H.R. 8200, Ending Health Disparities During COVID–19 Act of 2020
Summary
H.R. 8200 was introduced in the House of Representatives on September 11, 2020, by Kelly of Illinois, for herself and others, and referred to the Committee on Energy and Commerce. It may be cited as the Ending Health Disparities During COVID–19 Act of 2020 or the EHDC Act of 2020. The table of contents lists Title I, Racial and Ethnicity Data Collection, Title II, Equitable Testing and Tracing, Title III, Free Treatment for All Americans, and further titles on federal health equity oversight, expanded insurance access, community based grants, aid to providers serving minority communities, research, and education.
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“H.R. 8200, Ending Health Disparities During COVID–19 Act of 2020.”
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I
116TH CONGRESS
2D SESSION
H. R. 8200
To improve the health of minority individuals during the COVID–19
pandemic, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 11, 2020
Ms. KELLY of Illinois (for herself, Ms. BASS, Mr. CASTRO of Texas, Ms. JUDY
CHU of California, Mr. GARCÍA of Illinois, Ms. HAALAND, Ms. LEE of
California, Mr. SOTO, Ms. SEWELL of Alabama, Mr. BUTTERFIELD, Mr.
SABLAN, Ms. BARRAGÁN, Ms. CLARKE of New York, Mr. CÁRDENAS, Mr.
SARBANES, Ms. PRESSLEY, Mr. THOMPSON of Mississippi, Ms. ESCOBAR,
Mr. BRENDAN F. BOYLE of Pennsylvania, Mr. CARSON of Indiana, Mr.
CLAY, Mrs. BEATTY, Mr. KHANNA, Ms. GARCIA of Texas, Mr. SAN NICO-
LAS, Mr. ESPAILLAT, Ms. JAYAPAL, Mrs. DEMINGS, Mr. HASTINGS, Mrs.
WATSON COLEMAN, Ms. JOHNSON of Texas, Mr. GRIJALVA, Ms.
BONAMICI, and Mr. LYNCH) introduced the following bill; which was re-
ferred to the Committee on Energy and Commerce, and in addition to
the Committees on Ways and Means, the Judiciary, Transportation and
Infrastructure, Education and Labor, Agriculture, Natural Resources,
House Administration, Oversight and Reform, the Budget, and Small
Business, for a period to be subsequently determined by the Speaker, in
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned
A BILL
To improve the health of minority individuals during the
COVID–19 pandemic, and for other purposes.
1 Be it enacted by the Senate and House of Representa-
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2 tives of the United States of America in Congress assembled,
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1 SECTION 1. SHORT TITLE.
2 This Act may be cited as the ‘‘Ending Health Dis-
3 parities During COVID–19 Act of 2020’’ or the ‘‘EHDC
4 Act of 2020’’.
5 SEC. 2. TABLE OF CONTENTS.
Sec. 1. Short title.
Sec. 2. Table of contents.
TITLE I—RACIAL AND ETHNICITY DATA COLLECTION
Subtitle A—Collection and Reporting
Sec. 101. Equitable data collection and disclosure on COVID–19 Act.
Sec. 102. COVID–19 reporting portal.
Sec. 103. Regular CDC reporting on demographic data.
Sec. 104. Amendment to the Public Health Service Act.
Sec. 105. Elimination of prerequisite of direct appropriations for data collection
and analysis.
Sec. 106. Collection of data for the Medicare program.
Sec. 107. Revision of HIPAA claims standards.
Sec. 108. Disparities data collected by the Federal Government.
Sec. 109. Standards for measuring sexual orientation, gender identity, and so-
cioeconomic status in collection of health data.
Sec. 110. Improving health data regarding Native Hawaiians and other Pacific
Islanders.
Subtitle B—Improvements and Modernization
Sec. 121. Federal modernization for health inequities data.
Sec. 122. Modernization of State and local health inequities data.
Sec. 123. Additional reporting to Congress on the race and ethnicity rates of
COVID–19 testing, hospitalizations, and mortalities.
TITLE II—EQUITABLE TESTING AND TRACING
Subtitle A—Free Testing for Patients
Sec. 201. Sooner coverage of testing for COVID–19.
Subtitle B—National Testing Strategy
Sec. 211. COVID–19 testing strategy.
Sec. 212. Coronavirus immigrant families protection.
Sec. 213. ICE detention.
Subtitle C—Contact Tracing
Sec. 221. COVID–19 Testing, reaching, and contacting everyone.
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Sec. 222. National system for COVID–19 testing, contact tracing, surveillance,
containment, and mitigation.
Sec. 223. Grants.
Sec. 224. Grants to State and Tribal workforce agencies.
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TITLE III—FREE TREATMENT FOR ALL AMERICANS
Sec. 301. Coverage at no cost sharing of COVID–19 vaccine and treatment.
Sec. 302. Optional coverage at no cost sharing of COVID–19 treatment and
vaccines under Medicaid for uninsured individuals.
Sec. 303. Coverage of treatments for COVID–19 at no cost sharing under the
Medicare Advantage program.
Sec. 304. Requiring coverage under Medicare PDPS and MA–PD plans, with-
out the imposition of cost sharing or utilization management
requirements, of drugs intended to treat COVID–19 during
certain emergencies.
Sec. 305. Coverage of COVID–19 related treatment at no cost sharing.
Sec. 306. Reimbursement for additional health services relating to coronavirus.
TITLE IV—FEDERAL HEALTH EQUITY OVERSIGHT
Sec. 401. COVID-19 Racial and Ethnic Disparities Task Force Act of 2020.
Sec. 402. Protection of the HHS Offices of Minority Health.
Sec. 403. Establish an interagency counsel and grant programs on social deter-
minants of health.
Sec. 404. Accountability and transparency within the Department of Health
and Human Services.
TITLE V—EXPANDED INSURANCE ACCESS
Sec. 501. Medicare special enrollment period for individuals residing in COVID-
19 emergency areas.
Sec. 502. Special enrollment period through exchanges; Federal exchange out-
reach and educational activities.
Sec. 503. MOMMA’s Act.
Sec. 504. Allowing for medical assistance under Medicaid for inmates during
30-day period preceding release.
Sec. 505. Providing for immediate Medicaid eligibility for former foster youth.
Sec. 506. Expanded coverage for former foster youth.
Sec. 507. Removing citizenship and immigration barriers to access to affordable
health care under ACA.
Sec. 508. Medicaid in the territories.
Sec. 509. Removing Medicare barrier to health care.
Sec. 510. Removing barriers to health care and nutrition assistance for chil-
dren, pregnant persons, and lawfully present individuals.
Sec. 511. Repeal of requirement for documentation evidencing citizenship or
nationality under the Medicaid program.
TITLE VI—COMMUNITY BASED GRANTS
Sec. 601. Grants for racial and ethnic approaches to community health.
Sec. 602. Grants to promote health for underserved communities.
Sec. 603. Addressing COVID–19 health inequities and improving health equity.
Sec. 604. Improving social determinants of health.
Sec. 605. Funding to States, localities, and community-based organizations for
emergency aid and services.
Sec. 606. Supplemental nutrition assistance program.
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TITLE VII—CULTURALLY AND LINGUISTICALLY COMPETENT
CARE
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Sec. 701. Ensuring standards for culturally and linguistically appropriate serv-
ices in health care.
Sec. 702. Culturally and linguistically appropriate health care in the Public
Health Service Act.
Sec. 703. Training tomorrow’s doctors for culturally and linguistically appro-
priate care: graduate medical education.
Sec. 704. Federal reimbursement for culturally and linguistically appropriate
services under the Medicare, Medicaid, and State Children’s
Health Insurance Programs.
Sec. 705. Requirements for health programs or activities receiving Federal
funds.
Sec. 706. Report on Federal efforts to provide culturally and linguistically ap-
propriate health care services.
Sec. 707. Health professions competencies to address racial and ethnic mental
health disparities.
Sec. 708. Study on the uninsured.
TITLE VIII—AID TO PROVIDERS SERVING MINORITY
COMMUNITIES
Sec. 801. Temporary increase in Medicaid DSH allotments.
Sec. 802. COVID–19-related temporary increase of Medicaid FMAP.
Sec. 803. Appropriation for primary health care.
Sec. 804. Amendment to the Public Health Service Act.
Sec. 805. Pandemic premium pay for essential workers.
Sec. 806. COVID–19 Heroes Fund grants.
Sec. 807. Enforcement and outreach.
TITLE IX—HEALTH IT AND BRIDGING THE DIGITAL DIVIDE IN
HEALTH CARE
Sec. 901. HRSA assistance to health centers for promotion of Health IT.
Sec. 902. Assessment of impact of Health IT on racial and ethnic minority
communities; outreach and adoption of Health IT in such com-
munities.
Sec. 903. Extending funding to strengthen the Health IT infrastructure in ra-
cial and ethnic minority communities.
Sec. 904. 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. 905. Authorization of appropriations.
Sec. 906. Data collection and assessments conducted in coordination with mi-
nority-serving institutions.
Sec. 907. Study of health information technology in medically underserved com-
munities.
Sec. 908. Study on the effects of changes to telehealth under the Medicare and
Medicaid programs during the COVID-19 emergency.
Sec. 909. COVID–19 designation of immediate special authority of spectrum
for Tribes’ emergency response in Indian Country.
Sec. 910. Facilitating the provision of telehealth services across State lines.
TITLE X—PUBLIC AWARENESS
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Sec. 1001. Awareness campaigns.
Sec. 1002. Increasing understanding of and improving health literacy.
Sec. 1003. English for speakers of other languages.
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Sec. 1004. Influenza, COVID–19, and pneumonia vaccination campaign.
TITLE XI—RESEARCH
Sec. 1101. Research and development.
Sec. 1102. CDC field studies pertaining to specific health inequities.
Sec. 1103. Expanding capacity for health outcomes.
Sec. 1104. Data collection and analysis grants to minority-serving institutions.
Sec. 1105. Safety and effectiveness of drugs with respect to racial and ethnic
background.
Sec. 1106. GAO and NIH reports.
Sec. 1107. Health impact assessments.
Sec. 1108. Tribal funding to research health inequities including COVID–19.
Sec. 1109. Research endowments at both current and former centers of excel-
lence.
TITLE XII—EDUCATION
Sec. 1201. Grants for schools of medicine in diverse and underserved areas.
Sec. 1202. Amendment to the Public Health Service Act.
Sec. 1203. Hispanic-serving institutions, Historically Black Colleges and Uni-
versities, Asian American and Native American Pacific Is-
lander-serving institutions, Tribal colleges, regional community-
based organizations, and national minority medical associa-
tions.
Sec. 1204. Loan repayment program of Centers for Disease Control and Pre-
vention.
Sec. 1205. Study and report on strategies for increasing diversity.
Sec. 1206. Amendments to the Pandemic EBT Act.
TITLE XIII—PUBLIC HEALTH ASSISTANCE TO TRIBES
Sec. 1301. Appropriations for the Indian Health Service.
Sec. 1302. Improving State, local, and Tribal public health security.
Sec. 1303. Provision of items to Indian programs and facilities.
Sec. 1304. Health care access for urban native veterans.
Sec. 1305. Proper and reimbursed care for native veterans.
1 TITLE I—RACIAL AND
2 ETHNICITY DATA COLLECTION
3 Subtitle A—Collection and
4 Reporting
5 SEC. 101. EQUITABLE DATA COLLECTION AND DISCLOSURE
6 ON COVID–19 ACT.
7 (a) FINDINGS.—Congress makes the following find-
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8 ings:
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1 (1) The World Health Organization (WHO) de-
2 clared COVID–19 a ‘‘Public Health Emergency of
3 International Concern’’ on January 30, 2020. By
4 late March 2020, there have been over 470,000 con-
5 firmed cases of, and 20,000 deaths associated with,
6 COVID–19 worldwide.
7 (2) In the United States, cases of COVID–19
8 have quickly surpassed those across the world, and
9 as of April 12, 2020, over 500,000 cases and 20,000
10 deaths have been reported in the United States
11 alone.
12 (3) Early reporting on racial inequities in
13 COVID–19 testing and treatment have renewed calls
14 for the Centers for Disease Control and Prevention
15 and other relevant subagencies within the Depart-
16 ment of Health and Human Services to publicly re-
17 lease racial and demographic information to better
18 inform the pandemic response, specifically in com-
19 munities of color and in Limited English Proficient
20 (LEP) communities.
21 (4) The burden of morbidity and mortality in
22 the United States has historically fallen dispropor-
23 tionately on marginalized communities (those who
24 suffer the most from great public health needs and
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25 are the most medically underserved).
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1 (5) Historically, structures and systems, such
2 as racism, ableism and class oppression, have ren-
3 dered affected individuals more vulnerable to inequi-
4 ties and have prevented people from achieving their
5 optimal health even when there is not a crisis of
6 pandemic proportions.
7 (6) Significant differences in access to health
8 care, specifically to primary health care providers,
9 health care information, and greater perceived dis-
10 crimination in health care place communities of
11 color, individuals with disabilities, and LEP individ-
12 uals at greater risk of receiving delayed, and per-
13 haps poorer, health care.
14 (7) Stark racial inequities across the United
15 States, including unequal access to stable housing,
16 quality education, and decent employment signifi-
17 cantly impact the ability of individuals to take care
18 of their most basic health needs. Communities of
19 color are more likely to experience homelessness and
20 struggle with low-paying jobs or unemployment. To
21 date, experts have cited that 2 in 5 Latino residents
22 in New York City, the current epicenter of the
23 COVID–19 pandemic, are recently unemployed as a
24 direct consequence of COVID–19. And at a time
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25 when sheltering in place will save lives, less than 1
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1 in 5 Black workers and roughly 1 in 6 Latino work-
2 ers are able to work from home.
3 (8) Communities of color experience higher
4 rates of chronic disease and disabilities, such as dia-
5 betes, hypertension, and asthma, than non-Hispanic
6 White communities, which predisposes them to
7 greater risk of complications and mortality should
8 they contract COVID–19.
9 (9) Such communities are made even more vul-
10 nerable to the uncertainty of the preparation, re-
11 sponse, and events surrounding the pandemic public
12 health crisis, COVID–19. For instance, in the recent
13 past, multiple epidemiologic studies and reviews have
14 reported higher rates of hospitalization due to the
15 2009 H1N1 pandemic among the poor, individuals
16 with disabilities and preexisting conditions, those liv-
17 ing in impoverished neighborhoods, and individuals
18 of color and ethnic backgrounds in the United
19 States. These findings highlight the urgency to
20 adapt the COVID–19 response to monitor and act
21 on these inequities via data collection and research
22 by race and ethnicity.
23 (10) Research experts recognize that there are
24 underlying differences in illness and death when
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25 each of these factors are examined through socio-
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1 economic and racial or ethnic lenses. These socially
2 determinant factors of health accelerate disease and
3 degradation.
4 (11) Language barriers are highly correlated
5 with medication noncompliance and inconsistent en-
6 gagement with health systems. Without language ac-
7 cessibility data and research around COVID–19,
8 these communities are less likely to receive critical
9 testing and preventive health services. Yet, to date,
10 the Centers for Disease Control and Prevention do
11 not disseminate COVID–19 messaging in critical
12 languages, including Mandarin Chinese, Spanish,
13 and Korean within the same timeframe as informa-
14 tion in English despite requirements to ensure lim-
15 ited English proficient populations are not discrimi-
16 nated against under title VI of the Civil Rights Act
17 of 1964 and subsequent laws and Federal policies.
18 (12) Further, it is critical to disaggregate data
19 further by ancestry to address disparities among
20 Asian American, Native Hawaiian, and Pacific Is-
21 lander groups. According to the National Equity
22 Atlas, while 13 percent of the Asian population over-
23 all lived in poverty in 2015, 39 percent of Burmese
24 people, 29 percent of Hmong people, and 21 percent
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25 of Pacific Islanders lived in poverty.
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1 (13) Utilizing disaggregation of enrollment in
2 Affordable Care Act-sponsored health insurance, the
3 Asian and Pacific Islander American Health Forum
4 found that prior to the passage of the Patient Pro-
5 tection and Affordable Care Act (Public Law 111–
6 148), Korean Americans had a high uninsured rate
7 of 23 percent, compared to just 12 percent for all
8 Asian Americans. Developing targeted outreach ef-
9 forts assisted 1,000,000 people and resulted in a 56-
10 percent decrease in the uninsured among the Asian,
11 Native Hawaiian, and Pacific Islander population.
12 Such efforts show that disaggregated data is essen-
13 tial to public health mobilizations efforts.
14 (14) Without clear understanding of how
15 COVID–19 impacts marginalized racial and ethnic
16 communities, there will be exacerbated risk of en-
17 dangering the most historically vulnerable of our
18 Nation.
19 (15) The consequences of misunderstanding the
20 racial and ethnic impact of COVID–19 expound be-
21 yond communities of color such that it would impact
22 all.
23 (16) Race and ethnicity are valuable research
24 and practice variables when used and interpreted ap-
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25 propriately. Health data collected on patients by
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1 race and ethnicity will boost and more efficiently di-
2 rect critical resources and inform risk communica-
3 tion development in languages and at appropriate
4 health literacy levels, which resonate with historically
5 vulnerable communities of color.
6 (17) To date, there is no public standardized
7 and comprehensive race and ethnicity data reposi-
8 tory of COVID–19 testing, hospitalizations, or mor-
9 tality. The inconsistency of data collection by Fed-
10 eral, State, and local health authorities, and the in-
11 ability to access data by public research institutions
12 and academic organizations, poses a threat to anal-
13 ysis and synthesis of the pandemic impact on com-
14 munities of color. However, research and medical ex-
15 perts of Historically Black Colleges and Universities,
16 academic health care institutions which are histori-
17 cally and geographically embedded in minoritized
18 and marginalized communities, generally also pos-
19 sess rapport with the communities they serve. They
20 are well-positioned, as trusted thought leaders and
21 health care service providers, to collect data and con-
22 duct research toward creating holistic solutions to
23 remedy the inequitable impact of this and future
24 public health crises.
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1 (18) Well-designed, ethically sound research
2 aligns with the goals of medicine, addresses ques-
3 tions relevant to the population among whom the
4 study will be carried out, balances the potential for
5 benefit against the potential for harm, employs
6 study designs that will yield scientifically valid and
7 significant data, and generates useful knowledge.
8 (19) The dearth of racially and ethnically
9 disaggregated data reflecting the health of commu-
10 nities of color underlies the challenges of a fully in-
11 formed public health response.
12 (20) Without collecting race and ethnicity data
13 associated with COVID–19 testing, hospitalizations,
14 morbidities, and mortalities, as well as publicly dis-
15 closing it, communities of color will remain at great-
16 er risk of disease and death.
17 (b) EMERGENCY FUNDING FOR FEDERAL DATA COL-
18 LECTION ON THE RACIAL, ETHNIC, AND OTHER DEMO-
19 GRAPHIC DISPARITIES OF COVID–19.—To conduct or
20 support data collection on the racial, ethnic, and other de-
21 mographic implications of COVID–19 in the United States
22 and its territories, including support to assist in the capac-
23 ity building for State and local public health departments
24 to collect and transmit racial, ethnic, and other demo-
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25 graphic data to the relevant Department of Health and
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1 Human Services agencies, there is authorized to be appro-
2 priated—
3 (1) to the Centers for Disease Control and Pre-
4 vention, $12,000,000;
5 (2) to State, territorial, and Tribal public
6 health agencies, distributed proportionally based on
7 the total population of their residents who are en-
8 rolled in Medicaid or who have no health insurance,
9 $15,000,000;
10 (3) to the Indian Health Service, Indian Tribes
11 and Tribal organizations (as defined in section 4 of
12 the Indian Self-Determination and Education Assist-
13 ance Act), and urban Indian organizations (as de-
14 fined in section 4 of the Indian Health Care Im-
15 provement Act), $3,000,000;
16 (4) to the Centers for Medicare & Medicaid
17 Services, $5,000,000;
18 (5) to the Food and Drug Administration,
19 $5,000,000;
20 (6) to the Agency for Healthcare Research and
21 Quality, $5,000,000; and
22 (7) to the Office of the National Coordinator
23 for Health Information Technology, $5,000,000.
24 (c) COVID–19 DATA COLLECTION AND DISCLO-
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25 SURE.—
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1 (1) DATA COLLECTION.—The Secretary of
2 Health and Human Services (referred to in this sec-
3 tion as the ‘‘Secretary’’), acting through the Direc-
4 tor of the Centers for Disease Control and Preven-
5 tion and the Administrator of the Centers for Medi-
6 care & Medicaid Services, shall make publicly avail-
7 able on the website of the Centers for Disease Con-
8 trol and Prevention data collected across all surveil-
9 lance systems relating to COVID–19, disaggregated
10 by race, ethnicity, sex, age, primary language, socio-
11 economic status, disability status, and county, in-
12 cluding the following:
13 (A) Data related to all COVID–19 testing,
14 including the number of individuals tested and
15 the number of tests that were positive.
16 (B) Data related to treatment for COVID–
17 19, including hospitalizations and intensive care
18 unit admissions.
19 (C) Data related to COVID–19 outcomes,
20 including total fatalities and case fatality rates
21 (expressed as the proportion of individuals who
22 were infected with COVID–19 and died from
23 the virus).
24 (2) APPLICATION OF STANDARDS.—To the ex-
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25 tent practicable, data collection under this sub-
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1 section shall follow standards developed by the De-
2 partment of Health and Human Services Office of
3 Minority Health and be collected, analyzed, and re-
4 ported in accordance with the standards promul-
5 gated by the Assistant Secretary for Planning and
6 Evaluation under title XXXI of the Public Health
7 Service Act (42 U.S.C. 300kk et seq.).
8 (3) TIMELINE.—The data made available under
9 this subsection shall be updated on a daily basis
10 throughout the public health emergency.
11 (4) PRIVACY.—In publishing data under this
12 subsection, the Secretary shall take all necessary
13 steps to protect the privacy of individuals whose in-
14 formation is included in such data, including—
15 (A) complying with privacy protections
16 provided under the regulations promulgated
17 under section 264(c) of the Health Insurance
18 Portability and Accountability Act of 1996; and
19 (B) protections from all inappropriate in-
20 ternal use by an entity that collects, stores, or
21 receives the data, including use of such data in
22 determinations of eligibility (or continued eligi-
23 bility) in health plans, and from inappropriate
24 uses.
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1 (5) CONSULTATION WITH TRIBES.—The Indian
2 Health Service shall consult with Indian Tribes and
3 confer with urban Indian organizations on data col-
4 lection and reporting.
5 (6) REPORT.—Not later than 60 days after the
6 date on which the Secretary certifies that the public
7 health emergency related to COVID–19 has ended,
8 the Secretary shall make publicly available a sum-
9 mary of the final statistics related to COVID–19.
10 (7) REPORT.—Not later than 60 days after the
11 date on which the Secretary certifies that the public
12 health emergency related to COVID–19 has ended,
13 the Department of Health and Human Services shall
14 compile and submit to the Committee on Health,
15 Education, Labor, and Pensions and the Committee
16 on Finance of the Senate and the Committee on En-
17 ergy and Commerce and the Committee on Ways
18 and Means of the House of Representatives a pre-
19 liminary report—
20 (A) describing the testing, hospitalization,
21 mortality rates, and preferred language of pa-
22 tients associated with COVID–19 by race and
23 ethnicity; and
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1 (B) proposing evidenced-based response
2 strategies to safeguard the health of these com-
3 munities in future pandemics.
4 (d) COMMISSION ON ENSURING HEALTH EQUITY
5 DURING THE COVID–19 PUBLIC HEALTH EMER-
6 GENCY.—
7 (1) IN GENERAL.—Not later than 30 days after
8 the date of enactment of this Act, the Secretary
9 shall establish a commission, to be known as the
10 ‘‘Commission on Ensuring Health Equity During
11 the COVID–19 Public Health Emergency’’ (referred
12 to in this subsection as the ‘‘Commission’’) to pro-
13 vide clear and robust guidance on how to improve
14 the collection, analysis, and use of demographic data
15 in responding to future waves of the coronavirus.
16 (2) MEMBERSHIP AND CHAIRPERSON.—
17 (A) MEMBERSHIP.—The Commission shall
18 be composed of—
19 (i) the Director of the Centers for
20 Disease Control and Prevention;
21 (ii) the Director of the National Insti-
22 tutes of Health;
23 (iii) the Commissioner of Food and
24 Drugs;
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1 (iv) the Administrator of the Federal
2 Emergency Management Agency;
3 (v) the Director of the National Insti-
4 tute on Minority Health and Health Dis-
5 parities;
6 (vi) the Director of the Indian Health
7 Service;
8 (vii) the Administrator of the Centers
9 for Medicare & Medicaid Services;
10 (viii) the Director of the Agency for
11 Healthcare Research and Quality;
12 (ix) the Surgeon General;
13 (x) the Administrator of the Health
14 Resources and Services Administration;
15 (xi) the Director of the Office of Mi-
16 nority Health;
17 (xii) the Director of the Office of
18 Women’s Health;
19 (xiii) the Chairperson of the National
20 Council on Disability;
21 (xiv) at least 4 State, local, territorial,
22 and Tribal public health officials rep-
23 resenting departments of public health,
24 who shall represent jurisdictions from dif-
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1 relatively high concentrations of histori-
2 cally marginalized populations, to be ap-
3 pointed by the Secretary; and
4 (xv) racially and ethnically diverse
5 representation from at least 3 independent
6 experts with knowledge or field experience
7 with racial and ethnic disparities in public
8 health appointed by the Secretary.
9 (B) CHAIRPERSON.—The President of the
10 National Academies of Sciences, Engineering,
11 and Medicine, or designee, shall serve as the
12 chairperson of the Commission.
13 (3) DUTIES.—The Commission shall—
14 (A) examine barriers to collecting, ana-
15 lyzing, and using demographic data;
16 (B) determine how to best use such data
17 to promote health equity across the United
18 States and reduce racial, Tribal, and other de-
19 mographic disparities in COVID–19 prevalence
20 and outcomes;
21 (C) gather available data related to
22 COVID–19 treatment of individuals with dis-
23 abilities, including denial of treatment for pre-
24 existing conditions, removal or denial of dis-
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25 ability related equipment (including ventilators
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1 and CPAP), and data on completion of DNR
2 orders, and identify barriers to obtaining accu-
3 rate and timely data related to COVID–19
4 treatment of such individuals;
5 (D) solicit input from public health offi-
6 cials, community-connected organizations,
7 health care providers, State and local agency of-
8 ficials, and other experts on barriers to, and
9 best practices for, collecting demographic data;
10 and
11 (E) recommend policy changes that the
12 data indicates are necessary to reduce dispari-
13 ties.
14 (4) REPORT.—Not later than 60 days after the
15 date of enactment of this Act, and every 180 days
16 thereafter until the Secretary certifies that the pub-
17 lic health emergency related to COVID–19 has
18 ended, the Commission shall submit a written report
19 of its findings and recommendations to Congress
20 and post such report on a website of the Department
21 of Health and Human Services. Such reports shall
22 contain information concerning—
23 (A) how to enhance State, local, territorial,
24 and Tribal capacity to conduct public health re-
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1 capacity to analyze data on disparities cor-
2 related with race, ethnicity, income, sex, age,
3 disability status, specific geographic areas, and
4 other relevant demographic characteristics, and
5 an analysis of what demographic data is cur-
6 rently being collected about COVID–19, the ac-
7 curacy of that data and any gaps, how this data
8 is currently being used to inform efforts to com-
9 bat COVID–19, and what resources are needed
10 to supplement existing public health data collec-
11 tion;
12 (B) how to collect, process, and disclose to
13 the public the data described in subparagraph
14 (A) in a way that maintains individual privacy
15 while helping direct the State and local re-
16 sponse to the virus;
17 (C) how to improve demographic data col-
18 lection related to COVID–19 in the short- and
19 long-term, including how to continue to grow
20 and value the Tribal sovereignty of data and in-
21 formation concerning Tribal communities;
22 (D) to the extent possible, a preliminary
23 analysis of racial and other demographic dis-
24 parities in COVID–19 mortality, including an
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1 (E) to the extent possible, a preliminary
2 analysis of sex, gender, sexual orientation, and
3 gender identity disparities in COVID–19 treat-
4 ment and mortality;
5 (F) an analysis of COVID–19 treatment of
6 individuals with disabilities, including equity of
7 access to treatment and equipment and inter-
8 sections of disability status with other demo-
9 graphic factors, including race, and rec-
10 ommendations for how to improve transparency
11 and equity of treatment for such individuals
12 during the COVID–19 public health emergency
13 and future emergencies;
14 (G) how to support State, local, and Tribal
15 capacity to eliminate barriers to COVID–19
16 testing and treatment; and
17 (H) to the extent possible, a preliminary
18 analysis of Federal Government policies that
19 disparately exacerbate the COVID–19 impact,
20 and recommendations to improve racial and
21 other demographic disparities in health out-
22 comes.
23 (5) AUTHORIZATION OF APPROPRIATIONS.—
24 There is authorized to be appropriated such sums as
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1 SEC. 102. COVID–19 REPORTING PORTAL.
2 (a) IN GENERAL.—Not later than 15 days after the
3 date of enactment of this Act, the Secretary of Health and
4 Human Services (referred to in this section as the ‘‘Sec-
5 retary’’) shall establish and maintain an online portal for
6 use by eligible health care entities to track and transmit
7 data regarding their personal protective equipment and
8 medical supply inventory and capacity related to COVID–
9 19.
10 (b) ELIGIBLE HEALTH CARE ENTITIES.—In this sec-
11 tion, the term ‘‘eligible health care entity’’ means a li-
12 censed acute care hospital, hospital system, or long-term
13 care facility with confirmed cases of COVID–19.
14 (c) SUBMISSION.—An eligible health care entity shall
15 report using the portal under this section on a biweekly
16 basis in order to assist the Secretary in tracking usage
17 and need of COVID–related supplies and personnel in a
18 regular and real-time manner.
19 (d) INCLUDED INFORMATION.—The Secretary shall
20 design the portal under this section to include information
21 on personal protective equipment and medical supply in-
22 ventory and capacity related to COVID–19, including with
23 respect to the following:
24 (1) PERSONAL PROTECTIVE EQUIPMENT.—
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26 cluding, in units, the numbers of N95 masks and
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1 authorized equivalent respirator masks, surgical
2 masks, exam gloves, face shields, isolation gowns,
3 and coveralls.
4 (2) MEDICAL SUPPLY.—
5 (A) Total ventilator inventory, including, in
6 units, the number of universal, adult, pediatric,
7 and infant ventilators.
8 (B) Total diagnostic and serological test
9 inventory, including, in units, the number of
10 test platforms, tests, test kits, reagents, trans-
11 port media, swabs, and other materials or sup-
12 plies determined necessary by the Secretary.
13 (3) CAPACITY.—
14 (A) Case count measurements, including
15 confirmed positive cases and persons under in-
16 vestigation.
17 (B) Total number of staffed beds, includ-
18 ing medical surgical beds, intensive care beds,
19 and critical care beds.
20 (C) Available beds, including medical sur-
21 gical beds, intensive care beds, and critical care
22 beds.
23 (D) Total number of COVID–19 patients
24 currently utilizing a ventilator.
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1 (E) Average number of days a COVID–19
2 patient is utilizing a ventilator.
3 (F) Total number of additionally needed
4 professionals in each of the following categories:
5 intensivists, critical care physicians, respiratory
6 therapists, registered nurses, certified registered
7 nurse anesthetists, and laboratory personnel.
8 (G) Total number of hospital personnel
9 currently not working due to self-isolation fol-
10 lowing a known or presumed COVID–19 expo-
11 sure.
12 (e) ACCESS TO INFORMATION RELATED TO INVEN-
13 TORY AND CAPACITY.—The Secretary shall ensure that
14 relevant agencies and officials, including the Centers for
15 Disease Control and Prevention, the Assistant Secretary
16 for Preparedness and Response, and the Federal Emer-
17 gency Management Agency, have access to information re-
18 lated to inventory and capacity submitted under this sec-
19 tion.
20 (f) WEEKLY REPORT TO CONGRESS.—On a weekly
21 basis, the Secretary shall transmit information related to
22 inventory and capacity submitted under this section to the
23 appropriate committees of the House and Senate.
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1 SEC. 103. REGULAR CDC REPORTING ON DEMOGRAPHIC
2 DATA.
3 Not later than 14 days after the date of enactment
4 of this Act, the Secretary of Health and Human Services,
5 in coordination with the Director of the Centers for Dis-
6 ease Control and Prevention, shall amend the reporting
7 under the heading ‘‘Department of Health and Human
8 Services—Office of the Secretary—Public Health and So-
9 cial Service Emergency Fund’’ in title I of division B of
10 the Paycheck Protection Program and Health Care En-
11 hancement Act (Public Law 116–139; 134 Stat. 620, 626)
12 on the demographic characteristics, including race, eth-
13 nicity (including breakdowns of major ethnic groups and
14 Tribal affiliations within minority populations), age, sex,
15 gender, geographic region, primary written and spoken
16 language, disability status, sexual orientation, socio-
17 economic status, occupation, and other relevant factors of
18 individuals tested for or diagnosed with COVID–19, to in-
19 clude—
20 (1) providing technical assistance to State,
21 local, Tribal, and territorial health departments to
22 improve the collection and reporting of such demo-
23 graphic data;
24 (2) if such data is not so collected or reported,
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1 department of health has not been able to collect or
2 provide such information; and
3 (3) making a copy of such report available pub-
4 licly on the website of the Centers for Disease Con-
5 trol and Prevention.
6 SEC. 104. AMENDMENT TO THE PUBLIC HEALTH SERVICE
7 ACT.
8 (a) PURPOSE.—It is the purpose of the amendment
9 made by this section to promote data collection, analysis,
10 and reporting by race, ethnicity, sex, primary language,
11 sexual orientation, disability status, gender identity, age,
12 and socioeconomic status among federally supported
13 health programs.
14 (b) AMENDMENT.—The Public Health Service Act is
15 amended by adding at the end the following:
16 ‘‘TITLE XXXIV—STRENGTHENING
17 DATA COLLECTION, IMPROV-
18 ING DATA ANALYSIS, AND EX-
19 PANDING DATA REPORTING
20 ‘‘SEC. 3400. HEALTH DISPARITY DATA.
21 ‘‘(a) REQUIREMENTS.—
22 ‘‘(1) IN GENERAL.—Each health-related pro-
23 gram shall—
24 ‘‘(A) require the collection, by the agency
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1 nicity, sex, primary language, sexual orienta-
2 tion, disability status, gender identity, age, and
3 socioeconomic status of each applicant for and
4 recipient of health-related assistance under such
5 program, including—
6 ‘‘(i) using, at a minimum, standards
7 for data collection on race, ethnicity, sex,
8 primary language, sexual orientation, gen-
9 der identity, age, socioeconomic status, and
10 disability status as each are developed
11 under section 3101;
12 ‘‘(ii) collecting data for additional
13 population groups if such groups can be
14 aggregated into the race and ethnicity cat-
15 egories outlined by standards developed
16 under section 3101;
17 ‘‘(iii) using, where practicable, the
18 standards developed by the Health and
19 Medicine Division of the National Acad-
20 emies of Sciences, Engineering, and Medi-
21 cine (formerly known as the ‘Institute of
22 Medicine’) in the 2009 publication, entitled
23 ‘Race, Ethnicity, and Language Data:
24 Standardization for Health Care Quality
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25 Improvement’; and
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1 ‘‘(iv) where practicable, collecting
2 such data through self-reporting;
3 ‘‘(B) with respect to the collection of the
4 data described in subparagraph (A), for appli-
5 cants and recipients who are minors, require
6 communication assistance in speech or writing,
7 and for applicants and recipients who are other-
8 wise legally incapacitated, require that—
9 ‘‘(i) such data be collected from the
10 parent or legal guardian of such an appli-
11 cant or recipient; and
12 ‘‘(ii) the primary language of the par-
13 ent or legal guardian of such an applicant
14 or recipient be collected;
15 ‘‘(C) systematically analyze such data
16 using the smallest appropriate units of analysis
17 feasible to detect racial and ethnic disparities,
18 as well as disparities along the lines of primary
19 language, sex, disability status, sexual orienta-
20 tion, gender identity, age, and socioeconomic
21 status in health and health care, and report the
22 results of such analysis to the Secretary, the
23 Director of the Office for Civil Rights, each
24 agency listed in section 3101(c)(1), the Com-
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25 mittee on Health, Education, Labor, and Pen-
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1 sions and the Committee on Finance of the
2 Senate, and the Committee on Energy and
3 Commerce and the Committee on Ways and
4 Means of the House of Representatives;
5 ‘‘(D) provide such data to the Secretary on
6 at least an annual basis; and
7 ‘‘(E) ensure that the provision of assist-
8 ance to an applicant or recipient of assistance
9 is not denied or otherwise adversely affected be-
10 cause of the failure of the applicant or recipient
11 to provide race, ethnicity, primary language,
12 sex, sexual orientation, disability status, gender
13 identity, age, and socioeconomic status data.
14 ‘‘(2) RULES OF CONSTRUCTION.—Nothing in
15 this subsection shall be construed to—
16 ‘‘(A) permit the use of information col-
17 lected under this subsection in a manner that
18 would adversely affect any individual providing
19 any such information; or
20 ‘‘(B) diminish any requirements, including
21 such requirements in effect on or after the date
22 of enactment of this section, on health care pro-
23 viders to collect data.
24 ‘‘(3) NO COMPELLED DISCLOSURE OF DATA.—
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1 vider, Federal official, or other entity to compel the
2 disclosure of any data collected under this title. The
3 disclosure of any such data by an individual pursu-
4 ant to this title shall be strictly voluntary.
5 ‘‘(b) PROTECTION OF DATA.—The Secretary shall
6 ensure (through the promulgation of regulations or other-
7 wise) that all data collected pursuant to subsection (a) are
8 protected—
9 ‘‘(1) under the same privacy protections as the
10 Secretary applies to other health data under the reg-
11 ulations promulgated under section 264(c) of the
12 Health Insurance Portability and Accountability Act
13 of 1996 relating to the privacy of individually identi-
14 fiable health information and other protections; and
15 ‘‘(2) from all inappropriate internal use by any
16 entity that collects, stores, or receives the data, in-
17 cluding use of such data in determinations of eligi-
18 bility (or continued eligibility) in health plans, and
19 from other inappropriate uses, as defined by the
20 Secretary.
21 ‘‘(c) NATIONAL PLAN OF THE DATA COUNCIL.—The
22 Secretary shall develop and implement a national plan to
23 ensure the collection of data in a culturally and linguis-
24 tically appropriate manner, to improve the collection, anal-
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1 guage, sexual orientation, disability status, gender iden-
2 tity, age, and socioeconomic status data at the Federal,
3 State, territorial, Tribal, and local levels, including data
4 to be collected under subsection (a), and to ensure that
5 data collection activities carried out under this section are
6 in compliance with standards developed under section
7 3101. The Data Council of the Department of Health and
8 Human Services, in consultation with the National Com-
9 mittee on Vital Health Statistics, the Office of Minority
10 Health, Office on Women’s Health, and other appropriate
11 public and private entities, shall make recommendations
12 to the Secretary concerning the development, implementa-
13 tion, and revision of the national plan. Such plan shall
14 include recommendations on how to—
15 ‘‘(1) implement subsection (a) while minimizing
16 the cost and administrative burdens of data collec-
17 tion and reporting;
18 ‘‘(2) expand knowledge among Federal agen-
19 cies, States, territories, Indian Tribes, counties, mu-
20 nicipalities, health providers, health plans, and the
21 general public that data collection, analysis, and re-
22 porting by race, ethnicity, sex, primary language,
23 sexual orientation, gender identity, age, socio-
24 economic status, and disability status is legal and
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1 necessary to assure equity and nondiscrimination in
2 the quality of health care services;
3 ‘‘(3) ensure that future patient record systems
4 follow Federal standards promulgated under the
5 Health Information Technology for Economic and
6 Clinical Health Act for the collection and meaningful
7 use of electronic health data on race, ethnicity, sex,
8 primary language, sexual orientation, gender iden-
9 tity, age, socioeconomic status, and disability status;
10 ‘‘(4) improve health and health care data collec-
11 tion and analysis for more population groups if such
12 groups can be aggregated into the minimum race
13 and ethnicity categories, including exploring the fea-
14 sibility of enhancing collection efforts in States,
15 counties, and municipalities for racial and ethnic
16 groups that comprise a significant proportion of the
17 population of the State, county, or municipality;
18 ‘‘(5) provide researchers with greater access to
19 racial, ethnic, primary language, sex, sexual orienta-
20 tion, gender identity, age, socioeconomic status data,
21 and disability status data, subject to all applicable
22 privacy and confidentiality requirements, including
23 HIPAA privacy and security law as defined in sec-
24 tion 3009; and
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1 ‘‘(6) safeguard and prevent the misuse of data
2 collected under subsection (a).
3 ‘‘(d) COMPLIANCE WITH STANDARDS.—Data col-
4 lected under subsection (a) shall be obtained, maintained,
5 and presented (including for reporting purposes) in ac-
6 cordance with standards developed under section 3101.
7 ‘‘(e) ANALYSIS OF HEALTH DISPARITY DATA.—The
8 Secretary, acting through the Director of the Agency for
9 Healthcare Research and Quality and in coordination with
10 the Assistant Secretary for Planning and Evaluation, the
11 Administrator of the Centers for Medicare & Medicaid
12 Services, the Director of the National Center for Health
13 Statistics, and the Director of the National Institutes of
14 Health, shall provide technical assistance to agencies of
15 the Department of Health and Human Services in meeting
16 Federal standards for health disparity data collection and
17 for analysis of racial, ethnic, and other disparities in
18 health and health care in programs conducted or sup-
19 ported by such agencies by—
20 ‘‘(1) identifying appropriate quality assurance
21 mechanisms to monitor for health disparities;
22 ‘‘(2) specifying the clinical, diagnostic, or thera-
23 peutic measures which should be monitored;
24 ‘‘(3) developing new quality measures relating
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1 with other disparity factors in health and health
2 care;
3 ‘‘(4) identifying the level at which data analysis
4 should be conducted; and
5 ‘‘(5) sharing data with external organizations
6 for research and quality improvement purposes.
7 ‘‘(f) DEFINITIONS.—In this section—
8 ‘‘(1) the term ‘health-related program’ means a
9 program that is operated by the Secretary, or that
10 receives funding or reimbursement, in whole or in
11 part, either directly or indirectly from the Sec-
12 retary—
13 ‘‘(A) for activities under the Social Secu-
14 rity Act for health care services; or
15 ‘‘(B) for providing Federal financial assist-
16 ance for health care, biomedical research, or
17 health services research or for otherwise im-
18 proving the health of the public;
19 ‘‘(2) the term ‘primary language data’ includes
20 spoken and written primary language data; and
21 ‘‘(3) the term ‘primary language data collection
22 activities’ includes identifying, collecting, storing,
23 tracking, and analyzing primary language data and
24 information on the methods used to meet the lan-
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1 guage access needs of individuals with limited
2 English proficiency.
3 ‘‘(g) 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. 3401. ESTABLISHING GRANTS FOR DATA COLLECTION
8 IMPROVEMENT ACTIVITIES.
9 ‘‘(a) IN GENERAL.—The Secretary, acting through
10 the Director of the Agency for Healthcare Research and
11 Quality and in consultation with the Deputy Assistant
12 Secretary for Minority Health, the Director of the Na-
13 tional Institutes of Health, the Assistant Secretary for
14 Planning and Evaluation, and the Director of the National
15 Center for Health Statistics, shall establish a technical as-
16 sistance program under which the Secretary provides
17 grants to eligible entities to assist such entities in com-
18 plying with section 3431.
19 ‘‘(b) TYPES OF ASSISTANCE.—A grant provided
20 under this section may be used to—
21 ‘‘(1) enhance or upgrade computer technology
22 that will facilitate collection, analysis, and reporting
23 of racial, ethnic, primary language, sexual orienta-
24 tion, sex, gender identity, socioeconomic status, and
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1 ‘‘(2) improve methods for health data collection
2 and analysis, including additional population groups
3 if such groups can be aggregated into the race and
4 ethnicity categories outlined by standards developed
5 under section 3101;
6 ‘‘(3) develop mechanisms for submitting col-
7 lected data subject to any applicable privacy and
8 confidentiality regulations; and
9 ‘‘(4) develop educational programs to inform
10 health plans, health providers, health-related agen-
11 cies, and the general public that data collection and
12 reporting by race, ethnicity, primary language, sex-
13 ual orientation, sex, gender identity, disability sta-
14 tus, and socioeconomic status are legal and essential
15 for eliminating health and health care disparities.
16 ‘‘(c) ELIGIBLE ENTITY.—To be eligible for grants
17 under this section, an entity shall be a State, territory,
18 Indian Tribe, municipality, county, health provider, health
19 care organization, or health plan making a demonstrated
20 effort to bring data collections into compliance with sec-
21 tion 3431.
22 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There
23 are authorized to be appropriated to carry out this section
24 such sums as may be necessary for each of fiscal years
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25 2021 through 2025.
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1 ‘‘SEC. 3402. OVERSAMPLING OF UNDERREPRESENTED
2 GROUPS IN FEDERAL HEALTH SURVEYS.
3 ‘‘(a) NATIONAL STRATEGY.—
4 ‘‘(1) IN GENERAL.—The Secretary, acting
5 through the Director of the National Center for
6 Health Statistics of the Centers for Disease Control
7 and Prevention, and other agencies within the De-
8 partment of Health and Human Services as the Sec-
9 retary determines appropriate, shall develop and im-
10 plement an ongoing and sustainable national strat-
11 egy for oversampling underrepresented populations
12 within the categories of race, ethnicity, sex, primary
13 language, sexual orientation, disability status, gen-
14 der identity, and socioeconomic status as determined
15 appropriate by the Secretary in Federal health sur-
16 veys and program data collections. Such national
17 strategy shall include a strategy for oversampling of
18 Native Americans, Asian Americans, Native Hawai-
19 ians, and Pacific Islanders.
20 ‘‘(2) CONSULTATION.—In developing and imple-
21 menting a national strategy, as described in para-
22 graph (1), not later than 180 days after the date of
23 the enactment of this section, the Secretary shall—
24 ‘‘(A) consult with representatives of com-
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26 governmental organizations, and government
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1 agencies working with underrepresented popu-
2 lations;
3 ‘‘(B) solicit the participation of representa-
4 tives from other Federal departments and agen-
5 cies, including subagencies of the Department
6 of Health and Human Services; and
7 ‘‘(C) consult on, and use as models, the
8 2014 National Health Interview Survey over-
9 sample of Native Hawaiian and Pacific Islander
10 populations and the 2017 Behavioral Risk Fac-
11 tor Surveillance System oversample of American
12 Indian and Alaska Native communities.
13 ‘‘(b) PROGRESS REPORT.—Not later than 2 years
14 after the date of the enactment of this section, the Sec-
15 retary shall submit to the Congress a progress report,
16 which shall include the national strategy described in sub-
17 section (a)(1).
18 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To
19 carry out this section, there are authorized to be appro-
20 priated such sums as may be necessary for fiscal years
21 2021 through 2025.’’.
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1 SEC. 105. ELIMINATION OF PREREQUISITE OF DIRECT AP-
2 PROPRIATIONS FOR DATA COLLECTION AND
3 ANALYSIS.
4 Section 3101 of the Public Health Service Act (42
5 U.S.C. 300kk) is amended—
6 (1) by striking subsection (h); and
7 (2) by redesignating subsection (i) as subsection
8 (h).
9 SEC. 106. COLLECTION OF DATA FOR THE MEDICARE PRO-
10 GRAM.
11 Part A of title XI of the Social Security Act (42
12 U.S.C. 1301 et seq.) is amended by adding at the end
13 the following:
14 ‘‘COLLECTION OF DATA FOR THE MEDICARE PROGRAM
15 ‘‘SEC. 1150C.
16 ‘‘(a) REQUIREMENT.—
17 ‘‘(1) IN GENERAL.—The Commissioner of So-
18 cial Security, in consultation with the Administrator
19 of the Centers for Medicare & Medicaid Services,
20 shall collect data on the race, ethnicity, sex, primary
21 language, sexual orientation, gender identity, socio-
22 economic status, and disability status of all appli-
23 cants for Social Security benefits under title II or
24 Medicare benefits under title XVIII.
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25 ‘‘(2) DATA COLLECTION STANDARDS.—In col-
26 lecting data under paragraph (1), the Commissioner
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1 of Social Security shall at least use the standards
2 for data collection developed under section 3101 of
3 the Public Health Service Act or the standards de-
4 veloped by the Office of Management and Budget,
5 whichever is more disaggregated. In the event there
6 are no standards for the demographic groups listed
7 under paragraph (1), the Commissioner shall consult
8 with stakeholder groups representing the various
9 identities as well as with the Office of Minority
10 Health within the Centers for Medicare & Medicaid
11 Services to develop appropriate standards.
12 ‘‘(3) DATA FOR ADDITIONAL POPULATION
13 GROUPS.—Where practicable, the information col-
14 lected by the Commissioner of Social Security under
15 paragraph (1) shall include data for additional popu-
16 lation groups if such groups can be aggregated into
17 the race and ethnicity categories outlined by the
18 data collection standards described in paragraph (2).
19 ‘‘(4) COLLECTION OF DATA FOR MINORS AND
20 LEGALLY INCAPACITATED INDIVIDUALS.—With re-
21 spect to the collection of the data described in para-
22 graph (1) of applicants who are under 18 years of
23 age or otherwise legally incapacitated, the Commis-
24 sioner of Social Security shall require that—
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1 ‘‘(A) such data be collected from the par-
2 ent or legal guardian of such an applicant; and
3 ‘‘(B) the primary language of the parent
4 or legal guardian of such an applicant or recipi-
5 ent be used in collecting the data.
6 ‘‘(5) QUALITY OF DATA.—The Commissioner of
7 Social Security shall periodically review the quality
8 and completeness of the data collected under para-
9 graph (1) and make adjustments as necessary to im-
10 prove both.
11 ‘‘(6) TRANSMISSION OF DATA.—Upon enroll-
12 ment in Medicare benefits under title XVIII, the
13 Commissioner of Social Security shall transmit an
14 individual’s demographic data as collected under
15 paragraph (1) to the Centers for Medicare and Med-
16 icaid Services.
17 ‘‘(7) ANALYSIS AND REPORTING OF DATA.—
18 With respect to data transmitted under paragraph
19 (5), the Administrator of the Centers for Medicare
20 and Medicaid Services, in consultation with the
21 Commissioner of Social Security shall—
22 ‘‘(A) require that such data be uniformly
23 analyzed and that such analysis be reported at
24 least annually to Congress;
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1 ‘‘(B) incorporate such data in other anal-
2 ysis and reporting on health disparities as ap-
3 propriate;
4 ‘‘(C) make such data available to research-
5 ers, under the protections outlined in paragraph
6 (7);
7 ‘‘(D) provide opportunities to individuals
8 enrolled in Medicare to submit updated data;
9 and
10 ‘‘(E) ensure that the provision of assist-
11 ance or benefits to an applicant is not denied
12 or otherwise adversely affected because of the
13 failure of the applicant to provide any of the
14 data collected under paragraph (1).
15 ‘‘(8) PROTECTION OF DATA.—The Commis-
16 sioner of Social Security shall ensure (through the
17 promulgation of regulations or otherwise) that all
18 data collected pursuant to subsection (a) is pro-
19 tected—
20 ‘‘(A) under the same privacy protections as
21 the Secretary applies to health data under the
22 regulations promulgated under section 264(c) of
23 the Health Insurance Portability and Account-
24 ability Act of 1996 (relating to the privacy of
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1 individually identifiable health information and
2 other protections); and
3 ‘‘(B) from all inappropriate internal use by
4 any entity that collects, stores, or receives the
5 data, including use of such data in determina-
6 tions of eligibility (or continued eligibility) in
7 health plans, and from other inappropriate
8 uses, as defined by the Secretary.
9 ‘‘(b) RULE OF CONSTRUCTION.—Nothing in this sec-
10 tion shall be construed to permit the use of information
11 collected under this section in a manner that would ad-
12 versely affect any individual providing any such informa-
13 tion.
14 ‘‘(c) TECHNICAL ASSISTANCE.—The Secretary may,
15 either directly or by grant or contract, provide technical
16 assistance to enable any entity to comply with the require-
17 ments of this section or with regulations implementing this
18 section.
19 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There
20 are authorized to be appropriated to carry out this section
21 $500 million for 2020 and $100 million for each fiscal
22 year thereafter.’’.
23 SEC. 107. REVISION OF HIPAA CLAIMS STANDARDS.
24 (a) IN GENERAL.—Not later than 1 year after the
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1 Human Services shall revise the regulations promulgated
2 under part C of title XI of the Social Security Act (42
3 U.S.C. 1320d et seq.), relating to the collection of data
4 on race, ethnicity, and primary language in a health-re-
5 lated transaction, to require—
6 (1) the use, at a minimum, of standards for
7 data collection on race, ethnicity, primary language,
8 disability, sex, sexual orientation, gender identity,
9 and socioeconomic status developed under section
10 3101 of the Public Health Service Act (42 U.S.C.
11 300kk); and
12 (2) in consultation with the Office of the Na-
13 tional Coordinator for Health Information Tech-
14 nology, the designation of the appropriate racial,
15 ethnic, primary language, disability, sex, and other
16 code sets as required for claims and enrollment data.
17 (b) DISSEMINATION.—The Secretary of Health and
18 Human Services shall disseminate the new standards de-
19 veloped under subsection (a) to all entities that are subject
20 to the regulations described in such subsection and provide
21 technical assistance with respect to the collection of the
22 data involved.
23 (c) COMPLIANCE.—The Secretary of Health and
24 Human Services shall require that entities comply with the
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1 than 2 years after the final promulgation of such stand-
2 ards.
3 SEC. 108. DISPARITIES DATA COLLECTED BY THE FEDERAL
4 GOVERNMENT.
5 (a) REPOSITORY OF GOVERNMENT DATA.—The Sec-
6 retary of Health and Human Services, in coordination
7 with the departments, agencies, or offices described in
8 subsection (b), shall establish a centralized electronic re-
9 pository of Government data on factors related to the
10 health and well-being of the population of the United
11 States.
12 (b) COLLECTION; SUBMISSION.—Not later than 180
13 days after the date of the enactment of this Act, and Jan-
14 uary 31 of each year thereafter, each department, agency,
15 and office of the Federal Government that has collected
16 data on race, ethnicity, sex, primary language, sexual ori-
17 entation, disability status, gender identity, age, or socio-
18 economic status during the preceding calendar year shall
19 submit such data to the repository of Government data
20 established under subsection (a).
21 (c) ANALYSIS; PUBLIC AVAILABILITY; REPORTING.—
22 Not later than April 30, 2021, and April 30 of each year
23 thereafter, the Secretary of Health and Human Services,
24 acting through the Assistant Secretary for Planning and
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1 tor of the Agency for Healthcare Research and Quality,
2 the Director of the National Center for Health Statistics,
3 the Administrator of the Centers for Medicare & Medicaid
4 Services, the Director of the National Institute on Minor-
5 ity Health and Health Disparities, and the Deputy Assist-
6 ant Secretary for Minority Health, shall—
7 (1) prepare and make available datasets for
8 public use that relate to disparities in health status,
9 health care access, health care quality, health out-
10 comes, public health, and other areas of health and
11 well-being by factors that include race, ethnicity,
12 sex, primary language, sexual orientation, disability
13 status, gender identity, and socioeconomic status;
14 (2) ensure that these datasets are publicly iden-
15 tified on the repository established under subsection
16 (a) as ‘‘disparities’’ data; and
17 (3) submit a report to the Congress on the
18 availability and use of such data by public stake-
19 holders.
20 SEC. 109. STANDARDS FOR MEASURING SEXUAL ORIENTA-
21 TION, GENDER IDENTITY, AND SOCIO-
22 ECONOMIC STATUS IN COLLECTION OF
23 HEALTH DATA.
24 Section 3101(a) of the Public Health Service Act (42
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25 U.S.C. 300kk(a)) is amended—
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1 (1) in paragraph (1)(A), by inserting ‘‘sexual
2 orientation, gender identity, socioeconomic status,’’
3 before ‘‘and disability status’’;
4 (2) in paragraph (1)(C), by inserting ‘‘sexual
5 orientation, gender identity, socioeconomic status,’’
6 before ‘‘and disability status’’; and
7 (3) in paragraph (2)(B), by inserting ‘‘sexual
8 orientation, gender identity, socioeconomic status,’’
9 before ‘‘and disability status’’.
10 SEC. 110. IMPROVING HEALTH DATA REGARDING NATIVE
11 HAWAIIANS AND OTHER PACIFIC ISLANDERS.
12 Part B of title III of the Public Health Service Act
13 (42 U.S.C. 243 et seq.) is amended by inserting after sec-
14 tion 317U the following:
15 ‘‘SEC. 317V. NATIVE HAWAIIAN AND OTHER PACIFIC IS-
16 LANDER HEALTH DATA.
17 ‘‘(a) DEFINITIONS.—In this section:
18 ‘‘(1) COMMUNITY GROUP.—The term ‘commu-
19 nity group’ means a group of NHOPI who are orga-
20 nized at the community level, and may include a
21 church group, social service group, national advocacy
22 organization, or cultural group.
23 ‘‘(2) NONPROFIT, NONGOVERNMENTAL ORGANI-
24 ZATION.—The term ‘nonprofit, nongovernmental or-
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1 onstrated history of addressing NHOPI issues, in-
2 cluding a NHOPI coalition.
3 ‘‘(3) DESIGNATED ORGANIZATION.—The term
4 ‘designated organization’ means an entity estab-
5 lished to represent NHOPI populations and which
6 has statutory responsibilities to provide, or has com-
7 munity support for providing, health care.
8 ‘‘(4) GOVERNMENT REPRESENTATIVES OF
9 NHOPI POPULATIONS.—The term ‘government rep-
10 resentatives of NHOPI populations’ means rep-
11 resentatives from Hawaii, American Samoa, the
12 Commonwealth of the Northern Mariana Islands,
13 the Federated States of Micronesia, Guam, the Re-
14 public of Palau, and the Republic of the Marshall Is-
15 lands.
16 ‘‘(5) NATIVE HAWAIIANS AND OTHER PACIFIC
17 ISLANDERS (NHOPI).—The term ‘Native Hawaiians
18 and Other Pacific Islanders’ or ‘NHOPI’ means peo-
19 ple having origins in any of the original peoples of
20 American Samoa, the Commonwealth of the North-
21 ern Mariana Islands, the Federated States of Micro-
22 nesia, Guam, Hawaii, the Republic of the Marshall
23 Islands, the Republic of Palau, or any other Pacific
24 Island.
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1 ‘‘(6) INSULAR AREA.—The term ‘insular area’
2 means Guam, the Commonwealth of Northern Mar-
3 iana Islands, American Samoa, the United States
4 Virgin Islands, the Federated States of Micronesia,
5 the Republic of Palau, or the Republic of the Mar-
6 shall Islands.
7 ‘‘(b) NATIONAL STRATEGY.—
8 ‘‘(1) IN GENERAL.—The Secretary, acting
9 through the Director of the National Center for
10 Health Statistics (referred to in this section as
11 ‘NCHS’) of the Centers for Disease Control and
12 Prevention, and other agencies within the Depart-
13 ment of Health and Human Services as the Sec-
14 retary determines appropriate, shall develop and im-
15 plement an ongoing and sustainable national strat-
16 egy for identifying and evaluating the health status
17 and health care needs of NHOPI populations living
18 in the continental United States, Hawaii, American
19 Samoa, the Commonwealth of the Northern Mariana
20 Islands, the Federated States of Micronesia, Guam,
21 the Republic of Palau, and the Republic of the Mar-
22 shall Islands.
23 ‘‘(2) CONSULTATION.—In developing and imple-
24 menting a national strategy, as described in para-
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1 enactment of the Ending Health Disparities During
2 COVID–19 Act of 2020, the Secretary—
3 ‘‘(A) shall consult with representatives of
4 community groups, designated organizations,
5 and nonprofit, nongovernmental organizations
6 and with government representatives of NHOPI
7 populations; and
8 ‘‘(B) may solicit the participation of rep-
9 resentatives from other Federal departments.
10 ‘‘(c) PRELIMINARY HEALTH SURVEY.—
11 ‘‘(1) IN GENERAL.—The Secretary, acting
12 through the Director of NCHS, shall conduct a pre-
13 liminary health survey in order to identify the major
14 areas and regions in the continental United States,
15 Hawaii, American Samoa, the Commonwealth of the
16 Northern Mariana Islands, the Federated States of
17 Micronesia, Guam, the Republic of Palau, and the
18 Republic of the Marshall Islands in which NHOPI
19 people reside.
20 ‘‘(2) CONTENTS.—The health survey described
21 in paragraph (1) shall include health data and any
22 other data the Secretary determines to be—
23 ‘‘(A) useful in determining health status
24 and health care needs; or
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1 ‘‘(B) required for developing or imple-
2 menting a national strategy.
3 ‘‘(3) METHODOLOGY.—Methodology for the
4 health survey described in paragraph (1), including
5 plans for designing questions, implementation, sam-
6 pling, and analysis, shall be developed in consulta-
7 tion with community groups, designated organiza-
8 tions, nonprofit, nongovernmental organizations, and
9 government representatives of NHOPI populations,
10 as determined by the Secretary.
11 ‘‘(4) TIMEFRAME.—The survey required under
12 this subsection shall be completed not later than 18
13 months after the date of enactment of the Ending
14 Health Disparities During COVID–19 Act of 2020.
15 ‘‘(d) PROGRESS REPORT.—Not later than 2 years
16 after the date of enactment of the Ending Health Dispari-
17 ties During COVID–19 Act of 2020, the Secretary shall
18 submit to Congress a progress report, which shall include
19 the national strategy described in subsection (b)(1).
20 ‘‘(e) STUDY AND REPORT BY THE HEALTH AND
21 MEDICINE DIVISION.—
22 ‘‘(1) IN GENERAL.—The Secretary shall enter
23 into an agreement with the Health and Medicine Di-
24 vision of the National Academies of Sciences, Engi-
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1 from stakeholders in insular areas, on each of the
2 following:
3 ‘‘(A) The standards and definitions of
4 health care applied to health care systems in in-
5 sular areas and the appropriateness of such
6 standards and definitions.
7 ‘‘(B) The status and performance of health
8 care systems in insular areas, evaluated based
9 upon standards and definitions, as the Sec-
10 retary determines appropriate.
11 ‘‘(C) The effectiveness of donor aid in ad-
12 dressing health care needs and priorities in in-
13 sular areas.
14 ‘‘(D) The progress toward implementation
15 of recommendations of the Committee on
16 Health Care Services in the United States—As-
17 sociated Pacific Basin that are set forth in the
18 1998 report entitled ‘Pacific Partnerships for
19 Health: Charting a New Course’.
20 ‘‘(2) REPORT.—An agreement described in
21 paragraph (1) shall require the Health and Medicine
22 Division to submit to the Secretary and to Congress,
23 not later than 2 years after the date of the enact-
24 ment of the Ending Health Disparities During
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1 scription of the results of the study conducted under
2 paragraph (1), including the conclusions and rec-
3 ommendations of the Health and Medicine Division
4 for each of the items described in subparagraphs (A)
5 through (D) of such paragraph.
6 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To
7 carry out this section, there are authorized to be appro-
8 priated such sums as may be necessary for fiscal years
9 2021 through 2025.’’.
10 Subtitle B—Improvements and
11 Modernization
12 SEC. 121. FEDERAL MODERNIZATION FOR HEALTH INEQUI-
13 TIES DATA.
14 (a) IN GENERAL.—The Secretary of Health and
15 Human Services shall work with covered agencies to sup-
16 port the modernization of data collection methods and in-
17 frastructure at such agencies for the purpose of increasing
18 data collection related to health inequities, such as racial,
19 ethnic (including breakdowns of major ethnic groups and
20 Tribal affiliations within minority populations), socio-
21 economic, sex, gender, age, geographic region, primary
22 written and spoken language, sexual orientation, occupa-
23 tion, and disability status disparities.
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1 (b) COVERED AGENCY DEFINED.—In this section,
2 the term ‘‘covered agency’’ means each of the following
3 Federal agencies:
4 (1) The Agency for Healthcare Research and
5 Quality.
6 (2) The Centers for Disease Control and Pre-
7 vention.
8 (3) The Centers for Medicare & Medicaid Serv-
9 ices.
10 (4) The Food and Drug Administration.
11 (5) The Office of the National Coordinator for
12 Health Information Technology.
13 (6) The National Institutes of Health.
14 (c) AUTHORIZATION OF APPROPRIATIONS.—There is
15 authorized to be appropriated to each covered agency to
16 carry out this section $4,000,000, to remain available
17 until expended.
18 SEC. 122. MODERNIZATION OF STATE AND LOCAL HEALTH
19 INEQUITIES DATA.
20 (a) IN GENERAL.—Not later than 6 months after the
21 date of enactment of this Act, the Secretary of Health and
22 Human Services (referred to in this section as the ‘‘Sec-
23 retary’’), acting through the Director of the Centers for
24 Disease Control and Prevention, shall award grants to
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1 order to support the modernization of data collection
2 methods and infrastructure for the purposes of increasing
3 data related to health inequities, such as racial, ethnic (in-
4 cluding breakdowns of major ethnic groups and Tribal af-
5 filiations within minority populations), socioeconomic, sex,
6 gender, age, geographic region, primary written and spo-
7 ken language, sexual orientation, occupation, and dis-
8 ability status disparities. The Secretary shall—
9 (1) provide guidance, technical assistance, and
10 information to grantees under this section on best
11 practices regarding culturally competent, accurate,
12 and increased data collection and transmission; and
13 (2) track performance of grantees under this
14 section to help improve their health inequities data
15 collection by identifying gaps and taking effective
16 steps to support States, localities, and territories in
17 addressing the gaps.
18 (b) REPORT.—Not later than 1 year after the date
19 on which the first grant is awarded under this section,
20 the Secretary shall submit to the Committee on Energy
21 and Commerce of the House of Representatives and the
22 Committee on Health, Education, Labor, and Pensions of
23 the Senate an initial report detailing—
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1 (1) nationwide best practices for ensuring
2 States and localities collect and transmit health in-
3 equities data;
4 (2) nationwide trends which hinder the collec-
5 tion and transmission of health inequities data;
6 (3) Federal best practices for working with
7 States and localities to ensure culturally competent,
8 accurate, and increased data collection and trans-
9 mission; and
10 (4) any recommended changes to legislative or
11 regulatory authority to help improve and increase
12 health inequities data collection.
13 (c) FINAL REPORT.—Not later than December 31,
14 2023, the Secretary shall—
15 (1) update and finalize the initial report under
16 subsection (b); and
17 (2) submit such final report to the committees
18 specified in such subsection.
19 (d) AUTHORIZATION OF APPROPRIATIONS.—There is
20 authorized to be appropriated to carry out this section
21 $100,000,000, to remain available until expended.
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1 SEC. 123. ADDITIONAL REPORTING TO CONGRESS ON THE
2 RACE AND ETHNICITY RATES OF COVID–19
3 TESTING, HOSPITALIZATIONS, AND MORTALI-
4 TIES.
5 (a) IN GENERAL.—Not later than August 1, 2020,
6 the Secretary of Health and Human Services (referred to
7 in this section as the ‘‘Secretary’’) shall submit to the
8 Committee on Appropriations and the Committee on En-
9 ergy and Commerce of the House of Representatives and
10 the Committee on Appropriations and the Committee on
11 Health, Education, Labor, and Pensions of the Senate an
12 initial report—
13 (1) describing the testing, positive diagnoses,
14 hospitalization, intensive care admissions, and mor-
15 tality rates associated with COVID–19,
16 disaggregated by race, ethnicity (including break-
17 downs of major ethnic groups and Tribal affiliations
18 within minority populations), age, sex, gender, geo-
19 graphic region, primary written and spoken lan-
20 guage, disability status, sexual orientation, socio-
21 economic status, occupation, and other relevant fac-
22 tors as determined by the Secretary;
23 (2) including an analysis of any variances of
24 testing, positive diagnoses, hospitalizations, and
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1 (3) including proposals for evidenced-based re-
2 sponse strategies to reduce disparities related to
3 COVID–19.
4 (b) FINAL REPORT.—Not later than December 31,
5 2024, the Secretary shall—
6 (1) update and finalize the initial report under
7 subsection (a); and
8 (2) submit such final report to the committees
9 specified in such subsection.
10 (c) COORDINATION.—In preparing the report sub-
11 mitted under this section, the Secretary shall take into ac-
12 count and otherwise coordinate such report with reporting
13 required under section 103 and under the heading ‘‘De-
14 partment of Health and Human Services—Office of the
15 Secretary—Public Health and Social Service Emergency
16 Fund’’ in title I of division B of the Paycheck Protection
17 Program and Health Care Enhancement Act (Public Law
18 116–139; 134 Stat. 620, 626).
19 TITLE II—EQUITABLE TESTING
20 AND TRACING
21 Subtitle A—Free Testing for
22 Patients
23 SEC. 201. SOONER COVERAGE OF TESTING FOR COVID–19.
24 Section 6001(a) of division F of the Families First
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25 Coronavirus Response Act (42 U.S.C. 1320b–5 note) is
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1 amended by striking ‘‘beginning on or after’’ and inserting
2 ‘‘beginning before, on, or after’’.
3 Subtitle B—National Testing
4 Strategy
5 SEC. 211. COVID–19 TESTING STRATEGY.
6 (a) STRATEGY.—Not later than June 15, 2020, the
7 Secretary of Health and Human Services (referred to in
8 this section as the ‘‘Secretary’’) shall update the COVID–
9 19 strategic testing plan under the heading ‘‘Department
10 of Health and Human Services—Office of the Secretary—
11 Public Health and Social Service Emergency Fund’’ in
12 title I of division B of the Paycheck Protection Program
13 and Health Care Enhancement Act (Public Law 116–139,
14 134 Stat. 620, 626–627) and submit to the appropriate
15 congressional committees such updated national plan iden-
16 tifying—
17 (1) what level of, types of, and approaches to
18 testing (including predicted numbers of tests, popu-
19 lations to be tested, and frequency of testing and the
20 appropriate setting whether a health care setting
21 (such as hospital-based, high-complexity laboratory,
22 point-of-care, mobile testing units, pharmacies or
23 community health centers) or non-health care setting
24 (such as workplaces, schools, or child care centers))
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1 (A) to sufficiently monitor and contribute
2 to the control of the transmission of SARS–
3 CoV–2 in the United States;
4 (B) to ensure that any reduction in social
5 distancing efforts, when determined appropriate
6 by public health officials, can be undertaken in
7 a manner that optimizes the health and safety
8 of the people of the United States, and reduces
9 disparities (including disparities related to race,
10 ethnicity, sex, age, disability status, socio-
11 economic status, primary written and spoken
12 language, occupation, and geographic location)
13 in the prevalence of, incidence of, and health
14 outcomes with respect to, COVID–19; and
15 (C) to provide for ongoing surveillance suf-
16 ficient to support contact tracing, case identi-
17 fication, quarantine, and isolation to prevent fu-
18 ture outbreaks of COVID–19;
19 (2) specific plans and benchmarks, each with
20 clear timelines, to ensure—
21 (A) such level of, types of, and approaches
22 to testing as are described in paragraph (1),
23 with respect to optimizing health and safety;
24 (B) sufficient availability of all necessary
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1 tion and testing kits, reagents, transport media,
2 swabs, instruments, analysis equipment, per-
3 sonal protective equipment if necessary for test-
4 ing (including point-of-care testing), and other
5 equipment;
6 (C) allocation of testing materials and sup-
7 plies in a manner that optimizes public health,
8 including by considering the variable impact of
9 SARS–CoV–2 on specific States, territories, In-
10 dian Tribes, Tribal organizations, urban Indian
11 organizations, communities, industries, and pro-
12 fessions;
13 (D) sufficient evidence of validation for
14 tests that are deployed as a part of such strat-
15 egy;
16 (E) sufficient laboratory and analytical ca-
17 pacity, including target turnaround time for
18 test results;
19 (F) sufficient personnel, including per-
20 sonnel to collect testing samples, conduct and
21 analyze results, and conduct testing follow-up,
22 including contact tracing, as appropriate; and
23 (G) enforcement of the Families First
24 Coronavirus Response Act (Public Law 116–
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1 127) to ensure patients who are tested are not
2 subject to cost sharing;
3 (3) specific plans to ensure adequate testing in
4 rural areas, frontier areas, health professional short-
5 age areas, and medically underserved areas (as de-
6 fined in section 330I(a) of the Public Health Service
7 Act (42 U.S.C. 254c–14(a))), and for underserved
8 populations, Native Americans (including Indian
9 Tribes, Tribal organizations, and urban Indian orga-
10 nizations), and populations at increased risk related
11 to COVID–19;
12 (4) specific plans to ensure accessibility of test-
13 ing to people with disabilities, older individuals, indi-
14 viduals with limited English proficiency, and individ-
15 uals with underlying health conditions or weakened
16 immune systems; and
17 (5) specific plans for broadly developing and
18 implementing testing for potential immunity in the
19 United States, as appropriate, in a manner suffi-
20 cient—
21 (A) to monitor and contribute to the con-
22 trol of SARS–CoV–2 in the United States;
23 (B) to ensure that any reduction in social
24 distancing efforts, when determined appropriate
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1 a manner that optimizes the health and safety
2 of the people of the United States; and
3 (C) to reduce disparities (including dispari-
4 ties related to race, ethnicity, sex, age, dis-
5 ability status, socioeconomic status, primary
6 written and spoken language, occupation, and
7 geographic location) in the prevalence of, inci-
8 dence of, and health outcomes with respect to,
9 COVID–19.
10 (b) COORDINATION.—The Secretary shall carry out
11 this section—
12 (1) in coordination with the Administrator of
13 the Federal Emergency Management Agency;
14 (2) in collaboration with other agencies and de-
15 partments, as appropriate; and
16 (3) taking into consideration the State plans for
17 COVID–19 testing prepared as required under the
18 heading ‘‘Department of Health and Human Serv-
19 ices—Office of the Secretary—Public Health and
20 Social Service Emergency Fund’’ in title I of divi-
21 sion B of the Paycheck Protection Program and
22 Health Care Enhancement Act (Public Law 116–
23 139; 134 Stat. 620, 624).
24 (c) UPDATES.—
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1 (1) FREQUENCY.—The updated national plan
2 under subsection (a) shall be updated every 30 days
3 until the end of the public health emergency first de-
4 clared by the Secretary under section 319 of the
5 Public Health Service Act (42 U.S.C. 247d) on Jan-
6 uary 31, 2020, with respect to COVID–19.
7 (2) RELATION TO OTHER LAW.—Paragraph (1)
8 applies in lieu of the requirement (for updates every
9 90 days until funds are expended) in the second to
10 last proviso under the heading ‘‘Department of
11 Health and Human Services—Office of the Sec-
12 retary—Public Health and Social Service Emergency
13 Fund’’ in title I of division B of the Paycheck Pro-
14 tection Program and Health Care Enhancement Act
15 (Public Law 116–139; 134 Stat. 620, 627).
16 (d) APPROPRIATE CONGRESSIONAL COMMITTEES.—
17 In this section, the term ‘‘appropriate congressional com-
18 mittees’’ means—
19 (1) the Committee on Appropriations and the
20 Committee on Energy and Commerce of the House
21 of Representatives; and
22 (2) the Committee on Appropriations and the
23 Committee on Health, Education, Labor, and Pen-
24 sions of the Senate.
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1 SEC. 212. CORONAVIRUS IMMIGRANT FAMILIES PROTEC-
2 TION.
3 (a) DEFINITIONS.—In this section:
4 (1) CORONAVIRUS PUBLIC HEALTH EMER-
5 GENCY.—The term ‘‘coronavirus public health emer-
6 gency’’ means—
7 (A) an emergency involving Federal pri-
8 mary responsibility determined to exist by the
9 President under section 501(b) of the Robert T.
10 Stafford Disaster Relief and Emergency Assist-
11 ance Act (42 U.S.C. 5191(b)) with respect to
12 COVID–19 or any other coronavirus with pan-
13 demic potential;
14 (B) an emergency declared by a Federal
15 official with respect to coronavirus (as defined
16 in section 506 of the Coronavirus Preparedness
17 and Response Supplemental Appropriations
18 Act, 2020 (Public Law 116–123));
19 (C) a national emergency declared by the
20 President under the National Emergencies Act
21 (50 U.S.C. 1601 et seq.) with respect to
22 COVID–19 or any other coronavirus with pan-
23 demic potential; and
24 (D) a public health emergency declared by
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26 pursuant to section 319 of the Public Health
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1 Service Act (42 U.S.C. 247(d)) with respect to
2 COVID–19 or any other coronavirus with pan-
3 demic potential.
4 (2) CORONAVIRUS RESPONSE LAW.—The term
5 ‘‘coronavirus response law’’ means—
6 (A) the Coronavirus Preparedness and Re-
7 sponse Supplemental Appropriations Act, 2020
8 (Public Law 116–123);
9 (B) the Families First Coronavirus Re-
10 sponse Act (Public Law 116–127);
11 (C) the Coronavirus Aid, Relief, and Eco-
12 nomic Security Act (Public Law 116–136); and
13 (D) any subsequent law enacted as a re-
14 sponse to a coronavirus public health emer-
15 gency.
16 (3) COVID–19.—The term ‘‘COVID–19’’
17 means the Coronavirus Disease 2019.
18 (4) ENFORCEMENT ACTION.—The term ‘‘en-
19 forcement action’’ means an apprehension, an arrest,
20 a search, an interview, a request for identification,
21 or surveillance for the purposes of immigration en-
22 forcement.
23 (5) SENSITIVE LOCATION.—The term ‘‘sensitive
24 location’’ means all physical space located within
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25 1,000 feet of—
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1 (A) a medical treatment or health care fa-
2 cility, including a hospital, an office of a health
3 care practitioner, an accredited health clinic, an
4 alcohol or drug treatment center, an emergent
5 or urgent care facility, and a community health
6 center;
7 (B) a location at which emergency service
8 providers distribute food or provide shelter;
9 (C) an organization that provides—
10 (i) disaster or emergency social serv-
11 ices and assistance;
12 (ii) services for individuals experi-
13 encing homelessness, including food banks
14 and shelters; or
15 (iii) assistance for children, pregnant
16 women, victims of crime or abuse, or indi-
17 viduals with significant mental or physical
18 disabilities;
19 (D) a public assistance office, including
20 any Federal, State, or municipal location at
21 which individuals may apply for or receive un-
22 employment compensation or report violations
23 of labor and employment laws;
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1 (E) a Federal, State, or local courthouse,
2 including the office of the legal counsel or rep-
3 resentative of an individual;
4 (F) a domestic violence shelter, rape crisis
5 center, supervised visitation center, family jus-
6 tice center, or victim services provider;
7 (G) an office of the Social Security Admin-
8 istration;
9 (H) a childcare facility or a school, includ-
10 ing a preschool, primary school, secondary
11 school, post-secondary school up to and includ-
12 ing a college or university, and any other insti-
13 tution of learning such as a vocational or trade
14 school;
15 (I) a church, synagogue, mosque or any
16 other institution of worship, such as a building
17 rented for the purpose of a religious service;
18 (J) the site of a funeral, wedding, or any
19 other public religious ceremony;
20 (K) in the case of a jurisdiction in which
21 a shelter-in-place order is in effect during a
22 coronavirus public health emergency, any busi-
23 ness location considered to provide an essential
24 service, such as a pharmacy or a grocery store;
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25 and
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1 (L) any other location specified by the Sec-
2 retary of Homeland Security.
3 (b) SUSPENSION OF ADVERSE IMMIGRATION AC-
4 TIONS THAT DETER IMMIGRANT COMMUNITIES FROM
5 SEEKING HEALTH SERVICES IN A PUBLIC HEALTH
6 EMERGENCY.—
7 (1) IN GENERAL.—Beginning on the date on
8 which a coronavirus public health emergency is de-
9 clared and ending on the date that is 60 days after
10 the date on which the coronavirus public health
11 emergency expires—
12 (A) the Secretary of Homeland Security,
13 the Secretary of State, and the Attorney Gen-
14 eral shall not—
15 (i) implement the final rule of the De-
16 partment of Homeland Security entitled
17 ‘‘Inadmissibility on Public Charge
18 Grounds’’ (84 Fed. Reg. 41292 (August
19 14, 2019));
20 (ii) implement the interim final rule of
21 the Department of State entitled ‘‘Visas:
22 Ineligibility Based on Public Charge
23 Grounds’’ (84 Fed. Reg. 54996 (October
24 11, 2019));
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1 (iii) implement the proposed rule of
2 the Department of Justice entitled ‘‘Inad-
3 missibility on Public Charge Grounds’’
4 published in the Fall 2018 Uniform Regu-
5 latory Agenda;
6 (iv) conduct any enforcement action
7 against an individual at, or in transit to or
8 from, a sensitive location unless the en-
9 forcement action is conducted pursuant to
10 a valid judicial warrant;
11 (v) detain or remove—
12 (I) a survivor of domestic vio-
13 lence, sexual assault, or human traf-
14 ficking, or any other individual, who
15 has a pending application under sec-
16 tion 101(a)(15)(T), 101(a)(15)(U),
17 106, 240A(b)(2) of the Immigration
18 and Nationality Act (8 U.S.C.
19 1101(a)(15)(T), 1101(a)(15)(U),
20 1105a, 1229b(b)(2)) or section
21 244(a)(3) of that Act (as in effect on
22 March 31, 1997); or
23 (II) a VAWA self-petitioner de-
24 scribed in section 101(a)(51) of that
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1 Act (8 U.S.C. 1101(a)(51)) who has a
2 pending application for relief under—
3 (aa) a provision referred to
4 in any of subparagraphs (A)
5 through (G) of that section; or
6 (bb) section 101(a)(27)(J)
7 of that Act (8 U.S.C.
8 1101(a)(27)(J)); and
9 (vi) require an individual subject to
10 supervision by U.S. Immigration and Cus-
11 toms Enforcement to report in person.
12 (B) The Attorney General shall conduct
13 fully telephonic bond hearings and allow sup-
14 porting documents to be faxed and emailed to
15 the appropriate clerk.
16 (C) The Secretary of Homeland Security,
17 to the extent practicable, shall stipulate to bond
18 determinations on written motions.
19 (2) USE OF BENEFITS FUNDED BY
20 CORONAVIRUS RESPONSE LAW.—The Secretary of
21 Homeland Security, the Secretary of State, and the
22 Attorney General shall not consider in any deter-
23 mination affecting the current or future immigration
24 status of any individual the use of any benefit of any
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1 amounts made available under a coronavirus re-
2 sponse law.
3 (c) ACCESS TO COVID–19 TESTING AND TREAT-
4 MENT FOR ALL COMMUNITIES.—
5 (1) CLARIFICATION REGARDING EMERGENCY
6 SERVICES FOR CERTAIN INDIVIDUALS.—Section
7 1903(v)(2) of the Social Security Act (42 U.S.C.
8 1396b(v)(2)) is amended by adding at the end the
9 following flush sentence:
10 ‘‘For purposes of subparagraph (A), care and services
11 described in such subparagraph include any in vitro diag-
12 nostic product described in section 1905(a)(3)(B) that is
13 administered during any portion of the emergency period
14 described in such section beginning on or after the date
15 of the enactment of this sentence (and the administration
16 of such product), any COVID–19 vaccine that is adminis-
17 tered during any such portion (and the administration of
18 such vaccine), any item or service that is furnished during
19 any such portion for the treatment of COVID–19 or a con-
20 dition that may complicate the treatment of COVID–19,
21 and any services described in section 1916(a)(2)(G).’’.
22 (2) EMERGENCY MEDICAID FOR INDIVIDUALS
23 WITH SUSPECTED COVID–19 INFECTIONS.—Section
24 1903(v)(3) of the Social Security Act (42 U.S.C.
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25 1396b(v)(3)) is amended by striking ‘‘means a’’ and
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1 inserting ‘‘means any concern that the individual
2 may have contracted COVID–19 or another.’’.
3 (3) TREATMENT OF ASSISTANCE AND SERVICES
4 PROVIDED.—For any period during which a
5 coronavirus public health emergency is in effect—
6 (A) the value of assistance or services pro-
7 vided to any person under a program with re-
8 spect to which a coronavirus response law es-
9 tablishes or expands eligibility or benefits shall
10 not be considered income or resources; and
11 (B)(i) any medical coverage or services
12 shall be considered treatment for an emergency
13 medical condition (as defined in section
14 1903(v)(3) of the Social Security Act (42
15 U.S.C. 1396b(v)(3))) for any purpose under
16 any Federal, State, or local law, including law
17 relating to taxation, welfare, and public assist-
18 ance programs;
19 (ii) a participating State or political sub-
20 division of a State shall not decrease any assist-
21 ance otherwise provided to an individual be-
22 cause of the receipt of benefits under the Social
23 Security Act (42 U.S.C. 301 et seq.); and
24 (iii) assistance and services described in
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1 disaster assistance, notwithstanding the form in
2 which the assistance and services are provided,
3 except that cash received by an individual or a
4 household may be treated as income by any
5 public benefit program under the rules applica-
6 ble before the date of the enactment of this Act.
7 (4) NONDISCRIMINATION.—No person shall be,
8 on the basis of actual or perceived immigration sta-
9 tus, excluded from participation in, denied the bene-
10 fits of, or subject to discrimination under, any pro-
11 gram or activity funded in whole or in part by
12 amounts made available under a coronavirus re-
13 sponse law.
14 (d) LANGUAGE ACCESS AND PUBLIC OUTREACH FOR
15 PUBLIC HEALTH.—
16 (1) GRANTS AND COOPERATIVE AGREE-
17 MENTS.—
18 (A) IN GENERAL.—The Director of the
19 Centers for Disease Control and Prevention (re-
20 ferred to in this subsection as the ‘‘Director’’)
21 shall provide grants to, or enter into cooperative
22 agreements with, community-based organiza-
23 tions for the purpose of supporting culturally
24 and linguistically appropriate preparedness, re-
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1 velopment of educational programs and mate-
2 rials to promote screening, testing, treatment,
3 and public health practices.
4 (B) DEFINITION OF COMMUNITY-BASED
5 ORGANIZATION.—In this paragraph, the term
6 ‘‘community-based organization’’ means an en-
7 tity that has established relationships with
8 hard-to-reach populations, including racial and
9 ethnic minorities, individuals with limited
10 English proficiency, and individuals with dis-
11 abilities.
12 (2) TRANSLATION.—
13 (A) IN GENERAL.—The Director shall pro-
14 vide for the translation of materials on aware-
15 ness, screening, testing, and treatment for
16 COVID–19 into the languages described in the
17 language access plan of the Federal Emergency
18 Management Agency dated October 1, 2016, as
19 the languages most frequently encountered.
20 (B) PUBLIC AVAILABILITY.—Not later
21 than 7 days after the date on which the mate-
22 rials described in subparagraph (A) are made
23 available to the public in English, the Director
24 shall ensure that the translations required by
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1 that subparagraph are made available to the
2 public.
3 (3) HOTLINE.—The Director shall establish an
4 informational hotline line that provides, in the lan-
5 guages referred to in paragraph (2)(A), information
6 to the public directly on COVID–19.
7 (4) INTERAGENCY COORDINATION.—With re-
8 spect to individuals with limited English proficiency,
9 the Director shall facilitate interagency coordination
10 among agencies activated through the National Re-
11 sponse Framework based on the language access
12 standards established under the language access
13 plans of the Federal Emergency Management Agen-
14 cy and the Department of Health and Human Serv-
15 ices.
16 (5) AUTHORIZATION OF APPROPRIATIONS.—
17 (A) IN GENERAL.—There is authorized to
18 be appropriated to carry out this subsection
19 $100,000,000 for fiscal year 2020, to be avail-
20 able until expended.
21 (B) GRANTS AND COOPERATIVE AGREE-
22 MENTS.—Of the amount authorized to be ap-
23 propriated under subparagraph (A), not less
24 than $50,000,000 shall be made available to
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1 (e) ACCESS TO SUPPORT MEASURES FOR VULNER-
2 ABLE COMMUNITIES.—
3 (1) DISASTER SUPPLEMENTAL NUTRITION AS-
4 SISTANCE PROGRAM BENEFITS.—The Robert T.
5 Stafford Disaster Relief and Emergency Assistance
6 Act (42 U.S.C. 5121 et seq.) is amended—
7 (A) in section 102(1) (42 U.S.C. 5122(1)),
8 by inserting ‘‘or pandemic’’ after ‘‘catastrophe’’;
9 (B) in section 301 (42 U.S.C. 5141), by
10 inserting ‘‘or an emergency due to a pandemic’’
11 after ‘‘major disaster’’ each place the term ap-
12 pears;
13 (C) in section 412 (42 U.S.C. 5179)—
14 (i) by inserting ‘‘or an emergency due
15 to a pandemic’’ after ‘‘major disaster’’
16 each place the term appears;
17 (ii) in subsection (a), by inserting
18 ‘‘without regard to regular allotments’’ be-
19 fore ‘‘and to make surplus’’; and
20 (iii) by adding at the end the fol-
21 lowing:
22 ‘‘(d) ASSISTANCE DURING A PANDEMIC.—In the case
23 of an emergency due to a pandemic, for purposes of pro-
24 viding benefits under this section, the Secretary of Agri-
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1 person interview, and if an interview occurs, provide an
2 alternative to the in-person interview requirement for all
3 applicants. Assistance shall be provided based on need and
4 not lost provisions.
5 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There
6 are authorized to be appropriated such sums as are nec-
7 essary to carry out this section, only if such sums are des-
8 ignated by Congress as being for an emergency require-
9 ment pursuant to section 251(b)(2)(A)(i) of the Balanced
10 Budget and Emergency Deficit Control Act of 1985 (2
11 U.S.C. 901(b)(2)(A)(i)).’’; and
12 (D) in section 502(a) (42 U.S.C.
13 5192(a))—
14 (i) in paragraph (7), by striking
15 ‘‘and’’ at the end;
16 (ii) in paragraph (8)(B), by striking
17 the period at the end and inserting a semi-
18 colon; and
19 (iii) by adding at the end the fol-
20 lowing:
21 ‘‘(9) provide assistance in accordance with sec-
22 tion 412.’’.
23 (2) ACCESS TO BENEFITS USING INDIVIDUAL
24 NUMBER.—Subsection
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25 (g)(2)(A) of section 6428 of the Internal Revenue
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1 Code of 1986, as added by section 2201 of the
2 Coronavirus Aid, Relief, and Economic Security Act
3 (Public Law 116–136), is amended by inserting be-
4 fore the period at the end ‘‘or a taxpayer identifica-
5 tion number’’.
6 (3) EXTENSION OF IMMIGRATION STATUS AND
7 EMPLOYMENT AUTHORIZATION.—
8 (A) IN GENERAL.—Notwithstanding any
9 other provision of law, including the Immigra-
10 tion and Nationality Act (8 U.S.C. 1101 et
11 seq.), the Secretary of Homeland Security shall
12 automatically extend the immigration status
13 and employment authorization, as applicable, of
14 an alien described in subparagraph (B) for the
15 same period for which the status and employ-
16 ment authorization was initially granted.
17 (B) ALIEN DESCRIBED.—An alien de-
18 scribed in this subparagraph is an alien (as de-
19 fined in section 101(a) of the Immigration and
20 Nationality Act (8 U.S.C. 1101(a))) whose im-
21 migration status, including permanent, tem-
22 porary, and deferred status, or whose employ-
23 ment authorization—
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1 (i) expired during the 30-day period
2 preceding the date of the enactment of this
3 Act; or
4 (ii) will expire not later than—
5 (I) one year after such date of
6 enactment; or
7 (II) 90 days after the date on
8 which the national emergency declared
9 by the President under the National
10 Emergencies Act (50 U.S.C. 1601 et
11 seq.) with respect to the Coronavirus
12 Disease 2019 (COVID–19) is re-
13 scinded.
14 (4) LANGUAGE ACCESS.—Any agency receiving
15 funding under a coronavirus response law shall en-
16 sure that all programs and opportunities made avail-
17 able to the general public provide translated mate-
18 rials describing the programs and opportunities into
19 the languages described in the language access plan
20 of the Federal Emergency Management Agency
21 dated October 1, 2016, as the languages most fre-
22 quently encountered.
23 SEC. 213. ICE DETENTION.
24 (a) REVIEWING ICE DETENTION.—During the public
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1 Human Services under section 319 of the Public Health
2 Service Act (42 U.S.C. 247d) with respect to COVID–19,
3 the Secretary of Homeland Security shall review the immi-
4 gration files of all individuals in the custody of U.S. Immi-
5 gration and Customs Enforcement to assess the need for
6 continued detention. The Secretary of Homeland Security
7 shall prioritize for release on recognizance or alternatives
8 to detention individuals who are not subject to mandatory
9 detention laws, unless the individual is a threat to public
10 safety or national security.
11 (b) ACCESS TO ELECTRONIC COMMUNICATIONS AND
12 HYGIENE PRODUCTS.—During the period described in
13 subsection (c), the Secretary of Homeland Security shall
14 ensure that—
15 (1) all individuals in the custody of U.S. Immi-
16 gration and Customs Enforcement—
17 (A) have access to telephonic or video com-
18 munication at no cost to the detained indi-
19 vidual;
20 (B) have access to free, unmonitored tele-
21 phone calls, at any time, to contact attorneys or
22 legal service providers in a sufficiently private
23 space to protect confidentiality;
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1 (C) are permitted to receive legal cor-
2 respondence by fax or email rather than postal
3 mail; and
4 (D) are provided sufficient soap, hand san-
5 itizer, and other hygiene products; and
6 (2) nonprofit organizations providing legal ori-
7 entation programming or know-your-rights program-
8 ming to individuals in the custody of U.S. Immigra-
9 tion and Customs Enforcement are permitted broad
10 and flexible access to such individuals—
11 (A) to provide group presentations using
12 remote videoconferencing; and
13 (B) to schedule and provide individual ori-
14 entations using free telephone calls or remote
15 videoconferencing.
16 (c) PERIOD DESCRIBED.—The period described in
17 this subsection—
18 (1) begins on the first day of the public health
19 emergency declared by the Secretary of Health and
20 Human Services under section 319 of the Public
21 Health Service Act (42 U.S.C. 247d) with respect to
22 COVID–19; and
23 (2) ends 90 days after the date on which such
24 public health emergency terminates.
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1 Subtitle C—Contact Tracing
2 SEC. 221. COVID–19 TESTING, REACHING, AND CONTACTING
3 EVERYONE.
4 (a) IN GENERAL.—The Secretary of Health and
5 Human Services, acting through the Director of the Cen-
6 ters for Disease Control and Prevention, may award
7 grants to eligible entities to conduct diagnostic testing for
8 COVID–19, to trace and monitor the contacts of infected
9 individuals, and to support the quarantine of such con-
10 tacts, through—
11 (1) mobile health units; and
12 (2) as necessary, testing individuals and pro-
13 viding individuals with services related to testing and
14 quarantine at their residences.
15 (b) PERMISSIBLE USES OF FUNDS.—A grant recipi-
16 ent under this section may use the grant funds, in support
17 of the activities described in subsection (a)—
18 (1) to hire, train, compensate, and pay the ex-
19 penses of individuals; and
20 (2) to purchase personal protective equipment
21 and other supplies.
22 (c) PRIORITY.—In selecting grant recipients under
23 this section, the Secretary shall give priority to—
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1 (1) applicants proposing to conduct activities
2 funded under this section in hot spots and medically
3 underserved communities; and
4 (2) applicants that agree, in hiring individuals
5 to carry out activities funded under this section, to
6 hire residents of the area or community where the
7 activities will primarily occur, with higher priority
8 among applicants described in this paragraph given
9 based on the percentage of individuals to be hired
10 from such area or community.
11 (d) DISTRIBUTION.—In selecting grant recipients
12 under this section, the Secretary shall ensure that grants
13 are distributed across urban and rural areas.
14 (e) FEDERAL PRIVACY REQUIREMENTS.—Nothing in
15 this section shall be construed to supersede any Federal
16 privacy or confidentiality requirement, including the regu-
17 lations promulgated under section 264(c) of the Health
18 Insurance Portability and Accountability Act of 1996
19 (Public Law 104–191; 110 Stat. 2033) and section 543
20 of the Public Health Service Act (42 U.S.C. 290dd–2).
21 (f) DEFINITIONS.—In this section:
22 (1) The term ‘‘eligible entity’’ means—
23 (A) a Federally qualified health center (as
24 defined in section 1861(aa) of the Social Secu-
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25 rity Act (42 U.S.C. 1395x(aa)));
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1 (B) a school-based health clinic;
2 (C) a disproportionate share hospital (as
3 defined under the applicable State plan under
4 title XIX of the Social Security Act (42 U.S.C.
5 1396 et seq.) pursuant to section 1923(a)(1)(A)
6 of such Act (42 U.S.C. 1396r–4));
7 (D) an academic medical center;
8 (E) a nonprofit organization (including any
9 such faith-based organization);
10 (F) an institution of higher education (as
11 defined in section 101 of the Higher Education
12 Act of 1965 (20 U.S.C. 1001));
13 (G) a high school (as defined in section
14 8101 of the Elementary and Secondary Edu-
15 cation Act of 1965 (20 U.S.C. 7801));
16 (H) any Tribal organization including the
17 Indian Health Service and Native American
18 servicing facilities; or
19 (I) any other type of entity that is deter-
20 mined by the Secretary to be an eligible entity
21 for purposes of this section.
22 (2) The term ‘‘emergency period’’ has the
23 meaning given to that term in section 1135(g)(1)(B)
24 of the Social Security Act (42 U.S.C. 1320b–
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25 5(g)(1)(B)).
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1 (3) The term ‘‘hot spot’’ means a geographic
2 area where the rate of infection with the virus that
3 causes COVID–19 exceeds the national average.
4 (4) The term ‘‘medically underserved commu-
5 nity’’ has the meaning given to that term in section
6 799B of the Public Health Service Act (42 U.S.C.
7 295p).
8 (5) The term ‘‘Secretary’’ means the Secretary
9 of Health and Human Services.
10 (g) AUTHORIZATION OF APPROPRIATIONS.—To carry
11 out this section, there are authorized to be appropriated—
12 (1) $100,000,000,000 for fiscal year 2020; and
13 (2) such sums as may be necessary for each of
14 fiscal year 2021 and any subsequent fiscal year dur-
15 ing which the emergency period continues.
16 SEC. 222. NATIONAL SYSTEM FOR COVID–19 TESTING, CON-
17 TACT TRACING, SURVEILLANCE, CONTAIN-
18 MENT, AND MITIGATION.
19 (a) IN GENERAL.—The Secretary of Health and
20 Human Services (referred to in this section as the ‘‘Sec-
21 retary’’), acting through the Director of the Centers for
22 Disease Control and Prevention, and in coordination with
23 State, local, Tribal, and territorial health departments,
24 shall establish and implement a nationwide evidence-based
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25 system for—
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1 (1) testing, contact tracing, surveillance, con-
2 tainment, and mitigation with respect to COVID–19;
3 (2) offering guidance on voluntary isolation and
4 quarantine of individuals infected with, or exposed to
5 individuals infected with, the virus that causes
6 COVID–19; and
7 (3) public reporting on testing, contact tracing,
8 surveillance, and voluntary isolation and quarantine
9 activities with respect to COVID–19.
10 (b) COORDINATION; TECHNICAL ASSISTANCE.—In
11 carrying out the national system under this section, the
12 Secretary shall—
13 (1) coordinate State, local, Tribal, and terri-
14 torial activities related to testing, contact tracing,
15 surveillance, containment, and mitigation with re-
16 spect to COVID–19, as appropriate; and
17 (2) provide technical assistance for such activi-
18 ties, as appropriate.
19 (c) CONSIDERATION.—In establishing and imple-
20 menting the national system under this section, the Sec-
21 retary shall take into consideration—
22 (1) the State plans referred to in the heading
23 ‘‘Public Health and Social Services Emergency
24 Fund’’ in title I of division B of the Paycheck Pro-
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1 tection Program and Health Care Enhancement Act
2 (Public Law 116–139); and
3 (2) the testing strategy submitted under section
4 211.
5 (d) REPORTING.—The Secretary shall—
6 (1) not later than December 31, 2020, submit
7 to the Committee on Energy and Commerce of the
8 House of Representatives and the Committee on
9 Health, Education, Labor, and Pensions a prelimi-
10 nary report on the effectiveness of the activities car-
11 ried out pursuant to this subtitle; and
12 (2) not later than December 21, 2021, submit
13 to such committees a final report on such effective-
14 ness.
15 SEC. 223. GRANTS.
16 (a) IN GENERAL.—To implement the national system
17 under section 222, the Secretary of Health and Human
18 Services (referred to in this section as the ‘‘Secretary’’),
19 acting through the Director of the Centers for Disease
20 Control and Prevention, shall, subject to the availability
21 of appropriations, award grants to State, local, Tribal, and
22 territorial health departments that seek grants under this
23 section to carry out coordinated testing, contact tracing,
24 surveillance, containment, and mitigation with respect to
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25 COVID–19, including—
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1 (1) diagnostic and surveillance testing and re-
2 porting;
3 (2) community-based contact tracing efforts;
4 and
5 (3) policies related to voluntary isolation and
6 quarantine of individuals infected with, or exposed to
7 individuals infected with, the virus that causes
8 COVID–19.
9 (b) FLEXIBILITY.—The Secretary shall ensure that—
10 (1) the grants under subsection (a) provide
11 flexibility for State, local, Tribal, and territorial
12 health departments to modify, establish, or maintain
13 evidence-based systems; and
14 (2) local health departments receive funding
15 from State health departments or directly from the
16 Centers for Disease Control and Prevention to con-
17 tribute to such systems, as appropriate.
18 (c) ALLOCATIONS.—
19 (1) FORMULA.—The Secretary, acting through
20 the Director of the Centers for Disease Control and
21 Prevention, shall allocate amounts made available
22 pursuant to subsection (a) in accordance with a for-
23 mula to be established by the Secretary that pro-
24 vides a minimum level of funding to each State,
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25 local, Tribal, and territorial health department that
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1 seeks a grant under this section and allocates addi-
2 tional funding based on the following prioritization:
3 (A) The Secretary shall give highest pri-
4 ority to applicants proposing to serve popu-
5 lations in one or more geographic regions with
6 a high burden of COVID–19 based on data pro-
7 vided by the Centers for Disease Control and
8 Prevention, or other sources as determined by
9 the Secretary.
10 (B) The Secretary shall give second high-
11 est priority to applicants preparing for, or cur-
12 rently working to mitigate, a COVID–19 surge
13 in a geographic region that does not yet have
14 a high number of reported cases of COVID–19
15 based on data provided by the Centers for Dis-
16 ease Control and Prevention, or other sources
17 as determined by the Secretary.
18 (C) The Secretary shall give third highest
19 priority to applicants proposing to serve high
20 numbers of low-income and uninsured popu-
21 lations, including medically underserved popu-
22 lations (as defined in section 330(b)(3) of the
23 Public Health Service Act (42 U.S.C.
24 254b(b)(3))), health professional shortage areas
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1 Health Service Act (42 U.S.C. 254e(a))), racial
2 and ethnic minorities, or geographically diverse
3 areas, as determined by the Secretary.
4 (2) NOTIFICATION.—Not later than the date
5 that is one week before first awarding grants under
6 this section, the Secretary shall submit to the Com-
7 mittee on Energy and Commerce of the House of
8 Representatives and the Committee on Health, Edu-
9 cation, Labor, and Pensions of the Senate a notifica-
10 tion detailing the formula established under para-
11 graph (1) for allocating amounts made available pur-
12 suant to subsection (a).
13 (d) USE OF FUNDS.—A State, local, Tribal, and ter-
14 ritorial health department receiving a grant under this
15 section shall, to the extent possible, use the grant funds
16 for the following activities, or other activities deemed ap-
17 propriate by the Director of the Centers for Disease Con-
18 trol and Prevention:
19 (1) TESTING.—To implement a coordinated
20 testing system that—
21 (A) leverages or modernizes existing test-
22 ing infrastructure and capacity;
23 (B) is consistent with the updated testing
24 strategy required under section 211;
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1 (C) is coordinated with the State plan for
2 COVID–19 testing prepared as required under
3 the heading ‘‘Department of Health and
4 Human Services—Office of the Secretary—
5 Public Health and Social Service Emergency
6 Fund’’ in title I of division B of the Paycheck
7 Protection Program and Health Care Enhance-
8 ment Act (Public Law 116–139; 134 Stat. 620,
9 624);
10 (D) is informed by contact tracing and
11 surveillance activities under this subtitle;
12 (E) is informed by guidelines established
13 by the Centers for Disease Control and Preven-
14 tion for which populations should be tested;
15 (F) identifies how diagnostic and sero-
16 logical tests in such system shall be validated
17 prior to use;
18 (G) identifies how diagnostic and sero-
19 logical tests and testing supplies will be distrib-
20 uted to implement such system;
21 (H) identifies specific strategies for ensur-
22 ing testing capabilities and accessibility in
23 medically underserved populations (as defined
24 in section 330(b)(3) of the Public Health Serv-
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1 sional shortage areas (as defined under section
2 332(a) of the Public Health Service Act (42
3 U.S.C. 254e(a))), racial and ethnic minority
4 populations, and geographically diverse areas,
5 as determined by the Secretary;
6 (I) identifies how testing may be used, and
7 results may be reported, in both health care set-
8 tings (such as hospitals, laboratories for mod-
9 erate or high-complexity testing, pharmacies,
10 mobile testing units, and community health cen-
11 ters) and non-health care settings (such as
12 workplaces, schools, childcare centers, or drive-
13 throughs);
14 (J) allows for testing in sentinel surveil-
15 lance programs, as appropriate; and
16 (K) supports the procurement and dis-
17 tribution of diagnostic and serological tests and
18 testing supplies to meet the goals of the system.
19 (2) CONTACT TRACING.—To implement a co-
20 ordinated contact tracing system that—
21 (A) leverages or modernizes existing con-
22 tact tracing systems and capabilities, including
23 community health workers, health departments,
24 and Federally qualified health centers;
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1 (B) is able to investigate cases of COVID–
2 19, and help to identify other potential cases of
3 COVID–19, through tracing contacts of individ-
4 uals with positive diagnoses;
5 (C) establishes culturally competent and
6 multilingual strategies for contact tracing,
7 which may include consultation with and sup-
8 port for cultural or civic organizations with es-
9 tablished ties to the community;
10 (D) provides individuals identified under
11 the contact tracing program with information
12 and support for containment or mitigation;
13 (E) enables State, local, Tribal, and terri-
14 torial health departments to work with a non-
15 governmental, community partner or partners
16 and State and local workforce development sys-
17 tems (as defined in section 3(67) of Workforce
18 Innovation and Opportunity Act (29 U.S.C.
19 3102(67))) receiving grants under section
20 224(b) of this Act to hire and compensate a lo-
21 cally sourced contact tracing workforce, if nec-
22 essary, to supplement the public health work-
23 force, to—
24 (i) identify the number of contact
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25 tracers needed for the respective State, lo-
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1 cality, territorial, or Tribal health depart-
2 ment to identify all cases of COVID–19
3 currently in the jurisdiction and those an-
4 ticipated to emerge over the next 18
5 months in such jurisdiction;
6 (ii) outline qualifications necessary for
7 contact tracers;
8 (iii) train the existing and newly hired
9 public health workforce on best practices
10 related to tracing close contacts of individ-
11 uals diagnosed with COVID–19, including
12 the protection of individual privacy and
13 cybersecurity protection; and
14 (iv) equip the public health workforce
15 with tools and resources to enable a rapid
16 response to new cases;
17 (F) identifies the level of contact tracing
18 needed within the State, locality, territory, or
19 Tribal area to contain and mitigate the trans-
20 mission of COVID–19;
21 (G) establishes statewide mechanisms to
22 integrate regular evaluation to the Centers for
23 Disease Control and Prevention regarding con-
24 tact tracing efforts, makes such evaluation pub-
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1 vides for such evaluation at the county level;
2 and
3 (H) identifies specific strategies for ensur-
4 ing contact tracing activities in medically un-
5 derserved populations (as defined in section
6 330(b)(3) of the Public Health Service Act (42
7 U.S.C. 254b(b)(3))), health professional short-
8 age areas (as defined under section 332(a) of
9 the Public Health Service Act (42 U.S.C.
10 254e(a))), racial and ethnic minority popu-
11 lations, and geographically diverse areas, as de-
12 termined by the Secretary.
13 (3) SURVEILLANCE.—To strengthen the exist-
14 ing public health surveillance system that—
15 (A) leverages or modernizes existing sur-
16 veillance systems within the respective State,
17 local, Tribal, or territorial health department
18 and national surveillance systems;
19 (B) detects and identifies trends in
20 COVID–19 at the county level;
21 (C) evaluates State, local, Tribal, and ter-
22 ritorial health departments in achieving surveil-
23 lance capabilities with respect to COVID–19;
24 (D) integrates and improves disease sur-
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1 (E) identifies specific strategies for ensur-
2 ing disease surveillance in medically under-
3 served populations (as defined in section
4 330(b)(3) of the Public Health Service Act (42
5 U.S.C. 254b(b)(3))), health professional short-
6 age areas (as defined under section 332(a) of
7 the Public Health Service Act (42 U.S.C.
8 254e(a))), racial and ethnic minority popu-
9 lations, and geographically diverse areas, as de-
10 termined by the Secretary.
11 (4) CONTAINMENT AND MITIGATION.—To im-
12 plement a coordinated containment and mitigation
13 system that—
14 (A) leverages or modernizes existing con-
15 tainment and mitigation strategies within the
16 respective State, local, Tribal, or territorial gov-
17 ernments and national containment and mitiga-
18 tion strategies;
19 (B) may provide for, connect to, and lever-
20 age existing social services and support for indi-
21 viduals who have been infected with or exposed
22 to COVID–19 and who are isolated or quar-
23 antined in their homes, such as through—
24 (i) food assistance programs;
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1 (ii) guidance for household infection
2 control;
3 (iii) information and assistance with
4 childcare services; and
5 (iv) information and assistance per-
6 taining to support available under the
7 CARES Act (Public Law 116–136) and
8 this Act;
9 (C) provides guidance on the establishment
10 of safe, high-quality, facilities for the voluntary
11 isolation of individuals infected with, or quar-
12 antine of the contacts of individuals exposed to
13 COVID–19, where hospitalization is not re-
14 quired, which facilities should—
15 (i) be prohibited from making inquir-
16 ies relating to the citizenship status of an
17 individual isolated or quarantined; and
18 (ii) be operated by a non-Federal,
19 community partner or partners that—
20 (I) have previously established re-
21 lationships in localities;
22 (II) work with local places of
23 worship, community centers, medical
24 facilities, and schools to recruit local
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1 (III) are fully integrated into
2 State, local, Tribal, or territorial con-
3 tainment and mitigation efforts; and
4 (D) identifies specific strategies for ensur-
5 ing containment and mitigation activities in
6 medically underserved populations (as defined
7 in section 330(b)(3) of the Public Health Serv-
8 ice Act (42 U.S.C. 254b(b)(3))), health profes-
9 sional shortage areas (as defined under section
10 332(a) of the Public Health Service Act (42
11 U.S.C. 254e(a))), racial and ethnic minority
12 populations, and geographically diverse areas,
13 as determined by the Secretary.
14 (e) REPORTING.—The Secretary shall facilitate
15 mechanisms for timely, standardized reporting by grantees
16 under this section regarding implementation of the sys-
17 tems established under this section and coordinated proc-
18 esses with the reporting as required and under the heading
19 ‘‘Department of Health and Human Services—Office of
20 the Secretary—Public Health and Social Service Emer-
21 gency Fund’’ in title I of division B of the Paycheck Pro-
22 tection Program and Health Care Enhancement Act (Pub-
23 lic Law 116–139, 134 Stat. 620), including—
24 (1) a summary of county or local health depart-
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25 ment level information from the States receiving
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1 funding, and information from directly funded local-
2 ities, territories, and Tribal entities, about the activi-
3 ties that will be undertaken using funding awarded
4 under this section, including subgrants;
5 (2) any anticipated shortages of required mate-
6 rials for testing for COVID–19 under subsection (a);
7 and
8 (3) other barriers in the prevention, mitigation,
9 or treatment of COVID–19 under this section.
10 (f) PUBLIC LISTING OF AWARDS.—The Secretary
11 shall—
12 (1) not later than 7 days after first awarding
13 grants under this section, post in a searchable, elec-
14 tronic format a list of all awards made by the Sec-
15 retary under this section, including the recipients
16 and amounts of such awards; and
17 (2) update such list not less than every 7 days
18 until all funds made available to carry out this sec-
19 tion are expended.
20 SEC. 224. GRANTS TO STATE AND TRIBAL WORKFORCE
21 AGENCIES.
22 (a) DEFINITIONS.—In this section:
23 (1) IN GENERAL.—Except as otherwise pro-
24 vided, the terms in this section have the meanings
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1 given the terms in section 3 of the Workforce Inno-
2 vation and Opportunity Act (29 U.S.C. 3102).
3 (2) APPRENTICESHIP; APPRENTICESHIP PRO-
4 GRAM.—The term ‘‘apprenticeship’’ or ‘‘apprentice-
5 ship program’’ means an apprenticeship program
6 registered under the Act of August 16, 1937 (com-
7 monly known as the ‘‘National Apprenticeship Act’’)
8 (50 Stat. 664, chapter 663; 29 U.S.C. 50 et seq.),
9 including any requirement, standard, or rule promul-
10 gated under such Act, as such requirement, stand-
11 ard, or rule was in effect on December 30, 2019.
12 (3) CONTACT TRACING AND RELATED POSI-
13 TIONS.—The term ‘‘contact tracing and related posi-
14 tions’’ means employment related to contact tracing,
15 surveillance, containment, and mitigation activities
16 as described in paragraphs (2), (3), and (4) of sec-
17 tion 223(d).
18 (4) ELIGIBLE ENTITY.—The term ‘‘eligible enti-
19 ty’’ means—
20 (A) a State or territory, including the Dis-
21 trict of Columbia and Puerto Rico;
22 (B) an Indian Tribe, Tribal organization,
23 Alaska Native entity, Indian-controlled organi-
24 zations serving Indians, or Native Hawaiian or-
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1 (C) an outlying area; or
2 (D) a local board, if an eligible entity
3 under subparagraphs (A) through (C) has not
4 applied with respect to the area over which the
5 local board has jurisdiction as of the date on
6 which the local board submits an application
7 under subsection (c).
8 (5) ELIGIBLE INDIVIDUAL.—Notwithstanding
9 section 170(b)(2) of the Workforce Innovation and
10 Opportunity Act (29 U.S.C. 3225(b)(2)), the term
11 ‘‘eligible individual’’ means an individual seeking or
12 securing employment in contact tracing and related
13 positions and served by an eligible entity or commu-
14 nity-based organization receiving funding under this
15 section.
16 (6) SECRETARY.—The term ‘‘Secretary’’ means
17 the Secretary of Labor.
18 (b) GRANTS.—
19 (1) IN GENERAL.—Subject to the availability of
20 appropriations under subsection (g), the Secretary
21 shall award national dislocated worker grants under
22 section 170(b)(1)(B) of the Workforce Innovation
23 and Opportunity Act (29 U.S.C. 3225(b)(1)(B)) to
24 each eligible entity that seeks a grant to assist local
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1 rying out activities under subsections (f) and (d), re-
2 spectively, for the following purposes:
3 (A) To support the recruitment, place-
4 ment, and training, as applicable, of eligible in-
5 dividuals seeking employment in contact tracing
6 and related positions in accordance with the na-
7 tional system for COVID–19 testing, contact
8 tracing, surveillance, containment, and mitiga-
9 tion established under section 222.
10 (B) To assist with the employment transi-
11 tion to new employment or education and train-
12 ing of individuals employed under this section
13 in preparation for and upon termination of such
14 employment.
15 (2) TIMELINE.—The Secretary of Labor shall—
16 (A) issue application requirements under
17 subsection (c) not later than 10 days after the
18 date of enactment of this section; and
19 (B) award grants to an eligible entity
20 under paragraph (1) not later than 10 days
21 after the date on which the Secretary receives
22 an application from such entity.
23 (c) GRANT APPLICATION.—An eligible entity apply-
24 ing for a grant under this section shall submit an applica-
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1 manner as the Secretary may reasonably require, which
2 shall include a description of—
3 (1) how the eligible entity will support the re-
4 cruitment, placement, and training, as applicable, of
5 eligible individuals seeking employment in contact
6 tracing and related positions by partnering with—
7 (A) a State, local, Tribal, or territorial
8 health department; or
9 (B) one or more nonprofit or community-
10 based organizations partnering with such health
11 departments;
12 (2) how the activities described in paragraph
13 (1) will support State efforts to address the demand
14 for contact tracing and related positions with respect
15 to—
16 (A) the State plans referred to in the head-
17 ing ‘‘Public Health and Social Services Emer-
18 gency Fund’’ in title I of division B of the Pay-
19 check Protection Program and Health Care En-
20 hancement Act (Public Law 116–139);
21 (B) the testing strategy submitted under
22 section 211; and
23 (C) the number of eligible individuals that
24 the State plans to recruit and train under the
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1 plans and strategies described in subparagraphs
2 (A) and (B);
3 (3) the specific strategies for recruiting and
4 placement of eligible individuals from or residing
5 within the communities in which they will work, in-
6 cluding—
7 (A) plans for the recruitment of eligible in-
8 dividuals to serve as contact tracers and related
9 positions, including dislocated workers, individ-
10 uals with barriers to employment, veterans, new
11 entrants in the workforce, or underemployed or
12 furloughed workers, who are from or reside in
13 or near the local area in which they will serve,
14 and who, to the extent practicable—
15 (i) have experience or a background in
16 industry-sectors and occupations such as
17 public health, social services, customer
18 service, case management, or occupations
19 that require related qualifications, skills, or
20 competencies, such as strong interpersonal
21 and communication skills, needed for con-
22 tact tracing and related positions, as de-
23 scribed in section 223(d)(2)(E)(ii); or
24 (ii) seek to transition to public health
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1 the conclusion of employment in contact
2 tracing and related positions; and
3 (B) how such strategies will take into ac-
4 count the diversity of such community, includ-
5 ing racial, ethnic, socioeconomic, linguistic, or
6 geographic diversity;
7 (4) the amount, timing, and mechanisms for
8 distribution of funds provided to local boards or
9 through subgrants as described in subsection (d);
10 (5) for eligible entities described in subpara-
11 graphs (A) through (C) of subsection (a)(4), a de-
12 scription of how the eligible entity will ensure the eq-
13 uitable distribution of funds with respect to—
14 (A) geography (such as urban and rural
15 distribution);
16 (B) medically underserved populations (as
17 defined in section 33(b)(3) of the Public Health
18 Service Act (42 U.S.C. 254b(b)));
19 (C) health professional shortage areas (as
20 defined under section 332(a) of the Public
21 Health Service Act (42 U.S.C. 254e(a))); and
22 (D) the racial and ethnic diversity of the
23 area; and
24 (6) for eligible entities who are local boards, a
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1 would serve the equitable distribution of funds as de-
2 scribed in paragraph (5).
3 (d) SUBGRANT AUTHORIZATION AND APPLICATION
4 PROCESS.—
5 (1) IN GENERAL.—An eligible entity may award
6 a subgrant to one or more community-based organi-
7 zations for the purposes of partnering with a State
8 or local board to conduct outreach and education ac-
9 tivities to inform potentially eligible individuals
10 about employment opportunities in contact tracing
11 and related positions.
12 (2) APPLICATION.—A community-based organi-
13 zation shall submit an application at such time and
14 in such manner as the eligible entity may reasonably
15 require, including—
16 (A) a demonstration of the community-
17 based organization’s established expertise and
18 effectiveness in community outreach in the local
19 area that such organization plans to serve;
20 (B) a demonstration of the community-
21 based organization’s expertise in providing em-
22 ployment or public health information to the
23 local areas in which such organization plans to
24 serve; and
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1 (C) a description of the expertise of the
2 community-based organization in utilizing cul-
3 turally competent and multilingual strategies in
4 the provision of services.
5 (e) GRANT DISTRIBUTION.—
6 (1) FEDERAL DISTRIBUTION.—
7 (A) USE OF FUNDS.— The Secretary of
8 Labor shall use the funds appropriated to carry
9 out this section as follows:
10 (i) Subject to clause (ii), the Secretary
11 shall distribute funds among eligible enti-
12 ties in accordance with a formula to be es-
13 tablished by the Secretary that provides a
14 minimum level of funding to each eligible
15 entity that seeks a grant under this section
16 and allocates additional funding as follows:
17 (I) The formula shall give first
18 priority based on the number and pro-
19 portion of contact tracing and related
20 positions that the State plans to re-
21 cruit, place, and train individuals as a
22 part of the State strategy described in
23 subsection (c)(2)(A).
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1 (II) Subject to subclause (I), the
2 formula shall give priority in accord-
3 ance with section 223(c).
4 (ii) Not more than 2 percent of the
5 funding for administration of the grants
6 and for providing technical assistance to
7 recipients of funds under this section.
8 (B) EQUITABLE DISTRIBUTION.—If the ge-
9 ographic region served by one or more eligible
10 entities overlaps, the Secretary shall distribute
11 funds among such entities in such a manner
12 that ensures equitable distribution with respect
13 to the factors under subsection (c)(5).
14 (2) ELIGIBLE ENTITY USE OF FUNDS.—An eli-
15 gible entity described in subparagraphs (A) through
16 (C) of subsection (a)(4)—
17 (A) shall, not later than 30 days after the
18 date on which the entity receives grant funds
19 under this section, provide not less than 70 per-
20 cent of grant funds to local boards for the pur-
21 pose of carrying out activities in subsection (f);
22 (B) may use up to 20 percent of such
23 funds to make subgrants to community-based
24 organizations in the service area to conduct out-
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1 reach, to potential eligible individuals, as de-
2 scribed in subsection (d);
3 (C) in providing funds to local boards and
4 awarding subgrants under this subsection shall
5 ensure the equitable distribution with respect to
6 the factors described in subsection (c)(5); and
7 (D) may use not more than 10 percent of
8 the funds awarded under this section for the
9 administrative costs of carrying out the grant
10 and for providing technical assistance to local
11 boards and community-based organizations.
12 (3) LOCAL BOARD USE OF FUNDS.—A local
13 board, or an eligible entity that is a local board,
14 shall use—
15 (A) not less than 60 percent of the funds
16 for recruitment and training for COVID–19
17 testing, contact tracing, surveillance, contain-
18 ment, and mitigation established under section
19 222;
20 (B) not less than 30 percent of the funds
21 to support the transition of individuals hired as
22 contact tracers and related positions into an
23 education or training program, or unsubsidized
24 employment upon completion of such positions;
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1 (C) not more than 10 percent of the funds
2 for administrative costs.
3 (f) ELIGIBLE ACTIVITIES.—The State or local boards
4 shall use funds awarded under this section to support the
5 recruitment and placement of eligible individuals, training
6 and employment transition as related to contact tracing
7 and related positions, and for the following activities:
8 (1) Establishing or expanding partnerships
9 with—
10 (A) State, local, Tribal, and territorial
11 public health departments;
12 (B) community-based health providers, in-
13 cluding community health centers and rural
14 health clinics;
15 (C) labor organizations or joint labor man-
16 agement organizations;
17 (D) two-year and four-year institutions of
18 higher education (as defined in section 101 of
19 the Higher Education Act of 1965 (20 U.S.C.
20 1001)), including institutions eligible to receive
21 funds under section 371(a) of the Higher Edu-
22 cation Act of 1965 (20 U.S.C. 1067q(a)); and
23 (E) community action agencies or other
24 community-based organizations serving local
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1 areas in which there is a demand for contact
2 tracing and related positions.
3 (2) Providing training for contact tracing and
4 related positions in coordination with State, local,
5 Tribal, or territorial health departments that is con-
6 sistent with the State or territorial testing and con-
7 tact tracing strategy, and ensuring that eligible indi-
8 viduals receive compensation while participating in
9 such training.
10 (3) Providing eligible individuals with—
11 (A) adequate and safe equipment, environ-
12 ments, and facilities for training and super-
13 vision, as applicable;
14 (B) information regarding the wages and
15 benefits related to contact tracing and related
16 positions, as compared to State, local, and na-
17 tional averages;
18 (C) supplies and equipment needed by the
19 eligible individuals to support placement of an
20 individual in contact tracing and related posi-
21 tions, as applicable;
22 (D) an individualized employment plan for
23 each eligible individual, as applicable—
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1 (i) in coordination with the entity em-
2 ploying the eligible individual in a contact
3 tracing and related positions; and
4 (ii) which shall include providing a
5 case manager to work with each eligible in-
6 dividual to develop the plan, which may in-
7 clude—
8 (I) identifying employment and
9 career goals, and setting appropriate
10 achievement objectives to attain such
11 goals; and
12 (II) exploring career pathways
13 that lead to in-demand industries and
14 sectors, including in public health and
15 related occupations; and
16 (E) services for the period during which
17 the eligible individual is employed in a contact
18 tracing and related position to ensure job reten-
19 tion, which may include—
20 (i) supportive services throughout the
21 term of employment;
22 (ii) a continuation of skills training as
23 related to employment in contact tracing
24 and related positions, that is conducted in
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1 collaboration with the employers of such
2 individuals;
3 (iii) mentorship services and job re-
4 tention support for eligible individuals; or
5 (iv) targeted training for managers
6 and workers working with eligible individ-
7 uals (such as mentors), and human re-
8 source representatives.
9 (4) Supporting the transition and placement in
10 unsubsidized employment for eligible individuals
11 serving in contact tracing and related positions after
12 such positions are no longer necessary in the State
13 or local area, including—
14 (A) any additional training and employ-
15 ment activities as described in section 170(d)(4)
16 of the Workforce Innovation and Opportunity
17 Act (29 U.S.C. 3225(d)(4));
18 (B) developing the appropriate combina-
19 tion of services to enable the eligible individual
20 to achieve the employment and career goals
21 identified under paragraph (3)(D)(ii)(I); and
22 (C) services to assist eligible individuals in
23 maintaining employment for not less than 12
24 months after the completion of employment in
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1 contact tracing and related positions, as appro-
2 priate.
3 (5) Any other activities as described in sub-
4 sections (a)(3) and (b) of section 134 of the Work-
5 force Innovation and Opportunity Act (29 U.S.C.
6 3174).
7 (g) LIMITATION.—Notwithstanding section
8 170(d)(3)(A) of the Workforce Innovation and Oppor-
9 tunity Act (29 U.S.C. 3225(d)(3)(A)), a person may be
10 employed in a contact tracing and related positions using
11 funds under this section for a period not greater than 2
12 years.
13 (h) REPORTING BY THE DEPARTMENT OF LABOR.—
14 (1) IN GENERAL.—Not later than 120 days of
15 the enactment of this Act, and once grant funds
16 have been expended under this section, the Secretary
17 shall report to the Committee on Education and
18 Labor of the House of Representatives and the Com-
19 mittee on Health, Education, Labor, and Pensions
20 of the Senate, and make publicly available a report
21 containing a description of—
22 (A) the number of eligible individuals re-
23 cruited, hired, and trained in contact tracing
24 and related positions;
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1 (B) the number of individuals successfully
2 transitioned to unsubsidized employment or
3 training at the completion of employment in
4 contact tracing and related positions using
5 funds under this subtitle;
6 (C) the number of such individuals who
7 were unemployed prior to being hired, trained,
8 or deployed as described in paragraph (1);
9 (D) the performance of each program sup-
10 ported by funds under this subtitle with respect
11 to the indicators of performance under section
12 116 of the Workforce Innovation and Oppor-
13 tunity Act (29 U.S.C. 3141), as applicable;
14 (E) the number of individuals in unsub-
15 sidized employment within six months and 1
16 year, respectively, of the conclusion of employ-
17 ment in contact tracing and related positions
18 and, of those, the number of individuals within
19 a State, territorial, or local public health de-
20 partment in an occupation related to public
21 health;
22 (F) any information on how eligible enti-
23 ties, local boards, or community-based organiza-
24 tions that received funding under this sub-
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1 tional system for COVID–19 testing, contact
2 tracing, surveillance, containment, and mitiga-
3 tion established under section 222 of this Act;
4 and
5 (G) best practices for improving and in-
6 creasing the transition of individuals employed
7 in contract tracing and related positions to un-
8 subsidized employment.
9 (2) DISAGGREGATION.—All data reported under
10 paragraph (1) shall be disaggregated by race, eth-
11 nicity, sex, age, and, with respect to individuals with
12 barriers to employment, subpopulation of such indi-
13 viduals, except for when the number of participants
14 in a category is insufficient to yield statistically reli-
15 able information or when the results would reveal
16 personally identifiable information about an indi-
17 vidual participant.
18 (i) SPECIAL RULE.—Any funds used for programs
19 under this section that are used to fund an apprenticeship
20 or apprenticeship program shall only be used for, or pro-
21 vided to, an apprenticeship or apprenticeship program
22 that meets the definition of such term subsection (a) of
23 this section, including any funds awarded for the purposes
24 of grants, contracts, or cooperative agreements, or the de-
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1 velopment, implementation, or administration, of an ap-
2 prenticeship or an apprenticeship program.
3 (j) INFORMATION SHARING REQUIREMENT FOR
4 HHS.—The Secretary of Health and Human Services,
5 acting through the Director of the Centers for Disease
6 Control and Prevention, shall provide the Secretary of
7 Labor, acting through the Assistant Secretary of the Em-
8 ployment and Training Administration, with information
9 on grants under section 223, including—
10 (1) the formula used to award such grants to
11 State, local, Tribal, and territorial health depart-
12 ments;
13 (2) the dollar amounts of and scope of the work
14 funded under such grants;
15 (3) the geographic areas served by eligible enti-
16 ties that receive such grants; and
17 (4) the number of contact tracers and related
18 positions to be hired using such grants.
19 (k) AUTHORIZATION OF APPROPRIATIONS.—Of the
20 amounts appropriated to carry out this subtitle,
21 $500,000,000 shall be used by the Secretary of Labor to
22 carry out subsections (a) through (h) of this section.
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1 TITLE III—FREE TREATMENT
2 FOR ALL AMERICANS
3 SEC. 301. COVERAGE AT NO COST SHARING OF COVID–19
4 VACCINE AND TREATMENT.
5 (a) MEDICAID.—
6 (1) IN GENERAL.—Section 1905(a)(4) of the
7 Social Security Act (42 U.S.C. 1396d(a)(4)) is
8 amended—
9 (A) by striking ‘‘and (D)’’ and inserting
10 ‘‘(D)’’; and
11 (B) by striking the semicolon at the end
12 and inserting ‘‘; (E) during the portion of the
13 emergency period described in paragraph (1)(B)
14 of section 1135(g) beginning on the date of the
15 enactment of The Heroes Act, a COVID–19
16 vaccine licensed under section 351 of the Public
17 Health Service Act, or approved or authorized
18 under sections 505 or 564 of the Federal Food,
19 Drug, and Cosmetic Act, and administration of
20 the vaccine; and (F) during such portion of the
21 emergency period described in paragraph (1)(B)
22 of section 1135(g), items or services for the
23 prevention or treatment of COVID–19, includ-
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24 ing drugs approved or authorized under such
25 section 505 or such section 564 or, without re-
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1 gard to the requirements of section
2 1902(a)(10)(B) (relating to comparability), in
3 the case of an individual who is diagnosed with
4 or presumed to have COVID–19, during such
5 portion of such emergency period during which
6 such individual is infected (or presumed in-
7 fected) with COVID–19, the treatment of a
8 condition that may complicate the treatment of
9 COVID–19;’’.
10 (2) PROHIBITION OF COST SHARING.—
11 (A) IN GENERAL.—Subsections (a)(2) and
12 (b)(2) of section 1916 of the Social Security
13 Act (42 U.S.C. 1396o) are each amended—
14 (i) in subparagraph (F), by striking
15 ‘‘or’’ at the end;
16 (ii) in subparagraph (G), by striking
17 ‘‘; and’’ and inserting ‘‘;’’; and
18 (iii) by adding at the end the fol-
19 lowing subparagraphs:
20 ‘‘(H) during the portion of the emergency
21 period described in paragraph (1)(B) of section
22 1135(g) beginning on the date of the enactment
23 of this subparagraph, a COVID–19 vaccine li-
24 censed under section 351 of the Public Health
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25 Service Act, or approved or authorized under
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1 section 505 or 564 of the Federal Food, Drug,
2 and Cosmetic Act, and the administration of
3 such vaccine; or
4 ‘‘(I) during such portion of the emergency
5 period described in paragraph (1)(B) of section
6 1135(g), any item or service furnished for the
7 treatment of COVID–19, including drugs ap-
8 proved or authorized under such section 505 or
9 such section 564 or, in the case of an individual
10 who is diagnosed with or presumed to have
11 COVID–19, during the portion of such emer-
12 gency period during which such individual is in-
13 fected (or presumed infected) with COVID–19,
14 the treatment of a condition that may com-
15 plicate the treatment of COVID–19; and’’.
16 (B) APPLICATION TO ALTERNATIVE COST
17 SHARING.—Section 1916A(b)(3)(B) of the So-
18 cial Security Act (42 U.S.C. 1396o–1(b)(3)(B))
19 is amended—
20 (i) in clause (xi), by striking ‘‘any
21 visit’’ and inserting ‘‘any service’’; and
22 (ii) by adding at the end the following
23 clauses:
24 ‘‘(xii) During the portion of the emer-
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1 of section 1135(g) beginning on the date of
2 the enactment of this clause, a COVID–19
3 vaccine licensed under section 351 of the
4 Public Health Service Act, or approved or
5 authorized under section 505 or 564 of the
6 Federal Food, Drug, and Cosmetic Act,
7 and the administration of such vaccine.
8 ‘‘(xiii) During such portion of the
9 emergency period described in paragraph
10 (1)(B) of section 1135(g), an item or serv-
11 ice furnished for the treatment of COVID–
12 19, including drugs approved or authorized
13 under such section 505 or such section 564
14 or, in the case of an individual who is diag-
15 nosed with or presumed to have COVID–
16 19, during such portion of such emergency
17 period during which such individual is in-
18 fected (or presumed infected) with
19 COVID–19, the treatment of a condition
20 that may complicate the treatment of
21 COVID–19.’’.
22 (C) CLARIFICATION.—The amendments
23 made by this subsection shall apply with respect
24 to a State plan of a territory in the same man-
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1 (b) STATE PEDIATRIC VACCINE DISTRIBUTION PRO-
2 GRAM.—Section 1928 of the Social Security Act (42
3 U.S.C. 1396s) is amended—
4 (1) in subsection (a)(1)—
5 (A) in subparagraph (A), by striking ‘‘;
6 and’’ and inserting a semicolon;
7 (B) in subparagraph (B), by striking the
8 period and inserting ‘‘; and’’; and
9 (C) by adding at the end the following sub-
10 paragraph:
11 ‘‘(C) during the portion of the emergency
12 period described in paragraph (1)(B) of section
13 1135(g) beginning on the date of the enactment
14 of this subparagraph, each vaccine-eligible child
15 (as defined in subsection (b)) is entitled to re-
16 ceive a COVID–19 vaccine from a program-reg-
17 istered provider (as defined in subsection
18 (h)(7)) without charge for—
19 ‘‘(i) the cost of such vaccine; or
20 ‘‘(ii) the administration of such vac-
21 cine.’’;
22 (2) in subsection (c)(2)—
23 (A) in subparagraph (C)(ii), by inserting ‘‘,
24 but, during the portion of the emergency period
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1 1135(g) beginning on the date of the enactment
2 of The Heroes Act, may not impose a fee for
3 the administration of a COVID–19 vaccine’’ be-
4 fore the period; and
5 (B) by adding at the end the following sub-
6 paragraph:
7 ‘‘(D) The provider will provide and admin-
8 ister an approved COVID–19 vaccine to a vac-
9 cine-eligible child in accordance with the same
10 requirements as apply under the preceding sub-
11 paragraphs to the provision and administration
12 of a qualified pediatric vaccine to such a
13 child.’’; and
14 (3) in subsection (d)(1), in the first sentence,
15 by inserting ‘‘, including, during the portion of the
16 emergency period described in paragraph (1)(B) of
17 section 1135(g) beginning on the date of the enact-
18 ment of The Heroes Act, with respect to a COVID–
19 19 vaccine licensed under section 351 of the Public
20 Health Service Act, or approved or authorized under
21 section 505 or 564 of the Federal Food, Drug, and
22 Cosmetic Act’’ before the period.
23 (c) CHIP.—
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1 (1) IN GENERAL.—Section 2103(c) of the So-
2 cial Security Act (42 U.S.C. 1397cc(c)) is amended
3 by adding at the end the following paragraph:
4 ‘‘(11) COVERAGE OF COVID–19 VACCINES AND
5 TREATMENT.—Regardless of the type of coverage
6 elected by a State under subsection (a), child health
7 assistance provided under such coverage for targeted
8 low-income children and, in the case that the State
9 elects to provide pregnancy-related assistance under
10 such coverage pursuant to section 2112, such preg-
11 nancy-related assistance for targeted low-income
12 pregnant women (as defined in section 2112(d))
13 shall include coverage, during the portion of the
14 emergency period described in paragraph (1)(B) of
15 section 1135(g) beginning on the date of the enact-
16 ment of this paragraph, of—
17 ‘‘(A) a COVID–19 vaccine licensed under
18 section 351 of the Public Health Service Act, or
19 approved or authorized under section 505 or
20 564 of the Federal Food, Drug, and Cosmetic
21 Act, and the administration of such vaccine;
22 and
23 ‘‘(B) any item or service furnished for the
24 treatment of COVID–19, including drugs ap-
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1 such section 564, or, in the case of an indi-
2 vidual who is diagnosed with or presumed to
3 have COVID–19, during the portion of such
4 emergency period during which such individual
5 is infected (or presumed infected) with COVID–
6 19, the treatment of a condition that may com-
7 plicate the treatment of COVID–19.’’.
8 (2) PROHIBITION OF COST SHARING.—Section
9 2103(e)(2) of the Social Security Act (42 U.S.C.
10 1397cc(e)(2)), as amended by section 6004(b)(3) of
11 the Families First Coronavirus Response Act, is
12 amended—
13 (A) in the paragraph header, by inserting
14 ‘‘A COVID–19 VACCINE, COVID–19 TREATMENT,’’
15 before ‘‘OR PREGNANCY-RELATED ASSISTANCE’’;
16 and
17 (B) by striking ‘‘visits described in section
18 1916(a)(2)(G), or’’ and inserting ‘‘services de-
19 scribed in section 1916(a)(2)(G), vaccines de-
20 scribed in section 1916(a)(2)(H) administered
21 during the portion of the emergency period de-
22 scribed in paragraph (1)(B) of section 1135(g)
23 beginning on the date of the enactment of The
24 Heroes Act, items or services described in sec-
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1 tion 1916(a)(2)(I) furnished during such emer-
2 gency period, or’’.
3 (d) CONFORMING AMENDMENTS.—Section 1937 of
4 the Social Security Act (42 U.S.C. 1396u–7) is amend-
5 ed—
6 (1) in subsection (a)(1)(B), by inserting ‘‘,
7 under subclause (XXIII) of section
8 1902(a)(10)(A)(ii),’’ after ‘‘section
9 1902(a)(10)(A)(i)’’; and
10 (2) in subsection (b)(5), by adding before the
11 period the following: ‘‘, and, effective on the date of
12 the enactment of The Heroes Act, must comply with
13 subparagraphs (F) through (I) of subsections (a)(2)
14 and (b)(2) of section 1916 and subsection (b)(3)(B)
15 of section 1916A’’.
16 (e) EFFECTIVE DATE.—The amendments made by
17 this section shall take effect on the date of enactment of
18 this Act and shall apply with respect to a COVID–19 vac-
19 cine beginning on the date that such vaccine is licensed
20 under section 351 of the Public Health Service Act (42
21 U.S.C. 262), or approved or authorized under section 505
22 or 564 of the Federal Food, Drug, and Cosmetic Act.
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1 SEC. 302. OPTIONAL COVERAGE AT NO COST SHARING OF
2 COVID–19 TREATMENT AND VACCINES UNDER
3 MEDICAID FOR UNINSURED INDIVIDUALS.
4 (a) IN GENERAL.—Section 1902(a)(10) of the Social
5 Security Act (42 U.S.C. 1396a(a)(10)) is amended, in the
6 matter following subparagraph (G), by striking ‘‘and any
7 visit described in section 1916(a)(2)(G)’’ and inserting the
8 following: ‘‘, any COVID–19 vaccine that is administered
9 during any such portion (and the administration of such
10 vaccine), any item or service that is furnished during any
11 such portion for the treatment of COVID–19, including
12 drugs approved or authorized under section 505 or 564
13 of the Federal Food, Drug, and Cosmetic Act, or, in the
14 case of an individual who is diagnosed with or presumed
15 to have COVID–19, during the period such individual is
16 infected (or presumed infected) with COVID–19, the
17 treatment of a condition that may complicate the treat-
18 ment of COVID–19, and any services described in section
19 1916(a)(2)(G)’’.
20 (b) DEFINITION OF UNINSURED INDIVIDUAL.—
21 (1) IN GENERAL.—Subsection (ss) of section
22 1902 of the Social Security Act (42 U.S.C. 1396a)
23 is amended to read as follows:
24 ‘‘(ss) UNINSURED INDIVIDUAL DEFINED.—For pur-
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25 poses of this section, the term ‘uninsured individual’
26 means, notwithstanding any other provision of this title,
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1 any individual who is not covered by minimum essential
2 coverage (as defined in section 5000A(f)(1) of the Internal
3 Revenue Code of 1986).’’.
4 (2) EFFECTIVE DATE.—The amendment made
5 by paragraph (1) shall take effect and apply as if in-
6 cluded in the enactment of the Families First
7 Coronavirus Response Act (Public Law 116–127).
8 (c) CLARIFICATION REGARDING EMERGENCY SERV-
9 ICES FOR CERTAIN INDIVIDUALS.—Section 1903(v)(2) of
10 the Social Security Act (42 U.S.C. 1396b(v)(2)) is amend-
11 ed by adding at the end the following flush sentence:
12 ‘‘For purposes of subparagraph (A), care and serv-
13 ices described in such subparagraph include any in
14 vitro diagnostic product described in section
15 1905(a)(3)(B) (and the administration of such prod-
16 uct), any COVID–19 vaccine (and the administra-
17 tion of such vaccine), any item or service that is fur-
18 nished for the treatment of COVID–19, including
19 drugs approved or authorized under section 505 or
20 564 of the Federal Food, Drug, and Cosmetic Act,
21 or a condition that may complicate the treatment of
22 COVID–19, and any services described in section
23 1916(a)(2)(G).’’.
24 (d) INCLUSION COVID–19 CONCERN
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OF AS AN
25 EMERGENCY CONDITION.—Section 1903(v)(3) of the So-
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1 cial Security Act (42 U.S.C. 1396b(v)(3)) is amended by
2 adding at the end the following flush sentence:
3 ‘‘Such term includes any indication that an alien de-
4 scribed in paragraph (1) may have contracted
5 COVID–19.’’.
6 SEC. 303. COVERAGE OF TREATMENTS FOR COVID–19 AT NO
7 COST SHARING UNDER THE MEDICARE AD-
8 VANTAGE PROGRAM.
9 (a) IN GENERAL.—Section 1852(a)(1)(B) of the So-
10 cial Security Act (42 U.S.C. 1395w–22(a)(1)(B)) is
11 amended by adding at the end the following new clause:
12 ‘‘(vii) SPECIAL COVERAGE RULES FOR
13 SPECIFIED COVID–19 TREATMENT SERV-
14 ICES.—Notwithstanding clause (i), in the
15 case of a specified COVID–19 treatment
16 service (as defined in section 30201(b) of
17 The Heroes Act) that is furnished during
18 a plan year occurring during any portion
19 of the emergency period defined in section
20 1135(g)(1)(B) beginning on or after the
21 date of the enactment of this clause, a
22 Medicare Advantage plan may not, with re-
23 spect to such service, impose—
24 ‘‘(I) any cost-sharing require-
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25 ment (including a deductible, copay-
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1 ment, or coinsurance requirement);
2 and
3 ‘‘(II) in the case such service is a
4 critical specified COVID–19 treat-
5 ment service (including ventilator
6 services and intensive care unit serv-
7 ices), any prior authorization or other
8 utilization management requirement.
9 A Medicare Advantage plan may not take
10 the application of this clause into account
11 for purposes of a bid amount submitted by
12 such plan under section 1854(a)(6).’’.
13 (b) IMPLEMENTATION.—Notwithstanding any other
14 provision of law, the Secretary of Health and Human
15 Services may implement the amendments made by this
16 section by program instruction or otherwise.
17 SEC. 304. REQUIRING COVERAGE UNDER MEDICARE PDPS
18 AND MA–PD PLANS, WITHOUT THE IMPOSI-
19 TION OF COST SHARING OR UTILIZATION
20 MANAGEMENT REQUIREMENTS, OF DRUGS
21 INTENDED TO TREAT COVID–19 DURING CER-
22 TAIN EMERGENCIES.
23 (a) COVERAGE REQUIREMENT.—Section 1860D–
24 4(b)(3) of the Social Security Act (42 U.S.C. 1395w–
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1 104(b)(3)) is amended by adding at the end the following
2 new subparagraph:
3 ‘‘(I) REQUIRED INCLUSION OF DRUGS IN-
4 TENDED TO TREAT COVID–19.—
5 ‘‘(i) IN GENERAL.—Notwithstanding
6 any other provision of law, a PDP sponsor
7 offering a prescription drug plan shall,
8 with respect to a plan year, any portion of
9 which occurs during the period described
10 in clause (ii), be required to—
11 ‘‘(I) include in any formulary—
12 ‘‘(aa) all covered part D
13 drugs with a medically accepted
14 indication (as defined in section
15 1860D–2(e)(4)) to treat COVID–
16 19 that are marketed in the
17 United States; and
18 ‘‘(bb) all drugs authorized
19 under section 564 or 564A of the
20 Federal Food, Drug, and Cos-
21 metic Act to treat COVID–19;
22 and
23 ‘‘(II) not impose any prior au-
24 thorization or other utilization man-
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25 agement requirement with respect to
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1 such drugs described in item (aa) or
2 (bb) of subclause (I) (other than such
3 a requirement that limits the quantity
4 of drugs due to safety).
5 ‘‘(ii) PERIOD DESCRIBED.—For pur-
6 poses of clause (i), the period described in
7 this clause is the period during which there
8 exists the public health emergency declared
9 by the Secretary pursuant to section 319
10 of the Public Health Service Act on Janu-
11 ary 31, 2020, entitled ‘Determination that
12 a Public Health Emergency Exists Nation-
13 wide as the Result of the 2019 Novel
14 Coronavirus’ (including any renewal of
15 such declaration pursuant to such sec-
16 tion).’’.
17 (b) ELIMINATION OF COST SHARING.—
18 (1) ELIMINATION OF COST SHARING FOR
19 DRUGS INTENDED TO TREAT COVID–19 UNDER
20 STANDARD AND ALTERNATIVE PRESCRIPTION DRUG
21 COVERAGE.—Section 1860D–2 of the Social Security
22 Act (42 U.S.C. 1395w–102) is amended—
23 (A) in subsection (b)—
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1 (i) in paragraph (1)(A), by striking
2 ‘‘The coverage’’ and inserting ‘‘Subject to
3 paragraph (8), the coverage’’;
4 (ii) in paragraph (2)—
5 (I) in subparagraph (A), by in-
6 serting after ‘‘Subject to subpara-
7 graphs (C) and (D)’’ the following:
8 ‘‘and paragraph (8)’’;
9 (II) in subparagraph (C)(i), by
10 striking ‘‘paragraph (4)’’ and insert-
11 ing ‘‘paragraphs (4) and (8)’’; and
12 (III) in subparagraph (D)(i), by
13 striking ‘‘paragraph (4)’’ and insert-
14 ing ‘‘paragraphs (4) and (8)’’;
15 (iii) in paragraph (4)(A)(i), by strik-
16 ing ‘‘The coverage’’ and inserting ‘‘Subject
17 to paragraph (8), the coverage’’; and
18 (iv) by adding at the end the following
19 new paragraph:
20 ‘‘(8) ELIMINATION OF COST SHARING FOR
21 DRUGS INTENDED TO TREAT COVID–19.—The cov-
22 erage does not impose any deductible, copayment,
23 coinsurance, or other cost-sharing requirement for
24 drugs described in section 1860D–4(b)(3)(I)(i)(I)
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25 with respect to a plan year, any portion of which oc-
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1 curs during the period during which there exists the
2 public health emergency declared by the Secretary
3 pursuant to section 319 of the Public Health Service
4 Act on January 31, 2020, entitled ‘Determination
5 that a Public Health Emergency Exists Nationwide
6 as the Result of the 2019 Novel Coronavirus’ (in-
7 cluding any renewal of such declaration pursuant to
8 such section).’’; and
9 (B) in subsection (c), by adding at the end
10 the following new paragraph:
11 ‘‘(4) SAME ELIMINATION OF COST SHARING FOR
12 DRUGS INTENDED TO TREAT COVID–19.—The cov-
13 erage is in accordance with subsection (b)(8).’’.
14 (2) ELIMINATION OF COST SHARING FOR
15 DRUGS INTENDED TO TREAT COVID–19 DISPENSED
16 TO INDIVIDUALS WHO ARE SUBSIDY ELIGIBLE INDI-
17 VIDUALS.—Section 1860D–14(a) of the Social Secu-
18 rity Act (42 U.S.C. 1395w–114(a)) is amended—
19 (A) in paragraph (1)—
20 (i) in subparagraph (D)—
21 (I) in clause (ii), by striking ‘‘In
22 the case of’’ and inserting ‘‘Subject to
23 subparagraph (F), in the case of’’;
24 and
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1 (II) in clause (iii), by striking
2 ‘‘In the case of’’ and inserting ‘‘Sub-
3 ject to subparagraph (F), in the case
4 of’’; and
5 (ii) by adding at the end the following
6 new subparagraph:
7 ‘‘(F) ELIMINATION OF COST SHARING FOR
8 DRUGS INTENDED TO TREAT COVID–19.—Cov-
9 erage that is in accordance with section
10 1860D–2(b)(8).’’; and
11 (B) in paragraph (2)—
12 (i) in subparagraph (B), by striking
13 ‘‘A reduction’’ and inserting ‘‘Subject to
14 subparagraph (F), a reduction’’;
15 (ii) in subparagraph (D), by striking
16 ‘‘The substitution’’ and inserting ‘‘Subject
17 to subparagraph (F), the substitution’’;
18 (iii) in subparagraph (E), by inserting
19 after ‘‘Subject to’’ the following: ‘‘subpara-
20 graph (F) and’’; and
21 (iv) by adding at the end the following
22 new subparagraph:
23 ‘‘(F) ELIMINATION OF COST SHARING FOR
24 DRUGS INTENDED TO TREAT COVID–19.—Cov-
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1 erage that is in accordance with section
2 1860D–2(b)(8).’’.
3 (c) IMPLEMENTATION.—Notwithstanding any other
4 provision of law, the Secretary of Health and Human
5 Services may implement the amendments made by this
6 section by program instruction or otherwise.
7 SEC. 305. COVERAGE OF COVID–19 RELATED TREATMENT
8 AT NO COST SHARING.
9 (a) IN GENERAL.—A group health plan and a health
10 insurance issuer offering group or individual health insur-
11 ance coverage (including a grandfathered health plan (as
12 defined in section 1251(e) of the Patient Protection and
13 Affordable Care Act)) shall provide coverage, and shall not
14 impose any cost sharing (including deductibles, copay-
15 ments, and coinsurance) requirements, for the following
16 items and services furnished during any portion of the
17 emergency period defined in paragraph (1)(B) of section
18 1135(g) of the Social Security Act (42 U.S.C. 1320b–
19 5(g)) beginning on or after the date of the enactment of
20 this Act:
21 (1) Medically necessary items and services (in-
22 cluding in-person or telehealth visits in which such
23 items and services are furnished) that are furnished
24 to an individual who has been diagnosed with (or
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1 with) COVID–19 to treat or mitigate the effects of
2 COVID–19.
3 (2) Medically necessary items and services (in-
4 cluding in-person or telehealth visits in which such
5 items and services are furnished) that are furnished
6 to an individual who is presumed to have COVID–
7 19 but is never diagnosed as such, if the following
8 conditions are met:
9 (A) Such items and services are furnished
10 to the individual to treat or mitigate the effects
11 of COVID–19 or to mitigate the impact of
12 COVID–19 on society.
13 (B) Health care providers have taken ap-
14 propriate steps under the circumstances to
15 make a diagnosis, or confirm whether a diag-
16 nosis was made, with respect to such individual,
17 for COVID–19, if possible.
18 (b) ITEMS AND SERVICES RELATED TO COVID–
19 19.—For purposes of this section—
20 (1) not later than one week after the date of
21 the enactment of this section, the Secretary of
22 Health and Human Services, Secretary of Labor,
23 and Secretary of the Treasury shall jointly issue
24 guidance specifying applicable diagnoses and medi-
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1 cally necessary items and services related to
2 COVID–19; and
3 (2) such items and services shall include all
4 items or services that are relevant to the treatment
5 or mitigation of COVID–19, regardless of whether
6 such items or services are ordinarily covered under
7 the terms of a group health plan or group or indi-
8 vidual health insurance coverage offered by a health
9 insurance issuer.
10 (c) ENFORCEMENT.—
11 (1) APPLICATION WITH RESPECT TO PHSA,
12 ERISA, AND IRC.—The provisions of this section
13 shall be applied by the Secretary of Health and
14 Human Services, Secretary of Labor, and Secretary
15 of the Treasury to group health plans and health in-
16 surance issuers offering group or individual health
17 insurance coverage as if included in the provisions of
18 part A of title XXVII of the Public Health Service
19 Act, part 7 of the Employee Retirement Income Se-
20 curity Act of 1974, and subchapter B of chapter 100
21 of the Internal Revenue Code of 1986, as applicable.
22 (2) PRIVATE RIGHT OF ACTION.—An individual
23 with respect to whom an action is taken by a group
24 health plan or health insurance issuer offering group
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1 of subsection (a) may commence a civil action
2 against the plan or issuer for appropriate relief. The
3 previous sentence shall not be construed as limiting
4 any enforcement mechanism otherwise applicable
5 pursuant to paragraph (1).
6 (d) IMPLEMENTATION.—The Secretary of Health and
7 Human Services, Secretary of Labor, and Secretary of the
8 Treasury may implement the provisions of this section
9 through sub-regulatory guidance, program instruction or
10 otherwise.
11 (e) TERMS.—The terms ‘‘group health plan’’, ‘‘health
12 insurance issuer’’, ‘‘group health insurance coverage’’, and
13 ‘‘individual health insurance coverage’’ have the meanings
14 given such terms in section 2791 of the Public Health
15 Service Act (42 U.S.C. 300gg–91), section 733 of the Em-
16 ployee Retirement Income Security Act of 1974 (29
17 U.S.C. 1191b), and section 9832 of the Internal Revenue
18 Code of 1986, as applicable.
19 SEC. 306. REIMBURSEMENT FOR ADDITIONAL HEALTH
20 SERVICES RELATING TO CORONAVIRUS.
21 Title V of division A of the Families First
22 Coronavirus Response Act (Public Law 116–127) is
23 amended under the heading ‘‘Department of Health and
24 Human Services—Office of the Secretary—Public Health
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25 and Social Services Emergency Fund’’ by inserting ‘‘, or
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1 treatment related to SARS–CoV–2 or COVID–19 for un-
2 insured individuals’’ after ‘‘or visits described in para-
3 graph (2) of such section for uninsured individuals’’.
4 TITLE IV—FEDERAL HEALTH
5 EQUITY OVERSIGHT
6 SEC. 401. COVID-19 RACIAL AND ETHNIC DISPARITIES TASK
7 FORCE ACT OF 2020.
8 (a) IN GENERAL.—The Secretary of Health and
9 Human Services (referred to in this section as the ‘‘Sec-
10 retary’’) shall establish an interagency task force, to be
11 known as the ‘‘COVID–19 Racial and Ethnic Disparities
12 Task Force’’ (referred to in this section as the ‘‘task
13 force’’), to gather data about disproportionately affected
14 communities and provide recommendations to combat the
15 racial and ethnic disparities in the COVID–19 response
16 throughout the United States and in response to future
17 public health crises.
18 (b) MEMBERSHIP.—The task force shall be composed
19 of the following:
20 (1) The Secretary of Health and Human Serv-
21 ices.
22 (2) The Assistant Secretary for Planning and
23 Evaluation of the Department of Health and Human
24 Services.
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1 (3) The Assistant Secretary for Preparedness
2 and Response of the Department of Health and
3 Human Services.
4 (4) The Director of the Centers for Disease
5 Control and Prevention.
6 (5) The Director of the National Institutes of
7 Health.
8 (6) The Commissioner of Food and Drugs.
9 (7) The Administrator of the Federal Emer-
10 gency Management Agency.
11 (8) The Director of the National Institute on
12 Minority Health and Health Disparities.
13 (9) The Director of the Indian Health Service.
14 (10) The Administrator of the Centers for
15 Medicare & Medicaid Services.
16 (11) The Director of the Agency for Healthcare
17 Research and Quality.
18 (12) The Surgeon General.
19 (13) The Administrator of the Health Re-
20 sources and Services Administration.
21 (14) The Director of the Office of Minority
22 Health.
23 (15) The Secretary of Housing and Urban De-
24 velopment.
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25 (16) The Secretary of Education.
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1 (17) The Secretary of Labor.
2 (18) The Secretary of Defense.
3 (19) The Secretary of Transportation.
4 (20) The Secretary of the Treasury.
5 (21) The Administrator of the Small Business
6 Administration.
7 (22) The Administrator of the Environmental
8 Protection Agency.
9 (23) Five health care professionals with exper-
10 tise in addressing racial and ethnic disparities, with
11 at least one representative from a rural area, to be
12 appointed by the Secretary.
13 (24) Five policy experts specializing in address-
14 ing racial and ethnic disparities in education or ra-
15 cial and ethnic economic inequality to be appointed
16 by the Secretary.
17 (25) Six representatives from community-based
18 organizations specializing in providing culturally
19 competent care or services and addressing racial and
20 ethnic disparities, to be appointed by the Secretary,
21 with at least one representative from an urban In-
22 dian organization and one representative from a na-
23 tional organization that represents Tribal govern-
24 ments with expertise in Tribal public health.
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1 (26) Six State, local, territorial, or Tribal public
2 health officials representing departments of public
3 health, who shall represent jurisdictions from dif-
4 ferent regions of the United States with relatively
5 high concentrations of historically marginalized pop-
6 ulations, to be appointed by the Secretary, with at
7 least one territorial representative and one rep-
8 resentative of a Tribal public health department.
9 (c) ADMINISTRATIVE PROVISIONS.—
10 (1) APPOINTMENT OF NON-GOVERNMENT MEM-
11 BERS.—Notwithstanding any other provision of law,
12 the Secretary shall appoint all non-government mem-
13 bers of the task force within 30 days of the date en-
14 actment of this section.
15 (2) CHAIRPERSON.—The Secretary shall serve
16 as the chairperson of the task force. The Director of
17 the Office of Minority Health shall serve as the vice
18 chairperson.
19 (3) STAFF.—The task force shall have 10 full-
20 time staff members.
21 (4) MEETINGS.—Not later than 45 days after
22 the date of enactment of this section, the full task
23 force shall have its first meeting. The task force
24 shall convene at least once a month thereafter.
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1 (5) SUBCOMMITTEES.—The chairperson and
2 vice chairperson of the task force are authorized to
3 establish subcommittees to consider specific issues
4 related to the broader mission of addressing racial
5 and ethnic disparities.
6 (d) FEDERAL EMERGENCY MANAGEMENT AGENCY
7 RESOURCE ALLOCATION REPORTING AND RECOMMENDA-
8 TIONS.—
9 (1) WEEKLY REPORTS.—Not later than 7 days
10 after the task force first meets, and weekly there-
11 after, the task force shall submit to Congress and
12 the Federal Emergency Management Agency a re-
13 port that includes—
14 (A) a description of COVID–19 patient
15 outcomes, including cases, hospitalizations, pa-
16 tients on ventilation, and mortality,
17 disaggregated by race and ethnicity (where such
18 data is missing, the task force shall utilize ap-
19 propriate authorities to improve data collec-
20 tion);
21 (B) the identification of communities that
22 lack resources to combat the COVID–19 pan-
23 demic, including personal protective equipment,
24 ventilators, hospital beds, testing kits, testing
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1 sources to conduct surveillance and contact
2 tracing, funding, staffing, and other resources
3 the task force deems essential as needs arise;
4 (C) the identification of communities where
5 racial and ethnic disparities in COVID–19 in-
6 fection, hospitalization, and death rates are out
7 of proportion to the community’s population by
8 a certain threshold, to be determined by the
9 task force based on available public health data;
10 (D) recommendations about how to best al-
11 locate critical COVID–19 resources to—
12 (i) communities with disproportion-
13 ately high COVID–19 infection, hos-
14 pitalization, and death rates; and
15 (ii) communities identified in subpara-
16 graph (C);
17 (E) with respect to communities that are
18 able to reduce racial and ethnic disparities ef-
19 fectively, a description of best practices in-
20 volved; and
21 (F) an update with respect to the response
22 of the Federal Emergency Management Agency
23 to the task force’s previous weeks’ recommenda-
24 tions under this section.
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1 (2) GENERAL CONSULTATION.—In submitting
2 weekly reports and recommendations under this sub-
3 section, the task force shall consult with and notify
4 State, local, territorial, and Tribal officials and com-
5 munity-based organizations from communities iden-
6 tified as disproportionately impacted by COVID–19.
7 (3) CONSULTATION WITH INDIAN TRIBES.—In
8 submitting weekly reports and recommendations
9 under this subsection, the Director of Indian Health
10 Service shall, in coordination with the task force,
11 consult with Indian Tribes and Tribal organizations
12 that are disproportionately affected by COVID–19
13 on a government to government basis to identify
14 specific needs and recommendations.
15 (4) DISSEMINATION.—Reports under this sub-
16 section shall be disseminated to all relevant stake-
17 holders, including State, local, territorial, and Tribal
18 officials, and public health departments.
19 (5) TRIBAL DATA.—The task force, in consulta-
20 tion with Indian Tribes and Tribal organizations,
21 shall ensure that an Indian Tribe consents to any
22 public reporting of health data.
23 (e) COVID–19 RELIEF OVERSIGHT AND IMPLEMEN-
24 TATION REPORTS.—Not later than 14 days after the task
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1 after, the task force shall submit to Congress and the rel-
2 evant Federal agencies a report that includes—
3 (1) an examination of funds distributed under
4 COVID–19-related relief and stimulus laws (enacted
5 prior to and after the date of enactment of this Act),
6 including the Coronavirus Preparedness and Re-
7 sponse Emergency Supplemental Appropriations Act,
8 2020 (Public Law 116–123), the Families First
9 Coronavirus Response Act (Public Law 116–127),
10 the Coronavirus Aid, Relief, and Economic Security
11 Act (Public Law 116–136), and the Paycheck Pro-
12 tection Program and Health Care Enhancement Act
13 (Public Law 116–139), and how that distribution
14 impacted racial and ethnic disparities with respect to
15 the COVID–19 pandemic; and
16 (2) recommendations to relevant Federal agen-
17 cies about how to disburse any undisbursed funding
18 from COVID–19-related relief and stimulus laws
19 (enacted prior to and after the date of enactment of
20 this Act), including those laws described in para-
21 graph (1), to address racial and ethnic disparities
22 with respect to the COVID–19 pandemic, including
23 recommendations to—
24 (A) the Department of Health and Human
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25 Services about disbursement of funds under the
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1 Public Health and Social Service Emergency
2 Fund;
3 (B) the Small Business Administration
4 about disbursement of funds under the Pay-
5 check Protection Program and the Economic
6 Injury Disaster Loan Program; and
7 (C) the Department of Education about
8 disbursement of funds under the Education
9 Stabilization Fund.
10 (f) FINAL COVID–19 REPORTS.—Not later than 90
11 days after the date on which the President declares the
12 end of the COVID–19 public health emergency first de-
13 clared by the Secretary on January 31, 2020, the task
14 force shall submit to Congress a report that—
15 (1) describes inequities within the health care
16 system, implicit bias, structural racism, and social
17 determinants of health (including housing, nutrition,
18 education, economic, and environmental factors) that
19 contributed to racial and ethnic health disparities
20 with respect to the COVID–19 pandemic and how
21 these factors contributed to such disparities;
22 (2) examines the initial Federal response to the
23 COVID–19 pandemic and its impact on the racial
24 and ethnic disparities in COVID–19 infection, hos-
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25 pitalization, and death rates; and
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1 (3) contains recommendations to combat racial
2 and ethnic disparities in future infectious disease re-
3 sponses, including future COVID–19 outbreaks.
4 (g) SUNSET AND SUCCESSOR TASK FORCE.—
5 (1) SUNSET.—The task force shall terminate on
6 the date that is 90 days after the date on which the
7 President declares the end of the COVID–19 public
8 health emergency first declared by the Secretary on
9 January 31, 2020.
10 (2) SUCCESSOR.—Upon the termination of the
11 task force under paragraph (1), the Secretary shall
12 establish a permanent Infectious Disease Racial and
13 Ethnic Disparities Task Force based on the mem-
14 bership, convening, and reporting requirements rec-
15 ommended by the task force in reports submitted
16 under this section.
17 (h) AUTHORIZATION OF APPROPRIATIONS.—There is
18 authorized to be appropriated, such sums as may be nec-
19 essary to carry out this section.
20 SEC. 402. PROTECTION OF THE HHS OFFICES OF MINORITY
21 HEALTH.
22 (a) IN GENERAL.—Pursuant to section 1707A of the
23 Public Health Service Act (42 U.S.C. 300u–6a), the Of-
24 fices of Minority Health established within the Centers for
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25 Disease Control and Prevention, the Health Resources
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1 and Services Administration, the Substance Abuse and
2 Mental Health Services Administration, the Agency for
3 Healthcare Research and Quality, the Food and Drug Ad-
4 ministration, and the Centers for Medicare & Medicaid
5 Services, are offices that, regardless of change in the
6 structure of the Department of Health and Human Serv-
7 ices, shall report to the Secretary of Health and Human
8 Services.
9 (b) SENSE OF CONGRESS.—It is the sense of the
10 Congress that any effort to eliminate or consolidate such
11 Offices of Minority Health undermines the progress
12 achieved so far.
13 SEC. 403. ESTABLISH AN INTERAGENCY COUNSEL AND
14 GRANT PROGRAMS ON SOCIAL DETER-
15 MINANTS OF HEALTH.
16 (a) SHORT TITLE.—This section may be cited as the
17 ‘‘Social Determinants Accelerator Act of 2020’’.
18 (b) FINDINGS; PURPOSES.—
19 (1) FINDINGS.—Congress finds the following:
20 (A) There is a significant body of evidence
21 showing that economic and social conditions
22 have a powerful impact on individual and popu-
23 lation health outcomes, including health dispari-
24 ties associated with public health emergencies,
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25 and well-being, as well as medical costs.
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1 (B) State, local, and Tribal governments
2 and the service delivery partners of such gov-
3 ernments face significant challenges in coordi-
4 nating benefits and services delivered through
5 the Medicaid program and other social services
6 programs because of the fragmented and com-
7 plex nature of Federal and State funding and
8 administrative requirements.
9 (C) The Federal Government should
10 prioritize and proactively assist State and local
11 governments to strengthen the capacity of State
12 and local governments to improve health and
13 social outcomes for individuals, thereby improv-
14 ing cost-effectiveness and return on investment.
15 (2) PURPOSES.—The purposes of this Act are
16 as follows:
17 (A) To establish effective, coordinated Fed-
18 eral technical assistance to help State and local
19 governments to improve outcomes and cost-ef-
20 fectiveness of, and return on investment from,
21 health and social services programs.
22 (B) To build a pipeline of State and locally
23 designed, cross-sector interventions and strate-
24 gies that generate rigorous evidence about how
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1 crease the cost-effectiveness of, and return on
2 investment from, Federal, State, local, and
3 Tribal health and social services programs.
4 (C) To enlist State and local governments
5 and the service providers of such governments
6 as partners in identifying Federal statutory,
7 regulatory, and administrative challenges in im-
8 proving the health and social outcomes of, cost-
9 effectiveness of, and return on investment from,
10 Federal spending on individuals enrolled in
11 Medicaid.
12 (D) To develop strategies to improve
13 health and social outcomes without denying
14 services to, or restricting the eligibility of, vul-
15 nerable populations.
16 (c) SOCIAL DETERMINANTS ACCELERATOR COUN-
17 CIL.—
18 (1) ESTABLISHMENT.—The Secretary of Health
19 and Human Services (referred to in this Act as the
20 ‘‘Secretary’’), in coordination with the Administrator
21 of the Centers for Medicare & Medicaid Services (re-
22 ferred to in this Act as the ‘‘Administrator’’), shall
23 establish an interagency council, to be known as the
24 Social Determinants Accelerator Interagency Council
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1 (referred to in this Act as the ‘‘Council’’) to achieve
2 the purposes listed in subsection (b)(1).
3 (2) MEMBERSHIP.—
4 (A) FEDERAL COMPOSITION.—The Council
5 shall be composed of at least one designee from
6 each of the following Federal agencies:
7 (i) The Office of Management and
8 Budget.
9 (ii) The Department of Agriculture.
10 (iii) The Department of Education.
11 (iv) The Indian Health Service.
12 (v) The Department of Housing and
13 Urban Development.
14 (vi) The Department of Labor.
15 (vii) The Department of Transpor-
16 tation.
17 (viii) Any other Federal agency the
18 Chair of the Council determines necessary.
19 (B) DESIGNATION.—
20 (i) IN GENERAL.—The head of each
21 agency specified in subparagraph (A) shall
22 designate at least one employee to serve as
23 a member of the Council.
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1 (ii) RESPONSIBILITIES.—An employee
2 described in this clause shall be a senior
3 employee of the agency—
4 (I) whose responsibilities relate
5 to authorities, policies, and procedures
6 with respect to the health and well-
7 being of individuals receiving medical
8 assistance under a State plan (or a
9 waiver of such plan) under title XIX
10 of the Social Security Act (42 U.S.C.
11 1396 et seq.); or
12 (II) who has authority to imple-
13 ment and evaluate transformative ini-
14 tiatives that harness data or conducts
15 rigorous evaluation to improve the im-
16 pact and cost-effectiveness of federally
17 funded services and benefits.
18 (C) HHS REPRESENTATION.—In addition
19 to the designees under subparagraph (A), the
20 Council shall include designees from at least
21 three agencies within the Department of Health
22 and Human Services, including the Centers for
23 Medicare & Medicaid Services, at least one of
24 whom shall meet the criteria under this section.
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1 (D) OMB ROLE.—The Director of the Of-
2 fice of Management and Budget shall facilitate
3 the timely resolution of Governmentwide and
4 multiagency issues to help the Council achieve
5 consensus recommendations described under
6 this section.
7 (E) NON-FEDERAL COMPOSITION.—The
8 Comptroller General of the United States may
9 designate up to 6 Council designees—
10 (i) who have relevant subject matter
11 expertise, including expertise implementing
12 and evaluating transformative initiatives
13 that harness data and conduct evaluations
14 to improve the impact and cost-effective-
15 ness of Federal Government services; and
16 (ii) that each represent—
17 (I) State, local, and Tribal health
18 and human services agencies;
19 (II) public housing authorities or
20 State housing finance agencies;
21 (III) State and local government
22 budget offices;
23 (IV) State Medicaid agencies; or
24 (V) national consumer advocacy
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1 (F) CHAIR.—
2 (i) IN GENERAL.—The Secretary shall
3 select the Chair of the Council from among
4 the members of the Council.
5 (ii) INITIATING GUIDANCE.—The
6 Chair, on behalf of the Council, shall iden-
7 tify and invite individuals from diverse en-
8 tities to provide the Council with advice
9 and information pertaining to addressing
10 social determinants of health, including—
11 (I) individuals from State and
12 local government health and human
13 services agencies;
14 (II) individuals from State Med-
15 icaid agencies;
16 (III) individuals from State and
17 local government budget offices;
18 (IV) individuals from public
19 housing authorities or State housing
20 finance agencies;
21 (V) individuals from nonprofit or-
22 ganizations, small businesses, and
23 philanthropic organizations;
24 (VI) advocates;
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1 (VIII) any other individuals the
2 Chair determines to be appropriate.
3 (3) DUTIES.—The duties of the Council are—
4 (A) to make recommendations to the Sec-
5 retary and the Administrator regarding the cri-
6 teria for making awards under this section;
7 (B) to identify Federal authorities and op-
8 portunities for use by States or local govern-
9 ments to improve coordination of funding and
10 administration of Federal programs, the bene-
11 ficiaries of whom include individuals, and which
12 may be unknown or underutilized and to make
13 information on such authorities and opportuni-
14 ties publicly available;
15 (C) to provide targeted technical assistance
16 to States developing a social determinants ac-
17 celerator plan under this section, including
18 identifying potential statutory or regulatory
19 pathways for implementation of the plan and
20 assisting in identifying potential sources of
21 funding to implement the plan;
22 (D) to report to Congress annually on the
23 subjects set forth in this section;
24 (E) to develop and disseminate evaluation
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1 reliably assess the impact of an intervention or
2 approach that may be implemented pursuant to
3 this Act on outcomes, cost-effectiveness of, and
4 return on investment from Federal, State, local,
5 and Tribal governments, and to facilitate tech-
6 nical assistance, where needed, to help to im-
7 prove State and local evaluation designs and
8 implementation;
9 (F) to seek feedback from State, local, and
10 Tribal governments, including through an an-
11 nual survey by an independent third party, on
12 how to improve the technical assistance the
13 Council provides to better equip State, local,
14 and Tribal governments to coordinate health
15 and social service programs;
16 (G) to solicit applications for grants under
17 this section; and
18 (H) to coordinate with other cross-agency
19 initiatives focused on improving the health and
20 well-being of low-income and at-risk populations
21 in order to prevent unnecessary duplication be-
22 tween agency initiatives.
23 (4) SCHEDULE.—Not later than 60 days after
24 the date of the enactment of this Act, the Council
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25 shall convene to develop a schedule and plan for car-
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1 rying out the duties described in this section, includ-
2 ing solicitation of applications for the grants under
3 this section.
4 (5) REPORT TO CONGRESS.—The Council shall
5 submit an annual report to Congress, which shall in-
6 clude—
7 (A) a list of the Council members;
8 (B) activities and expenditures of the
9 Council;
10 (C) summaries of the interventions and ap-
11 proaches that will be supported by State, local,
12 and Tribal governments that received a grant
13 under this section, including—
14 (i) the best practices and evidence-
15 based approaches such governments plan
16 to employ to achieve the purposes listed in
17 this section; and
18 (ii) a description of how the practices
19 and approaches will impact the outcomes,
20 cost-effectiveness of, and return on invest-
21 ment from, Federal, State, local, and Trib-
22 al governments with respect to such pur-
23 poses;
24 (D) the feedback received from State and
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1 nical assistance of the Council, including find-
2 ings from a third-party survey and actions the
3 Council plans to take in response to such feed-
4 back; and
5 (E) the major statutory, regulatory, and
6 administrative challenges identified by State,
7 local, and Tribal governments that received a
8 grant under subsection (d), and the actions that
9 Federal agencies are taking to address such
10 challenges.
11 (6) FACA APPLICABILITY.—The Federal Advi-
12 sory Committee Act (5 U.S.C. App.) shall not apply
13 to the Council.
14 (7) COUNCIL PROCEDURES.—The Secretary, in
15 consultation with the Comptroller General of the
16 United States and the Director of the Office of Man-
17 agement and Budget, shall establish procedures for
18 the Council to—
19 (A) ensure that adequate resources are
20 available to effectively execute the responsibil-
21 ities of the Council;
22 (B) effectively coordinate with other rel-
23 evant advisory bodies and working groups to
24 avoid unnecessary duplication;
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1 (C) create transparency to the public and
2 Congress with regard to Council membership,
3 costs, and activities, including through use of
4 modern technology and social media to dissemi-
5 nate information; and
6 (D) avoid conflicts of interest that would
7 jeopardize the ability of the Council to make de-
8 cisions and provide recommendations.
9 (d) SOCIAL DETERMINANTS ACCELERATOR GRANTS
10 TO STATES OR LOCAL GOVERNMENTS.—
11 (1) GRANTS TO STATES, LOCAL GOVERNMENTS,
12 AND TRIBES.—Not later than 180 days after the
13 date of the enactment of this Act, the Administrator,
14 in consultation with the Secretary and the Council,
15 shall award on a competitive basis not more than 25
16 grants to eligible applicants described in this section,
17 for the development of social determinants accel-
18 erator plans, as described in this section.
19 (2) ELIGIBLE APPLICANT.—An eligible appli-
20 cant described in this section is a State, local, or
21 Tribal health or human services agency that—
22 (A) demonstrates the support of relevant
23 parties across relevant State, local, or Tribal ju-
24 risdictions; and
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1 (B) in the case of an applicant that is a
2 local government agency, provides to the Sec-
3 retary a letter of support from the lead State
4 health or human services agency for the State
5 in which the local government is located.
6 (3) AMOUNT OF GRANT.—The Administrator,
7 in coordination with the Council, shall determine the
8 total amount that the Administrator will make avail-
9 able to each grantee under this section.
10 (4) APPLICATION.—An eligible applicant seek-
11 ing a grant under this section shall include in the
12 application the following information:
13 (A) The target population (or populations)
14 that would benefit from implementation of the
15 social determinants accelerator plan proposed to
16 be developed by the applicant.
17 (B) A description of the objective or objec-
18 tives and outcome goals of such proposed plan,
19 which shall include at least one health outcome
20 and at least one other important social out-
21 come.
22 (C) The sources and scope of inefficiencies
23 that, if addressed by the plan, could result in
24 improved cost-effectiveness of or return on in-
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1 vestment from Federal, State, local, and Tribal
2 governments.
3 (D) A description of potential interventions
4 that could be designed or enabled using such
5 proposed plan.
6 (E) The State, local, Tribal, academic,
7 nonprofit, community-based organizations, and
8 other private sector partners that would partici-
9 pate in the development of the proposed plan
10 and subsequent implementation of programs or
11 initiatives included in such proposed plan.
12 (F) Such other information as the Admin-
13 istrator, in consultation with the Secretary and
14 the Council, determines necessary to achieve the
15 purposes of this Act.
16 (5) USE OF FUNDS.—A recipient of a grant
17 under this section may use funds received through
18 the grant for the following purposes:
19 (A) To convene and coordinate with rel-
20 evant government entities and other stake-
21 holders across sectors to assist in the develop-
22 ment of a social determinant accelerator plan.
23 (B) To identify populations of individuals
24 receiving medical assistance under a State plan
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25 (or a waiver of such plan) under title XIX of
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1 the Social Security Act (42 U.S.C. 1396 et
2 seq.) who may benefit from the proposed ap-
3 proaches to improving the health and well-being
4 of such individuals through the implementation
5 of the proposed social determinants accelerator
6 plan.
7 (C) To engage qualified research experts to
8 advise on relevant research and to design a pro-
9 posed evaluation plan, in accordance with the
10 standards and guidelines issued by the Admin-
11 istrator.
12 (D) To collaborate with the Council to sup-
13 port the development of social determinants ac-
14 celerator plans.
15 (E) To prepare and submit a final social
16 determinants accelerator plan to the Council.
17 (6) CONTENTS OF PLANS.—A social deter-
18 minant accelerator plan developed under this section
19 shall include the following:
20 (A) A description of the target population
21 (or populations) that would benefit from imple-
22 mentation of the social determinants accelerator
23 plan, including an analysis describing the pro-
24 jected impact on the well-being of individuals
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25 described in paragraph (5)(B).
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1 (B) A description of the interventions or
2 approaches designed under the social deter-
3 minants accelerator plan and the evidence for
4 selecting such interventions or approaches.
5 (C) The objectives and outcome goals of
6 such interventions or approaches, including at
7 least one health outcome and at least one other
8 important social outcome.
9 (D) A plan for accessing and linking rel-
10 evant data to enable coordinated benefits and
11 services for the jurisdictions described in this
12 section and an evaluation of the proposed inter-
13 ventions and approaches.
14 (E) A description of the State, local, Trib-
15 al, academic, nonprofit, or community-based or-
16 ganizations, or any other private sector organi-
17 zations that would participate in implementing
18 the proposed interventions or approaches, and
19 the role each would play to contribute to the
20 success of the proposed interventions or ap-
21 proaches.
22 (F) The identification of the funding
23 sources that would be used to finance the pro-
24 posed interventions or approaches.
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1 (G) A description of any financial incen-
2 tives that may be provided, including outcome-
3 focused contracting approaches to encourage
4 service providers and other partners to improve
5 outcomes of, cost-effectiveness of, and return on
6 investment from, Federal, State, local, or Tribal
7 government spending.
8 (H) The identification of the applicable
9 Federal, State, local, or Tribal statutory and
10 regulatory authorities, including waiver authori-
11 ties, to be leveraged to implement the proposed
12 interventions or approaches.
13 (I) A description of potential consider-
14 ations that would enhance the impact,
15 scalability, or sustainability of the proposed
16 interventions or approaches and the actions the
17 grant awardee would take to address such con-
18 siderations.
19 (J) A proposed evaluation plan, to be car-
20 ried out by an independent evaluator, to meas-
21 ure the impact of the proposed interventions or
22 approaches on the outcomes of, cost-effective-
23 ness of, and return on investment from, Fed-
24 eral, State, local, and Tribal governments.
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1 (K) Precautions for ensuring that vulner-
2 able populations will not be denied access to
3 Medicaid or other essential services as a result
4 of implementing the proposed plan.
5 (e) FUNDING.—
6 (1) IN GENERAL.—Out of any money in the
7 Treasury not otherwise appropriated, there is appro-
8 priated to carry out this Act $25,000,000, of which
9 up to $5,000,000 may be used to carry out this Act,
10 to remain available for obligation until the date that
11 is 5 years after the date of enactment of this Act.
12 (2) RESERVATION OF FUNDS.—
13 (A) IN GENERAL.—Of the funds made
14 available under paragraph (1), the Secretary
15 shall reserve not less than 20 percent to award
16 grants to eligible applicants for the development
17 of social determinants accelerator plans under
18 this section intended to serve rural populations.
19 (B) EXCEPTION.—In the case of a fiscal
20 year for which the Secretary determines that
21 there are not sufficient eligible applicants to
22 award up to 25 grants under section 4 that are
23 intended to serve rural populations and the Sec-
24 retary cannot satisfy the 20-percent require-
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25 ment, the Secretary may reserve an amount
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1 that is less than 20 percent of amounts made
2 available under paragraph (1) to award grants
3 for such purpose.
4 (3) RULE OF CONSTRUCTION.—Nothing in this
5 Act shall prevent Federal agencies represented on
6 the Council from contributing additional funding
7 from other sources to support activities to improve
8 the effectiveness of the Council.
9 SEC. 404. ACCOUNTABILITY AND TRANSPARENCY WITHIN
10 THE DEPARTMENT OF HEALTH AND HUMAN
11 SERVICES.
12 Title XXXIV of the Public Health Service Act is
13 amended by inserting after subtitle C the following:
14 ‘‘Subtitle D—Strengthening
15 Accountability
16 ‘‘SEC. 3441. ELEVATION OF THE OFFICE OF CIVIL RIGHTS.
17 ‘‘(a) IN GENERAL.—The Secretary shall establish
18 within the Office for Civil Rights an Office of Health Dis-
19 parities, which shall be headed by a director to be ap-
20 pointed by the Secretary.
21 ‘‘(b) PURPOSE.—The Office of Health Disparities
22 shall ensure that the health programs, activities, and oper-
23 ations of health entities that receive Federal financial as-
24 sistance are in compliance with title VI of the Civil Rights
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25 Act, including through the following activities:
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1 ‘‘(1) The development and implementation of
2 an action plan to address racial and ethnic health
3 care disparities, which shall address concerns relat-
4 ing to the Office for Civil Rights as released by the
5 United States Commission on Civil Rights in the re-
6 port entitled ‘Health Care Challenge: Acknowledging
7 Disparity, Confronting Discrimination, and Ensur-
8 ing Equity’ (September 1999) in conjunction with
9 the reports by the National Academy of Sciences
10 (formerly known as the Institute of Medicine) enti-
11 tled ‘Unequal Treatment: Confronting Racial and
12 Ethnic Disparities in Health Care’, ‘Crossing the
13 Quality Chasm: A New Health System for the 21st
14 Century’, ‘In the Nation’s Compelling Interest: En-
15 suring Diversity in the Health Care Workforce’,
16 ‘The National Partnership for Action to End Health
17 Disparities’, and ‘The Health of Lesbian, Gay, Bi-
18 sexual, and Transgender People’, and other related
19 reports by the National Academy of Sciences. This
20 plan shall be publicly disclosed for review and com-
21 ment and the final plan shall address any comments
22 or concerns that are received by the Office.
23 ‘‘(2) Investigative and enforcement actions
24 against intentional discrimination and policies and
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25 practices that have a disparate impact on minorities.
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1 ‘‘(3) The review of racial, ethnic, gender iden-
2 tity, sexual orientation, sex, disability status, socio-
3 economic status, and primary language health data
4 collected by Federal health agencies to assess health
5 care disparities related to intentional discrimination
6 and policies and practices that have a disparate im-
7 pact on minorities. Such review shall include an as-
8 sessment of health disparities in communities with a
9 combination of these classes.
10 ‘‘(4) Outreach and education activities relating
11 to compliance with title VI of the Civil Rights Act.
12 ‘‘(5) The provision of technical assistance for
13 health entities to facilitate compliance with title VI
14 of the Civil Rights Act.
15 ‘‘(6) Coordination and oversight of activities of
16 the civil rights compliance offices established under
17 section 3442.
18 ‘‘(7) Ensuring—
19 ‘‘(A) at a minimum, compliance with the
20 most recent version of the Office of Manage-
21 ment and Budget statistical policy directive en-
22 titled ‘Standards for Maintaining, Collecting,
23 and Presenting Federal Data on Race and Eth-
24 nicity’; and
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1 ‘‘(B) consideration of available data and
2 language standards such as—
3 ‘‘(i) the standards for collecting and
4 reporting data under section 3101; and
5 ‘‘(ii) the National Standards on Cul-
6 turally and Linguistically Appropriate
7 Services of the Office of Minority Health.
8 ‘‘(c) FUNDING AND STAFF.—The Secretary shall en-
9 sure the effectiveness of the Office of Health Disparities
10 by ensuring that the Office is provided with—
11 ‘‘(1) adequate funding to enable the Office to
12 carry out its duties under this section; and
13 ‘‘(2) staff with expertise in—
14 ‘‘(A) epidemiology;
15 ‘‘(B) statistics;
16 ‘‘(C) health quality assurance;
17 ‘‘(D) minority health and health dispari-
18 ties;
19 ‘‘(E) cultural and linguistic competency;
20 ‘‘(F) civil rights; and
21 ‘‘(G) social, behavioral, and economic de-
22 terminants of health.
23 ‘‘(d) REPORT.—Not later than December 31, 2021,
24 and annually thereafter, the Secretary, in collaboration
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1 Deputy Assistant Secretary for Minority Health, shall
2 submit a report to the Committee on Health, Education,
3 Labor, and Pensions of the Senate and the Committee on
4 Energy and Commerce of the House of Representatives
5 that includes—
6 ‘‘(1) the number of cases filed, broken down by
7 category;
8 ‘‘(2) the number of cases investigated and
9 closed by the office;
10 ‘‘(3) the outcomes of cases investigated;
11 ‘‘(4) the staffing levels of the office including
12 staff credentials;
13 ‘‘(5) the number of other lingering and emerg-
14 ing cases in which civil rights inequities can be dem-
15 onstrated; and
16 ‘‘(6) the number of cases remaining open and
17 an explanation for their open status.
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 2026.
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1 ‘‘SEC. 3442. ESTABLISHMENT OF HEALTH PROGRAM OF-
2 FICES FOR CIVIL RIGHTS WITHIN FEDERAL
3 HEALTH AND HUMAN SERVICES AGENCIES.
4 ‘‘(a) IN GENERAL.—The Secretary shall establish
5 civil rights compliance offices in each agency within the
6 Department of Health and Human Services that admin-
7 isters health programs.
8 ‘‘(b) PURPOSE OF OFFICES.—Each office established
9 under subsection (a) shall ensure that recipients of Fed-
10 eral financial assistance under Federal health programs
11 administer programs, services, and activities in a manner
12 that—
13 ‘‘(1) does not discriminate, either intentionally
14 or in effect, on the basis of race, national origin, lan-
15 guage, ethnicity, sex, age, disability, sexual orienta-
16 tion, and gender identity; and
17 ‘‘(2) promotes the reduction and elimination of
18 disparities in health and health care based on race,
19 national origin, language, ethnicity, sex, age, dis-
20 ability, sexual orientation, and gender identity.
21 ‘‘(c) POWERS AND DUTIES.—The offices established
22 in subsection (a) shall have the following powers and du-
23 ties:
24 ‘‘(1) The establishment of compliance and pro-
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25 gram participation standards for recipients of Fed-
26 eral financial assistance under each program admin-
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1 istered by the applicable agency, including the estab-
2 lishment of disparity reduction standards to encom-
3 pass disparities in health and health care related to
4 race, national origin, language, ethnicity, sex, age,
5 disability, sexual orientation, and gender identity.
6 ‘‘(2) The development and implementation of
7 program-specific guidelines that interpret and apply
8 Department of Health and Human Services guid-
9 ance under title VI of the Civil Rights Act of 1964
10 and section 1557 of the Patient Protection and Af-
11 fordable Care Act to each Federal health program
12 administered by the agency.
13 ‘‘(3) The development of a disparity-reduction
14 impact analysis methodology that shall be applied to
15 every rule issued by the agency and published as
16 part of the formal rulemaking process under sections
17 555, 556, and 557 of title 5, United States Code.
18 ‘‘(4) Oversight of data collection, analysis, and
19 publication requirements for all recipients of Federal
20 financial assistance under each Federal health pro-
21 gram administered by the agency; compliance with,
22 at a minimum, the most recent version of the Office
23 of Management and Budget statistical policy direc-
24 tive entitled ‘Standards for Maintaining, Collecting,
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25 and Presenting Federal Data on Race and Eth-
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1 nicity’; and consideration of available data and lan-
2 guage standards such as—
3 ‘‘(A) the standards for collecting and re-
4 porting data under section 3101; and
5 ‘‘(B) the National Standards on Culturally
6 and Linguistically Appropriate Services of the
7 Office of Minority Health.
8 ‘‘(5) The conduct of publicly available studies
9 regarding discrimination within Federal health pro-
10 grams administered by the agency as well as dis-
11 parity reduction initiatives by recipients of Federal
12 financial assistance under Federal health programs.
13 ‘‘(6) Annual reports to the Committee on
14 Health, Education, Labor, and Pensions and the
15 Committee on Finance of the Senate and the Com-
16 mittee on Energy and Commerce and the Committee
17 on Ways and Means of the House of Representatives
18 on the progress in reducing disparities in health and
19 health care through the Federal programs adminis-
20 tered by the agency.
21 ‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS
22 IN THE DEPARTMENT OF JUSTICE.—
23 ‘‘(1) DEPARTMENT OF HEALTH AND HUMAN
24 SERVICES.—The Office for Civil Rights of the De-
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1 vide standard-setting and compliance review inves-
2 tigation support services to the Civil Rights Compli-
3 ance Office for each agency described in subsection
4 (a), subject to paragraph (2).
5 ‘‘(2) DEPARTMENT OF JUSTICE.—The Office
6 for Civil Rights of the Department of Justice may,
7 as appropriate, institute formal proceedings when a
8 civil rights compliance office established under sub-
9 section (a) determines that a recipient of Federal fi-
10 nancial assistance is not in compliance with the dis-
11 parity reduction standards of the applicable agency.
12 ‘‘(e) DEFINITION.—In this section, the term ‘Federal
13 health programs’ mean programs—
14 ‘‘(1) under the Social Security Act (42 U.S.C.
15 301 et seq.) that pay for health care and services;
16 and
17 ‘‘(2) under this Act that provide Federal finan-
18 cial assistance for health care, biomedical research,
19 health services research, and programs designed to
20 improve the public’s health, including health service
21 programs.’’.
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1 TITLE V—EXPANDED
2 INSURANCE ACCESS
3 SEC. 501. MEDICARE SPECIAL ENROLLMENT PERIOD FOR
4 INDIVIDUALS RESIDING IN COVID-19 EMER-
5 GENCY AREAS.
6 (a) IN GENERAL.—Section 1837(i) of the Social Se-
7 curity Act (42 U.S.C. 1395p(i)) is amended by adding at
8 the end the following new paragraph:
9 ‘‘(5)(A) In the case of an individual who—
10 ‘‘(i) is eligible under section 1836 to enroll
11 in the medical insurance program established by
12 this part,
13 ‘‘(ii) did not enroll (or elected not to be
14 deemed enrolled) under this section during an
15 enrollment period, and
16 ‘‘(iii) during the emergency period (as de-
17 scribed in section 1135(g)(1)(B)), resided in an
18 emergency area (as described in such section),
19 there shall be a special enrollment period de-
20 scribed in subparagraph (B).
21 ‘‘(B) The special enrollment period re-
22 ferred to in subparagraph (A) is the period that
23 begins not later than July 1, 2020, and ends on
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24 the last day of the month in which the emer-
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1 gency period (as described in section
2 1135(g)(1)(B)) ends.’’.
3 (b) COVERAGE PERIOD FOR INDIVIDUALS
4 TRANSITIONING FROM OTHER COVERAGE.—Section
5 1838(e) of the Social Security Act (42 U.S.C. 1395q(e))
6 is amended—
7 (1) by striking ‘‘pursuant to section 1837(i)(3)
8 or 1837(i)(4)(B)—’’ and inserting the following:
9 ‘‘pursuant to—
10 ‘‘(1) section 1837(i)(3) or 1837(i)(4)(B)—’’;
11 (2) by redesignating paragraphs (1) and (2) as
12 subparagraphs (A) and (B), respectively, and mov-
13 ing the indentation of each such subparagraph 2
14 ems to the right;
15 (3) by striking the period at the end of the sub-
16 paragraph (B), as so redesignated, and inserting ‘‘;
17 or’’; and
18 (4) by adding at the end the following new
19 paragraph:
20 ‘‘(2) section 1837(i)(5), the coverage period
21 shall begin on the first day of the month following
22 the month in which the individual so enrolls.’’.
23 (c) FUNDING.—The Secretary of Health and Human
24 Services shall provide for the transfer from the Federal
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25 Hospital Insurance Trust Fund (as described in section
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1 1817 of the Social Security Act (42 U.S.C. 1395i)) and
2 the Federal Supplementary Medical Insurance Trust
3 Fund (as described in section 1841 of such Act (42 U.S.C.
4 1395t)), in such proportions as determined appropriate by
5 the Secretary, to the Social Security Administration, of
6 $30,000,000, to remain available until expended, for pur-
7 poses of carrying out the amendments made by this sec-
8 tion.
9 (d) IMPLEMENTATION.—Notwithstanding any other
10 provision of law, the Secretary of Health and Human
11 Services may implement the amendments made by this
12 section by program instruction or otherwise.
13 SEC. 502. SPECIAL ENROLLMENT PERIOD THROUGH EX-
14 CHANGES; FEDERAL EXCHANGE OUTREACH
15 AND EDUCATIONAL ACTIVITIES.
16 (a) SPECIAL ENROLLMENT PERIOD THROUGH EX-
17 CHANGES.—Section 1311(c) of the Patient Protection and
18 Affordable Care Act (42 U.S.C. 18031(c)) is amended—
19 (1) in paragraph (6)—
20 (A) in subparagraph (C), by striking at the
21 end ‘‘and’’;
22 (B) in subparagraph (D), by striking at
23 the end the period and inserting ‘‘; and’’; and
24 (C) by adding at the end the following new
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25 subparagraph:
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1 ‘‘(E) subject to subparagraph (B) of para-
2 graph (8), the special enrollment period de-
3 scribed in subparagraph (A) of such para-
4 graph.’’; and
5 (2) by adding at the end the following new
6 paragraph:
7 ‘‘(8) SPECIAL ENROLLMENT PERIOD FOR CER-
8 TAIN PUBLIC HEALTH EMERGENCY.—
9 ‘‘(A) IN GENERAL.—The Secretary shall,
10 subject to subparagraph (B), require an Ex-
11 change to provide—
12 ‘‘(i) for a special enrollment period
13 during the emergency period described in
14 section 1135(g)(1)(B) of the Social Secu-
15 rity Act—
16 ‘‘(I) which shall begin on the
17 date that is one week after the date of
18 the enactment of this paragraph and
19 which, in the case of an Exchange es-
20 tablished or operated by the Secretary
21 within a State pursuant to section
22 1321(c), shall be an 8-week period;
23 and
24 ‘‘(II) during which any individual
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1 qualified health plan through the Ex-
2 change may enroll in such a qualified
3 health plan; and
4 ‘‘(ii) that, in the case of an individual
5 who enrolls in a qualified health plan
6 through the Exchange during such enroll-
7 ment period, the coverage period under
8 such plan shall begin, at the option of the
9 individual, on April 1, 2020, or on the first
10 day of the month following the day the in-
11 dividual selects a plan through such special
12 enrollment period.
13 ‘‘(B) EXCEPTION.—The requirement of
14 subparagraph (A) shall not apply to a State-op-
15 erated or State-established Exchange if such
16 Exchange, prior to the date of the enactment of
17 this paragraph, established or otherwise pro-
18 vided for a special enrollment period to address
19 access to coverage under qualified health plans
20 offered through such Exchange during the
21 emergency period described in section
22 1135(g)(1)(B) of the Social Security Act.’’.
23 (b) FEDERAL EXCHANGE OUTREACH AND EDU-
24 ACTIVITIES.—Section 1321(c) of the Patient
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25 Protection and Affordable Care Act (42 U.S.C. 18041(c))
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1 is amended by adding at the end the following new para-
2 graph:
3 ‘‘(3) OUTREACH AND EDUCATIONAL ACTIVI-
4 TIES.—
5 ‘‘(A) IN GENERAL.—In the case of an Ex-
6 change established or operated by the Secretary
7 within a State pursuant to this subsection, the
8 Secretary shall carry out outreach and edu-
9 cational activities for purposes of informing po-
10 tential enrollees in qualified health plans offered
11 through the Exchange of the availability of cov-
12 erage under such plans and financial assistance
13 for coverage under such plans. Such outreach
14 and educational activities shall be provided in a
15 manner that is culturally and linguistically ap-
16 propriate to the needs of the populations being
17 served by the Exchange (including hard-to-
18 reach populations, such as racial and sexual mi-
19 norities, limited English proficient populations,
20 and young adults).
21 ‘‘(B) LIMITATION ON USE OF FUNDS.—No
22 funds appropriated under this paragraph shall
23 be used for expenditures for promoting non-
24 ACA compliant health insurance coverage.
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1 ‘‘(C) NON-ACA COMPLIANT HEALTH IN-
2 SURANCE COVERAGE.—For purposes of sub-
3 paragraph (B):
4 ‘‘(i) The term ‘non-ACA compliant
5 health insurance coverage’ means health
6 insurance coverage, or a group health plan,
7 that is not a qualified health plan.
8 ‘‘(ii) Such term includes the following:
9 ‘‘(I) An association health plan.
10 ‘‘(II) Short-term limited duration
11 insurance.
12 ‘‘(D) FUNDING.—There are appropriated,
13 out of any funds in the Treasury not otherwise
14 appropriated, $25,000,000, to remain available
15 until expended—
16 ‘‘(i) to carry out this paragraph; and
17 ‘‘(ii) at the discretion of the Sec-
18 retary, to carry out section 1311(i), with
19 respect to an Exchange established or op-
20 erated by the Secretary within a State pur-
21 suant to this subsection.’’.
22 (c) IMPLEMENTATION.—The Secretary of Health and
23 Human Services may implement the provisions of (includ-
24 ing amendments made by) this section through subregu-
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25 latory guidance, program instruction, or otherwise.
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1 SEC. 503. MOMMA’S ACT.
2 (a) SHORT TITLE.—This section may be cited as the
3 ‘‘Mothers and Offspring Mortality and Morbidity Aware-
4 ness Act’’ or the ‘‘MOMMA’s Act’’.
5 (b) FINDINGS.—Congress finds the following:
6 (1) Every year, across the United States,
7 4,000,000 women give birth, about 700 women suf-
8 fer fatal complications during pregnancy, while giv-
9 ing birth or during the postpartum period, and
10 70,000 women suffer near-fatal, partum-related
11 complications.
12 (2) The maternal mortality rate is often used as
13 a proxy to measure the overall health of a popu-
14 lation. While the infant mortality rate in the United
15 States has reached its lowest point, the risk of death
16 for women in the United States during pregnancy,
17 childbirth, or the postpartum period is higher than
18 such risk in many other developed nations. The esti-
19 mated maternal mortality rate (per 100,000 live
20 births) for the 48 contiguous States and Wash-
21 ington, DC increased from 18.8 percent in 2000 to
22 23.8 percent in 2014 to 26.6 percent in 2018. This
23 estimated rate is on par with such rate for under-
24 developed nations such as Iraq and Afghanistan.
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25 (3) International studies estimate the 2015 ma-
26 ternal mortality rate in the United States as 26.4
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1 per 100,000 live births, which is almost twice the
2 2015 World Health Organization estimation of 14
3 per 100,000 live births.
4 (4) It is estimated that more than 60 percent
5 of maternal deaths in the United States are prevent-
6 able.
7 (5) 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 (6) 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 (7) The findings described in paragraphs (1)
23 through (6) are of major concern to researchers,
24 academics, members of the business community, and
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25 providers across the obstetrical continuum rep-
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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 (8) 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 (9) 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-
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25 causing bacteria to her baby. Moreover, some evi-
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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 (10) The United States has not been able to
13 submit a formal maternal mortality rate to inter-
14 national data repositories since 2007. Thus, no offi-
15 cial maternal mortality rate exists for the United
16 States. There can be no maternal mortality rate
17 without streamlining maternal mortality-related data
18 from the State level and extrapolating such data to
19 the Federal level.
20 (11) 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
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25 Disease Control and Prevention has the capacity and
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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 (12) 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
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25 United States compared to other developed nations.
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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 (13) 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 (14) 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
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1 thwart, pregnancy-related or pregnancy-associated
2 mortality and morbidity.
3 (15) The United Nations’ Millennium Develop-
4 ment Goal 5a aimed to reduce by 75 percent, be-
5 tween 1990 and 2015, the maternal mortality rate,
6 yet this metric has not been achieved. In fact, the
7 maternal mortality rate in the United States has
8 been estimated to have more than doubled between
9 2000 and 2014. Yet, because national data are not
10 fully available, the United States does not have an
11 official maternal mortality rate.
12 (16) Many States have struggled to establish or
13 maintain Maternal Mortality Review Committees
14 (referred to in this section as ‘‘MMRC’’). On the
15 State level, MMRCs have lagged because States have
16 not had the resources to mount local reviews. State-
17 level reviews are necessary as only the State depart-
18 ments of health have the authority to request med-
19 ical records, autopsy reports, and police reports crit-
20 ical to the function of the MMRC.
21 (17) The United Kingdom regards maternal
22 deaths as a health systems failure and a national
23 committee of obstetrics experts review each maternal
24 death or near-fatal childbirth complication. Such
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25 committee also establishes the predominant course of
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1 maternal-related deaths from conditions such as
2 preeclampsia. Consequently, the United Kingdom
3 has been able to reduce its incidence of preeclampsia
4 to less than one in 10,000 women—its lowest rate
5 since 1952.
6 (18) The United States has no comparable, co-
7 ordinated Federal process by which to review cases
8 of maternal mortality, systems failures, or best prac-
9 tices. Many States have active MMRCs and leverage
10 their work to impact maternal wellness. For exam-
11 ple, the State of California has worked extensively
12 with their State health departments, health and hos-
13 pital systems, and research collaborative organiza-
14 tions, including the California Maternal Quality Care
15 Collaborative and the Alliance for Innovation on Ma-
16 ternal Health, to establish MMRCs, wherein such
17 State has determined the most prevalent causes of
18 maternal mortality and recorded and shared data
19 with providers and researchers, who have developed
20 and implemented safety bundles and care protocols
21 related to preeclampsia, maternal hemorrhage, and
22 the like. In this way, the State of California has
23 been able to leverage its maternal mortality review
24 board system, generate data, and apply those data
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25 to effect changes in maternal care-related protocol.
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1 To date, the State of California has reduced its ma-
2 ternal mortality rate, which is now comparable to
3 the low rates of the United Kingdom.
4 (19) Hospitals and health systems across the
5 United States lack standardization of emergency ob-
6 stetrical protocols before, during, and after delivery.
7 Consequently, many providers are delayed in recog-
8 nizing critical signs indicating maternal distress that
9 quickly escalate into fatal or near-fatal incidences.
10 Moreover, any attempt to address an obstetrical
11 emergency that does not consider both clinical and
12 public health approaches falls woefully under the
13 mark of excellent care delivery. State-based maternal
14 quality collaborative organizations, such as the Cali-
15 fornia Maternal Quality Care Collaborative or enti-
16 ties participating in the Alliance for Innovation on
17 Maternal Health (AIM), have formed obstetrical pro-
18 tocols, tool kits, and other resources to improve sys-
19 tem care and response as they relate to maternal
20 complications and warning signs for such conditions
21 as maternal hemorrhage, hypertension, and
22 preeclampsia.
23 (20) The Centers for Disease Control and Pre-
24 vention reports that nearly half of all maternal
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25 deaths occur in the immediate postpartum period—
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1 the 42 days following a pregnancy—whereas more
2 than one-third of pregnancy-related or pregnancy-as-
3 sociated deaths occur while a person is still preg-
4 nant. Yet, for women eligible for the Medicaid pro-
5 gram on the basis of pregnancy, such Medicaid cov-
6 erage lapses at the end of the month on which the
7 60th postpartum day lands.
8 (21) The experience of serious traumatic
9 events, such as being exposed to domestic violence,
10 substance use disorder, or pervasive racism, can
11 over-activate the body’s stress-response system.
12 Known as toxic stress, the repetition of high-doses
13 of cortisol to the brain, can harm healthy neuro-
14 logical development, which can have cascading phys-
15 ical and mental health consequences, as documented
16 in the Adverse Childhood Experiences study of the
17 Centers for Disease Control and Prevention.
18 (22) A growing body of evidence-based research
19 has shown the correlation between the stress associ-
20 ated with one’s race—the stress of racism—and
21 one’s birthing outcomes. The stress of sex and race
22 discrimination and institutional racism has been
23 demonstrated to contribute to a higher risk of ma-
24 ternal mortality, irrespective of one’s gestational
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25 age, maternal age, socioeconomic status, or indi-
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1 vidual-level health risk factors, including poverty,
2 limited access to prenatal care, and poor physical
3 and mental health (although these are not nominal
4 factors). African-American women remain the most
5 at risk for pregnancy-associated or pregnancy-re-
6 lated causes of death. When it comes to
7 preeclampsia, for example, which is related to obe-
8 sity, African-American women of normal weight re-
9 main the most at risk of dying during the perinatal
10 period compared to non-African-American obese
11 women.
12 (23) The rising maternal mortality rate in the
13 United States is driven predominantly by the dis-
14 proportionately high rates of African-American ma-
15 ternal mortality.
16 (24) African-American women are 3 to 4 times
17 more likely to die from pregnancy or maternal-re-
18 lated distress than are White women, yielding one of
19 the greatest and most disconcerting racial disparities
20 in public health.
21 (25) Compared to women from other racial and
22 ethnic demographics, African-American women
23 across the socioeconomic spectrum experience pro-
24 longed, unrelenting stress related to racial and gen-
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25 der discrimination, contributing to higher rates of
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1 maternal mortality, giving birth to low-weight ba-
2 bies, and experiencing pre-term birth. Racism is a
3 risk-factor for these aforementioned experiences.
4 This cumulative stress often extends across the life
5 course and is situated in everyday spaces where Afri-
6 can-American women establish livelihood. Structural
7 barriers, lack of access to care, and genetic pre-
8 dispositions to health vulnerabilities exacerbate Afri-
9 can-American women’s likelihood to experience poor
10 or fatal birthing outcomes, but do not fully account
11 for the great disparity.
12 (26) African-American women are twice as like-
13 ly to experience postpartum depression, and dis-
14 proportionately higher rates of preeclampsia com-
15 pared to White women.
16 (27) Racism is deeply ingrained in United
17 States systems, including in health care delivery sys-
18 tems between patients and providers, often resulting
19 in disparate treatment for pain, irreverence for cul-
20 tural norms with respect to health, and
21 dismissiveness. Research has demonstrated that pa-
22 tients respond more warmly and adhere to medical
23 treatment plans at a higher degree with providers of
24 the same race or ethnicity or with providers with
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25 great ability to exercise empathy. However, the pro-
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1 vider pool is not primed with many people of color,
2 nor are providers (whether student-doctors in train-
3 ing or licensed practitioners) consistently required to
4 undergo implicit bias, cultural competency, or empa-
5 thy training on a consistent, on-going basis.
6 (c) IMPROVING FEDERAL EFFORTS WITH RESPECT
7 TO PREVENTION OF MATERNAL MORTALITY.—
8 (1) TECHNICAL ASSISTANCE FOR STATES WITH
9 RESPECT TO REPORTING MATERNAL MORTALITY.—
10 Not later than one year after the date of enactment
11 of this Act, the Director of the Centers for Disease
12 Control and Prevention (referred to in this section
13 as the ‘‘Director’’), in consultation with the Admin-
14 istrator of the Health Resources and Services Ad-
15 ministration, shall provide technical assistance to
16 States that elect to report comprehensive data on
17 maternal mortality, including oral, mental, and
18 breastfeeding health information, for the purpose of
19 encouraging uniformity in the reporting of such data
20 and to encourage the sharing of such data among
21 the respective States.
22 (2) BEST PRACTICES RELATING TO PREVEN-
23 TION OF MATERNAL MORTALITY.—
24 (A) IN GENERAL.—Not later than one year
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25 after the date of enactment of this Act—
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1 (i) the Director, in consultation with
2 relevant patient and provider groups, shall
3 issue best practices to State maternal mor-
4 tality review committees on how best to
5 identify and review maternal mortality
6 cases, taking into account any data made
7 available by States relating to maternal
8 mortality, including data on oral, mental,
9 and breastfeeding health, and utilization of
10 any emergency services; and
11 (ii) the Director, working in collabora-
12 tion with the Health Resources and Serv-
13 ices Administration, shall issue best prac-
14 tices to hospitals, State professional society
15 groups, and perinatal quality collaboratives
16 on how best to prevent maternal mortality.
17 (B) AUTHORIZATION OF APPROPRIA-
18 TIONS.—For purposes of carrying out this sub-
19 section, there is authorized to be appropriated
20 $5,000,000 for each of fiscal years 2021
21 through 2025.
22 (3) ALLIANCE FOR INNOVATION ON MATERNAL
23 HEALTH GRANT PROGRAM.—
24 (A) IN GENERAL.—Not later than one year
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25 after the date of enactment of this Act, the Sec-
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1 retary of Health and Human Services (referred
2 to in this subsection as the ‘‘Secretary’’), acting
3 through the Associate Administrator of the Ma-
4 ternal and Child Health Bureau of the Health
5 Resources and Services Administration, shall
6 establish a grant program to be known as the
7 Alliance for Innovation on Maternal Health
8 Grant Program (referred to in this subsection
9 as ‘‘AIM’’) under which the Secretary shall
10 award grants to eligible entities for the purpose
11 of—
12 (i) directing widespread adoption and
13 implementation of maternal safety bundles
14 through collaborative State-based teams;
15 and
16 (ii) collecting and analyzing process,
17 structure, and outcome data to drive con-
18 tinuous improvement in the implementa-
19 tion of such safety bundles by such State-
20 based teams with the ultimate goal of
21 eliminating preventable maternal mortality
22 and severe maternal morbidity in the
23 United States.
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1 (B) ELIGIBLE ENTITIES.—In order to be
2 eligible for a grant under paragraph (1), an en-
3 tity shall—
4 (i) submit to the Secretary an applica-
5 tion at such time, in such manner, and
6 containing such information as the Sec-
7 retary may require; and
8 (ii) demonstrate in such application
9 that the entity is an interdisciplinary,
10 multi-stakeholder, national organization
11 with a national data-driven maternal safety
12 and quality improvement initiative based
13 on implementation approaches that have
14 been proven to improve maternal safety
15 and outcomes in the United States.
16 (C) USE OF FUNDS.—An eligible entity
17 that receives a grant under paragraph (1) shall
18 use such grant funds—
19 (i) to develop and implement, through
20 a robust, multi-stakeholder process, mater-
21 nal safety bundles to assist States and
22 health care systems in aligning national,
23 State, and hospital-level quality improve-
24 ment efforts to improve maternal health
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25 outcomes, specifically the reduction of ma-
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1 ternal mortality and severe maternal mor-
2 bidity;
3 (ii) to ensure, in developing and im-
4 plementing maternal safety bundles under
5 subparagraph (A), that such maternal
6 safety bundles—
7 (I) satisfy the quality improve-
8 ment needs of a State or health care
9 system by factoring in the results and
10 findings of relevant data reviews, such
11 as reviews conducted by a State ma-
12 ternal mortality review committee;
13 and
14 (II) address topics such as—
15 (aa) obstetric hemorrhage;
16 (bb) maternal mental health;
17 (cc) the maternal venous
18 system;
19 (dd) obstetric care for
20 women with substance use dis-
21 orders, including opioid use dis-
22 order;
23 (ee) postpartum care basics
24 for maternal safety;
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1 (ff) reduction of peripartum
2 racial and ethnic disparities;
3 (gg) reduction of primary
4 caesarean birth;
5 (hh) severe hypertension in
6 pregnancy;
7 (ii) severe maternal mor-
8 bidity reviews;
9 (jj) support after a severe
10 maternal morbidity event;
11 (kk) thromboembolism;
12 (ll) optimization of support
13 for breastfeeding; and
14 (mm) maternal oral health;
15 and
16 (iii) to provide ongoing technical as-
17 sistance at the national and State levels to
18 support implementation of maternal safety
19 bundles under subparagraph (A).
20 (D) MATERNAL SAFETY BUNDLE DE-
21 FINED.—For purposes of this subsection, the
22 term ‘‘maternal safety bundle’’ means standard-
23 ized, evidence-informed processes for maternal
24 health care.
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1 (E) AUTHORIZATION OF APPROPRIA-
2 TIONS.—For purposes of carrying out this sub-
3 section, there is authorized to be appropriated
4 $10,000,000 for each of fiscal years 2021
5 through 2025.
6 (4) FUNDING FOR STATE-BASED PERINATAL
7 QUALITY COLLABORATIVES DEVELOPMENT AND SUS-
8 TAINABILITY.—
9 (A) IN GENERAL.—Not later than one year
10 after the date of enactment of this Act, the Sec-
11 retary of Health and Human Services (referred
12 to in this subsection as the ‘‘Secretary’’), acting
13 through the Division of Reproductive Health of
14 the Centers for Disease Control and Prevention,
15 shall establish a grant program to be known as
16 the State-Based Perinatal Quality Collaborative
17 grant program under which the Secretary
18 awards grants to eligible entities for the pur-
19 pose of development and sustainability of
20 perinatal quality collaboratives in every State,
21 the District of Columbia, and eligible terri-
22 tories, in order to measurably improve perinatal
23 care and perinatal health outcomes for preg-
24 nant and postpartum women and their infants.
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1 (B) GRANT AMOUNTS.—Grants awarded
2 under this subsection shall be in amounts not to
3 exceed $250,000 per year, for the duration of
4 the grant period.
5 (C) STATE-BASED PERINATAL QUALITY
6 COLLABORATIVE DEFINED.—For purposes of
7 this subsection, the term ‘‘State-based perinatal
8 quality collaborative’’ means a network of mul-
9 tidisciplinary teams that—
10 (i) work to improve measurable out-
11 comes for maternal and infant health by
12 advancing evidence-informed clinical prac-
13 tices using quality improvement principles;
14 (ii) work with hospital-based or out-
15 patient facility-based clinical teams, ex-
16 perts, and stakeholders, including patients
17 and families, to spread best practices and
18 optimize resources to improve perinatal
19 care and outcomes;
20 (iii) employ strategies that include the
21 use of the collaborative learning model to
22 provide opportunities for hospitals and
23 clinical teams to collaborate on improve-
24 ment strategies, rapid-response data to
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25 provide timely feedback to hospital and
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1 other clinical teams to track progress, and
2 quality improvement science to provide
3 support and coaching to hospital and clin-
4 ical teams; and
5 (iv) have the goal of improving popu-
6 lation-level outcomes in maternal and in-
7 fant health.
8 (D) AUTHORIZATION OF APPROPRIA-
9 TIONS.—For purposes of carrying out this sub-
10 section, there is authorized to be appropriated
11 $14,000,000 per year for each of fiscal years
12 2021 through 2025.
13 (5) EXPANSION OF MEDICAID AND CHIP COV-
14 ERAGE FOR PREGNANT AND POSTPARTUM WOMEN.—
15 (A) REQUIRING COVERAGE OF ORAL
16 HEALTH SERVICES FOR PREGNANT AND
17 POSTPARTUM WOMEN.—
18 (i) MEDICAID.—Section 1905 of the
19 Social Security Act (42 U.S.C. 1396d) is
20 amended—
21 (I) in subsection (a)(4)—
22 (aa) by striking ‘‘; and (D)’’
23 and inserting ‘‘; (D)’’; and
24 (bb) by inserting ‘‘; and (E)
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25 oral health services for pregnant
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1 and postpartum women (as de-
2 fined in subsection (ee))’’ after
3 ‘‘subsection (bb))’’; and
4 (II) by adding at the end the fol-
5 lowing new subsection:
6 ‘‘(ee) ORAL HEALTH SERVICES FOR PREGNANT AND
7 POSTPARTUM WOMEN.—
8 ‘‘(1) IN GENERAL.—For purposes of this title,
9 the term ‘oral health services for pregnant and
10 postpartum women’ means dental services necessary
11 to prevent disease and promote oral health, restore
12 oral structures to health and function, and treat
13 emergency conditions that are furnished to a woman
14 during pregnancy (or during the 1-year period be-
15 ginning on the last day of the pregnancy).
16 ‘‘(2) COVERAGE REQUIREMENTS.—To satisfy
17 the requirement to provide oral health services for
18 pregnant and postpartum women, a State shall, at
19 a minimum, provide coverage for preventive, diag-
20 nostic, periodontal, and restorative care consistent
21 with recommendations for perinatal oral health care
22 and dental care during pregnancy from the Amer-
23 ican Academy of Pediatric Dentistry and the Amer-
24 ican College of Obstetricians and Gynecologists.’’.
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1 (ii) CHIP.—Section 2103(c)(5)(A) of
2 the Social Security Act (42 U.S.C.
3 1397cc(c)(5)(A)) is amended by inserting
4 ‘‘or a targeted low-income pregnant
5 woman’’ after ‘‘targeted low-income child’’.
6 (B) EXTENDING MEDICAID COVERAGE FOR
7 PREGNANT AND POSTPARTUM WOMEN.—Section
8 1902 of the Social Security Act (42 U.S.C.
9 1396a) is amended—
10 (i) in subsection (e)—
11 (I) in paragraph (5)—
12 (aa) by inserting ‘‘(including
13 oral health services for pregnant
14 and postpartum women (as de-
15 fined in section 1905(ee))’’ after
16 ‘‘postpartum medical assistance
17 under the plan’’; and
18 (bb) by striking ‘‘60-day’’
19 and inserting ‘‘1-year’’; and
20 (II) in paragraph (6), by striking
21 ‘‘60-day’’ and inserting ‘‘1-year’’; and
22 (ii) in subsection (l)(1)(A), by striking
23 ‘‘60-day’’ and inserting ‘‘1-year’’.
24 (C) EXTENDING MEDICAID COVERAGE FOR
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25 LAWFUL RESIDENTS.—Section 1903(v)(4)(A) of
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1 the Social Security Act (42 U.S.C.
2 1396b(v)(4)(A)) is amended by striking ‘‘60-
3 day’’ and inserting ‘‘1-year’’.
4 (D) EXTENDING CHIP COVERAGE FOR
5 PREGNANT AND POSTPARTUM WOMEN.—Section
6 2112(d)(2)(A) of the Social Security Act (42
7 U.S.C. 1397ll(d)(2)(A)) is amended by striking
8 ‘‘60-day’’ and inserting ‘‘1-year’’.
9 (E) MAINTENANCE OF EFFORT.—
10 (i) MEDICAID.—Section 1902(l) of the
11 Social Security Act (42 U.S.C. 1396a(l)) is
12 amended by adding at the end the fol-
13 lowing new paragraph:
14 ‘‘(5) During the period that begins on the date of
15 enactment of this paragraph and ends on the date that
16 is five years after such date of enactment, as a condition
17 for receiving any Federal payments under section 1903(a)
18 for calendar quarters occurring during such period, a
19 State shall not have in effect, with respect to women who
20 are eligible for medical assistance under the State plan
21 or under a waiver of such plan on the basis of being preg-
22 nant or having been pregnant, eligibility standards, meth-
23 odologies, or procedures under the State plan or waiver
24 that are more restrictive than the eligibility standards,
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1 plan or waiver that are in effect on the date of enactment
2 of this paragraph.’’.
3 (ii) CHIP.—Section 2105(d) of the
4 Social Security Act (42 U.S.C. 1397ee(d))
5 is amended by adding at the end the fol-
6 lowing new paragraph:
7 ‘‘(4) IN ELIGIBILITY STANDARDS FOR TAR-
8 GETED LOW-INCOME PREGNANT WOMEN.—During
9 the period that begins on the date of enactment of
10 this paragraph and ends on the date that is five
11 years after such date of enactment, as a condition
12 of receiving payments under subsection (a) and sec-
13 tion 1903(a), a State that elects to provide assist-
14 ance to women on the basis of being pregnant (in-
15 cluding pregnancy-related assistance provided to tar-
16 geted low-income pregnant women (as defined in
17 section 2112(d)), pregnancy-related assistance pro-
18 vided to women who are eligible for such assistance
19 through application of section 1902(v)(4)(A)(i)
20 under section 2107(e)(1), or any other assistance
21 under the State child health plan (or a waiver of
22 such plan) which is provided to women on the basis
23 of being pregnant) shall not have in effect, with re-
24 spect to such women, eligibility standards, meth-
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25 odologies, or procedures under such plan (or waiver)
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1 that are more restrictive than the eligibility stand-
2 ards, methodologies, or procedures, respectively,
3 under such plan (or waiver) that are in effect on the
4 date of enactment of this paragraph.’’.
5 (F) INFORMATION ON BENEFITS.—The
6 Secretary of Health and Human Services shall
7 make publicly available on the internet website
8 of the Department of Health and Human Serv-
9 ices, information regarding benefits available to
10 pregnant and postpartum women and under the
11 Medicaid program and the Children’s Health
12 Insurance Program, including information on—
13 (i) benefits that States are required to
14 provide to pregnant and postpartum
15 women under such programs;
16 (ii) optional benefits that States may
17 provide to pregnant and postpartum
18 women under such programs; and
19 (iii) the availability of different kinds
20 of benefits for pregnant and postpartum
21 women, including oral health and mental
22 health benefits, under such programs.
23 (G) FEDERAL FUNDING FOR COST OF EX-
24
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TENDED MEDICAID AND CHIP COVERAGE FOR
25 POSTPARTUM WOMEN.—
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1 (i) MEDICAID.—Section 1905 of the
2 Social Security Act (42 U.S.C. 1396d), as
3 amended by paragraph (1), is further
4 amended—
5 (I) in subsection (b), by striking
6 ‘‘and (aa)’’ and inserting ‘‘(aa), and
7 (ff)’’; and
8 (II) by adding at the end the fol-
9 lowing:
10 ‘‘(ff) INCREASED FMAP FOR EXTENDED MEDICAL
11 ASSISTANCE FOR POSTPARTUM WOMEN.—Notwith-
12 standing subsection (b), the Federal medical assistance
13 percentage for a State, with respect to amounts expended
14 by such State for medical assistance for a woman who is
15 eligible for such assistance on the basis of being pregnant
16 or having been pregnant that is provided during the 305-
17 day period that begins on the 60th day after the last day
18 of her pregnancy (including any such assistance provided
19 during the month in which such period ends), shall be
20 equal to—
21 ‘‘(1) 100 percent for the first 20 calendar quar-
22 ters during which this subsection is in effect; and
23 ‘‘(2) 90 percent for calendar quarters there-
24 after.’’.
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1 (ii) CHIP.—Section 2105(c) of the
2 Social Security Act (42 U.S.C. 1397ee(c))
3 is amended by adding at the end the fol-
4 lowing new paragraph:
5 ‘‘(12) ENHANCED PAYMENT FOR EXTENDED
6 ASSISTANCE PROVIDED TO PREGNANT WOMEN.—
7 Notwithstanding subsection (b), the enhanced
8 FMAP, with respect to payments under subsection
9 (a) for expenditures under the State child health
10 plan (or a waiver of such plan) for assistance pro-
11 vided under the plan (or waiver) to a woman who is
12 eligible for such assistance on the basis of being
13 pregnant (including pregnancy-related assistance
14 provided to a targeted low-income pregnant woman
15 (as defined in section 2112(d)), pregnancy-related
16 assistance provided to a woman who is eligible for
17 such assistance through application of section
18 1902(v)(4)(A)(i) under section 2107(e)(1), or any
19 other assistance under the plan (or waiver) provided
20 to a woman who is eligible for such assistance on the
21 basis of being pregnant) during the 305-day period
22 that begins on the 60th day after the last day of her
23 pregnancy (including any such assistance provided
24 during the month in which such period ends), shall
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25 be equal to—
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1 ‘‘(A) 100 percent for the first 20 calendar
2 quarters during which this paragraph is in ef-
3 fect; and
4 ‘‘(B) 90 percent for calendar quarters
5 thereafter.’’.
6 (H) EFFECTIVE DATE.—
7 (i) IN GENERAL.—Subject to subpara-
8 graph (B), the amendments made by this
9 subsection shall take effect on the first day
10 of the first calendar quarter that begins on
11 or after the date that is one year after the
12 date of enactment of this Act.
13 (ii) EXCEPTION FOR STATE LEGISLA-
14 TION.—In the case of a State plan under
15 title XIX of the Social Security Act or a
16 State child health plan under title XXI of
17 such Act that the Secretary of Health and
18 Human Services determines requires State
19 legislation in order for the respective plan
20 to meet any requirement imposed by
21 amendments made by this subsection, the
22 respective plan shall not be regarded as
23 failing to comply with the requirements of
24 such title solely on the basis of its failure
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25 to meet such an additional requirement be-
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1 fore the first day of the first calendar
2 quarter beginning after the close of the
3 first regular session of the State legislature
4 that begins after the date of enactment of
5 this Act. For purposes of the previous sen-
6 tence, in the case of a State that has a 2-
7 year legislative session, each year of the
8 session shall be considered to be a separate
9 regular session of the State legislature.
10 (6) REGIONAL CENTERS OF EXCELLENCE.—
11 Part P of title III of the Public Health Service Act
12 is amended by adding at the end the following new
13 section:
14 ‘‘SEC. 399V–7. REGIONAL CENTERS OF EXCELLENCE AD-
15 DRESSING IMPLICIT BIAS AND CULTURAL
16 COMPETENCY IN PATIENT-PROVIDER INTER-
17 ACTIONS EDUCATION.
18 ‘‘(a) IN GENERAL.—Not later than one year after the
19 date of enactment of this section, the Secretary, in con-
20 sultation with such other agency heads as the Secretary
21 determines appropriate, shall award cooperative agree-
22 ments for the establishment or support of regional centers
23 of excellence addressing implicit bias and cultural com-
24 petency in patient-provider interactions education for the
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25 purpose of enhancing and improving how health care pro-
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1 fessionals are educated in implicit bias and delivering cul-
2 turally competent health care.
3 ‘‘(b) ELIGIBILITY.—To be eligible to receive a cooper-
4 ative agreement under subsection (a), an entity shall—
5 ‘‘(1) be a public or other nonprofit entity speci-
6 fied by the Secretary that provides educational and
7 training opportunities for students and health care
8 professionals, which may be a health system, teach-
9 ing hospital, community health center, medical
10 school, school of public health, dental school, social
11 work school, school of professional psychology, or
12 any other health professional school or program at
13 an institution of higher education (as defined in sec-
14 tion 101 of the Higher Education Act of 1965) fo-
15 cused on the prevention, treatment, or recovery of
16 health conditions that contribute to maternal mor-
17 tality and the prevention of maternal mortality and
18 severe maternal morbidity;
19 ‘‘(2) demonstrate community engagement and
20 participation, such as through partnerships with
21 home visiting and case management programs; and
22 ‘‘(3) provide to the Secretary such information,
23 at such time and in such manner, as the Secretary
24 may require.
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1 ‘‘(c) DIVERSITY.—In awarding a cooperative agree-
2 ment under subsection (a), the Secretary shall take into
3 account any regional differences among eligible entities
4 and make an effort to ensure geographic diversity among
5 award recipients.
6 ‘‘(d) DISSEMINATION OF INFORMATION.—
7 ‘‘(1) PUBLIC AVAILABILITY.—The Secretary
8 shall make publicly available on the internet website
9 of the Department of Health and Human Services
10 information submitted to the Secretary under sub-
11 section (b)(3).
12 ‘‘(2) EVALUATION.—The Secretary shall evalu-
13 ate each regional center of excellence established or
14 supported pursuant to subsection (a) and dissemi-
15 nate the findings resulting from each such evalua-
16 tion to the appropriate public and private entities.
17 ‘‘(3) DISTRIBUTION.—The Secretary shall share
18 evaluations and overall findings with State depart-
19 ments of health and other relevant State level offices
20 to inform State and local best practices.
21 ‘‘(e) MATERNAL MORTALITY DEFINED.—In this sec-
22 tion, the term ‘maternal mortality’ means death of a
23 woman that occurs during pregnancy or within the one-
24 year period following the end of such pregnancy.
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1 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—For
2 purposes of carrying out this section, there is authorized
3 to be appropriated $5,000,000 for each of fiscal years
4 2021 through 2025.’’.
5 (7) SPECIAL SUPPLEMENTAL NUTRITION PRO-
6 GRAM FOR WOMEN, INFANTS, AND CHILDREN.—Sec-
7 tion 17(d)(3)(A)(ii) of the Child Nutrition Act of
8 1966 (42 U.S.C. 1786(d)(3)(A)(ii)) is amended—
9 (A) by striking the clause designation and
10 heading and all that follows through ‘‘A State’’
11 and inserting the following:
12 ‘‘(ii) WOMEN.—
13 ‘‘(I) BREASTFEEDING WOMEN.—
14 A State’’;
15 (B) in subclause (I) (as so designated), by
16 striking ‘‘1 year’’ and all that follows through
17 ‘‘earlier’’ and inserting ‘‘2 years postpartum’’;
18 and
19 (C) by adding at the end the following:
20 ‘‘(II) POSTPARTUM WOMEN.—A
21 State may elect to certify a
22 postpartum woman for a period of 2
23 years.’’.
24 (8) DEFINITIONS.—In this section:
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1 (A) MATERNAL MORTALITY.—The term
2 ‘‘maternal mortality’’ means death of a woman
3 that occurs during pregnancy or within the one-
4 year period following the end of such preg-
5 nancy.
6 (B) SEVERE MATERNAL MORBIDITY.—The
7 term ‘‘severe maternal morbidity’’ includes un-
8 expected outcomes of labor and delivery that re-
9 sult in significant short-term or long-term con-
10 sequences to a woman’s health.
11 (d) INCREASING EXCISE TAXES ON CIGARETTES AND
12 ESTABLISHING EXCISE TAX EQUITY AMONG ALL TO-
13 BACCO PRODUCT TAX RATES.—
14 (1) TAX PARITY FOR ROLL-YOUR-OWN TO-
15 BACCO.—Section 5701(g) of the Internal Revenue
16 Code of 1986 is amended by striking ‘‘$24.78’’ and
17 inserting ‘‘$49.56’’.
18 (2) TAX PARITY FOR PIPE TOBACCO.—Section
19 5701(f) of the Internal Revenue Code of 1986 is
20 amended by striking ‘‘$2.8311 cents’’ and inserting
21 ‘‘$49.56’’.
22 (3) TAX PARITY FOR SMOKELESS TOBACCO.—
23 (A) Section 5701(e) of the Internal Rev-
24 enue Code of 1986 is amended—
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1 (i) in paragraph (1), by striking
2 ‘‘$1.51’’ and inserting ‘‘$26.84’’;
3 (ii) in paragraph (2), by striking
4 ‘‘50.33 cents’’ and inserting ‘‘$10.74’’; and
5 (iii) by adding at the end the fol-
6 lowing:
7 ‘‘(3) SMOKELESS TOBACCO SOLD IN DISCRETE
8 SINGLE-USE UNITS.—On discrete single-use units,
9 $100.66 per thousand.’’.
10 (B) Section 5702(m) of such Code is
11 amended—
12 (i) in paragraph (1), by striking ‘‘or
13 chewing tobacco’’ and inserting ‘‘, chewing
14 tobacco, or discrete single-use unit’’;
15 (ii) in paragraphs (2) and (3), by in-
16 serting ‘‘that is not a discrete single-use
17 unit’’ before the period in each such para-
18 graph; and
19 (iii) by adding at the end the fol-
20 lowing:
21 ‘‘(4) DISCRETE SINGLE-USE UNIT.—The term
22 ‘discrete single-use unit’ means any product con-
23 taining tobacco that—
24 ‘‘(A) is not intended to be smoked; and
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1 ‘‘(B) is in the form of a lozenge, tablet,
2 pill, pouch, dissolvable strip, or other discrete
3 single-use or single-dose unit.’’.
4 (4) TAX PARITY FOR SMALL CIGARS.—Para-
5 graph (1) of section 5701(a) of the Internal Revenue
6 Code of 1986 is amended by striking ‘‘$50.33’’ and
7 inserting ‘‘$100.66’’.
8 (5) TAX PARITY FOR LARGE CIGARS.—
9 (A) IN GENERAL.—Paragraph (2) of sec-
10 tion 5701(a) of the Internal Revenue Code of
11 1986 is amended by striking ‘‘52.75 percent’’
12 and all that follows through the period and in-
13 serting the following: ‘‘$49.56 per pound and a
14 proportionate tax at the like rate on all frac-
15 tional parts of a pound but not less than
16 10.066 cents per cigar.’’.
17 (B) GUIDANCE.—The Secretary of the
18 Treasury, or the Secretary’s delegate, may issue
19 guidance regarding the appropriate method for
20 determining the weight of large cigars for pur-
21 poses of calculating the applicable tax under
22 section 5701(a)(2) of the Internal Revenue
23 Code of 1986.
24 (6) TAX PARITY FOR ROLL-YOUR-OWN TOBACCO
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25 AND CERTAIN PROCESSED TOBACCO.—Subsection (o)
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1 of section 5702 of the Internal Revenue Code of
2 1986 is amended by inserting ‘‘, and includes proc-
3 essed tobacco that is removed for delivery or deliv-
4 ered to a person other than a person with a permit
5 provided under section 5713, but does not include
6 removals of processed tobacco for exportation’’ after
7 ‘‘wrappers thereof’’.
8 (7) CLARIFYING TAX RATE FOR OTHER TO-
9 BACCO PRODUCTS.—
10 (A) IN GENERAL.—Section 5701 of the In-
11 ternal Revenue Code of 1986 is amended by
12 adding at the end the following new subsection:
13 ‘‘(i) OTHER TOBACCO PRODUCTS.—Any product not
14 otherwise described under this section that has been deter-
15 mined to be a tobacco product by the Food and Drug Ad-
16 ministration through its authorities under the Family
17 Smoking Prevention and Tobacco Control Act shall be
18 taxed at a level of tax equivalent to the tax rate for ciga-
19 rettes on an estimated per use basis as determined by the
20 Secretary.’’.
21 (B) ESTABLISHING PER USE BASIS.—For
22 purposes of section 5701(i) of the Internal Rev-
23 enue Code of 1986, not later than 12 months
24 after the later of the date of the enactment of
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25 this Act or the date that a product has been de-
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1 termined to be a tobacco product by the Food
2 and Drug Administration, the Secretary of the
3 Treasury (or the Secretary of the Treasury’s
4 delegate) shall issue final regulations estab-
5 lishing the level of tax for such product that is
6 equivalent to the tax rate for cigarettes on an
7 estimated per use basis.
8 (8) CLARIFYING DEFINITION OF TOBACCO
9 PRODUCTS.—
10 (A) IN GENERAL.—Subsection (c) of sec-
11 tion 5702 of the Internal Revenue Code of 1986
12 is amended to read as follows:
13 ‘‘(c) TOBACCO PRODUCTS.—The term ‘tobacco prod-
14 ucts’ means—
15 ‘‘(1) cigars, cigarettes, smokeless tobacco, pipe
16 tobacco, and roll-your-own tobacco, and
17 ‘‘(2) any other product subject to tax pursuant
18 to section 5701(i).’’.
19 (B) CONFORMING AMENDMENTS.—Sub-
20 section (d) of section 5702 of such Code is
21 amended by striking ‘‘cigars, cigarettes, smoke-
22 less tobacco, pipe tobacco, or roll-your-own to-
23 bacco’’ each place it appears and inserting ‘‘to-
24 bacco products’’.
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25 (9) INCREASING TAX ON CIGARETTES.—
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1 (A) SMALL CIGARETTES.—Section
2 5701(b)(1) of such Code is amended by striking
3 ‘‘$50.33’’ and inserting ‘‘$100.66’’.
4 (B) LARGE CIGARETTES.—Section
5 5701(b)(2) of such Code is amended by striking
6 ‘‘$105.69’’ and inserting ‘‘$211.38’’.
7 (10) TAX RATES ADJUSTED FOR INFLATION.—
8 Section 5701 of such Code, as amended by sub-
9 section (g), is amended by adding at the end the fol-
10 lowing new subsection:
11 ‘‘(j) INFLATION ADJUSTMENT.—
12 ‘‘(1) IN GENERAL.—In the case of any calendar
13 year beginning after 2021, the dollar amounts pro-
14 vided under this chapter shall each be increased by
15 an amount equal to—
16 ‘‘(A) such dollar amount, multiplied by
17 ‘‘(B) the cost-of-living adjustment deter-
18 mined under section 1(f)(3) for the calendar
19 year, determined by substituting ‘calendar year
20 2017’ for ‘calendar year 2016’ in subparagraph
21 (A)(ii) thereof.
22 ‘‘(2) ROUNDING.—If any amount as adjusted
23 under paragraph (1) is not a multiple of $0.01, such
24 amount shall be rounded to the next highest multiple
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25 of $0.01.’’.
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1 (11) FLOOR STOCKS TAXES.—
2 (A) IMPOSITION OF TAX.—On tobacco
3 products manufactured in or imported into the
4 United States which are removed before any tax
5 increase date and held on such date for sale by
6 any person, there is hereby imposed a tax in an
7 amount equal to the excess of—
8 (i) the tax which would be imposed
9 under section 5701 of the Internal Rev-
10 enue Code of 1986 on the article if the ar-
11 ticle had been removed on such date, over
12 (ii) the prior tax (if any) imposed
13 under section 5701 of such Code on such
14 article.
15 (B) CREDIT AGAINST TAX.—Each person
16 shall be allowed as a credit against the taxes
17 imposed by paragraph (1) an amount equal to
18 $500. Such credit shall not exceed the amount
19 of taxes imposed by paragraph (1) on such date
20 for which such person is liable.
21 (C) LIABILITY FOR TAX AND METHOD OF
22 PAYMENT.—
23 (i) LIABILITY FOR TAX.—A person
24 holding tobacco products on any tax in-
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25 crease date to which any tax imposed by
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1 paragraph (1) applies shall be liable for
2 such tax.
3 (ii) METHOD OF PAYMENT.—The tax
4 imposed by paragraph (1) shall be paid in
5 such manner as the Secretary shall pre-
6 scribe by regulations.
7 (iii) TIME FOR PAYMENT.—The tax
8 imposed by paragraph (1) shall be paid on
9 or before the date that is 120 days after
10 the effective date of the tax rate increase.
11 (D) ARTICLES IN FOREIGN TRADE
12 ZONES.—Notwithstanding the Act of June 18,
13 1934 (commonly known as the Foreign Trade
14 Zone Act, 48 Stat. 998, 19 U.S.C. 81a et seq.),
15 or any other provision of law, any article which
16 is located in a foreign trade zone on any tax in-
17 crease date shall be subject to the tax imposed
18 by paragraph (1) if—
19 (i) internal revenue taxes have been
20 determined, or customs duties liquidated,
21 with respect to such article before such
22 date pursuant to a request made under the
23 1st proviso of section 3(a) of such Act; or
24 (ii) such article is held on such date
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25 under the supervision of an officer of the
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1 United States Customs and Border Protec-
2 tion of the Department of Homeland Secu-
3 rity pursuant to the 2d proviso of such sec-
4 tion 3(a).
5 (E) DEFINITIONS.—For purposes of this
6 subsection—
7 (i) IN GENERAL.—Any term used in
8 this subsection which is also used in sec-
9 tion 5702 of such Code shall have the
10 same meaning as such term has in such
11 section.
12 (ii) TAX INCREASE DATE.—The term
13 ‘‘tax increase date’’ means the effective
14 date of any increase in any tobacco prod-
15 uct excise tax rate pursuant to the amend-
16 ments made by this section (other than
17 subsection (j) thereof).
18 (iii) SECRETARY.—The term ‘‘Sec-
19 retary’’ means the Secretary of the Treas-
20 ury or the Secretary’s delegate.
21 (F) CONTROLLED GROUPS.—Rules similar
22 to the rules of section 5061(e)(3) of such Code
23 shall apply for purposes of this subsection.
24 (G) OTHER LAWS APPLICABLE.—All provi-
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1 respect to the taxes imposed by section 5701 of
2 such Code shall, insofar as applicable and not
3 inconsistent with the provisions of this sub-
4 section, apply to the floor stocks taxes imposed
5 by paragraph (1), to the same extent as if such
6 taxes were imposed by such section 5701. The
7 Secretary may treat any person who bore the
8 ultimate burden of the tax imposed by para-
9 graph (1) as the person to whom a credit or re-
10 fund under such provisions may be allowed or
11 made.
12 (12) EFFECTIVE DATES.—
13 (A) IN GENERAL.—Except as provided in
14 paragraphs (2) through (4), the amendments
15 made by this section shall apply to articles re-
16 moved (as defined in section 5702(j) of the In-
17 ternal Revenue Code of 1986) after the last day
18 of the month which includes the date of the en-
19 actment of this Act.
20 (B) DISCRETE SINGLE-USE UNITS AND
21 PROCESSED TOBACCO.—The amendments made
22 by subsections (c)(1)(C), (c)(2), and (f) shall
23 apply to articles removed (as defined in section
24 5702(j) of the Internal Revenue Code of 1986)
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1 after the date that is 6 months after the date
2 of the enactment of this Act.
3 (C) LARGE CIGARS.—The amendments
4 made by subsection (e) shall apply to articles
5 removed after December 31, 2021.
6 (D) OTHER TOBACCO PRODUCTS.—The
7 amendments made by subsection (g)(1) shall
8 apply to products removed after the last day of
9 the month which includes the date that the Sec-
10 retary of the Treasury (or the Secretary of the
11 Treasury’s delegate) issues final regulations es-
12 tablishing the level of tax for such product.
13 SEC. 504. ALLOWING FOR MEDICAL ASSISTANCE UNDER
14 MEDICAID FOR INMATES DURING 30-DAY PE-
15 RIOD PRECEDING RELEASE.
16 (a) IN GENERAL.—The subdivision (A) following
17 paragraph (30) of section 1905(a) of the Social Security
18 Act (42 U.S.C. 1396d(a)) is amended by inserting ‘‘and
19 except during the 30-day period preceding the date of re-
20 lease of such individual from such public institution’’ after
21 ‘‘medical institution’’.
22 (b) REPORT.—Not later than June 30, 2022, the
23 Medicaid and CHIP Payment and Access Commission
24 shall submit a report to Congress on the Medicaid inmate
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25 exclusion under the subdivision (A) following paragraph
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1 (30) of section 1905(a) of the Social Security Act (42
2 U.S.C. 1396d(a)). Such report may, to the extent prac-
3 ticable, include the following information:
4 (1) The number of incarcerated individuals who
5 would otherwise be eligible to enroll for medical as-
6 sistance under a State plan approved under title
7 XIX of the Social Security Act (42 U.S.C. 1396 et
8 seq.) (or a waiver of such a plan).
9 (2) Access to health care for incarcerated indi-
10 viduals, including a description of medical services
11 generally available to incarcerated individuals.
12 (3) A description of current practices related to
13 the discharge of incarcerated individuals, including
14 how prisons interact with State Medicaid agencies to
15 ensure that such individuals who are eligible to en-
16 roll for medical assistance under a State plan or
17 waiver described in paragraph (1) are so enrolled.
18 (4) If determined appropriate by the Commis-
19 sion, recommendations for Congress, the Depart-
20 ment of Health and Human Services, or States re-
21 garding the Medicaid inmate exclusion.
22 (5) Any other information that the Commission
23 determines would be useful to Congress.
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1 SEC. 505. PROVIDING FOR IMMEDIATE MEDICAID ELIGI-
2 BILITY FOR FORMER FOSTER YOUTH.
3 Section 1002(a)(2) of the SUPPORT for Patients
4 and Communities Act (Public Law 115–271) is amended
5 by striking ‘‘January 1, 2023’’ and inserting ‘‘the date
6 of enactment of the Ending Health Disparities During
7 COVID–19 Act of 2020’’.
8 SEC. 506. EXPANDED COVERAGE FOR FORMER FOSTER
9 YOUTH.
10 (a) COVERAGE CONTINUITY FOR FORMER FOSTER
11 CARE CHILDREN UP TO AGE 26.—
12 (1) IN GENERAL.—Section 1002(a)(1)(B) of the
13 SUPPORT for Patients and Communities Act (Pub-
14 lic Law 115–271) is amended by striking all that
15 follows after ‘‘item (cc),’’ and inserting the following:
16 ‘‘by striking ‘responsibility of the State’ and all that
17 follows through ‘475(8)(B)(iii); and’ and inserting
18 ‘responsibility of a State on the date of attaining 18
19 years of age (or such higher age as such State has
20 elected under section 475(8)(B)(iii)), or who were in
21 such care at any age but subsequently left such care
22 to enter into a legal guardianship with a kinship
23 caregiver (without regard to whether kinship guard-
24 ianship payments are being made on behalf of the
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25 child under this part) or were emancipated from
26 such care prior to attaining age 18;’ ’’.
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1 (2) AMENDMENTS TO SOCIAL SECURITY ACT.—
2 (A) IN GENERAL.—Section
3 1902(a)(10)(A)(i)(IX) of the Social Security
4 Act (42 U.S.C. 1396a(a)(10)(A)(i)(IX)), as
5 amended by section 1002(a) of the SUPPORT
6 for Patients and Communities Act (Public Law
7 115–271), is amended—
8 (i) in item (bb), by striking the semi-
9 colon at the end and inserting ‘‘; and’’; and
10 (ii) by striking item (dd).
11 (B) EFFECTIVE DATE.—The amendments
12 made by this paragraph shall take effect on
13 January 1, 2023.
14 (b) OUTREACH EFFORTS FOR ENROLLMENT OF
15 FORMER FOSTER CHILDREN.—Section 1902(a) of the So-
16 cial Security Act (42 U.S.C. 1396a(a)) is amended—
17 (1) in paragraph (85), by striking ‘‘; and’’ and
18 inserting a semicolon;
19 (2) in paragraph (86), by striking the period at
20 the end and inserting ‘‘; and’’; and
21 (3) by inserting after paragraph (86) the fol-
22 lowing new paragraph:
23 ‘‘(87) not later than January 1, 2020, establish
24 an outreach and enrollment program, in coordination
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25 with the State agency responsible for administering
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1 the State plan under part E of title IV and any
2 other appropriate or interested agencies, designed to
3 increase the enrollment of individuals who are eligi-
4 ble for medical assistance under the State plan
5 under paragraph (10)(A)(i)(IX) in accordance with
6 best practices established by the Secretary.’’.
7 SEC. 507. REMOVING CITIZENSHIP AND IMMIGRATION BAR-
8 RIERS TO ACCESS TO AFFORDABLE HEALTH
9 CARE UNDER ACA.
10 (a) IN GENERAL.—
11 (1) PREMIUM TAX CREDITS.—Section 36B of
12 the Internal Revenue Code of 1986 is amended—
13 (A) in subsection (c)(1)(B)—
14 (i) by amending the heading to read
15 as follows: ‘‘SPECIAL RULE FOR CERTAIN
16 INDIVIDUALS INELIGIBLE FOR MEDICAID
17 DUE TO STATUS’’, and
18 (ii) in clause (ii), by striking ‘‘lawfully
19 present in the United States, but’’ and in-
20 serting ‘‘who’’, and
21 (B) by striking subsection (e).
22 (2) COST-SHARING REDUCTIONS.—Section 1402
23 of the Patient Protection and Affordable Care Act
24 (42 U.S.C. 18071) is amended by striking sub-
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25 section (e).
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1 (3) BASIC HEALTH PROGRAM ELIGIBILITY.—
2 Section 1331(e)(1)(B) of the Patient Protection and
3 Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is
4 amended by striking ‘‘lawfully present in the United
5 States’’.
6 (4) RESTRICTIONS ON FEDERAL PAYMENTS.—
7 Section 1412 of the Patient Protection and Afford-
8 able Care Act (42 U.S.C. 18082) is amended by
9 striking subsection (d).
10 (5) REQUIREMENT TO MAINTAIN MINIMUM ES-
11 SENTIAL COVERAGE.—Section 5000A(d) of the In-
12 ternal Revenue Code of 1986 is amended by striking
13 paragraph (3) and by redesignating paragraph (4)
14 as paragraph (3).
15 (b) CONFORMING AMENDMENTS.—
16 (1) Section 1411(a) of the Patient Protection
17 and Affordable Care Act (42 U.S.C. 18081(a)) is
18 amended by striking paragraph (1) and redesig-
19 nating paragraphs (2), (3), and (4) as paragraphs
20 (1), (2), and (3), respectively.
21 (2) Section 1312(f) of the Patient Protection
22 and Affordable Care Act (42 U.S.C. 18032(f)) is
23 amended—
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1 (A) in the heading, by striking ‘‘; ACCESS
2 LIMITED TO CITIZENS AND LAWFUL RESI-
3 DENTS’’; and
4 (B) by striking paragraph (3).
5 SEC. 508. MEDICAID IN THE TERRITORIES.
6 (a) ELIMINATION OF GENERAL MEDICAID FUNDING
7 LIMITATIONS (‘‘CAP’’) FOR TERRITORIES.—
8 (1) IN GENERAL.—Section 1108 of the Social
9 Security Act (42 U.S.C. 1308) is amended—
10 (A) in subsection (f), in the matter pre-
11 ceding paragraph (1), by striking ‘‘subsection
12 (g)’’ and inserting ‘‘subsections (g) and (h)’’;
13 (B) in subsection (g)(2), in the matter pre-
14 ceding subparagraph (A), by inserting ‘‘and
15 subsection (h)’’ after ‘‘paragraphs (3) and (5)’’;
16 and
17 (C) by adding at the end the following new
18 subsection:
19 ‘‘(h) SUNSET OF MEDICAID FUNDING LIMITATIONS
20 FOR PUERTO RICO, THE VIRGIN ISLANDS OF THE
21 UNITED STATES, GUAM, THE NORTHERN MARIANA IS-
22 LANDS, AND AMERICAN SAMOA.—Subsections (f) and (g)
23 shall not apply to Puerto Rico, the Virgin Islands of the
24 United States, Guam, the Northern Mariana Islands, and
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25 American Samoa beginning with fiscal year 2020.’’.
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1 (2) CONFORMING AMENDMENTS.—
2 (A) Section 1902(j) of the Social Security
3 Act (42 U.S.C. 1396a(j)) is amended by strik-
4 ing ‘‘, the limitation in section 1108(f),’’.
5 (B) Section 1903(u) of the Social Security
6 Act (42 U.S.C. 1396b(u)) is amended by strik-
7 ing paragraph (4).
8 (C) Section 1323(c)(1) of the Patient Pro-
9 tection and Affordable Care Act (42 U.S.C.
10 18043(c)(1)) is amended by striking ‘‘2019’’
11 and inserting ‘‘2018’’.
12 (3) EFFECTIVE DATE.—The amendments made
13 by this section shall apply beginning with fiscal year
14 2021.
15 (b) ELIMINATION OF SPECIFIC FEDERAL MEDICAL
16 ASSISTANCE PERCENTAGE (FMAP) LIMITATION FOR
17 TERRITORIES.—Section 1905(b) of the Social Security
18 Act (42 U.S.C. 1396d(b)) is amended, in clause (2), by
19 inserting ‘‘for fiscal years before fiscal year 2020’’ after
20 ‘‘American Samoa’’.
21 (c) APPLICATION OF MEDICAID WAIVER AUTHORITY
22 TO ALL OF THE TERRITORIES.—
23 (1) IN GENERAL.—Section 1902(j) of the Social
24 Security Act (42 U.S.C. 1396a(j)) is amended—
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1 (A) by striking ‘‘American Samoa and the
2 Northern Mariana Islands’’ and inserting
3 ‘‘Puerto Rico, the Virgin Islands of the United
4 States, Guam, the Northern Mariana Islands,
5 and American Samoa’’;
6 (B) by striking ‘‘American Samoa or the
7 Northern Mariana Islands’’ and inserting
8 ‘‘Puerto Rico, the Virgin Islands of the United
9 States, Guam, the Northern Mariana Islands,
10 or American Samoa’’;
11 (C) by inserting ‘‘(1)’’ after ‘‘(j)’’;
12 (D) by inserting ‘‘except as otherwise pro-
13 vided in this subsection,’’ after ‘‘Notwith-
14 standing any other requirement of this title’’;
15 and
16 (E) by adding at the end the following:
17 ‘‘(2) The Secretary may not waive under this
18 subsection the requirement of subsection
19 (a)(10)(A)(i)(IX) (relating to coverage of adults for-
20 merly under foster care) with respect to any terri-
21 tory.’’.
22 (2) EFFECTIVE DATE.—The amendments made
23 by this section shall apply beginning October 1,
24 2021.
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1 (d) PERMITTING MEDICAID DSH ALLOTMENTS FOR
2 TERRITORIES.—Section 1923(f) of the Social Security Act
3 (42 U.S.C. 1396r–4) is amended—
4 (1) in paragraph (6), by adding at the end the
5 following new subparagraph:
6 ‘‘(C) TERRITORIES.—
7 ‘‘(i) FISCAL YEAR 2020.—For fiscal
8 year 2020, the DSH allotment for Puerto
9 Rico, the Virgin Islands of the United
10 States, Guam, the Northern Mariana Is-
11 lands, and American Samoa shall bear the
12 same ratio to $300,000,000 as the ratio of
13 the number of individuals who are low-in-
14 come or uninsured and residing in such re-
15 spective territory (as estimated from time
16 to time by the Secretary) bears to the
17 sums of the number of such individuals re-
18 siding in all of the territories.
19 ‘‘(ii) SUBSEQUENT FISCAL YEAR.—
20 For each subsequent fiscal year, the DSH
21 allotment for each such territory is subject
22 to an increase in accordance with para-
23 graph (2).’’; and
24 (2) in paragraph (9), by inserting before the pe-
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25 riod at the end the following: ‘‘, and includes, begin-
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1 ning with fiscal year 2021, Puerto Rico, the Virgin
2 Islands of the United States, Guam, the Northern
3 Mariana Islands, and American Samoa’’.
4 SEC. 509. REMOVING MEDICARE BARRIER TO HEALTH
5 CARE.
6 (a) PART A.—Section 1818(a)(3) of the Social Secu-
7 rity Act (42 U.S.C. 1395i–2(a)(3)) is amended by striking
8 ‘‘an alien’’ and all that follows through ‘‘under this sec-
9 tion’’ and inserting ‘‘an individual who is lawfully present
10 in the United States’’.
11 (b) PART B.—Section 1836(2) of the Social Security
12 Act (42 U.S.C. 1395o(2)) is amended by striking ‘‘an
13 alien’’ and all that follows through ‘‘under this part’’ and
14 inserting ‘‘an individual who is lawfully present in the
15 United States’’.
16 SEC. 510. REMOVING BARRIERS TO HEALTH CARE AND NU-
17 TRITION ASSISTANCE FOR CHILDREN, PREG-
18 NANT PERSONS, AND LAWFULLY PRESENT IN-
19 DIVIDUALS.
20 (a) MEDICAID.—Section 1903(v) of the Social Secu-
21 rity Act (42 U.S.C. 1396b(v)) is amended by striking
22 paragraph (4) and inserting the following new paragraph:
23 ‘‘(4)(A) Notwithstanding sections 401(a), 402(b),
24 403, and 421 of the Personal Responsibility and Work Op-
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25 portunity Reconciliation Act of 1996 and paragraph (1),
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1 payment shall be made to a State under this section for
2 medical assistance furnished to an alien under this title
3 (including an alien described in such paragraph) who
4 meets any of the following conditions:
5 ‘‘(i) The alien is otherwise eligible for such as-
6 sistance under the State plan approved under this
7 title (other than the requirement of the receipt of
8 aid or assistance under title IV, supplemental secu-
9 rity income benefits under title XVI, or a State sup-
10 plementary payment) within either or both of the
11 following eligibility categories:
12 ‘‘(I) Children under 21 years of age, in-
13 cluding any optional targeted low-income child
14 (as such term is defined in section
15 1905(u)(2)(B)).
16 ‘‘(II) Pregnant persons during pregnancy
17 and during the 12-month period beginning on
18 the last day of the pregnancy.
19 ‘‘(ii) The alien is lawfully present in the United
20 States.
21 ‘‘(B) No debt shall accrue under an affidavit of sup-
22 port against any sponsor of an alien who meets the condi-
23 tions specified in subparagraph (A) on the basis of the
24 provision of medical assistance to such alien under this
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1 paragraph and the cost of such assistance shall not be con-
2 sidered as an unreimbursed cost.’’.
3 (b) SCHIP.—Subparagraph (N) of section
4 2107(e)(1) of the Social Security Act (42 U.S.C.
5 1397gg(e)(1)) is amended to read as follows:
6 ‘‘(N) Paragraph (4) of section 1903(v) (re-
7 lating to coverage of categories of children,
8 pregnant persons, and other lawfully present in-
9 dividuals).’’.
10 (c) SUPPLEMENTAL NUTRITION ASSISTANCE.—Not-
11 withstanding sections 401(a), 402(a), and 403(a) of the
12 Personal Responsibility and Work Opportunity Reconcili-
13 ation Act of 1996 (8 U.S.C. 1611(a); 1612(a); 1613(a))
14 and section 6(f) of the Food and Nutrition Act of 2008
15 (7 U.S.C. 2015(f)), persons who are lawfully present in
16 the United States shall be not be ineligible for benefits
17 under the supplemental nutrition assistance program on
18 the basis of their immigration status or date of entry into
19 the United States.
20 (d) ELIGIBILITY FOR FAMILIES WITH CHILDREN.—
21 Section 421(d)(3) of the Personal Responsibility and
22 Work Opportunity Reconciliation Act of 1996 (8 U.S.C.
23 1631(d)(3)) is amended by striking ‘‘to the extent that
24 a qualified alien is eligible under section 402(a)(2)(J)’’
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25 and inserting, ‘‘to the extent that a child is a member of
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1 a household under the supplemental nutrition assistance
2 program’’.
3 (e) ENSURING PROPER SCREENING.—Section
4 11(e)(2)(B) of the Food and Nutrition Act of 2008 (7
5 U.S.C. 2020(e)(2)(B)) is amended—
6 (1) by redesignating clauses (vi) and (vii) as
7 clauses (vii) and (viii); and
8 (2) by inserting after clause (v) the following:
9 ‘‘(vi) shall provide a method for imple-
10 menting section 421 of the Personal Re-
11 sponsibility and Work Opportunity Rec-
12 onciliation Act of 1996 (8 U.S.C. 1631)
13 that does not require any unnecessary in-
14 formation from persons who may be ex-
15 empt from that provision;’’.
16 SEC. 511. REPEAL OF REQUIREMENT FOR DOCUMENTA-
17 TION EVIDENCING CITIZENSHIP OR NATION-
18 ALITY UNDER THE MEDICAID PROGRAM.
19 (a) REPEAL.—Subsections (i)(22) and (x) of section
20 1903 of the Social Security Act (42 U.S.C. 1396b) are
21 each repealed.
22 (b) CONFORMING AMENDMENTS.—
23 (1) STATE PAYMENTS FOR MEDICAL ASSIST-
24 ANCE.—Section 1902 of the Social Security Act (42
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25 U.S.C. 1396a) is amended—
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1 (A) by amending paragraph (46) of sub-
2 section (a) to read as follows:
3 ‘‘(46) provide that information is requested and
4 exchanged for purposes of income and eligibility
5 verification in accordance with a State system which
6 meets the requirements of section 1137 of this
7 Act;’’;
8 (B) in subsection (e)(13)(A)(i)—
9 (i) in the matter preceding subclause
10 (I), by striking ‘‘sections 1902(a)(46)(B)
11 and 1137(d)’’ and inserting ‘‘section
12 1137(d)’’; and
13 (ii) in subclause (IV), by striking
14 ‘‘1902(a)(46)(B) or’’; and
15 (C) by striking subsection (ee).
16 (2) PAYMENT TO STATES.—Section 1903 of the
17 Social Security Act (42 U.S.C. 1396b) is amended—
18 (A) in subsection (i), by redesignating
19 paragraphs (23) through (26) as paragraphs
20 (22) through (25), respectively; and
21 (B) by redesignating subsections (y) and
22 (z) as subsections (x) and (y), respectively.
23 (3) REPEAL.—Subsection (c) of section 6036 of
24 the Deficit Reduction Act of 2005 (42 U.S.C. 1396b
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25 note) is repealed.
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1 (c) EFFECTIVE DATE.—The amendments made by
2 this section shall take effect as if included in the enact-
3 ment of the Deficit Reduction Act of 2005.
4 TITLE VI—COMMUNITY BASED
5 GRANTS
6 SEC. 601. GRANTS FOR RACIAL AND ETHNIC APPROACHES
7 TO COMMUNITY HEALTH.
8 (a) PURPOSE.—It is the purpose of this section to
9 award grants to assist communities in mobilizing and or-
10 ganizing resources in support of effective and sustainable
11 programs that will reduce or eliminate disparities in health
12 and health care experienced by racial and ethnic minority
13 individuals.
14 (b) AUTHORITY TO AWARD GRANTS.—The Secretary
15 of Health and Human Services, acting through the Ad-
16 ministrator of the Health Resources and Services Admin-
17 istration (referred to in this section as the ‘‘Secretary’’),
18 shall award grants to eligible entities to assist in design-
19 ing, implementing, and evaluating culturally and linguis-
20 tically appropriate, science-based, and community-driven
21 sustainable strategies to eliminate racial and ethnic health
22 and health care disparities.
23 (c) ELIGIBLE ENTITIES.—To be eligible to receive a
24 grant under this section, an entity shall—
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25 (1) represent a coalition—
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1 (A) whose principal purpose is to develop
2 and implement interventions to reduce or elimi-
3 nate a health or health care disparity in a tar-
4 geted racial or ethnic minority group in the
5 community served by the coalition; and
6 (B) that includes—
7 (i) members selected from among—
8 (I) public health departments;
9 (II) community-based organiza-
10 tions;
11 (III) university and research or-
12 ganizations;
13 (IV) Indian tribes or tribal orga-
14 nizations (as such terms are defined
15 in section 4 of the Indian Self-Deter-
16 mination and Education Assistance
17 Act (25 U.S.C. 5304)), the Indian
18 Health Service, or any other organiza-
19 tion that serves Alaska Natives; and
20 (V) interested public or private
21 health care providers or organizations
22 as determined appropriate by the Sec-
23 retary; and
24 (ii) at least 1 member from a commu-
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1 targeted racial or ethnic minority group;
2 and
3 (2) submit to the Secretary an application at
4 such time, in such manner, and containing such in-
5 formation as the Secretary may require, which shall
6 include—
7 (A) a description of the targeted racial or
8 ethnic populations in the community to be
9 served under the grant;
10 (B) a description of at least 1 health dis-
11 parity that exists in the racial or ethnic tar-
12 geted populations, including health issues such
13 as infant mortality, breast and cervical cancer
14 screening and management, musculoskeletal
15 diseases and obesity, prostate cancer screening
16 and management, cardiovascular disease, diabe-
17 tes, child and adult immunization levels, oral
18 disease, or other health priority areas as des-
19 ignated by the Secretary; and
20 (C) a demonstration of a proven record of
21 accomplishment of the coalition members in
22 serving and working with the targeted commu-
23 nity.
24 (d) SUSTAINABILITY.—The Secretary shall give pri-
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1 agrees that, with respect to the costs to be incurred by
2 the entity in carrying out the activities for which the grant
3 was awarded, the entity (and each of the participating
4 partners in the coalition represented by the entity) will
5 maintain its expenditures of non-Federal funds for such
6 activities at a level that is not less than the level of such
7 expenditures during the fiscal year immediately preceding
8 the first fiscal year for which the grant is awarded.
9 (e) NONDUPLICATION.—Any funds provided to an eli-
10 gible entity through a grant under this section shall—
11 (1) supplement, not supplant, any other Federal
12 funds made available to the entity for the purposes
13 of this section; and
14 (2) not be used to duplicate the activities of any
15 other health disparity grant program under this Act,
16 including an amendment made by this Act.
17 (f) TECHNICAL ASSISTANCE.—The Secretary may,
18 either directly or by grant or contract, provide any entity
19 that receives a grant under this section with technical and
20 other nonfinancial assistance necessary to meet the re-
21 quirements of this section.
22 (g) DISSEMINATION.—The Secretary shall encourage
23 and enable eligible entities receiving grants under this sec-
24 tion to share best practices, evaluation results, and reports
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1 using the Internet, conferences, and other pertinent infor-
2 mation regarding the projects funded by this section, in-
3 cluding through using outreach efforts of the Office of Mi-
4 nority Health and the Centers for Disease Control and
5 Prevention.
6 (h) ADMINISTRATIVE BURDENS.—The Secretary
7 shall make every effort to minimize duplicative or unneces-
8 sary administrative burdens on eligible entities receiving
9 grants under this section.
10 (i) AUTHORIZATION OF APPROPRIATIONS.—There
11 are authorized to be appropriated such sums as may be
12 necessary to carry out this section.
13 SEC. 602. GRANTS TO PROMOTE HEALTH FOR UNDER-
14 SERVED COMMUNITIES.
15 Part Q of title III of the Public Health Service Act
16 (42 U.S.C. 280g et seq.) is amended by adding at the end
17 the following:
18 ‘‘SEC. 399Z–3. GRANTS TO PROMOTE HEALTH FOR UNDER-
19 SERVED COMMUNITIES.
20 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col-
21 laboration with the Administrator of the Health Resources
22 and Services Administration and other Federal officials
23 determined appropriate by the Secretary, is authorized to
24 award grants to eligible entities—
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1 ‘‘(1) to promote health for underserved commu-
2 nities, with preference given to projects that benefit
3 racial and ethnic minority women, racial and ethnic
4 minority children, adolescents, and lesbian, gay, bi-
5 sexual, transgender, queer, or questioning commu-
6 nities; and
7 ‘‘(2) to strengthen health outreach initiatives in
8 medically underserved communities, including lin-
9 guistically isolated populations.
10 ‘‘(b) USE OF FUNDS.—Grants awarded pursuant to
11 subsection (a) may be used to support the activities of
12 community health workers, including such activities—
13 ‘‘(1) to educate and provide outreach regarding
14 enrollment in health insurance including the State
15 Children’s Health Insurance Program under title
16 XXI of the Social Security Act, Medicare under title
17 XVIII of such Act, and Medicaid under title XIX of
18 such Act;
19 ‘‘(2) to educate and provide outreach in a com-
20 munity setting regarding health problems prevalent
21 among underserved communities, and especially
22 among racial and ethnic minority women, racial and
23 ethnic minority children, adolescents, and lesbian,
24 gay, bisexual, transgender, queer, or questioning
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1 ‘‘(3) to educate and provide experiential learn-
2 ing opportunities and target risk factors and healthy
3 behaviors that impede or contribute to achieving
4 positive health outcomes, including—
5 ‘‘(A) healthy nutrition;
6 ‘‘(B) physical activity;
7 ‘‘(C) overweight or obesity;
8 ‘‘(D) tobacco use, including the use of e-
9 cigarettes and vaping;
10 ‘‘(E) alcohol and substance use;
11 ‘‘(F) injury and violence;
12 ‘‘(G) sexual health;
13 ‘‘(H) mental health;
14 ‘‘(I) musculoskeletal health and arthritis;
15 ‘‘(J) prenatal and postnatal care;
16 ‘‘(K) dental and oral health;
17 ‘‘(L) understanding informed consent;
18 ‘‘(M) stigma; and
19 ‘‘(N) environmental hazards;
20 ‘‘(4) to promote community wellness and aware-
21 ness; and
22 ‘‘(5) to educate and refer target populations to
23 appropriate health care agencies and community-
24 based programs and organizations in order to in-
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1 crease access to quality health care services, includ-
2 ing preventive health services.
3 ‘‘(c) APPLICATION.—
4 ‘‘(1) IN GENERAL.—Each eligible entity that
5 desires to receive a grant under subsection (a) shall
6 submit an application to the Secretary, at such time,
7 in such manner, and accompanied by such additional
8 information as the Secretary may require.
9 ‘‘(2) CONTENTS.—Each application submitted
10 pursuant to paragraph (1) shall—
11 ‘‘(A) describe the activities for which as-
12 sistance under this section is sought;
13 ‘‘(B) contain an assurance that, with re-
14 spect to each community health worker pro-
15 gram receiving funds under the grant awarded,
16 such program provides in-language training and
17 supervision to community health workers to en-
18 able such workers to provide authorized pro-
19 gram activities in (at least) the most commonly
20 used languages within a particular geographic
21 region;
22 ‘‘(C) contain an assurance that the appli-
23 cant will evaluate the effectiveness of commu-
24 nity health worker programs receiving funds
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25 under the grant;
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1 ‘‘(D) contain an assurance that each com-
2 munity health worker program receiving funds
3 under the grant will provide culturally com-
4 petent services in the linguistic context most
5 appropriate for the individuals served by the
6 program;
7 ‘‘(E) contain a plan to document and dis-
8 seminate project descriptions and results to
9 other States and organizations as identified by
10 the Secretary; and
11 ‘‘(F) describe plans to enhance the capac-
12 ity of individuals to utilize health services and
13 health-related social services under Federal,
14 State, and local programs by—
15 ‘‘(i) assisting individuals in estab-
16 lishing eligibility under the programs and
17 in receiving the services or other benefits
18 of the programs; and
19 ‘‘(ii) providing other services, as the
20 Secretary determines to be appropriate,
21 which may include transportation and
22 translation services.
23 ‘‘(d) PRIORITY.—In awarding grants under sub-
24 section (a), the Secretary shall give priority to those appli-
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1 ‘‘(1) who propose to target geographic areas
2 that—
3 ‘‘(A)(i) have a high percentage of residents
4 who are uninsured or underinsured (if the tar-
5 geted geographic area is located in a State that
6 has elected to make medical assistance available
7 under section 1902(a)(10)(A)(i)(VIII) of the
8 Social Security Act to individuals described in
9 such section);
10 ‘‘(ii) have a high percentage of under-
11 insured residents in a particular geographic
12 area (if the targeted geographic area is located
13 in a State that has not so elected); or
14 ‘‘(iii) have a high number of households ex-
15 periencing extreme poverty; and
16 ‘‘(B) have a high percentage of families for
17 whom English is not their primary language or
18 including smaller limited English-proficient
19 communities within the region that are not oth-
20 erwise reached by linguistically appropriate
21 health services;
22 ‘‘(2) with experience in providing health or
23 health-related social services to individuals who are
24 underserved with respect to such services; and
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1 ‘‘(3) with documented community activity and
2 experience with community health workers.
3 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU-
4 TIONS.—The Secretary shall encourage community health
5 worker programs receiving funds under this section to col-
6 laborate with academic institutions, including minority-
7 serving institutions. Nothing in this section shall be con-
8 strued to require such collaboration.
9 ‘‘(f) QUALITY ASSURANCE AND COST EFFECTIVE-
10 NESS.—The Secretary shall establish guidelines for ensur-
11 ing the quality of the training and supervision of commu-
12 nity health workers under the programs funded under this
13 section and for ensuring the cost effectiveness of such pro-
14 grams.
15 ‘‘(g) MONITORING.—The Secretary shall monitor
16 community health worker programs identified in approved
17 applications and shall determine whether such programs
18 are in compliance with the guidelines established under
19 subsection (f).
20 ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may
21 provide technical assistance to community health worker
22 programs identified in approved applications with respect
23 to planning, developing, and operating programs under the
24 grant.
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25 ‘‘(i) REPORT TO CONGRESS.—
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1 ‘‘(1) IN GENERAL.—Not later than 4 years
2 after the date on which the Secretary first awards
3 grants under subsection (a), the Secretary shall sub-
4 mit to Congress a report regarding the grant
5 project.
6 ‘‘(2) CONTENTS.—The report required under
7 paragraph (1) shall include the following:
8 ‘‘(A) A description of the programs for
9 which grant funds were used.
10 ‘‘(B) The number of individuals served.
11 ‘‘(C) An evaluation of—
12 ‘‘(i) the effectiveness of these pro-
13 grams;
14 ‘‘(ii) the cost of these programs; and
15 ‘‘(iii) the impact of these programs on
16 the health outcomes of the community resi-
17 dents.
18 ‘‘(D) Recommendations for sustaining the
19 community health worker programs developed
20 or assisted under this section.
21 ‘‘(E) Recommendations regarding training
22 to enhance career opportunities for community
23 health workers.
24 ‘‘(j) DEFINITIONS.—In this section:
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1 ‘‘(1) COMMUNITY HEALTH WORKER.—The term
2 ‘community health worker’ means an individual who
3 promotes health or nutrition within the community
4 in which the individual resides—
5 ‘‘(A) by serving as a liaison between com-
6 munities and health care agencies;
7 ‘‘(B) by providing guidance and social as-
8 sistance to community residents;
9 ‘‘(C) by enhancing community residents’
10 ability to effectively communicate with health
11 care providers;
12 ‘‘(D) by providing culturally and linguis-
13 tically appropriate health or nutrition edu-
14 cation;
15 ‘‘(E) by advocating for individual and com-
16 munity health, including dental, oral, mental,
17 and environmental health, or nutrition needs;
18 ‘‘(F) by taking into consideration the
19 needs of the communities served, including the
20 prevalence rates of risk factors that impede
21 achieving positive healthy outcomes among
22 women and children, especially among racial
23 and ethnic minority women and children; and
24 ‘‘(G) by providing referral and followup
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1 ‘‘(2) COMMUNITY SETTING.—The term ‘commu-
2 nity setting’ means a home or a community organi-
3 zation that serves a population.
4 ‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en-
5 tity’ means—
6 ‘‘(A) a unit of State, territorial, local, or
7 Tribal government (including a federally recog-
8 nized Tribe or Alaska Native village); or
9 ‘‘(B) a community-based organization.
10 ‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.—
11 The term ‘medically underserved community’ means
12 a community—
13 ‘‘(A) that has a substantial number of in-
14 dividuals who are members of a medically un-
15 derserved population, as defined by section
16 330(b)(3);
17 ‘‘(B) a significant portion of which is a
18 health professional shortage area as designated
19 under section 332; and
20 ‘‘(C) that includes populations that are lin-
21 guistically isolated, such as geographic areas
22 with a shortage of health professionals able to
23 provide linguistically appropriate services.
24 ‘‘(5) SUPPORT.—The term ‘support’ means the
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1 needed to effectively deliver the services described in
2 subsection (b), reimbursement for services, and
3 other benefits.
4 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There
5 are authorized to be appropriated to carry out this section
6 $15,000,000 for each of fiscal years 2021 through 2025.’’.
7 SEC. 603. ADDRESSING COVID–19 HEALTH INEQUITIES AND
8 IMPROVING HEALTH EQUITY.
9 (a) IN GENERAL.—Not later than 60 days after the
10 date of enactment of this Act, the Secretary of Health and
11 Human Services (referred to in this section as the ‘‘Sec-
12 retary’’), acting through the Director of the Centers for
13 Disease Control and Prevention, shall award grants to eli-
14 gible entities to establish or expand programs to improve
15 health equity regarding COVID–19 and reduce or elimi-
16 nate inequities, including racial and ethnic inequities, in
17 the incidence, prevalence, and health outcomes of COVID–
18 19.
19 (b) ELIGIBILITY.—To be eligible to receive a grant
20 under subsection (a), an entity shall—
21 (1) be a nongovernmental entity or consortium
22 of entities that works to improve health and health
23 equity in populations or communities disproportion-
24 ately affected by adverse health outcomes, includ-
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