents are updated; and 5 (F) not later than 2 years after the date 6 of the establishment of the Prostate Cancer 7 Task Force, submit to the expert advisory pan- 8 els appointed under paragraph (4) to be re- 9 viewed and returned within 30 days, and then 10 within 90 days submitted to Congress, rec- 11 ommendations— 12 (i) regarding any appropriate changes 13 to research and health care programs, in- 14 cluding recommendations to improve the 15 research portfolio of the Department of 16 Veterans Affairs, the Department of De- 17 fense, the National Institutes of Health, 18 and other Federal agencies to ensure that 19 scientifically based strategic planning is 20 implemented in support of research and 21 health care program priorities; 22 (ii) designed to ensure that the re- 23 search and health care programs and ac- 24 tivities of the Department of Veterans Af- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00589 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 590 •S 4819 IS fairs, the Department of Defense, the De- 1 partment of Health and Human Services, 2 and other Federal agencies are free of un- 3 necessary duplication; 4 (iii) regarding public participation in 5 decisions relating to prostate cancer re- 6 search and health care programs to in- 7 crease the involvement of patient advo- 8 cates, community organizations, and med- 9 ical associations representing a broad geo- 10 graphical area; 11 (iv) on how to best disseminate infor- 12 mation on prostate cancer research and 13 progress achieved by health care programs; 14 (v) about how to expand partnerships 15 between public entities, including Federal 16 agencies, and private entities to encourage 17 collaborative, cross-cutting research and 18 health care delivery; 19 (vi) assessing any cost savings and ef- 20 ficiencies realized through the efforts iden- 21 tified and supported in this subsection and 22 recommending expansion of those efforts 23 that have proved most promising while also 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00590 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 591 •S 4819 IS ensuring against any conflicts in directives 1 in law; 2 (vii) identifying key priority action 3 items from among the recommendations; 4 and 5 (viii) with respect to the level of fund- 6 ing needed by each agency to implement 7 the recommendations contained in the re- 8 port. 9 (3) MEMBERS OF THE PROSTATE CANCER TASK 10 FORCE.—The Prostate Cancer Task Force shall be 11 comprised of representatives from such Federal 12 agencies, as the head of each such applicable agency 13 determines necessary, so as to coordinate a uniform 14 message relating to prostate cancer screening and 15 treatment where appropriate, including representa- 16 tives of the following: 17 (A) The Department of Veterans Affairs, 18 including representatives of each relevant pro- 19 gram area of the Department of Veterans Af- 20 fairs. 21 (B) The Prostate Cancer Research Pro- 22 gram of the Congressionally Directed Medical 23 Research Program of the Department of De- 24 fense. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00591 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 592 •S 4819 IS (C) The Department of Health and 1 Human Services, including, at a minimum, rep- 2 resentatives of each of the following: 3 (i) The National Institutes of Health. 4 (ii) National research institutes and 5 centers, including the National Cancer In- 6 stitute, the National Institute of Allergy 7 and Infectious Diseases, and the Office of 8 Minority Health. 9 (iii) The Centers for Medicare & Med- 10 icaid Services. 11 (iv) The Food and Drug Administra- 12 tion. 13 (v) The Centers for Disease Control 14 and Prevention. 15 (vi) The Agency for Healthcare Re- 16 search and Quality. 17 (vii) The Health Resources and Serv- 18 ices Administration. 19 (4) APPOINTING EXPERT ADVISORY PANELS.— 20 The Prostate Cancer Task Force shall appoint ex- 21 pert advisory panels, as the task force determines 22 appropriate, to provide input and concurrence from 23 individuals and organizations from the medical, 24 prostate cancer patient and advocate, research, and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00592 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 593 •S 4819 IS delivery communities with expertise in prostate can- 1 cer diagnosis, treatment, and research, including 2 practicing urologists, primary care providers, and 3 others, and individuals with expertise in education 4 and outreach to underserved populations affected by 5 prostate cancer. 6 (5) MEETINGS.—The Prostate Cancer Task 7 Force shall convene not less frequently than twice 8 each year, or more frequently as the Secretary of 9 Veterans Affairs determines to be appropriate. 10 (6) FEDERAL ADVISORY COMMITTEE ACT.—The 11 Federal Advisory Committee Act (5 U.S.C. App.) 12 shall apply to the Prostate Cancer Task Force. 13 (7) SUNSET DATE.—The Prostate Cancer Task 14 Force shall terminate on September 30, 2025. 15 (d) PROSTATE CANCER RESEARCH.— 16 (1) RESEARCH COORDINATION PROGRAM.— 17 (A) IN GENERAL.—The Secretary of Vet- 18 erans Affairs, in coordination with the Sec- 19 retary of Defense and the Secretary of Health 20 and Human Services, shall establish and carry 21 out a program to coordinate and intensify pros- 22 tate cancer research. 23 (B) ELEMENTS.—The program established 24 under subparagraph (A) shall— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00593 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 594 •S 4819 IS (i) develop advances in diagnostic and 1 prognostic methods and tests, including 2 biomarkers and an improved prostate can- 3 cer screening blood test, including improve- 4 ments or alternatives to the prostate spe- 5 cific antigen test and additional tests to 6 distinguish indolent from aggressive dis- 7 ease; 8 (ii) develop better understanding of 9 the etiology of the disease (including an 10 analysis of lifestyle factors proven to be in- 11 volved in higher rates of prostate cancer, 12 such as obesity and diet, and in different 13 ethnic, racial, and socioeconomic groups, 14 such as the African-American, Latino or 15 Hispanic, and American Indian popu- 16 lations and men with a family history of 17 prostate cancer) to improve prevention ef- 18 forts; 19 (iii) expand basic research into pros- 20 tate cancer, including studies of funda- 21 mental molecular and cellular mechanisms; 22 (iv) identify and provide clinical test- 23 ing of novel agents for the prevention and 24 treatment of prostate cancer; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00594 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 595 •S 4819 IS (v) establish clinical registries for 1 prostate cancer; 2 (vi) use the National Institute of Bio- 3 medical Imaging and Bioengineering and 4 the National Cancer Institute for assess- 5 ment of appropriate imaging modalities; 6 and 7 (vii) address such other matters relat- 8 ing to prostate cancer research as may be 9 identified by the Federal agencies partici- 10 pating in the program under this sub- 11 section. 12 (C) UNDERSERVED MINORITY GRANT PRO- 13 GRAM.—In carrying out the program estab- 14 lished under subparagraph (A), the Secretary 15 shall— 16 (i) award grants to eligible entities to 17 carry out components of the research out- 18 lined in subparagraph (B); 19 (ii) integrate and build upon existing 20 knowledge gained from comparative effec- 21 tiveness research; and 22 (iii) recognize and address— 23 (I) the racial and ethnic dispari- 24 ties in the incidence and mortality 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00595 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 596 •S 4819 IS rates of prostate cancer and men with 1 a family history of prostate cancer; 2 (II) any barriers in access to care 3 and participation in clinical trials that 4 are specific to racial, ethnic, and other 5 underserved minorities and men with 6 a family history of prostate cancer; 7 (III) outreach and educational ef- 8 forts to raise awareness among the 9 populations described in subclause 10 (II); and 11 (IV) appropriate access and utili- 12 zation of imaging modalities. 13 (2) PROSTATE CANCER ADVISORY BOARD.— 14 (A) IN GENERAL.—There is established in 15 the Office of the Chief Scientist of the Food 16 and Drug Administration a Prostate Cancer 17 Scientific Advisory Board. 18 (B) DUTIES.—The board established under 19 subparagraph (A) shall be responsible for accel- 20 erating real-time sharing of the latest research 21 data and accelerating movement of new medi- 22 cines to patients. 23 (e) TELEHEALTH AND RURAL ACCESS PILOT 24 PROJECTS.— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00596 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 597 •S 4819 IS (1) ESTABLISHMENT OF PILOT PROJECTS.— 1 (A) IN GENERAL.—The Secretary of Vet- 2 erans Affairs, in cooperation with the Secretary 3 of Defense and the Secretary of Health and 4 Human Services (referred to in this subsection 5 collectively as the ‘‘Secretaries’’) shall establish 6 4-year telehealth pilot projects for the purpose 7 of analyzing the clinical outcomes and cost-ef- 8 fectiveness associated with telehealth services in 9 a variety of geographic areas that contain high 10 proportions of medically underserved popu- 11 lations, including African Americans, Latinos or 12 Hispanics, American Indians or Alaska Natives, 13 and those in rural areas. 14 (B) EFFICIENT AND EFFECTIVE CARE.— 15 Pilot projects established under subparagraph 16 (A) shall promote efficient use of specialist care 17 through better coordination of primary care and 18 physician extender teams in underserved areas 19 and more effectively employ tumor boards to 20 better counsel patients. 21 (2) ELIGIBLE ENTITIES.— 22 (A) IN GENERAL.—The Secretaries shall 23 select eligible entities to participate in the pilot 24 projects established under this subsection. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00597 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 598 •S 4819 IS (B) PRIORITY.—In selecting eligible enti- 1 ties to participate in the pilot projects under 2 this subsection, the Secretaries shall give pri- 3 ority to entities located in medically under- 4 served areas, particularly those that include Af- 5 rican Americans, Latinos and Hispanics, and 6 facilities of the Indian Health Service, including 7 facilities operated by the Indian Health Service, 8 tribally operated facilities, and Urban Indian 9 Clinics, and those in rural areas. 10 (3) EVALUATION.—The Secretaries shall, 11 through the pilot projects, evaluate— 12 (A) the effective and economic delivery of 13 care in diagnosing and treating prostate cancer 14 with the use of telehealth services in medically 15 underserved and Tribal areas including collabo- 16 rative uses of health professionals and integra- 17 tion of the range of telehealth and other tech- 18 nologies; 19 (B) the effectiveness of improving the ca- 20 pacity of nonmedical providers and nonspecial- 21 ized medical providers to provide health services 22 for prostate cancer in medically underserved 23 and Tribal areas, including the exploration of 24 innovative medical home models with collabora- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00598 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 599 •S 4819 IS tion between urologists, other relevant medical 1 specialists, including oncologists, radiologists, 2 and primary care teams, and coordination of 3 care through the efficient use of primary care 4 teams and physician extenders; and 5 (C) the effectiveness of using telehealth 6 services to provide prostate cancer treatment in 7 medically underserved areas, including the use 8 of tumor boards to facilitate better patient 9 counseling. 10 (4) REPORT.—Not later than 1 year after the 11 completion of the pilot projects under this sub- 12 section, the Secretaries shall submit to Congress a 13 report describing the outcomes of such pilot projects, 14 including any cost savings and efficiencies realized, 15 and providing recommendations, if any, for expand- 16 ing the use of telehealth services. 17 (f) EDUCATION AND AWARENESS.— 18 (1) CAMPAIGN.— 19 (A) IN GENERAL.—The Secretary of Vet- 20 erans Affairs shall develop a national education 21 campaign for prostate cancer. 22 (B) ELEMENTS.—The campaign developed 23 under subparagraph (A) shall involve the use of 24 written educational materials and public service 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00599 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 600 •S 4819 IS announcements consistent with the findings of 1 the Prostate Cancer Task Force under sub- 2 section (c) that are intended to encourage men 3 to seek prostate cancer screening when appro- 4 priate. 5 (2) RACIAL DISPARITIES AND THE POPULATION 6 OF MEN WITH A FAMILY HISTORY OF PROSTATE 7 CANCER.—In developing the campaign under para- 8 graph (1), the Secretary shall ensure that edu- 9 cational materials and public service announcements 10 used in the campaign are more readily available in 11 communities experiencing racial disparities in the in- 12 cidence and mortality rates of prostate cancer and to 13 men of any race classification with a family history 14 of prostate cancer. 15 (3) GRANTS.—In carrying out the campaign 16 under this subsection, the Secretary shall award 17 grants to nonprofit private entities to enable such 18 entities to test alternative outreach and education 19 strategies. 20 (g) AUTHORIZATION OF APPROPRIATIONS.—There is 21 authorized to be appropriated to carry out this section for 22 the period of fiscal years 2021 through 2025 an amount 23 equal to the amount of savings for the Federal Govern- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00600 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 601 •S 4819 IS ment projected to be achieved over such period by imple- 1 mentation of this section. 2 SEC. 703. PROSTATE RESEARCH, IMAGING, AND MEN’S EDU- 3 CATION (PRIME). 4 (a) SHORT TITLE.—This section may be cited as the 5 ‘‘Prostate Research, Imaging, and Men’s Education Act 6 of 2020’’ or the ‘‘PRIME Act of 2020’’. 7 (b) FINDINGS.—Congress makes the following find- 8 ings: 9 (1) Prostate cancer has reached epidemic pro- 10 portions, particularly among African-American men, 11 and strikes and kills men in numbers comparable to 12 the number of women who lose their lives from 13 breast cancer. 14 (2) Life-saving breakthroughs in screening, di- 15 agnosis, and treatment of breast cancer resulted 16 from the development of advanced imaging tech- 17 nologies led by the Federal Government. 18 (3) Men should have accurate and affordable 19 prostate cancer screening exams and minimally 20 invasive treatment tools, similar to what women have 21 for breast cancer. 22 (4) While it is important for men to take ad- 23 vantage of current prostate cancer screening tech- 24 niques, a recent NCI-funded study demonstrated 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00601 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 602 •S 4819 IS that the most common available methods of detect- 1 ing prostate cancer (PSA blood test and physical 2 exams) are not foolproof, causing numerous false 3 alarms and false reassurances. 4 (5) The absence of advanced imaging tech- 5 nologies for prostate cancer causes the lack of accu- 6 rate information critical for clinical decisions, result- 7 ing in missed cancers and lost lives, as well as un- 8 necessary and costly medical procedures, with re- 9 lated complications. 10 (6) With prostate imaging tools, men and their 11 families would face less physical, psychological, fi- 12 nancial, and emotional trauma and billions of dollars 13 could be saved in private and public health care sys- 14 tems. 15 (c) RESEARCH AND DEVELOPMENT OF PROSTATE 16 CANCER IMAGING TECHNOLOGIES.— 17 (1) EXPANSION OF RESEARCH.—The Secretary 18 of Health and Human Services (referred to in this 19 section as the ‘‘Secretary’’), acting through the Di- 20 rector of the National Institutes of Health and the 21 Administrator of the Health Resources and Services 22 Administration, and in consultation with the Sec- 23 retary of Defense, shall carry out a program to ex- 24 pand and intensify research to develop innovative 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00602 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 603 •S 4819 IS advanced imaging technologies for prostate cancer 1 detection, diagnosis, and treatment comparable to 2 state-of-the-art mammography technologies. 3 (2) EARLY STAGE RESEARCH.—In imple- 4 menting the program under paragraph (1), the Sec- 5 retary, acting through the Administrator of the 6 Health Resources and Services Administration, shall 7 carry out a grant program to encourage the early 8 stages of research in prostate imaging to develop 9 and implement new ideas, proof of concepts, and 10 pilot studies for high-risk technologic innovation in 11 prostate cancer imaging that would have a high po- 12 tential impact for improving patient care, including 13 individualized care, quality of life, and cost-effective- 14 ness. 15 (3) LARGE SCALE LATER STAGE RESEARCH.— 16 In implementing the program under paragraph (1), 17 the Secretary, acting through the Director of the 18 National Institutes of Health, shall utilize the Na- 19 tional Institute of Biomedical Imaging and Bio- 20 engineering and the National Cancer Institute for 21 advanced stages of research in prostate imaging, in- 22 cluding technology development and clinical trials for 23 projects determined by the Secretary to have dem- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00603 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 604 •S 4819 IS onstrated promising preliminary results and proof of 1 concept. 2 (4) INTERDISCIPLINARY PRIVATE-PUBLIC PART- 3 NERSHIPS.—In developing the program under para- 4 graph (1), the Secretary, acting through the Admin- 5 istrator of the Health Resources and Services Ad- 6 ministration, shall establish interdisciplinary private- 7 public partnerships to develop and implement re- 8 search strategies for expedited innovation in imaging 9 and image-guided treatment and to conduct such re- 10 search. 11 (5) RACIAL DISPARITIES.—In developing the 12 program under paragraph (1), the Secretary shall 13 recognize and address— 14 (A) the racial disparities in the incidences 15 of prostate cancer and mortality rates with re- 16 spect to such disease; and 17 (B) any barriers in access to care and par- 18 ticipation in clinical trials that are specific to 19 racial minorities. 20 (6) AUTHORIZATION OF APPROPRIATIONS.— 21 (A) IN GENERAL.—Subject to subpara- 22 graph (B), there is authorized to be appro- 23 priated to carry out this section, $100,000,000 24 for each of the fiscal years 2021 through 2025. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00604 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 605 •S 4819 IS (B) SPECIFIC ALLOCATIONS.—Of the 1 amount authorized to be appropriated under 2 subparagraph (A) for each of the fiscal years 3 described in such subparagraph— 4 (i) no less than 10 percent may be ap- 5 propriated to carry out the grant program 6 under paragraph (2); and 7 (ii) no more than 1 percent may be 8 appropriated to carry out paragraph (4). 9 (d) PUBLIC AWARENESS AND EDUCATION CAM- 10 PAIGN.— 11 (1) NATIONAL CAMPAIGN.—The Secretary shall 12 carry out a national campaign to increase the aware- 13 ness and knowledge of individuals in the United 14 States with respect to the need for prostate cancer 15 screening and for improved detection technologies. 16 (2) REQUIREMENTS.—The national campaign 17 conducted under this subsection shall include— 18 (A) roles for the Health Resources Services 19 Administration, the Office of Minority Health 20 of the Department of Health and Human Serv- 21 ices, the Centers for Disease Control and Pre- 22 vention, and the Office of Minority Health and 23 Health Equity of the Centers for Disease Con- 24 trol and Prevention; and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00605 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 606 •S 4819 IS (B) the development and distribution of 1 written educational materials, and the develop- 2 ment and placing of public service announce- 3 ments, that are intended to encourage men to 4 seek prostate cancer screening and to create 5 awareness of the need for improved imaging 6 technologies for prostate cancer screening and 7 diagnosis, including in vitro blood testing and 8 imaging technologies. 9 (3) RACIAL DISPARITIES.—In developing the 10 national campaign under paragraph (1), the Sec- 11 retary shall recognize and address— 12 (A) the racial disparities in the incidences 13 of prostate cancer and mortality rates with re- 14 spect to such disease; and 15 (B) any barriers in access to care and par- 16 ticipation in clinical trials that are specific to 17 racial minorities. 18 (4) GRANTS.—The Secretary shall establish a 19 program to award grants to nonprofit private enti- 20 ties to enable such entities to test alternative out- 21 reach and education strategies to increase the 22 awareness and knowledge of individuals in the 23 United States with respect to the need for prostate 24 cancer screening and improved imaging technologies. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00606 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 607 •S 4819 IS (5) AUTHORIZATION OF APPROPRIATIONS.— 1 There is authorized to be appropriated to carry out 2 this section, $10,000,000 for each of fiscal years 3 2021 through 2025. 4 (e) IMPROVING PROSTATE CANCER SCREENING 5 BLOOD TESTS.— 6 (1) IN GENERAL.—The Secretary, in coordina- 7 tion with the Secretary of Defense, shall carry out 8 research to develop an improved prostate cancer 9 screening blood test using in-vitro detection. 10 (2) AUTHORIZATION OF APPROPRIATIONS.— 11 There is authorized to be appropriated to carry out 12 this section, $20,000,000 for each of fiscal years 13 2021 through 2025. 14 (f) REPORTING AND COMPLIANCE.— 15 (1) REPORT AND STRATEGY.—Not later than 16 12 months after the date of the enactment of this 17 Act, the Secretary shall submit to Congress a report 18 that details the strategy of the Secretary for imple- 19 menting the requirements of this section and the 20 status of such efforts. 21 (2) FULL COMPLIANCE.—Not later than 36 22 months after the date of the enactment of this Act, 23 and annually thereafter, the Secretary shall submit 24 to Congress a report that— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00607 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 608 •S 4819 IS (A) describes the research and development 1 and public awareness and education campaigns 2 funded under this section; 3 (B) provides evidence that projects involv- 4 ing high-risk, high impact technologic innova- 5 tion, proof of concept, and pilot studies are 6 prioritized; 7 (C) provides evidence that the Secretary 8 recognizes and addresses any barriers in access 9 to care and participation in clinical trials that 10 are specific to racial minorities in the imple- 11 mentation of this section; 12 (D) contains assurances that all the other 13 provisions of this section are fully implemented; 14 and 15 (E) certifies compliance with the provisions 16 of this section, or in the case of a Federal agen- 17 cy that has not complied with any of such pro- 18 visions, an explanation as to such failure to 19 comply. 20 SEC. 704. PROSTATE CANCER DETECTION RESEARCH AND 21 EDUCATION. 22 (a) SHORT TITLE.—This section may be cited as the 23 ‘‘Prostate Cancer Detection Research and Education 24 Act’’. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00608 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 609 •S 4819 IS (b) PLAN TO DEVELOP AND VALIDATE A TEST OR 1 TESTS FOR PROSTATE CANCER.— 2 (1) IN GENERAL.—The Secretary of Health and 3 Human Services (referred to in this section as the 4 ‘‘Secretary’’), acting through the Director of the Na- 5 tional Institutes of Health, shall establish an advi- 6 sory council on prostate cancer (referred to in this 7 section as the ‘‘advisory council’’) to draft a plan for 8 the development and validation of an accurate test 9 or tests, such as biomarkers or imaging, to detect 10 and diagnose prostate cancer. 11 (2) ADVISORY COUNCIL.— 12 (A) MEMBERSHIP.— 13 (i) FEDERAL MEMBERS.—The advi- 14 sory council shall be comprised of the fol- 15 lowing experts: 16 (I) A designee of the Centers for 17 Disease Control and Prevention. 18 (II) A designee of the Centers for 19 Medicare & Medicaid Services. 20 (III) A designee of the Office of 21 the Director of the National Cancer 22 Institute. 23 (IV) A designee of the Director 24 of the Department of Defense Con- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00609 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 610 •S 4819 IS gressionally Directed Medical Re- 1 search Programs. 2 (V) A designee of the Director of 3 the National Institute of Biomedical 4 Imaging and Bioengineering. 5 (VI) A designee of the Director 6 of the National Institute of General 7 Medical Sciences. 8 (VII) A designee of the Director 9 of the National Institute on Minority 10 Health and Health Disparities. 11 (VIII) A designee of the Office of 12 the Director of the National Institutes 13 of Health. 14 (IX) A designee of the Food and 15 Drug Administration. 16 (X) A designee of the Agency for 17 Healthcare Research and Quality. 18 (XI) A designee of the Director 19 of the Telemedicine and Advanced 20 Technology Research Center of the 21 Department of Defense. 22 (ii) NON-FEDERAL MEMBERS.—In ad- 23 dition to the members described in clause 24 (i), the advisory council shall include 8 ex- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00610 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 611 •S 4819 IS pert members from outside the Federal 1 Government to be appointed by the Sec- 2 retary, which shall include— 3 (I) 2 prostate cancer patient ad- 4 vocates; 5 (II) 2 health care providers with 6 a range of expertise and experience in 7 prostate cancer; and 8 (III) 4 leading researchers with 9 prostate cancer-related expertise in a 10 range of clinical disciplines. 11 (B) MEETINGS.—The advisory council 12 shall meet quarterly and such meetings shall be 13 open to the public. 14 (C) ADVICE.—The advisory council shall 15 advise the Secretary, or the Secretary’s des- 16 ignee. 17 (D) ANNUAL REPORT.—Not later than 1 18 year after the date of enactment of this Act, the 19 advisory council shall provide to the Secretary, 20 or the Secretary’s designee, and Congress— 21 (i) an initial evaluation of all federally 22 funded efforts in prostate cancer research 23 relating to the development and validation 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00611 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 612 •S 4819 IS of an accurate test or tests to detect and 1 diagnose prostate cancer; 2 (ii) a plan for the development and 3 validation of a reliable test or tests for the 4 detection and accurate diagnosis of pros- 5 tate cancer; and 6 (iii) a set of standards for prostate 7 cancer screening, developed in coordination 8 with the United States Preventive Services 9 Task Force, to ensure that any tools for 10 screening, detection, and diagnosis devel- 11 oped in accordance with the plan under 12 clause (ii) will meet the requirements of 13 the Task Force for recommendation as a 14 proven preventive or diagnostic service. 15 (E) TERMINATION.—The advisory council 16 shall terminate on December 31, 2024. 17 (3) FUNDING.—Notwithstanding any other pro- 18 vision of law, the Secretary may make available 19 $1,000,000, from any unobligated amounts appro- 20 priated to the National Institutes of Health, for each 21 of fiscal years 2021 through 2025 to carry out this 22 subsection. 23 (c) COORDINATION AND INTENSIFICATION OF PROS- 24 TATE CANCER RESEARCH.— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00612 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 613 •S 4819 IS (1) IN GENERAL.—The Director of the National 1 Institutes of Health, in consultation with the Sec- 2 retary of Defense, shall coordinate and intensify re- 3 search in accordance with the plan provided under 4 subsection (b)(2)(D)(ii), with particular attention 5 provided to leveraging existing research to develop 6 and validate a test or tests, such as biomarkers or 7 imaging, to detect and accurately diagnose prostate 8 cancer in order to improve quality of life for millions 9 of individuals in the United States, and decrease 10 health care system costs. 11 (2) FUNDING.—Notwithstanding any other pro- 12 vision of law, the Secretary may make available 13 $30,000,000, from any unobligated amounts appro- 14 priated to the National Institutes of Health, for each 15 of fiscal years 2022 through 2026 to carry out this 16 subsection. 17 (d) PUBLIC AWARENESS AND EDUCATION CAM- 18 PAIGN.— 19 (1) NATIONAL CAMPAIGN.—The Secretary, in 20 coordination with the Director of the National Insti- 21 tutes of Health and the Director of the Centers for 22 Disease Control and Prevention, shall carry out a 23 national campaign to increase the awareness and 24 knowledge of prostate cancer. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00613 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 614 •S 4819 IS (2) REQUIREMENTS.—The national campaign 1 conducted under paragraph (1) shall include— 2 (A) roles for the National Cancer Institute, 3 the National Institute on Minority Health and 4 Health Disparities, the Office of Minority 5 Health of the Department of Health and 6 Human Services, and the Office of Minority 7 Health and Health Equity of the Centers for 8 Disease Control and Prevention; and 9 (B) the development and distribution of 10 written educational materials, and the develop- 11 ment and placing of public service announce- 12 ments, that are intended to encourage men to 13 seek prostate cancer screening when symptoms 14 are present, when they have a family history of 15 prostate cancer, or if they belong to a high-risk 16 population. 17 (3) RACIAL DISPARITIES.—In developing the 18 national campaign under paragraph (1), the Sec- 19 retary shall recognize and address— 20 (A) the racial disparities in the incidences 21 of prostate cancer and mortality rates with re- 22 spect to such disease; and 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00614 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 615 •S 4819 IS (B) any barriers in access to patient care 1 and participation in clinical trials that are spe- 2 cific to racial minorities. 3 (4) GRANTS.—The Secretary shall establish a 4 program to award grants to nonprofit private enti- 5 ties to enable such entities to test alternative out- 6 reach and education strategies to increase the 7 awareness and knowledge of individuals in the 8 United States with respect to prostate cancer. 9 (5) AUTHORIZATION OF APPROPRIATIONS.— 10 There is authorized to be appropriated to carry out 11 this subsection, $5,000,000 for each of fiscal years 12 2021 through 2025. 13 SEC. 705. NATIONAL PROSTATE CANCER COUNCIL. 14 (a) SHORT TITLE.—This section may be cited as the 15 ‘‘National Prostate Cancer Plan Act’’. 16 (b) NATIONAL PROSTATE CANCER COUNCIL.— 17 (1) ESTABLISHMENT.—There is established in 18 the Office of the Secretary of Health and Human 19 Services (referred to in this section as the ‘‘Sec- 20 retary’’) the National Prostate Cancer Council on 21 Screening, Early Detection, Assessment, and Moni- 22 toring of Prostate Cancer (referred to in this section 23 as the ‘‘Council’’). 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00615 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 616 •S 4819 IS (2) PURPOSE OF THE COUNCIL.—The Council 1 shall— 2 (A) develop and implement a national stra- 3 tegic plan for the accelerated creation, advance- 4 ment, and testing of diagnostic tools to improve 5 screening, early detection, assessment, and 6 monitoring of prostate cancer, including— 7 (i) early detection of aggressive pros- 8 tate cancer to save lives; 9 (ii) monitoring of tumor response to 10 treatment, including recurrence and pro- 11 gression; and 12 (iii) accurate assessment and surveil- 13 lance of indolent disease to reduce unnec- 14 essary biopsies and treatment; 15 (B) provide information and coordination 16 of prostate cancer research and services across 17 all Federal agencies; 18 (C) review diagnostic tools and their over- 19 all effectiveness at screening, detecting, assess- 20 ing, and monitoring of prostate cancer; 21 (D) evaluate all programs in prostate can- 22 cer that are in existence on the date of enact- 23 ment of this Act, including Federal budget re- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00616 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 617 •S 4819 IS quests and approvals and public-private part- 1 nerships; 2 (E) submit an annual report to the Sec- 3 retary and Congress on the creation and imple- 4 mentation of the national strategic plan under 5 subparagraph (A); and 6 (F) ensure the inclusion of men at high- 7 risk for prostate cancer, including men from 8 minority ethnic and racial populations and men 9 who are least likely to receive care, in clinical, 10 research, and service efforts, with the purpose 11 of decreasing health disparities. 12 (3) MEMBERSHIP.— 13 (A) FEDERAL MEMBERS.—The Council 14 shall be led by the Secretary or designee and 15 comprised of the following experts: 16 (i) Two representatives of the Na- 17 tional Institutes of Health, including 1 rep- 18 resentative of the National Institute of 19 Biomedical Imaging and Bioengineering 20 and 1 representative of the National Can- 21 cer Institute. 22 (ii) A representative of the Centers 23 for Disease Control and Prevention. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00617 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 618 •S 4819 IS (iii) A representative of the Centers 1 for Medicare & Medicaid Services. 2 (iv) A designee of the Director of the 3 Department of Defense Congressionally 4 Directed Medical Research Programs. 5 (v) A designee of the Director of the 6 Office of Minority Health. 7 (vi) A representative of the Food and 8 Drug Administration. 9 (vii) A representative of the Agency 10 for Healthcare Research and Quality. 11 (B) NON-FEDERAL MEMBERS.—In addi- 12 tion to the members described in subparagraph 13 (A), the Council shall include 14 expert mem- 14 bers from outside the Federal Government, 15 which shall include— 16 (i) 6 prostate cancer patient advo- 17 cates, including— 18 (I) 2 patient-survivors; 19 (II) 2 caregivers of prostate can- 20 cer patients; and 21 (III) 2 representatives from na- 22 tional prostate cancer disease organi- 23 zations that fund research or have 24 demonstrated experience in providing 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00618 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 619 •S 4819 IS assistance to patients, families, and 1 medical professionals, including infor- 2 mation on health care options, edu- 3 cation, and referral; and 4 (ii) 8 health care stakeholders with 5 specific expertise in prostate cancer re- 6 search in the critical areas of clinical ex- 7 pertise, including medical oncology, radi- 8 ology, radiation oncology, urology, and pa- 9 thology. 10 (4) MEETINGS.—The Council shall meet quar- 11 terly and meetings shall be open to the public. 12 (5) ADVICE.—The Council shall advise the Sec- 13 retary, or the Secretary’s designee. 14 (6) ANNUAL REPORT.—The Council shall sub- 15 mit annual reports, beginning not later than 1 year 16 after the date of enactment of this Act, to the Sec- 17 retary or the Secretary’s designee and to Congress. 18 The annual report shall include— 19 (A) in the first year— 20 (i) an evaluation of all federally fund- 21 ed efforts in prostate cancer research and 22 gaps relating to the development and vali- 23 dation of diagnostic tools for prostate can- 24 cer; and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00619 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 620 •S 4819 IS (ii) recommendations for priority ac- 1 tions to expand, eliminate, coordinate, or 2 condense programs based on the perform- 3 ance, mission, and purpose of the pro- 4 grams; and 5 (B) annually thereafter for 5 years— 6 (i) an outline for the development and 7 implementation of a national research plan 8 for creation and validation of accurate di- 9 agnostic tools to improve prostate cancer 10 care in accordance with paragraph (1); 11 (ii) roles for the National Cancer In- 12 stitute, National Institute on Minority 13 Health and Health Disparities, and the Of- 14 fice of Minority Health of the Department 15 of Health and Human Services; 16 (iii) an analysis of the disparities in 17 the incidence and mortality rates of pros- 18 tate cancer in men at high risk of the dis- 19 ease, including individuals with family his- 20 tory, increasing age, or African-American 21 heritage; and 22 (iv) a review of the progress towards 23 the realization of the proposed strategic 24 plan. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00620 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 621 •S 4819 IS (7) TERMINATION.—The Council shall termi- 1 nate on December 31, 2025. 2 SEC. 706. IMPROVED MEDICAID COVERAGE FOR CERTAIN 3 BREAST AND CERVICAL CANCER PATIENTS 4 IN THE TERRITORIES. 5 (a) ELIMINATION OF FUNDING LIMITATIONS.—Sec- 6 tion 1108(g)(4) of the Social Security Act (42 U.S.C. 7 1308(g)(4)) is amended— 8 (1) by striking ‘‘paragraphs (1), (2), (3), and 9 (4) of’’; and 10 (2) by adding at the end the following: ‘‘With 11 respect to fiscal years beginning with fiscal year 12 2021, payment for medical assistance for individuals 13 who are eligible for such assistance only on the basis 14 of section 1902(a)(10)(A)(ii)(XVIII) shall not be 15 taken into account in applying subsection (f) (as in- 16 creased in accordance with this subsection) to Puer- 17 to Rico, the Virgin Islands, Guam, the Northern 18 Mariana Islands, or American Samoa for such fiscal 19 year.’’. 20 (b) APPLICATION OF ENHANCED FMAP FOR HIGH- 21 EST STATE.—Section 1905(b) of such Act (42 U.S.C. 22 1396d(b)) is amended by adding at the end the following: 23 ‘‘Notwithstanding the first sentence of this subsection, 24 with respect to medical assistance described in clause (4) 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00621 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 622 •S 4819 IS of such sentence that is furnished in Puerto Rico, the Vir- 1 gin Islands, Guam, the Northern Mariana Islands, or 2 American Samoa in a fiscal year, the Federal medical as- 3 sistance percentage is equal to the highest such percentage 4 applied under such clause for such fiscal year for any of 5 the 50 States or the District of Columbia that provides 6 such medical assistance for any portion of such fiscal 7 year.’’. 8 (c) EFFECTIVE DATE.—The amendments made by 9 this section shall apply to payment for medical assistance 10 for items and services furnished on or after October 1, 11 2021. 12 SEC. 707. CANCER PREVENTION AND TREATMENT DEM- 13 ONSTRATION FOR ETHNIC AND RACIAL MI- 14 NORITIES. 15 (a) DEMONSTRATION.— 16 (1) IN GENERAL.—The Secretary of Health and 17 Human Services (referred to in this section as the 18 ‘‘Secretary’’) shall conduct demonstration projects 19 for the purpose of developing models and evaluating 20 methods that— 21 (A) improve the quality of items and serv- 22 ices provided to target individuals in order to 23 facilitate reduced disparities in early detection 24 and treatment of cancer; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00622 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 623 •S 4819 IS (B) improve clinical outcomes, satisfaction, 1 quality of life, appropriate use of items and 2 services covered under the Medicare program 3 under title XVIII of the Social Security Act (42 4 U.S.C. 1395 et seq.), and referral patterns with 5 respect to target individuals with cancer; 6 (C) eliminate disparities in the rate of pre- 7 ventive cancer screening measures, such as Pap 8 smears, prostate cancer screenings, colon cancer 9 screenings, breast cancer screenings, and com- 10 puted tomography scans, for lung cancer among 11 target individuals; 12 (D) promote collaboration with community- 13 based organizations to ensure cultural com- 14 petency of health care professionals and lin- 15 guistic access for target individuals who are 16 persons with limited English proficiency; and 17 (E) encourage the incorporation of commu- 18 nity health workers to increase the efficiency 19 and appropriateness of cancer screening pro- 20 grams. 21 (2) COMMUNITY HEALTH WORKER DEFINED.— 22 In this section, the term ‘‘community health worker’’ 23 includes a community health advocate, a lay health 24 worker, a community health representative, a peer 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00623 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 624 •S 4819 IS health promoter, a community health outreach work- 1 er, and a promotore de salud, who promotes health 2 or nutrition within the community in which the indi- 3 vidual resides. 4 (3) TARGET INDIVIDUAL DEFINED.—In this 5 section, the term ‘‘target individual’’ means an indi- 6 vidual of a racial and ethnic minority group, as de- 7 fined in section 1707(g)(1) of the Public Health 8 Service Act (42 U.S.C. 300u–6(g)(1)), who is enti- 9 tled to benefits under part A, and enrolled under 10 part B, of title XVIII of the Social Security Act. 11 (b) PROGRAM DESIGN.— 12 (1) INITIAL DESIGN.—Not later than 1 year 13 after the date of the enactment of this Act, the Sec- 14 retary shall evaluate best practices in the private 15 sector, community programs, and academic research 16 of methods that reduce disparities among individuals 17 of racial and ethnic minority groups in the preven- 18 tion and treatment of cancer and shall design the 19 demonstration projects based on such evaluation. 20 (2) NUMBER AND PROJECT AREAS.—Not later 21 than 2 years after the date of the enactment of this 22 Act, the Secretary shall implement at least 9 dem- 23 onstration projects, including the following: 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00624 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 625 •S 4819 IS (A) Two projects, each of which shall tar- 1 get different ethnic subpopulations, for each of 2 the 4 following major racial and ethnic minority 3 groups: 4 (i) American Indians and Alaska Na- 5 tives, Eskimos, and Aleuts. 6 (ii) Asian Americans. 7 (iii) Blacks and African Americans. 8 (iv) Latinos and Hispanics. 9 (v) Native Hawaiians and other Pa- 10 cific Islanders. 11 (B) One project within the Pacific Islands 12 or United States insular areas. 13 (C) At least one project in a rural area. 14 (D) At least one project in an inner-city 15 area. 16 (3) EXPANSION OF PROJECTS; IMPLEMENTA- 17 TION OF DEMONSTRATION PROJECT RESULTS.—The 18 Secretary shall continue the existing demonstration 19 projects and may expand the number of demonstra- 20 tion projects if the initial report under subsection (c) 21 contains an evaluation that demonstration 22 projects— 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00625 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 626 •S 4819 IS (A) reduce expenditures under the Medi- 1 care program under title XVIII of the Social 2 Security Act (42 U.S.C. 1395 et seq.); or 3 (B) do not increase expenditures under 4 such Medicare program and reduce racial and 5 ethnic health disparities in the quality of health 6 care services provided to target individuals and 7 increase satisfaction of Medicare beneficiaries 8 and health care providers. 9 (c) REPORT TO CONGRESS.— 10 (1) IN GENERAL.—Not later than 2 years after 11 the date the Secretary implements the initial dem- 12 onstration projects, and biannually thereafter, the 13 Secretary shall submit to Congress a report regard- 14 ing the demonstration projects. 15 (2) CONTENT OF REPORT.—Each report under 16 paragraph (1) shall include the following: 17 (A) A description of the demonstration 18 projects. 19 (B) An evaluation of— 20 (i) the cost-effectiveness of the dem- 21 onstration projects; 22 (ii) the quality of the health care serv- 23 ices provided to target individuals under 24 the demonstration projects; and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00626 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 627 •S 4819 IS (iii) beneficiary and health care pro- 1 vider satisfaction under the demonstration 2 projects. 3 (C) Any other information regarding the 4 demonstration projects that the Secretary de- 5 termines to be appropriate. 6 (d) WAIVER AUTHORITY.—The Secretary shall waive 7 compliance with the requirements of title XVIII of the So- 8 cial Security Act (42 U.S.C. 1395 et seq.) to such extent 9 and for such period as the Secretary determines is nec- 10 essary to conduct demonstration projects. 11 SEC. 708. REDUCING CANCER DISPARITIES WITHIN MEDI- 12 CARE. 13 (a) DEVELOPMENT OF MEASURES OF DISPARITIES 14 IN QUALITY OF CANCER CARE.— 15 (1) DEVELOPMENT OF MEASURES.—The Sec- 16 retary of Health and Human Services (in this sec- 17 tion referred to as the ‘‘Secretary’’) shall enter into 18 an agreement with an entity that specializes in de- 19 veloping quality measures for cancer care under 20 which the entity shall develop a uniform set of meas- 21 ures to evaluate disparities in the quality of cancer 22 care and annually update such set of measures. 23 (2) MEASURES TO BE INCLUDED.—Such set of 24 measures shall include, with respect to the treatment 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00627 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 628 •S 4819 IS of cancer, measures of patient outcomes, the process 1 for delivering medical care related to such treat- 2 ment, patient counseling and engagement in deci- 3 sion-making, patient experience of care, resource 4 use, and practice capabilities, such as care coordina- 5 tion. 6 (b) ESTABLISHMENT OF REPORTING PROCESS.— 7 (1) IN GENERAL.—The Secretary shall establish 8 a reporting process that requires and provides for a 9 method for health care providers specified under 10 paragraph (2) to submit to the Secretary and make 11 public data on the performance of such providers 12 during each reporting period through use of the 13 measures developed pursuant to subsection (a). Such 14 data shall be submitted in a form and manner and 15 at a time specified by the Secretary. 16 (2) SPECIFICATION OF PROVIDERS TO REPORT 17 ON MEASURES.—The Secretary shall specify the 18 classes of Medicare providers of services and sup- 19 pliers, including hospitals, cancer centers, physi- 20 cians, primary care providers, and specialty pro- 21 viders, that will be required under such process to 22 publicly report on the measures specified under sub- 23 section (a). 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00628 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 629 •S 4819 IS (3) ASSESSMENT OF CHANGES.—Under such 1 reporting process, the Secretary shall establish a for- 2 mat that assesses changes in both the absolute and 3 relative disparities in cancer care over time. These 4 measures shall be presented in an easily comprehen- 5 sible format, such as those presented in the final 6 publications relating to Healthy People 2010 or the 7 National Healthcare Disparities Report. 8 (4) INITIAL IMPLEMENTATION.—The Secretary 9 shall implement the reporting process under this 10 subsection for reporting periods beginning not later 11 than 6 months after the date that measures are first 12 established under subsection (a). 13 SEC. 709. CANCER CLINICAL TRIALS. 14 (a) SHORT TITLE.—This section may be cited as the 15 ‘‘Henrietta Lacks Enhancing Cancer Research Act of 16 2020’’. 17 (b) FINDINGS.—Congress finds as follows: 18 (1) Only a small percent of patients participate 19 in cancer clinical trials, even though most express an 20 interest in clinical research. There are several obsta- 21 cles that restrict individuals from participating in- 22 cluding lack of available local trials, restrictive eligi- 23 bility criteria, transportation to trial sites, taking 24 time off from work, and potentially increased med- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00629 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 630 •S 4819 IS ical and nonmedical costs. Ultimately, about 1 in 5 1 cancer clinical trials fail because of lack of patient 2 enrollment. 3 (2) Groups that are generally underrepresented 4 in clinical trials include racial and ethnic minorities 5 and older, rural, and lower-income individuals. 6 (3) Henrietta Lacks, an African-American 7 woman, was diagnosed with cervical cancer at the 8 age of 31, and despite receiving painful radium 9 treatments, passed away on October 4, 1951. 10 (4) Medical researchers took samples of Hen- 11 rietta Lacks’ tumor during her treatment and the 12 HeLa cell line from her tumor proved remarkably 13 resilient. 14 (5) HeLa cells were the first immortal line of 15 human cells. Henrietta Lacks’ cells were unique, 16 growing by the millions, commercialized and distrib- 17 uted worldwide to researchers, resulting in advances 18 in medicine. 19 (6) Henrietta Lacks’ prolific cells continue to 20 grow and contribute to remarkable advances in med- 21 icine, including the development of the polio vaccine, 22 as well as drugs for treating the effects of cancer, 23 HIV/AIDS, hemophilia, leukemia, and Parkinson’s 24 disease. These cells have been used in research that 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00630 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 631 •S 4819 IS has contributed to our understanding of the effects 1 of radiation and zero gravity on human cells. These 2 immortal cells have informed research on chromo- 3 somal conditions, cancer, gene mapping, and preci- 4 sion medicine. 5 (7) Henrietta Lacks and her immortal cells 6 have made a significant contribution to global 7 health, scientific research, quality of life, and patient 8 rights. 9 (8) For more than 20 years, the advances made 10 possible by Henrietta Lacks’ cells were without her 11 or her family’s consent, and the revenues they gen- 12 erated were not known to or shared with her family. 13 (9) Henrietta Lacks and her family’s experience 14 is fundamental to modern and future bioethics poli- 15 cies and informed consent laws that benefit patients 16 nationwide by building patient trust; promoting eth- 17 ical research that benefits all individuals, including 18 traditionally underrepresented populations; and pro- 19 tecting research participants. 20 (c) GAO STUDY ON BARRIERS TO PARTICIPATION IN 21 FEDERALLY FUNDED CANCER CLINICAL TRIALS BY POP- 22 ULATIONS THAT HAVE BEEN TRADITIONALLY UNDER- 23 REPRESENTED IN SUCH TRIALS.— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00631 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 632 •S 4819 IS (1) IN GENERAL.—Not later than 2 years after 1 the date of enactment of this Act, the Comptroller 2 General of the United States shall— 3 (A) complete a study that— 4 (i) reviews what actions Federal agen- 5 cies have taken to help to address barriers 6 to participation in federally funded cancer 7 clinical trials by populations that have 8 been traditionally underrepresented in such 9 trials, and identifies challenges, if any, in 10 implementing such actions; and 11 (ii) identifies additional actions that 12 can be taken by Federal agencies to ad- 13 dress barriers to participation in federally 14 funded cancer clinical trials by populations 15 that have been traditionally underrep- 16 resented in such trials; and 17 (B) submit a report to the Congress on the 18 results of such study, including recommenda- 19 tions on potential changes in practices and poli- 20 cies to improve participation in such trials by 21 such populations. 22 (2) INCLUSION OF CLINICAL TRIALS.—The 23 study under paragraph (1)(A) shall include review of 24 cancer clinical trials that are largely funded by Fed- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00632 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 633 •S 4819 IS eral agencies, including the National Institutes of 1 Health, the Department of Defense, the Department 2 of Veterans Affairs, the Agency for Healthcare Re- 3 search and Quality, the Food and Drug Administra- 4 tion, and such other Federal agencies as the Comp- 5 troller General of the United States may identify. 6 Subtitle B—Viral Hepatitis and 7 Liver Cancer Control and Pre- 8 vention 9 SEC. 711. VIRAL HEPATITIS AND LIVER CANCER CONTROL 10 AND PREVENTION. 11 (a) SHORT TITLE.—This subtitle may be cited as the 12 ‘‘Viral Hepatitis and Liver Cancer Control and Prevention 13 Act of 2020’’. 14 (b) FINDINGS.—Congress finds the following: 15 (1) In the United States, nearly 5,000,000 per- 16 sons are living with the hepatitis B virus (referred 17 to in this section as ‘‘HBV’’) or the hepatitis C virus 18 (referred to in this section as ‘‘HCV’’). 19 (2) In the United States, chronic HBV and 20 HCV are the most common causes of liver cancer, 21 the second deadliest and fastest growing cancer in 22 this country. Such viruses are the most common 23 cause of chronic liver disease, liver cirrhosis, and the 24 most common indications for liver transplantation. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00633 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 634 •S 4819 IS At least 21,000 deaths per year in the United States 1 can be attributed to chronic HBV and HCV. Chron- 2 ic HCV is also a leading cause of death in Ameri- 3 cans living with HIV/AIDS; many of those living 4 with HIV/AIDS are coinfected with chronic HBV, 5 chronic HCV, or both. 6 (3) According to the Centers for Disease Con- 7 trol and Prevention (referred to in this section as 8 the ‘‘CDC’’), approximately 2 percent of the popu- 9 lation of the United States is living with chronic 10 HBV, chronic HCV, or both. The CDC has recog- 11 nized HCV as the Nation’s most common chronic 12 bloodborne virus infection and HBV as the deadliest 13 vaccine-preventable disease. 14 (4) HBV is transmitted through contact with 15 infectious blood, semen, or other bodily fluids and is 16 100 times more infectious than HIV. HCV is trans- 17 mitted by contact with infectious blood, particularly 18 through percutaneous exposures (such as puncture 19 through the skin). 20 (5) The CDC estimates that in 2016, more 21 than 41,000 people in the United States were newly 22 infected with HCV and nearly 21,000 people in the 23 United States were newly infected with HBV. These 24 estimates could be much higher due to many rea- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00634 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 635 •S 4819 IS sons, including lack of screening education and 1 awareness, and perceived marginalization of the pop- 2 ulations at risk. 3 (6) In 2012, CDC released new guidelines rec- 4 ommending every person born between 1945 and 5 1965 receive a one-time test for HCV. Among the 6 estimated 102,000,000 (1,600,000 chronically HCV- 7 infected) eligible for screening, birth-cohort screen- 8 ing leads to 84,000 fewer cases of decompensated 9 cirrhosis, 46,000 fewer cases of hepatocellular car- 10 cinoma, 10,000 fewer liver transplants, and 78,000 11 fewer HCV-related deaths gained versus risk-based 12 screening. 13 (7) In 2013, the United States Preventive Serv- 14 ices Task Force (referred to in this section as the 15 ‘‘USPSTF’’) issued a Grade B rating for screening 16 for HCV infection in persons at high risk for infec- 17 tion and adults born between 1945 and 1965. In 18 2014, the USPSTF issued a Grade B for screening 19 for HBV in persons at high-risk of hepatitis B infec- 20 tion. In 2009, the USPSTF issued a Grade A for 21 screening pregnant women for HBV during their 22 first prenatal visit, and in 2019, reaffirmed this 23 grade. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00635 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 636 •S 4819 IS (8) There were 59 outbreaks (24 of HBV and 1 36 of HCV, including one of both HBV and HCV) 2 reported to CDC for investigation from 2008 3 through 2016 related to health care-associated infec- 4 tion of HBV and HCV, 56 of which occurred in non- 5 hospital settings. There were more than 115,983 pa- 6 tients potentially exposed to one of the viruses. 7 (9) Chronic HBV and chronic HCV usually do 8 not cause symptoms early in the course of the dis- 9 ease, but after many years of a clinically ‘‘silent’’ 10 phase, CDC estimates show more than 33 percent of 11 infected individuals will develop cirrhosis, end-stage 12 liver disease, or liver cancer. Since most individuals 13 with chronic HBV, HCV, or both are unaware of 14 their infection, they do not know to take precautions 15 to prevent the spread of their infection and can un- 16 knowingly exacerbate their own disease progression. 17 (10) HBV and HCV disproportionately affect 18 certain populations in the United States. Although 19 representing only about 6 percent of the population, 20 Asian Americans and Pacific Islanders account for 21 half of all chronic HBV cases in the United States. 22 Baby Boomers (those born between 1945 and 1965) 23 account for approximately 75 percent of domestic 24 chronic HCV cases. In addition, African Americans, 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00636 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 637 •S 4819 IS Latinos, and American Indian and Native Alaskans 1 are among the groups which have disproportionately 2 high rates of HBV or HCV infections in the United 3 States. 4 (11) For both chronic HBV and chronic HCV, 5 behavioral changes and appropriate medical care can 6 slow disease progression if diagnosis is made early. 7 Early diagnosis, which is determined through simple 8 blood tests, can reduce the risk of transmission and 9 disease progression through education and vaccina- 10 tion of household members and other susceptible 11 persons at risk. 12 (12) Advancements have led to the development 13 of improved diagnostic tests for viral hepatitis. 14 These tests, including rapid, point of care testing 15 and others in development, can facilitate testing, no- 16 tification of results and post-test counseling, and re- 17 ferral to care at the time of the testing visit. In par- 18 ticular, these tests are also advantageous because 19 they can be used simultaneously with HIV rapid 20 testing for persons at risk for both HCV and HIV 21 infections. 22 (13) For those chronically infected with HBV 23 or HCV, regular monitoring can lead to the early de- 24 tection of liver cancer at a stage where a cure is still 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00637 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 638 •S 4819 IS possible. Liver cancer is the second deadliest cancer 1 in the United States; however, liver cancer has re- 2 ceived little funding for research, prevention, or 3 treatment. 4 (14) Treatment for chronic HCV can eradicate 5 the disease in approximately 90 percent of those cur- 6 rently treated. While there is no cure for chronic 7 HBV, available treatments can effectively suppress 8 viral replication in the overwhelming majority of 9 those treated, thereby reducing the risk of trans- 10 mission and progression to liver scarring or liver 11 cancer. 12 (15) To combat the viral hepatitis epidemic in 13 the United States, in February 2017, the Depart- 14 ment of Health and Human Services released its 15 ‘‘National Viral Hepatitis Action Plan 2017–2020’’ 16 (referred to in this section as the ‘‘HHS Action 17 Plan’’). In March 2017, the National Academies of 18 Sciences, Engineering, and Medicine released a re- 19 port entitled, ‘‘A National Strategy for the Elimi- 20 nation of Hepatitis B and C: Phase Two Report’’ 21 (referred to in this section as the ‘‘NAS report’’), 22 recommending specific actions to eliminate viral hep- 23 atitis as public health problems in the United States 24 by 2030. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00638 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 639 •S 4819 IS (16) The annual health care costs attributable 1 to HBV and HCV in the United States are signifi- 2 cant. For HBV, it is estimated to be approximately 3 $2,500,000,000 ($2,000 per infected person). In 4 2000, the lifetime cost of HBV—before the avail- 5 ability of most current therapies—was approximately 6 $80,000 per chronically infected person, totaling 7 more than $100,000,000,000. For HCV, medical 8 costs for patients are expected to increase from 9 $30,000,000,000 in 2009 to over $85,000,000,000 10 in 2024. Avoiding these costs by screening and diag- 11 nosing individuals earlier—and connecting them to 12 appropriate treatment and care, will save lives and 13 critical health care dollars. Currently, without a 14 comprehensive screening, testing, and diagnosis pro- 15 gram, most patients are diagnosed too late when 16 they need a liver transplant costing at least 17 $314,000 for uncomplicated cases or when they have 18 liver cancer or end-stage liver disease which costs 19 $30,980 to $110,576 per hospital admission. As 20 health care costs continue to grow, it is critical that 21 the Federal Government invests in effective mecha- 22 nisms to avoid documented cost drivers. 23 (17) According to the NAS report in 2010, 24 chronic HBV and HCV infections cause substantial 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00639 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 640 •S 4819 IS morbidity and mortality despite being preventable 1 and treatable. Deficiencies in the implementation of 2 established guidelines for the prevention, diagnosis, 3 and medical management of chronic HBV and HCV 4 infections perpetuate personal and economic bur- 5 dens. Existing grants are not sufficient for the scale 6 of the health burden presented by HBV and HCV. 7 (18) Screening and testing for HBV and HCV 8 is aligned with the goal of Healthy People 2020 to 9 increase immunization rates and reduce preventable 10 infectious diseases. Awareness of disease and access 11 to prevention and treatment remain essential compo- 12 nents for reducing infectious disease transmission. 13 (19) Federal support is necessary to increase 14 knowledge and awareness of HBV and HCV and to 15 assist State and local prevention and control efforts 16 in reducing the morbidity and mortality of these 17 epidemics. 18 (20) The Centers for Disease Control and Pre- 19 vention reported a 233 percent increase in hepatitis 20 C cases from 2010 to 2016, stemming from the 21 opioid, heroin, and overdose epidemics affecting com- 22 munities nationwide. From 2014 to 2015, the num- 23 ber of reported cases of acute hepatitis B infection 24 in the United States rose for the first time since 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00640 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 641 •S 4819 IS 2006, increasing by 20.7 percent, which is also 1 largely attributable to the opioid epidemic. 2 (21) The Secretary of Health and Human Serv- 3 ices has the discretion to carry out this subtitle (in- 4 cluding the amendments made by this subtitle) di- 5 rectly and through whichever of the agencies of the 6 Public Health Service the Secretary determines to be 7 appropriate, which may (in the Secretary’s discre- 8 tion) include the Centers for Disease Control and 9 Prevention, the Health Resources and Services Ad- 10 ministration, the Substance Abuse and Mental 11 Health Services Administration, the National Insti- 12 tutes of Health (including the National Institute on 13 Minority Health and Health Disparities), and other 14 agencies of such Service. 15 (c) BIENNIAL ASSESSMENT OF HHS HEPATITIS B 16 AND HEPATITIS C PREVENTION, EDUCATION, RESEARCH, 17 AND MEDICAL MANAGEMENT PLAN.—Title III of the 18 Public Health Service Act (42 U.S.C. 241 et seq.), as 19 amended by title V, is further amended— 20 (1) by striking section 317N (42 U.S.C. 247b– 21 15); and 22 (2) by adding after part W, as added by section 23 508, the following: 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00641 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 642 •S 4819 IS ‘‘PART X—BIENNIAL ASSESSMENT OF HHS HEPA- 1 TITIS B AND HEPATITIS C PREVENTION, EDU- 2 CATION, RESEARCH, AND MEDICAL MANAGE- 3 MENT PLAN 4 ‘‘SEC. 399PP. BIENNIAL UPDATE OF THE PLAN. 5 ‘‘(a) IN GENERAL.—The Secretary shall conduct a bi- 6 ennial assessment of the Secretary’s plan for the preven- 7 tion, control, and medical management of, and education 8 and research relating to, hepatitis B and hepatitis C, for 9 the purposes of— 10 ‘‘(1) incorporating into such plan new knowl- 11 edge or observations relating to hepatitis B and hep- 12 atitis C (such as knowledge and observations that 13 may be derived from clinical, laboratory, and epide- 14 miological research and disease detection, preven- 15 tion, and surveillance outcomes); 16 ‘‘(2) addressing gaps in the coverage or effec- 17 tiveness of the plan; and 18 ‘‘(3) evaluating and, if appropriate, updating 19 recommendations, guidelines, or educational mate- 20 rials of the Centers for Disease Control and Preven- 21 tion or the National Institutes of Health for health 22 care providers or the public on viral hepatitis in 23 order to be consistent with the plan. 24 ‘‘(b) PUBLICATION OF NOTICE OF ASSESSMENTS.— 25 Not later than October 1 of the first even-numbered year 26 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00642 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 643 •S 4819 IS beginning after the date of the enactment of this part, 1 and October 1 of each even-numbered year thereafter, the 2 Secretary shall publish in the Federal Register a notice 3 of the results of the assessments conducted under para- 4 graph (1). Such notice shall include— 5 ‘‘(1) a description of any revisions to the plan 6 referred to in subsection (a) as a result of the as- 7 sessment; 8 ‘‘(2) an explanation of the basis for any such 9 revisions, including the ways in which such revisions 10 can reasonably be expected to further promote the 11 original goals and objectives of the plan; and 12 ‘‘(3) in the case of a determination by the Sec- 13 retary that the plan does not need revision, an expla- 14 nation of the basis for such determination. 15 ‘‘SEC. 399PP–1. ELEMENTS OF PROGRAM. 16 ‘‘(a) EDUCATION AND AWARENESS PROGRAMS.—The 17 Secretary, acting through the Director of the Centers for 18 Disease Control and Prevention, the Administrator of the 19 Health Resources and Services Administration, and the 20 Assistant Secretary for Mental Health and Substance Use, 21 and in accordance with the plan referred to in section 22 399PP(a), shall implement programs to increase aware- 23 ness and enhance knowledge and understanding of hepa- 24 titis B and hepatitis C. Such programs shall include— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00643 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 644 •S 4819 IS ‘‘(1) the conduct of culturally and linguistically 1 appropriate health education in primary and sec- 2 ondary schools, college campuses, public awareness 3 campaigns, and community outreach activities (espe- 4 cially to the ethnic communities with high rates of 5 chronic hepatitis B and chronic hepatitis C and 6 other high-risk groups) to promote public awareness 7 and knowledge about the value of hepatitis A and 8 hepatitis B immunization; risk factors, transmission, 9 and prevention of hepatitis B and hepatitis C; the 10 value of screening for the early detection of hepatitis 11 B and hepatitis C; and options available for the 12 treatment of chronic hepatitis B and chronic hepa- 13 titis C; 14 ‘‘(2) the promotion of immunization programs 15 that increase awareness and access to hepatitis A 16 and hepatitis B vaccines for susceptible adults and 17 children; 18 ‘‘(3) the training of health care professionals 19 regarding the importance of vaccinating individuals 20 infected with hepatitis C and individuals who are at 21 risk for hepatitis C infection against hepatitis A and 22 hepatitis B; 23 ‘‘(4) the training of health care professionals 24 regarding the importance of vaccinating individuals 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00644 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 645 •S 4819 IS chronically infected with hepatitis B and individuals 1 who are at risk for chronic hepatitis B infection 2 against the hepatitis A virus; 3 ‘‘(5) the training of health care professionals 4 and health educators to make them aware of the 5 high rates of chronic hepatitis B and chronic hepa- 6 titis C in certain adult ethnic populations, and the 7 importance of prevention, detection, and medical 8 management of hepatitis B and hepatitis C and of 9 liver cancer screening; 10 ‘‘(6) the development and distribution of health 11 education curricula (including information relating 12 to the special needs of individuals infected with or 13 at risk of hepatitis B and hepatitis C, such as the 14 importance of prevention and early intervention, reg- 15 ular monitoring, the recognition of psychosocial 16 needs, appropriate treatment, and liver cancer 17 screening) for individuals providing hepatitis B and 18 hepatitis C counseling; and 19 ‘‘(7) support for the implementation of the cur- 20 ricula described in paragraph (6) by State and local 21 public health agencies. 22 ‘‘(b) IMMUNIZATION, PREVENTION, AND CONTROL 23 PROGRAMS.— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00645 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 646 •S 4819 IS ‘‘(1) IN GENERAL.—The Secretary, acting 1 through the Director of the Centers for Disease 2 Control and Prevention, shall support the integra- 3 tion of activities described in paragraph (3) into ex- 4 isting clinical and public health programs at State, 5 local, territorial, and Tribal levels (including commu- 6 nity health clinics, programs for the prevention and 7 treatment of HIV/AIDS, sexually transmitted infec- 8 tions, and substance abuse, and programs for indi- 9 viduals in correctional settings). 10 ‘‘(2) COORDINATION OF DEVELOPMENT OF 11 FEDERAL SCREENING GUIDELINES.— 12 ‘‘(A) REFERENCES.—For purposes of this 13 subsection, the term ‘CDC Director’ means the 14 Director of the Centers for Disease Control and 15 Prevention, and the term ‘AHRQ Director’ 16 means the Director of the Agency for 17 Healthcare Research and Quality. 18 ‘‘(B) AGENCY FOR HEALTHCARE RE- 19 SEARCH AND QUALITY.—Due to the rapidly 20 evolving standard of care associated with diag- 21 nosing and treating viral hepatitis infection, the 22 AHRQ Director shall convene the Preventive 23 Services Task Force under section 915(a) to re- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00646 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 647 •S 4819 IS view its recommendation for screening for HBV 1 and HCV infection every 3 years. 2 ‘‘(3) ACTIVITIES.— 3 ‘‘(A) VOLUNTARY TESTING PROGRAMS.— 4 ‘‘(i) IN GENERAL.—The Secretary 5 shall establish a mechanism by which to 6 support and promote the development of 7 State, local, territorial, and tribal vol- 8 untary hepatitis B and hepatitis C testing 9 programs to screen the high-prevalence 10 populations to aid in the early identifica- 11 tion of chronically infected individuals. 12 ‘‘(ii) CONFIDENTIALITY OF THE TEST 13 RESULTS.—The Secretary shall prohibit 14 the use of the results of a hepatitis B or 15 hepatitis C test conducted by a testing pro- 16 gram developed or supported under this 17 subparagraph for any of the following: 18 ‘‘(I) Issues relating to health in- 19 surance. 20 ‘‘(II) To screen or determine 21 suitability for employment. 22 ‘‘(III) To discharge a person 23 from employment. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00647 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 648 •S 4819 IS ‘‘(B) COUNSELING REGARDING VIRAL HEP- 1 ATITIS.—The Secretary shall support State, 2 local, territorial, and tribal programs in a wide 3 variety of settings, including those providing 4 primary and specialty health care services in 5 nonprofit private and public sectors, to— 6 ‘‘(i) provide individuals with ongoing 7 risk factors for hepatitis B and hepatitis C 8 infection with client-centered education 9 and counseling which concentrates on— 10 ‘‘(I) promoting testing of individ- 11 uals that have been exposed to their 12 blood, family members, and their sex- 13 ual partners; and 14 ‘‘(II) changing behaviors that 15 place individuals at risk for infection; 16 ‘‘(ii) provide individuals chronically in- 17 fected with hepatitis B or hepatitis C with 18 education, health information, and coun- 19 seling to reduce their risk of— 20 ‘‘(I) dying from end-stage liver 21 disease and liver cancer; and 22 ‘‘(II) transmitting viral hepatitis 23 to others; and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00648 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 649 •S 4819 IS ‘‘(iii) provide women chronically in- 1 fected with hepatitis B or hepatitis C who 2 are pregnant or of childbearing age with 3 culturally and linguistically appropriate 4 health information, such as how to prevent 5 hepatitis B perinatal infection, and to al- 6 leviate fears associated with pregnancy or 7 raising a family. 8 ‘‘(C) IMMUNIZATION.—The Secretary shall 9 support State, local, territorial, and tribal ef- 10 forts to expand the current vaccination pro- 11 grams to protect every child in the Nation and 12 all susceptible adults, particularly those infected 13 with hepatitis C and high-prevalence ethnic 14 populations and other high-risk groups, from 15 the risks of acute and chronic hepatitis B infec- 16 tion by— 17 ‘‘(i) ensuring continued funding for 18 hepatitis B vaccination for all children 18 19 years of age or younger through the Vac- 20 cines for Children program; 21 ‘‘(ii) ensuring that the recommenda- 22 tions of the Advisory Committee on Immu- 23 nization Practices of the Centers for Dis- 24 ease Control and Prevention are followed 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00649 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 650 •S 4819 IS regarding the birth dose of hepatitis B vac- 1 cinations for newborns; 2 ‘‘(iii) requiring proof of hepatitis B 3 vaccination for entry into public or private 4 daycare, preschool, elementary school, sec- 5 ondary school, and institutions of higher 6 education; 7 ‘‘(iv) expanding the availability of 8 hepatitis B vaccination for all adults to 9 protect them from becoming acutely or 10 chronically infected, including ethnic and 11 other populations with high prevalence 12 rates of chronic hepatitis B infection; 13 ‘‘(v) expanding the availability of hep- 14 atitis B vaccination for all adults, particu- 15 larly those of reproductive age (women and 16 men less than 45 years of age), to protect 17 them from the risk of hepatitis B infection; 18 ‘‘(vi) ensuring the vaccination of indi- 19 viduals infected, or at risk for infection, 20 with hepatitis C against hepatitis A, hepa- 21 titis B, and other infectious diseases, as 22 appropriate, for which such individuals 23 may be at increased risk; and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00650 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 651 •S 4819 IS ‘‘(vii) ensuring the vaccination of indi- 1 viduals infected, or at risk for infection, 2 with hepatitis B against hepatitis A virus 3 and other infectious diseases, as appro- 4 priate, for which such individuals may be 5 at increased risk. 6 ‘‘(D) MEDICAL REFERRAL.—The Secretary 7 shall support State, local, territorial, and tribal 8 programs that support— 9 ‘‘(i) referral of persons chronically in- 10 fected with hepatitis B or hepatitis C— 11 ‘‘(I) for medical evaluation to de- 12 termine the appropriateness for 13 antiviral treatment to reduce the risk 14 of progression to cirrhosis and liver 15 cancer; and 16 ‘‘(II) for ongoing medical man- 17 agement including regular monitoring 18 of liver function and screening for 19 liver cancer; and 20 ‘‘(ii) referral of persons infected with 21 acute or chronic hepatitis B infection or 22 acute or chronic hepatitis C infection for 23 drug and alcohol abuse treatment where 24 appropriate. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00651 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 652 •S 4819 IS ‘‘(4) INCREASED SUPPORT FOR ADULT VIRAL 1 HEPATITIS PREVENTION COORDINATORS.—The Sec- 2 retary, acting through the CDC Director, shall pro- 3 vide increased support to adult viral hepatitis pre- 4 vention coordinators in State, local, territorial, and 5 tribal health departments in order to enhance the 6 additional management, networking, and technical 7 expertise needed to ensure successful integration of 8 hepatitis B and hepatitis C prevention and control 9 activities into existing public health programs. 10 ‘‘(c) EPIDEMIOLOGICAL SURVEILLANCE.— 11 ‘‘(1) IN GENERAL.—The Secretary, acting 12 through the Director of the Centers for Disease 13 Control and Prevention, shall support the establish- 14 ment and maintenance of a national chronic and 15 acute hepatitis B and hepatitis C surveillance pro- 16 gram, in order to identify— 17 ‘‘(A) trends in the incidence of acute and 18 chronic hepatitis B and acute and chronic hepa- 19 titis C; 20 ‘‘(B) trends in the prevalence of acute and 21 chronic hepatitis B and acute and chronic hepa- 22 titis C infection among groups that may be dis- 23 proportionately affected; and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00652 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 653 •S 4819 IS ‘‘(C) trends in liver cancer and end-stage 1 liver disease incidence and deaths, caused by 2 chronic hepatitis B and chronic hepatitis C in 3 the high-risk ethnic populations. 4 ‘‘(2) SEROPREVALENCE AND LIVER CANCER 5 STUDIES.—The Secretary, acting through the Direc- 6 tor of the Centers for Disease Control and Preven- 7 tion, shall prepare a report outlining the population- 8 based seroprevalence studies currently underway, fu- 9 ture planned studies, the criteria involved in deter- 10 mining which seroprevalence studies to conduct, 11 defer, or suspend, and the scope of those studies, the 12 economic and clinical impact of hepatitis B and hep- 13 atitis C, and the impact of chronic hepatitis B and 14 chronic hepatitis C infections on the quality of life. 15 Not later than one year after the date of the enact- 16 ment of this part, the Secretary shall submit the re- 17 port to the Committee on Health, Education, Labor, 18 and Pensions of the Senate and the Committee on 19 Energy and Commerce of the House of Representa- 20 tives. 21 ‘‘(3) CONFIDENTIALITY.—The Secretary shall 22 not disclose any individually identifiable information 23 identified under paragraph (1) or derived through 24 studies under paragraph (2). 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00653 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 654 •S 4819 IS ‘‘(d) RESEARCH.—The Secretary, acting through the 1 Director of the Centers for Disease Control and Preven- 2 tion, the Director of the National Cancer Institute, and 3 the Director of the National Institutes of Health, shall— 4 ‘‘(1) conduct epidemiologic and community- 5 based research to develop, implement, and evaluate 6 best practices for hepatitis B and hepatitis C pre- 7 vention especially in the ethnic populations with high 8 rates of chronic hepatitis B and chronic hepatitis C 9 and other high-risk groups; 10 ‘‘(2) conduct research on hepatitis B and hepa- 11 titis C natural history, pathophysiology, improved 12 treatments and prevention (such as the hepatitis C 13 vaccine), and noninvasive tests that help to predict 14 the risk of progression to liver cirrhosis and liver 15 cancer; 16 ‘‘(3) conduct research that will lead to better 17 noninvasive or blood tests to screen for liver cancer, 18 and more effective treatments of liver cancer caused 19 by chronic hepatitis B and chronic hepatitis C; and 20 ‘‘(4) conduct research comparing the effective- 21 ness of screening, diagnostic, management, and 22 treatment approaches for chronic hepatitis B, chron- 23 ic hepatitis C, and liver cancer in the affected com- 24 munities. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00654 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 655 •S 4819 IS ‘‘(e) UNDERSERVED AND DISPROPORTIONATELY AF- 1 FECTED POPULATIONS.—In carrying out this section, the 2 Secretary shall provide expanded support for individuals 3 with limited access to health education, testing, and health 4 care services and groups that may be disproportionately 5 affected by hepatitis B and hepatitis C. 6 ‘‘(f) EVALUATION OF PROGRAM.—The Secretary 7 shall develop benchmarks for evaluating the effectiveness 8 of the programs and activities conducted under this sec- 9 tion and make determinations as to whether such bench- 10 marks have been achieved. 11 ‘‘SEC. 399PP–2. GRANTS. 12 ‘‘(a) IN GENERAL.—The Secretary may award grants 13 to, or enter into contracts or cooperative agreements with, 14 States, political subdivisions of States, territories, Indian 15 tribes, or nonprofit entities that have special expertise re- 16 lating to hepatitis B, hepatitis C, or both, to carry out 17 activities under this part. 18 ‘‘(b) APPLICATION.—To be eligible for a grant, con- 19 tract, or cooperative agreement under subsection (a), an 20 entity shall prepare and submit to the Secretary an appli- 21 cation at such time, in such manner, and containing such 22 information as the Secretary may require. 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00655 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 656 •S 4819 IS ‘‘SEC. 399PP–3. AUTHORIZATION OF APPROPRIATIONS. 1 ‘‘There are authorized to be appropriated to carry out 2 this part $90,000,000 for fiscal year 2021, $90,000,000 3 for fiscal year 2022, $110,000,000 for fiscal year 2023, 4 $130,000,000 for fiscal year 2024, and $150,000,000 for 5 fiscal year 2025.’’. 6 Subtitle C—Acquired Bone Marrow 7 Failure Diseases 8 SEC. 721. ACQUIRED BONE MARROW FAILURE DISEASES. 9 (a) SHORT TITLE.—This subtitle may be cited as the 10 ‘‘Bone Marrow Failure Disease Research and Treatment 11 Act of 2020’’. 12 (b) FINDINGS.—The Congress finds the following: 13 (1) Between 20,000 and 30,000 people in the 14 United States are diagnosed each year with 15 myelodysplastic syndromes, aplastic anemia, parox- 16 ysmal nocturnal hemoglobinuria, and other acquired 17 bone marrow failure diseases. 18 (2) Acquired bone marrow failure diseases have 19 a debilitating and often fatal impact on those diag- 20 nosed with these diseases. 21 (3) While some treatments for acquired bone 22 marrow failure diseases can prolong and improve the 23 quality of patients’ lives, there is no single cure for 24 these diseases. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00656 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 657 •S 4819 IS (4) The prevalence of acquired bone marrow 1 failure diseases in the United States will continue to 2 grow as the general public ages. 3 (5) Evidence exists suggesting that acquired 4 bone marrow failure diseases occur more often in 5 minority populations, particularly in Asian-American 6 and Latino or Hispanic populations. 7 (6) The National Heart, Lung, and Blood Insti- 8 tute and the National Cancer Institute have con- 9 ducted important research into the causes of and 10 treatments for acquired bone marrow failure dis- 11 eases. 12 (7) The National Marrow Donor Program Reg- 13 istry has made significant contributions to the fight 14 against bone marrow failure diseases by connecting 15 millions of potential marrow donors with individuals 16 and families suffering from these conditions. 17 (8) Despite these advances, a more comprehen- 18 sive Federal strategic effort among numerous Fed- 19 eral agencies is needed to discover a cure for ac- 20 quired bone marrow failure disorders. 21 (9) Greater Federal surveillance of acquired 22 bone marrow failure diseases is needed to gain a bet- 23 ter understanding of the causes of acquired bone 24 marrow failure diseases. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00657 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 658 •S 4819 IS (10) The Federal Government should increase 1 its research support for and engage with public and 2 private organizations in developing a comprehensive 3 approach to combat and cure acquired bone marrow 4 failure diseases. 5 (c) NATIONAL ACQUIRED BONE MARROW FAILURE 6 DISEASE REGISTRY.—Title III of the Public Health Serv- 7 ice Act (42 U.S.C. 241 et seq.) is amended by inserting 8 after section 317V (as added by section 110) the following: 9 ‘‘SEC. 317W. NATIONAL ACQUIRED BONE MARROW FAILURE 10 DISEASE REGISTRY. 11 ‘‘(a) ESTABLISHMENT OF REGISTRY.— 12 ‘‘(1) IN GENERAL.—Not later than 6 months 13 after the date of the enactment of this section, the 14 Secretary, acting through the Director of the Cen- 15 ters for Disease Control and Prevention, shall— 16 ‘‘(A) develop a system to collect data on 17 acquired bone marrow failure diseases; and 18 ‘‘(B) establish and maintain a national and 19 publicly available registry, to be known as the 20 National Acquired Bone Marrow Failure Dis- 21 ease Registry, in accordance with paragraph 22 (3). 23 ‘‘(2) RECOMMENDATIONS OF ADVISORY COM- 24 MITTEE.—In carrying out this subsection, the Sec- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00658 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 659 •S 4819 IS retary shall take into consideration the recommenda- 1 tions of the Advisory Committee on Acquired Bone 2 Marrow Failure Diseases established under sub- 3 section (b). 4 ‘‘(3) PURPOSES OF REGISTRY.—The National 5 Acquired Bone Marrow Failure Disease Registry 6 shall— 7 ‘‘(A) identify the incidence and prevalence 8 of acquired bone marrow failure diseases in the 9 United States; 10 ‘‘(B) be used to collect and store data on 11 acquired bone marrow failure diseases, includ- 12 ing data concerning— 13 ‘‘(i) the age, race or ethnicity, general 14 geographic location, sex, and family history 15 of individuals who are diagnosed with ac- 16 quired bone marrow failure diseases, and 17 any other characteristics of such individ- 18 uals determined appropriate by the Sec- 19 retary; 20 ‘‘(ii) the genetic and environmental 21 factors that may be associated with devel- 22 oping acquired bone marrow failure dis- 23 eases; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00659 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 660 •S 4819 IS ‘‘(iii) treatment approaches for deal- 1 ing with acquired bone marrow failure dis- 2 eases; 3 ‘‘(iv) outcomes for individuals treated 4 for acquired bone marrow failure diseases, 5 including outcomes for recipients of stem 6 cell therapeutic products as contained in 7 the database established pursuant to sec- 8 tion 379A; and 9 ‘‘(v) any other factors pertaining to 10 acquired bone marrow failure diseases de- 11 termined appropriate by the Secretary; and 12 ‘‘(C) be made available— 13 ‘‘(i) to the general public; and 14 ‘‘(ii) to researchers to facilitate fur- 15 ther research into the causes of, and treat- 16 ments for, acquired bone marrow failure 17 diseases in accordance with standard prac- 18 tices of the Centers for Disease Control 19 and Prevention. 20 ‘‘(b) ADVISORY COMMITTEE.— 21 ‘‘(1) ESTABLISHMENT.—Not later than 6 22 months after the date of the enactment of this sec- 23 tion, the Secretary, acting through the Director of 24 the Centers for Disease Control and Prevention, 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00660 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 661 •S 4819 IS shall establish an advisory committee, to be known 1 as the Advisory Committee on Acquired Bone Mar- 2 row Failure Diseases. 3 ‘‘(2) MEMBERS.—The members of the Advisory 4 Committee on Acquired Bone Marrow Failure Dis- 5 eases shall be appointed by the Secretary, acting 6 through the Director of the Centers for Disease 7 Control and Prevention, and shall include at least 8 one representative from each of the following: 9 ‘‘(A) A national patient advocacy organiza- 10 tion with experience advocating on behalf of pa- 11 tients suffering from acquired bone marrow 12 failure diseases. 13 ‘‘(B) The National Institutes of Health, in- 14 cluding at least one representative from each 15 of— 16 ‘‘(i) the National Cancer Institute; 17 ‘‘(ii) the National Heart, Lung, and 18 Blood Institute; and 19 ‘‘(iii) the Office of Rare Diseases. 20 ‘‘(C) The Centers for Disease Control and 21 Prevention. 22 ‘‘(D) Clinicians with experience in— 23 ‘‘(i) diagnosing or treating acquired 24 bone marrow failure diseases; or 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00661 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 662 •S 4819 IS ‘‘(ii) medical data registries. 1 ‘‘(E) Epidemiologists who have experience 2 with data registries. 3 ‘‘(F) Publicly or privately funded research- 4 ers who have experience researching acquired 5 bone marrow failure diseases. 6 ‘‘(G) The entity operating the C.W. Bill 7 Young Cell Transplantation Program estab- 8 lished pursuant to section 379 and the entity 9 operating the C.W. Bill Young Cell Transplan- 10 tation Program Outcomes Database. 11 ‘‘(3) RESPONSIBILITIES.—The Advisory Com- 12 mittee on Acquired Bone Marrow Failure Diseases 13 shall provide recommendations to the Secretary on 14 the establishment and maintenance of the National 15 Acquired Bone Marrow Failure Disease Registry, in- 16 cluding recommendations on the collection, mainte- 17 nance, and dissemination of data. 18 ‘‘(4) PUBLIC AVAILABILITY.—The Secretary 19 shall make the recommendations of the Advisory 20 Committee on Acquired Bone Marrow Failure Dis- 21 ease publicly available. 22 ‘‘(c) GRANTS.—The Secretary, acting through the 23 Director of the Centers for Disease Control and Preven- 24 tion, may award grants to, and enter into contracts and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00662 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 663 •S 4819 IS cooperative agreements with, public or private nonprofit 1 entities for the management of, as well as the collection, 2 analysis, and reporting of data to be included in, the Na- 3 tional Acquired Bone Marrow Failure Disease Registry. 4 ‘‘(d) DEFINITION.—In this section, the term ‘ac- 5 quired bone marrow failure disease’ means— 6 ‘‘(1) myelodysplastic syndromes; 7 ‘‘(2) aplastic anemia; 8 ‘‘(3) paroxysmal nocturnal hemoglobinuria; 9 ‘‘(4) pure red cell aplasia; 10 ‘‘(5) acute myeloid leukemia that has pro- 11 gressed from myelodysplastic syndromes; or 12 ‘‘(6) large granular lymphocytic leukemia. 13 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 14 is authorized to be appropriated to carry out this section 15 $3,000,000 for each of fiscal years 2021 through 2025.’’. 16 (d) PILOT STUDIES THROUGH THE AGENCY FOR 17 TOXIC SUBSTANCES AND DISEASE REGISTRY.— 18 (1) PILOT STUDIES.—The Secretary of Health 19 and Human Services, acting through the Director of 20 the Agency for Toxic Substances and Disease Reg- 21 istry, shall conduct pilot studies to determine which 22 environmental factors, including exposure to toxins, 23 may cause acquired bone marrow failure diseases. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00663 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 664 •S 4819 IS (2) COLLABORATION WITH THE RADIATION IN- 1 JURY TREATMENT NETWORK.—In carrying out the 2 directives of this section, the Secretary may collabo- 3 rate with the Radiation Injury Treatment Network 4 of the C.W. Bill Young Cell Transplantation Pro- 5 gram established pursuant to section 379 of the 6 Public Health Service Act (42 U.S.C. 274k) to— 7 (A) augment data for the pilot studies au- 8 thorized by this section; 9 (B) access technical assistance that may be 10 provided by the Radiation Injury Treatment 11 Network; or 12 (C) perform joint research projects. 13 (3) AUTHORIZATION OF APPROPRIATIONS.— 14 There is authorized to be appropriated to carry out 15 this section $1,000,000 for each of fiscal years 2021 16 through 2025. 17 (e) MINORITY-FOCUSED PROGRAMS ON ACQUIRED 18 BONE MARROW FAILURE DISEASES.—Title XVII of the 19 Public Health Service Act (42 U.S.C. 300u et seq.) is 20 amended by inserting after section 1707A the following: 21 ‘‘SEC. 1707B. MINORITY-FOCUSED PROGRAMS ON AC- 22 QUIRED BONE MARROW FAILURE DISEASE. 23 ‘‘(a) INFORMATION AND REFERRAL SERVICES.— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00664 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 665 •S 4819 IS ‘‘(1) IN GENERAL.—Not later than 6 months 1 after the date of the enactment of this section, the 2 Secretary, acting through the Deputy Assistant Sec- 3 retary for Minority Health, shall establish and co- 4 ordinate outreach and informational programs tar- 5 geted to minority populations affected by acquired 6 bone marrow failure diseases. 7 ‘‘(2) PROGRAM REQUIREMENTS.—Minority-fo- 8 cused outreach and informational programs author- 9 ized by this section at the National Minority Health 10 Resource Center supported under section 1707(b)(8) 11 (including by means of the Center’s website, through 12 appropriate locations such as the Center’s knowledge 13 center, and through appropriate programs such as 14 the Center’s resource persons network) and through 15 minority health consultants located at each Depart- 16 ment of Health and Human Services regional of- 17 fice— 18 ‘‘(A) shall make information about treat- 19 ment options and clinical trials for acquired 20 bone marrow failure diseases publicly available; 21 and 22 ‘‘(B) shall provide referral services for 23 treatment options and clinical trials. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00665 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 666 •S 4819 IS ‘‘(b) HISPANIC AND ASIAN-AMERICAN AND PACIFIC 1 ISLANDER OUTREACH.— 2 ‘‘(1) IN GENERAL.—The Secretary, acting 3 through the Deputy Assistant Secretary for Minority 4 Health, shall undertake a coordinated outreach ef- 5 fort to connect Hispanic, Asian-American, and Pa- 6 cific Islander communities with comprehensive serv- 7 ices focused on treatment of, and information about, 8 acquired bone marrow failure diseases. 9 ‘‘(2) COLLABORATION.—In carrying out this 10 subsection, the Secretary may collaborate with public 11 health agencies, nonprofit organizations, community 12 groups, and online entities to disseminate informa- 13 tion about treatment options and clinical trials for 14 acquired bone marrow failure diseases. 15 ‘‘(c) GRANTS AND COOPERATIVE AGREEMENTS.— 16 ‘‘(1) IN GENERAL.—Not later than 6 months 17 after the date of the enactment of this section, the 18 Secretary, acting through the Deputy Assistant Sec- 19 retary for Minority Health, shall award grants to, or 20 enter into cooperative agreements with, entities to 21 perform research on acquired bone marrow failure 22 diseases. 23 ‘‘(2) REQUIREMENT.—Grants and cooperative 24 agreements authorized by this subsection shall be 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00666 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 667 •S 4819 IS awarded or entered into on a competitive, peer-re- 1 viewed basis. 2 ‘‘(3) SCOPE OF RESEARCH.—Research funded 3 under this section shall examine factors affecting the 4 incidence of acquired bone marrow failure diseases 5 in minority populations. 6 ‘‘(d) DEFINITION.—In this section, the term ‘ac- 7 quired bone marrow failure disease’ has the meaning given 8 to such term in section 317W(d). 9 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 10 is authorized to be appropriated to carry out this section 11 $2,000,000 for each of fiscal years 2021 through 2025.’’. 12 (f) DIAGNOSIS AND QUALITY OF CARE FOR AC- 13 QUIRED BONE MARROW FAILURE DISEASES.— 14 (1) GRANTS.—The Secretary of Health and 15 Human Services, acting through the Director of the 16 Agency for Healthcare Research and Quality, shall 17 award grants to entities to improve diagnostic prac- 18 tices and quality of care with respect to patients 19 with acquired bone marrow failure diseases. 20 (2) AUTHORIZATION OF APPROPRIATIONS.— 21 There is authorized to be appropriated to carry out 22 this section $2,000,000 for each of fiscal years 2021 23 through 2025. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00667 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 668 •S 4819 IS (g) DEFINITION.—In this section, the term ‘‘acquired 1 bone marrow failure disease’’ has the meaning given such 2 term in section 317W(d) of the Public Health Service Act, 3 as added by subsection (c). 4 Subtitle D—Cardiovascular Dis- 5 ease, Chronic Disease, Obesity, 6 and Other Disease Issues 7 SEC. 731. GUIDELINES FOR DISEASE SCREENING FOR MI- 8 NORITY PATIENTS. 9 (a) IN GENERAL.—The Secretary, acting through the 10 Director of the Agency for Healthcare Research and Qual- 11 ity, shall convene a series of meetings to develop guidelines 12 for disease screening for minority patient populations that 13 have a higher than average risk for many chronic diseases 14 and cancers. 15 (b) PARTICIPANTS.—In convening meetings under 16 subsection (a), the Secretary shall ensure that meeting 17 participants include representatives of— 18 (1) professional societies and associations; 19 (2) minority health organizations; 20 (3) health care researchers and providers, in- 21 cluding those with expertise in minority health; 22 (4) Federal health agencies, including the Of- 23 fice of Minority Health, the National Institute on 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00668 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 669 •S 4819 IS Minority Health and Health Disparities, and the 1 National Institutes of Health; and 2 (5) other experts as the Secretary determines 3 appropriate. 4 (c) DISEASES.—Screening guidelines for minority 5 populations shall be developed as appropriate under sub- 6 section (a) for— 7 (1) hypertension; 8 (2) hypercholesterolemia; 9 (3) diabetes; 10 (4) cardiovascular disease; 11 (5) cancers, including breast, prostate, colon, 12 cervical, and lung cancer; 13 (6) other pulmonary problems including sleep 14 apnea; 15 (7) asthma; 16 (8) kidney diseases; 17 (9) eye diseases and disorders, including glau- 18 coma; 19 (10) HIV/AIDS and sexually transmitted infec- 20 tions; 21 (11) uterine fibroids; 22 (12) autoimmune disease; 23 (13) mental health conditions; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00669 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 670 •S 4819 IS (14) dental health conditions and oral diseases, 1 including oral cancer; 2 (15) environmental and related health illnesses 3 and conditions; 4 (16) sickle cell disease and sickle cell trait; 5 (17) violence and injury prevention and control; 6 (18) genetic and related conditions; 7 (19) heart disease and stroke; 8 (20) tuberculosis; 9 (21) chronic obstructive pulmonary disease; 10 (22) musculoskeletal diseases, arthritis, and 11 obesity; and 12 (23) other diseases determined appropriate by 13 the Secretary. 14 (d) DISSEMINATION.—Not later than 2 years after 15 the date of enactment of this Act, the Secretary shall pub- 16 lish and disseminate to health care provider organizations 17 the guidelines developed under subsection (a). 18 (e) AUTHORIZATION OF APPROPRIATIONS.—There 19 are authorized to be appropriated to carry out this section 20 such sums as may be necessary for each of fiscal years 21 2021 through 2025. 22 SEC. 732. CDC WISEWOMAN SCREENING PROGRAM. 23 Section 1509 of the Public Health Service Act (42 24 U.S.C. 300n–4a) is amended— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00670 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 671 •S 4819 IS (1) in subsection (a)— 1 (A) by striking the heading and inserting 2 ‘‘IN GENERAL.—’’; and 3 (B) in the matter preceding paragraph (1), 4 by striking ‘‘may make grants’’ and all that fol- 5 lows through ‘‘purpose’’ and inserting the fol- 6 lowing: ‘‘may make grants to such States for 7 the purpose’’; and 8 (2) in subsection (d)(1), by striking ‘‘there are 9 authorized’’ and all that follows through the period 10 and inserting ‘‘there are authorized to be appro- 11 priated $23,000,000 for fiscal year 2021, 12 $25,300,000 for fiscal year 2022, $27,800,000 for 13 fiscal year 2023, $30,800,000 for fiscal year 2024, 14 and $34,000,000 for fiscal year 2025.’’. 15 SEC. 733. REPORT ON CARDIOVASCULAR CARE FOR WOMEN 16 AND MINORITIES. 17 Part P of title III of the Public Health Service Act 18 (42 U.S.C. 280g et seq.), as amended by section 531, is 19 further amended by adding at the end the following: 20 ‘‘SEC. 399V–9. REPORT ON CARDIOVASCULAR CARE FOR 21 WOMEN AND MINORITIES. 22 ‘‘Not later than September 30, 2021, and annually 23 thereafter, the Secretary shall prepare and submit to Con- 24 gress a report on the quality of and access to care for 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00671 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 672 •S 4819 IS women and minorities with heart disease, stroke, and 1 other cardiovascular diseases. The report shall contain rec- 2 ommendations for eliminating disparities in, and improv- 3 ing the treatment of, heart disease, stroke, and other car- 4 diovascular diseases in women, racial and ethnic minori- 5 ties, those for whom English is not their primary lan- 6 guage, and individuals with disabilities.’’. 7 SEC. 734. COVERAGE OF COMPREHENSIVE TOBACCO CES- 8 SATION SERVICES IN MEDICAID AND PRI- 9 VATE HEALTH INSURANCE. 10 (a) REQUIRING MEDICAID COVERAGE OF COUN- 11 SELING AND PHARMACOTHERAPY FOR CESSATION OF TO- 12 BACCO USE.—Section 1905 of the Social Security Act (42 13 U.S.C. 1396d) is amended— 14 (1) in subsection (a)(4)(D), by striking ‘‘by 15 pregnant women’’; and 16 (2) in subsection (bb)— 17 (A) by striking ‘‘by pregnant women’’ each 18 place it appears; 19 (B) in paragraph (1), in the matter before 20 subparagraph (A), by inserting ‘‘by individuals’’ 21 before ‘‘who use tobacco’’; and 22 (C) in paragraph (2)(A), by striking ‘‘with 23 respect to pregnant women’’. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00672 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 673 •S 4819 IS (b) EXCEPTION FROM OPTIONAL RESTRICTION 1 UNDER MEDICAID PRESCRIPTION DRUG COVERAGE.— 2 Section 1927(d)(2)(F) of the Social Security Act (42 3 U.S.C. 1396r–8(d)(2)(F)) is amended— 4 (1) by striking ‘‘, in the case of pregnant 5 women’’; and 6 (2) by striking ‘‘under the over-the-counter 7 monograph process’’. 8 (c) STATE MONITORING AND PROMOTING OF COM- 9 PREHENSIVE TOBACCO CESSATION SERVICES UNDER 10 MEDICAID.—Section 1902(a) of the Social Security Act 11 (42 U.S.C. 1396a(a)), as amended by section 12 433(d)(2)(A), is amended— 13 (1) by striking ‘‘and’’ at the end of paragraph 14 (86); 15 (2) by striking the period at the end of para- 16 graph (87) and inserting ‘‘; and’’; and 17 (3) by inserting after paragraph (87) the fol- 18 lowing new paragraph: 19 ‘‘(88) provide for the State to monitor and pro- 20 mote the use of comprehensive tobacco cessation 21 services under the State plan, including conducting 22 an outreach campaign to increase awareness of, and 23 the benefits of using, such services among— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00673 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 674 •S 4819 IS ‘‘(A) individuals entitled to medical assist- 1 ance under the State plan who use tobacco 2 products; and 3 ‘‘(B) clinicians and others who provide 4 services to individuals entitled to medical assist- 5 ance under the State plan.’’. 6 (d) FEDERAL REIMBURSEMENT FOR MEDICAID OUT- 7 REACH CAMPAIGN TO INCREASE AWARENESS.—Section 8 1903(a) of the Social Security Act (42 U.S.C. 1396b(a)) 9 is amended— 10 (1) by striking the period at the end of para- 11 graph (7) and inserting ‘‘; plus’’; and 12 (2) by inserting after paragraph (7) the fol- 13 lowing new paragraph: 14 ‘‘(8) an amount equal to 90 percent of the 15 sums expended during each quarter which are attrib- 16 utable to the development, implementation, and eval- 17 uation of an outreach campaign to— 18 ‘‘(A) increase awareness of comprehensive 19 tobacco cessation services covered in the State 20 plan among— 21 ‘‘(i) individuals who are likely to be el- 22 igible for medical assistance under the 23 State plan; and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00674 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 675 •S 4819 IS ‘‘(ii) clinicians and others who provide 1 services to individuals who are likely to be 2 eligible for medical assistance under the 3 State plan; and 4 ‘‘(B) increase awareness of the benefits of 5 using comprehensive tobacco cessation services 6 covered in the State plan among— 7 ‘‘(i) individuals who are likely to be el- 8 igible for medical assistance under the 9 State plan; and 10 ‘‘(ii) clinicians and others who provide 11 services to individuals who are likely to be 12 eligible for medical assistance under the 13 State plan about the benefits of using com- 14 prehensive tobacco cessation services.’’. 15 (e) REMOVAL OF COST SHARING FOR COUNSELING 16 AND PHARMACOTHERAPY FOR CESSATION OF TOBACCO 17 USE UNDER MEDICAID.— 18 (1) GENERAL COST SHARING LIMITATIONS.— 19 Section 1916 of the Social Security Act (42 U.S.C. 20 1396o) is amended— 21 (A) in subsections (a)(2)(B) and (b)(2)(B), 22 by striking ‘‘and counseling and 23 pharmacotherapy for cessation of tobacco use 24 by pregnant women (as defined in section 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00675 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 676 •S 4819 IS 1905(bb)) and covered outpatient drugs (as de- 1 fined in subsection (k)(2) of section 1927 and 2 including nonprescription drugs described in 3 subsection (d)(2) of such section) that are pre- 4 scribed for purposes of promoting, and when 5 used to promote, tobacco cessation by pregnant 6 women in accordance with the Guideline re- 7 ferred to in section 1905(bb)(2)(A)’’ each place 8 it appears; and 9 (B) in each of subsections (a)(2)(B) and 10 (b)(2)(B) by inserting ‘‘and counseling and 11 pharmacotherapy for cessation of tobacco use 12 (as defined in section 1905d(bb)) and covered 13 outpatient drugs (as defined in subsection 14 (k)(2) of section 1927 and including non- 15 prescription drugs described in subsection 16 (d)(2) of such section) that are prescribed for 17 purposes of promoting, and when used to pro- 18 mote, tobacco cessation in accordance with the 19 Guideline referred to in section 20 1905(bb)(2)(A)’’ after ‘‘(or at the option of the 21 State, any services furnished to pregnant 22 women’’. 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00676 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 677 •S 4819 IS (2) APPLICATION TO ALTERNATIVE COST SHAR- 1 ING.—Section 1916A(b)(3)(B) of such Act (42 2 U.S.C. 1396o–1(b)(3)(B)) is amended— 3 (A) in clause (iii), by striking ‘‘, and coun- 4 seling and pharmacotherapy for cessation of to- 5 bacco use by pregnant women (as defined in 6 section 1905(bb))’’; and 7 (B) by adding at the end the following: 8 ‘‘(xii) Counseling and 9 pharmacotherapy for cessation of tobacco 10 use (as defined in section 1905(bb)) and 11 covered outpatient drugs (as defined in 12 subsection (k)(2) of section 1927 and in- 13 cluding nonprescription drugs described in 14 subsection (d)(2) of such section) that are 15 prescribed for purposes of promoting, and 16 when used to promote, tobacco cessation in 17 accordance with the Guideline referred to 18 in section 1905(bb)(2)(A).’’. 19 (f) NO PRIOR AUTHORIZATION FOR TOBACCO CES- 20 SATION DRUGS UNDER MEDICAID.—Section 1927(d) of 21 the Social Security Act (42 U.S.C. 1396r–8) is amended— 22 (1) by striking in paragraph (1)(A) ‘‘A State’’ 23 and inserting ‘‘Except as otherwise provided in para- 24 graph (6), a State’’; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00677 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 678 •S 4819 IS (2) by redesignating paragraphs (6) and (7) as 1 paragraphs (7) and (8), respectively; and 2 (3) by inserting after paragraph (5) the fol- 3 lowing: 4 ‘‘(6) NO PRIOR AUTHORIZATION PROGRAMS FOR 5 TOBACCO CESSATION DRUGS.—A State plan under 6 this title shall not require, as a condition of coverage 7 or payment for a covered outpatient drug for which 8 Federal financial participation is available in accord- 9 ance with this section, the approval of an agent 10 when used to promote smoking cessation, including 11 agents approved by the Food and Drug Administra- 12 tion for the purposes of promoting, and when used 13 to promote, tobacco cessation.’’. 14 (g) COMPREHENSIVE COVERAGE OF TOBACCO CES- 15 SATION COVERAGE IN PRIVATE HEALTH INSURANCE.— 16 Section 2713 of the Public Health Service Act (42 U.S.C. 17 300gg–13) is amended by adding at the end the following: 18 ‘‘(d) NO PRIOR AUTHORIZATION.—A group health 19 plan and a health insurance issuer offering group or indi- 20 vidual health insurance coverage shall not impose any 21 prior authorization requirement for tobacco cessation 22 counseling and pharmacotherapy that has in effect a rat- 23 ing of ‘A’ or ‘B’ in the current recommendations of the 24 United States Preventive Services Task Force.’’. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00678 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 679 •S 4819 IS (h) EFFECTIVE DATE.—The amendments made by 1 this section shall apply to items and services furnished on 2 or after January 1, 2021. 3 SEC. 735. CLINICAL RESEARCH FUNDING FOR ORAL 4 HEALTH. 5 (a) IN GENERAL.—The Secretary of Health and 6 Human Services shall expand and intensify the conduct 7 and support of the research activities of the National In- 8 stitutes of Health and the National Institute of Dental 9 and Craniofacial Research to improve the oral health of 10 the population through the prevention and management 11 of oral diseases and conditions. 12 (b) INCLUDED RESEARCH ACTIVITIES.—Research 13 activities under subsection (a) shall include— 14 (1) comparative effectiveness research and clin- 15 ical disease management research addressing early 16 childhood caries and oral cancer; and 17 (2) awarding of grants and contracts to support 18 the training and development of health services re- 19 searchers, comparative effectiveness researchers, and 20 clinical researchers whose research improves the oral 21 health of the population. 22 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00679 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 680 •S 4819 IS SEC. 736. PARTICIPATION BY MEDICAID BENEFICIARIES IN 1 APPROVED CLINICAL TRIALS. 2 (a) IN GENERAL.—Title XIX of the Social Security 3 Act (42 U.S.C. 1396 et seq.) is amended by adding at 4 the end the following new section: 5 ‘‘SEC. 1947. PARTICIPATION IN AN APPROVED CLINICAL 6 TRIAL. 7 ‘‘(a) COVERAGE OF ROUTINE PATIENT COSTS ASSO- 8 CIATED WITH APPROVED CLINICAL TRIALS.— 9 ‘‘(1) INCLUSION.—Subject to paragraph (2), 10 routine patient costs shall include all items and serv- 11 ices consistent with the medical assistance provided 12 under the State plan that would otherwise be pro- 13 vided to the individual under such State plan if such 14 individual was not enrolled in an approved clinical 15 trial, including any items or services related to the 16 prevention, detection, and treatment of any medical 17 complications that arise as a result of participation 18 in the approved clinical trial. 19 ‘‘(2) EXCLUSION.—For purposes of paragraph 20 (1), routine patient costs does not include— 21 ‘‘(A) the investigational item, device, or 22 service itself; 23 ‘‘(B) items and services that are provided 24 solely to satisfy data collection and analysis 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00680 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 681 •S 4819 IS needs and that are not used in the direct clin- 1 ical management of the patient; or 2 ‘‘(C) a service that is clearly inconsistent 3 with widely accepted and established standards 4 of care for a particular diagnosis. 5 ‘‘(3) INFORMATION CONCERNING CLINICAL 6 TRIALS.— 7 ‘‘(A) IN GENERAL.—Subject to subpara- 8 graph (B), the Secretary, in consultation with 9 relevant stakeholders, shall develop a single 10 standardized electronic form for use by the indi- 11 vidual or the referring health care provider to 12 submit to the State agency administering the 13 State plan in order to verify that the clinical 14 trial meets the conditions established for an ap- 15 proved clinical trial (as defined in subsection 16 (c)). 17 ‘‘(B) EXCLUDED INFORMATION.—For pur- 18 poses of subparagraph (A) or any such request 19 by the State agency for information regarding 20 a clinical trial, an individual or referring health 21 care provider shall not be required to submit— 22 ‘‘(i) the clinical protocol document for 23 the clinical trial; or 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00681 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 682 •S 4819 IS ‘‘(ii) subject to subparagraph (C), any 1 additional information other than such in- 2 formation as is required pursuant to the 3 form described in subparagraph (A). 4 ‘‘(C) OPTIONAL INFORMATION.—For pur- 5 poses of subparagraphs (A) and (B)(ii), the 6 form may include a requirement that the refer- 7 ring health care provider attest that the indi- 8 vidual is eligible to participate in the clinical 9 trial pursuant to the trial protocol and that in- 10 dividual participation in such trial would be ap- 11 propriate. 12 ‘‘(D) REVIEW OF INFORMATION.— 13 ‘‘(i) IN GENERAL.—A State plan 14 under this title shall establish a process for 15 timely review by the State agency of the 16 form and information submitted pursuant 17 to subparagraph (A) and, not later than 18 48 hours after receipt of such form, con- 19 firmation that the information provided in 20 such form satisfies the requirements estab- 21 lished under such subparagraph, with such 22 process to include establishment and oper- 23 ation of a 24-hour, toll-free telephone num- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00682 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 683 •S 4819 IS ber and email address to provide for expe- 1 dited communication. 2 ‘‘(ii) FAILURE TO RESPOND.—If an 3 individual or the referring health care pro- 4 vider does not receive a response or re- 5 quest for additional information from the 6 State agency following the 48-hour period 7 described in clause (i), the information 8 provided in the form may be presumed to 9 satisfy the requirements established under 10 this paragraph. 11 ‘‘(b) ENCOURAGEMENT OF PARTICIPATION IN AP- 12 PROVED CLINICAL TRIALS.— 13 ‘‘(1) REASONABLY ACCESSIBLE PROVIDER.— 14 For purposes of participation in an approved clinical 15 trial by an individual eligible for medical assistance 16 under this title, the State agency administering the 17 State plan shall make reasonable efforts to ensure 18 that the individual is provided with access to a pro- 19 vider who is— 20 ‘‘(A) participating in the approved clinical 21 trial; 22 ‘‘(B) located not more than 25 miles from 23 the residence of the individual (or, if no such 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00683 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 684 •S 4819 IS provider is available, as close as possible to the 1 residence of the individual); and 2 ‘‘(C) a participating provider under the 3 State plan or has been deemed to be a partici- 4 pating provider under the State plan for pur- 5 poses of providing medical assistance to the in- 6 dividual during their participation in the ap- 7 proved clinical trial. 8 ‘‘(2) INFORMATIONAL MATERIALS.—The State 9 agency administering the plan approved under this 10 title shall develop informational materials and pro- 11 grams to encourage participating providers to make 12 appropriate referrals to physicians and other appro- 13 priate health care professionals who can provide in- 14 dividuals with access to approved clinical trials. 15 ‘‘(c) DEFINITION OF APPROVED CLINICAL TRIAL.— 16 The term ‘approved clinical trial’ has the same meaning 17 as provided under subsection (d) of the section 2709 of 18 the Public Health Service Act that relates to coverage for 19 individuals participating in approved clinical trials.’’. 20 (b) CONFORMING AMENDMENT.—Section 1902(a) of 21 the Social Security Act (42 U.S.C. 1396a(a)), as amended 22 by section 734(c), is amended— 23 (1) by striking ‘‘and’’ at the end of paragraph 24 (87); 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00684 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 685 •S 4819 IS (2) by striking the period at the end of para- 1 graph (88) and inserting ‘‘; and’’; and 2 (3) by inserting after paragraph (88) the fol- 3 lowing new paragraph: 4 ‘‘(89) provide that participation in an approved 5 clinical trial and coverage of routine patient costs 6 associated with such trial for an individual eligible 7 for medical assistance under this title is conducted 8 in accordance with the requirements under section 9 1947.’’. 10 (c) EFFECTIVE DATE.— 11 (1) IN GENERAL.—Except as provided in para- 12 graph (2), the amendments made by this section 13 shall apply to calendar quarters beginning on or 14 after October 1, 2021. 15 (2) DELAY PERMITTED FOR STATE PLAN 16 AMENDMENT.—In the case of a State plan for med- 17 ical assistance under title XIX of the Social Security 18 Act (42 U.S.C. 1396 et seq.) which the Secretary of 19 Health and Human Services determines requires 20 State legislation (other than legislation appro- 21 priating funds) in order for the plan to meet the ad- 22 ditional requirements imposed by the amendments 23 made by this section, the State plan shall not be re- 24 garded as failing to comply with the requirements of 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00685 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 686 •S 4819 IS such title solely on the basis of its failure to meet 1 these additional requirements before the first day of 2 the first calendar quarter beginning after the close 3 of the first regular session of the State legislature 4 that begins after the date of enactment of this Act. 5 For purposes of the previous sentence, in the case 6 of a State that has a 2-year legislative session, each 7 year of such session shall be deemed to be a sepa- 8 rate regular session of the State legislature. 9 SEC. 737. GUIDE ON EVIDENCE-BASED STRATEGIES FOR 10 PUBLIC HEALTH DEPARTMENT OBESITY PRE- 11 VENTION PROGRAMS. 12 (a) DEVELOPMENT AND DISSEMINATION OF AN EVI- 13 DENCE-BASED STRATEGIES GUIDE.—The Secretary of 14 Health and Human Services (referred to in this section 15 as the ‘‘Secretary’’), acting through the Director of the 16 Centers for Disease Control and Prevention, not later than 17 2 years after the date of enactment of this Act, shall— 18 (1) develop a guide on evidence-based strategies 19 for State, territorial, and local health departments to 20 use to build and maintain effective obesity preven- 21 tion and reduction programs, and, in consultation 22 with stakeholders that have expertise in Tribal 23 health, a guide on such evidence-based strategies 24 with respect to Indian Tribes and Tribal organiza- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00686 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 687 •S 4819 IS tions for such Indian Tribes and Tribal organiza- 1 tions to use for such purpose, both of which guides 2 shall— 3 (A) describe an integrated program struc- 4 ture for implementing interventions proven to 5 be effective in preventing and reducing the inci- 6 dence of obesity; and 7 (B) recommend— 8 (i) optimal resources, including staff- 9 ing and infrastructure, for promoting nu- 10 trition and obesity prevention and reduc- 11 tion; and 12 (ii) strategies for effective obesity pre- 13 vention programs for State and local 14 health departments, Indian Tribes, and 15 Tribal organizations, including strategies 16 related to— 17 (I) the application of evidence- 18 based and evidence-informed practices 19 to prevent and reduce obesity rates; 20 (II) the development, implemen- 21 tation, and evaluation of obesity pre- 22 vention and reduction strategies for 23 specific communities and populations; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00687 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 688 •S 4819 IS (III) demonstrated knowledge of 1 obesity prevention practices that re- 2 duce associated preventable diseases, 3 health conditions, death, and health 4 care costs; 5 (IV) best practices for the coordi- 6 nation of efforts to prevent and re- 7 duce obesity and related chronic dis- 8 eases; 9 (V) addressing the underlying 10 risk factors and social determinants of 11 health that impact obesity rates; and 12 (VI) interdisciplinary coordina- 13 tion between relevant public health of- 14 ficials specializing in fields such as 15 nutrition, physical activity, epidemi- 16 ology, communications, and policy im- 17 plementation, and collaboration be- 18 tween public health officials and com- 19 munity-based organizations; and 20 (2) disseminate the guides and current re- 21 search, evidence-based practices, tools, and edu- 22 cational materials related to obesity prevention, con- 23 sistent with the guides, to State and local health de- 24 partments, Indian Tribes, and Tribal organizations. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00688 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 689 •S 4819 IS (b) TECHNICAL ASSISTANCE.—The Secretary, acting 1 through the Director of the Centers for Disease Control 2 and Prevention, shall provide technical assistance to State 3 and local health departments, Indian Tribes, and Tribal 4 organizations to support such health departments in im- 5 plementing the guides developed under subsection (a)(1). 6 (c) INDIAN TRIBES; TRIBAL ORGANIZATIONS.—In 7 this section, the terms ‘‘Indian Tribe’’ and ‘‘Tribal organi- 8 zation’’ have the meanings given the terms ‘‘Indian tribe’’ 9 and ‘‘tribal organization’’, respectively, in section 4 of the 10 Indian Self-Determination and Education Assistance Act 11 (25 U.S.C. 5304). 12 Subtitle E—HIV/AIDS 13 SEC. 741. STATEMENT OF POLICY. 14 It is the policy of the United States to achieve an 15 AIDS-free generation, and to— 16 (1) expand access to lifesaving antiretroviral 17 therapy for people living with HIV and immediately 18 link people to continuous and coordinated high-qual- 19 ity care when they learn they are living with HIV; 20 (2) expand targeted efforts to prevent HIV in- 21 fection using a combination of effective, evidence- 22 based approaches, including routine HIV screening, 23 and universal access to HIV prevention tools in com- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00689 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 690 •S 4819 IS munities disproportionately impacted by HIV, par- 1 ticularly communities of color; 2 (3) ensure laws, policies, and regulations do not 3 impede access to prevention, treatment, and care for 4 people living with HIV or disproportionately im- 5 pacted by HIV; 6 (4) accelerate research for more efficacious HIV 7 prevention and treatments tools, a cure, and a vac- 8 cine; and 9 (5) respect the human rights and dignity of 10 persons living with HIV. 11 SEC. 742. FINDINGS. 12 The Congress finds the following: 13 (1) Over 1,100,000 people are estimated to be 14 living with HIV in the United States according to 15 the Centers for Disease Control and Prevention, 14 16 percent of whom are unaware they are living with 17 HIV. 18 (2) Annually there are about 37,600 new HIV 19 infections and 15,800 deaths in people with an HIV 20 diagnosis in 50 States and 6 dependent areas of the 21 United States. 22 (3) The Centers for Disease Control and Pre- 23 vention estimates that, in 2017, there were approxi- 24 mately 38,700 people newly diagnosed with HIV. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00690 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 691 •S 4819 IS The estimated number of annual new HIV infections 1 declined 9 percent from 2010 to 2016. However, the 2 number of new infections is increasing among cer- 3 tain populations, such as Latino gay and bisexual 4 men, where annual infections increase 21 percent. 5 (4) HIV disproportionately affects certain popu- 6 lations in the United States. Though African Ameri- 7 cans represent approximately 12 percent of the pop- 8 ulation, African Americans account for almost half 9 (42 percent) of all people living with HIV in the 10 United States. African-American men who have sex 11 with men account for 26 percent of all new HIV in- 12 fections and have remained stable from 2010 to 13 2016. 14 (5) Disparities continue to exist among Latinos 15 and Hispanics; in 2017, Latinos and Hispanics 16 made up 18 percent of the United States population 17 and 26 percent of new infections. 18 (6) Though the rate of new infections among 19 American Indians and Alaska Natives (referred to in 20 this section as ‘‘AI/AN’’) is proportional to their 21 population size, from 2010 to 2016, the annual 22 number of HIV diagnoses increased 46 percent 23 among AI/AN overall and 81 percent among AI/AN 24 gay and bisexual men. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00691 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 692 •S 4819 IS (7) Asian Americans account for about 2 per- 1 cent of new HIV infections, but in 2013, 22 percent 2 were undiagnosed, the highest rate of undiagnosed 3 HIV among any race or ethnicity. Between 2010 4 and 2016, the number of Asians receiving an HIV 5 diagnosis increased by 42 percent. 6 (8) The latest data from the Centers for Dis- 7 ease Control and Prevention indicates that new in- 8 fections among women declined 21 percent between 9 2010 and 2016. 10 (9) The history of HIV shows that culturally 11 relevant and gender-responsive supportive services, 12 including psychosocial support, treatment literacy, 13 case management, and transportation are necessary 14 strategies to reach and engage women and girls in 15 medical care. 16 (10) Among the 3,000,000 HIV testing events 17 reported to the Centers for Disease Control and Pre- 18 vention in 2017, the percentage of transgender peo- 19 ple who received a new HIV diagnosis was 3 times 20 the national average. A 2019 systematic review and 21 meta-analysis found that an estimated 14 percent of 22 transgender women have HIV. By race/ethnicity, an 23 estimated 44 percent of Black/African-American 24 transgender women, 26 percent of Hispanic/Latina 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00692 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 693 •S 4819 IS transgender women, and 7 percent of White 1 transgender women have HIV. The limited data 2 available on transgender individuals point to a dis- 3 proportionate burden of HIV infection. 4 (11) Stigma and discrimination contribute to 5 such disparities. 6 (12) The Centers for Disease Control and Pre- 7 vention has determined that increasing the propor- 8 tion of people who know their HIV status is an es- 9 sential component of comprehensive HIV treatment 10 and prevention efforts and that early diagnosis is 11 critical in order for people with HIV to receive life- 12 extending therapy. Additionally, the Centers for Dis- 13 ease Control and Prevention recommend routine 14 HIV screening in health care settings for all patients 15 aged 13 to 64, regardless of risk. 16 (13) In 1998, Congress created the National 17 Minority AIDS Initiative to provide technical assist- 18 ance, build capacity, and strengthen outreach efforts 19 among local institutions and community-based orga- 20 nizations that serve racial and ethnic minorities liv- 21 ing with or vulnerable to HIV. 22 (14) To combat the HIV epidemic in the United 23 States, the National HIV/AIDS Strategy (referred 24 to in this section as ‘‘NHAS’’) provides a framework 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00693 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 694 •S 4819 IS of increasing access to care, reducing new infections, 1 and eliminating HIV-related health disparities. The 2 vision of NHAS is ‘‘The United States will become 3 a place where new HIV infections are rare and when 4 they do occur, every person, regardless of age, gen- 5 der, race/ethnicity, gender identity, or socioeconomic 6 circumstance, will have unfettered access to high 7 quality, life-extending care, free from stigma and 8 discrimination.’’. 9 (15) In January 2019, the Department of 10 Health and Human Services began implementing the 11 initiative ‘‘Ending the HIV Epidemic: A Plan for 12 America’’. The initiative seeks to reduce the number 13 of new HIV infections in the United States by 75 14 percent by 2025, and then by at least 90 percent by 15 2030, for an estimated 250,000 total HIV infection 16 averted. 17 (16) At present, many States and United 18 States territories have criminal statutes based on 19 ‘‘exposure’’ to HIV. Most of these laws were adopted 20 before the availability of effective antiretroviral 21 treatment for HIV/AIDS. 22 (17) Research shows that stable housing leads 23 to better health outcomes for those living with HIV. 24 Inadequate or unstable housing is not only a barrier 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00694 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 695 •S 4819 IS to effective treatment, but also increases the likeli- 1 hood of engaging in risky behaviors leading to HIV 2 infection. Insecure housing puts people with HIV/ 3 AIDS at risk of premature death from exposure to 4 other diseases, poor nutrition, and lack of medical 5 care. 6 (18) Due to advances in treatment, many peo- 7 ple living with HIV today are living healthy lives and 8 have the ability and desire to fully participate in all 9 aspects of community life, including employment. 10 Research associates being employed with tremendous 11 economic, social, and health benefits for many people 12 living with HIV. 13 (19) The common benefits associated with em- 14 ployment include income, autonomy, productivity, 15 and status within society, daily structure, making a 16 contribution to one’s community, and increased skills 17 and self-esteem. Research also indicates that many 18 people with disabilities, including people living with 19 HIV, report perceiving themselves as being less dis- 20 abled or not disabled at all, when working. Further- 21 more, some studies link working with better physical 22 and mental health outcomes for people living with 23 HIV when compared to those who are not working. 24 Preliminary data also suggest that transitioning to 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00695 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 696 •S 4819 IS employment is associated with reduced HIV-related 1 health risk behavior for many people. 2 (20) In July 2012, the Food and Drug Admin- 3 istration approved the first drug to be used as pre- 4 exposure prophylaxis (PrEP). PrEP reduces the risk 5 of HIV infection in HIV-negative individuals. Stud- 6 ies have shown that PrEP reduces HIV transmission 7 from sex by about 99 percent when taken consist- 8 ently. Despite increases in PrEP uptake, PrEP use 9 remains low among gay and bisexual men of color. 10 The Centers for Disease Control and Prevention 11 found that uptake was lower among African-Amer- 12 ican (26 percent) and Latino (30 percent) men com- 13 pared with White men (42 percent). Similarly, PrEP 14 awareness was lower among African-American (86 15 percent) and Latino (87 percent) men compared 16 with White men (95 percent). While clinical research 17 on transgender populations and PrEP is currently 18 limited, the Centers for Disease Control and Preven- 19 tion recommends PrEP use in transgender popu- 20 lations. In September 2019, the Food and Drug Ad- 21 ministration approved the second drug to be used as 22 PrEP. 23 (21) Syringe service programs have been associ- 24 ated with lowered HIV infections, lower hepatitis C 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00696 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 697 •S 4819 IS infections, and increased linkage to substance use 1 treatment. 2 (22) There is now conclusive scientific evidence 3 that a person living with HIV who is on 4 antiretroviral therapy and is durably virally sup- 5 pressed (defined as having a consistent viral load of 6 less than 200 copies/ml) does not sexually transmit 7 HIV. The conclusive evidence about the highly effec- 8 tive preventative benefits of antiretroviral therapy 9 provides an unprecedented opportunity to improve 10 the lives of people living with HIV, improve treat- 11 ment uptake and adherence, and advocate for ex- 12 panded access to treatment and care. 13 SEC. 743. ADDITIONAL FUNDING FOR AIDS DRUG ASSIST- 14 ANCE PROGRAM TREATMENTS. 15 Section 2623 of the Public Health Service Act (42 16 U.S.C. 300ff–31b) is amended by adding at the end the 17 following: 18 ‘‘(c) ADDITIONAL FUNDING FOR AIDS DRUG AS- 19 SISTANCE PROGRAM TREATMENTS.—In addition to 20 amounts otherwise authorized to be appropriated for car- 21 rying out this subpart, there are authorized to be appro- 22 priated such sums as may be necessary to carry out sec- 23 tions 2612(b)(3)(B) and 2616 for each of fiscal years 24 2021 through 2024.’’. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00697 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 698 •S 4819 IS SEC. 744. ENHANCING THE NATIONAL HIV SURVEILLANCE 1 SYSTEM. 2 (a) GRANTS.—The Secretary of Health and Human 3 Services, acting through the Director of the Centers for 4 Disease Control and Prevention, shall make grants to 5 States to support integration of public health surveillance 6 systems into all electronic health records in order to allow 7 rapid communications between the clinical setting and 8 health departments, by means that include— 9 (1) providing technical assistance and policy 10 guidance to State and local health departments, clin- 11 ical providers, and other agencies serving individuals 12 with HIV to improve the interoperability of data sys- 13 tems relevant to monitoring HIV care and sup- 14 portive services; 15 (2) capturing longitudinal data pertaining to 16 the initiation and ongoing prescription or dispensing 17 of antiretroviral therapy for individuals diagnosed 18 with HIV (such as through pharmacy-based report- 19 ing); 20 (3) obtaining information— 21 (A) on a voluntary basis, on sexual orienta- 22 tion and gender identity; and 23 (B) on sources of coverage (or the lack of 24 coverage) for medical treatment (including cov- 25 erage through the Medicaid program, the Medi- 26 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00698 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 699 •S 4819 IS care program, the program under title XXVI of 1 the Public Health Service Act (42 U.S.C. 2 300ff–11 et seq.); commonly referred to as the 3 ‘‘Ryan White HIV/AIDS Program’’), other pub- 4 lic funding, private insurance, and health main- 5 tenance organizations); and 6 (4) obtaining and using current geographic 7 markers of residence (such as current address, zip 8 code, partial zip code, and census block). 9 (b) PRIVACY AND SECURITY SAFEGUARDS.—In car- 10 rying out this section, the Secretary of Health and Human 11 Services shall ensure that appropriate privacy and security 12 safeguards are met to prevent unauthorized disclosure of 13 protected health information and compliance with the 14 HIPAA privacy and security law (as defined in section 15 3009 of the Public Health Service Act (42 U.S.C. 300jj– 16 19)) and other relevant laws and regulations. 17 (c) PROHIBITION AGAINST IMPROPER USE OF 18 DATA.—No grant under this section may be used to allow 19 or facilitate the collection or use of surveillance or clinical 20 data or records— 21 (1) for punitive measures of any kind, civil or 22 criminal, against the subject of such data or records; 23 or 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00699 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 700 •S 4819 IS (2) for imposing any requirement or restriction 1 with respect to an individual without the individual’s 2 written consent. 3 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 4 out this section, there are authorized to be appropriated 5 such sums as may be necessary for each of fiscal years 6 2021 through 2024. 7 SEC. 745. EVIDENCE-BASED STRATEGIES FOR IMPROVING 8 LINKAGE TO AND RETENTION IN APPRO- 9 PRIATE CARE. 10 (a) STRATEGIES.—The Secretary of Health and 11 Human Services, in collaboration with the Director of the 12 Centers for Disease Control and Prevention, the Assistant 13 Secretary for Mental Health and Substance Use, the Di- 14 rector of the Office of AIDS Research, the Administrator 15 of the Health Resources and Services Administration, and 16 the Administrator of the Centers for Medicare & Medicaid 17 Services, shall— 18 (1) identify evidence-based strategies most ef- 19 fective at addressing the multifaceted issues that im- 20 pede disease status awareness and linkage to and re- 21 tention in appropriate care, taking into consideration 22 health care systems issues, clinic and provider 23 issues, and individual psychosocial, environmental, 24 and other contextual factors; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00700 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 701 •S 4819 IS (2) support the wide-scale implementation of 1 the evidence-based strategies identified pursuant to 2 paragraph (1), including through incorporating such 3 strategies into health care coverage supported by the 4 Medicaid program under title XIX of the Social Se- 5 curity Act (42 U.S.C. 1396 et seq.), the program 6 under title XXVI of the Public Health Service Act 7 (42 U.S.C. 300ff–11 et seq.; commonly referred to 8 as the ‘‘Ryan White HIV/AIDS Program’’), and 9 health plans purchased through an American Health 10 Benefit Exchange established pursuant to section 11 1311 of the Patient Protection and Affordable Care 12 Act (42 U.S.C. 18031); and 13 (3) not later than 1 year after the date of the 14 enactment of this Act, submit a report to the Con- 15 gress on the status of activities under paragraphs 16 (1) and (2). 17 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 18 out this section, there are authorized to be appropriated 19 such sums as may be necessary for fiscal years 2021 20 through 2024. 21 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00701 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 702 •S 4819 IS SEC. 746. IMPROVING ENTRY INTO AND RETENTION IN 1 CARE AND ANTIRETROVIRAL ADHERENCE 2 FOR PERSONS WITH HIV. 3 (a) SENSE OF CONGRESS.—It is the sense of Con- 4 gress that AIDS research has led to scientific advance- 5 ments that have— 6 (1) saved the lives of millions of people living 7 with HIV; 8 (2) prevented millions from new diagnoses; and 9 (3) had broad benefits that extend far beyond 10 helping people at risk for or living with HIV. 11 (b) IN GENERAL.—The Secretary of Health and 12 Human Services, acting through the Director of the Na- 13 tional Institutes of Health, shall expand, intensify, and co- 14 ordinate operational and translational research and other 15 activities of the National Institutes of Health regarding 16 methods— 17 (1) to increase adoption of evidence-based ad- 18 herence strategies within HIV care and treatment 19 programs; 20 (2) to increase HIV testing and case detection 21 rates; 22 (3) to reduce HIV-related health disparities; 23 (4) to ensure that research to improve adher- 24 ence to HIV care and treatment programs address 25 the unique concerns of women; 26 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00702 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 703 •S 4819 IS (5) to integrate HIV prevention and care serv- 1 ices with mental health and substance use preven- 2 tion and treatment delivery systems; 3 (6) to increase knowledge on the implementa- 4 tion of preexposure prophylaxis (referred to in this 5 section as ‘‘PrEP’’), including with respect to— 6 (A) who can benefit most from PrEP; 7 (B) how to provide PrEP safely and effi- 8 ciently; 9 (C) how to integrate PrEP with other es- 10 sential prevention methods such as condoms; 11 and 12 (D) how to ensure high levels of adherence; 13 and 14 (7) to increase knowledge of ‘‘undetectable and 15 untransmittable’’, when a person living with HIV 16 who is on antiretroviral therapy and is durably 17 virally suppressed (defined as having a consistent 18 viral load of less than 200 copies/ml) cannot sexually 19 transmit HIV. 20 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 21 out this section, there are authorized to be appropriated 22 such sums as may be necessary for fiscal years 2021 23 through 2024. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00703 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 704 •S 4819 IS SEC. 747. SERVICES TO REDUCE HIV/AIDS IN RACIAL AND 1 ETHNIC MINORITY COMMUNITIES. 2 (a) IN GENERAL.—For the purpose of reducing new 3 HIV diagnoses in racial and ethnic minority communities, 4 the Secretary of Health and Human Services, acting 5 through the Deputy Assistant Secretary for Minority 6 Health, may make grants to public health agencies and 7 faith-based organizations to conduct— 8 (1) outreach activities related to HIV preven- 9 tion and testing activities; 10 (2) HIV prevention activities; and 11 (3) HIV testing activities. 12 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 13 out this section, there are authorized to be appropriated 14 such sums as may be necessary for fiscal years 2021 15 through 2024. 16 SEC. 748. MINORITY AIDS INITIATIVE. 17 (a) EXPANDED FUNDING.—The Secretary of Health 18 and Human Services, in collaboration with the Deputy As- 19 sistant Secretary for Minority Health, the Director of the 20 Centers for Disease Control and Prevention, the Adminis- 21 trator of the Health Resources and Services Administra- 22 tion, and the Assistant Secretary for Mental Health and 23 Substance Use, shall provide funds and carry out activities 24 to expand the Minority AIDS Initiative. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00704 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 705 •S 4819 IS (b) USE OF FUNDS.—The additional funds made 1 available under this section may be used, through the Mi- 2 nority AIDS Initiative, to support the following activities: 3 (1) Providing technical assistance and infra- 4 structure support to reduce HIV/AIDS in minority 5 populations. 6 (2) Increasing minority populations’ access to 7 HIV prevention and care services. 8 (3) Building strong community programs and 9 partnerships to address HIV prevention and the 10 health care needs of specific racial and ethnic minor- 11 ity populations. 12 (c) PRIORITY INTERVENTIONS.—Within the racial 13 and ethnic minority populations referred to in subsection 14 (b), priority in conducting intervention services shall be 15 given to— 16 (1) men who have sex with men; 17 (2) youth; 18 (3) persons who engage in intravenous drug 19 abuse; 20 (4) women; 21 (5) homeless individuals; and 22 (6) individuals incarcerated or in the penal sys- 23 tem. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00705 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 706 •S 4819 IS (d) AUTHORIZATION OF APPROPRIATIONS.—For car- 1 rying out this section, there are authorized to be appro- 2 priated $610,000,000 for fiscal year 2021 and such sums 3 as may be necessary for each of fiscal years 2022 through 4 2025. 5 SEC. 749. HEALTH CARE PROFESSIONALS TREATING INDI- 6 VIDUALS WITH HIV. 7 (a) IN GENERAL.—The Secretary of Health and 8 Human Services, acting through the Administrator of the 9 Health Resources and Services Administration, shall ex- 10 pand, intensify, and coordinate workforce initiatives of the 11 Health Resources and Services Administration to increase 12 the capacity of the health workforce focusing primarily on 13 HIV to meet the demand for culturally competent care, 14 and may award grants for any of the following: 15 (1) Development of curricula for training pri- 16 mary care providers in HIV/AIDS prevention and 17 care, including routine HIV testing. 18 (2) Support to expand access to culturally and 19 linguistically accessible benefits counselors, trained 20 peer navigators, and mental and behavioral health 21 professionals with expertise in HIV. 22 (3) Training health care professionals to pro- 23 vide care to individuals living with HIV. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00706 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 707 •S 4819 IS (4) Development by grant recipients under title 1 XXVI of the Public Health Service Act (42 U.S.C. 2 300ff–11 et seq.; commonly referred to as the ‘‘Ryan 3 White HIV/AIDS Program’’) and other persons, of 4 policies for providing culturally relevant and sen- 5 sitive treatment to individuals living with HIV, with 6 particular emphasis on treatment to racial and eth- 7 nic minorities, men who have sex with men, and 8 women, young people, and children living with HIV. 9 (5) Development and implementation of pro- 10 grams to increase the use of telehealth to respond to 11 HIV-specific health care needs in rural and minority 12 communities, with particular emphasis given to 13 medically underserved communities and insular 14 areas. 15 (6) Evaluating interdisciplinary medical pro- 16 vider care team models that promote high-quality 17 care, with particular emphasis on care to racial and 18 ethnic minorities. 19 (7) Training health care professionals to make 20 them aware of the high rates of chronic hepatitis B 21 and chronic hepatitis C in adult racial and ethnic 22 populations, and the importance of prevention, de- 23 tection, and medical management of hepatitis B and 24 hepatitis C and of liver cancer screening. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00707 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 708 •S 4819 IS (8) Development of curricula for training pri- 1 mary care providers that HIV and tuberculosis are 2 significant mutual comorbidities, and that a patient 3 who tests positive for one disease should be offered 4 and encouraged to receive testing for the other. 5 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 6 out this section, there are authorized to be appropriated 7 such sums as may be necessary for fiscal years 2021 8 through 2024. 9 SEC. 750. HIV/AIDS PROVIDER LOAN REPAYMENT PRO- 10 GRAM. 11 (a) IN GENERAL.—The Secretary may enter into an 12 agreement with any physician, nurse practitioner, or phy- 13 sician assistant under which— 14 (1) the physician, nurse practitioner, or physi- 15 cian assistant agrees to serve as a medical provider 16 for a period of not less than 2 years— 17 (A) at a Ryan White-funded or title X- 18 funded facility with a critical shortage of doc- 19 tors (as determined by the Secretary); or 20 (B) in an area with a high incidence of 21 HIV/AIDS; and 22 (2) the Secretary agrees to make payments in 23 accordance with subsection (b) on the professional 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00708 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 709 •S 4819 IS education loans of the physician, nurse practitioner, 1 or physician assistant. 2 (b) MANNER OF PAYMENTS.—The payments de- 3 scribed in subsection (a) shall be made by the Secretary 4 as follows: 5 (1) Upon completion by the physician, nurse 6 practitioner, or physician assistant for whom the 7 payments are to be made of the first year of the 8 service specified in the agreement entered into with 9 the Secretary under subsection (a), the Secretary 10 shall pay 30 percent of the principal of and the in- 11 terest on the individual’s professional education 12 loans. 13 (2) Upon completion by the physician, nurse 14 practitioner, or physician assistant of the second 15 year of such service, the Secretary shall pay another 16 30 percent of the principal of and the interest on 17 such loans. 18 (3) Upon completion by that individual of a 19 third year of such service, the Secretary shall pay 20 another 25 percent of the principal of and the inter- 21 est on such loans. 22 (c) APPLICABILITY OF CERTAIN PROVISIONS.—Sub- 23 part III of part D of title III of the Public Health Service 24 Act (42 U.S.C. 254l et seq.) shall, except as inconsistent 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00709 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 710 •S 4819 IS with this section, apply to the program carried out under 1 this section in the same manner and to the same extent 2 as such provisions apply to the National Health Service 3 Corps loan repayment program. 4 (d) REPORTS.—Not later than 18 months after the 5 date of the enactment of this Act, and annually thereafter, 6 the Secretary shall prepare and submit to Congress a re- 7 port describing the program carried out under this section, 8 including statements regarding the following: 9 (1) The number of physicians, nurse practi- 10 tioners, and physician assistants enrolled in the pro- 11 gram. 12 (2) The number and amount of loan repay- 13 ments. 14 (3) The placement location of loan repayment 15 recipients at facilities described in subsection (a)(1). 16 (4) The default rate and actions required. 17 (5) The amount of outstanding default funds. 18 (6) To the extent that it can be determined, the 19 reason for the default. 20 (7) The demographics of individuals partici- 21 pating in the program. 22 (8) An evaluation of the overall costs and bene- 23 fits of the program. 24 (e) DEFINITIONS.—In this section: 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00710 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 711 •S 4819 IS (1) HIV/AIDS.—The term ‘‘HIV/AIDS’’ means 1 human immunodeficiency virus and acquired im- 2 mune deficiency syndrome. 3 (2) NURSE PRACTITIONER.—The term ‘‘nurse 4 practitioner’’ means a registered nurse who has com- 5 pleted an accredited graduate degree program in ad- 6 vanced nurse practice and has successfully passed a 7 national certification exam. 8 (3) PHYSICIAN.—The term ‘‘physician’’ means 9 a graduate of a school of medicine who has com- 10 pleted postgraduate training in general or pediatric 11 medicine. 12 (4) PHYSICIAN ASSISTANT.—The term ‘‘physi- 13 cian assistant’’ means a medical provider who com- 14 pleted an accredited physician assistant training pro- 15 gram and successfully passed the Physician Assist- 16 ant National Certifying Examination. 17 (5) PROFESSIONAL EDUCATION LOAN.—The 18 term ‘‘professional education loan’’— 19 (A) means a loan that is incurred for the 20 cost of attendance (including tuition, other rea- 21 sonable educational expenses, and reasonable 22 living costs) at a school of medicine, nursing, or 23 physician assistant training program; and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00711 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 712 •S 4819 IS (B) includes only the portion of the loan 1 that is outstanding on the date the physician, 2 nurse practitioner, or physician assistant in- 3 volved begins the service specified in the agree- 4 ment under subsection (a). 5 (6) RYAN WHITE-FUNDED.—The term ‘‘Ryan 6 White-funded’’ means, with respect to a facility, re- 7 ceiving funds under title XXVI of the Public Health 8 Service Act (42 U.S.C. 300ff–11 et seq.). 9 (7) SECRETARY.—The term ‘‘Secretary’’ means 10 the Secretary of Health and Human Services. 11 (8) SCHOOL OF MEDICINE.—The term ‘‘school 12 of medicine’’ has the meaning given to that term in 13 section 799B of the Public Health Service Act (42 14 U.S.C. 295p). 15 (9) TITLE X-FUNDED.—The term ‘‘title X-fund- 16 ed’’ means, with respect to a facility, receiving funds 17 under title X of the Public Health Service Act (42 18 U.S.C. 300 et seq.). 19 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 20 out this section, there are authorized to be appropriated 21 such sums as may be necessary for fiscal years 2021 22 through 2024. 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00712 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 713 •S 4819 IS SEC. 751. DENTAL EDUCATION LOAN REPAYMENT PRO- 1 GRAM. 2 (a) IN GENERAL.—The Secretary may enter into an 3 agreement with any dentist under which— 4 (1) the dentist agrees to serve as a dentist for 5 a period of not less than 2 years at a facility with 6 a critical shortage of dentists (as determined by the 7 Secretary) in an area with a high incidence of HIV/ 8 AIDS; and 9 (2) the Secretary agrees to make payments in 10 accordance with subsection (b) on the dental edu- 11 cation loans of the dentist. 12 (b) MANNER OF PAYMENTS.—The payments de- 13 scribed in subsection (a) shall be made by the Secretary 14 as follows: 15 (1) Upon completion by the dentist for whom 16 the payments are to be made of the first year of the 17 service specified in the agreement entered into with 18 the Secretary under subsection (a), the Secretary 19 shall pay 30 percent of the principal of and the in- 20 terest on the dental education loans of the dentist. 21 (2) Upon completion by the dentist of the sec- 22 ond year of such service, the Secretary shall pay an- 23 other 30 percent of the principal of and the interest 24 on such loans. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00713 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 714 •S 4819 IS (3) Upon completion by that individual of a 1 third year of such service, the Secretary shall pay 2 another 25 percent of the principal of and the inter- 3 est on such loans. 4 (c) APPLICABILITY OF CERTAIN PROVISIONS.—Sub- 5 part III of part D of title III of the Public Health Service 6 Act (42 U.S.C. 254l et seq.) shall, except as inconsistent 7 with this section, apply to the program carried out under 8 this section in the same manner and to the same extent 9 as such provisions apply to the National Health Service 10 Corps Loan Repayment Program. 11 (d) REPORTS.—Not later than 18 months after the 12 date of the enactment of this Act, and annually thereafter, 13 the Secretary shall prepare and submit to the Congress 14 a report describing the program carried out under this sec- 15 tion, including statements regarding the following: 16 (1) The number of dentists enrolled in the pro- 17 gram. 18 (2) The number and amount of loan repay- 19 ments. 20 (3) The placement location of loan repayment 21 recipients at facilities described in subsection (a)(1). 22 (4) The default rate and actions required. 23 (5) The amount of outstanding default funds. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00714 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 715 •S 4819 IS (6) To the extent that it can be determined, the 1 reason for the default. 2 (7) The demographics of individuals partici- 3 pating in the program. 4 (8) An evaluation of the overall costs and bene- 5 fits of the program. 6 (e) DEFINITIONS.—In this section: 7 (1) DENTAL EDUCATION LOAN.—The term 8 ‘‘dental education loan’’— 9 (A) means a loan that is incurred for the 10 cost of attendance (including tuition, other rea- 11 sonable educational expenses, and reasonable 12 living costs) at a school of dentistry; and 13 (B) includes only the portion of the loan 14 that is outstanding on the date the dentist in- 15 volved begins the service specified in the agree- 16 ment under subsection (a). 17 (2) DENTIST.—The term ‘‘dentist’’ means a 18 graduate of a school of dentistry who has completed 19 postgraduate training in general or pediatric den- 20 tistry. 21 (3) HIV/AIDS.—The term ‘‘HIV/AIDS’’ means 22 human immunodeficiency virus and acquired im- 23 mune deficiency syndrome. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00715 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 716 •S 4819 IS (4) SCHOOL OF DENTISTRY.—The term ‘‘school 1 of dentistry’’ has the meaning given to that term in 2 section 799B of the Public Health Service Act (42 3 U.S.C. 295p). 4 (5) SECRETARY.—The term ‘‘Secretary’’ means 5 the Secretary of Health and Human Services. 6 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 7 out this section, there are authorized to be appropriated 8 such sums as may be necessary for each of fiscal years 9 2021 through 2024. 10 SEC. 752. REDUCING NEW HIV INFECTIONS AMONG INJECT- 11 ING DRUG USERS. 12 (a) SENSE OF CONGRESS.—It is the sense of Con- 13 gress that providing sterile syringes and sterilized equip- 14 ment to injecting drug users substantially reduces risk of 15 HIV infection, increases the probability that they will ini- 16 tiate drug treatment, and does not increase drug use. 17 (b) IN GENERAL.—The Secretary of Health and 18 Human Services may provide grants and technical assist- 19 ance for the purpose of reducing the rate of HIV infections 20 among injecting drug users through a comprehensive 21 package of services for such users, including the provision 22 of sterile syringes, education and outreach, access to infec- 23 tious disease testing, overdose prevention, and treatment 24 for drug dependence. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00716 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 717 •S 4819 IS (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 1 out this section, there are authorized to be appropriated 2 such sums as may be necessary for fiscal years 2021 3 through 2024. 4 SEC. 753. REPORT ON IMPACT OF HIV/AIDS IN VULNERABLE 5 POPULATIONS. 6 (a) IN GENERAL.—The Secretary shall submit to 7 Congress and the President an annual report on the im- 8 pact of HIV/AIDS for racial and ethnic minority commu- 9 nities, women, and youth aged 24 and younger. 10 (b) CONTENTS.—The report under subsection (a) 11 shall include information on the— 12 (1) progress that has been made in reducing 13 the impact of HIV/AIDS in such communities; 14 (2) opportunities that exist to make additional 15 progress in reducing the impact of HIV/AIDS in 16 such communities; 17 (3) challenges that may impede such additional 18 progress; and 19 (4) Federal funding necessary to achieve sub- 20 stantial reductions in HIV/AIDS in racial and ethnic 21 minority communities. 22 SEC. 754. NATIONAL HIV/AIDS OBSERVANCE DAYS. 23 (a) NATIONAL OBSERVANCE DAYS.—It is the sense 24 of Congress that national observance days highlighting the 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00717 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 718 •S 4819 IS impact of HIV on communities of color include the fol- 1 lowing: 2 (1) National Black HIV/AIDS Awareness Day. 3 (2) National Latino AIDS Awareness Day. 4 (3) National Asian and Pacific Islander HIV/ 5 AIDS Awareness Day. 6 (4) National Native American HIV/AIDS 7 Awareness Day. 8 (5) National Youth HIV/AIDS Awareness Day. 9 (b) CALL TO ACTION.—It is the sense of Congress 10 that the President should call on members of communities 11 of color— 12 (1) to become involved at the local community 13 level in HIV testing, policy, and advocacy; 14 (2) to become aware, engaged, and empowered 15 on the HIV epidemic within their communities; and 16 (3) to urge members of their communities to re- 17 duce risk factors, practice safe sex and other preven- 18 tive measures, be tested for HIV, and seek care 19 when appropriate. 20 SEC. 755. REVIEW OF ALL FEDERAL AND STATE LAWS, 21 POLICIES, AND REGULATIONS REGARDING 22 THE CRIMINAL PROSECUTION OF INDIVID- 23 UALS FOR HIV-RELATED OFFENSES. 24 (a) DEFINITIONS.—In this section: 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00718 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 719 •S 4819 IS (1) HIV.—The term ‘‘HIV’’ has the meaning 1 given to the term in section 2689 of the Public 2 Health Service Act (42 U.S.C. 300ff–88). 3 (2) STATE.—The term ‘‘State’’ includes the 4 District of Columbia, American Samoa, the Com- 5 monwealth of the Northern Mariana Islands, Guam, 6 Puerto Rico, and the United States Virgin Islands. 7 (b) SENSE OF CONGRESS REGARDING LAWS OR REG- 8 ULATIONS DIRECTED AT PEOPLE LIVING WITH HIV.— 9 It is the sense of Congress that Federal and State laws, 10 policies, and regulations regarding people living with 11 HIV— 12 (1) should not place unique or additional bur- 13 dens on such individuals solely as a result of their 14 HIV status; and 15 (2) should instead demonstrate a public health- 16 oriented, evidence-based, medically accurate, and 17 contemporary understanding of— 18 (A) the multiple factors that lead to HIV 19 transmission; 20 (B) the relative risk of HIV transmission 21 routes; 22 (C) the current health implications of liv- 23 ing with HIV; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00719 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 720 •S 4819 IS (D) the associated benefits of treatment 1 and support services for people living with HIV; 2 (E) the impact of punitive HIV-specific 3 laws and policies on public health, on people liv- 4 ing with or affected by HIV, and on their fami- 5 lies and communities; and 6 (F) the current science on HIV prevention 7 and treatment, including pre-exposure prophy- 8 laxis (PrEP), post-exposure prophylaxis (PEP), 9 and viral suppression. 10 (c) REVIEW OF ALL FEDERAL AND STATE LAWS, 11 POLICIES, AND REGULATIONS REGARDING THE CRIMINAL 12 PROSECUTION OF INDIVIDUALS FOR HIV-RELATED OF- 13 FENSES.— 14 (1) REVIEW OF FEDERAL AND STATE LAWS.— 15 (A) IN GENERAL.—Not later than 90 days 16 after the date of the enactment of this Act, the 17 Attorney General, the Secretary of Health and 18 Human Services, and the Secretary of Defense 19 acting jointly (in this paragraph and paragraph 20 (2) referred to as the ‘‘designated officials’’) 21 shall initiate a national review of Federal and 22 State laws, policies, regulations, and judicial 23 precedents and decisions regarding criminal and 24 related civil commitment cases involving people 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00720 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 721 •S 4819 IS living with HIV, including in regards to the 1 Uniform Code of Military Justice. 2 (B) CONSULTATION.—In carrying out the 3 review under subparagraph (A), the designated 4 officials shall ensure diverse participation and 5 consultation from each State, including with— 6 (i) State attorneys general (or their 7 representatives); 8 (ii) State public health officials (or 9 their representatives); 10 (iii) State judicial and court system 11 officers, including judges, district attor- 12 neys, prosecutors, defense attorneys, law 13 enforcement, and correctional officers; 14 (iv) members of the United States 15 Armed Forces, including members of other 16 Federal services subject to the Uniform 17 Code of Military Justice; 18 (v) people living with HIV, particu- 19 larly those who have been subject to HIV- 20 related prosecution or who are from com- 21 munities whose members have been dis- 22 proportionately subject to HIV-specific ar- 23 rests and prosecutions; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00721 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 722 •S 4819 IS (vi) legal advocacy and HIV service 1 organizations that work with people living 2 with HIV; 3 (vii) nongovernmental health organi- 4 zations that work on behalf of people living 5 with HIV; and 6 (viii) trade organizations or associa- 7 tions representing persons or entities de- 8 scribed in clauses (i) through (vii). 9 (C) RELATION TO OTHER REVIEWS.—In 10 carrying out the review under subparagraph 11 (A), the designated officials may utilize other 12 existing reviews of criminal and related civil 13 commitment cases involving people living with 14 HIV, including any such review conducted by 15 any Federal or State agency or any public 16 health, legal advocacy, or trade organization or 17 association if the designated officials determine 18 that such reviews were conducted in accordance 19 with the principles set forth in subsection (b). 20 (2) REPORT.—No later than 180 days after ini- 21 tiating the review required by paragraph (1), the At- 22 torney General shall transmit to Congress and make 23 publicly available a report containing the results of 24 the review, which includes the following: 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00722 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 723 •S 4819 IS (A) For each State and for the Uniform 1 Code of Military Justice, a summary of the rel- 2 evant laws, policies, regulations, and judicial 3 precedents and decisions regarding criminal 4 cases involving people living with HIV, includ- 5 ing, if applicable, the following: 6 (i) A determination of whether such 7 laws, policies, regulations, and judicial 8 precedents and decisions place any unique 9 or additional burdens upon people living 10 with HIV. 11 (ii) A determination of whether such 12 laws, policies, regulations, and judicial 13 precedents and decisions demonstrate a 14 public health-oriented, evidence-based, 15 medically accurate, and contemporary un- 16 derstanding of— 17 (I) the multiple factors that lead 18 to HIV transmission; 19 (II) the relative risk of HIV 20 transmission routes; 21 (III) the current health implica- 22 tions of living with HIV; 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00723 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 724 •S 4819 IS (IV) the associated benefits of 1 treatment and support services for 2 people living with HIV; 3 (V) the impact of punitive HIV- 4 specific laws and policies on public 5 health, on people living with or af- 6 fected by HIV, and on their families 7 and communities; and 8 (VI) the current science on HIV 9 prevention and treatment, including 10 pre-exposure prophylaxis (PrEP), 11 post-exposure prophylaxis (PEP), and 12 viral suppression. 13 (iii) An analysis of the public health 14 and legal implications of such laws, poli- 15 cies, regulations, and judicial precedents, 16 including an analysis of the consequences 17 of having a similar penal scheme applied to 18 comparable situations involving other com- 19 municable diseases. 20 (iv) An analysis of the proportionality 21 of punishments imposed under HIV-spe- 22 cific laws, policies, regulations, and judicial 23 precedents, taking into consideration pen- 24 alties attached to violation of State laws 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00724 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 725 •S 4819 IS against similar degrees of endangerment or 1 harm, such as driving while intoxicated or 2 transmission of other communicable dis- 3 eases, or more serious harms, such as ve- 4 hicular manslaughter offenses. 5 (B) An analysis of common elements 6 shared among State laws, policies, regulations, 7 and judicial precedents. 8 (C) A set of best practice recommendations 9 directed to State governments, including State 10 attorneys general, public health officials, and 11 judicial officers, in order to ensure that laws, 12 policies, regulations, and judicial precedents re- 13 garding people living with HIV are in accord- 14 ance with the principles set forth in subsection 15 (b). 16 (D) Recommendations for adjustments to 17 the Uniform Code of Military Justice, as may 18 be necessary, in order to ensure that laws, poli- 19 cies, regulations, and judicial precedents re- 20 garding people living with HIV are in accord- 21 ance with the principles set forth in subsection 22 (b). 23 (3) GUIDANCE.—Within 90 days of the release 24 of the report required by paragraph (2), the Attor- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00725 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 726 •S 4819 IS ney General and the Secretary of Health and 1 Human Services, acting jointly, shall develop and 2 publicly release updated guidance for States based 3 on the set of best practice recommendations required 4 by paragraph (2)(C) in order to assist States dealing 5 with criminal and related civil commitment cases re- 6 garding people living with HIV. 7 (4) MONITORING AND EVALUATION SYSTEM.— 8 Within 60 days of the release of the guidance re- 9 quired by paragraph (3), the Attorney General and 10 the Secretary of Health and Human Services, acting 11 jointly, shall establish an integrated monitoring and 12 evaluation system which includes, where appropriate, 13 objective and quantifiable performance goals and in- 14 dicators to measure progress toward statewide im- 15 plementation in each State of the best practice rec- 16 ommendations required in paragraph (2)(C), includ- 17 ing to monitor, track, and evaluate the effectiveness 18 of assistance provided pursuant to subsection (d). 19 (5) ADJUSTMENTS TO FEDERAL LAWS, POLI- 20 CIES, OR REGULATIONS.—Within 90 days of the re- 21 lease of the report required by paragraph (2), the 22 Attorney General, the Secretary of Health and 23 Human Services, and the Secretary of Defense, act- 24 ing jointly, shall develop and transmit to the Presi- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00726 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 727 •S 4819 IS dent and the Congress, and make publicly available, 1 such proposals as may be necessary to implement 2 adjustments to Federal laws, policies, or regulations, 3 including to the Uniform Code of Military Justice, 4 based on the recommendations required by para- 5 graph (2)(D), either through Executive order or 6 through changes to statutory law. 7 (6) AUTHORIZATION OF APPROPRIATIONS.— 8 (A) IN GENERAL.—There are authorized to 9 be appropriated such sums as may be necessary 10 for the purpose of carrying out this subsection. 11 Amounts authorized to be appropriated by the 12 preceding sentence are in addition to amounts 13 otherwise authorized to be appropriated for 14 such purpose. 15 (B) AVAILABILITY OF FUNDS.—Amounts 16 appropriated pursuant to the authorization of 17 appropriations in subparagraph (A) are author- 18 ized to remain available until expended. 19 (d) AUTHORIZATION TO PROVIDE GRANTS.— 20 (1) GRANTS BY ATTORNEY GENERAL.— 21 (A) IN GENERAL.—The Attorney General 22 may provide assistance to eligible State and 23 local entities and eligible nongovernmental orga- 24 nizations for the purpose of incorporating the 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00727 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 728 •S 4819 IS best practice recommendations developed under 1 subsection (c)(2)(C) within relevant State laws, 2 policies, regulations, and judicial decisions re- 3 garding people living with HIV. 4 (B) AUTHORIZED ACTIVITIES.—The assist- 5 ance authorized by subparagraph (A) may in- 6 clude— 7 (i) direct technical assistance to eligi- 8 ble State and local entities in order to de- 9 velop, disseminate, or implement State 10 laws, policies, regulations, or judicial deci- 11 sions that conform with the best practice 12 recommendations developed under sub- 13 section (c)(2)(C); 14 (ii) direct technical assistance to eligi- 15 ble nongovernmental organizations in order 16 to provide education and training, includ- 17 ing through classes, conferences, meetings, 18 and other educational activities, to eligible 19 State and local entities; and 20 (iii) subcontracting authority to allow 21 eligible State and local entities and eligible 22 nongovernmental organizations to seek 23 technical assistance from legal and public 24 health experts with a demonstrated under- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00728 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 729 •S 4819 IS standing of the principles underlying the 1 best practice recommendations developed 2 under subsection (c)(2)(C). 3 (2) GRANTS BY SECRETARY OF HEALTH AND 4 HUMAN SERVICES.— 5 (A) IN GENERAL.—The Secretary of 6 Health and Human Services, acting through the 7 Director of the Centers for Disease Control and 8 Prevention, may provide assistance to State and 9 local public health departments and eligible 10 nongovernmental organizations for the purpose 11 of supporting eligible State and local entities to 12 incorporate the best practice recommendations 13 developed under subsection (c)(2)(C) within rel- 14 evant State laws, policies, regulations, and judi- 15 cial decisions regarding people living with HIV. 16 (B) AUTHORIZED ACTIVITIES.—The assist- 17 ance authorized by subparagraph (A) may in- 18 clude— 19 (i) direct technical assistance to State 20 and local public health departments in 21 order to support the development, dissemi- 22 nation, or implementation of State laws, 23 policies, regulations, or judicial decisions 24 that conform with the set of best practice 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00729 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 730 •S 4819 IS recommendations developed under sub- 1 section (c)(2)(C); 2 (ii) direct technical assistance to eligi- 3 ble nongovernmental organizations in order 4 to provide education and training, includ- 5 ing through classes, conferences, meetings, 6 and other educational activities, to State 7 and local public health departments; and 8 (iii) subcontracting authority to allow 9 State and local public health departments 10 and eligible nongovernmental organizations 11 to seek technical assistance from legal and 12 public health experts with a demonstrated 13 understanding of the principles underlying 14 the best practice recommendations devel- 15 oped under subsection (c)(2)(C). 16 (3) LIMITATION.—As a condition of receiving 17 assistance through this subsection, eligible State and 18 local entities, State and local public health depart- 19 ments, and eligible nongovernmental organizations 20 shall agree— 21 (A) not to place any unique or additional 22 burdens on people living with HIV solely as a 23 result of their HIV status; and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00730 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 731 •S 4819 IS (B) that if the entity, department, or orga- 1 nization promulgates any laws, policies, regula- 2 tions, or judicial decisions regarding people liv- 3 ing with HIV, such actions shall demonstrate a 4 public health-oriented, evidence-based, medically 5 accurate, and contemporary understanding of— 6 (i) the multiple factors that lead to 7 HIV transmission; 8 (ii) the relative risk of HIV trans- 9 mission routes; 10 (iii) the current health implications of 11 living with HIV; 12 (iv) the associated benefits of treat- 13 ment and support services for people living 14 with HIV; 15 (v) the impact of punitive HIV-spe- 16 cific laws and policies on public health, on 17 people living with or affected by HIV, and 18 on their families and communities; and 19 (vi) the current science on HIV pre- 20 vention and treatment, including pre-expo- 21 sure prophylaxis (PrEP), post-exposure 22 prophylaxis (PEP), and viral suppression. 23 (4) REPORT.—No later than 1 year after the 24 date of the enactment of this Act, and annually 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00731 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 732 •S 4819 IS thereafter, the Attorney General and the Secretary 1 of Health and Human Services, acting jointly, shall 2 transmit to Congress and make publicly available a 3 report describing, for each State, the impact and ef- 4 fectiveness of the assistance provided through this 5 section. Each such report shall include— 6 (A) a detailed description of the progress 7 each State has made, if any, in implementing 8 the best practice recommendations developed 9 under subsection (c)(2)(C) as a result of the as- 10 sistance provided under this subsection, and 11 based on the performance goals and indicators 12 established as part of the monitoring and eval- 13 uation system in subsection (c)(4); 14 (B) a brief summary of any outreach ef- 15 forts undertaken during the prior year by the 16 Attorney General and the Secretary of Health 17 and Human Services to encourage States to 18 seek assistance under this subsection in order 19 to implement the best practice recommenda- 20 tions developed under subsection (c)(2)(C); 21 (C) a summary of how assistance provided 22 through this subsection is being utilized by eli- 23 gible State and local entities, State and local 24 public health departments, and eligible non- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00732 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 733 •S 4819 IS governmental organizations and, if applicable, 1 any contractors, including with respect to non- 2 governmental organizations, the type of tech- 3 nical assistance provided, and an evaluation of 4 the impact of such assistance on eligible State 5 and local entities; and 6 (D) a summary and description of eligible 7 State and local entities, State and local public 8 health departments, and eligible nongovern- 9 mental organizations receiving assistance 10 through this subsection, including if applicable, 11 a summary and description of any contractors 12 selected to assist in implementing such assist- 13 ance. 14 (5) DEFINITIONS.—For the purposes of this 15 subsection: 16 (A) ELIGIBLE STATE AND LOCAL ENTI- 17 TIES.—The term ‘‘eligible State and local enti- 18 ties’’ means the relevant individuals, offices, or 19 organizations that directly participate in the de- 20 velopment, dissemination, or implementation of 21 State laws, policies, regulations, or judicial deci- 22 sions, including— 23 (i) State governments, including State 24 attorneys general, State departments of 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00733 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 734 •S 4819 IS justice, and State National Guards, or 1 their equivalents; 2 (ii) State judicial and court systems, 3 including trial courts, appellate courts, 4 State supreme courts and courts of appeal, 5 and State correctional facilities, or their 6 equivalents; and 7 (iii) local governments, including city 8 and county governments, district attorneys, 9 and local law enforcement departments, or 10 their equivalents. 11 (B) STATE AND LOCAL PUBLIC HEALTH 12 DEPARTMENTS.—The term ‘‘State and local 13 public health departments’’ means the fol- 14 lowing: 15 (i) State public health departments, or 16 their equivalents, including the chief officer 17 of such departments and infectious disease 18 and communicable disease specialists with- 19 in such departments. 20 (ii) Local public health departments, 21 or their equivalents, including city and 22 county public health departments, the chief 23 officer of such departments, and infectious 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00734 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 735 •S 4819 IS disease and communicable disease special- 1 ists within such departments. 2 (iii) Public health departments or offi- 3 cials, or their equivalents, within State or 4 local correctional facilities. 5 (iv) Public health departments or offi- 6 cials, or their equivalents, within State Na- 7 tional Guards. 8 (v) Any other recognized State or 9 local public health organization or entity 10 charged with carrying out official State or 11 local public health duties. 12 (C) ELIGIBLE NONGOVERNMENTAL ORGA- 13 NIZATIONS.—The term ‘‘eligible nongovern- 14 mental organizations’’ means the following: 15 (i) Nongovernmental organizations, 16 including trade organizations or associa- 17 tions that represent— 18 (I) State attorneys general, or 19 their equivalents; 20 (II) State public health officials, 21 or their equivalents; 22 (III) State judicial and court offi- 23 cers, including judges, district attor- 24 neys, prosecutors, defense attorneys, 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00735 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 736 •S 4819 IS law enforcement, and correctional offi- 1 cers; 2 (IV) State National Guards; 3 (V) people living with HIV; 4 (VI) legal advocacy and HIV 5 service organizations that work with 6 people living with HIV; and 7 (VII) nongovernmental health or- 8 ganizations that work on behalf of 9 people living with HIV. 10 (ii) Nongovernmental organizations, 11 including trade organizations or associa- 12 tions that demonstrate a public-health ori- 13 ented, evidence-based, medically accurate, 14 and contemporary understanding of— 15 (I) the multiple factors that lead 16 to HIV transmission; 17 (II) the relative risk of HIV 18 transmission routes; 19 (III) the current health implica- 20 tions of living with HIV; 21 (IV) the associated benefits of 22 treatment and support services for 23 people living with HIV; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00736 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 737 •S 4819 IS (V) the impact of punitive HIV- 1 specific laws and policies on public 2 health, on people living with or af- 3 fected by HIV, and on their families 4 and communities; and 5 (VI) the current science on HIV 6 prevention and treatment, including 7 pre-exposure prophylaxis (PrEP), 8 post-exposure prophylaxis (PEP), and 9 viral suppression. 10 (6) AUTHORIZATION OF APPROPRIATIONS.— 11 (A) IN GENERAL.—In addition to amounts 12 otherwise made available, there are authorized 13 to be appropriated to the Attorney General and 14 the Secretary of Health and Human Services 15 such sums as may be necessary to carry out 16 this subsection for each of the fiscal years 2021 17 through 2024. 18 (B) AVAILABILITY OF FUNDS.—Amounts 19 appropriated pursuant to the authorizations of 20 appropriations in subparagraph (A) are author- 21 ized to remain available until expended. 22 SEC. 756. EXPANDING SUPPORT FOR CONDOMS IN PRIS- 23 ONS. 24 (a) DEFINITIONS.—In this section: 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00737 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 738 •S 4819 IS (1) COMMUNITY ORGANIZATION.—The term 1 ‘‘community organization’’ means a public health 2 care facility or a nonprofit organization that pro- 3 vides health- or STI-related services according to es- 4 tablished public health standards. 5 (2) COMPREHENSIVE SEXUALITY EDUCATION.— 6 The term ‘‘comprehensive sexuality education’’ 7 means sexuality education— 8 (A) that includes information about absti- 9 nence and about the proper use and disposal of 10 sexual barrier protection devices; and 11 (B) that is— 12 (i) evidence-based; 13 (ii) medically accurate; 14 (iii) age and developmentally appro- 15 priate; 16 (iv) gender and identity sensitive; 17 (v) culturally and linguistically appro- 18 priate; and 19 (vi) structured to promote critical 20 thinking, self-esteem, respect for others, 21 and the development of healthy attitudes 22 and relationships. 23 (3) CORRECTIONAL FACILITY.—The term ‘‘cor- 24 rectional facility’’ means any prison, penitentiary, 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00738 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 739 •S 4819 IS adult detention facility, juvenile detention facility, 1 jail, or other facility to which individuals may be 2 sent after conviction of a crime or act of juvenile de- 3 linquency within the United States. 4 (4) INCARCERATED INDIVIDUAL.—The term 5 ‘‘incarcerated individual’’ means any individual who 6 is serving a sentence in a correctional facility after 7 conviction of a crime. 8 (5) SEXUAL BARRIER PROTECTION DEVICE.— 9 The term ‘‘sexual barrier protection device’’ means 10 any physical device approved by the Food and Drug 11 Administration that has not been tampered with and 12 which reduces the probability of STI transmission or 13 infection between sexual partners, including female 14 condoms, male condoms, and dental dams. 15 (6) SEXUALLY TRANSMITTED INFECTION.—The 16 term ‘‘sexually transmitted infection’’ or ‘‘STI’’ 17 means any disease or infection that is commonly 18 transmitted through sexual activity, including HIV, 19 gonorrhea, chlamydia, syphilis, genital herpes, viral 20 hepatitis, and human papillomavirus. 21 (7) STATE.—The term ‘‘State’’ includes the 22 District of Columbia, American Samoa, the Com- 23 monwealth of the Northern Mariana Islands, Guam, 24 Puerto Rico, and the United States Virgin Islands. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00739 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 740 •S 4819 IS (b) AUTHORITY TO ALLOW COMMUNITY ORGANIZA- 1 TIONS TO PROVIDE STI COUNSELING, STI PREVENTION 2 EDUCATION, AND SEXUAL BARRIER PROTECTION DE- 3 VICES IN FEDERAL CORRECTIONAL FACILITIES.— 4 (1) DIRECTIVE TO ATTORNEY GENERAL.—Not 5 later than 30 days after the date of enactment of 6 this Act, the Attorney General shall direct the Direc- 7 tor of the Bureau of Prisons to allow community or- 8 ganizations to, in accordance with all relevant Fed- 9 eral laws and regulations that govern visitation in 10 correctional facilities— 11 (A) distribute sexual barrier protection de- 12 vices in Federal correctional facilities; and 13 (B) engage in STI counseling and STI pre- 14 vention education in Federal correctional facili- 15 ties. 16 (2) INFORMATION REQUIREMENT.—Any com- 17 munity organization permitted to distribute sexual 18 barrier protection devices under paragraph (1) shall 19 ensure that the individuals to whom the devices are 20 distributed are informed about the proper use and 21 disposal of sexual barrier protection devices in ac- 22 cordance with established public health practices. 23 Any community organization conducting STI coun- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00740 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 741 •S 4819 IS seling or STI prevention education under paragraph 1 (1) shall offer comprehensive sexuality education. 2 (3) POSSESSION OF DEVICE PROTECTED.—A 3 Federal correctional facility may not, because of the 4 possession or use of a sexual barrier protection de- 5 vice— 6 (A) take adverse action against an incar- 7 cerated individual; or 8 (B) consider possession or use as evidence 9 of prohibited activity for the purpose of any 10 Federal correctional facility administrative pro- 11 ceeding. 12 (4) IMPLEMENTATION.—The Attorney General 13 and the Director of the Bureau of Prisons shall im- 14 plement this section according to established public 15 health practices in a manner that protects the 16 health, safety, and privacy of incarcerated individ- 17 uals and of correctional facility staff. 18 (c) SENSE OF CONGRESS REGARDING DISTRIBUTION 19 OF SEXUAL BARRIER PROTECTION DEVICES IN STATE 20 PRISON SYSTEMS.—It is the sense of the Congress that 21 States should allow for the legal distribution of sexual bar- 22 rier protection devices in State correctional facilities to re- 23 duce the prevalence and spread of STIs in those facilities. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00741 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 742 •S 4819 IS (d) SURVEY OF AND REPORT ON CORRECTIONAL FA- 1 CILITY PROGRAMS AIMED AT REDUCING THE SPREAD OF 2 STIS.— 3 (1) SURVEY.—Not later than 180 days after 4 the date of enactment of this Act, and annually 5 thereafter for 5 years, the Attorney General, after 6 consulting with the Secretary of Health and Human 7 Services, State officials, and community organiza- 8 tions, shall, to the maximum extent practicable, con- 9 duct a survey of all Federal and State correctional 10 facilities, to determine the following: 11 (A) COUNSELING, TREATMENT, AND SUP- 12 PORTIVE SERVICES.—Whether the correctional 13 facility— 14 (i) requires incarcerated individuals to 15 participate in counseling, treatment, and 16 supportive services related to STIs; or 17 (ii) offers such programs to incarcer- 18 ated individuals. 19 (B) ACCESS TO SEXUAL BARRIER PROTEC- 20 TION DEVICES.—Whether incarcerated individ- 21 uals can— 22 (i) possess sexual barrier protection 23 devices; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00742 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 743 •S 4819 IS (ii) purchase sexual barrier protection 1 devices; 2 (iii) purchase sexual barrier protection 3 devices at a reduced cost; or 4 (iv) obtain sexual barrier protection 5 devices without cost. 6 (C) INCIDENCE OF SEXUAL VIOLENCE.— 7 The incidence of sexual violence and assault 8 committed by incarcerated individuals and by 9 correctional facility staff. 10 (D) PREVENTION EDUCATION OFFERED.— 11 The type of prevention education, information, 12 or training offered to incarcerated individuals 13 and correctional facility staff regarding sexual 14 violence and the spread of STIs, including 15 whether such education, information, or train- 16 ing— 17 (i) constitutes comprehensive sexuality 18 education; 19 (ii) is compulsory for new incarcerated 20 individuals and for new staff; and 21 (iii) is offered on an ongoing basis. 22 (E) STI TESTING.—Whether the correc- 23 tional facility tests incarcerated individuals for 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00743 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 744 •S 4819 IS STIs or gives them the option to undergo such 1 testing— 2 (i) at intake; 3 (ii) on a regular basis; and 4 (iii) prior to release. 5 (F) STI TEST RESULTS.—The number of 6 incarcerated individuals who are tested for STIs 7 and the outcome of such tests at each correc- 8 tional facility, disaggregated to include results 9 for— 10 (i) the type of sexually transmitted in- 11 fection tested for; 12 (ii) the race and ethnicity of individ- 13 uals tested; 14 (iii) the age of individuals tested; and 15 (iv) the gender of individuals tested. 16 (G) PRERELEASE REFERRAL POLICY.— 17 Whether incarcerated individuals are informed 18 prior to release about STI-related services or 19 other health services in their communities, in- 20 cluding free and low-cost counseling and treat- 21 ment options. 22 (H) PRERELEASE REFERRALS MADE.— 23 The number of referrals to community-based 24 organizations or public health facilities offering 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00744 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 745 •S 4819 IS STI-related or other health services provided to 1 incarcerated individuals prior to release, and 2 the type of counseling or treatment for which 3 the referral was made. 4 (I) REINSTATEMENT OF MEDICAID BENE- 5 FITS.—Whether the correctional facility assists 6 incarcerated individuals that were enrolled in 7 the State Medicaid program prior to their in- 8 carceration, in reinstating their enrollment 9 upon release and whether such individuals re- 10 ceive referrals as provided by subparagraph (G) 11 to entities that accept the State Medicaid pro- 12 gram, including if applicable— 13 (i) the number of such individuals, in- 14 cluding those diagnosed with HIV, that 15 have been reinstated; 16 (ii) a list of obstacles to reinstating 17 enrollment or to making determinations of 18 eligibility for reinstatement, if any; and 19 (iii) the number of individuals denied 20 enrollment. 21 (J) OTHER ACTIONS TAKEN.—Whether the 22 correctional facility has taken any other action, 23 in conjunction with community organizations or 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00745 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 746 •S 4819 IS otherwise, to reduce the prevalence and spread 1 of STIs in that facility. 2 (2) PRIVACY.—In conducting the survey under 3 paragraph (1), the Attorney General shall not re- 4 quest or retain the identity of any individual who 5 has sought or been offered counseling, treatment, 6 testing, or prevention education information regard- 7 ing an STI (including information about sexual bar- 8 rier protection devices), or who has tested positive 9 for an STI. 10 (3) REPORT.— 11 (A) IN GENERAL.—The Attorney General 12 shall transmit to Congress and make publicly 13 available the results of the survey required 14 under paragraph (1), both for the United 15 States as a whole and disaggregated as to each 16 State and each correctional facility. 17 (B) DEADLINES.—To the maximum extent 18 possible, the Attorney General shall— 19 (i) issue the first report under sub- 20 paragraph (A) not later than 1 year after 21 the date of enactment of this Act; and 22 (ii) issue reports under subparagraph 23 (A) annually thereafter for 5 years. 24 (e) STRATEGY.— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00746 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 747 •S 4819 IS (1) DIRECTIVE TO ATTORNEY GENERAL.—The 1 Attorney General, in consultation with the Secretary 2 of Health and Human Services, State officials, and 3 community organizations, shall develop and imple- 4 ment a 5-year strategy to reduce the prevalence and 5 spread of STIs in Federal and State correctional fa- 6 cilities. To the maximum extent possible, the strat- 7 egy shall be developed, transmitted to Congress, and 8 made publicly available no later than 180 days after 9 the transmission of the first report required under 10 subsection (d)(3). 11 (2) CONTENTS OF STRATEGY.—The strategy 12 developed under paragraph (1) shall include the fol- 13 lowing: 14 (A) PREVENTION EDUCATION.—A plan for 15 improving prevention education, information, 16 and training offered to incarcerated individuals 17 and correctional facility staff, including infor- 18 mation and training on sexual violence and the 19 spread of STIs, and comprehensive sexuality 20 education. 21 (B) SEXUAL BARRIER PROTECTION DEVICE 22 ACCESS.—A plan for expanding access to sexual 23 barrier protection devices in correctional facili- 24 ties. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00747 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 748 •S 4819 IS (C) SEXUAL VIOLENCE REDUCTION.—A 1 plan for reducing the incidence of sexual vio- 2 lence among incarcerated individuals and cor- 3 rectional facility staff, developed in consultation 4 with the National Prison Rape Elimination 5 Commission. 6 (D) COUNSELING AND SUPPORTIVE SERV- 7 ICES.—A plan for expanding access to coun- 8 seling and supportive services related to STIs in 9 correctional facilities. 10 (E) TESTING.—A plan for testing incarcer- 11 ated individuals for STIs during intake, during 12 regular health exams, and prior to release, and 13 that— 14 (i) is conducted in accordance with 15 guidelines established by the Centers for 16 Disease Control and Prevention; 17 (ii) includes pretest counseling; 18 (iii) requires that incarcerated individ- 19 uals are notified of their option to decline 20 testing at any time; 21 (iv) requires that incarcerated individ- 22 uals are confidentially notified of their test 23 results in a timely manner; and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00748 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 749 •S 4819 IS (v) ensures that incarcerated individ- 1 uals testing positive for STIs receive post- 2 test counseling, care, treatment, and sup- 3 portive services. 4 (F) TREATMENT.—A plan for ensuring 5 that correctional facilities have the necessary 6 medicine and equipment to treat and monitor 7 STIs and for ensuring that incarcerated indi- 8 viduals living with or testing positive for STIs 9 receive and have access to care and treatment 10 services. 11 (G) STRATEGIES FOR DEMOGRAPHIC 12 GROUPS.—A plan for developing and imple- 13 menting culturally appropriate, sensitive, and 14 specific strategies to reduce the spread of STIs 15 among demographic groups heavily impacted by 16 STIs. 17 (H) LINKAGES WITH COMMUNITIES AND 18 FACILITIES.—A plan for establishing and 19 strengthening linkages to local communities and 20 health facilities that— 21 (i) provide counseling, testing, care, 22 and treatment services; 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00749 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 750 •S 4819 IS (ii) may receive individuals recently 1 released from incarceration who are living 2 with STIs; and 3 (iii) accept payment through the State 4 Medicaid program. 5 (I) ENROLLMENT IN STATE MEDICAID 6 PROGRAMS.—Plans to ensure that— 7 (i) incarcerated individuals who were 8 enrolled in their State Medicaid program 9 prior to incarceration in a correctional fa- 10 cility are automatically reenrolled in such 11 program upon their release; and 12 (ii) incarcerated individuals who were 13 not enrolled in their State Medicaid pro- 14 gram prior to incarceration, and who are 15 diagnosed with HIV while incarcerated in 16 a correctional facility, are automatically 17 enrolled in such program upon their re- 18 lease. 19 (J) OTHER PLANS.—Any other plans de- 20 veloped by the Attorney General for reducing 21 the spread of STIs or improving the quality of 22 health care in correctional facilities. 23 (K) MONITORING SYSTEM.—A monitoring 24 system that establishes performance goals re- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00750 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 751 •S 4819 IS lated to reducing the prevalence and spread of 1 STIs in correctional facilities and which, where 2 feasible, expresses such goals in quantifiable 3 form. 4 (L) MONITORING SYSTEM PERFORMANCE 5 INDICATORS.—Performance indicators that 6 measure or assess the achievement of the per- 7 formance goals described in subparagraph (K). 8 (M) COST ESTIMATE.—A detailed estimate 9 of the funding necessary to implement the 10 strategy at the Federal and State levels for all 11 5 years, including the amount of funds required 12 by community organizations to implement the 13 parts of the strategy in which they take part. 14 (3) REPORT.—Not later than 1 year after the 15 date of the enactment of this Act, and annually 16 thereafter, the Attorney General shall transmit to 17 Congress and make publicly available an annual 18 progress report regarding the implementation and 19 effectiveness of the strategy described in paragraph 20 (1). The progress report shall include an evaluation 21 of the implementation of the strategy using the mon- 22 itoring system and performance indicators provided 23 for in subparagraphs (K) and (L) of paragraph (2). 24 (f) AUTHORIZATION OF APPROPRIATIONS.— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00751 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 752 •S 4819 IS (1) IN GENERAL.—There are authorized to be 1 appropriated such sums as may be necessary to 2 carry out this section for each of fiscal years 2021 3 through 2025. 4 (2) AVAILABILITY OF FUNDS.—Amounts made 5 available under paragraph (1) are authorized to re- 6 main available until expended. 7 SEC. 757. AUTOMATIC REINSTATEMENT OR ENROLLMENT 8 IN MEDICAID FOR PEOPLE WHO TEST POSI- 9 TIVE FOR HIV BEFORE REENTERING COMMU- 10 NITIES. 11 (a) IN GENERAL.—Section 1902(e) of the Social Se- 12 curity Act (42 U.S.C. 1396a(e)) is amended by adding at 13 the end the following: 14 ‘‘(16) ENROLLMENT OF EX-OFFENDERS.— 15 ‘‘(A) AUTOMATIC ENROLLMENT OR REIN- 16 STATEMENT.— 17 ‘‘(i) IN GENERAL.—The State plan 18 shall provide for the automatic enrollment 19 or reinstatement of enrollment of an eligi- 20 ble individual— 21 ‘‘(I) if such individual is sched- 22 uled to be released from a public insti- 23 tution due to the completion of sen- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00752 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 753 •S 4819 IS tence, not less than 30 days prior to 1 the scheduled date of the release; and 2 ‘‘(II) if such individual is to be 3 released from a public institution on 4 parole or on probation, as soon as 5 possible after the date on which the 6 determination to release such indi- 7 vidual was made, and before the date 8 such individual is released. 9 ‘‘(ii) EXCEPTION.—If a State makes a 10 determination that an individual is not eli- 11 gible to be enrolled under the State plan— 12 ‘‘(I) on or before the date by 13 which the individual would be enrolled 14 under clause (i), such clause shall not 15 apply to such individual; or 16 ‘‘(II) after such date, the State 17 may terminate the enrollment of such 18 individual. 19 ‘‘(B) RELATIONSHIP OF ENROLLMENT TO 20 PAYMENT FOR SERVICES.— 21 ‘‘(i) IN GENERAL.—Subject to sub- 22 paragraph (A)(ii), an eligible individual 23 who is enrolled, or whose enrollment is re- 24 instated, under subparagraph (A) shall be 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00753 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 754 •S 4819 IS eligible for all services for which medical 1 assistance is provided under the State plan 2 after the date that the eligible individual is 3 released from the public institution. 4 ‘‘(ii) RELATIONSHIP TO PAYMENT 5 PROHIBITION FOR INMATES.—No provision 6 of this paragraph may be construed to per- 7 mit payment for care or services for which 8 payment is excluded under subdivision (A) 9 following paragraph (31) of section 10 1905(a). 11 ‘‘(C) TREATMENT OF CONTINUOUS ELIGI- 12 BILITY.— 13 ‘‘(i) SUSPENSION FOR INMATES.—Any 14 period of continuous eligibility under this 15 title shall be suspended on the date an in- 16 dividual enrolled under this title becomes 17 an inmate of a public institution (except as 18 a patient of a medical institution). 19 ‘‘(ii) DETERMINATION OF REMAINING 20 PERIOD.—Notwithstanding any changes to 21 State law related to continuous eligibility 22 during the time that an individual is an in- 23 mate of a public institution (except as a 24 patient of a medical institution), subject to 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00754 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 755 •S 4819 IS clause (iii), with respect to an eligible indi- 1 vidual who was subject to a suspension 2 under clause (i), on the date that such in- 3 dividual is released from a public institu- 4 tion the suspension of continuous eligibility 5 under such clause shall be lifted for a pe- 6 riod that is equal to the time remaining in 7 the period of continuous eligibility for such 8 individual on the date that such period was 9 suspended under such clause. 10 ‘‘(iii) EXCEPTION.—If a State makes 11 a determination that an individual is not 12 eligible to be enrolled under the State 13 plan— 14 ‘‘(I) on or before the date that 15 the suspension of continuous eligibility 16 is lifted under clause (ii), such clause 17 shall not apply to such individual; or 18 ‘‘(II) after such date, the State 19 may terminate the enrollment of such 20 individual. 21 ‘‘(D) AUTOMATIC ENROLLMENT OR REIN- 22 STATEMENT OF ENROLLMENT DEFINED.—For 23 purposes of this paragraph, the term ‘automatic 24 enrollment or reinstatement of enrollment’ 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00755 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 756 •S 4819 IS means that the State determines eligibility for 1 medical assistance under the State plan without 2 a program application from, or on behalf of, the 3 eligible individual, but an individual can only be 4 automatically enrolled in the State Medicaid 5 plan if the individual affirmatively consents to 6 being enrolled through affirmation in writing, 7 by telephone, orally, through electronic signa- 8 ture, or through any other means specified by 9 the Secretary. 10 ‘‘(E) ELIGIBLE INDIVIDUAL DEFINED.— 11 For purposes of this paragraph, the term ‘eligi- 12 ble individual’ means an individual who is an 13 inmate of a public institution (except as a pa- 14 tient in a medical institution)— 15 ‘‘(i) who was enrolled under the State 16 plan for medical assistance immediately be- 17 fore becoming an inmate of such an insti- 18 tution; or 19 ‘‘(ii) who is diagnosed with human im- 20 munodeficiency virus.’’. 21 (b) SUPPLEMENTAL FUNDING FOR STATE IMPLE- 22 MENTATION OF AUTOMATIC REINSTATEMENT OF MED- 23 ICAID BENEFITS.— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00756 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 757 •S 4819 IS (1) IN GENERAL.—Subject to paragraph (3), 1 with respect to a State, for each of the first 4 cal- 2 endar quarters in which the State plan meets the re- 3 quirements of paragraph (16) of section 1902(e) of 4 the Social Security Act (42 U.S.C. 1396a(e)) (as 5 added by subsection (a)), the Federal matching pay- 6 ments (including payments based on the Federal 7 medical assistance percentage) made to such State 8 under section 1903 of the Social Security Act (42 9 U.S.C. 1396b) for the State expenditures described 10 in paragraph (2) shall be increased by 5 percentage 11 points. 12 (2) EXPENDITURES.—The expenditures de- 13 scribed in this paragraph are the following: 14 (A) Expenditures for which payment is 15 available under section 1903 of the Social Secu- 16 rity Act (42 U.S.C. 1396b) and which are at- 17 tributable to strengthening the State’s enroll- 18 ment and administrative resources for the pur- 19 pose of improving processes for enrolling (or re- 20 instating the enrollment of) eligible individuals 21 (as such term is defined in subparagraph (E) of 22 paragraph (16) of section 1902(e) of the Social 23 Security Act (42 U.S.C. 1396a(e)) (as amended 24 by subsection (a))). 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00757 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 758 •S 4819 IS (B) Expenditures for medical assistance 1 (as such term is defined in section 1905(a) of 2 the Social Security Act (42 U.S.C. 1396d(a))) 3 provided to such eligible individuals. 4 (3) REQUIREMENTS; LIMITATION.— 5 (A) REPORT.—A State is not eligible for 6 an increase in its Federal matching payments 7 under paragraph (1) unless the State agrees to 8 submit to the Secretary of Health and Human 9 Services, and make publicly available, a report 10 that contains the information required under 11 paragraph (4) by the end of the 1-year period 12 during which the State receives increased Fed- 13 eral matching payments in accordance with that 14 paragraph. 15 (B) MAINTENANCE OF ELIGIBILITY.— 16 (i) IN GENERAL.—Subject to clause 17 (ii), a State is not eligible for an increase 18 in its Federal matching payments under 19 paragraph (1) if eligibility standards, 20 methodologies, or procedures under its 21 State plan under title XIX of the Social 22 Security Act (42 U.S.C. 1396 et seq.), or 23 waiver of such a plan, are more restrictive 24 than the eligibility standards, methodolo- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00758 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 759 •S 4819 IS gies, or procedures, respectively, under 1 such plan or waiver as in effect on the date 2 of enactment of this Act. 3 (ii) STATE REINSTATEMENT OF ELIGI- 4 BILITY PERMITTED.—A State that has re- 5 stricted eligibility standards, methodolo- 6 gies, or procedures under its State plan 7 under title XIX of the Social Security Act 8 (42 U.S.C. 1396 et seq.), or a waiver of 9 such plan, after the date of enactment of 10 this Act, is no longer ineligible under 11 clause (i) beginning with the first calendar 12 quarter in which the State has reinstated 13 eligibility standards, methodologies, or pro- 14 cedures that are no more restrictive than 15 the eligibility standards, methodologies, or 16 procedures, respectively, under such plan 17 (or waiver) as in effect on such date. 18 (C) LIMITATION OF MATCHING PAYMENTS 19 TO 100 PERCENT.—In no case shall an increase 20 in Federal matching payments under paragraph 21 (1) result in Federal matching payments that 22 exceed 100 percent of State expenditures. 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00759 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 760 •S 4819 IS (4) REQUIRED REPORT INFORMATION.—The in- 1 formation that is required in the report under para- 2 graph (3)(A) shall include— 3 (A) the results of an evaluation of the im- 4 pact of the implementation of the requirements 5 of paragraph (16) of section 1902(e) of the So- 6 cial Security Act (42 U.S.C. 1396a(e)) on im- 7 proving the State’s processes for enrolling indi- 8 viduals who are released from public institu- 9 tions under the State Medicaid plan; 10 (B) the number of individuals who were 11 automatically enrolled (or whose enrollment was 12 reinstated) under such paragraph during the 1- 13 year period during which the State received in- 14 creased payments under this subsection; and 15 (C) any other information that is required 16 by the Secretary of Health and Human Serv- 17 ices. 18 (c) EFFECTIVE DATE.— 19 (1) IN GENERAL.—Except as provided in para- 20 graph (2), the amendments made by subsection (a) 21 shall take effect 180 days after the date of the en- 22 actment of this Act. 23 (2) RULE FOR CHANGES REQUIRING STATE 24 LEGISLATION.—In the case of a State plan for med- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00760 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 761 •S 4819 IS ical assistance under title XIX of the Social Security 1 Act (42 U.S.C. 1396 et seq.) which the Secretary of 2 Health and Human Services determines requires 3 State legislation (other than legislation appro- 4 priating funds) in order for the plan to meet the ad- 5 ditional requirement imposed by the amendments 6 made by subsection (a), the State plan shall not be 7 regarded as failing to comply with the requirements 8 of such title solely on the basis of its failure to meet 9 this additional requirement before the first day of 10 the first calendar quarter beginning after the close 11 of the first regular session of the State legislature 12 that begins after the date of the enactment of this 13 Act. For purposes of the previous sentence, in the 14 case of a State that has a 2-year legislative session, 15 each year of such session shall be deemed to be a 16 separate regular session of the State legislature. 17 SEC. 758. STOP HIV IN PRISON. 18 (a) SHORT TITLE.—This section may be cited as the 19 ‘‘Stop HIV in Prison Act’’. 20 (b) IN GENERAL.—The Director of the Bureau of 21 Prisons (referred to in this section as the ‘‘Director’’) shall 22 develop a comprehensive policy to provide HIV testing, 23 treatment, and prevention for inmates within the correc- 24 tional setting and upon reentry. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00761 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 762 •S 4819 IS (c) PURPOSE.—The purposes of the policy required 1 to be developed under subsection (b) shall be as follows: 2 (1) To stop the spread of HIV among inmates. 3 (2) To protect prison guards and other per- 4 sonnel from HIV infection. 5 (3) To provide comprehensive medical treat- 6 ment to inmates who are living with HIV. 7 (4) To promote HIV awareness and prevention 8 among inmates. 9 (5) To encourage inmates to take personal re- 10 sponsibility for their health. 11 (6) To reduce the risk that inmates will trans- 12 mit HIV to other persons in the community fol- 13 lowing their release from prison. 14 (d) CONSULTATION.—The Director shall consult with 15 appropriate officials of the Department of Health and 16 Human Services, the Office of National Drug Control Pol- 17 icy, and the Centers for Disease Control and Prevention 18 regarding the development of the policy required under 19 subsection (b). 20 (e) TIME LIMIT.—Not later than 1 year after the 21 date of enactment of this Act, the Director shall draft ap- 22 propriate regulations to implement the policy required to 23 be developed under subsection (b). 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00762 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 763 •S 4819 IS (f) REQUIREMENTS FOR POLICY.—The policy re- 1 quired to be developed under subsection (b) shall provide 2 for the following: 3 (1) TESTING AND COUNSELING UPON IN- 4 TAKE.— 5 (A) Health care personnel shall provide 6 routine HIV testing to all inmates as a part of 7 a comprehensive medical examination imme- 8 diately following admission to a facility. Health 9 care personnel need not provide routine HIV 10 testing to an inmate who is transferred to a fa- 11 cility from another facility if the inmate’s med- 12 ical records are transferred with the inmate and 13 indicate that the inmate has been tested pre- 14 viously. 15 (B) To all inmates admitted to a facility 16 prior to the effective date of this policy, health 17 care personnel shall provide routine HIV testing 18 within no more than 6 months. HIV testing for 19 these inmates may be performed in conjunction 20 with other health services provided to these in- 21 mates by health care personnel. 22 (C) All HIV tests under this paragraph 23 shall comply with the opt-out provision. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00763 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 764 •S 4819 IS (2) PRE-TEST AND POST-TEST COUNSELING.— 1 Health care personnel shall provide confidential pre- 2 test and post-test counseling to all inmates who are 3 tested for HIV. Counseling may be included with 4 other general health counseling provided to inmates 5 by health care personnel. 6 (3) HIV PREVENTION EDUCATION.— 7 (A) Health care personnel shall improve 8 HIV awareness through frequent educational 9 programs for all inmates. HIV educational pro- 10 grams may be provided by community-based or- 11 ganizations, local health departments, and in- 12 mate peer educators. 13 (B) HIV educational materials shall be 14 made available to all inmates at orientation, at 15 health care clinics, at regular educational pro- 16 grams, and prior to release. Both written and 17 audiovisual materials shall be made available to 18 all inmates. 19 (C)(i) The HIV educational programs and 20 materials under this paragraph shall include in- 21 formation on— 22 (I) modes of transmission, including 23 transmission through tattooing, sexual con- 24 tact, and intravenous drug use; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00764 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 765 •S 4819 IS (II) prevention methods; 1 (III) treatment; and 2 (IV) disease progression. 3 (ii) The programs and materials shall be 4 culturally sensitive, written or designed for low- 5 literacy levels, available in a variety of lan- 6 guages, and present scientifically accurate in- 7 formation in a clear and understandable man- 8 ner. 9 (4) HIV TESTING UPON REQUEST.— 10 (A) Health care personnel shall allow in- 11 mates to obtain HIV tests upon request once 12 per year or whenever an inmate has a reason to 13 believe the inmate may have been exposed to 14 HIV. Health care personnel shall, both orally 15 and in writing, inform inmates, during orienta- 16 tion and periodically throughout incarceration, 17 of their right to obtain HIV tests. 18 (B) Health care personnel shall encourage 19 inmates to request HIV tests if the inmate is 20 sexually active, has been raped, uses intra- 21 venous drugs, receives a tattoo, or if the inmate 22 is concerned that the inmate may have been ex- 23 posed to HIV. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00765 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 766 •S 4819 IS (C) An inmate’s request for an HIV test 1 shall not be considered an indication that the 2 inmate has put him/herself at risk of infection 3 and/or committed a violation of prison rules. 4 (5) HIV TESTING OF PREGNANT WOMAN.— 5 (A) Health care personnel shall provide 6 routine HIV testing to all inmates who become 7 pregnant. 8 (B) All HIV tests under this paragraph 9 shall comply with the opt-out provision. 10 (6) COMPREHENSIVE TREATMENT.— 11 (A) Health care personnel shall provide all 12 inmates who test positive for HIV— 13 (i) timely, comprehensive medical 14 treatment; 15 (ii) confidential counseling on man- 16 aging their medical condition and pre- 17 venting its transmission to other persons; 18 and 19 (iii) voluntary partner notification 20 services. 21 (B) Health care provided under this para- 22 graph shall be consistent with current Depart- 23 ment of Health and Human Services guidelines 24 and standard medical practice. Health care per- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00766 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 767 •S 4819 IS sonnel shall discuss treatment options, the im- 1 portance of adherence to antiretroviral therapy, 2 and the side effects of medications with inmates 3 receiving treatment. 4 (C) Health care personnel and pharmacy 5 personnel shall ensure that the facility for- 6 mulary contains all Food and Drug Administra- 7 tion-approved medications necessary to provide 8 comprehensive treatment for inmates living with 9 HIV, and that the facility maintains adequate 10 supplies of such medications to meet inmates’ 11 medical needs. Health care personnel and phar- 12 macy personnel shall also develop and imple- 13 ment automatic renewal systems for these medi- 14 cations to prevent interruptions in care. 15 (D) Correctional staff, health care per- 16 sonnel, and pharmacy personnel shall develop 17 and implement distribution procedures to en- 18 sure timely and confidential access to medica- 19 tions. 20 (7) PROTECTION OF CONFIDENTIALITY.— 21 (A) Health care personnel shall develop 22 and implement procedures to ensure the con- 23 fidentiality of inmate tests, diagnoses, and 24 treatment. Health care personnel and correc- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00767 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 768 •S 4819 IS tional staff shall receive regular training on the 1 implementation of these procedures. Penalties 2 for violations of inmate confidentiality by health 3 care personnel or correctional staff shall be 4 specified and strictly enforced. 5 (B) HIV testing, counseling, and treat- 6 ment shall be provided in a confidential setting 7 where other routine health services are provided 8 and in a manner that allows the inmate to re- 9 quest and obtain these services as routine med- 10 ical services. 11 (8) TESTING, COUNSELING, AND REFERRAL 12 PRIOR TO REENTRY.— 13 (A) Health care personnel shall provide 14 routine HIV testing to all inmates not earlier 15 than 3 months prior to their release and re- 16 entry into the community. Inmates who are al- 17 ready known to be infected need not be tested 18 again. This requirement may be waived if an in- 19 mate’s release occurs without sufficient notice 20 to the Bureau to allow health care personnel to 21 perform a routine HIV test and notify the in- 22 mate of the results. 23 (B) All HIV tests under this paragraph 24 shall comply with the opt-out provision. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00768 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 769 •S 4819 IS (C) To all inmates who test positive for 1 HIV and all inmates who already are known to 2 have HIV, health care personnel shall provide— 3 (i) confidential prerelease counseling 4 on managing their medical condition in the 5 community, accessing appropriate treat- 6 ment and services in the community, and 7 preventing the transmission of their condi- 8 tion to family members and other persons 9 in the community; 10 (ii) referrals to appropriate health 11 care providers and social service agencies 12 in the community that meet the inmate’s 13 individual needs, including voluntary part- 14 ner notification services and prevention 15 counseling services for people living with 16 HIV; and 17 (iii) a 30-day supply of any medically 18 necessary medications the inmate is cur- 19 rently receiving. 20 (9) OPT-OUT PROVISION.—Inmates shall have 21 the right to refuse routine HIV testing. Inmates 22 shall be informed both orally and in writing of this 23 right. Oral and written disclosure of this right may 24 be included with other general health information 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00769 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 770 •S 4819 IS and counseling provided to inmates by health care 1 personnel. If an inmate refuses a routine test for 2 HIV, health care personnel shall make a note of the 3 inmate’s refusal in the inmate’s confidential medical 4 records. However, the inmate’s refusal shall not be 5 considered a violation of prison rules or result in dis- 6 ciplinary action. Any reference in this section to the 7 ‘‘opt-out provision’’ shall be deemed a reference to 8 the requirement of this paragraph. 9 (10) EXCLUSION OF TESTS PERFORMED UNDER 10 SECTION 4014(b) FROM THE DEFINITION OF ROU- 11 TINE HIV TESTING.—HIV testing of an inmate 12 under section 4014(b) of title 18, United States 13 Code, is not routine HIV testing for the purposes of 14 the opt-out provision. Health care personnel shall 15 document the reason for testing under section 16 4014(b) of title 18, United States Code, in the in- 17 mate’s confidential medical records. 18 (11) TIMELY NOTIFICATION OF TEST RE- 19 SULTS.—Health care personnel shall provide timely 20 notification to inmates of the results of HIV tests. 21 (g) CHANGES IN EXISTING LAW.— 22 (1) SCREENING IN GENERAL.—Section 4014(a) 23 of title 18, United States Code, is amended— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00770 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 771 •S 4819 IS (A) by striking ‘‘for a period of 6 months 1 or more’’; 2 (B) by striking ‘‘, as appropriate,’’; and 3 (C) by striking ‘‘if such individual is deter- 4 mined to be at risk for infection with such virus 5 in accordance with the guidelines issued by the 6 Bureau of Prisons relating to infectious disease 7 management’’ and inserting ‘‘unless the indi- 8 vidual declines. The Attorney General shall also 9 cause such individual to be so tested before re- 10 lease unless the individual declines.’’. 11 (2) INADMISSIBILITY OF HIV TEST RESULTS IN 12 CIVIL AND CRIMINAL PROCEEDINGS.—Section 13 4014(d) of title 18, United States Code, is amended 14 by inserting ‘‘or under the Stop HIV in Prison Act’’ 15 after ‘‘under this section’’. 16 (3) SCREENING AS PART OF ROUTINE SCREEN- 17 ING.—Section 4014(e) of title 18, United States 18 Code, is amended by adding at the end the fol- 19 lowing: ‘‘Such rules shall also provide that the initial 20 test under this section be performed as part of the 21 routine health screening conducted at intake.’’. 22 (h) REPORTING REQUIREMENTS.— 23 (1) REPORT ON HEPATITIS, LIVER, AND OTHER 24 DISEASES.—Not later than 1 year after the date of 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00771 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 772 •S 4819 IS enactment of this Act, the Director shall provide a 1 report to the Congress on the policies and proce- 2 dures of the Bureau of Prisons to provide testing, 3 treatment, and prevention education programs for 4 hepatitis, liver failure, and other liver-related dis- 5 eases transmitted through sexual activity, intra- 6 venous drug use, or other means. The Director shall 7 consult with appropriate officials of the Department 8 of Health and Human Services, the Office of Na- 9 tional Drug Control Policy, the Office of National 10 AIDS Policy, and the Centers for Disease Control 11 and Prevention regarding the development of this re- 12 port. 13 (2) ANNUAL REPORTS.— 14 (A) GENERALLY.—Not later than 2 years 15 after the date of enactment of this Act, and 16 then annually thereafter, the Director shall re- 17 port to Congress on the incidence among in- 18 mates of diseases transmitted through sexual 19 activity and intravenous drug use. 20 (B) MATTERS PERTAINING TO VARIOUS 21 DISEASES.—Each report under paragraph (1) 22 shall discuss— 23 (i) the incidence among inmates of 24 HIV, hepatitis, and other diseases trans- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00772 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 773 •S 4819 IS mitted through sexual activity and intra- 1 venous drug use; and 2 (ii) updates on the testing, treatment, 3 and prevention education programs for 4 these diseases conducted by the Bureau of 5 Prisons. 6 (C) MATTERS PERTAINING TO HIV 7 ONLY.—Each report under paragraph (1) shall 8 also include— 9 (i) the number of inmates who tested 10 positive for HIV upon intake; 11 (ii) the number of inmates who tested 12 positive prior to reentry; 13 (iii) the number of inmates who were 14 not tested prior to reentry because they 15 were released without sufficient notice; 16 (iv) the number of inmates who opted- 17 out of taking the test; 18 (v) the number of inmates who were 19 tested under section 4014(b) of title 18, 20 United States Code; and 21 (vi) the number of inmates under 22 treatment for HIV. 23 (D) CONSULTATION.—The Director shall 24 consult with appropriate officials of the Depart- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00773 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 774 •S 4819 IS ment of Health and Human Services, the Office 1 of National Drug Control Policy, and the Cen- 2 ters for Disease Control and Prevention regard- 3 ing the development of each report under para- 4 graph (1). 5 SEC. 759. SUPPORT DATA SYSTEM REVIEW AND INDICA- 6 TORS FOR MONITORING HIV CARE. 7 The Secretary of Health and Human Services, in col- 8 laboration with the Assistant Secretary for Health, the Di- 9 rector of the Office of Infectious Disease and HIV/AIDS 10 Policy, the Director of the Centers for Disease Control and 11 Prevention, the Assistant Secretary for Mental Health and 12 Substance Use, the Director of the Department of Hous- 13 ing and Urban Development, the Director of the Office 14 of AIDS Research, the Administrator of the Health Re- 15 sources and Services Administration, and the Adminis- 16 trator of the Centers for Medicare & Medicaid Services, 17 shall expand and coordinate efforts to align metrics across 18 agencies and modify Federal data systems, to— 19 (1) adopt the National Academy of Medicine’s 20 clinical HIV care indicators as the core metrics for 21 monitoring the quality of HIV care, mental health, 22 substance abuse, and supportive services; 23 (2) better enable assessment of the impact of 24 the National HIV/AIDS Strategy and the Patient 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00774 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 775 •S 4819 IS Protection and Affordable Care Act (Public Law 1 111–148) on improving HIV care and access to sup- 2 portive services for individuals with HIV; 3 (3) expand the demographic data elements to be 4 captured by Federal data systems relevant to HIV 5 care to permit calculation of the indicators for sub- 6 groups of the population of people with diagnosed 7 HIV infection, including— 8 (A) age; 9 (B) race; 10 (C) ethnicity; 11 (D) sex (assigned at birth); 12 (E) gender identity; 13 (F) sexual orientation; 14 (G) current geographic marker of resi- 15 dence; 16 (H) income or poverty level; and 17 (I) primary means of reimbursement for 18 medical services (including a State Medicaid 19 program, the Medicare program, the Ryan 20 White HIV/AIDS Program, private insurance, 21 health maintenance organizations, and no cov- 22 erage); and 23 (4) streamline data collection and systematically 24 review all existing reporting requirements for feder- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00775 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 776 •S 4819 IS ally funded HIV programs to ensure that only essen- 1 tial data are collected. 2 SEC. 760. TRANSFER OF FUNDS FOR IMPLEMENTATION OF 3 ENDING THE HIV EPIDEMIC: A PLAN FOR 4 AMERICA. 5 Title II of the Public Health Service Act (42 U.S.C. 6 202 et seq.) is amended by inserting after section 241 the 7 following: 8 ‘‘SEC. 241A. TRANSFER OF FUNDS FOR IMPLEMENTATION 9 OF NATIONAL HIV/AIDS STRATEGY. 10 ‘‘(a) TRANSFER AUTHORIZATION.—Of the discre- 11 tionary appropriations made available to the Department 12 of Health and Human Services for any fiscal year for pro- 13 grams and activities that, as determined by the Secretary, 14 pertain to HIV, the Secretary may transfer up to 1 per- 15 cent of such appropriations to the Office of the Assistant 16 Secretary for Health for implementation of the Ending the 17 HIV Epidemic: A Plan for America. 18 ‘‘(b) CONGRESSIONAL NOTIFICATION.—Not less than 19 30 days before making any transfer under this section, 20 the Secretary shall give notice of the transfer to the Con- 21 gress. 22 ‘‘(c) DEFINITIONS.—In this section, the term ‘End- 23 ing the HIV Epidemic: A Plan for America’ means the 24 initiative of the Department of Health and Human Serv- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00776 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 777 •S 4819 IS ices that seeks to reduce the number of new HIV infec- 1 tions in the United States by 75 percent by 2025, and 2 then by at least 90 percent by 2030, for an estimated 3 250,000 total HIV infections averted.’’. 4 Subtitle F—Diabetes 5 SEC. 771. RESEARCH, TREATMENT, AND EDUCATION. 6 Subpart 3 of part C of title IV of the Public Health 7 Service Act (42 U.S.C. 285c et seq.) is amended by adding 8 at the end the following new section: 9 ‘‘SEC. 434B. DIABETES IN MINORITY POPULATIONS. 10 ‘‘(a) IN GENERAL.—The Director of NIH shall ex- 11 pand, intensify, and support ongoing research and other 12 activities with respect to prediabetes and diabetes, particu- 13 larly type 2, in minority populations. 14 ‘‘(b) RESEARCH.— 15 ‘‘(1) DESCRIPTION.—Research under subsection 16 (a) shall include investigation into— 17 ‘‘(A) the causes of diabetes, including so- 18 cioeconomic, geographic, clinical, environmental, 19 genetic, and other factors that may contribute 20 to increased rates of diabetes in minority popu- 21 lations; and 22 ‘‘(B) the causes of increased incidence of 23 diabetes complications in minority populations, 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00777 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 778 •S 4819 IS and possible interventions to decrease such inci- 1 dence. 2 ‘‘(2) INCLUSION OF MINORITY PARTICIPANTS.— 3 In conducting and supporting research described in 4 subsection (a), the Director of NIH shall seek to in- 5 clude minority participants as study subjects in clin- 6 ical trials. 7 ‘‘(c) REPORT; COMPREHENSIVE PLAN.— 8 ‘‘(1) IN GENERAL.—The Diabetes Mellitus 9 Interagency Coordinating Committee shall— 10 ‘‘(A) prepare and submit to the Congress, 11 not later than 6 months after the date of enact- 12 ment of this section, a report on Federal re- 13 search and public health activities with respect 14 to prediabetes and diabetes in minority popu- 15 lations; and 16 ‘‘(B) develop and submit to Congress, not 17 later than 1 year after the date of enactment of 18 this section, an effective and comprehensive 19 Federal plan (including all appropriate Federal 20 health programs) to address prediabetes and di- 21 abetes in minority populations. 22 ‘‘(2) CONTENTS.—The report under paragraph 23 (1)(A) shall at minimum address each of the fol- 24 lowing: 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00778 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 779 •S 4819 IS ‘‘(A) Research on diabetes and prediabetes 1 in minority populations, including such research 2 on— 3 ‘‘(i) genetic, behavioral, and environ- 4 mental factors; and 5 ‘‘(ii) prevention and complications 6 among individuals within these populations 7 who have already developed diabetes. 8 ‘‘(B) Surveillance and data collection on 9 diabetes and prediabetes in minority popu- 10 lations, including with respect to— 11 ‘‘(i) efforts to better determine the 12 prevalence of diabetes among Asian-Amer- 13 ican and Pacific Islander subgroups; and 14 ‘‘(ii) efforts to coordinate data collec- 15 tion on the American Indian population. 16 ‘‘(C) Community-based interventions to ad- 17 dress diabetes and prediabetes targeting minor- 18 ity populations, including— 19 ‘‘(i) the evidence base for such inter- 20 ventions; 21 ‘‘(ii) the cultural appropriateness of 22 such interventions; and 23 ‘‘(iii) efforts to educate the public on 24 the causes and consequences of diabetes. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00779 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 780 •S 4819 IS ‘‘(D) Education and training programs for 1 health professionals (including community 2 health workers) on the prevention and manage- 3 ment of diabetes and its related complications 4 that is supported by the Health Resources and 5 Services Administration, including such pro- 6 grams supported by— 7 ‘‘(i) the National Health Service 8 Corps; or 9 ‘‘(ii) the community health centers 10 program under section 330. 11 ‘‘(d) EDUCATION.—The Director of NIH shall— 12 ‘‘(1) through the National Institute on Minority 13 Health and Health Disparities and the National Di- 14 abetes Education Program— 15 ‘‘(A) make grants to programs funded 16 under section 464z–4 for the purpose of estab- 17 lishing a mentoring program for health care 18 professionals to be more involved in weight 19 counseling, obesity research, and nutrition; and 20 ‘‘(B) provide for the participation of mi- 21 nority health professionals in diabetes-focused 22 research programs; and 23 ‘‘(2) make grants for programs to establish a 24 pipeline from high school to professional school that 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00780 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 781 •S 4819 IS will increase minority representation in diabetes-fo- 1 cused health fields by expanding Minority Access to 2 Research Careers program internships and men- 3 toring opportunities for recruitment. 4 ‘‘(e) DEFINITIONS.—For purposes of this section: 5 ‘‘(1) DIABETES MELLITUS INTERAGENCY CO- 6 ORDINATING COMMITTEE.—The ‘Diabetes Mellitus 7 Interagency Coordinating Committee’ means the Di- 8 abetes Mellitus Interagency Coordinating Committee 9 established under section 429. 10 ‘‘(2) MINORITY POPULATION.—The term ‘mi- 11 nority population’ means a racial and ethnic minor- 12 ity group, as defined in section 1707.’’. 13 SEC. 772. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 14 Part B of title III of the Public Health Service Act 15 (42 U.S.C. 243 et seq.), as amended by section 721, is 16 further amended by inserting after section 317W the fol- 17 lowing section: 18 ‘‘SEC. 317X. DIABETES IN MINORITY POPULATIONS. 19 ‘‘(a) RESEARCH AND OTHER ACTIVITIES.— 20 ‘‘(1) IN GENERAL.—The Secretary, acting 21 through the Director of the Centers for Disease 22 Control and Prevention, shall conduct and support 23 research and public health activities with respect to 24 diabetes in minority populations. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00781 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 782 •S 4819 IS ‘‘(2) CERTAIN ACTIVITIES.—Activities under 1 paragraph (1) regarding diabetes in minority popu- 2 lations shall include the following: 3 ‘‘(A) Further enhancing the National 4 Health and Nutrition Examination Survey by 5 oversampling Asian Americans, Native Hawai- 6 ians, and Pacific Islanders in appropriate geo- 7 graphic areas to better determine the preva- 8 lence of diabetes in such populations as well as 9 to improve the data collection of diabetes pene- 10 tration disaggregated into major ethnic groups 11 within such populations. The Secretary shall en- 12 sure that any such oversampling does not re- 13 duce the oversampling of other minority popu- 14 lations including African-American and Latino 15 populations. 16 ‘‘(B) Through the Division of Diabetes 17 Translation— 18 ‘‘(i) providing for prevention research 19 to better understand how to influence 20 health care systems changes to improve 21 quality of care being delivered to such pop- 22 ulations; 23 ‘‘(ii) carrying out model demonstra- 24 tion projects to design, implement, and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00782 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 783 •S 4819 IS evaluate effective diabetes prevention and 1 control interventions for minority popu- 2 lations, including culturally appropriate 3 community-based interventions; 4 ‘‘(iii) developing and implementing a 5 strategic plan to reduce diabetes in minor- 6 ity populations through applied research to 7 reduce disparities and culturally and lin- 8 guistically appropriate community-based 9 interventions; 10 ‘‘(iv) supporting, through the national 11 diabetes prevention program under section 12 399V–3, diabetes prevention program sites 13 in underserved regions highly impacted by 14 diabetes; and 15 ‘‘(v) implementing, through the na- 16 tional diabetes prevention program under 17 section 399V–3, a demonstration program 18 developing new metrics measuring health 19 outcomes related to diabetes that can be 20 stratified by specific minority populations. 21 ‘‘(b) EDUCATION.—The Secretary, acting through 22 the Director of the Centers for Disease Control and Pre- 23 vention, shall direct the Division of Diabetes Translation 24 to conduct and support both programs to educate the pub- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00783 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 784 •S 4819 IS lic on diabetes in minority populations and programs to 1 educate minority populations about the causes and effects 2 of diabetes. 3 ‘‘(c) DIABETES; HEALTH PROMOTION, PREVENTION 4 ACTIVITIES, AND ACCESS.—The Secretary, acting through 5 the Director of the Centers for Disease Control and Pre- 6 vention and the National Diabetes Education Program, 7 shall conduct and support programs to educate specific 8 minority populations through culturally appropriate and 9 linguistically appropriate information campaigns about 10 prevention of, and managing, diabetes. 11 ‘‘(d) DEFINITION.—For purposes of this section, the 12 term ‘minority population’ means a racial and ethnic mi- 13 nority group, as defined in section 1707.’’. 14 SEC. 773. PROGRAMS TO EDUCATE HEALTH PROVIDERS ON 15 THE CAUSES AND EFFECTS OF DIABETES IN 16 MINORITY POPULATIONS. 17 Part P of title III of the Public Health Service Act 18 (42 U.S.C. 280g et seq.), as amended by section 733, is 19 further amended by adding at the end the following new 20 section: 21 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00784 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 785 •S 4819 IS ‘‘SEC. 399V–10. PROGRAMS TO EDUCATE HEALTH PRO- 1 VIDERS ON THE CAUSES AND EFFECTS OF DI- 2 ABETES IN MINORITY POPULATIONS. 3 ‘‘(a) IN GENERAL.—The Secretary, acting through 4 the Director of the Health Resources and Services Admin- 5 istration, shall conduct and support programs described 6 in subsection (b) to educate health professionals on the 7 causes and effects of diabetes in minority populations. 8 ‘‘(b) PROGRAMS.—Programs described in this sub- 9 section, with respect to education on diabetes in minority 10 populations, shall include the following: 11 ‘‘(1) Giving priority, under the primary care 12 training and enhancement program under section 13 747— 14 ‘‘(A) to awarding grants to focus on or ad- 15 dress diabetes; and 16 ‘‘(B) to adding minority populations to the 17 list of vulnerable populations that should be 18 served by such grants. 19 ‘‘(2) Providing additional funds for the Health 20 Careers Opportunity Program, the Centers for Ex- 21 cellence, and the Minority Faculty Fellowship Pro- 22 gram to partner with the Office of Minority Health 23 under section 1707 and the National Institutes of 24 Health to strengthen programs for career opportuni- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00785 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 786 •S 4819 IS ties focused on diabetes treatment and care within 1 underserved regions highly impacted by diabetes. 2 ‘‘(3) Developing a diabetes focus within, and 3 providing additional funds for, the National Health 4 Service Corps scholarship program— 5 ‘‘(A) to place individuals in areas that are 6 disproportionately affected by diabetes and to 7 provide diabetes treatment and care in such 8 areas; and 9 ‘‘(B) to provide such individuals continuing 10 medical education specific to diabetes care.’’. 11 SEC. 774. RESEARCH, EDUCATION, AND OTHER ACTIVITIES 12 REGARDING DIABETES IN AMERICAN INDIAN 13 POPULATIONS. 14 Part P of title III of the Public Health Service Act 15 (42 U.S.C. 280g et seq.), as amended by section 773, is 16 further amended by adding at the end the following sec- 17 tion: 18 ‘‘SEC. 399V–11. RESEARCH, EDUCATION, AND OTHER ACTIVI- 19 TIES REGARDING DIABETES IN AMERICAN IN- 20 DIAN POPULATIONS. 21 ‘‘In addition to activities under sections 317X, 399V– 22 10, and 434B, the Secretary, acting through the Indian 23 Health Service and in collaboration with other appropriate 24 Federal agencies, shall— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00786 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 787 •S 4819 IS ‘‘(1) conduct and support research and other 1 activities with respect to diabetes; and 2 ‘‘(2) coordinate the collection of data on clini- 3 cally and culturally appropriate diabetes treatment, 4 care, prevention, and services by health care profes- 5 sionals to the American Indian population.’’. 6 SEC. 775. UPDATED REPORT ON HEALTH DISPARITIES. 7 The Secretary of Health and Human Services shall 8 seek to enter into an arrangement with the National Acad- 9 emy of Medicine under which the National Academy will— 10 (1) not later than 1 year after the date of en- 11 actment of this Act, submit to Congress an updated 12 version of the 2003 report entitled ‘‘Unequal Treat- 13 ment: Confronting Racial and Ethnic Disparities in 14 Health Care’’; and 15 (2) in such updated version, address how racial 16 and ethnic health disparities have changed since the 17 publication of the original report. 18 Subtitle G—Lung Disease 19 SEC. 776. EXPANSION OF THE NATIONAL ASTHMA EDU- 20 CATION AND PREVENTION PROGRAM. 21 (a) FINDINGS.—Congress finds as follows: 22 (1) The prevalence of asthma has increased 23 since 1980 and affects more than 26,000,000 people 24 in the United States. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00787 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 788 •S 4819 IS (2) Significant disparities in asthma morbidity 1 and mortality exist for both adults and children par- 2 ticularly for low-income and minority populations, 3 particularly African Americans and Puerto Ricans. 4 (3) African-American children are twice as like- 5 ly to have asthma as White children. 6 (4) In 2016, almost 4,500,000 non-Hispanic 7 African Americans reported having asthma. African 8 Americans with asthma are 3 times as likely to visit 9 the emergency department and twice as likely to get 10 hospitalized as White patients with asthma. 11 (5) Puerto Ricans are 3.4 times as likely to die 12 from asthma compared with all other Hispanic or 13 Latino groups. Overall Hispanic Americans are 30 14 percent more likely to be hospitalized for asthma 15 than non-Hispanic Whites. 16 (6) The majority of adults with asthma are 17 women. 18 (b) IN GENERAL.—Not later than 2 years after the 19 date of the enactment of this Act, the Secretary of Health 20 and Human Services shall convene a working group com- 21 prised of patient groups, nonprofit organizations, medical 22 societies, and other relevant governmental and nongovern- 23 mental entities, including those that participate in the Na- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00788 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 789 •S 4819 IS tional Asthma Education and Prevention Program, to de- 1 velop a report to Congress that— 2 (1) catalogs, with respect to asthma prevention, 3 management, and surveillance— 4 (A) the activities of the Federal Govern- 5 ment, including identifying all Federal pro- 6 grams that carry out asthma-related activities, 7 as well as assessment of the progress of the 8 Federal Government and States, with respect to 9 achieving the goals of Healthy People 2020; 10 and 11 (B) the activities of other entities that par- 12 ticipate in the program, including nonprofit or- 13 ganizations, patient advocacy groups, and med- 14 ical societies; and 15 (2) makes recommendations for the future di- 16 rection of asthma activities, in consultation with re- 17 searchers from the National Institutes of Health and 18 other member bodies of the National Asthma Edu- 19 cation and Prevention Program who are qualified to 20 review and analyze data and evaluate interventions, 21 including— 22 (A) a description of how the Federal Gov- 23 ernment may better coordinate and improve its 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00789 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 790 •S 4819 IS response to asthma including identifying any 1 barriers that may exist; 2 (B) a description of how the Federal Gov- 3 ernment may continue, expand, and improve its 4 private-public partnerships with respect to asth- 5 ma including identifying any barriers that may 6 exist; 7 (C) identification of steps that may be 8 taken to reduce the— 9 (i) morbidity, mortality, and overall 10 prevalence of asthma; 11 (ii) financial burden of asthma on so- 12 ciety; 13 (iii) burden of asthma on dispropor- 14 tionately affected areas, particularly those 15 in medically underserved populations (as 16 defined in section 330(b)(3) of the Public 17 Health Service Act (42 U.S.C. 18 254b(b)(3))); and 19 (iv) burden of asthma as a chronic 20 disease; 21 (D) identification of programs and policies 22 that have achieved the steps described in sub- 23 paragraph (C), and steps that may be taken to 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00790 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 791 •S 4819 IS expand such programs and policies to benefit 1 larger populations; and 2 (E) recommendations for future research 3 and interventions. 4 (c) REPORT TO CONGRESS.—At the end of the 5-year 5 period following the submission of the report under this 6 section, the National Asthma Education and Prevention 7 Program shall evaluate the analyses and recommendations 8 under such report and determine whether a new report 9 to the Congress is necessary, and make appropriate rec- 10 ommendations to the Congress. 11 SEC. 777. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 12 FOR DISEASE CONTROL AND PREVENTION. 13 Section 317I of the Public Health Service Act (42 14 U.S.C. 247b–10) is amended to read as follows: 15 ‘‘SEC. 317I. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 16 FOR DISEASE CONTROL AND PREVENTION. 17 ‘‘(a) PROGRAM FOR PROVIDING INFORMATION AND 18 EDUCATION TO THE PUBLIC.—The Secretary, acting 19 through the Director of the Centers for Disease Control 20 and Prevention, shall collaborate with State and local 21 health departments to conduct activities, including the 22 provision of information and education to the public re- 23 garding asthma including— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00791 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 792 •S 4819 IS ‘‘(1) deterring the harmful consequences of un- 1 controlled asthma; and 2 ‘‘(2) disseminating health education and infor- 3 mation regarding prevention of asthma episodes and 4 strategies for managing asthma. 5 ‘‘(b) DEVELOPMENT OF STATE ASTHMA PLANS.— 6 The Secretary, acting through the Director of the Centers 7 for Disease Control and Prevention, shall collaborate with 8 State and local health departments to develop State plans 9 incorporating public health responses to reduce the burden 10 of asthma, particularly regarding disproportionately af- 11 fected populations. 12 ‘‘(c) COMPILATION OF DATA.—The Secretary, acting 13 through the Director of the Centers for Disease Control 14 and Prevention, shall, in cooperation with State and local 15 public health officials— 16 ‘‘(1) conduct asthma surveillance activities to 17 collect data on the prevalence and severity of asth- 18 ma, the effectiveness of public health asthma inter- 19 ventions, and the quality of asthma management, in- 20 cluding— 21 ‘‘(A) collection of household data on the 22 local burden of asthma; 23 ‘‘(B) surveillance of health care facilities; 24 and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00792 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 793 •S 4819 IS ‘‘(C) collection of data not containing indi- 1 vidually identifiable information from electronic 2 health records or other electronic communica- 3 tions; 4 ‘‘(2) compile and annually publish data regard- 5 ing the prevalence and incidence of childhood asth- 6 ma, the child mortality rate, and the number of hos- 7 pital admissions and emergency department visits by 8 children associated with asthma nationally and in 9 each State and at the county level by age, sex, race, 10 and ethnicity, as well as lifetime and current preva- 11 lence; and 12 ‘‘(3) compile and annually publish data regard- 13 ing the prevalence and incidence of adult asthma, 14 the adult mortality rate, and the number of hospital 15 admissions and emergency department visits by 16 adults associated with asthma nationally and in each 17 State and at the county level by age, sex, race, eth- 18 nicity, industry, and occupation, as well as lifetime 19 and current prevalence. 20 ‘‘(d) COORDINATION OF DATA COLLECTION.—The 21 Director of the Centers for Disease Control and Preven- 22 tion, in conjunction with State and local health depart- 23 ments, shall coordinate data collection activities under 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00793 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 794 •S 4819 IS paragraphs (2) and (3) of subsection (c) so as to maximize 1 comparability of results. 2 ‘‘(e) COLLABORATION.—The Centers for Disease 3 Control and Prevention are encouraged to collaborate with 4 national, State, and local nonprofit organizations to pro- 5 vide information and education about asthma, and to 6 strengthen such collaborations when possible. 7 ‘‘(f) ADDITIONAL FUNDING.—In addition to any 8 other authorization of appropriations that is available to 9 the Centers for Disease Control and Prevention for the 10 purpose of carrying out this section, there are authorized 11 to be appropriated to such Centers such sums as may be 12 necessary for each of fiscal years 2021 through 2025 for 13 the purpose of carrying out this section.’’. 14 SEC. 778. INFLUENZA AND PNEUMONIA VACCINATION CAM- 15 PAIGN. 16 (a) IN GENERAL.—The Secretary of Health and 17 Human Services shall— 18 (1) enhance the annual campaign by the De- 19 partment of Health and Human Services to increase 20 the number of people vaccinated each year for influ- 21 enza and pneumonia; and 22 (2) include in such campaign the use of written 23 educational materials, public service announcements, 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00794 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 795 •S 4819 IS physician education, and any other means which the 1 Secretary deems effective. 2 (b) MATERIALS AND ANNOUNCEMENTS.—In carrying 3 out the annual campaign described in subsection (a), the 4 Secretary of Health and Human Services shall ensure 5 that— 6 (1) educational materials and public service an- 7 nouncements are readily and widely available in 8 communities experiencing disparities in the incidence 9 and mortality rates of influenza and pneumonia; and 10 (2) the campaign uses targeted, culturally ap- 11 propriate messages and messengers to reach under- 12 served communities. 13 (c) 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 2021 through 2025. 17 SEC. 779. CHRONIC OBSTRUCTIVE PULMONARY DISEASE 18 ACTION PLAN. 19 (a) FINDINGS.—Congress finds as follows: 20 (1) Chronic obstructive pulmonary disease (re- 21 ferred to in this subsection as ‘‘COPD’’) refers to 22 chronic bronchitis and emphysema, incurable dis- 23 eases that make it difficult to exhale all the air from 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00795 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 796 •S 4819 IS one’s lungs, and that can cause persistent coughing, 1 shortness of breath, and sputum. 2 (2) COPD exacerbations—episodes of acute dif- 3 ficulty breathing and moderate to severe fatigue— 4 are dangerous, and their treatment often requires 5 hospitalization. 6 (3) While smoking is the primary risk factor for 7 COPD, other risk factors include air pollution, occu- 8 pational exposures, heredity, a history of childhood 9 respiratory infections, and socioeconomic status. 10 (4) It is estimated that over 13,500,000 adults 11 in the United States have COPD. 12 (5) COPD is the third-leading cause of death in 13 the United States, claiming over 134,000 lives in 14 2010. 15 (6) Since 2000, deaths for women with COPD 16 have exceeded deaths in men. 17 (7) Although African Americans have a lower 18 prevalence of COPD in the United States, research- 19 ers have shown that African Americans may be 20 underdiagnosed. Furthermore, research has shown 21 that African Americans develop COPD with less cu- 22 mulative smoke exposure and at a younger age. 23 (b) IN GENERAL.—The Director of the Centers for 24 Disease Control and Prevention shall conduct, support, 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00796 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 797 •S 4819 IS and expand public health strategies, prevention, diagnosis, 1 surveillance, and public and professional awareness activi- 2 ties regarding chronic obstructive pulmonary disease. 3 (c) NATIONAL ACTION PLAN.— 4 (1) DEVELOPMENT.—Not later than 2 years 5 after the date of the enactment of this Act, the Di- 6 rector of the National Heart, Lung, and Blood Insti- 7 tute, in consultation with the Director of the Centers 8 for Disease Control and Prevention, shall develop a 9 national action plan to address chronic obstructive 10 pulmonary disease in the United States with partici- 11 pation from patients, caregivers, health profes- 12 sionals, patient advocacy organizations, researchers, 13 providers, public health professionals, and other 14 stakeholders. 15 (2) CONTENTS.—At a minimum, such plan 16 shall include recommendations for— 17 (A) public health interventions for the pur- 18 pose of implementation of the national plan; 19 (B) biomedical, health services, and public 20 health research on chronic obstructive pul- 21 monary disease; and 22 (C) inclusion of chronic obstructive pul- 23 monary disease in the health data collections of 24 all Federal agencies. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00797 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 798 •S 4819 IS (3) CONSIDERATION.—In developing such plan, 1 the Director of the National Heart, Lung, and Blood 2 Institute shall consider the recommendations and 3 findings of the National Academy of Medicine in the 4 report entitled ‘‘A Nationwide Framework for Sur- 5 veillance of Cardiovascular and Chronic Lung Dis- 6 eases’’ (July 22, 2011). 7 (d) CHRONIC DISEASE PREVENTION PROGRAMS.— 8 The Director of the National Heart, Lung, and Blood In- 9 stitute shall carry out the following: 10 (1) Conduct public education and awareness ac- 11 tivities with patient and professional organizations 12 to stimulate earlier diagnosis and improve patient 13 outcomes from treatment of chronic obstructive pul- 14 monary disease. To the extent known and relevant, 15 such public education and awareness activities shall 16 reflect differences in chronic obstructive pulmonary 17 disease by cause (tobacco, environmental, occupa- 18 tional, biological, and genetic) and include a focus 19 on outreach to undiagnosed and, as appropriate, mi- 20 nority populations. 21 (2) Supplement and expand upon the activities 22 of the National Heart, Lung, and Blood Institute by 23 making grants to nonprofit organizations, State and 24 local jurisdictions, and Indian tribes for the purpose 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00798 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 799 •S 4819 IS of reducing the burden of chronic obstructive pul- 1 monary disease, especially in disproportionately im- 2 pacted communities, through public health interven- 3 tions and related activities. 4 (3) Coordinate with the Centers for Disease 5 Control and Prevention, the Indian Health Service, 6 the Health Resources and Services Administration, 7 and the Department of Veterans Affairs to develop 8 pilot programs to demonstrate best practices for the 9 diagnosis and management of chronic obstructive 10 pulmonary disease. 11 (4) Develop improved techniques and identify 12 best practices, in coordination with the Secretary of 13 Veterans Affairs, for assisting chronic obstructive 14 pulmonary disease patients to successfully stop 15 smoking, including identification of subpopulations 16 with different needs. Initiatives under this para- 17 graph may include research to determine whether 18 successful smoking cessation strategies are different 19 for chronic obstructive pulmonary disease patients 20 compared to such strategies for patients with other 21 chronic diseases. 22 (e) ENVIRONMENTAL AND OCCUPATIONAL HEALTH 23 PROGRAMS.—The Director of the Centers for Disease 24 Control and Prevention shall— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00799 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 800 •S 4819 IS (1) support research into the environmental and 1 occupational causes and biological mechanisms that 2 contribute to chronic obstructive pulmonary disease; 3 and 4 (2) develop and disseminate public health inter- 5 ventions that will lessen the impact of environmental 6 and occupational causes of chronic obstructive pul- 7 monary disease. 8 (f) DATA COLLECTION.—Not later than 180 days 9 after the enactment of this Act, the Director of the Na- 10 tional Heart, Lung, and Blood Institute and the Director 11 of the Centers for Disease Control and Prevention, acting 12 jointly, shall assess the depth and quality of information 13 on chronic obstructive pulmonary disease that is collected 14 in surveys and population studies conducted by the Cen- 15 ters for Disease Control and Prevention, including wheth- 16 er there are additional opportunities for information to be 17 collected in the National Health and Nutrition Examina- 18 tion Survey, the National Health Interview Survey, and 19 the Behavioral Risk Factors Surveillance System surveys. 20 The Director of the National Heart, Lung, and Blood In- 21 stitute shall include the results of such assessment in the 22 national action plan under subsection (c). 23 (g) AUTHORIZATION OF APPROPRIATIONS.—There 24 are authorized to be appropriated to carry out this section 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00800 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 801 •S 4819 IS such sums as may be necessary for each of fiscal years 1 2021 through 2025. 2 Subtitle H—Tuberculosis 3 SEC. 781. ELIMINATION OF ALL FORMS OF TUBERCULOSIS. 4 (a) SHORT TITLE.—This subtitle may be cited as the 5 ‘‘End Tuberculosis Act’’. 6 (b) FINDINGS.—Congress makes the following find- 7 ings: 8 (1) In the United States, 9,025 people were di- 9 agnosed with tuberculosis (referred to in this section 10 as ‘‘TB’’) in 2018. 11 (2) Disparities in TB exist and significantly im- 12 pact minority communities in the United States. The 13 Centers for Disease Control and Prevention (re- 14 ferred to in this section as ‘‘CDC’’) finds that 70 15 percent of people diagnosed with TB in 2018 self- 16 identified as racial and ethnic minorities. 17 (3) African Americans comprised 20 percent of 18 people diagnosed with TB during 2018. The popu- 19 lation-adjusted rate of TB among African Americans 20 is 1.7 times higher than the national total, and 8.0 21 times higher than among Whites. 22 (4) Asian Americans, Native Hawaiians, and 23 other Pacific Islanders comprised 37 percent of peo- 24 ple diagnosed with TB during 2018. The population- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00801 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 802 •S 4819 IS adjusted rate of TB among Asian Americans is 6.2 1 times higher than the national total, and 31 times 2 higher than among Whites. The population-adjusted 3 rate of TB among Native Hawaiians and other Pa- 4 cific Islanders is 4.8 times higher than the national 5 total, and 23.2 times higher than among Whites. 6 (5) Hispanics and Latinos comprised 26 per- 7 cent of people diagnosed with TB during 2018. The 8 population-adjusted rate of TB among Hispanics 9 and Latinos is 1.6 times higher than the national 10 total, and 8.0 times higher than among Whites. 11 (6) TB is both preventable and curable, but the 12 current rate of decline of TB in the United States 13 remains too slow to achieve TB elimination in this 14 century. 15 (7) TB is transmitted through the air when a 16 person who has TB disease in their lungs coughs or 17 sneezes. People who are in close proximity to the 18 person with TB can breathe in the TB bacteria, and 19 the bacteria will initially settle in their lungs. With- 20 out proper and timely diagnosis and access to treat- 21 ment, the TB bacteria may grow and spread to 22 other parts of their body. 23 (8) As many as 13,000,000 people in the 24 United States may have latent TB Infection (re- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00802 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 803 •S 4819 IS ferred to in this section as ‘‘LTBI’’). People with 1 LTBI have TB bacteria in their bodies, but their 2 immune system is containing the bacteria, and they 3 are not sick, nor do they have any current risk of 4 spreading TB to others. LTBI can activate into in- 5 fectious, life-threatening TB if not treated. Modeling 6 has shown that eliminating TB is not possible with- 7 out addressing LTBI. 8 (9) Comorbidities associated with TB include 9 cancer, diabetes mellitus, and HIV. People with 10 these medical conditions and compromised immune 11 systems are more likely to develop active TB disease 12 and to have worse outcomes from TB. 13 (10) Forms of active TB that do not show drug 14 resistance are classified as drug-susceptible TB (re- 15 ferred to in this section as ‘‘DS–TB’’). Drug-resist- 16 ant TB (referred to in this section as ‘‘DR–TB’’) is 17 a rising threat to the public health of the United 18 States. DR–TB that exhibits resistance to two or 19 more first-line drugs is referred to as multi-drug re- 20 sistant TB (referred to in this section as ‘‘MDR– 21 TB’’). MDR–TB that also is resistant to at least 22 one injectable second-line medication and at least 23 one fluoroquinolone is classified as extensively drug- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00803 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 804 •S 4819 IS resistant TB (referred to in this section as ‘‘XDR– 1 TB’’). 2 (11) Approximately 97 people in the United 3 States were diagnosed with MDR–TB in 2018. One 4 person was diagnosed with XDR–TB in the same 5 year. 6 (12) In the United States, $480,000,000 was 7 spent in 2018 to treat TB; direct treatment costs 8 average $19,000 to treat a patient with DS–TB, 9 $175,000 to treat a patient with MDR–TB, and 10 $544,000 to treat a patient with XDR–TB. When 11 factoring in productivity losses during treatment, 12 DS–TB averages $46,000, MDR–TB averages 13 $294,000 and XDR–TB averages $694,000. Treat- 14 ment is often difficult, with daily complex multi-pill 15 regimens and injections, with side-effects ranging 16 from hearing and vision loss to mental health issues. 17 (13) Recognizing the public health, economic 18 and societal costs to the threat of MDR–TB, the 19 National Action Plan to Combat MDR–TB was de- 20 veloped by the White House to provide the United 21 States with a comprehensive three-pronged strategy 22 to address MDR–TB by strengthening domestic ca- 23 pacity to combat MDR–TB; improve international 24 capacity and cooperation to combat MDR–TB; accel- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00804 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 805 •S 4819 IS erate basic and applied research and development 1 for new therapies, diagnostics and prevention strate- 2 gies to combat MDR–TB. 3 (14) Additional Federal support is necessary to 4 expand TB control efforts in case finding and treat- 5 ment to address LTBI in a national prevention ini- 6 tiative. Key policy and research breakthroughs in- 7 crease the success of a TB prevention initiative: the 8 U.S. Preventative Services Task Force recommenda- 9 tion’s ‘‘B’’ rating, screening for LTBI among high- 10 risk adults as a covered service increases the likeli- 11 hood that impacted racial and ethnic minority 12 groups can get tested for TB; a new, shorter course 13 treatment regimen reduces the length of treatment 14 for LTBI from every day for 6 to 9 months to one 15 dose per week for 12 weeks, increasing likelihood of 16 treatment completion; and the use of blood-based di- 17 agnostic tests, Interferon-gamma release assays or 18 IGRAs, increases ability to detect LTBI among pa- 19 tients in affected communities. 20 (15) The right to health, and the right to 21 science as a necessary human right to help achieve 22 the right to health, is enshrined in Articles 25 and 23 27 of the Universal Declaration of Human Rights. 24 These fundamental human rights cannot be achieved 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00805 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 806 •S 4819 IS when anyone lacks access to TB prevention or treat- 1 ment, and when the benefits of scientific innovation 2 are not extended to people with all forms of TB. 3 SEC. 782. ADDITIONAL FUNDING FOR STATES IN COM- 4 BATING AND ELIMINATING TUBERCULOSIS. 5 Section 317E(h) of the Public Health Act (42 U.S.C. 6 247b–6(h)) is amended by adding at the end the following: 7 ‘‘(3) ADDITIONAL FUNDING FOR STATES IN 8 COMBATING AND ELIMINATING TUBERCULOSIS.—In 9 addition to amounts otherwise authorized to be ap- 10 propriated to carry out this section, there are au- 11 thorized to be appropriated such sums as may be 12 necessary to carry out this section for each of fiscal 13 years 2020 through 2021.’’. 14 SEC. 783. STRENGTHENING CLINICAL RESEARCH FUNDING 15 FOR TUBERCULOSIS. 16 (a) IN GENERAL.—The Secretary of Health and 17 Human Services shall expand and intensify support for 18 current and prospective research activities of the National 19 Institutes of Health, the Biomedical Advanced Research 20 and Development Authority, and the Centers for Disease 21 Control and Prevention Division of Tuberculosis Elimi- 22 nation to develop new therapeutics, diagnostics, vaccines, 23 and other prevention modalities in addressing all forms 24 of tuberculosis (referred to in this section as ‘‘TB’’). 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00806 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 807 •S 4819 IS (b) INCLUDED RESEARCH ACTIVITIES.—Research 1 activities under subsection (a) shall include— 2 (1) research and development, and pathways to 3 approval, for novel, safe drugs and drug regimens 4 for the treatment of TB, including in adolescent and 5 pediatric populations and in pregnant and lactating 6 women; 7 (2) research to develop rapid diagnostic tests 8 for all forms of TB, including diagnostics that can 9 be used for pediatric populations and people living 10 with HIV, diagnostics that can detect extra pul- 11 monary TB and drug resistance, and diagnostics 12 that can be used at the point of care; 13 (3) research to advance basic knowledge of the 14 pathogenesis of TB and its major comorbidities, in- 15 cluding HIV and diabetes mellitus; 16 (4) research to improve knowledge and under- 17 standings of the role of latency in TB and the fac- 18 tors that increase the risk of latent TB infection 19 progressing to active, symptomatic TB disease; 20 (5) awarding grants and contracts to specifi- 21 cally develop new and needed vaccines to address 22 TB; 23 (6) awarding grants and contracts to support 24 the training and development of clinical researchers 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00807 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 808 •S 4819 IS whose research improves the landscape of tools to 1 combat TB; and 2 (7) awarding grants and contracts to support 3 capacity-building and develop clinical trial site infra- 4 structure in the United States and in TB endemic 5 countries to support the aforementioned research ac- 6 tivities. 7 Subtitle I—Osteoarthritis and 8 Musculoskeletal Diseases 9 SEC. 785. FINDINGS. 10 Congress finds as follows: 11 (1) Eighty percent of African-American women 12 and nearly 74 percent of Hispanic men are either 13 overweight or obese, speeding the onset and progres- 14 sion of arthritis. 15 (2) Arthritis affects 46,000,000 people in the 16 United States, and that number will rise to 17 67,000,000 by the year 2030. 18 (3) Twenty-seven million people in the United 19 States suffer from osteoarthritis, the most common 20 form of arthritis, making it the leading cause of dis- 21 ability in the United States. Osteoarthritis is some- 22 times referred to as degenerative joint disease. 23 (4) Obesity accelerates the onset of arthritis: 70 24 percent of obese adults with mild osteoarthritis of 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00808 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 809 •S 4819 IS the knee at age 60 will develop advanced end-stage 1 disease by age 80. In contrast, just 43 percent of 2 non-obese adults will have end-stage disease over the 3 same time period. 4 (5) Arthritis affects 1 in 5 people in the United 5 States and is the single greatest cause of chronic 6 pain and disability in the United States. 7 (6) Women, African Americans, and Hispanics 8 have more severe arthritis and functional limitations. 9 These same individuals are more likely to be obese, 10 diabetic, and have higher incidence of heart dis- 11 ease—medical conditions that can be improved with 12 physical activity. Instead of moving, however, these 13 groups have an inactivity rate of 40 to 50 percent, 14 which continues to increase. 15 (7) Arthritis costs $128,000,000,000 a year, in- 16 cluding $81,000,000,000 in direct costs (medical) 17 and $47,000,000,000 in indirect costs (lost earn- 18 ings). Each year, $309,000,000,000 in direct and in- 19 direct costs is lost due to disparities in osteoarthritis 20 and musculoskeletal diseases. 21 (8) Obesity and other chronic health conditions 22 exacerbate the debilitating impact of arthritis, lead- 23 ing to inactivity, loss of independence, and a per- 24 petual cycle of comorbid chronic conditions. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00809 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 810 •S 4819 IS (9) Sixty-one percent of arthritis sufferers are 1 women, and women represent 64 percent of an esti- 2 mated 43,000,000 annual visits to physicians’ offices 3 and outpatient clinics where arthritis was the pri- 4 mary diagnosis. Women also represented 60 percent 5 of approximately 1,000,000 hospitalizations that oc- 6 curred in 2003 for which arthritis was the primary 7 diagnosis. 8 (10) Women ages 65 and older have up to 21⁄2 9 times more disabilities than men of the same age. 10 Higher rates of obesity and arthritis among this 11 group explained up to 48 percent of the gender gap 12 in disability, above all other common chronic health 13 conditions. 14 (11) The primary indication for total knee 15 arthroplasty (referred to in this section as ‘‘TKA’’), 16 also known as knee replacement, is relief of signifi- 17 cant, disabling pain caused by severe arthritis. 18 (12) Knee replacement is surgery for people 19 with severe knee damage. Knee replacement can re- 20 lieve pain and allow an individual to be more active. 21 The process for a total knee replacement involves 22 the surgeon removing damaged cartilage and bone 23 from the surface of the knee joint and replacing the 24 cartilage and bone with a man-made surface of 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00810 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 811 •S 4819 IS metal and plastic. In a partial knee replacement, the 1 surgeon only replaces part of the knee joint. 2 (13) Total hip replacement, also called total hip 3 arthroplasty (referred to in this section as ‘‘THA’’), 4 is used if hip pain interferes with daily activities and 5 more conservative treatments have not helped. Ar- 6 thritis damage is the most common reason to need 7 hip replacement. 8 (14) The odds of a family practice physician 9 recommending TKA to a male patient with moderate 10 arthritis are twice that of a female patient, while the 11 odds of an orthopaedic surgeon recommending TKA 12 to a male patient with moderate arthritis are 22 13 times that of a female patient. 14 (15) African Americans with doctor-diagnosed 15 arthritis have a higher prevalence of severe pain at- 16 tributable to arthritis, compared with Whites (34.0 17 percent versus 22.6 percent). African Americans, 18 compared to Whites, report a higher proportion of 19 work limitations (39.5 percent versus 28.0 percent) 20 and a higher prevalence of arthritis-attributable 21 work limitation (6.6 percent versus 4.6 percent). 22 (16) Hispanics are 50 percent more likely than 23 non-Hispanic Whites to report needing assistance 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00811 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 812 •S 4819 IS with at least one instrumental activity of daily living 1 and to have difficulty walking. 2 (17) African Americans and Hispanics were 1.3 3 times more likely to have activity limitation, 1.6 4 times more likely to have work limitations, and 1.9 5 times more likely to have severe joint pain than 6 Whites. 7 (18) In 2003, the National Academy of Medi- 8 cine reported that the rates of TKA and THA 9 among African-American and Hispanic patients are 10 significantly lower than for Whites—even for those 11 with equitable health care coverage such as through 12 Medicare or the Department of Veterans Affairs. 13 (19) According to the Centers for Disease Con- 14 trol and Prevention, in 2000, African-American 15 Medicare enrollees were 37 percent less likely than 16 White Medicare enrollees to undergo total knee re- 17 placements. In 2006, the disparity increased to 39 18 percent. 19 (20) Even after adjusting for insurance and 20 health access, Hispanics and African Americans are 21 almost 50 percent less likely to undergo total knee 22 replacement than Whites. 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00812 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 813 •S 4819 IS SEC. 786. OSTEOARTHRITIS AND OTHER MUSCULO- 1 SKELETAL HEALTH-RELATED ACTIVITIES OF 2 THE CENTERS FOR DISEASE CONTROL AND 3 PREVENTION. 4 (a) EDUCATION AND AWARENESS ACTIVITIES.—The 5 Secretary of Health and Human Services, acting through 6 the Director of the Centers for Disease Control and Pre- 7 vention, shall direct the National Center for Chronic Dis- 8 ease Prevention and Health Promotion to conduct and ex- 9 pand the Health Community Program and Arthritis Pro- 10 gram to educate the public on— 11 (1) the causes of, preventive health actions for, 12 and effects of arthritis and other musculoskeletal 13 conditions in minority patient populations; and 14 (2) the effects of such conditions on other 15 comorbidities including obesity, hypertension, and 16 cardiovascular disease. 17 (b) PROGRAMS ON ARTHRITIS AND MUSCULO- 18 SKELETAL CONDITIONS.—Education and awareness pro- 19 grams of the Centers for Disease Control and Prevention 20 on arthritis and other musculoskeletal conditions in minor- 21 ity communities shall— 22 (1) be culturally and linguistically appropriate 23 to minority patients, targeting musculoskeletal 24 health promotion and prevention programs of each 25 major ethnic group, including— 26 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00813 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 814 •S 4819 IS (A) Native Americans and Alaska Natives; 1 (B) Asian Americans; 2 (C) African Americans and Blacks; 3 (D) Hispanic and Latino Americans; and 4 (E) Native Hawaiians and Pacific Island- 5 ers; and 6 (2) include public awareness campaigns directed 7 toward these patient populations that emphasize the 8 importance of musculoskeletal health, physical activ- 9 ity, diet and healthy lifestyle, and weight reduction 10 for overweight and obese patients. 11 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 12 out this section, there are authorized to be appropriated 13 such sums as are necessary for fiscal year 2021 and each 14 subsequent fiscal year. 15 SEC. 787. GRANTS FOR COMPREHENSIVE OSTEOARTHRITIS 16 AND MUSCULOSKELETAL DISEASE HEALTH 17 EDUCATION WITHIN HEALTH PROFESSIONS 18 SCHOOLS. 19 (a) PROGRAM AUTHORIZED.—The Secretary of 20 Health and Human Services (in this section referred to 21 as the ‘‘Secretary’’), in coordination with the Secretary of 22 Education, shall award grants, on a competitive basis, to 23 academic health science centers, health professions 24 schools, and institutions of higher education to enable 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00814 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 815 •S 4819 IS such centers, schools, and institutions to provide people 1 with comprehensive education on arthritis and musculo- 2 skeletal health, particularly— 3 (1) obesity-related musculoskeletal diseases; 4 (2) arthritis and osteoarthritis; 5 (3) arthritis and musculoskeletal health dispari- 6 ties; and 7 (4) the relationship between arthritis and mus- 8 culoskeletal diseases and metabolic activity, psycho- 9 logical health, and comorbidities such as diabetes, 10 cardiovascular disease, and hypertension. 11 (b) DURATION.—Grants awarded under this section 12 shall be for a period of 5 years. 13 (c) APPLICATIONS.—An academic health science cen- 14 ter, health professions school, or institution of higher edu- 15 cation seeking a grant under this section shall submit an 16 application to the Secretary at such time, in such manner, 17 and containing such information as the Secretary may re- 18 quire. 19 (d) PRIORITY.—In awarding grants under this sec- 20 tion, the Secretary shall give priority to an institution of 21 higher education that— 22 (1) has an enrollment of needy students, as de- 23 fined in section 318(b) of the Higher Education Act 24 of 1965 (20 U.S.C. 1059e(b)); 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00815 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 816 •S 4819 IS (2) is a Hispanic-serving institution, as defined 1 in section 502(a) of such Act (20 U.S.C. 1101a(a)); 2 (3) is a Tribal College or University, as defined 3 in section 316(b) of such Act (20 U.S.C. 1059c(b)); 4 (4) is an Alaska Native-serving institution, as 5 defined in section 317(b) of such Act (20 U.S.C. 6 1059d(b)); 7 (5) is a Native Hawaiian-serving institution, as 8 defined in section 317(b) of such Act (20 U.S.C. 9 1059d(b)); 10 (6) is a Predominately Black Institution, as de- 11 fined in section 318(b) of such Act (20 U.S.C. 12 1059e(b)); 13 (7) is a Native American-serving, non-Tribal in- 14 stitution, as defined in section 319(b) of such Act 15 (20 U.S.C. 1059f(b)); 16 (8) is an Asian American and Native American 17 Pacific Islander-serving institution, as defined in 18 section 320(b) of such Act (20 U.S.C. 1059g(b)); or 19 (9) is a minority institution, as defined in sec- 20 tion 365 of such Act (20 U.S.C. 1067k), with an en- 21 rollment of needy students, as defined in section 312 22 of such Act (20 U.S.C. 1058). 23 (e) USES OF FUNDS.—An academic health science 24 center, health professions school, or institution of higher 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00816 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 817 •S 4819 IS education receiving a grant under this section may use 1 grant funds to integrate issues relating to comprehensive 2 arthritis and musculoskeletal health into the academic or 3 support sectors of the center, school, or institution in 4 order to reach a large number of students, by carrying 5 out 1 or more of the following activities: 6 (1) Developing educational content for issues 7 relating to comprehensive arthritis and musculo- 8 skeletal health education that will be incorporated 9 into first-year orientation or core courses. 10 (2) Creating innovative technology-based ap- 11 proaches to deliver arthritis and musculoskeletal 12 health education to students, faculty, and staff. 13 (3) Developing and employing peer-outreach 14 and education programs to generate discussion, edu- 15 cate, and raise awareness among students about 16 issues relating to arthritis and musculoskeletal 17 health disorders, and their relationship to diabetes, 18 hypertension, cardiovascular disease, psychological 19 health, and other comorbid conditions. 20 (f) REPORT TO CONGRESS.— 21 (1) IN GENERAL.—Not later than 1 year after 22 the date of the enactment of this Act, and annually 23 thereafter for a period of 5 years, the Secretary shall 24 prepare and submit to the appropriate committees of 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00817 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 818 •S 4819 IS Congress a report on the activities to provide health 1 professions students with comprehensive arthritis 2 and musculoskeletal health education funded under 3 this section. 4 (2) REPORT ELEMENTS.—The report described 5 in paragraph (1) shall include information about— 6 (A) the number of entities that are receiv- 7 ing grant funds; 8 (B) the specific activities supported by 9 grant funds; 10 (C) the number of students served by 11 grant programs; and 12 (D) the status of program evaluations. 13 (g) DEFINITION OF INSTITUTION OF HIGHER EDU- 14 CATION.—In this section, the term ‘‘institution of higher 15 education’’ has the meaning given such term in section 16 101(b) of the Higher Education Act of 1965 (20 U.S.C. 17 1001(b)). 18 Subtitle J—Sleep and Circadian 19 Rhythm Disorders 20 SEC. 791. SHORT TITLE; FINDINGS. 21 (a) SHORT TITLE.—This subtitle may be cited as the 22 ‘‘Sleep and Circadian Rhythm Disorders Health Dispari- 23 ties Act’’. 24 (b) FINDINGS.—Congress finds the following: 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00818 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 819 •S 4819 IS (1) Decrements in sleep health such as sleep 1 apnea, insufficient sleep time, and insomnia, affect 2 50,000,000 to 70,000,000 adults in the United 3 States. Twelve to eighteen million United States 4 adults have sleep apnea, a chronic disorder charac- 5 terized by one or more pauses in breathing which 6 can last from a few seconds to minutes. They may 7 occur 30 times or more an hour, disrupting sleep 8 and resulting in excessive daytime sleepiness and 9 loss in productivity. 10 (2) Seventy percent of high school students are 11 not getting enough sleep on school nights, while 33 12 percent of people in the United States get fewer 13 than 7 hours of sleep per night, and roughly 6,000 14 fatal motor vehicle crashes are caused by drowsy 15 drivers. 16 (3) Insufficient sleep and insomnia are more 17 prevalent in women. Women who are pregnant and 18 have sleep apnea are at an increased risk of cardio- 19 vascular complications during pregnancy. The im- 20 pact of disparities in sleep health is associated with 21 a growing number of health problems, including the 22 following: 23 (A) Hypertension. 24 (B) Cancer. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00819 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 820 •S 4819 IS (C) Stroke. 1 (D) Cardiac arrhythmia. 2 (E) Chronic heart failure and heart dis- 3 ease. 4 (F) Diabetes. 5 (G) Cognitive functioning and behavior. 6 (H) Depression and bipolar disorder. 7 (I) Substance abuse. 8 (4) A sleep disparity exists in that poor sleep 9 quality is strongly associated with poverty and race. 10 Factors such as employment, education, and health 11 status, amongst others, significantly mediated this 12 effect only in poor subjects, suggesting a differential 13 vulnerability to these factors in poor relative to 14 nonpoor individuals in the context of sleep quality. 15 (5) African Americans sleep worse than Cauca- 16 sian Americans. African Americans take longer to 17 fall asleep, report poorer sleep quality, have more 18 light and less deep sleep, and nap more often and 19 longer. 20 (6) African Americans and individuals in lower 21 socioeconomic status groups may be at an increased 22 risk for sleep disturbances and associated health 23 consequences. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00820 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 821 •S 4819 IS (7) Among young African Americans, the likeli- 1 hood of having sleep disordered breathing and exhib- 2 iting risk factors for poor sleep is twice that in 3 young Caucasians. Frequent snoring is more com- 4 mon among African-American and Hispanic women 5 and Hispanic men compared to non-Hispanic Cauca- 6 sians, independent of other factors including obesity. 7 (8) African Americans with sleep-disordered 8 breathing develop symptoms at a younger age than 9 Caucasians but appear less likely to be diagnosed 10 and treated in a timely manner. This delay may at 11 least in part be due to reduced access to care. 12 (9) Sleep loss contributes to increased risk for 13 chronic conditions such as obesity, diabetes, and hy- 14 pertension, all of which have increased prevalence in 15 underserved, underrepresented minorities. Racial 16 and ethnic disparities related to obesity may also 17 contribute to disparities in health outcomes related 18 to sleep-disordered breathing. 19 (10) Non-Caucasian adults report an insomnia 20 rate of 12.9 percent compared to only 6.6 percent 21 for Caucasians. 22 (11) African-American women have a higher in- 23 cidence of insomnia than African-American men, 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00821 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 822 •S 4819 IS perhaps related in part to higher risk for chronic 1 persisting symptoms. 2 SEC. 792. SLEEP AND CIRCADIAN RHYTHM DISORDERS RE- 3 SEARCH ACTIVITIES OF THE NATIONAL IN- 4 STITUTES OF HEALTH. 5 (a) IN GENERAL.—The Director of the National In- 6 stitutes of Health, acting through the Director of the Na- 7 tional Heart, Lung, and Blood Institute, shall— 8 (1) continue to expand research activities ad- 9 dressing sleep health disparities; and 10 (2) continue implementation of the NIH Sleep 11 Disorders Research Plan across all institutes and 12 centers of the National Institutes of Health to im- 13 prove treatment and prevention of sleep health dis- 14 parities. 15 (b) REQUIRED RESEARCH ACTIVITIES.—In con- 16 ducting or supporting research relating to sleep and circa- 17 dian rhythm, the Director of the National Heart, Lung, 18 and Blood Institute shall— 19 (1) advance epidemiology and clinical research 20 to achieve a more complete understanding of dispari- 21 ties in domains of sleep health and across population 22 subgroups for which cardiovascular and metabolic 23 health disparities exist, including— 24 (A) prevalence and severity of sleep apnea; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00822 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 823 •S 4819 IS (B) habitual sleep duration; 1 (C) sleep timing and regularity; and 2 (D) insomnia; 3 (2) develop study designs and analytical ap- 4 proaches to explain and predict multilevel and life- 5 course determinants of sleep health and to elucidate 6 the sleep-related causes of cardiovascular and meta- 7 bolic health disparities across the age spectrum, in- 8 cluding such determinants and causes that are— 9 (A) environmental; 10 (B) biological or genetic; 11 (C) psychosocial; 12 (D) societal; 13 (E) political; or 14 (F) economic; 15 (3) determine the contribution of sleep impair- 16 ments such as sleep apnea, insufficient sleep dura- 17 tion, irregular sleep schedules, and insomnia to un- 18 explained disparities in cardiovascular and metabolic 19 risk and disease outcomes; 20 (4) develop study designs, data sampling and 21 collection tools, and analytical approaches to opti- 22 mize understanding of mediating and moderating 23 factors, and feedback mechanisms coupling sleep to 24 cardiovascular and metabolic health disparities; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00823 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 824 •S 4819 IS (5) advance research to understand cultural 1 and linguistic barriers (on the person, provider, or 2 system level) to access to care, medical diagnosis, 3 and treatment of sleep disorders in diverse popu- 4 lation groups; 5 (6) develop and test multilevel interventions (in- 6 cluding sleep health education in diverse commu- 7 nities) to reduce disparities in sleep health that will 8 impact ability to improve disparities in cardio- 9 vascular and metabolic risk or disease; 10 (7) create opportunities to integrate sleep and 11 health disparity science by strategically utilizing re- 12 sources (existing or anticipated cohorts), exchanging 13 scientific data and ideas (cross-over into scientific 14 meetings), and develop multidisciplinary investi- 15 gator-initiated grant applications; and 16 (8) enhance the diversity and foster career de- 17 velopment of young investigators involved in sleep 18 and health disparities science. 19 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 20 out this section, there are authorized to be appropriated 21 such sums as may be necessary for fiscal year 2021 and 22 each subsequent fiscal year. 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00824 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 825 •S 4819 IS SEC. 793. SLEEP AND CIRCADIAN RHYTHM HEALTH DIS- 1 PARITIES-RELATED ACTIVITIES OF THE CEN- 2 TERS FOR DISEASE CONTROL AND PREVEN- 3 TION. 4 (a) IN GENERAL.—The Director of the Centers for 5 Disease Control and Prevention shall conduct, support, 6 and expand public health strategies and prevention, diag- 7 nosis, surveillance, and public and professional awareness 8 activities regarding sleep and circadian rhythm disorders. 9 (b) FINDINGS.—Congress finds as follows: 10 (1) Sleep disorders and sleep deficiency unre- 11 lated to a primary sleep disorder are underdiagnosed 12 and are increasingly detrimental to health status. 13 (2) The consequences to society include addi- 14 tional diseases, motor vehicle accidents, decreased 15 longevity, elevated direct medical costs, and indirect 16 costs related to work absenteeism and property dam- 17 age. 18 (c) REQUIRED SURVEILLANCE AND EDUCATION 19 AWARENESS ACTIVITIES.—In conducting or supporting 20 research relating to sleep and circadian rhythm disorders 21 surveillance and education awareness activities, the Direc- 22 tor of the Centers for Disease Control and Prevention 23 shall— 24 (1) ensure that such activities are culturally 25 and linguistically appropriate to minority patients, 26 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00825 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 826 •S 4819 IS targeting sleep and circadian rhythm health pro- 1 motion and prevention programs of each major eth- 2 nic group, including— 3 (A) Native Americans and Alaska Natives; 4 (B) Asian Americans; 5 (C) African Americans and Blacks; 6 (D) Hispanic and Latino-Americans; and 7 (E) Native Hawaiians and Pacific Island- 8 ers; 9 (2) collect and compile national and State sur- 10 veillance data on sleep disorders health disparities; 11 (3) continue to develop and implement new 12 sleep questions in public health surveillance systems 13 to increase public awareness of sleep health and 14 sleep disorders and their impact on health; 15 (4) publish monthly reports highlighting geo- 16 graphic, racial, and ethnic disparities in sleep health, 17 as well as relationships between insufficient sleep 18 and chronic disease, health risk behaviors, and other 19 outcomes as determined necessary by the Director; 20 and 21 (5) include public awareness campaigns that in- 22 form patient populations from major ethnic groups 23 about the prevalence of sleep and circadian rhythm 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00826 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 827 •S 4819 IS disorders and emphasize the importance of sleep 1 health. 2 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 3 out this section, there are authorized to be appropriated 4 such sums as may be necessary for fiscal year 2021 and 5 each subsequent fiscal year. 6 SEC. 794. GRANTS FOR COMPREHENSIVE SLEEP AND CIR- 7 CADIAN HEALTH EDUCATION WITHIN 8 HEALTH PROFESSIONS SCHOOLS. 9 (a) PROGRAM AUTHORIZED.—The Secretary of 10 Health and Human Services (referred to in this section 11 as the ‘‘Secretary’’), in coordination with the Secretary of 12 Education, shall award grants, on a competitive basis, to 13 academic health science centers, health professions 14 schools, and institutions of higher education to enable 15 such centers, schools, and institutions to provide people 16 with comprehensive education on sleep and circadian 17 health, particularly— 18 (1) poor sleep health; 19 (2) sleep disorders; 20 (3) sleep health disparities; and 21 (4) the relationship between sleep and circadian 22 health on metabolic activity, neurological activity, 23 comorbidities, and other diseases. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00827 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 828 •S 4819 IS (b) DURATION.—Grants awarded under this section 1 shall be for a period of 5 years. 2 (c) APPLICATIONS.—An academic health science cen- 3 ter, health professions school, or institution of higher edu- 4 cation seeking a grant under this section shall submit an 5 application to the Secretary at such time, in such manner, 6 and containing such information as the Secretary may re- 7 quire. 8 (d) PRIORITY.—In awarding grants under this sec- 9 tion, the Secretary shall give priority to an institution of 10 higher education that— 11 (1) has an enrollment of needy students, as de- 12 fined in section 318(b) of the Higher Education Act 13 of 1965 (20 U.S.C. 1059e(b)); 14 (2) is a Hispanic-serving institution, as defined 15 in section 502(a) of such Act (20 U.S.C. 1101a(a)); 16 (3) is a Tribal College or University, as defined 17 in section 316(b) of such Act (20 U.S.C. 1059c(b)); 18 (4) is an Alaska Native-serving institution, as 19 defined in section 317(b) of such Act (20 U.S.C. 20 1059d(b)); 21 (5) is a Native Hawaiian-serving institution, as 22 defined in section 317(b) of such Act (20 U.S.C. 23 1059d(b)); 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00828 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 829 •S 4819 IS (6) is a Predominately Black Institution, as de- 1 fined in section 318(b) of such Act (20 U.S.C. 2 1059e(b)); 3 (7) is a Native American-serving, nontribal in- 4 stitution, as defined in section 319(b) of such Act 5 (20 U.S.C. 1059f(b)); 6 (8) is an Asian American and Native American 7 Pacific Islander-serving institution, as defined in 8 section 320(b) of such Act (20 U.S.C. 1059g(b)); or 9 (9) is a minority institution, as defined in sec- 10 tion 365 of such Act (20 U.S.C. 1067k), with an en- 11 rollment of needy students, as defined in section 312 12 of such Act (20 U.S.C. 1058). 13 (e) USES OF FUNDS.—An academic health science 14 center, health professions school, or institution of higher 15 education receiving a grant under this section may use the 16 grant funds to integrate issues relating to comprehensive 17 sleep and circadian health into the academic or support 18 sectors of the center, school, or institution, in order to 19 reach a large number of students, by carrying out 1 or 20 more of the following activities: 21 (1) Developing educational content for issues 22 relating to comprehensive sleep and circadian health 23 education that will be incorporated into first-year 24 orientation or core courses. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00829 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 830 •S 4819 IS (2) Creating innovative technology-based ap- 1 proaches to deliver sleep health education to stu- 2 dents, faculty, and staff. 3 (3) Developing and employing peer-outreach 4 and education programs to generate discussion, edu- 5 cate, and raise awareness among students about 6 issues relating to poor quality sleep, sleep and circa- 7 dian disorders, and the role sleep health plays in 8 other diseases and comorbidities. 9 (f) REPORT TO CONGRESS.— 10 (1) IN GENERAL.—Not later than 1 year after 11 the date of the enactment of this Act, and annually 12 thereafter for a period of 5 years, the Secretary shall 13 prepare and submit to the appropriate committees of 14 Congress a report on the activities to provide health 15 professions students with comprehensive sleep and 16 circadian health education funded under this section. 17 (2) REPORT ELEMENTS.—The report described 18 in paragraph (1) shall include information about— 19 (A) the number of entities that are receiv- 20 ing grant funds; 21 (B) the specific activities supported by 22 grant funds; 23 (C) the number of students served by 24 grant programs; and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00830 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 831 •S 4819 IS (D) the status of program evaluations. 1 (g) DEFINITION OF INSTITUTION OF HIGHER EDU- 2 CATION.—In this section, the term ‘‘institution of higher 3 education’’ has the meaning given such term in section 4 101(b) of the Higher Education Act of 1965 (20 U.S.C. 5 1001(b)). 6 SEC. 795. REPORT ON IMPACT OF SLEEP AND CIRCADIAN 7 HEALTH DISORDERS IN VULNERABLE AND 8 RACIAL/ETHNIC POPULATIONS. 9 (a) IN GENERAL.—Not later than 1 year after the 10 date of enactment of this Act, the Secretary of Health and 11 Human Services shall submit to Congress and the Presi- 12 dent a report on the impact of sleep and circadian health 13 disorders for racial and ethnic minority communities and 14 other vulnerable populations. 15 (b) CONTENTS.—The report under subsection (a) 16 shall include information on the— 17 (1) progress that has been made in reducing 18 the impact of sleep and circadian health disorders in 19 such communities and populations; 20 (2) opportunities that exist to make additional 21 progress in reducing the impact of sleep and circa- 22 dian health disorders in such communities and popu- 23 lations; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00831 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 832 •S 4819 IS (3) challenges that may impede such additional 1 progress; and 2 (4) Federal funding necessary to achieve sub- 3 stantial reductions in sleep and circadian health dis- 4 orders in racial and ethnic minority communities. 5 Subtitle K—Kidney Disease Re- 6 search, Surveillance, Preven- 7 tion, and Treatment 8 SEC. 797. KIDNEY DISEASE, RESEARCH, SURVEILLANCE, 9 PREVENTION, AND TREATMENT. 10 (a) SHORT TITLE.—This section may be cited as the 11 ‘‘Kidney Disease Research, Surveillance, Prevention and 12 Treatment Improvement Act of 2020’’. 13 (b) FINDINGS.—Congress makes the following find- 14 ings: 15 (1) Kidney diseases impact 37,000,000 individ- 16 uals in the United States. 17 (2) African Americans comprise just 13 percent 18 of the United States population, but 33 percent of 19 the United States dialysis patient population. Com- 20 pared to Caucasians, kidney failure prevalence is 21 about 3.7 times greater in African Americans, 1.4 22 times greater in Native Americans, and 1.5 times 23 greater in Asian Americans. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00832 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 833 •S 4819 IS (3) Peritoneal dialysis and home hemodialysis 1 use is 40–50 percent lower among African Ameri- 2 cans and Hispanics. 3 (4) Every racial and ethnic minority group in 4 the United States is significantly less likely to be 5 treated with home dialysis than Whites, and demo- 6 graphic and clinical characteristics are insufficient to 7 explain this differential use. 8 (5) African Americans on dialysis, irrespective 9 of dialysis modality, and Hispanics undergoing PD 10 or in-center HD, are significantly less likely than 11 their White counterparts to receive a kidney trans- 12 plant. 13 (6) African Americans, Hispanics, and Asian 14 Americans are less likely to receive living donor kid- 15 ney transplants than Whites. Efforts to reduce dis- 16 parities in live donor kidney transplantation for Afri- 17 can-American, Hispanic, and Asian patients with 18 kidney failure have been unsuccessful. 19 (7) Medicare and Medicaid patients are less 20 likely to receive a preemptive transplant from a de- 21 ceased donor compared to private insurance patients 22 (5 percent and 11 percent versus 24 percent), and 23 Black and Hispanic patients are less likely to receive 24 a preemptive transplant from a deceased donor com- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00833 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 834 •S 4819 IS pared with White patients even after changes to the 1 kidney allocation system (5 percent of Black patients 2 and 5 percent of Hispanic patients compared with 3 18 percent of White patients). 4 (8) Low-income populations are significantly 5 more likely to progress to kidney failure. 6 (9) Low socioeconomic status is associated with 7 increased incidence of chronic kidney disease, pro- 8 gression to kidney failure, inadequate dialysis treat- 9 ment, and reduced access to kidney transplantation. 10 (10) The 3 goals of Executive Order 13879 of 11 July 10, 2019 (84 Fed. Reg. 33817; relating to Ad- 12 vancing American Kidney Health), recognizes the 13 need for more transplants, better prevention and 14 education, and improved access to treatment modali- 15 ties. 16 SEC. 798. KIDNEY DISEASE RESEARCH IN MINORITY POPU- 17 LATIONS. 18 (a) IN GENERAL.—The Director of the National In- 19 stitutes of Health shall expand, intensify, and support on- 20 going research and other activities with respect to kidney 21 disease in minority populations. 22 (b) RESEARCH.— 23 (1) DESCRIPTION.—Research under subsection 24 (a) shall include investigation into— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00834 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 835 •S 4819 IS (A) the causes of kidney disease, including 1 socioeconomic, geographic, clinical, environ- 2 mental, genetic, and other factors that may 3 contribute to increased rates of kidney disease 4 in minority populations; and 5 (B) the causes of increased incidence of 6 kidney disease complications in minority popu- 7 lations, and possible interventions to decrease 8 such incidence. 9 (2) INCLUSION OF MINORITY PARTICIPANTS.— 10 In conducting and supporting research described in 11 subsection (a), the Director of the National Insti- 12 tutes of Health shall seek to include minority par- 13 ticipants as study subjects in clinical trials. 14 (c) REPORT; COMPREHENSIVE PLAN.— 15 (1) IN GENERAL.—The Secretary of Health and 16 Human Services shall— 17 (A) prepare and submit to the Congress, 18 not later than 6 months after the date of enact- 19 ment of this section, a report on Federal re- 20 search and public health activities with respect 21 to kidney disease in minority populations; and 22 (B) develop and submit to Congress, not 23 later than 1 year after the date of enactment of 24 this section, an effective and comprehensive 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00835 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 836 •S 4819 IS Federal plan (including all appropriate Federal 1 health programs) to address kidney disease in 2 minority populations. 3 (2) CONTENTS.—The report under paragraph 4 (1)(A) shall at minimum address each of the fol- 5 lowing: 6 (A) Research on kidney disease in minority 7 populations, including such research on— 8 (i) genetic, behavioral, and environ- 9 mental factors; and 10 (ii) prevention and complications 11 among individuals within these populations 12 who have already developed kidney disease. 13 (B) Surveillance and data collection on 14 kidney disease in minority populations, includ- 15 ing with respect to— 16 (i) efforts to better determine the 17 prevalence of kidney disease among Asian- 18 American and Pacific Islander subgroups; 19 and 20 (ii) efforts to coordinate data collec- 21 tion on the American Indian population. 22 (C) Community-based interventions to ad- 23 dress kidney disease targeting minority popu- 24 lations, including— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00836 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 837 •S 4819 IS (i) the evidence base for such inter- 1 ventions; 2 (ii) the cultural appropriateness of 3 such interventions; and 4 (iii) efforts to educate the public on 5 the causes and consequences of kidney dis- 6 ease. 7 (D) Education and training programs for 8 health professionals (including community 9 health workers) on the prevention and manage- 10 ment of kidney disease and its related complica- 11 tions that are supported by the Health Re- 12 sources and Services Administration, including 13 such programs supported by the Bureau of 14 Health Workforce, the Bureau of Primary 15 Health Care, and the Healthcare Systems Bu- 16 reau. 17 SEC. 799. KIDNEY DISEASE ACTION PLAN. 18 (a) IN GENERAL.—The Director of the Centers for 19 Disease Control and Prevention shall conduct, support, 20 and expand public health strategies, prevention, diagnosis, 21 surveillance, and public and professional awareness activi- 22 ties regarding kidney disease. 23 (b) NATIONAL ACTION PLAN.— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00837 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 838 •S 4819 IS (1) DEVELOPMENT.—Not later than 2 years 1 after the date of the enactment of this Act, the Di- 2 rector of the National Institute of Diabetes and Di- 3 gestive and Kidney Diseases, in consultation with 4 the Director of the Centers for Disease Control and 5 Prevention, shall develop a national action plan to 6 address kidney disease in the United States with 7 participation from patients, caregivers, health pro- 8 fessionals, patient advocacy organizations, research- 9 ers, providers, public health professionals, and other 10 stakeholders. 11 (2) CONTENTS.—At a minimum, such plan 12 shall include recommendations for— 13 (A) public health interventions for the pur- 14 pose of implementation of the national plan; 15 (B) biomedical, health services, and public 16 health research on kidney disease; and 17 (C) inclusion of kidney disease in the 18 health data collections of all Federal agencies. 19 (c) KIDNEY DISEASE PREVENTION PROGRAMS.—The 20 Director of the National Institute of Diabetes and Diges- 21 tive and Kidney Diseases shall carry out the following: 22 (1) Conduct public education and awareness ac- 23 tivities with patient and professional organizations 24 to stimulate earlier diagnosis and improve patient 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00838 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 839 •S 4819 IS outcomes from treatment of kidney disease. To the 1 extent known and relevant, such public education 2 and awareness activities shall reflect differences in 3 kidney disease by cause (such as hypertension, dia- 4 betes, and polycystic kidney disease) and include a 5 focus on outreach to undiagnosed and, as appro- 6 priate, minority populations. 7 (2) Supplement and expand upon the activities 8 of the National Institute of Diabetes and Digestive 9 and Kidney Diseases by making grants to nonprofit 10 organizations, State and local jurisdictions, and In- 11 dian tribes for the purpose of reducing the burden 12 of kidney disease, especially in disproportionately im- 13 pacted communities, through public health interven- 14 tions and related activities. 15 (3) Coordinate with the Centers for Disease 16 Control and Prevention, the Indian Health Service, 17 the Health Resources and Services Administration, 18 and the Department of Veterans Affairs to develop 19 pilot programs to demonstrate best practices for the 20 diagnosis and management of kidney disease. 21 (4) Develop improved techniques and identify 22 best practices, in coordination with the Secretary of 23 Veterans Affairs, for assisting kidney disease pa- 24 tients. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00839 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 840 •S 4819 IS (d) DATA COLLECTION.—Not later than 180 days 1 after the date of enactment of this Act, the Director of 2 the National Institute of Diabetes and Digestive and Kid- 3 ney Diseases and the Director of the Centers for Disease 4 Control and Prevention, acting jointly, shall assess the 5 depth and quality of information on kidney disease that 6 is collected in surveys and population studies conducted 7 by the Centers for Disease Control and Prevention, includ- 8 ing whether there are additional opportunities for informa- 9 tion to be collected in the National Health and Nutrition 10 Examination Survey, the National Health Interview Sur- 11 vey, and the Behavioral Risk Factor Surveillance System 12 surveys. The Director of the National Institute of Diabetes 13 and Digestive and Kidney Diseases shall include the re- 14 sults of such assessment in the national action plan under 15 subsection (b). 16 (e) AUTHORIZATION OF APPROPRIATIONS.—There 17 are authorized to be appropriated to carry out this section 18 $1,000,000 for fiscal year 2021, $1,000,000 for fiscal year 19 2022, $1,000,000 for fiscal year 2023, $1,000,000 for fis- 20 cal year 2024, and $1,000,000 for fiscal year 2025. 21 SEC. 799A. HOME DIALYSIS AND INCREASING END-STAGE 22 RENAL DISEASE TREATMENT MODALITIES IN 23 MINORITY COMMUNITIES ACTION PLAN. 24 (a) NATIONAL ACTION PLAN.— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00840 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 841 •S 4819 IS (1) DEVELOPMENT.—Not later than 2 years 1 after the date of the enactment of this Act, the Di- 2 rector of the National Institute of Diabetes and Di- 3 gestive and Kidney Diseases, in consultation with 4 the Director of the Centers for Disease Control and 5 Prevention, shall develop a national action plan to 6 increase the number of home dialyzers and choice in 7 dialysis treatment modality in the United States 8 with participation from patients, caregivers, health 9 professionals, patient advocacy organizations, re- 10 searchers, providers, public health professionals, and 11 other stakeholders in minority communities. 12 (2) CONTENTS.—At a minimum, such plan 13 shall include recommendations for— 14 (A) public health officials for the purpose 15 of implementation of the national plan; 16 (B) biomedical, health services, and public 17 health research on home dialysis and modalities 18 in minority communities; and 19 (C) inclusion of dialysis location and mo- 20 dality in the health data collections of all Fed- 21 eral agencies. 22 (b) AUTHORIZATION OF APPROPRIATIONS.—There 23 are authorized to be appropriated to carry out this section 24 $1,000,000 for fiscal year 2021, $1,000,000 for fiscal year 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00841 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 842 •S 4819 IS 2022, $1,000,000 for fiscal year 2023, $1,000,000 for fis- 1 cal year 2024, and $1,000,000 for fiscal year 2025. 2 SEC. 799B. INCREASING KIDNEY TRANSPLANTS IN MINOR- 3 ITY POPULATIONS. 4 (a) IN GENERAL.—The Director of the National In- 5 stitutes of Health shall expand, intensify, and support on- 6 going research and other activities with respect to kidney 7 transplants in minority populations. 8 (b) RESEARCH.—Research under subsection (a) shall 9 include investigation into— 10 (1) the causes of lower rates of kidney trans- 11 plants in minority populations, including socio- 12 economic, geographic, clinical, environmental, ge- 13 netic, and other factors that may contribute to lower 14 rates of kidney transplants in minority populations; 15 and 16 (2) possible interventions to increase kidney 17 transplants. 18 (c) REPORT; COMPREHENSIVE PLAN.— 19 (1) IN GENERAL.—The Secretary of Health and 20 Human Services shall— 21 (A) prepare and submit to the Congress, 22 not later than 6 months after the date of enact- 23 ment of this section, a report on Federal re- 24 search and public health activities with respect 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00842 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 843 •S 4819 IS to kidney transplants as a treatment for end- 1 stage renal disease in minority populations; and 2 (B) develop and submit to the Congress, 3 not later than 1 year after the date of enact- 4 ment of this section, an effective and com- 5 prehensive Federal plan (including all appro- 6 priate Federal health programs) to increase the 7 number of kidney transplants in minority popu- 8 lations. 9 (2) CONTENTS.—The report under paragraph 10 (1)(A) shall at a minimum address each of the fol- 11 lowing: 12 (A) Research on kidney transplants in mi- 13 nority populations, including such research on 14 financial, insurance coverage, genetic, behav- 15 ioral, and environmental factors. 16 (B) Surveillance and data collection on 17 kidney transplants in minority populations, in- 18 cluding with respect to— 19 (i) efforts to increase kidney trans- 20 plants among Asian-American and Pacific 21 Islander subgroups with end-stage renal 22 disease; and 23 (ii) efforts to increase kidney trans- 24 plants in the American Indian population. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00843 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 844 •S 4819 IS (C) Community-based efforts to increase 1 kidney transplants targeting minority popu- 2 lations, including— 3 (i) the evidence base for such in- 4 creases; 5 (ii) the cultural appropriateness of 6 such increases; and 7 (iii) efforts to educate the public on 8 kidney transplants. 9 (D) Education and training programs for 10 health professionals (including community 11 health workers) on the kidney transplants that 12 are supported by the Health Resources and 13 Services Administration, including such pro- 14 grams supported by the Bureau of Health 15 Workforce, the Bureau of Primary Health Care, 16 and the Healthcare Systems Bureau. 17 SEC. 799C. ENVIRONMENTAL AND OCCUPATIONAL HEALTH 18 PROGRAMS. 19 The Director of the Centers for Disease Control and 20 Prevention shall— 21 (1) support research into the environmental and 22 occupational causes and biological mechanisms that 23 contribute to kidney disease; and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00844 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 845 •S 4819 IS (2) develop and disseminate public health inter- 1 ventions that will lessen the impact of environmental 2 and occupational causes of kidney disease. 3 SEC. 799D. UNDERSTANDING THE TREATMENT PATTERNS 4 ASSOCIATED WITH PROVIDING CARE AND 5 TREATMENT OF KIDNEY FAILURE IN MINOR- 6 ITY POPULATIONS. 7 (a) STUDY.—The Secretary of Health and Human 8 Services (in this section referred to as the ‘‘Secretary’’) 9 shall conduct a study on treatment patterns associated 10 with providing care, under the Medicare program under 11 title XVIII of the Social Security Act (42 U.S.C. 1395 12 et seq.), the Medicaid program under title XIX of such 13 Act (42 U.S.C. 1396 et seq.), and through private health 14 insurance, to minority populations that are disproportion- 15 ately affected by kidney failure. 16 (b) REPORT.—Not later than 1 year after the date 17 of the enactment of this Act, the Secretary shall submit 18 to Congress a report on the study conducted under sub- 19 section (a), together with such recommendations as the 20 Secretary determines to be appropriate. 21 SEC. 799E. IMPROVING ACCESS IN UNDERSERVED AREAS. 22 (a) DEFINITION OF PRIMARY CARE SERVICES.—Sec- 23 tion 331(a)(3)(D) of the Public Health Service Act (42 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00845 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 846 •S 4819 IS U.S.C. 254d(a)(3)(D)) is amended by inserting ‘‘renal di- 1 alysis,’’ after ‘‘dentistry,’’. 2 (b) NATIONAL HEALTH SERVICE CORPS SCHOLAR- 3 SHIP PROGRAM.—Section 338A(a)(2) of the Public Health 4 Service Act (42 U.S.C. 254l(a)(2)) is amended by insert- 5 ing ‘‘, which may include nephrology health professionals’’ 6 before the period at the end. 7 (c) NATIONAL HEALTH SERVICE CORPS LOAN RE- 8 PAYMENT PROGRAM.—Section 338B(a)(2) of the Public 9 Health Service Act (42 U.S.C. 254l–1(a)(2)) is amended 10 by inserting ‘‘, which may include nephrology health pro- 11 fessionals’’ before the period at the end. 12 TITLE VIII—HEALTH 13 INFORMATION TECHNOLOGY 14 SEC. 800. DEFINITIONS. 15 In this title: 16 (1) CERTIFIED ELECTRONIC HEALTH RECORD 17 TECHNOLOGY.—The term ‘‘certified EHR tech- 18 nology’’ has the meaning given such term in section 19 3000 of the Public Health Service Act (42 U.S.C. 20 300jj). 21 (2) EHR.—The term ‘‘EHR’’ means an elec- 22 tronic health record. 23 (3) INTEROPERABILITY.—The term ‘‘interoper- 24 ability’’ has the meaning given such term in section 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00846 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 847 •S 4819 IS 3000 of the Public Health Service Act (42 U.S.C. 1 300jj). Evaluation and measurement of interoper- 2 ability shall consider exchange of electronic health 3 information, usability of exchanged electronic health 4 information, effective application and use of the ex- 5 changed electronic health information, and impact 6 on outcomes of interoperability. 7 (4) ACCESS.—The term ‘‘access’’, with respect 8 to health information, means access described in sec- 9 tion 164.524 of title 45, Code of Federal Regula- 10 tions (or any successor regulations). 11 (5) CERTIFIED ELECTRONIC HEALTH RECORD 12 TECHNOLOGY; EHR.—The terms ‘‘certified electronic 13 health record technology’’ and ‘‘EHR’’ include the 14 health information infrastructure for interoper- 15 ability, access, exchange, and use of electronic health 16 information required under title XXX of the Public 17 Health Service Act (42 U.S.C. 300jj et seq.), and 18 are not limited to electronic health records main- 19 tained by doctors. 20 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00847 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 848 •S 4819 IS Subtitle A—Reducing Health 1 Disparities Through Health IT 2 SEC. 801. HRSA ASSISTANCE TO HEALTH CENTERS FOR 3 PROMOTION OF HEALTH IT. 4 The Secretary of Health and Human Services, acting 5 through the Administrator of the Health Resources and 6 Services Administration, shall expand and intensify the 7 programs and activities of the Administration (directly or 8 through grants or contracts) to provide technical assist- 9 ance and resources to health centers (as defined in section 10 330(a) of the Public Health Service Act (42 U.S.C. 11 254b(a))) to adopt and meaningfully use certified EHR 12 technology for the management of chronic diseases and 13 health conditions and reduction of health disparities. 14 SEC. 802. ASSESSMENT OF IMPACT OF HEALTH IT ON RA- 15 CIAL AND ETHNIC MINORITY COMMUNITIES; 16 OUTREACH AND ADOPTION OF HEALTH IT IN 17 SUCH COMMUNITIES. 18 (a) NATIONAL COORDINATOR FOR HEALTH INFOR- 19 MATION TECHNOLOGY.— 20 (1) IN GENERAL.—Not later than 18 months 21 after the date of enactment of this Act, the National 22 Coordinator for Health Information Technology (re- 23 ferred to in this section as the ‘‘National Coordi- 24 nator’’) shall— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00848 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 849 •S 4819 IS (A) conduct an evaluation of the level of 1 interoperability, access, use, and accessibility of 2 electronic health records in racial and ethnic 3 minority communities, focusing on whether pa- 4 tients in such communities have providers who 5 use electronic health records, and the degree to 6 which patients in such communities can access, 7 exchange, and use without special effort their 8 health information in those electronic health 9 records, and indicating whether such pro- 10 viders— 11 (i) are participating in the Medicare 12 program under title XVIII of the Social 13 Security Act (42 U.S.C. 1395 et seq.) or 14 a State plan under title XIX of such Act 15 (42 U.S.C. 1396 et seq.) (or a waiver of 16 such plan); 17 (ii) have received incentive payments 18 or incentive payment adjustments under 19 Medicare and Medicaid Electronic Health 20 Records Incentive Programs (as defined in 21 subsection (c)(2)); 22 (iii) are MIPS eligible professionals, 23 as defined in paragraph (1)(C) of section 24 1848(q) of the Social Security Act (42 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00849 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 850 •S 4819 IS U.S.C. 1395w–4(q)), for purposes of the 1 Merit-Based Incentive Payment System 2 under such section; or 3 (iv) have been recruited by any of the 4 Health Information Technology Regional 5 Extension Centers established under sec- 6 tion 3012 of the Public Health Service Act 7 (42 U.S.C. 300jj–32); and 8 (B) publish the results of such evaluation 9 including the race and ethnicity of such pro- 10 viders and the populations served by such pro- 11 viders. 12 (2) CERTIFICATION CRITERION.—Not later 13 than 1 year after the date of enactment of this Act, 14 the National Coordinator shall— 15 (A) promulgate a certification criterion and 16 module of certified EHR technology that strati- 17 fies quality measures for purposes of the Merit- 18 Based Incentive Payment System by disparity 19 characteristics, including race, ethnicity, lan- 20 guage, gender, gender identity, sexual orienta- 21 tion, socio-economic status, and disability sta- 22 tus, as such characteristics are defined for pur- 23 poses of certified EHR technology; and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00850 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 851 •S 4819 IS (B) report to the Centers for Medicare & 1 Medicaid Services the quality measures strati- 2 fied by race and at least 2 other disparity char- 3 acteristics. 4 (b) NATIONAL CENTER FOR HEALTH STATISTICS.— 5 As soon as practicable after the date of enactment of this 6 Act, the Director of the National Center for Health Statis- 7 tics shall provide to Congress a more detailed analysis of 8 the data presented in National Center for Health Statis- 9 tics data brief entitled ‘‘Adoption of Certified Electronic 10 Health Record Systems and Electronic Information Shar- 11 ing in Physician Offices: United States, 2013 and 2014’’ 12 (NCHS Data Brief No. 236). 13 (c) CENTERS FOR MEDICARE & MEDICAID SERV- 14 ICES.— 15 (1) IN GENERAL.—As part of the process of 16 collecting information, with respect to a provider, at 17 registration and attestation for purposes of Medicare 18 and Medicaid Electronic Health Records Incentive 19 Programs (as defined in paragraph (2)) or the 20 Merit-Based Incentive Payment System under sec- 21 tion 1848(q) of the Social Security Act (42 U.S.C. 22 1395w–4(q)), the Secretary of Health and Human 23 Services shall collect the race and ethnicity of such 24 provider. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00851 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 852 •S 4819 IS (2) MEDICARE AND MEDICAID ELECTRONIC 1 HEALTH RECORDS INCENTIVE PROGRAMS DE- 2 FINED.—For purposes of paragraph (1), the term 3 ‘‘Medicare and Medicaid Electronic Health Records 4 Incentive Programs’’ means the incentive programs 5 under section 1814(l)(3), subsections (a)(7) and (o) 6 of section 1848, subsections (l) and (m) of section 7 1853, subsections (b)(3)(B)(ix)(I) and (n) of section 8 1886, and subsections (a)(3)(F) and (t) of section 9 1903 of the Social Security Act (42 U.S.C. 10 1395f(l)(3), 1395w–4, 1395w–23, 1395ww, and 11 1396b). 12 (d) NATIONAL COORDINATOR’S ASSESSMENT OF IM- 13 PACT OF HIT.—Section 3001(c)(6)(C) of the Public 14 Health Service Act (42 U.S.C. 300jj–11(c)(6)(C)) is 15 amended— 16 (1) in the heading by inserting ‘‘, RACIAL AND 17 ETHNIC MINORITY COMMUNITIES,’’ after ‘‘HEALTH 18 DISPARITIES’’; 19 (2) by inserting ‘‘, in communities with a high 20 proportion of individuals from racial and ethnic mi- 21 nority groups (as defined in section 1707(g)), in- 22 cluding people with disabilities in these groups,’’ 23 after ‘‘communities with health disparities’’; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00852 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 853 •S 4819 IS (3) by striking ‘‘The National Coordinator’’ and 1 inserting the following: 2 ‘‘(i) IN GENERAL.—The National Co- 3 ordinator’’; and 4 (4) by adding at the end the following: 5 ‘‘(ii) CRITERIA.—In any publication 6 under clause (i), the National Coordinator 7 shall include best practices for encouraging 8 partnerships between the Federal Govern- 9 ment, States, and private entities to ex- 10 pand outreach for and the adoption of cer- 11 tified EHR technology in communities with 12 a high proportion of individuals from racial 13 and ethnic minority groups (as so defined), 14 while also maintaining the accessibility re- 15 quirements of section 508 of the Rehabili- 16 tation Act of 1973 to encourage patient in- 17 volvement in patient health care. The Na- 18 tional Coordinator shall— 19 ‘‘(I) not later than 6 months 20 after the submission of the report re- 21 quired under section 822 of the 22 Health Equity and Accountability Act 23 of 2020, establish criteria for evalu- 24 ating the impact of health information 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00853 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 854 •S 4819 IS technology on communities with a 1 high proportion of individuals from 2 racial and ethnic minority groups (as 3 so defined) taking into account the 4 findings in such report; and 5 ‘‘(II) not later than 1 year after 6 the submission of such report, conduct 7 and publish the results of an evalua- 8 tion of such impact.’’. 9 SEC. 803. NONDISCRIMINATION AND HEALTH EQUITY IN 10 HEALTH INFORMATION TECHNOLOGY. 11 (a) IN GENERAL.—Covered entities shall ensure that 12 electronic and information technology in their health pro- 13 grams or activities does not exclude individuals from par- 14 ticipation in, deny individuals the benefits of, or subject 15 individuals to discrimination under any health program or 16 activity on the basis of race, color, national origin, sex, 17 age, or disability. 18 (b) COVERED ENTITIES.—In this section, the term 19 ‘‘covered entity’’ means— 20 (1) an entity that operates a health program or 21 activity, any part of which receives Federal financial 22 assistance; 23 (2) an entity established under title I of the Pa- 24 tient Protection and Affordable Care Act (Public 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00854 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 855 •S 4819 IS Law 114–148) that administers a health program or 1 activity; or 2 (3) the Department of Health and Human 3 Services. 4 SEC. 804. LANGUAGE ACCESS IN HEALTH INFORMATION 5 TECHNOLOGY. 6 The National Coordinator shall— 7 (1) not later than 18 months after the date of 8 enactment of this Act, propose a rule for providing 9 access to patients, through certified EHR tech- 10 nology, to their personal health information in a 11 computable format, including using patient portals 12 or third-party applications (as described in section 13 3009(e) of the Public Health Service Act (42 U.S.C. 14 300jj–19(e))), in the 10 most common non-English 15 languages; 16 (2) hold a public hearing to identify best prac- 17 tices for carrying out paragraph (1); and 18 (3) not later than 6 months after the public 19 hearing under paragraph (2), promulgate a final 20 regulation with respect to paragraph (1). 21 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00855 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 856 •S 4819 IS Subtitle B—Modifications To 1 Achieve Parity in Existing Pro- 2 grams 3 SEC. 811. EXTENDING FUNDING TO STRENGTHEN THE 4 HEALTH IT INFRASTRUCTURE IN RACIAL 5 AND ETHNIC MINORITY COMMUNITIES. 6 Section 3011 of the Public Health Service Act (42 7 U.S.C. 300jj–31) is amended— 8 (1) in subsection (a), in the matter preceding 9 paragraph (1), by inserting ‘‘, including with respect 10 to communities with a high proportion of individuals 11 from racial and ethnic minority groups (as defined 12 in section 1707(g))’’ before the colon; and 13 (2) by adding at the end the following new sub- 14 section: 15 ‘‘(e) ANNUAL REPORT ON EXPENDITURES.—The 16 National Coordinator shall report annually to Congress on 17 activities and expenditures under this section.’’. 18 SEC. 812. EXTENDING COMPETITIVE GRANTS FOR THE DE- 19 VELOPMENT OF LOAN PROGRAMS TO FACILI- 20 TATE ADOPTION OF CERTIFIED EHR TECH- 21 NOLOGY BY PROVIDERS SERVING RACIAL 22 AND ETHNIC MINORITY GROUPS. 23 Section 3014(e) of the Public Health Service Act (42 24 U.S.C. 300jj–34(e)) is amended, in the matter preceding 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00856 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 857 •S 4819 IS paragraph (1), by inserting ‘‘, including with respect to 1 communities with a high proportion of individuals from 2 racial and ethnic minority groups (as defined in section 3 1707(g))’’ after ‘‘health care provider to’’. 4 SEC. 813. AUTHORIZATION OF APPROPRIATIONS. 5 Section 3018 of the Public Health Service Act (42 6 U.S.C. 300jj–38) is amended by striking ‘‘fiscal years 7 2009 through 2013’’ and inserting ‘‘fiscal years 2021 8 through 2026’’. 9 Subtitle C—Additional Research 10 and Studies 11 SEC. 821. DATA COLLECTION AND ASSESSMENTS CON- 12 DUCTED IN COORDINATION WITH MINORITY- 13 SERVING INSTITUTIONS. 14 Section 3001(c)(6) of the Public Health Service Act 15 (42 U.S.C. 300jj–11(c)(6)) is amended by adding at the 16 end the following new subparagraph: 17 ‘‘(F) DATA COLLECTION AND ASSESS- 18 MENTS CONDUCTED IN COORDINATION WITH 19 MINORITY-SERVING INSTITUTIONS.— 20 ‘‘(i) IN GENERAL.—In carrying out 21 subparagraph (C) with respect to commu- 22 nities with a high proportion of individuals 23 from racial and ethnic minority groups (as 24 defined in section 1707(g)), the National 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00857 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 858 •S 4819 IS Coordinator shall, to the greatest extent 1 possible, coordinate with an entity de- 2 scribed in clause (ii). 3 ‘‘(ii) MINORITY-SERVING INSTITU- 4 TIONS.—For purposes of clause (i), an en- 5 tity described in this clause is a historically 6 black college or university, a Hispanic-serv- 7 ing institution, a Tribal College or Univer- 8 sity, or an Asian-American-, Native Amer- 9 ican-, or Pacific Islander-serving institu- 10 tion with an accredited public health, 11 health policy, or health services research 12 program.’’. 13 SEC. 822. STUDY OF HEALTH INFORMATION TECHNOLOGY 14 IN MEDICALLY UNDERSERVED COMMU- 15 NITIES. 16 (a) IN GENERAL.—Not later than 2 years after the 17 date of enactment of this Act, the Secretary of Health and 18 Human Services shall— 19 (1) enter into an agreement with the National 20 Academies of Sciences, Engineering, and Medicine to 21 conduct a study on the development, implementa- 22 tion, and effectiveness of health information tech- 23 nology within medically underserved areas (as de- 24 scribed in subsection (c)); and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00858 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 859 •S 4819 IS (2) submit a report to Congress describing the 1 results of such study, including any recommenda- 2 tions for legislative or administrative action. 3 (b) STUDY.—The study described in subsection 4 (a)(1) shall— 5 (1) identify barriers to successful implementa- 6 tion of health information technology in medically 7 underserved areas; 8 (2) survey a cross-section of individuals in 9 medically underserved areas and report their opin- 10 ions about the various topics of study; 11 (3) examine the degree of interoperability 12 among health information technology and users of 13 health information technology in medically under- 14 served areas, including patients, providers, and com- 15 munity services; 16 (4) examine the impact of health information 17 technology on providing quality care and reducing 18 the cost of care to individuals in such areas, includ- 19 ing the impact of such technology on improved 20 health outcomes for individuals, including which 21 technology worked for which population and how it 22 improved health outcomes for that population; 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00859 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 860 •S 4819 IS (5) examine the impact of health information 1 technology on improving health care-related deci- 2 sions by both patients and providers in such areas; 3 (6) identify specific best practices for using 4 health information technology to foster the con- 5 sistent provision of physical accessibility and reason- 6 able policy accommodations in health care to individ- 7 uals with disabilities in such areas; 8 (7) assess the feasibility and costs associated 9 with the use of health information technology in 10 such areas; 11 (8) evaluate whether the adoption and use of 12 qualified electronic health records (as defined in sec- 13 tion 3000 of the Public Health Service Act (42 14 U.S.C. 300jj)) is effective in reducing health dispari- 15 ties, including analysis of clinical quality measures 16 reported by providers who are participating in the 17 Medicare program under title XVIII of the Social 18 Security Act (42 U.S.C. 1395 et seq.) or a State 19 plan under title XIX of such Act (42 U.S.C. 1396 20 et seq.) (or a waiver of such plan), pursuant to pro- 21 grams to encourage the adoption and use of certified 22 EHR technology; 23 (9) identify providers in medically underserved 24 areas that are not electing to adopt and use elec- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00860 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 861 •S 4819 IS tronic health records and determine what barriers 1 are preventing those providers from adopting and 2 using such records; and 3 (10) examine urban and rural community 4 health systems and determine the impact that health 5 information technology may have on the capacity of 6 primary health providers in those systems. 7 (c) MEDICALLY UNDERSERVED AREA.—The term 8 ‘‘medically underserved area’’ means— 9 (1) a population that has been designated as a 10 medically underserved population under section 11 330(b)(3) of the Public Health Service Act (42 12 U.S.C. 254b(b)(3)); 13 (2) an area that has been designated as a 14 health professional shortage area under section 332 15 of the Public Health Service Act (42 U.S.C. 254e); 16 (3) an area or population that has been des- 17 ignated as a medically underserved community under 18 section 799B of the Public Health Service Act (42 19 U.S.C. 295p); or 20 (4) another area or population that— 21 (A) experiences significant barriers to ac- 22 cessing quality health services; and 23 (B) has a high prevalence of diseases or 24 conditions described in title VII, with such dis- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00861 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 862 •S 4819 IS eases or conditions having a disproportionate 1 impact on racial and ethnic minority groups (as 2 defined in section 1707(g) of the Public Health 3 Service Act (42 U.S.C. 300u–6(g))) or a sub- 4 group of people with disabilities who have spe- 5 cific functional impairments. 6 SEC. 823. ASSESSMENT OF USE AND MISUSE OF DE-IDENTI- 7 FIED HEALTH DATA. 8 (a) IN GENERAL.—Not later than 18 months after 9 the date of enactment of this Act, the Secretary of Health 10 and Human Services shall— 11 (1) enter into an agreement with the Office of 12 the National Coordinator to conduct a study, in con- 13 sultation with relevant stakeholders, on the impact 14 of digital health technology on medically underserved 15 areas (as described in section 822(c)); and 16 (2) submit a report to Congress describing the 17 results of such study, including any recommenda- 18 tions for legislative or administrative action. 19 (b) STUDY.—The study described in subsection 20 (a)(1) shall— 21 (1) examine the overall prevalence, and histor- 22 ical and existing practices and their respective preva- 23 lence, of use and misuse of de-identified protected 24 health information, as defined in section 160.103, 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00862 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 863 •S 4819 IS title 45, Code of Federal Regulations (or any suc- 1 cessor regulations), to discriminate against or ben- 2 efit medically underserved areas; 3 (2) identify best practices and tools to leverage 4 the benefits and prevent misuse of de-identified pro- 5 tected health information to discriminate against 6 medically underserved areas; 7 (3) examine the overall prevalence, and histor- 8 ical and existing practices and their respective preva- 9 lence, of use and misuse of de-identified personal 10 health information other than protected health infor- 11 mation, as defined in section 160.103, title 45, Code 12 of Federal Regulations (or any successor regula- 13 tions), to discriminate against or benefit medically 14 underserved areas; and 15 (4) identify best practices and tools to leverage 16 the benefits and prevent misuse of de-identified per- 17 sonal health information other than protected health 18 information to discriminate against medically under- 19 served areas. 20 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00863 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 864 •S 4819 IS Subtitle D—Closing Gaps in 1 Funding To Adopt Certified EHRs 2 SEC. 831. EXTENDING MEDICAID EHR INCENTIVE PAY- 3 MENTS TO REHABILITATION FACILITIES, 4 LONG-TERM CARE FACILITIES, AND HOME 5 HEALTH AGENCIES. 6 (a) IN GENERAL.—Section 1903(t)(2)(B) of the So- 7 cial Security Act (42 U.S.C. 1396b(t)(2)(B)) is amend- 8 ed— 9 (1) in clause (i), by striking ‘‘, or’’ and insert- 10 ing a semicolon; 11 (2) in clause (ii), by striking the period at the 12 end and inserting a semicolon; and 13 (3) by inserting after clause (ii) the following 14 new clauses: 15 ‘‘(iii) a rehabilitation facility (as defined in sec- 16 tion 1886(j)(1)) that furnishes acute or subacute re- 17 habilitation services; 18 ‘‘(iv) a long-term care hospital (as defined in 19 section 1886(d)(1)(B)(iv)); or 20 ‘‘(v) a home health agency (as defined in sec- 21 tion 1861(o)).’’. 22 (b) EFFECTIVE DATE.—The amendment made by 23 subsection (a) shall apply with respect to amounts ex- 24 pended under section 1903(a)(3)(F) of the Social Security 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00864 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 865 •S 4819 IS Act (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters be- 1 ginning on or after the date of the enactment of this Act. 2 SEC. 832. EXTENDING PHYSICIAN ASSISTANT ELIGIBILITY 3 FOR MEDICAID ELECTRONIC HEALTH 4 RECORD INCENTIVE PAYMENTS. 5 (a) IN GENERAL.—Section 1903(t)(3)(B)(v) of the 6 Social Security Act (42 U.S.C. 1396b(t)(3)(B)(v)) is 7 amended to read as follows: 8 ‘‘(v) physician assistant.’’. 9 (b) EFFECTIVE DATE.—The amendment made by 10 subsection (a) shall apply with respect to amounts ex- 11 pended under section 1903(a)(3)(F) of the Social Security 12 Act (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters be- 13 ginning on or after the date of the enactment of this Act. 14 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00865 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 866 •S 4819 IS TITLE IX—ACCOUNTABILITY 1 AND EVALUATION 2 SEC. 901. PROHIBITION ON DISCRIMINATION IN FEDERAL 3 ASSISTED HEALTH CARE SERVICES AND RE- 4 SEARCH PROGRAMS ON THE BASIS OF SEX 5 (INCLUDING SEX ORIENTATION, GENDER 6 IDENTITY, AND PREGNANCY, INCLUDING 7 TERMINATION OF PREGNANCY), RACE, 8 COLOR, NATIONAL ORIGIN, MARITAL STATUS, 9 FAMILIAL STATUS, SEXUAL ORIENTATION, 10 GENDER IDENTITY, OR DISABILITY STATUS. 11 (a) IN GENERAL.—No person in the United States 12 shall, on the basis of sex (including sex orientation, gender 13 identity, and pregnancy, including termination of preg- 14 nancy), race, color, national origin, marital status, familial 15 status, sexual orientation, gender identity, or disability 16 status, be excluded from participation in, be denied the 17 benefits of, or be subjected to discrimination under any 18 health program or activity, including any health research 19 program or activity, receiving Federal financial assistance, 20 including credits, subsidies, or contracts of insurance or 21 any health program or activity that is administered by an 22 executive agency. 23 (b) DEFINITION.—In this section, the term ‘‘familial 24 status’’ means, with respect to one or more individuals— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00866 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 867 •S 4819 IS (1) being domiciled with any individual related 1 by blood or affinity whose close association with the 2 individual is the equivalent of a family relationship; 3 (2) being in the process of securing legal cus- 4 tody of any individual; or 5 (3) being pregnant. 6 SEC. 902. TREATMENT OF MEDICARE PAYMENTS UNDER 7 TITLE VI OF THE CIVIL RIGHTS ACT OF 1964. 8 A payment to a provider of services, physician, or 9 other supplier under part B, C, or D of title XVIII of 10 the Social Security Act shall be deemed a grant, and not 11 a contract of insurance or guaranty, for the purposes of 12 title VI of the Civil Rights Act of 1964. 13 SEC. 903. ACCOUNTABILITY AND TRANSPARENCY WITHIN 14 THE DEPARTMENT OF HEALTH AND HUMAN 15 SERVICES. 16 Title XXXIV of the Public Health Service Act, as 17 amended by titles I, II, and III of this Act, is further 18 amended by inserting after subtitle C the following: 19 ‘‘Subtitle D—Strengthening 20 Accountability 21 ‘‘SEC. 3441. ELEVATION OF THE OFFICE OF CIVIL RIGHTS. 22 ‘‘(a) IN GENERAL.—The Secretary shall establish 23 within the Office for Civil Rights an Office of Health Dis- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00867 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 868 •S 4819 IS parities, which shall be headed by a director to be ap- 1 pointed by the Secretary. 2 ‘‘(b) PURPOSE.—The Office of Health Disparities 3 shall ensure that the health programs, activities, and oper- 4 ations of health entities that receive Federal financial as- 5 sistance are in compliance with title VI of the Civil Rights 6 Act, including through the following activities: 7 ‘‘(1) The development and implementation of 8 an action plan to address racial and ethnic health 9 care disparities, which shall address concerns relat- 10 ing to the Office for Civil Rights as released by the 11 United States Commission on Civil Rights in the re- 12 port entitled ‘Health Care Challenge: Acknowledging 13 Disparity, Confronting Discrimination, and Ensur- 14 ing Equity’ (September 1999) in conjunction with 15 the reports by the National Academy of Sciences 16 (formerly known as the Institute of Medicine) enti- 17 tled ‘Unequal Treatment: Confronting Racial and 18 Ethnic Disparities in Health Care’, ‘Crossing the 19 Quality Chasm: A New Health System for the 21st 20 Century’, ‘In the Nation’s Compelling Interest: En- 21 suring Diversity in the Health Care Workforce’, 22 ‘The National Partnership for Action to End Health 23 Disparities’, and ‘The Health of Lesbian, Gay, Bi- 24 sexual, and Transgender People’, and other related 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00868 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 869 •S 4819 IS reports by the National Academy of Sciences. This 1 plan shall be publicly disclosed for review and com- 2 ment and the final plan shall address any comments 3 or concerns that are received by the Office. 4 ‘‘(2) Investigative and enforcement actions 5 against intentional discrimination and policies and 6 practices that have a disparate impact on minorities. 7 ‘‘(3) The review of racial, ethnic, gender iden- 8 tity, sexual orientation, sex, disability status, socio- 9 economic status, and primary language health data 10 collected by Federal health agencies to assess health 11 care disparities related to intentional discrimination 12 and policies and practices that have a disparate im- 13 pact on minorities. Such review shall include an as- 14 sessment of health disparities in communities with a 15 combination of these classes. 16 ‘‘(4) Outreach and education activities relating 17 to compliance with title VI of the Civil Rights Act. 18 ‘‘(5) The provision of technical assistance for 19 health entities to facilitate compliance with title VI 20 of the Civil Rights Act. 21 ‘‘(6) Coordination and oversight of activities of 22 the civil rights compliance offices established under 23 section 3442. 24 ‘‘(7) Ensuring— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00869 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 870 •S 4819 IS ‘‘(A) at a minimum, compliance with the 1 most recent version of the Office of Manage- 2 ment and Budget statistical policy directive en- 3 titled ‘Standards for Maintaining, Collecting, 4 and Presenting Federal Data on Race and Eth- 5 nicity’; and 6 ‘‘(B) consideration of available data and 7 language standards such as— 8 ‘‘(i) the standards for collecting and 9 reporting data under section 3101; and 10 ‘‘(ii) the National Standards on Cul- 11 turally and Linguistically Appropriate 12 Services of the Office of Minority Health. 13 ‘‘(c) FUNDING AND STAFF.—The Secretary shall en- 14 sure the effectiveness of the Office of Health Disparities 15 by ensuring that the Office is provided with— 16 ‘‘(1) adequate funding to enable the Office to 17 carry out its duties under this section; and 18 ‘‘(2) staff with expertise in— 19 ‘‘(A) epidemiology; 20 ‘‘(B) statistics; 21 ‘‘(C) health quality assurance; 22 ‘‘(D) minority health and health dispari- 23 ties; 24 ‘‘(E) cultural and linguistic competency; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00870 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 871 •S 4819 IS ‘‘(F) civil rights; and 1 ‘‘(G) social, behavioral, and economic de- 2 terminants of health. 3 ‘‘(d) REPORT.—Not later than December 31, 2021, 4 and annually thereafter, the Secretary, in collaboration 5 with the Director of the Office for Civil Rights and the 6 Deputy Assistant Secretary for Minority Health, shall 7 submit a report to the Committee on Health, Education, 8 Labor, and Pensions of the Senate and the Committee on 9 Energy and Commerce of the House of Representatives 10 that includes— 11 ‘‘(1) the number of cases filed, broken down by 12 category; 13 ‘‘(2) the number of cases investigated and 14 closed by the office; 15 ‘‘(3) the outcomes of cases investigated; 16 ‘‘(4) the staffing levels of the office including 17 staff credentials; 18 ‘‘(5) the number of other lingering and emerg- 19 ing cases in which civil rights inequities can be dem- 20 onstrated; and 21 ‘‘(6) the number of cases remaining open and 22 an explanation for their open status. 23 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 24 are authorized to be appropriated to carry out this section 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00871 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 872 •S 4819 IS such sums as may be necessary for each of fiscal years 1 2021 through 2026. 2 ‘‘SEC. 3442. ESTABLISHMENT OF HEALTH PROGRAM OF- 3 FICES FOR CIVIL RIGHTS WITHIN FEDERAL 4 HEALTH AND HUMAN SERVICES AGENCIES. 5 ‘‘(a) IN GENERAL.—The Secretary shall establish 6 civil rights compliance offices in each agency within the 7 Department of Health and Human Services that admin- 8 isters health programs. 9 ‘‘(b) PURPOSE OF OFFICES.—Each office established 10 under subsection (a) shall ensure that recipients of Fed- 11 eral financial assistance under Federal health programs 12 administer programs, services, and activities in a manner 13 that— 14 ‘‘(1) does not discriminate, either intentionally 15 or in effect, on the basis of race, national origin, lan- 16 guage, ethnicity, sex, age, disability, sexual orienta- 17 tion, and gender identity; and 18 ‘‘(2) promotes the reduction and elimination of 19 disparities in health and health care based on race, 20 national origin, language, ethnicity, sex, age, dis- 21 ability, sexual orientation, and gender identity. 22 ‘‘(c) POWERS AND DUTIES.—The offices established 23 in subsection (a) shall have the following powers and du- 24 ties: 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00872 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 873 •S 4819 IS ‘‘(1) The establishment of compliance and pro- 1 gram participation standards for recipients of Fed- 2 eral financial assistance under each program admin- 3 istered by the applicable agency, including the estab- 4 lishment of disparity reduction standards to encom- 5 pass disparities in health and health care related to 6 race, national origin, language, ethnicity, sex, age, 7 disability, sexual orientation, and gender identity. 8 ‘‘(2) The development and implementation of 9 program-specific guidelines that interpret and apply 10 Department of Health and Human Services guid- 11 ance under title VI of the Civil Rights Act of 1964 12 and section 1557 of the Patient Protection and Af- 13 fordable Care Act to each Federal health program 14 administered by the agency. 15 ‘‘(3) The development of a disparity-reduction 16 impact analysis methodology that shall be applied to 17 every rule issued by the agency and published as 18 part of the formal rulemaking process under sections 19 555, 556, and 557 of title 5, United States Code. 20 ‘‘(4) Oversight of data collection, analysis, and 21 publication requirements for all recipients of Federal 22 financial assistance under each Federal health pro- 23 gram administered by the agency; compliance with, 24 at a minimum, the most recent version of the Office 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00873 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 874 •S 4819 IS of Management and Budget statistical policy direc- 1 tive entitled ‘Standards for Maintaining, Collecting, 2 and Presenting Federal Data on Race and Eth- 3 nicity’; and consideration of available data and lan- 4 guage standards such as— 5 ‘‘(A) the standards for collecting and re- 6 porting data under section 3101; and 7 ‘‘(B) the National Standards on Culturally 8 and Linguistically Appropriate Services of the 9 Office of Minority Health. 10 ‘‘(5) The conduct of publicly available studies 11 regarding discrimination within Federal health pro- 12 grams administered by the agency as well as dis- 13 parity reduction initiatives by recipients of Federal 14 financial assistance under Federal health programs. 15 ‘‘(6) Annual reports to the Committee on 16 Health, Education, Labor, and Pensions and the 17 Committee on Finance of the Senate and the Com- 18 mittee on Energy and Commerce and the Committee 19 on Ways and Means of the House of Representatives 20 on the progress in reducing disparities in health and 21 health care through the Federal programs adminis- 22 tered by the agency. 23 ‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS 24 IN THE DEPARTMENT OF JUSTICE.— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00874 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 875 •S 4819 IS ‘‘(1) DEPARTMENT OF HEALTH AND HUMAN 1 SERVICES.—The Office for Civil Rights of the De- 2 partment of Health and Human Services shall pro- 3 vide standard-setting and compliance review inves- 4 tigation support services to the Civil Rights Compli- 5 ance Office for each agency described in subsection 6 (a), subject to paragraph (2). 7 ‘‘(2) DEPARTMENT OF JUSTICE.—The Office 8 for Civil Rights of the Department of Justice may, 9 as appropriate, institute formal proceedings when a 10 civil rights compliance office established under sub- 11 section (a) determines that a recipient of Federal fi- 12 nancial assistance is not in compliance with the dis- 13 parity reduction standards of the applicable agency. 14 ‘‘(e) DEFINITION.—In this section, the term ‘Federal 15 health programs’ mean programs— 16 ‘‘(1) under the Social Security Act (42 U.S.C. 17 301 et seq.) that pay for health care and services; 18 and 19 ‘‘(2) under this Act that provide Federal finan- 20 cial assistance for health care, biomedical research, 21 health services research, and programs designed to 22 improve the public’s health, including health service 23 programs.’’. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00875 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 876 •S 4819 IS SEC. 904. UNITED STATES COMMISSION ON CIVIL RIGHTS. 1 (a) COORDINATION WITHIN DEPARTMENT OF JUS- 2 TICE OF ACTIVITIES REGARDING HEALTH DISPARI- 3 TIES.—Section 3(a) of the Civil Rights Commission Act 4 of 1983 (42 U.S.C. 1975a(a)) is amended— 5 (1) in paragraph (1), by striking ‘‘and’’ at the 6 end; 7 (2) in paragraph (2), by striking the period at 8 the end and inserting ‘‘; and’’; and 9 (3) by adding at the end the following: 10 ‘‘(3) shall, with respect to activities carried out 11 in health care and correctional facilities toward the 12 goal of eliminating health disparities between the 13 general population and members of minority groups 14 based on race or color, promote coordination of such 15 activities of— 16 ‘‘(A) the Office for Civil Rights within the 17 Office of Justice Programs of the Department 18 of Justice; 19 ‘‘(B) the Office of Justice Programs within 20 the Department of Justice; 21 ‘‘(C) the Office for Civil Rights within the 22 Department of Health and Human Services; 23 and 24 ‘‘(D) the Office of Minority Health within 25 the Department of Health and Human Services 26 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00876 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 877 •S 4819 IS (headed by the Deputy Assistant Secretary for 1 Minority Health).’’. 2 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 3 5 of the Civil Rights Commission Act of 1983 (42 U.S.C. 4 1975c) is amended by striking the first sentence and in- 5 serting the following: ‘‘For the purpose of carrying out 6 this Act, there are authorized to be appropriated 7 $30,000,000 for fiscal year 2021, and such sums as may 8 be necessary for each of the fiscal years 2022 through 9 2026.’’. 10 SEC. 905. SENSE OF CONGRESS CONCERNING FULL FUND- 11 ING OF ACTIVITIES TO ELIMINATE RACIAL 12 AND ETHNIC HEALTH DISPARITIES. 13 (a) FINDINGS.—Congress makes the following find- 14 ings: 15 (1) The health status of the population of the 16 United States is declining and the United States 17 currently ranks below most industrialized nations in 18 health status measured by longevity, sickness, and 19 mortality. 20 (2) Racial and ethnic minority populations tend 21 to have the poorest health status and face substan- 22 tial cultural, social, and economic barriers to obtain- 23 ing quality health care. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00877 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 878 •S 4819 IS (3) Lesbian, gay, bisexual, transgender, queer, 1 and questioning populations experience significant 2 personal and structural barriers to obtaining high- 3 quality health care. 4 (4) Efforts to improve minority health have 5 been limited by inadequate resources (funding, staff- 6 ing, and stewardship) and lack of accountability. 7 (b) SENSE OF CONGRESS.—It is the sense of Con- 8 gress that— 9 (1) health disparities negatively impact out- 10 comes for health and human security of the Nation; 11 (2) reducing racial, ethnic, sexual, and gender 12 disparities in prevention and treatment are unique 13 civil and human rights challenges and, as such, Fed- 14 eral agencies and health care entities and systems 15 receiving Federal funds should be accountable for 16 their role in causing disparities and inequity; 17 (3) funding for the National Institute on Mi- 18 nority Health and Health Disparities, the Office of 19 Civil Rights in the Department of Health and 20 Human Services, the National Institute of Nursing 21 Research, and the Office of Minority Health should 22 be doubled by fiscal year 2022; 23 (4) adequate funding by fiscal year 2022, and 24 subsequent funding increases, should be provided for 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00878 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 879 •S 4819 IS health and human service professions training pro- 1 grams, the Racial and Ethnic Approaches to Com- 2 munity Health Initiative at the Centers for Disease 3 Control and Prevention, the Minority HIV/AIDS 4 Initiative, and the Excellence Centers to Eliminate 5 Ethnic/Racial Disparities Program at the Agency for 6 Healthcare Research and Quality; 7 (5) funding should be fully restored to the Ra- 8 cial and Ethnic Approaches to Community Health 9 Initiative at the Centers for Disease Control and 10 Prevention, which has been a successful program at 11 the community health level, and efforts should con- 12 tinue to place a strong emphasis on building commu- 13 nity capacity to secure financial resources and tech- 14 nical assistance to eliminate health disparities; 15 (6) adequate funding for fiscal year 2022 and 16 increased funding for future years should be pro- 17 vided for the Racial and Ethnic Approaches to Com- 18 munity Health Initiative’s United States Risk Fac- 19 tor Survey to ensure adequate data collection to 20 track health disparities, and there should be appro- 21 priate avenues provided to disseminate findings to 22 the general public; 23 (7) current and newly created health disparity 24 elimination incentives, programs, agencies, and de- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00879 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 880 •S 4819 IS partments under this Act (and the amendments 1 made by this Act) should receive adequate staffing 2 and funding by fiscal year 2022; and 3 (8) stewardship and accountability should be 4 provided to the Congress and the President for 5 measurable and sustainable progress toward health 6 disparity elimination. 7 SEC. 906. GAO AND NIH REPORTS. 8 (a) GAO REPORT ON NIH GRANT RACIAL AND ETH- 9 NIC DIVERSITY.— 10 (1) IN GENERAL.—The Comptroller General of 11 the United States shall conduct a study on the racial 12 and ethnic diversity among the following groups: 13 (A) All applicants for grants, contracts, 14 and cooperative agreements awarded by the Na- 15 tional Institutes of Health during the period be- 16 ginning on January 1, 2009, and ending De- 17 cember 31, 2019. 18 (B) All recipients of such grants, con- 19 tracts, and cooperative agreements during such 20 period. 21 (C) All members of the peer review panels 22 of such applicants and recipients, respectively. 23 (2) REPORT.—Not later than 6 months after 24 the date of the enactment of this Act, the Comp- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00880 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 881 •S 4819 IS troller General shall complete the study under para- 1 graph (1) and submit to Congress a report con- 2 taining the results of such study. 3 (b) NIH REPORT ON CERTAIN AUTHORITY OF NA- 4 TIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH 5 DISPARITIES.—Not later than 6 months after the date of 6 the enactment of this Act, and biennially thereafter, the 7 Director of the National Institutes of Health, in collabora- 8 tion with the Director of the National Institute on Minor- 9 ity Health and Health Disparities, shall submit to Con- 10 gress a report that details and evaluates— 11 (1) the steps taken during the applicable report 12 period by the Director of the National Institutes of 13 Health to enforce the expanded planning, coordina- 14 tion, review, and evaluation authority provided the 15 National Institute on Minority Health and Health 16 Disparities under section 464z–3(h) of the Public 17 Health Service Act (42 U.S.C. 285(h)) over all mi- 18 nority health and health disparity research that is 19 conducted or supported by the Institutes and Cen- 20 ters at the National Institutes of Health; and 21 (2) the outcomes of such steps. 22 (c) GAO REPORT RELATED TO RECIPIENTS OF 23 PPACA FUNDING.—Not later than one year after the 24 date of the enactment of this Act and biennially thereafter 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00881 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 882 •S 4819 IS until 2024, the Comptroller General of the United States 1 shall submit to Congress a report that identifies— 2 (1) the racial and ethnic diversity of commu- 3 nity-based organizations that applied for Federal en- 4 rollment funding provided pursuant to the Patient 5 Protection and Affordable Care Act (Public Law 6 111–148) (including the amendments made by such 7 Act); 8 (2) the percentage of such organizations that 9 were awarded such funding; and 10 (3) the impact of such community-based organi- 11 zations’ enrollment efforts on the insurance status of 12 their communities. 13 (d) ANNUAL REPORT ON ACTIVITIES OF NATIONAL 14 INSTITUTE ON MINORITY HEALTH AND HEALTH DIS- 15 PARITIES.—The Director of the National Institute on Mi- 16 nority Health and Health Disparities shall prepare an an- 17 nual report on the activities carried out or to be carried 18 out by such institute, and shall submit each such report 19 to the Committee on Health, Education, Labor, and Pen- 20 sions of the Senate, the Committee on Energy and Com- 21 merce of the House of Representatives, the Secretary of 22 Health and Human Services, and the Director of the Na- 23 tional Institutes of Health. With respect to the fiscal year 24 involved, the report shall— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00882 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 883 •S 4819 IS (1) describe and evaluate the progress made in 1 health disparities research conducted or supported 2 by institutes and centers of the National Institutes 3 of Health; 4 (2) summarize and analyze expenditures made 5 for activities with respect to health disparities re- 6 search conducted or supported by the National Insti- 7 tutes of Health; 8 (3) include a separate statement applying the 9 requirements of paragraphs (1) and (2) specifically 10 to minority health disparities research; and 11 (4) contain such recommendations as the Direc- 12 tor of the Institute considers appropriate. 13 TITLE X—ADDRESSING SOCIAL 14 DETERMINANTS AND IM- 15 PROVING ENVIRONMENTAL 16 JUSTICE 17 Subtitle A—In General 18 SEC. 1001. DEFINITIONS. 19 In this title: 20 (1) DETERMINANTS OF HEALTH.—The term 21 ‘‘determinants of health’’— 22 (A) means the range of personal, social, 23 economic, and environmental factors that influ- 24 ence health status; and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00883 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 884 •S 4819 IS (B) includes social determinants of health 1 (which are sometimes referred to as ‘‘social and 2 economic determinants of health’’, ‘‘socio- 3 economic determinants of health’’, ‘‘environ- 4 mental determinants of health’’, ‘‘social drivers 5 of inequality’’, or ‘‘personal determinants of 6 health’’). 7 (2) ENVIRONMENTAL DETERMINANTS OF 8 HEALTH.—The term ‘‘environmental determinants 9 of health’’ means the broad physical (including man- 10 made and natural), psychological, social, spiritual, 11 cultural, and aesthetic environment. 12 (3) BUILT ENVIRONMENT.—The term ‘‘built 13 environment’’ means the components of the environ- 14 ment, and the location of these components in a geo- 15 graphically defined space, that are created or modi- 16 fied by individuals to form the physical and social 17 characteristics of a community or enhance quality of 18 human life, including— 19 (A) homes, schools, and places of work and 20 worship; 21 (B) parks, recreation areas, and green- 22 ways; 23 (C) transportation systems; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00884 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 885 •S 4819 IS (D) business, industry, and agriculture; 1 and 2 (E) land-use plans, projects, and policies 3 that impact the physical or social characteris- 4 tics of a community, including access to services 5 and amenities. 6 (4) PERSONAL DETERMINANTS OF HEALTH.— 7 The term ‘‘personal determinants of health’’ means 8 an individual’s behavior, biology, and genetics. 9 (5) SOCIAL DETERMINANTS OF HEALTH.—The 10 term ‘‘social determinants of health’’ means a subset 11 of determinants of the health of individuals and en- 12 vironments (such as communities, neighborhoods, 13 and societies) that describe an individual’s or group 14 of people’s social identity, describe the social and 15 economic resources to which such individual or 16 group has access, and describe the conditions in 17 which an individual or group of people works, lives, 18 and plays. 19 (6) ECONOMIC DETERMINANTS OF HEALTH.— 20 The term ‘‘economic determinants of health’’ refers 21 to income and social status. Higher income and so- 22 cioeconomic status are linked to decreased rates of 23 morbidity and mortality, with higher socioeconomic 24 status correlated with better health and longer life, 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00885 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 886 •S 4819 IS and lower socioeconomic status correlated with an 1 increased risk of illness and death. 2 SEC. 1002. FINDINGS. 3 Congress finds as follows: 4 (1) Social determinants of health are the great- 5 est predictors of health outcomes. 6 (2) Social determinants of health, including 7 health-related behaviors, social and economic factors, 8 and physical environment factors account for 80 per- 9 cent of health outcomes, whereas clinical care ac- 10 counts for 20 percent of improved health outcomes. 11 Yet, in 2017, public health spending represented 12 only 2.5 percent of all health spending in the United 13 States. 14 (3) There are more opportunities to improve 15 health for everyone when we understand that health 16 starts, first, not in a medical setting, but in our 17 families, in our schools and workplaces, in our 18 neighborhoods, in the air we breathe, and in the 19 water we drink. 20 (4)(A) Healthy People 2020 identifies health 21 and health care quality as a function of not only ac- 22 cess to health care, but also the social determinants 23 of health, categorized into the following: neighbor- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00886 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 887 •S 4819 IS hoods and the built environment; social and commu- 1 nity context; education; and economic stability. 2 (B) The following examples illustrate the nexus 3 between the unequal distribution of the social deter- 4 minants of health and health disparities: 5 (i) The built environment influences resi- 6 dents’ level of physical activity. Neighborhoods 7 with high levels of poverty are significantly less 8 likely to have places where children can be 9 physically active, such as parks, green spaces, 10 and bike paths and lanes. Neighborhoods and 11 communities can provide opportunities for phys- 12 ical activity and support active lifestyles 13 through accessible and safe parks and open 14 spaces and through land use policy, zoning, and 15 healthy community design. 16 (ii) Emotional and physical health and 17 well-being are directly impacted by perceived 18 levels of safety, such as unlit streets at night. 19 Community members have expressed that safety 20 is not only a barrier to accessing programs and 21 services that increase quality of life but they 22 are also not able to access physical activity in 23 their community through the built environment. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00887 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 888 •S 4819 IS (iii) Historical and institutional racism in 1 the United States has shaped the way in which 2 social and economic resources and exposure to 3 health promoting environments are distributed. 4 Income, education, occupation, neighborhood 5 conditions, schools, workplaces, the use of 6 health and social services, and experiences with 7 the criminal justice system are all highly pat- 8 terned by race, with people of color experiencing 9 more that is health harming. Finding ways to 10 uncouple the link between race and access to re- 11 sources and healthy environments is a principal 12 means of reducing health disparities. Addition- 13 ally, the anticipation of racism itself causes 14 higher psychological and cardiovascular stress 15 levels that are linked to poor health outcomes. 16 Remedying discriminatory practices at the indi- 17 vidual and systemic levels will likely reduce 18 health disparities caused by this unequal dis- 19 tribution of stress. 20 (iv) Poor health among Native Americans 21 has largely been driven by post-colonial oppres- 22 sion and historical trauma. The expropriation of 23 native lands and territories to the American 24 state had severe consequences on Native Amer- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00888 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 889 •S 4819 IS ican health. This resulted in the deprivation of 1 traditional food sources—and nutrients—for 2 Native Americans and also the destruction of 3 traditional economies and community organiza- 4 tion. Today, Native Americans have twice the 5 rate of diabetes of non-Hispanic Whites. Rec- 6 ognition of the origins of the diabetes as having 7 a social and community context, rather than 8 just individual responsibility and genetic pre- 9 disposition, will shape better policy to provide 10 food security. 11 (v) In the context of prisons, overcrowding 12 has led to the deterioration of the physical and 13 mental health of individuals after they leave 14 prison. In particular, the mass incarceration of 15 African-American males as a result of unequal 16 contact with and treatment in the criminal jus- 17 tice system has contributed to an overburdening 18 of certain infectious diseases within the African- 19 American community. As a social institution, 20 incarceration amplifies existing adverse health 21 conditions by concentrating diseases and harm- 22 ful health behaviors such as tobacco use, drug 23 use, and violence. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00889 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 890 •S 4819 IS (vi) Educational attainment is the strong- 1 est predictor of adult mortality. It is a basic 2 component of socioeconomic status that shapes 3 earning potential to access resources that pro- 4 mote health. People with more education are 5 less likely to report that they are in poor health, 6 and are also less likely to have diabetes and 7 other chronic diseases. 8 (vii) Individuals with lower levels of edu- 9 cational attainment are much more likely to re- 10 port to be current smokers. In 2017, smoking 11 prevalence was 36.8 percent among adults with 12 a GED diploma, 23.1 percent with less than a 13 high school diploma, and 18.7 percent with a 14 high school diploma, while dropping signifi- 15 cantly to 7.1 percent among adults with an un- 16 dergraduate college degree and 4.1 percent with 17 a postgraduate college degree. 18 (viii) Income inequality differences account 19 for a large part of health disparities.. For ex- 20 ample, children living in poverty experience 21 poorer housing conditions, increased exposure 22 to indoor allergens and toxins (such as pes- 23 ticides, lead, mercury, radon, air pollution, and 24 carcinogens), increased food insecurity, and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00890 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 891 •S 4819 IS more psychological stress. These experiences 1 culminate in worse adult health as compared 2 with children with higher socioeconomic status. 3 Specifically, children living in lower socio- 4 economic neighborhoods have higher rates of 5 asthma due to higher rates of psychological 6 stress resulting from higher rates of violence. 7 Food insecurity is associated with obesity and 8 racial and ethnic minorities have higher rates of 9 food insecurity. 10 (ix) Lesbian, gay, bisexual, transgender, 11 queer or questioning, intersex, and asexual or 12 allied (referred to in this section as 13 ‘‘LGBTQIA’’) individuals face health disparities 14 linked to societal stigma, discrimination, and 15 denial of their civil and human rights. Discrimi- 16 nation against LGBTQIA individuals has been 17 associated with high rates of psychiatric dis- 18 orders, substance abuse, and suicide. Experi- 19 ences of violence and victimization are frequent 20 for LGBTQIA individuals, and have long-last- 21 ing effects on the individual and the commu- 22 nity. Personal, family, and social acceptance of 23 sexual orientation and gender identity affects 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00891 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 892 •S 4819 IS the mental health and personal safety of 1 LGBTQIA individuals. 2 (x) Individuals in older and cheaper hous- 3 ing are at higher risks to be exposed to lead, 4 particularly in housing built prior to 1960. The 5 threat of lead poisoning disproportionally af- 6 fects vulnerable populations, with children living 7 in poverty (5.6 percent) and Black children 8 (5.6) experiencing the highest rates. According 9 to the Department of Housing and Urban De- 10 velopment, about 3,600,000 homes nationwide 11 that house young children have lead hazards 12 such as contaminated drinking water, peeling 13 paint, contaminated dust, or toxic soil. The 14 combined cost of medical treatment and special 15 education for lead poisoned children averages 16 about $5,600 per child per year, and lead poi- 17 soning costs the United States an estimated 18 $50,000,000,000 annually. 19 (xi) According to the report Healthy Peo- 20 ple 2020, individuals with disabilities, as a 21 group, experience health disparities in routine 22 public health arenas such as health behaviors, 23 clinical preventive services, and chronic condi- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00892 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 893 •S 4819 IS tions. Compared with individuals without dis- 1 abilities, individuals with disabilities are— 2 (I) less likely to receive recommended 3 preventive health care services, such as 4 routine teeth cleanings and cancer 5 screenings; 6 (II) at a high risk for poor health out- 7 comes such as obesity, hypertension, falls- 8 related injuries, and mood disorders such 9 as depression; and 10 (III) more likely to engage in 11 unhealthy behaviors that put their health 12 at risk, such as cigarette smoking and in- 13 adequate physical activity. 14 (5) Laws and regulations that improve opportu- 15 nities to live in safe neighborhoods with more social 16 cohesion, attain higher education, sustain stable em- 17 ployment, and bridge class differences help foster 18 the health and safety of individuals. 19 (6) The global public health community has 20 reached consensus through the Rio Political Declara- 21 tion of Social Determinants of Health adopted by 22 the World Health Organization in October 2011 that 23 ‘‘[c]ollaboration in coordinated and intersectoral pol- 24 icy actions has proven to be effective. Health in All 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00893 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 894 •S 4819 IS Policies, an initiative of the American Public Health 1 Association, together with intersectoral cooperation 2 and action, is one promising approach to enhance 3 accountability in other sectors of health, as well as 4 the promotion of health equity and more inclusive 5 and productive societies.’’. 6 SEC. 1003. HEALTH IMPACT ASSESSMENTS. 7 (a) FINDINGS.—Congress makes the following find- 8 ings: 9 (1) Health Impact Assessment is a tool to help 10 planners, health officials, decision makers, and the 11 public make more informed decisions about the po- 12 tential health effects of proposed plans, policies, pro- 13 grams, and projects in order to maximize health 14 benefits and minimize harms. 15 (2) Health Impact Assessments fosters commu- 16 nity leadership, ownership and participation in deci- 17 sion-making processes. 18 (3) Health Impact Assessments can build com- 19 munity support and reduce opposition to a project or 20 policy, thereby facilitating economic growth by aid- 21 ing the development of consensus regarding new de- 22 velopment proposals. 23 (4) Health Impact Assessments facilitate col- 24 laboration across sectors. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00894 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 895 •S 4819 IS (b) PURPOSES.—It is the purpose of this section to— 1 (1) provide more information about the poten- 2 tial human health effects of policy decisions and the 3 distribution of those effects; 4 (2) improve how health is considered in plan- 5 ning and decision-making processes; and 6 (3) build stronger, healthier communities 7 through the use of Health Impact Assessments. 8 (c) HEALTH IMPACT ASSESSMENTS.—Part P of title 9 III of the Public Health Service Act (42 U.S.C. 280g et 10 seq.), as amended by section 744, is further amended by 11 adding at the end the following: 12 ‘‘SEC. 399V–12. HEALTH IMPACT ASSESSMENTS. 13 ‘‘(a) DEFINITIONS.—In this section: 14 ‘‘(1) ADMINISTRATOR.—The term ‘Adminis- 15 trator’ means the Administrator of the Environ- 16 mental Protection Agency. 17 ‘‘(2) DIRECTOR.—The term ‘Director’ means 18 the Director of the Centers for Disease Control and 19 Prevention. 20 ‘‘(3) HEALTH IMPACT ASSESSMENT.—The term 21 ‘health impact assessment’ means a systematic proc- 22 ess that uses an array of data sources and analytic 23 methods and considers input from stakeholders to 24 determine the potential effects of a proposed policy, 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00895 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 896 •S 4819 IS plan, program, or project on the health of a popu- 1 lation and the distribution of those effects within the 2 population. Such term includes identifying and rec- 3 ommending appropriate actions on monitoring and 4 maximizing potential benefits and minimizing the 5 potential harms. 6 ‘‘(4) HEALTH DISPARITY.—The term ‘health 7 disparity’ means a particular type of health dif- 8 ference that is closely linked with social, economic, 9 or environmental disadvantage and that adversely 10 affects groups of people who have systematically ex- 11 perienced greater obstacles to health based on their 12 racial or ethnic group; religion; socioeconomic status; 13 gender; age; mental health; cognitive, sensory, or 14 physical disability; sexual orientation or gender iden- 15 tity; geographic location; citizenship status; or other 16 characteristics historically linked to discrimination 17 or exclusion. 18 ‘‘(b) ESTABLISHMENT.—The Secretary, acting 19 through the Director and in collaboration with the Admin- 20 istrator, shall— 21 ‘‘(1) in consultation with the Director of the 22 National Center for Chronic Disease Prevention and 23 Health Promotion and relevant offices within the 24 Department of Housing and Urban Development, 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00896 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 897 •S 4819 IS the Department of Transportation, and the Depart- 1 ment of Agriculture, establish a program at the Na- 2 tional Center for Environmental Health at the Cen- 3 ters for Disease Control and Prevention focused on 4 advancing the field of health impact assessment that 5 includes— 6 ‘‘(A) collecting and disseminating best 7 practices; 8 ‘‘(B) administering capacity building 9 grants to States to support grantees in initi- 10 ating health impact assessments, in accordance 11 with subsection (d); 12 ‘‘(C) providing technical assistance; 13 ‘‘(D) developing training tools and pro- 14 viding training on conducting health impact as- 15 sessment and the implementation of built envi- 16 ronment and health indicators; 17 ‘‘(E) making information available, as ap- 18 propriate, regarding the existence of other com- 19 munity healthy living tools, checklists, and indi- 20 ces that help connect public health to other sec- 21 tors, and tools to help examine the effect of the 22 indoor built environment and building codes on 23 population health; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00897 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 898 •S 4819 IS ‘‘(F) conducting research and evaluations 1 of health impact assessments; and 2 ‘‘(G) awarding competitive extramural re- 3 search grants; 4 ‘‘(2) develop guidance and guidelines to conduct 5 health impact assessments in accordance with sub- 6 section (c); and 7 ‘‘(3) establish a grant program to allow States 8 to fund eligible entities to conduct health impact as- 9 sessments. 10 ‘‘(c) GUIDANCE.— 11 ‘‘(1) IN GENERAL.—Not later than 1 year after 12 the date of enactment of the Health Equity and Ac- 13 countability Act of 2020, the Secretary, acting 14 through the Director, shall issue final guidance for 15 conducting the health impact assessments. In devel- 16 oping such guidance the Secretary shall— 17 ‘‘(A) consult with the Director of the Na- 18 tional Center for Environmental Health and, 19 the Director of the National Center for Chronic 20 Disease Prevention and Health Promotion, and 21 relevant offices within the Department of Hous- 22 ing and Urban Development, the Department of 23 Transportation, and the Department of Agri- 24 culture; and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00898 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 899 •S 4819 IS ‘‘(B) consider available international health 1 impact assessment guidance, North American 2 health impact assessment practice standards, 3 and recommendations from the National Acad- 4 emy of Science. 5 ‘‘(2) CONTENT.—The guidance under this sub- 6 section shall include— 7 ‘‘(A) background on national and inter- 8 national efforts to bridge urban planning, cli- 9 mate forecasting, and public health institutions 10 and disciplines, including a review of health im- 11 pact assessment best practices internationally; 12 ‘‘(B) evidence-based direct and indirect 13 pathways that link land-use planning, transpor- 14 tation, and housing policy and objectives to 15 human health outcomes; 16 ‘‘(C) data resources and quantitative and 17 qualitative forecasting methods to evaluate both 18 the status of health determinants and health ef- 19 fects, including identification of existing pro- 20 grams that can disseminate these resources; 21 ‘‘(D) best practices for inclusive public in- 22 volvement in conducting health impact assess- 23 ments; and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00899 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 900 •S 4819 IS ‘‘(E) technical assistance for other agen- 1 cies seeking to develop their own guidelines and 2 procedures for health impact assessment. 3 ‘‘(d) GRANT PROGRAM.— 4 ‘‘(1) IN GENERAL.—The Secretary, acting 5 through the Director and in collaboration with the 6 Administrator, shall— 7 ‘‘(A) award grants to States to fund eligi- 8 ble entities for capacity building or to prepare 9 health impact assessments; and 10 ‘‘(B) ensure that States receiving a grant 11 under this subsection further support training 12 and technical assistance for grantees under the 13 program by funding and overseeing appropriate 14 local, State, Tribal, Federal, institution of high- 15 er education, or nonprofit health impact assess- 16 ment experts to provide such technical assist- 17 ance. 18 ‘‘(2) APPLICATIONS.— 19 ‘‘(A) IN GENERAL.—To be eligible to re- 20 ceive a grant under this section, an eligible enti- 21 ty shall— 22 ‘‘(i) be a State, Indian tribe, or tribal 23 organization that includes individuals or 24 populations the health of which are, or will 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00900 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 901 •S 4819 IS be, affected by an activity or a proposed 1 activity; and 2 ‘‘(ii) submit to the Secretary an appli- 3 cation in accordance with this subsection, 4 at such time, in such manner, and con- 5 taining such additional information as the 6 Secretary may require. 7 ‘‘(B) INCLUSION.—An application under 8 this subsection shall include a list of proposed 9 activities that require or would benefit from 10 conducting a health impact assessment within 11 six months of awarding funds. The list should 12 be accompanied by supporting documentation, 13 including letters of support, from potential con- 14 ductors of health impact assessments for the 15 listed proposed activities. Each application 16 should also include an assessment by the eligi- 17 ble entity of the health of the population of its 18 jurisdiction and describe potential adverse or 19 positive effects on health that the proposed ac- 20 tivities may create. 21 ‘‘(C) PREFERENCE.—Preference in award- 22 ing funds under this section may be given to el- 23 igible entities that demonstrate the potential to 24 significantly improve population health or lower 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00901 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 902 •S 4819 IS health care costs as a result of potential health 1 impact assessment work. 2 ‘‘(3) USE OF FUNDS.— 3 ‘‘(A) IN GENERAL.—An entity receiving a 4 grant under this section shall use such grant 5 funds to conduct health impact assessment ca- 6 pacity building or to fund subgrantees in con- 7 ducting a health impact assessment for a pro- 8 posed activity in accordance with this sub- 9 section. 10 ‘‘(B) PURPOSES.—The purposes of a 11 health impact assessment under this subsection 12 are— 13 ‘‘(i) to facilitate the involvement of 14 tribal, State, and local public health offi- 15 cials in community planning, transpor- 16 tation, housing, and land use decisions and 17 other decisions affecting the built environ- 18 ment to identify any potential health con- 19 cern or health benefit relating to an activ- 20 ity or proposed activity; 21 ‘‘(ii) to provide for an investigation of 22 any health-related issue of concern raised 23 in a planning process, an environmental 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00902 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 903 •S 4819 IS impact assessment process, or policy ap- 1 praisal relating to a proposed activity; 2 ‘‘(iii) to describe and compare alter- 3 natives (including no-action alternatives) to 4 a proposed activity to provide clarification 5 with respect to the potential health out- 6 comes associated with the proposed activity 7 and, where appropriate, to the related ben- 8 efit-cost or cost-effectiveness of the pro- 9 posed activity and alternatives; 10 ‘‘(iv) to contribute, when applicable, 11 to the findings of a planning process, pol- 12 icy appraisal, or an environmental impact 13 statement with respect to the terms and 14 conditions of implementing a proposed ac- 15 tivity or related mitigation recommenda- 16 tions, as necessary; 17 ‘‘(v) to ensure that the dispropor- 18 tionate distribution of negative impacts 19 among vulnerable populations is minimized 20 as much as possible; 21 ‘‘(vi) to engage affected community 22 members and ensure adequate opportunity 23 for public comment on all stages of the 24 health impact assessment; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00903 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 904 •S 4819 IS ‘‘(vii) where appropriate, to consult 1 with local and county health departments 2 and appropriate organizations, including 3 planning, transportation, and housing or- 4 ganizations and providing them with infor- 5 mation and tools regarding how to conduct 6 and integrate health impact assessment 7 into their work; and 8 ‘‘(viii) to inspect homes, water sys- 9 tems, and other elements that pose risks to 10 lead exposure, with an emphasis on areas 11 that pose a higher risk to children. 12 ‘‘(4) ASSESSMENTS.—Health impact assess- 13 ments carried out using grant funds under this sec- 14 tion shall— 15 ‘‘(A) take appropriate health factors into 16 consideration as early as practicable during the 17 planning, review, or decision-making processes; 18 ‘‘(B) assess the effect on the health of in- 19 dividuals and populations of proposed policies, 20 projects, or plans that result in modifications to 21 the built environment; and 22 ‘‘(C) assess the distribution of health ef- 23 fects across various factors, such as race, in- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00904 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 905 •S 4819 IS come, ethnicity, age, disability status, gender, 1 and geography. 2 ‘‘(5) ELIGIBLE ACTIVITIES.— 3 ‘‘(A) IN GENERAL.—Eligible entities fund- 4 ed under this subsection shall conduct an eval- 5 uation of any proposed activity to determine 6 whether it will have a significant adverse or 7 positive effect on the health of the affected pop- 8 ulation in the jurisdiction of the eligible entity, 9 based on the criteria described in subparagraph 10 (B). 11 ‘‘(B) CRITERIA.—The criteria described in 12 this subparagraph include, as applicable to the 13 proposed activity, the following: 14 ‘‘(i) Any substantial adverse effect or 15 significant health benefit on health out- 16 comes or factors known to influence health, 17 including the following: 18 ‘‘(I) Physical activity. 19 ‘‘(II) Injury. 20 ‘‘(III) Mental health. 21 ‘‘(IV) Accessibility to health-pro- 22 moting goods and services. 23 ‘‘(V) Respiratory health. 24 ‘‘(VI) Chronic disease. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00905 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 906 •S 4819 IS ‘‘(VII) Nutrition. 1 ‘‘(VIII) Land use changes that 2 promote local, sustainable food 3 sources. 4 ‘‘(IX) Infectious disease. 5 ‘‘(X) Health disparities. 6 ‘‘(XI) Existing air quality, 7 ground or surface water quality or 8 quantity, or noise levels. 9 ‘‘(XII) Lead exposure. 10 ‘‘(XIII) Drinking water quality 11 and accessibility. 12 ‘‘(ii) Other factors that may be con- 13 sidered, including— 14 ‘‘(I) the potential for a proposed 15 activity to result in systems failure 16 that leads to a public health emer- 17 gency; 18 ‘‘(II) the probability that the pro- 19 posed activity will result in a signifi- 20 cant increase in tourism, economic de- 21 velopment, or employment in the ju- 22 risdiction of the eligible entity; 23 ‘‘(III) any other significant po- 24 tential hazard or enhancement to 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00906 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 907 •S 4819 IS human health, as determined by the 1 eligible entity; or 2 ‘‘(IV) whether the evaluation of a 3 proposed activity would duplicate an- 4 other analysis or study being under- 5 taken in conjunction with the pro- 6 posed activity. 7 ‘‘(C) FACTORS FOR CONSIDERATION.—In 8 evaluating a proposed activity under subpara- 9 graph (A), an eligible entity may take into con- 10 sideration any reasonable, direct, indirect, or 11 cumulative effect that can be clearly related to 12 potential health effects and that is related to 13 the proposed activity, including the effect of 14 any action that is— 15 ‘‘(i) included in the long-range plan 16 relating to the proposed activity; 17 ‘‘(ii) likely to be carried out in coordi- 18 nation with the proposed activity; 19 ‘‘(iii) dependent on the occurrence of 20 the proposed activity; or 21 ‘‘(iv) likely to have a disproportionate 22 impact on high-risk or vulnerable popu- 23 lations. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00907 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 908 •S 4819 IS ‘‘(6) REQUIREMENTS.—A health impact assess- 1 ment prepared with funds awarded under this sub- 2 section shall incorporate the following, after con- 3 ducting the screening phase (identifying projects or 4 policies for which a health impact assessment would 5 be valuable and feasible) through the application 6 process: 7 ‘‘(A) SCOPING.—Identifying which health 8 effects to consider and the research methods to 9 be utilized. 10 ‘‘(B) ASSESSING RISKS AND BENEFITS.— 11 Assessing the baseline health status and factors 12 known to influence the health status in the af- 13 fected community, which may include aggre- 14 gating and synthesizing existing health assess- 15 ment evidence and data from the community. 16 ‘‘(C) DEVELOPING RECOMMENDATIONS.— 17 Suggesting changes to proposals to promote 18 positive or mitigate adverse health effects. 19 ‘‘(D) REPORTING.—Synthesizing the as- 20 sessment and recommendations and commu- 21 nicating the results to decision makers. 22 ‘‘(E) MONITORING AND EVALUATING.— 23 Tracking the decision and implementation effect 24 on health determinants and health status. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00908 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 909 •S 4819 IS ‘‘(7) PLAN.—An eligible entity that is awarded 1 a grant under this section shall develop and imple- 2 ment a plan, to be approved by the Director, for 3 meaningful and inclusive stakeholder involvement in 4 all phases of the health impact assessment. Stake- 5 holders may include community leaders, community- 6 based organizations, youth-serving organizations, 7 planners, public health experts, State and local pub- 8 lic health departments and officials, health care ex- 9 perts or officials, housing experts or officials, and 10 transportation experts or officials. 11 ‘‘(8) SUBMISSION OF FINDINGS.—An eligible 12 entity that is awarded a grant under this section 13 shall submit the findings of any funded health im- 14 pact assessment activities to the Secretary and make 15 these findings publicly available. 16 ‘‘(9) ASSESSMENT OF IMPACTS.—An eligible en- 17 tity that is awarded a grant under this section shall 18 ensure the assessment of the distribution of health 19 impacts (related to the proposed activity) across 20 race, ethnicity, income, age, gender, disability status, 21 and geography. 22 ‘‘(10) CONDUCT OF ASSESSMENT.—To the 23 greatest extent feasible, a health impact assessment 24 shall be conducted under this section in a manner 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00909 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 910 •S 4819 IS that respects the needs and timing of the decision- 1 making process it evaluates. 2 ‘‘(11) METHODOLOGY.—In preparing a health 3 impact assessment under this subsection, an eligible 4 entity or partner shall follow the guidance published 5 under subsection (c). 6 ‘‘(e) HEALTH IMPACT ASSESSMENT DATABASE.— 7 The Secretary, acting through the Director and in collabo- 8 ration with the Administrator, shall establish, maintain, 9 and make publicly available a health impact assessment 10 database, including— 11 ‘‘(1) a catalog of health impact assessments re- 12 ceived under this section; 13 ‘‘(2) an inventory of tools used by eligible enti- 14 ties to conduct health impact assessments; and 15 ‘‘(3) guidance for eligible entities with respect 16 to the selection of appropriate tools described in 17 paragraph (2). 18 ‘‘(f) EVALUATION OF GRANTEE ACTIVITIES.—The 19 Secretary shall award competitive grants to Prevention 20 Research Centers, or nonprofit organizations or academic 21 institutions with expertise in health impact assessments 22 to— 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00910 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 911 •S 4819 IS ‘‘(1) assist grantees with the provision of train- 1 ing and technical assistance in the conducting of 2 health impact assessments; 3 ‘‘(2) evaluate the activities carried out with 4 grants under subsection (d); and 5 ‘‘(3) assist the Secretary in disseminating evi- 6 dence, best practices, and lessons learned from 7 grantees. 8 ‘‘(g) REPORT TO CONGRESS.—Not later than 1 year 9 after the date of enactment of the Health Equity and Ac- 10 countability Act of 2020, the Secretary shall submit to 11 Congress a report concerning the evaluation of the pro- 12 grams under this section, including recommendations as 13 to how lessons learned from such programs can be incor- 14 porated into future guidance documents developed and 15 provided by the Secretary and other Federal agencies, as 16 appropriate. 17 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 18 are authorized to be appropriated to carry out this section 19 such sums as may be necessary. 20 ‘‘SEC. 399V–13. IMPLEMENTATION OF RESEARCH FINDINGS 21 TO IMPROVE HEALTH OUTCOMES THROUGH 22 THE BUILT ENVIRONMENT. 23 ‘‘(a) RESEARCH GRANT PROGRAM.—The Secretary, 24 in collaboration with the Administrator of the Environ- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00911 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 912 •S 4819 IS mental Protection Agency (referred to in this section as 1 the ‘Administrator’), shall award grants to public agencies 2 or private nonprofit institutions to implement evidence- 3 based programming to improve human health through im- 4 provements to the built environment and subsequently 5 human health, by addressing— 6 ‘‘(1) levels of physical activity; 7 ‘‘(2) consumption of nutritional foods; 8 ‘‘(3) rates of crime; 9 ‘‘(4) air, water, and soil quality; 10 ‘‘(5) risk or rate of injury; 11 ‘‘(6) accessibility to health-promoting goods and 12 services; 13 ‘‘(7) chronic disease rates; 14 ‘‘(8) community design; 15 ‘‘(9) housing; 16 ‘‘(10) transportation options; and 17 ‘‘(11) other factors, as the Secretary determines 18 appropriate. 19 ‘‘(b) APPLICATIONS.—A public agency or private 20 nonprofit institution desiring a grant under this section 21 shall submit to the Secretary an application at such time, 22 in such manner, and containing such agreements, assur- 23 ances, and information as the Secretary, in consultation 24 with the Administrator, may require. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00912 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 913 •S 4819 IS ‘‘(c) RESEARCH.—The Secretary, in consultation 1 with the Administrator, shall support, through grants 2 awarded under this section, research that— 3 ‘‘(1) uses evidence-based research to improve 4 the built environment and human health; 5 ‘‘(2) examines— 6 ‘‘(A) the scope and intensity of the impact 7 that the built environment (including the var- 8 ious characteristics of the built environment) 9 has on the human health; or 10 ‘‘(B) the distribution of such impacts by— 11 ‘‘(i) location; and 12 ‘‘(ii) population subgroup; 13 ‘‘(3) is used to develop— 14 ‘‘(A) measures and indicators to address 15 health impacts and the connection of health to 16 the built environment; 17 ‘‘(B) efforts to link the measures to trans- 18 portation, land use, and health databases; and 19 ‘‘(C) efforts to enhance the collection of 20 built environment surveillance data; 21 ‘‘(4) distinguishes carefully between personal 22 attitudes and choices and external influences on be- 23 havior to determine how much the association be- 24 tween the built environment and the health of resi- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00913 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 914 •S 4819 IS dents, versus the lifestyle preferences of the people 1 that choose to live in the neighborhood, reflects the 2 physical characteristics of the neighborhood; and 3 ‘‘(5)(A) identifies or develops effective interven- 4 tion strategies focusing on enhancements to the built 5 environment that promote increased use physical ac- 6 tivity, access to nutritious foods, or other health-pro- 7 moting activities by residents; and 8 ‘‘(B) in developing the intervention strategies 9 under subparagraph (A), ensures that the interven- 10 tion strategies will reach out to high-risk or vulner- 11 able populations, including low-income urban and 12 rural communities and aging populations, in addi- 13 tion to the general population. 14 ‘‘(d) SURVEYS.—The Secretary may allow recipients 15 of grants under this section to use such grant funds to 16 support the expansion of national surveys and data track- 17 ing systems to provide more detailed information about 18 the connection between the built environment and health. 19 ‘‘(e) PRIORITY.—In awarding grants under this sec- 20 tion, the Secretary and the Administrator shall give pri- 21 ority to entities with programming that incorporates— 22 ‘‘(1) interdisciplinary approaches; or 23 ‘‘(2) the expertise of the public health, physical 24 activity, urban planning, land use, and transpor- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00914 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 915 •S 4819 IS tation research communities in the United States 1 and abroad. 2 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 3 are authorized to be appropriated such sums as may be 4 necessary to carry out this section. The Secretary may al- 5 locate not more than 20 percent of the amount so appro- 6 priated for a fiscal year for purposes of conducting re- 7 search under subsection (c).’’. 8 SEC. 1004. IMPLEMENTATION OF RECOMMENDATIONS BY 9 ENVIRONMENTAL PROTECTION AGENCY. 10 (a) INSPECTOR GENERAL RECOMMENDATIONS.—The 11 Administrator of the Environmental Protection Agency 12 (referred to in this section as the ‘‘Administrator’’) shall, 13 as promptly as practicable, carry out each of the following 14 recommendations of the Inspector General of the Environ- 15 mental Protection Agency as described in the report enti- 16 tled ‘‘EPA Needs to Conduct Environmental Justice Re- 17 views of Its Programs, Policies and Activities’’ (Report 18 No. 2006–P–00034): 19 (1) The recommendation that the program and 20 regional offices of the Environmental Protection 21 Agency identify which programs, policies, and activi- 22 ties need environmental justice reviews and the Ad- 23 ministrator require those offices to establish a plan 24 to complete the necessary reviews. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00915 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 916 •S 4819 IS (2) The recommendation that the Administrator 1 ensure that the reviews described in paragraph (1) 2 determine whether the programs, policies, and activi- 3 ties may have a disproportionately high and adverse 4 health or environmental impact on minority and low- 5 income populations. 6 (3) The recommendation that each program 7 and regional office of the Environmental Protection 8 Agency develop specific environmental justice review 9 guidance for conducting environmental justice re- 10 views. 11 (4) The recommendation that the Administrator 12 designate a responsible office to compile results of 13 environmental justice reviews and recommend appro- 14 priate actions. 15 (b) GAO RECOMMENDATIONS.—In promulgating reg- 16 ulations of the Environmental Protection Agency, the Ad- 17 ministrator shall, as promptly as practicable, carry out 18 each of the following recommendations of the Comptroller 19 General of the United States as described in the report 20 entitled ‘‘EPA Should Devote More Attention to Environ- 21 mental Justice when Developing Clean Air Rules’’ (GAO– 22 05–289): 23 (1) The recommendation that the Administrator 24 ensure that workgroups involved in developing a rule 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00916 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 917 •S 4819 IS devote attention to environmental justice while draft- 1 ing and finalizing the rule. 2 (2) The recommendation that the Administrator 3 enhance the ability of the workgroups described in 4 paragraph (1) to identify potential environmental 5 justice issues through steps such as— 6 (A) providing workgroup members with 7 guidance and training to help those members 8 identify potential environmental justice prob- 9 lems; and 10 (B) involving environmental justice coordi- 11 nators in the workgroups if appropriate. 12 (3) The recommendation that the Administrator 13 improve assessments of potential environmental jus- 14 tice impacts in economic reviews by identifying the 15 data and developing the modeling techniques needed 16 to assess those impacts. 17 (4) The recommendation that the Administrator 18 direct appropriate officers and employees of the En- 19 vironmental Protection Agency, if feasible, to re- 20 spond fully to public comments on environmental 21 justice, including by— 22 (A) improving the explanation by the Ad- 23 ministrator of the basis for any conclusions re- 24 lating to environmental justice; and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00917 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 918 •S 4819 IS (B) including in an explanation under sub- 1 paragraph (A) supporting data. 2 (c) 2004 INSPECTOR GENERAL REPORT.— 3 (1) IN GENERAL.—The Administrator shall, as 4 promptly as practicable, carry out each of the fol- 5 lowing recommendations of the Inspector General of 6 the Environmental Protection Agency as described 7 in the report entitled ‘‘EPA Needs to Consistently 8 Implement the Intent of the Executive Order on En- 9 vironmental Justice’’ (Report No. 2004–P–00007): 10 (A) The recommendation that the Admin- 11 istrator clearly define the mission of the Office 12 of Environmental Justice and provide Environ- 13 mental Protection Agency staff with an under- 14 standing of the roles and responsibilities of that 15 Office. 16 (B) The recommendation that the Admin- 17 istrator— 18 (i) establish, through the issuance of 19 guidance or a policy statement, specific 20 timeframes for the development of defini- 21 tions, goals, and measurements regarding 22 environmental justice; and 23 (ii) provide the regions and program 24 offices a standard and consistent definition 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00918 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 919 •S 4819 IS for a minority and low-income community, 1 with instructions on how the Environ- 2 mental Protection Agency will implement 3 and put into operation environmental jus- 4 tice in the daily activities of the Environ- 5 mental Protection Agency. 6 (C) The recommendation that the Adminis- 7 trator ensure that the comprehensive training 8 program that was under development (as of the 9 date of the report) includes standard and con- 10 sistent definitions of the key environmental jus- 11 tice concepts, such as ‘‘low-income’’, ‘‘minor- 12 ity’’, and ‘‘disproportionately impacted’’, and 13 instructions for implementation of those con- 14 cepts. 15 (2) REPORTS.— 16 (A) INITIAL REPORT.—Not later than 180 17 days after the date of enactment of this Act, 18 the Administrator shall submit to Congress an 19 initial report on the strategy of the Adminis- 20 trator for implementing the recommendations 21 described in subparagraphs (A), (B), and (C) of 22 paragraph (1). 23 (B) SUBSEQUENT REPORTS.—After sub- 24 mitting the initial report under subparagraph 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00919 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 920 •S 4819 IS (A), the Administrator shall submit to Congress 1 semiannual reports on the progress of the Ad- 2 ministrator in— 3 (i) implementing the recommendations 4 referred to in subparagraph (A); and 5 (ii) modifying the emergency manage- 6 ment procedures of the Administrator to 7 incorporate environmental justice in the 8 Incident Command Structure of the Envi- 9 ronmental Protection Agency, in accord- 10 ance with the December 18, 2006, letter 11 from the Deputy Administrator to the Act- 12 ing Inspector General of the Environ- 13 mental Protection Agency. 14 (d) FEDERAL ACTION PLAN FOR SAVING LIVES, 15 PROTECTING PEOPLE AND THEIR FAMILIES FROM 16 RADON.— 17 (1) FINDINGS.—Congress finds that radon is a 18 naturally occurring radioactive gas that is— 19 (A) recognized as the leading cause of lung 20 cancer among nonsmokers; and 21 (B) a particular environmental threat for 22 low-income and minority individuals because of 23 the lack of information about radon levels in 24 the homes of those individuals. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00920 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 921 •S 4819 IS (2) IMPLEMENTATION.—Not later than 180 1 days after the date of enactment of this Act, the Ad- 2 ministrator shall implement the action plan entitled 3 ‘‘Protecting People and Families from Radon: A 4 Federal Action Plan for Saving Lives’’ (June 20, 5 2011), in consultation with the Director of the Cen- 6 ters for Disease Control and Prevention and any 7 other Federal agencies referred to in the action plan. 8 (3) SPECIFIC STEPS.—In carrying out para- 9 graph (2), the Administrator shall ensure that— 10 (A) the workgroup comprised of the Fed- 11 eral agencies participating in the development 12 of the action plan referred to in paragraph (2) 13 implements specific steps within the existing 14 authority and activities of each Federal agency 15 to reduce exposure to radon; and 16 (B) not later than the date that is 1 year 17 after the date on which the Administrator be- 18 gins implementation of the action plan de- 19 scribed in paragraph (2), the workgroup de- 20 scribed in subparagraph (A) meets to assess 21 and recognize achievements of the plan. 22 (4) REPORT.—After the progress meeting of 23 the workgroup under paragraph (3)(B), the Admin- 24 istrator shall submit to Congress a report on the im- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00921 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 922 •S 4819 IS plementation of the action plan described in para- 1 graph (2), including the challenges remaining and 2 the progress in reducing radon exposure, particularly 3 for low-income and minority families. 4 (e) FEDERAL ACTION PLAN FOR PREVENTING 5 CHILDHOOD LEAD POISONING.— 6 (1) FINDINGS.—Congress finds that— 7 (A) the effects of lead poisoning are irre- 8 versible and cost the United States millions an- 9 nually in medical and education costs; 10 (B) the cognitive effects suffered by chil- 11 dren exposed to lead result in a lifetime of 12 health and behavioral problems, which makes 13 prevention efforts more critical; and 14 (C) the risk is especially high for vulner- 15 able minority populations who are more likely 16 to live in older homes, where lead-based paint 17 is more likely to be present. 18 (2) ACTION PLAN.—Not later than 180 days 19 after the date of enactment of this Act, the Adminis- 20 trator, in consultation with the Director of the Cen- 21 ters for Disease Control and Prevention and other 22 relevant Federal agencies, shall develop an action 23 plan to reduce exposure to lead. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00922 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 923 •S 4819 IS (3) SPECIFIC STEPS.—In carrying out para- 1 graph (2), the Administrator shall— 2 (A) establish a working group, comprised 3 of representatives of the Federal agencies par- 4 ticipating in the development of the action plan 5 described in paragraph (2), to make rec- 6 ommendations for the implementation of spe- 7 cific steps within the existing authority and ac- 8 tivities of each Federal agency to reduce expo- 9 sure to lead; and 10 (B) assist other Federal agencies in the de- 11 velopment of materials on the hazards of lead- 12 based paint for the purpose of educating ten- 13 ants and landlords, how to recognize potential 14 sources of exposure, and how to remediate those 15 sources. 16 SEC. 1005. GRANT PROGRAM TO CONDUCT ENVIRON- 17 MENTAL HEALTH IMPROVEMENT ACTIVITIES 18 AND TO IMPROVE SOCIAL DETERMINANTS OF 19 HEALTH. 20 (a) DEFINITIONS.—In this section: 21 (1) DIRECTOR.—The term ‘‘Director’’ means 22 the Director of the Centers for Disease Control and 23 Prevention, acting in collaboration with the Adminis- 24 trator of the Environmental Protection Agency and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00923 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 924 •S 4819 IS the Director of the National Institute of Environ- 1 mental Health Sciences. 2 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti- 3 ty’’ means a State or local community that— 4 (A) bears a disproportionate burden of ex- 5 posure to environmental health hazards; 6 (B) bears a disproportionate burden of ex- 7 posure to unhealthy living conditions, low 8 standard housing conditions, low socioeconomic 9 status, poor nutrition, less opportunity for edu- 10 cational attainment, disproportionately high un- 11 employment rates, or lower literacy levels and 12 access to information; 13 (C) has established a coalition— 14 (i) with not less than 1 community- 15 based organization or demonstration pro- 16 gram; and 17 (ii) with not less than 1— 18 (I) public health entity; 19 (II) health care provider organi- 20 zation; 21 (III) academic institution, includ- 22 ing any minority-serving institution 23 (including a Hispanic-serving institu- 24 tion, a historically Black college or 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00924 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 925 •S 4819 IS university, or a Tribal College or Uni- 1 versity); 2 (IV) child-serving institution; or 3 (V) landlord or housing provider 4 working on lead remediation; 5 (D) ensures planned activities and funding 6 streams are coordinated to improve community 7 health; and 8 (E) submits an application in accordance 9 with subsection (c). 10 (b) ESTABLISHMENT.—The Director shall establish a 11 grant program under which eligible entities shall receive 12 grants to conduct environmental health improvement ac- 13 tivities and to improve social determinants of health. 14 (c) APPLICATION.—To receive a grant under this sec- 15 tion, an eligible entity shall submit an application to the 16 Director at such time, in such manner, and accompanied 17 by such information as the Director may require. 18 (d) USE OF GRANT FUNDS.—An eligible entity may 19 use a grant under this section— 20 (1) to promote environmental health; 21 (2) to address environmental health disparities 22 among all populations, including children; and 23 (3) to address racial and ethnic disparities in 24 social determinants of health. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00925 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 926 •S 4819 IS (e) AMOUNT OF COOPERATIVE AGREEMENT.—The 1 Director shall award grants to eligible entities at the fol- 2 lowing 3 funding levels: 3 (1) LEVEL 1 COOPERATIVE AGREEMENTS.— 4 (A) IN GENERAL.—An eligible entity 5 awarded a grant under this paragraph shall use 6 the funds to identify environmental health prob- 7 lems and solutions by— 8 (i) establishing a planning and 9 prioritizing council in accordance with sub- 10 paragraph (B); and 11 (ii) conducting an environmental 12 health assessment in accordance with sub- 13 paragraph (C). 14 (B) PLANNING AND PRIORITIZING COUN- 15 CIL.— 16 (i) IN GENERAL.—A prioritizing and 17 planning council established under sub- 18 paragraph (A)(i) (referred to in this para- 19 graph as a ‘‘PPC’’) shall assist the envi- 20 ronmental health assessment process and 21 environmental health promotion activities 22 of the eligible entity. 23 (ii) MEMBERSHIP.—Membership of a 24 PPC shall consist of representatives from 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00926 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 927 •S 4819 IS various organizations within public health, 1 planning, development, and environmental 2 services and shall include stakeholders 3 from vulnerable groups such as children, 4 the elderly, disabled, and minority ethnic 5 groups that are often not actively involved 6 in democratic or decision-making proc- 7 esses. 8 (iii) DUTIES.—A PPC shall— 9 (I) identify key stakeholders and 10 engage and coordinate potential part- 11 ners in the planning process; 12 (II) establish a formal advisory 13 group to plan for the establishment of 14 services; 15 (III) conduct an in-depth review 16 of the nature and extent of the need 17 for an environmental health assess- 18 ment, including a local epidemiological 19 profile, an evaluation of the service 20 provider capacity of the community, 21 and a profile of any target popu- 22 lations; and 23 (IV) define the components of 24 care and form essential programmatic 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00927 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 928 •S 4819 IS linkages with related providers in the 1 community. 2 (C) ENVIRONMENTAL HEALTH ASSESS- 3 MENT.— 4 (i) IN GENERAL.—A PPC shall carry 5 out an environmental health assessment to 6 identify environmental health concerns. 7 (ii) ASSESSMENT PROCESS.—The 8 PPC shall— 9 (I) define the goals of the assess- 10 ment; 11 (II) generate the environmental 12 health issue list; 13 (III) analyze issues with a sys- 14 tems framework; 15 (IV) develop appropriate commu- 16 nity environmental health indicators; 17 (V) rank the environmental 18 health issues; 19 (VI) set priorities for action; 20 (VII) develop an action plan; 21 (VIII) implement the plan; and 22 (IX) evaluate progress and plan- 23 ning for the future. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00928 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 929 •S 4819 IS (D) EVALUATION.—Each eligible entity 1 that receives a grant under this paragraph shall 2 evaluate, report, and disseminate program find- 3 ings and outcomes. 4 (E) TECHNICAL ASSISTANCE.—The Direc- 5 tor may provide such technical and other non- 6 financial assistance to eligible entities as the 7 Director determines to be necessary. 8 (2) LEVEL 2 COOPERATIVE AGREEMENTS.— 9 (A) ELIGIBILITY.— 10 (i) IN GENERAL.—The Director shall 11 award grants under this paragraph to eli- 12 gible entities that have already— 13 (I) established broad-based col- 14 laborative partnerships; and 15 (II) completed environmental as- 16 sessments. 17 (ii) NO LEVEL 1 REQUIREMENT.—To 18 be eligible to receive a grant under this 19 paragraph, an eligible entity is not re- 20 quired to have successfully completed a 21 Level 1 Cooperative Agreement (as de- 22 scribed in paragraph (1)). 23 (B) USE OF GRANT FUNDS.—An eligible 24 entity awarded a grant under this paragraph 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00929 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 930 •S 4819 IS shall use the funds to further activities to carry 1 out environmental health improvement activi- 2 ties, including— 3 (i) addressing community environ- 4 mental health priorities in accordance with 5 paragraph (1)(C)(ii), including— 6 (I) geography; 7 (II) the built environment; 8 (III) air quality; 9 (IV) water quality; 10 (V) land use; 11 (VI) solid waste; 12 (VII) housing; 13 (VIII) violence; 14 (IX) socioeconomic status; 15 (X) ethnicity, social construct 16 and language preference; 17 (XI) educational attainment; 18 (XII) employment; 19 (XIII) food safety, accessibility, 20 and affordability; 21 (XIV) nutrition; 22 (XV) health care services; and 23 (XVI) injuries; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00930 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 931 •S 4819 IS (ii) building partnerships between 1 planning, public health, and other sectors, 2 including child-serving institutions, to ad- 3 dress how the built environment impacts 4 food availability and access and physical 5 activity to promote healthy behaviors and 6 lifestyles and reduce overweight and obe- 7 sity, musculoskeletal diseases, respiratory 8 conditions, dental, oral and mental health 9 conditions, poverty, and related co- 10 morbidities; 11 (iii) establishing programs to ad- 12 dress— 13 (I) how environmental and social 14 conditions of work and living choices 15 influence physical activity and dietary 16 intake; or 17 (II) how the conditions described 18 in subclause (I) influence the concerns 19 and needs of people who have im- 20 paired mobility and use assistance de- 21 vices, including wheelchairs, lower 22 limb prostheses, and hip, knee, and 23 other joint replacements; and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00931 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 932 •S 4819 IS (iv) convening intervention and dem- 1 onstration programs that examine the role 2 of the social environment in connection 3 with the physical and chemical environ- 4 ment in— 5 (I) determining access to nutri- 6 tional food; 7 (II) improving physical activity to 8 reduce overweight, obesity, and co- 9 morbidities and increase quality of 10 life; and 11 (III) location and access to med- 12 ical facilities. 13 (3) LEVEL 3 COOPERATIVE AGREEMENTS.— 14 (A) IN GENERAL.—An eligible entity 15 awarded a grant under this paragraph shall use 16 the funds to identify and address racial and 17 ethnic disparities in social determinants of 18 health by creating demonstration programs that 19 assess the feasibility of establishing a federally 20 funded comprehensive program and describe 21 key outcomes that address racial and ethnic dis- 22 parities in social determinants of health. 23 (B) PROGRAM DESIGN.— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00932 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 933 •S 4819 IS (i) EVALUATION.—No later than 1 1 year after enactment of this Act, the Di- 2 rector shall evaluate the best practices of 3 existing programs from the private, public, 4 community based, and academically sup- 5 ported initiatives focused on reducing dis- 6 parities in the social determinants of 7 health for racial and ethnic populations. 8 (ii) DEMONSTRATION PROJECTS.— 9 Not later than two years after the date of 10 enactment of this Act, the Director shall 11 implement at least ten demonstration 12 projects including at least one project for 13 each major racial and ethnic minority 14 group, each of which is unique to the cul- 15 tural and linguistic needs of each of the 16 following groups: 17 (I) Native Americans and Alaska 18 Natives. 19 (II) Asian Americans. 20 (III) African Americans/Blacks. 21 (IV) Hispanic/Latino-Americans. 22 (V) Native Hawaiians and Pacific 23 Islanders. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00933 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 934 •S 4819 IS (iii) REPORT TO CONGRESS.—No later 1 than 2 years after the implementation of 2 the initial demonstration projects, the Di- 3 rector shall submit to Congress a report 4 which includes— 5 (I) a description of each dem- 6 onstration project and design; 7 (II) an evaluation of the cost-ef- 8 fectiveness of each project’s preven- 9 tion and treatment efforts; 10 (III) an evaluation of the cultural 11 and linguistic appropriateness of each 12 project by racial and ethnic group; 13 and 14 (IV) an evaluation of the bene- 15 ficiary’s health status improvement 16 under the demonstration project. 17 (iv) ANY OTHER INFORMATION 18 DEEMED APPROPRIATE BY THE DIREC- 19 TOR.—The Director shall require eligible 20 entities awarded a grant under this para- 21 graph to report any other information the 22 Director determines appropriate to be 23 shared by or developed by such entity, in- 24 cluding the following: 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00934 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 935 •S 4819 IS (I) Developing models and evalu- 1 ating methods that improve the cul- 2 tural and linguistically appropriate 3 services provided through the Centers 4 for Disease Control and Prevention to 5 target individuals impacted by health 6 disparities based on their race, eth- 7 nicity, and gender. 8 (II) Promoting the collaboration 9 between primary and specialty care 10 health care providers and patients, to 11 ensure patients impacted by health 12 disparities based on race, ethnicity, 13 and gender are receiving comprehen- 14 sive and organized treatment and 15 care. 16 (III) Educating health care pro- 17 fessionals on the causes and effects of 18 disparities in the social determinants 19 of health as it relates to minority and 20 racial and ethnic communities and the 21 need for culturally and linguistically 22 appropriate care in the prevention and 23 treatment of high-impact diseases. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00935 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 936 •S 4819 IS (IV) Encouraging collaboration 1 among community and patient-based 2 organizations which work to address 3 disparities in the social determinants 4 of health as it relates to high-impact 5 diseases in minority and racial and 6 ethnic populations. 7 (f) AUTHORIZATION OF APPROPRIATIONS.—There 8 are authorized to be appropriated to carry out this sec- 9 tion— 10 (1) $25,000,000 for fiscal year 2021; and 11 (2) such sums as may be necessary for fiscal 12 years 2022 through 2024. 13 SEC. 1006. ADDITIONAL RESEARCH ON THE RELATIONSHIP 14 BETWEEN THE BUILT ENVIRONMENT AND 15 THE HEALTH OF COMMUNITY RESIDENTS. 16 (a) DEFINITION OF ELIGIBLE INSTITUTION.—In this 17 section, the term ‘‘eligible institution’’ means a public or 18 private nonprofit institution that submits to the Secretary 19 of Health and Human Services (in this section referred 20 to as the ‘‘Secretary’’) and the Administrator of the Envi- 21 ronmental Protection Agency (in this section referred to 22 as the ‘‘Administrator’’) an application for a grant under 23 the grant program authorized under subsection (b)(2) at 24 such time, in such manner, and containing such agree- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00936 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 937 •S 4819 IS ments, assurances, and information as the Secretary and 1 Administrator may require. 2 (b) RESEARCH GRANT PROGRAM.— 3 (1) DEFINITION OF HEALTH.—In this section, 4 the term ‘‘health’’ includes— 5 (A) levels of physical activity; 6 (B) degree of mobility due to factors such 7 as musculoskeletal diseases, arthritis, and obe- 8 sity; 9 (C) consumption of nutritional foods; 10 (D) rates of crime; 11 (E) air, water, and soil quality; 12 (F) risk of injury; 13 (G) accessibility to health care services; 14 (H) levels of educational attainment; and 15 (I) other indicators as determined appro- 16 priate by the Secretary. 17 (2) GRANTS.—The Secretary, in collaboration 18 with the Administrator, shall provide grants to eligi- 19 ble institutions to conduct and coordinate research 20 on the built environment and its influence on indi- 21 vidual and population-based health. 22 (3) RESEARCH.—The Secretary shall support 23 research that— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00937 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 938 •S 4819 IS (A) investigates and defines the causal 1 links between all aspects of the built environ- 2 ment and the health of residents; 3 (B) examines— 4 (i) the extent of the impact of the 5 built environment (including the various 6 characteristics of the built environment) on 7 the health of residents; 8 (ii) the variance in the health of resi- 9 dents by— 10 (I) location (such as inner cities, 11 inner suburbs, and outer suburbs); 12 and 13 (II) population subgroup (includ- 14 ing children, the elderly, the disadvan- 15 taged); or 16 (iii) the importance of the built envi- 17 ronment to the total health of residents, 18 which is the primary variable of interest 19 from a public health perspective; 20 (C) is used to develop— 21 (i) measures to address health and the 22 connection of health to the built environ- 23 ment; and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00938 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 939 •S 4819 IS (ii) efforts to link the measures to 1 travel and health databases; 2 (D) distinguishes carefully between per- 3 sonal attitudes and choices and external influ- 4 ences on observed behavior to determine how 5 much an observed association between the built 6 environment and the health of residents, versus 7 the lifestyle preferences of the people that 8 choose to live in the neighborhood, reflects the 9 physical characteristics of the neighborhood; 10 and 11 (E)(i) identifies or develops effective inter- 12 vention strategies to promote better health 13 among residents with a focus on behavioral 14 interventions and enhancements of the built en- 15 vironment that promote increased use by resi- 16 dents; and 17 (ii) in developing the intervention strate- 18 gies under clause (i), ensures that the interven- 19 tion strategies will reach out to high-risk popu- 20 lations, including racial and ethnic minorities, 21 low-income urban and rural communities, and 22 children. 23 (4) PRIORITY.—In providing assistance under 24 the grant program authorized under paragraph (2), 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00939 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 940 •S 4819 IS the Secretary and the Administrator shall give pri- 1 ority to research that incorporates— 2 (A) minority-serving institutions as grant- 3 ees; 4 (B) interdisciplinary approaches; or 5 (C) the expertise of the public health, 6 physical activity, nutrition and health care (in- 7 cluding child health), urban planning, and 8 transportation research communities in the 9 United States and abroad. 10 SEC. 1007. ENVIRONMENT AND PUBLIC HEALTH RESTORA- 11 TION. 12 (a) FINDINGS.—Congress finds that— 13 (1) humans share an environment with a wide 14 variety of habitats and ecosystems that nurture and 15 sustain a diversity of species; 16 (2) the abundance of natural resources in the 17 environment forms the basis for the economy and 18 has greatly contributed to human development 19 throughout history; 20 (3) the accelerated pace of human development 21 over the last several hundred years has significantly 22 impacted— 23 (A) the natural environment and its re- 24 sources; 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00940 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 941 •S 4819 IS (B) the health and diversity of plant and 1 animal life; 2 (C) the availability of critical habitats; 3 (D) the quality of the air and water; and 4 (E) the global climate; 5 (4) the intervention of the Federal Government 6 is necessary to minimize and mitigate human impact 7 on the environment— 8 (A) for the benefit of public health; 9 (B) to maintain air quality and water qual- 10 ity; 11 (C) to sustain the diversity of plants and 12 animals; 13 (D) to combat global climate change; and 14 (E) to protect the environment; 15 (5) laws and regulations in the United States 16 have been enacted and promulgated to minimize and 17 mitigate human impact on the environment for the 18 benefit of public health, to maintain air quality and 19 water quality, to sustain wildlife, and to protect the 20 environment; and 21 (6) attempts to repeal or weaken key environ- 22 mental safeguards pose dangers to the public health, 23 air quality, water quality, wildlife, and the environ- 24 ment. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00941 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 942 •S 4819 IS (b) STATEMENT OF POLICY.—It is the policy of the 1 Federal Government to work in conjunction with States, 2 territories, Tribal governments, international organiza- 3 tions, and foreign governments as a steward of the envi- 4 ronment for the benefit of public health, to maintain air 5 quality and water quality, to sustain the diversity of plant 6 and animal species, to combat global climate change, and 7 to protect the environment for future generations. 8 (c) STUDY AND REPORT ON PUBLIC HEALTH OR EN- 9 VIRONMENTAL IMPACT OF REVISED RULES, REGULA- 10 TIONS, LAWS, OR OTHER AGENCY DECISIONS.— 11 (1) STUDY.—Not later than 30 days after the 12 date of enactment of this Act, the President shall 13 seek to enter into an arrangement under which the 14 National Academy of Sciences shall conduct a study 15 to determine the impact on public health, air quality, 16 water quality, wildlife, and the environment of the 17 following regulations, laws, and other agency deci- 18 sions: 19 (A) CLEAN WATER.— 20 (i) The final rule of the Environ- 21 mental Protection Agency and the Corps of 22 Engineers entitled ‘‘Final Revisions to the 23 Clean Water Act Regulatory Definitions of 24 ‘Fill Material’ and ‘Discharge of Fill Mate- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00942 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 943 •S 4819 IS rial’ ’’ (67 Fed. Reg. 31129 (May 9, 1 2002)). 2 (ii) The final rule of the Environ- 3 mental Protection Agency entitled ‘‘Na- 4 tional Pollutant Discharge Elimination 5 System Permit Regulation for Con- 6 centrated Animal Feeding Operations: Re- 7 moval of Vacated Elements in Response to 8 2011 Court Decision’’ (77 Fed. Reg. 9 44494 (July 30, 2012)). 10 (iii) The final rule entitled ‘‘With- 11 drawal of Revisions to the Water Quality 12 Planning and Management Regulation and 13 Revisions to the National Pollutant Dis- 14 charge Elimination System Program in 15 Support of Revisions to the Water Quality 16 Planning and Management Regulation’’ 17 (68 Fed. Reg. 13608 (March 19, 2003)). 18 (iv) The final rule of the Environ- 19 mental Protection Agency entitled ‘‘Con- 20 solidated Permit Regulations: RCRA Haz- 21 ardous Waste; SDWA Underground Injec- 22 tion Control; CWA National Pollutant Dis- 23 charge Elimination System; CWA Section 24 404 Dredge or Fill Programs; and CAA 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00943 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 944 •S 4819 IS Prevention of Significant Deterioration’’ 1 (45 Fed. Reg. 33290 (May 19, 1980)), 2 with respect to the definition of the ‘‘wa- 3 ters of the United States’’. 4 (v) The final rule of the Corps of En- 5 gineers and the Environmental Protection 6 Agency entitled ‘‘Definition of ‘Waters of 7 the United States’—Recodification of Pre- 8 Existing Rules’’ (84 Fed. Reg. 56626 (Oc- 9 tober 22, 2019)). 10 (vi) The final rule of the Corps of En- 11 gineers and the Environmental Protection 12 Agency entitled ‘‘The Navigable Waters 13 Protection Rule: Definition of ‘Waters of 14 the United States’ ’’ (85 Fed. Reg. 22250 15 (April 21, 2020)). 16 (B) FORESTS AND LAND MANAGEMENT.— 17 (i) The Healthy Forests Restoration 18 Act of 2003 (16 U.S.C. 6501 et seq.). 19 (ii) The application of section 553(e) 20 of title 5, United States Code, such that a 21 State may petition for a special rule for 22 the National Forest System inventoried 23 roadless areas within the State. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00944 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 945 •S 4819 IS (iii) The final rules entitled ‘‘National 1 Forest System Land Management Plan- 2 ning’’ (77 Fed. Reg. 21162 (April 9, 3 2012)) and ‘‘National Forest System Land 4 Management Planning’’ (81 Fed. Reg. 5 90723 (December 15, 2016)). 6 (iv) The final rule entitled ‘‘Oil Shale 7 Management—General’’ (73 Fed. Reg. 8 69414 (November 18, 2008)). 9 (v) The record of decision described in 10 the notice of availability entitled ‘‘Notice of 11 Availability of Approved Land Use Plan 12 Amendments/Record of Decision for Allo- 13 cation of Oil Shale and Tar Sands Re- 14 sources on Lands Administered by the Bu- 15 reau of Land Management in Colorado, 16 Utah, and Wyoming and Final Pro- 17 grammatic Environmental Impact State- 18 ment’’ (78 Fed. Reg. 19518 (April 1, 19 2013)). 20 (C) SCIENTIFIC REVIEW.—The final rule 21 entitled ‘‘Interagency Cooperation Under the 22 Endangered Species Act’’ (73 Fed. Reg. 76272 23 (December 16, 2008)), as amended by the final 24 rule entitled ‘‘Endangered and Threatened 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00945 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 946 •S 4819 IS Wildlife and Plants; Regulations for Inter- 1 agency Cooperation’’ (84 Fed. Reg. 44976 (Au- 2 gust 27, 2019)). 3 (2) METHOD.—In conducting the study under 4 paragraph (1), the National Academy of Sciences 5 may use and compare existing scientific studies re- 6 garding the regulations, laws, and other agency deci- 7 sions described in paragraph (1). 8 (3) REPORT.—Not later than 270 days after 9 the date on which the President enters into the ar- 10 rangement under paragraph (1), the National Acad- 11 emy of Sciences shall make publicly available and 12 shall submit to Congress and to the head of each de- 13 partment and agency of the Federal Government 14 that issued, implements, or would implement a regu- 15 lation, law, or other agency decision described in 16 paragraph (1), a report that includes— 17 (A) a description of the impact of each 18 regulation, law, or other agency decision de- 19 scribed in paragraph (1) on public health, air 20 quality, water quality, wildlife, and the environ- 21 ment, compared to the impact of preexisting 22 regulations, laws, or other agency decisions in 23 effect, as applicable, including— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00946 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 947 •S 4819 IS (i) any negative impacts to air quality 1 or water quality; 2 (ii) any negative impacts to wildlife; 3 (iii) any delays in hazardous waste 4 cleanup that are projected to be hazardous 5 to public health; and 6 (iv) any other negative impact on pub- 7 lic health or the environment; and 8 (B) any recommendations that the Na- 9 tional Academy of Sciences considers appro- 10 priate to maintain, restore, or improve in whole 11 or in part protections for public health, air 12 quality, water quality, wildlife, and the environ- 13 ment for each of the regulations, laws, and 14 other agency decisions described in paragraph 15 (1), which may include recommendations for 16 the adoption of any regulation or law in place 17 or proposed prior to January 1, 2001. 18 (d) DEPARTMENT AND AGENCY REVISION OF EXIST- 19 ING RULES, REGULATIONS, OR LAWS.—Not later than 20 180 days after the date on which the report is submitted 21 pursuant to subsection (c)(3), the head of each depart- 22 ment or agency that has issued or implemented a regula- 23 tion, law, or other agency decision described in subsection 24 (c)(1) shall submit to Congress a plan describing the steps 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00947 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 948 •S 4819 IS the department or agency will take, or has taken, to re- 1 store or improve protections for public health and the envi- 2 ronment in whole or in part that were in existence prior 3 to the issuance of the applicable regulation, law, or other 4 agency decision. 5 SEC. 1008. GAO REPORT ON HEALTH EFFECTS OF DEEP- 6 WATER HORIZON OIL RIG EXPLOSION IN THE 7 GULF COAST. 8 (a) STUDY.—The Comptroller General of the United 9 States shall conduct a study on the type and scope of 10 health care services administered through the Department 11 of Health and Human Services addressing the provision 12 of health care to racial and ethnic minorities, including 13 residents, cleanup workers, and volunteers, affected by the 14 blowout and explosion of the mobile offshore drilling unit 15 Deepwater Horizon that occurred on April 20, 2010, and 16 resulting hydrocarbon releases into the environment. 17 (b) SPECIFIC COMPONENTS.—In carrying out sub- 18 section (a), the Comptroller General of the United States 19 shall— 20 (1) assess the type, size, and scope of programs 21 administered by the Secretary of Health and Human 22 Services that focus on the provision of health care 23 to communities on the Gulf Coast; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00948 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 949 •S 4819 IS (2) identify the merits and disadvantages asso- 1 ciated with each of the programs; 2 (3) perform an analysis of the costs and bene- 3 fits of the programs; and 4 (4) determine whether there is any duplication 5 of programs. 6 (c) REPORT.—Not later than 180 days after the date 7 of enactment of this Act, the Comptroller General of the 8 United States shall submit to Congress a report that in- 9 cludes— 10 (1) the findings of the study conducted under 11 subsection (a); and 12 (2) recommendations for improving access to 13 health care for racial and ethnic minorities. 14 SEC. 1009. ESTABLISH AN INTERAGENCY COUNSEL AND 15 GRANT PROGRAMS ON SOCIAL DETER- 16 MINANTS OF HEALTH. 17 (a) SHORT TITLE.—This section may be cited as the 18 ‘‘Social Determinants Accelerator Act of 2020’’. 19 (b) FINDINGS; PURPOSES.— 20 (1) FINDINGS.—Congress finds the following: 21 (A) There is a significant body of evidence 22 showing that economic and social conditions 23 have a powerful impact on individual and popu- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00949 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 950 •S 4819 IS lation health outcomes and well-being, as well 1 as medical costs. 2 (B) State, local, and Tribal governments 3 and the service delivery partners of such gov- 4 ernments face significant challenges in coordi- 5 nating benefits and services delivered through 6 the Medicaid program and other social services 7 programs because of the fragmented and com- 8 plex nature of Federal and State funding and 9 administrative requirements. 10 (C) The Federal Government should 11 prioritize and proactively assist State and local 12 governments to strengthen the capacity of State 13 and local governments to improve health and 14 social outcomes for individuals, thereby improv- 15 ing cost-effectiveness and return on investment. 16 (2) PURPOSES.—The purposes of this section 17 are as follows: 18 (A) To establish effective, coordinated Fed- 19 eral technical assistance to help State and local 20 governments to improve outcomes and cost-ef- 21 fectiveness of, and return on investment from, 22 health and social services programs. 23 (B) To build a pipeline of State and locally 24 designed, cross-sector interventions and strate- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00950 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 951 •S 4819 IS gies that generate rigorous evidence about how 1 to improve health and social outcomes, and in- 2 crease the cost-effectiveness of, and return on 3 investment from, Federal, State, local, and 4 Tribal health and social services programs. 5 (C) To enlist State and local governments 6 and the service providers of such governments 7 as partners in identifying Federal statutory, 8 regulatory, and administrative challenges in im- 9 proving the health and social outcomes of, cost- 10 effectiveness of, and return on investment from, 11 Federal spending on individuals enrolled in 12 Medicaid. 13 (D) To develop strategies to improve 14 health and social outcomes without denying 15 services to, or restricting the eligibility of, vul- 16 nerable populations. 17 (c) SOCIAL DETERMINANTS ACCELERATOR COUN- 18 CIL.— 19 (1) ESTABLISHMENT.—The Secretary of Health 20 and Human Services (referred to in this section as 21 the ‘‘Secretary’’), in coordination with the Adminis- 22 trator of the Centers for Medicare & Medicaid Serv- 23 ices (referred to in this section as the ‘‘Adminis- 24 trator’’), shall establish an interagency council, to be 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00951 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 952 •S 4819 IS known as the Social Determinants Accelerator Inter- 1 agency Council (referred to in this section as the 2 ‘‘Council’’) to achieve the purposes listed in sub- 3 section (b)(2). 4 (2) MEMBERSHIP.— 5 (A) FEDERAL COMPOSITION.—The Council 6 shall be composed of at least one designee from 7 each of the following Federal agencies: 8 (i) The Office of Management and 9 Budget. 10 (ii) The Department of Agriculture. 11 (iii) The Department of Education. 12 (iv) The Indian Health Service. 13 (v) The Department of Housing and 14 Urban Development. 15 (vi) The Department of Labor. 16 (vii) The Department of Transpor- 17 tation. 18 (viii) Any other Federal agency the 19 Chair of the Council determines necessary. 20 (B) DESIGNATION.— 21 (i) IN GENERAL.—The head of each 22 agency specified in subparagraph (A) shall 23 designate at least one employee to serve as 24 a member of the Council. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00952 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 953 •S 4819 IS (ii) RESPONSIBILITIES.—An employee 1 described in this clause shall be a senior 2 employee of the agency— 3 (I) whose responsibilities relate 4 to authorities, policies, and procedures 5 with respect to the health and well- 6 being of individuals receiving medical 7 assistance under a State plan (or a 8 waiver of such plan) under title XIX 9 of the Social Security Act (42 U.S.C. 10 1396 et seq.); or 11 (II) who has authority to imple- 12 ment and evaluate transformative ini- 13 tiatives that harness data or conducts 14 rigorous evaluation to improve the im- 15 pact and cost-effectiveness of federally 16 funded services and benefits. 17 (C) HHS REPRESENTATION.—In addition 18 to the designees under subparagraph (A), the 19 Council shall include designees from at least 3 20 agencies within the Department of Health and 21 Human Services, including the Centers for 22 Medicare & Medicaid Services, at least one of 23 whom shall meet the criteria under this section. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00953 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 954 •S 4819 IS (D) OMB ROLE.—The Director of the Of- 1 fice of Management and Budget shall facilitate 2 the timely resolution of Federal Government- 3 wide and multiagency issues to help the Council 4 achieve consensus recommendations described 5 under this section. 6 (E) NON-FEDERAL COMPOSITION.—The 7 Comptroller General of the United States may 8 designate up to 6 Council designees— 9 (i) who have relevant subject matter 10 expertise, including expertise implementing 11 and evaluating transformative initiatives 12 that harness data and conduct evaluations 13 to improve the impact and cost-effective- 14 ness of Federal Government services; and 15 (ii) that each represent— 16 (I) State, local, and Tribal health 17 and human services agencies; 18 (II) public housing authorities or 19 State housing finance agencies; 20 (III) State and local government 21 budget offices; 22 (IV) State Medicaid agencies; or 23 (V) national consumer advocacy 24 organizations. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00954 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 955 •S 4819 IS (F) CHAIR.— 1 (i) IN GENERAL.—The Secretary shall 2 select the Chair of the Council from among 3 the members of the Council. 4 (ii) INITIATING GUIDANCE.—The 5 Chair, on behalf of the Council, shall iden- 6 tify and invite individuals from diverse en- 7 tities to provide the Council with advice 8 and information pertaining to addressing 9 social determinants of health, including— 10 (I) individuals from State and 11 local government health and human 12 services agencies; 13 (II) individuals from State Med- 14 icaid agencies; 15 (III) individuals from State and 16 local government budget offices; 17 (IV) individuals from public 18 housing authorities or State housing 19 finance agencies; 20 (V) individuals from nonprofit or- 21 ganizations, small businesses, and 22 philanthropic organizations; 23 (VI) advocates; 24 (VII) researchers; and 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00955 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 956 •S 4819 IS (VIII) any other individuals the 1 Chair determines to be appropriate. 2 (3) DUTIES.—The duties of the Council are— 3 (A) to make recommendations to the Sec- 4 retary and the Administrator regarding the cri- 5 teria for making awards under this section; 6 (B) to identify Federal authorities and op- 7 portunities for use by States or local govern- 8 ments to improve coordination of funding and 9 administration of Federal programs, the bene- 10 ficiaries of whom include individuals, and which 11 may be unknown or underutilized and to make 12 information on such authorities and opportuni- 13 ties publicly available; 14 (C) to provide targeted technical assistance 15 to States developing a social determinants ac- 16 celerator plan under this section, including 17 identifying potential statutory or regulatory 18 pathways for implementation of the plan and 19 assisting in identifying potential sources of 20 funding to implement the plan; 21 (D) to report to Congress annually on the 22 subjects set forth in this section; 23 (E) to develop and disseminate evaluation 24 guidelines and standards that can be used to 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00956 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 957 •S 4819 IS reliably assess the impact of an intervention or 1 approach that may be implemented pursuant to 2 this section on outcomes, cost-effectiveness of, 3 and return on investment from Federal, State, 4 local, and Tribal governments, and to facilitate 5 technical assistance, where needed, to help to 6 improve State and local evaluation designs and 7 implementation; 8 (F) to seek feedback from State, local, and 9 Tribal governments, including through an an- 10 nual survey by an independent third party, on 11 how to improve the technical assistance the 12 Council provides to better equip State, local, 13 and Tribal governments to coordinate health 14 and social service programs; 15 (G) to solicit applications for grants under 16 this section; and 17 (H) to coordinate with other cross-agency 18 initiatives focused on improving the health and 19 well-being of low-income and at-risk populations 20 in order to prevent unnecessary duplication be- 21 tween agency initiatives. 22 (4) SCHEDULE.—Not later than 60 days after 23 the date of the enactment of this Act, the Council 24 shall convene to develop a schedule and plan for car- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00957 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 958 •S 4819 IS rying out the duties described in this section, includ- 1 ing solicitation of applications for the grants under 2 this section. 3 (5) REPORT TO CONGRESS.—The Council shall 4 submit an annual report to Congress, which shall in- 5 clude— 6 (A) a list of the Council members; 7 (B) activities and expenditures of the 8 Council; 9 (C) summaries of the interventions and ap- 10 proaches that will be supported by State, local, 11 and Tribal governments that received a grant 12 under this section, including— 13 (i) the best practices and evidence- 14 based approaches such governments plan 15 to employ to achieve the purposes listed in 16 this section; and 17 (ii) a description of how the practices 18 and approaches will impact the outcomes, 19 cost-effectiveness of, and return on invest- 20 ment from, Federal, State, local, and Trib- 21 al governments with respect to such pur- 22 poses; 23 (D) the feedback received from State and 24 local governments on ways to improve the tech- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00958 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 959 •S 4819 IS nical assistance of the Council, including find- 1 ings from a third-party survey and actions the 2 Council plans to take in response to such feed- 3 back; and 4 (E) the major statutory, regulatory, and 5 administrative challenges identified by State, 6 local, and Tribal governments that received a 7 grant under subsection (d), and the actions that 8 Federal agencies are taking to address such 9 challenges. 10 (6) FACA APPLICABILITY.—The Federal Advi- 11 sory Committee Act (5 U.S.C. App.) shall not apply 12 to the Council. 13 (7) COUNCIL PROCEDURES.—The Secretary, in 14 consultation with the Comptroller General of the 15 United States and the Director of the Office of Man- 16 agement and Budget, shall establish procedures for 17 the Council to— 18 (A) ensure that adequate resources are 19 available to effectively execute the responsibil- 20 ities of the Council; 21 (B) effectively coordinate with other rel- 22 evant advisory bodies and working groups to 23 avoid unnecessary duplication; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00959 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 960 •S 4819 IS (C) create transparency to the public and 1 Congress with regard to Council membership, 2 costs, and activities, including through use of 3 modern technology and social media to dissemi- 4 nate information; and 5 (D) avoid conflicts of interest that would 6 jeopardize the ability of the Council to make de- 7 cisions and provide recommendations. 8 (d) SOCIAL DETERMINANTS ACCELERATOR GRANTS 9 TO STATES OR LOCAL GOVERNMENTS.— 10 (1) GRANTS TO STATES, LOCAL GOVERNMENTS, 11 AND TRIBES.—Not later than 180 days after the 12 date of the enactment of this Act, the Administrator, 13 in consultation with the Secretary and the Council, 14 shall award on a competitive basis not more than 25 15 grants to eligible applicants described in this sub- 16 section, for the development of social determinants 17 accelerator plans, as described in this subsection. 18 (2) ELIGIBLE APPLICANT.—An eligible appli- 19 cant described in this subsection is a State, local, or 20 Tribal health or human services agency that— 21 (A) demonstrates the support of relevant 22 parties across relevant State, local, or Tribal ju- 23 risdictions; and 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00960 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 961 •S 4819 IS (B) in the case of an applicant that is a 1 local government agency, provides to the Sec- 2 retary a letter of support from the lead State 3 health or human services agency for the State 4 in which the local government is located. 5 (3) AMOUNT OF GRANT.—The Administrator, 6 in coordination with the Council, shall determine the 7 total amount that the Administrator will make avail- 8 able to each grantee under this subsection. 9 (4) APPLICATION.—An eligible applicant seek- 10 ing a grant under this subsection shall include in the 11 application the following information: 12 (A) The target population (or populations) 13 that would benefit from implementation of the 14 social determinants accelerator plan proposed to 15 be developed by the applicant. 16 (B) A description of the objective or objec- 17 tives and outcome goals of such proposed plan, 18 which shall include at least one health outcome 19 and at least one other important social out- 20 come. 21 (C) The sources and scope of inefficiencies 22 that, if addressed by the plan, could result in 23 improved cost-effectiveness of or return on in- 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00961 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 962 •S 4819 IS vestment from Federal, State, local, and Tribal 1 governments. 2 (D) A description of potential interventions 3 that could be designed or enabled using such 4 proposed plan. 5 (E) The State, local, Tribal, academic, 6 nonprofit, community-based organizations, and 7 other private sector partners that would partici- 8 pate in the development of the proposed plan 9 and subsequent implementation of programs or 10 initiatives included in such proposed plan. 11 (F) Such other information as the Admin- 12 istrator, in consultation with the Secretary and 13 the Council, determines necessary to achieve the 14 purposes of this section. 15 (5) USE OF FUNDS.—A recipient of a grant 16 under this subsection may use funds received 17 through the grant for the following purposes: 18 (A) To convene and coordinate with rel- 19 evant government entities and other stake- 20 holders across sectors to assist in the develop- 21 ment of a social determinant accelerator plan. 22 (B) To identify populations of individuals 23 receiving medical assistance under a State plan 24 (or a waiver of such plan) under title XIX of 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00962 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 963 •S 4819 IS the Social Security Act (42 U.S.C. 1396 et 1 seq.) who may benefit from the proposed ap- 2 proaches to improving the health and well-being 3 of such individuals through the implementation 4 of the proposed social determinants accelerator 5 plan. 6 (C) To engage qualified research experts to 7 advise on relevant research and to design a pro- 8 posed evaluation plan, in accordance with the 9 standards and guidelines issued by the Admin- 10 istrator. 11 (D) To collaborate with the Council to sup- 12 port the development of social determinants ac- 13 celerator plans. 14 (E) To prepare and submit a final social 15 determinants accelerator plan to the Council. 16 (6) CONTENTS OF PLANS.—A social deter- 17 minant accelerator plan developed under this sub- 18 section shall include the following: 19 (A) A description of the target population 20 (or populations) that would benefit from imple- 21 mentation of the social determinants accelerator 22 plan, including an analysis describing the pro- 23 jected impact on the well-being of individuals 24 described in paragraph (5)(B). 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00963 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 964 •S 4819 IS (B) A description of the interventions or 1 approaches designed under the social deter- 2 minants accelerator plan and the evidence for 3 selecting such interventions or approaches. 4 (C) The objectives and outcome goals of 5 such interventions or approaches, including at 6 least one health outcome and at least one other 7 important social outcome. 8 (D) A plan for accessing and linking rel- 9 evant data to enable coordinated benefits and 10 services for the jurisdictions described in this 11 section and an evaluation of the proposed inter- 12 ventions and approaches. 13 (E) A description of the State, local, Trib- 14 al, academic, nonprofit, or community-based or- 15 ganizations, or any other private sector organi- 16 zations that would participate in implementing 17 the proposed interventions or approaches, and 18 the role each would play to contribute to the 19 success of the proposed interventions or ap- 20 proaches. 21 (F) The identification of the funding 22 sources that would be used to finance the pro- 23 posed interventions or approaches. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00964 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 965 •S 4819 IS (G) A description of any financial incen- 1 tives that may be provided, including outcome- 2 focused contracting approaches to encourage 3 service providers and other partners to improve 4 outcomes of, cost-effectiveness of, and return on 5 investment from, Federal, State, local, or Tribal 6 government spending. 7 (H) The identification of the applicable 8 Federal, State, local, or Tribal statutory and 9 regulatory authorities, including waiver authori- 10 ties, to be leveraged to implement the proposed 11 interventions or approaches. 12 (I) A description of potential consider- 13 ations that would enhance the impact, 14 scalability, or sustainability of the proposed 15 interventions or approaches and the actions the 16 grant awardee would take to address such con- 17 siderations. 18 (J) A proposed evaluation plan, to be car- 19 ried out by an independent evaluator, to meas- 20 ure the impact of the proposed interventions or 21 approaches on the outcomes of, cost-effective- 22 ness of, and return on investment from, Fed- 23 eral, State, local, and Tribal governments. 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00965 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 966 •S 4819 IS (K) Precautions for ensuring that vulner- 1 able populations will not be denied access to 2 Medicaid or other essential services as a result 3 of implementing the proposed plan. 4 (e) FUNDING.— 5 (1) IN GENERAL.—Out of any money in the 6 Treasury not otherwise appropriated, there is appro- 7 priated to carry out this section $25,000,000 to re- 8 main available for obligation until the date that is 9 5 years after the date of enactment of this section. 10 (2) RESERVATION OF FUNDS.— 11 (A) IN GENERAL.—Of the funds made 12 available under paragraph (1), the Secretary 13 shall reserve not less than 20 percent to award 14 grants to eligible applicants for the development 15 of social determinants accelerator plans under 16 this section intended to serve rural populations. 17 (B) EXCEPTION.—In the case of a fiscal 18 year for which the Secretary determines that 19 there are not sufficient eligible applicants to 20 award up to 25 grants under subsection (d) 21 that are intended to serve rural populations and 22 the Secretary cannot satisfy the 20-percent re- 23 quirement, the Secretary may reserve an 24 amount that is less than 20 percent of amounts 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00966 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 967 •S 4819 IS made available under paragraph (1) to award 1 grants for such purpose. 2 (3) RULE OF CONSTRUCTION.—Nothing in this 3 section shall prevent Federal agencies represented 4 on the Council from contributing additional funding 5 from other sources to support activities to improve 6 the effectiveness of the Council. 7 SEC. 1010. CORRECTING HURTFUL AND ALIENATING 8 NAMES IN GOVERNMENT EXPRESSION 9 (CHANGE). 10 (a) SHORT TITLE.—This section may be cited as the 11 ‘‘Correcting Hurtful and Alienating Names in Government 12 Expression (CHANGE) Act’’. 13 (b) DEFINITIONS.—In this section: 14 (1) EMPLOYEE.—The term ‘‘employee’’ has the 15 meaning given the term in section 2105 of title 5, 16 United States Code. 17 (2) EXECUTIVE AGENCY.—The term ‘‘Executive 18 agency’’ has the meaning given the term in section 19 105 of title 5, United States Code. 20 (3) OFFICER.—The term ‘‘officer’’ has the 21 meaning given the term in section 2104 of title 5, 22 United States Code. 23 (4) PROHIBITED TERM.—The term ‘‘prohibited 24 term’’ means— 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00967 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 968 •S 4819 IS (A) the term ‘‘alien’’, when used to refer to 1 an individual who is not a citizen or national of 2 the United States; and 3 (B) the term ‘‘illegal alien’’, when used to 4 refer to an individual who— 5 (i) is unlawfully present in the United 6 States; or 7 (ii) lacks a lawful immigration status 8 in the United States. 9 (c) MODERNIZATION OF LANGUAGE REFERRING TO 10 INDIVIDUALS WHO ARE NOT CITIZENS OR NATIONALS OF 11 THE UNITED STATES.— 12 (1) IN GENERAL.—Except as provided in para- 13 graph (2), on and after the date of enactment of this 14 Act, an Executive agency may not use a prohibited 15 term in any proposed or final rule, regulation, inter- 16 pretation, publication, other document, display, or 17 sign issued by the Executive agency. 18 (2) EXCEPTION.—An Executive agency may use 19 a prohibited term under paragraph (1) if the Execu- 20 tive agency uses the prohibited term while quoting 21 or reproducing text written by a source that is not 22 an officer or employee of the Executive agency. 23 (d) UNIFORM DEFINITION.— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00968 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 969 •S 4819 IS (1) IN GENERAL.—Chapter 1 of title 1, United 1 States Code, is amended by adding at the end the 2 following: 3 ‘‘§ 9. Definition of ‘foreign national’ 4 ‘‘In determining the meaning of any Act of Congress 5 or any ruling, regulation, or interpretation of an adminis- 6 trative bureau or agency of the United States, the term 7 ‘foreign national’ means any individual that is not an indi- 8 vidual who— 9 ‘‘(1) is a citizen of the United States; or 10 ‘‘(2) though not a citizen of the United States, 11 owes permanent allegiance to the United States.’’. 12 (2) TECHNICAL AMENDMENT.—The table of 13 sections for chapter 1 of title 1, United States Code, 14 is amended by adding at the end the following: 15 ‘‘9. Definition of ‘foreign national’.’’. (e) REFERENCES.— 16 (1) IN GENERAL.—Any reference in any Fed- 17 eral statute, rule, regulation, Executive order, publi- 18 cation, or other document of the United States— 19 (A) to the term ‘‘alien’’, when used to refer 20 to an individual who is not a citizen or national 21 of the United States, is deemed to refer to the 22 term ‘‘foreign national’’; and 23 (B) to the term ‘‘illegal alien’’ is deemed to 24 refer to the term ‘‘undocumented foreign na- 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00969 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 970 •S 4819 IS tional’’, when used to refer to an individual 1 who— 2 (i) is unlawfully present in the United 3 States; or 4 (ii) lacks a lawful immigration status 5 in the United States. 6 (2) CONFORMING AMENDMENTS.— 7 (A) Section 421(5)(A)(ii)(II) of the Con- 8 gressional Budget and Impoundment Control 9 Act of 1974 (2 U.S.C. 658(5)(A)(ii)(II)) is 10 amended— 11 (i) by striking ‘‘illegal, deportable, and 12 excludable aliens’’ and inserting ‘‘undocu- 13 mented foreign nationals and deportable 14 and excludable foreign nationals’’; and 15 (ii) by striking ‘‘illegal aliens’’ each 16 place it appears and inserting ‘‘undocu- 17 mented foreign nationals’’. 18 (B) Section 432(e) of the Homeland Secu- 19 rity Act of 2002 (6 U.S.C. 240(e)) is amended 20 by striking ‘‘illegal alien’’ and inserting ‘‘un- 21 documented foreign national’’. 22 (C) Section 439 of the Antiterrorism and 23 Effective Death Penalty Act of 1996 (8 U.S.C. 24 1252c) is amended in the section heading by 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00970 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 971 •S 4819 IS striking ‘‘ILLEGAL ALIENS’’ and inserting 1 ‘‘UNDOCUMENTED FOREIGN NATIONALS’’. 2 (D) Section 280(b)(3)(A)(iii) of the Immi- 3 gration and Nationality Act (8 U.S.C. 4 1330(b)(3)(A)(iii)) is amended by striking ‘‘ille- 5 gal aliens’’ and inserting ‘‘undocumented for- 6 eign nationals’’. 7 (E) Section 286(r)(3)(ii) of the Immigra- 8 tion and Nationality Act (8 U.S.C. 9 1356(r)(3)(ii)) is amended by striking ‘‘illegal 10 aliens’’ and inserting ‘‘undocumented foreign 11 nationals’’. 12 (F) Title V of the Immigration Reform 13 and Control Act of 1986 (Public Law 99–603; 14 100 Stat. 3443) is amended— 15 (i) in the title heading, by striking 16 ‘‘ILLEGAL ALIENS’’ and inserting 17 ‘‘UNDOCUMENTED FOREIGN 18 NATIONALS’’; and 19 (ii) in section 501 (8 U.S.C. 1365)— 20 (I) in the section heading, by 21 striking ‘‘ILLEGAL ALIENS’’ and in- 22 serting ‘‘UNDOCUMENTED FOR- 23 EIGN NATIONALS’’; 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00971 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 972 •S 4819 IS (II) in subsection (b), in the sub- 1 section heading, by striking ‘‘ILLEGAL 2 ALIENS’’ and inserting ‘‘UNDOCU- 3 MENTED FOREIGN NATIONALS’’; and 4 (III) by striking ‘‘illegal alien’’ 5 each place such term appears and in- 6 serting ‘‘undocumented foreign na- 7 tional’’. 8 (G) Section 332 of the Omnibus Consoli- 9 dated Appropriations Act, 1997 (8 U.S.C. 10 1366) is amended by striking ‘‘illegal aliens’’ 11 each place it appears and inserting ‘‘undocu- 12 mented foreign nationals’’. 13 (H) Section 411(d) of the Personal Re- 14 sponsibility and Work Opportunity Reconcili- 15 ation Act of 1996 (8 U.S.C. 1621(d)) is amend- 16 ed in the subsection heading by striking ‘‘ILLE- 17 GAL ALIENS’’ and inserting ‘‘UNDOCUMENTED 18 FOREIGN NATIONALS’’. 19 (I) Section 40125(a)(2) of title 49, United 20 States Code, is amended by striking ‘‘illegal 21 aliens’’ and inserting ‘‘undocumented foreign 22 nationals’’. 23 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00972 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 973 •S 4819 IS Subtitle B—Gun Violence 1 SEC. 1011. FINDINGS. 2 Congress finds as follows: 3 (1) On average, 86 Americans are killed by 4 guns each day. 5 (2) An estimated 39,773 people were killed by 6 guns in 2017, of which two-thirds committed suicide. 7 (3) Gun violence disproportionately affects com- 8 munities of color, especially African Americans (who 9 comprise around 14 percent of the United States 10 population but account for more than half the coun- 11 try’s gun homicide victims). 12 (4) On average, there is more than one mass 13 shooting each day in the United States. 14 SEC. 1012. REAFFIRMING RESEARCH AUTHORITY OF THE 15 CENTERS FOR DISEASE CONTROL AND PRE- 16 VENTION. 17 (a) IN GENERAL.—Section 391 of the Public Health 18 Service Act (42 U.S.C. 280b) is amended— 19 (1) in subsection (a)(1), by striking ‘‘research 20 relating to the causes, mechanisms, prevention, diag- 21 nosis, treatment of injuries, and rehabilitation from 22 injuries;’’ and inserting the following: ‘‘research, in- 23 cluding data collection, relating to— 24 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00973 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 974 •S 4819 IS ‘‘(A) the causes, mechanisms, prevention, 1 diagnosis, and treatment of injuries, including 2 with respect to gun violence; and 3 ‘‘(B) rehabilitation from such injuries;’’; 4 and 5 (2) by adding at the end the following new sub- 6 section: 7 ‘‘(c) NO ADVOCACY OR PROMOTION OF GUN CON- 8 TROL.—Nothing in this section shall be construed to— 9 ‘‘(1) authorize the Secretary to give assistance, 10 make grants, or enter into cooperative agreements or 11 contracts for the purpose of advocating or promoting 12 gun control; or 13 ‘‘(2) permit a recipient of any assistance, grant, 14 cooperative agreement, or contract under this section 15 to use such assistance, grant, agreement, or contract 16 for the purpose of advocating or promoting gun con- 17 trol.’’. 18 SEC. 1013. NATIONAL VIOLENT DEATH REPORTING SYSTEM. 19 The Secretary of Health and Human Services, acting 20 through the Director of the Centers for Disease Control 21 and Prevention, shall improve, particularly through the in- 22 clusion of additional States, the National Violent Death 23 Reporting System, as authorized by sections 301(a) and 24 391(a) of the Public Service Health Act (42 U.S.C. 25 VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00974 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS 975 •S 4819 IS 241(a), 280(b)). Participation in the system by the States 1 shall be voluntary. 2 SEC. 1014. REPORT ON EFFECTS OF GUN VIOLENCE ON 3 PUBLIC HEALTH. 4 Not later than one year after the date of the enact- 5 ment of this Act, and annually thereafter, the Surgeon 6 General shall submit to Congress a report on the effects 7 on public health, including mental health, of gun violence 8 in the United States during the preceding year, and the 9 status of actions taken to address such effects. 10 SEC. 1015. REPORT ON EFFECTS OF GUN VIOLENCE ON 11 MENTAL HEALTH IN MINORITY COMMU- 12 NITIES. 13 Not later than one year after the date of the enact- 14 ment of this Act, the Deputy Assistant Secretary for Mi- 15 nority Health in the Office of the Secretary of Health and 16 Human Services shall submit to the Congress a report on 17 the effects of gun violence on public health, including men- 18 tal health, in minority communities in the United States, 19 and the status of actions taken to address such effects. 20 Æ VerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00975 Fmt 6652 Sfmt 6301 E:\BILLS\S4819.IS S4819 khammond on DSKJM1Z7X2PROD with BILLS