S. 4486, Health Equity and Accountability Act of 2022
Summary
Senate bill 4486, the Health Equity and Accountability Act of 2022, is a bill to improve the health of minority individuals, and for other purposes. Booker introduced it on June 23, 2022, with cosponsors listed beginning with Warnock, Brown and Merkley, and it was read twice and referred to the Committee on Finance. The table of contents lists Title I on data collection and reporting, Title II on culturally and linguistically appropriate health and health care, and Title III on health workforce diversity. Sections in Title I include one on a Commission on Ensuring Data for Health Equity and one on data collection regarding pandemic preparedness, testing, infections, and deaths.
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Cite this document
“S. 4486, Health Equity and Accountability Act of 2022.”
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II
117TH CONGRESS
2D SESSION
S. 4486
To improve the health of minority individuals, and for other purposes.
IN THE SENATE OF THE UNITED STATES
JUNE 23, 2022
Mr. BOOKER (for himself, Mr. WARNOCK, Mr. BROWN, Mr. MERKLEY, Mr.
CARDIN, Mr. KAINE, Ms. HIRONO, Ms. WARREN, Ms. DUCKWORTH, Mrs.
GILLIBRAND, and Mr. SANDERS) introduced the following bill; which was
read twice and referred to the Committee on Finance
A BILL
To improve the health of minority individuals, and for other
purposes.
1 Be it enacted by the Senate and House of Representa-
2 tives of the United States of America in Congress assembled,
3 SECTION 1. SHORT TITLE.
4 This Act may be cited as the ‘‘Health Equity and
5 Accountability Act of 2022’’.
6 SEC. 2. TABLE OF CONTENTS.
7 The table of contents of this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
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Sec. 3. Findings.
TITLE I—DATA COLLECTION AND REPORTING
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Sec. 1001. Strengthening data collection, improving data analysis, and expand-
ing data reporting.
Sec. 1002. Elimination of prerequisite of direct appropriations for data collec-
tion and analysis.
Sec. 1003. Collection of data for the Medicare program.
Sec. 1004. Revision of HIPAA claims standards.
Sec. 1005. National Center for Health Statistics.
Sec. 1006. Disparities data collected by the Federal Government.
Sec. 1007. Data collection and analysis grants to minority-serving institutions.
Sec. 1008. Safety and effectiveness of drugs with respect to racial and ethnic
background.
Sec. 1009. Improving health data regarding Native Hawaiians and Pacific Is-
landers.
Sec. 1010. Clarification of simplified administrative reporting requirement.
Sec. 1011. Data collection regarding pandemic preparedness, testing, infections,
and deaths.
Sec. 1012. Commission on Ensuring Data for Health Equity.
Sec. 1013. Task Force on Preventing Bias in AI and Algorithms.
TITLE II—CULTURALLY AND LINGUISTICALLY APPROPRIATE
HEALTH AND HEALTH CARE
Sec. 2001. Definitions; findings.
Sec. 2002. Improving access to services for individuals with limited English
proficiency.
Sec. 2003. Ensuring standards for culturally and linguistically appropriate
services in health care.
Sec. 2004. Culturally and linguistically appropriate health care in the Public
Health Service Act.
Sec. 2005. Pilot program for improvement and development of State medical
interpreting services.
Sec. 2006. Training tomorrow’s doctors for culturally and linguistically appro-
priate care: graduate medical education.
Sec. 2007. Federal reimbursement for culturally and linguistically appropriate
services under the Medicare, Medicaid, and State Children’s
Health Insurance Programs.
Sec. 2008. Increasing understanding of and improving health literacy.
Sec. 2009. Requirements for health programs or activities receiving Federal
funds.
Sec. 2010. Report on Federal efforts to provide culturally and linguistically ap-
propriate health care services.
Sec. 2011. English instruction for individuals with limited English proficiency.
Sec. 2012. Implementation.
Sec. 2013. Language access services.
Sec. 2014. Medically underserved populations.
TITLE III—HEALTH WORKFORCE DIVERSITY
Sec. 3001. Amendment to the Public Health Service Act.
Sec. 3002. Hispanic-serving institutions, historically Black colleges and univer-
sities, historically Black professional or graduate institutions,
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Asian American and Native American Pacific Islander-serving
institutions, Tribal Colleges, regional community-based organi-
zations, and national minority medical associations.
Sec. 3003. Loan repayment program of Centers for Disease Control and Pre-
vention.
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Sec. 3004. Allied health workforce diversity.
Sec. 3005. Cooperative agreements for online degree programs at schools of
public health and schools of allied health.
Sec. 3006. National Health Care Workforce Commission.
Sec. 3007. Scholarship and fellowship programs.
Sec. 3008. McNair Postbaccalaureate Achievement Program.
Sec. 3009. Rules for determination of full-time equivalent residents for cost-re-
porting periods.
Sec. 3010. Developing and implementing strategies for local health equity.
Sec. 3011. Health Professions Workforce Fund.
Sec. 3012. Future advancement of academic nursing.
Sec. 3013. Findings; sense of Congress relating to graduate medical education.
Sec. 3014. Career support for skilled, internationally educated health profes-
sionals.
Sec. 3015. Study and report on strategies for increasing diversity.
Sec. 3016. Conrad State 30 program; physician retention.
Sec. 3017. National Hispanic Nurses Day.
Sec. 3018. Expanding medical education.
TITLE IV—IMPROVING HEALTH CARE ACCESS AND QUALITY
Sec. 4000. Definition.
Subtitle A—Reducing Barriers to Accessing Care
Sec. 4001. Protecting protected areas.
Sec. 4002. Repeal of requirement for documentation evidencing citizenship or
nationality under the Medicaid program.
Sec. 4003. Availability of basic assistance to lawfully present noncitizens.
Sec. 4004. Improve affordability and reduce premium costs of health insurance
for consumers.
Sec. 4005. Removing citizenship and immigration barriers to access to afford-
able health care under the ACA.
Sec. 4006. Removing barriers to access to affordable health care for lawfully re-
siding immigrants under Medicaid and CHIP.
Sec. 4007. Consistency in health insurance coverage for individuals with feder-
ally authorized presence, including deferred action.
Sec. 4008. Study on the uninsured.
Sec. 4009. Medicaid fallback coverage program for low-income adults in non-
expansion States.
Sec. 4010. Increase and extension of temporary enhanced FMAP for States
which begin to expend amounts for certain mandatory individ-
uals.
Subtitle B—Improvement of Coverage
Sec. 4101. Medicaid in the territories.
Sec. 4102. Extension of the Supplemental Security Income Program to Puerto
Rico, the United States Virgin Islands, Guam, and American
Samoa.
Sec. 4103. Extension of Medicare secondary payer.
Sec. 4104. Indian defined in title I of the Patient Protection and Affordable
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Care Act.
Sec. 4105. Removing Medicare barrier to health care.
Sec. 4106. Lowering Medicare premiums and prescription drug costs.
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Sec. 4107. Reducing cost-sharing, aligning income and resource eligibility tests,
simplifying enrollment, and other program improvements for
low-income beneficiaries.
Sec. 4108. 100 percent FMAP for medical assistance provided by urban Indian
organizations.
Sec. 4109. 100 percent FMAP for medical assistance provided to a Native Ha-
waiian through a federally qualified health center or a Native
Hawaiian health care system under the Medicaid program.
Sec. 4110. Repeal of requirement for estate recovery under the Medicaid pro-
gram.
Sec. 4111. Allow for suspension of Medicare benefits and premium liability for
individuals who are incarcerated and provide a special enroll-
ment period around the date of release.
Sec. 4112. Federal Employee Health Benefit Plans.
Sec. 4113. Continuation of Medicaid income eligibility standard for pregnant
individuals and infants.
Subtitle C—Expansion of Access
PART 1—GENERAL PROVISIONS
Sec. 4201. Amendment to the Public Health Service Act.
Sec. 4202. Border health grants.
Sec. 4203. Critical access hospital improvements.
Sec. 4204. Medicare remote monitoring pilot projects.
Sec. 4205. Community health center collaborative access expansion.
Sec. 4206. Facilitating the provision of telehealth services across State lines.
Sec. 4207. Scoring of preventive health savings.
Sec. 4208. Sense of Congress on maintenance of effort provisions regarding
children’s health.
Sec. 4209. Protection of the HHS Offices of Minority Health.
Sec. 4210. Office of Minority Health in Veterans Health Administration of De-
partment of Veterans Affairs.
Sec. 4211. Study of DSH payments to ensure hospital access for low-income
patients.
Sec. 4212. Reauthorization of programs under the Native Hawaiian Health
Care Improvement Act.
PART 2—RURAL
Sec. 4221. Establishment of Rural Community Hospital (RCH) Program.
Sec. 4222. Rural Health Quality Advisory Commission and demonstration
projects.
Sec. 4223. Rural health care services.
PART 3—INDIAN COMMUNITIES
Sec. 4231. Assistant Secretary of the Indian Health Service.
Sec. 4232. Extension of full Federal medical assistance percentage to Indian
health care providers.
Sec. 4233. Conferring with urban Indian organizations.
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PART 4—PROVIDERS
Sec. 4241. Availability of non-English language speaking providers.
Sec. 4242. Access to essential community providers.
Sec. 4243. Provider network adequacy in communities of color.
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PART 5—DENTAL
Sec. 4251. Improving access to dental care.
Sec. 4252. Oral health literacy and awareness campaign.
Subtitle D—Advancing Health Equity Through Payment and Delivery Reform
Sec. 4301. Sense of Congress.
Sec. 4302. Centers for Medicare & Medicaid Services reporting and value-based
programs.
Sec. 4303. Development and testing of disparity reducing delivery and payment
models.
Sec. 4304. Diversity in Centers for Medicare and Medicaid consultation.
Sec. 4305. Supporting safety net and community-based providers to compete in
value-based payment systems.
Subtitle E—Health Empowerment Zones
Sec. 4401. Designation of health empowerment zones.
Sec. 4402. Assistance to those seeking designation.
Sec. 4403. Benefits of designation.
Sec. 4404. Definition of Secretary.
Sec. 4405. Authorization of appropriations.
Subtitle F—Equitable Health Care for All
Sec. 4501. Findings.
Sec. 4502. Data collection and reporting.
Sec. 4503. Requiring equitable health care in the hospital value-based pur-
chasing program.
Sec. 4504. Provision of inequitable health care as a basis for permissive exclu-
sion from Medicare and State health care programs.
Sec. 4505. Office for Civil Rights and Health Equity of the Department of
Health and Human Services.
Sec. 4506. Prohibiting discrimination in health care.
Sec. 4507. Federal Health Equity Commission.
Sec. 4508. Grants for hospitals to promote equitable health care and outcomes.
Subtitle G—Investing in Equity
Sec. 4601. Definitions.
Sec. 4602. Strategy to incentivize health equity.
Sec. 4603. Pay for Equity Advisory Council.
TITLE V—IMPROVING HEALTH OUTCOMES FOR WOMEN,
CHILDREN, AND FAMILIES
Subtitle A—In General
Sec. 5001. Grants to promote health for underserved communities.
Subtitle B—Pregnancy Screening
Sec. 5101. Pregnancy intention screening initiative demonstration program.
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Sec. 5102. Birth defects prevention, risk reduction, and awareness.
Subtitle C—Pregnancy-Related Care
Sec. 5201. Mothers and offspring mortality and morbidity awareness.
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Sec. 5202. MOMMIES.
Sec. 5203. Justice for incarcerated moms.
Sec. 5204. IMPACT To Save Moms Act.
Sec. 5205. Protecting moms and babies against climate change.
Sec. 5206. Tech to save moms.
Sec. 5207. Social determinants for moms.
Sec. 5208. Data to save moms.
Sec. 5209. Kira Johnson Act.
Sec. 5210. Moms matter.
Sec. 5211. Taskforce Recommending Improvements for Unaddressed Mental
Perinatal & Postpartum Health (TRIUMPH) for New Moms.
Sec. 5212. Protect moms from domestic violence.
Sec. 5213. Perinatal workforce.
Sec. 5214. Midwives schools and programs expansion.
Sec. 5215. Gestational diabetes.
Sec. 5216. Consumer education campaign.
Sec. 5217. Bibliographic database of systematic reviews for care of childbearing
individuals and newborns.
Sec. 5218. Development of interprofessional maternity care educational models
and tools.
Sec. 5219. Dissemination of the quality family planning guidelines.
Subtitle D—Federal Agency Coordination on Maternal Health
Sec. 5301. Interagency Coordinating Committee on the Promotion of Optimal
Maternity Outcomes.
Sec. 5302. Expansion of CDC Prevention Research Centers Program to include
Centers on Optimal Maternity Outcomes.
Sec. 5303. Expanding models to be tested by Center for Medicare and Medicaid
Innovation to explicitly include maternity care and children’s
health models.
Sec. 5304. Interagency update to the quality family planning guidelines.
Subtitle E—Reproductive and Sexual Health
Sec. 5401. Findings; sense of Congress on urgent barriers to abortion access
and vital solutions.
Sec. 5402. Emergency contraception education and information programs.
Sec. 5403. Access to birth control duties of pharmacies to ensure provision of
FDA-approved contraception.
Sec. 5404. Real education and access for healthy youth.
Sec. 5405. Compassionate assistance for rape emergencies.
Sec. 5406. Menstrual Equity for All Act of 2022.
Sec. 5407. Additional focus area for the Office on Women’s Health.
Sec. 5408. Including services furnished by certain students, interns, and resi-
dents supervised by certified nurse midwives or certified mid-
wives within inpatient hospital services under Medicare.
Sec. 5409. Grants to professional organizations and minority-serving institu-
tions to increase diversity in maternal, reproductive, and sexual
health professionals.
Subtitle F—Children’s Health
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Sec. 5501. CARING for Kids Act.
Sec. 5502. End Diaper Need Act of 2022.
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Sec. 5503. Decreasing the risk factors for sudden unexpected infant death and
sudden unexplained death in childhood.
Subtitle G—Nutrition for Women, Children, Families
Sec. 5601. Closing the meal gap.
Sec. 5602. Repeal of denial of Supplemental Nutrition Assistance Program ben-
efits.
Subtitle H—Universal School Meals Program
Sec. 5701. Short title.
Sec. 5702. Effective date.
Sec. 5703. Free school breakfast program.
Sec. 5704. Apportionment to States.
Sec. 5705. Nutritional and other program requirements.
Sec. 5706. Special assistance program.
Sec. 5707. Price for a paid lunch.
Sec. 5708. Summer food service program for children.
Sec. 5709. Summer Electronic Benefit Transfer for Children Program.
Sec. 5710. Child and adult care food program.
Sec. 5711. Meals and supplements for children in afterschool care.
Sec. 5712. Access to local foods: farm to school program.
Sec. 5713. Fresh fruit and vegetable program.
Sec. 5714. Training, technical assistance, and Food Service Management Insti-
tute.
Sec. 5715. Reimbursement of school meal delinquent debt program.
Sec. 5716. Conforming amendments.
Sec. 5717. Measure of poverty.
Sec. 5718. Supplemental nutrition assistance program.
Sec. 5719. Higher Education Act of 1965.
Sec. 5720. Elementary and Secondary Education Act of 1965.
Sec. 5721. America COMPETES Act.
Sec. 5722. Workforce Innovation and Opportunity Act.
Sec. 5723. National Science Foundation Authorization Act of 2002.
Sec. 5724. Child care and development block grant.
Sec. 5725. Children’s Health Act of 2000.
Sec. 5726. Juvenile justice and delinquency prevention.
Subtitle I—Elder Care
Sec. 5801. Expenses for household and elder care services necessary for gainful
employment.
Subtitle J—Miscellaneous Provisions
Sec. 5901. Clarification supporting permissible use of funds for stillbirth pre-
vention activities.
TITLE VI—MENTAL HEALTH AND SUBSTANCE USE DISORDERS
Sec. 6001. Mental health findings.
Sec. 6002. Sense of Congress.
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Subtitle A—Access to Care and Funding Streams
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Sec. 6011. Coverage of marriage and family therapist services, mental health
counselor services, substance abuse counselor services, and peer
support specialist services under part B of the Medicare pro-
gram.
Sec. 6012. Reauthorization of Minority Fellowship Program.
Sec. 6013. Additional funds for National Institutes of Health.
Sec. 6014. Additional funds for National Institute on Minority Health and
Health Disparities.
Sec. 6015. Grants for increasing racial and ethnic minority access to high-qual-
ity trauma support services and mental health care.
Sec. 6016. Grants for unarmed 9–1–1 response programs.
Subtitle B—Interprofessional Care
Sec. 6021. Health professions competencies to address racial and ethnic mental
health inequities.
Sec. 6022. Interprofessional health care teams for behavioral health care.
Sec. 6023. Integrated Health Care Demonstration Program.
Subtitle C—Workforce Development
Sec. 6031. Building an effective workforce in mental health.
Sec. 6032. Pilot program to increase language access at Federally qualified
health centers.
Sec. 6033. Health professions competencies to address racial and ethnic minor-
ity mental health disparities.
Subtitle D—Children’s Mental Health
Sec. 6041. Pediatric behavioral health care.
Sec. 6042. Mental health in schools.
Sec. 6043. Additional support for youth and young adult mental health service
provision.
Sec. 6044. Early intervention and prevention programs for transition-age
youth.
Sec. 6045. Strategies to increase access to telehealth under Medicaid and Chil-
dren’s Health Insurance Program.
Sec. 6046. Youth and young adult mental health promotion, prevention, inter-
vention, and treatment.
Sec. 6047. Study on the effects of smartphone and social media use on adoles-
cents.
Subtitle E—Community-Based Care
Sec. 6051. Mental health at the border.
Sec. 6052. Asian American, African American, Native Hawaiian, Pacific Is-
lander, Indigenous, Middle Eastern and North African, and
Hispanic and Latino behavioral and mental health outreach
and education strategy.
Subtitle F—Reports
Sec. 6061. Addressing racial and ethnic mental health inequities research gaps.
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Sec. 6062. Research on adverse health effects associated with interactions with
law enforcement.
Sec. 6063. GeoAccess study.
Sec. 6064. Co-occurring conditions.
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Sec. 6065. Technical correction.
Subtitle G—Miscellaneous Provisions
Sec. 6071. Children’s Mental Health Infrastructure Act.
Sec. 6072. Mental health for Latinos.
Sec. 6073. Strengthening mental health supports for BIPOC communities.
Sec. 6074. STRONG support for children.
Sec. 6075. Improving access to mental health.
Sec. 6076. Mental Health in Schools Excellence Program.
Sec. 6077. School social workers improving student success.
Sec. 6078. Opioid grants to support caregivers, kinship care families, and kin-
ship caregivers.
TITLE VII—ADDRESSING HIGH-IMPACT MINORITY DISEASES
Subtitle A—Cancer
Sec. 7001. Lung cancer mortality reduction.
Sec. 7002. Expansion of prostate cancer research, outreach, screening, testing,
access, and treatment effectiveness.
Sec. 7003. Prostate research, imaging, and men’s education.
Sec. 7004. Prostate cancer detection research and education.
Sec. 7005. National Prostate Cancer Council.
Sec. 7006. Improved Medicaid coverage for certain breast and cervical cancer
patients in the territories.
Sec. 7007. Cancer prevention and treatment demonstration for ethnic and ra-
cial minorities.
Sec. 7008. Reducing cancer disparities within Medicare.
Subtitle B—Viral Hepatitis and Liver Cancer Control and Prevention
Sec. 7051. Viral hepatitis and liver cancer control and prevention.
Sec. 7052. Liver cancer and disease prevention, awareness, and patient track-
ing grants.
Subtitle C—Acquired Bone Marrow Failure Diseases
Sec. 7101. Acquired bone marrow failure diseases.
Subtitle D—Cardiovascular Disease, Chronic Disease, Obesity, and Other
Disease Issues
Sec. 7151. Guidelines for disease screening for minority patients.
Sec. 7152. CDC Wisewoman Screening Program.
Sec. 7153. Report on cardiovascular care for women and minorities.
Sec. 7154. Coverage of comprehensive tobacco cessation services in Medicaid,
CHIP, and private health insurance.
Sec. 7155. Clinical research funding for oral health.
Sec. 7156. Guide on evidence-based strategies for public health department obe-
sity prevention programs.
Sec. 7157. Stephanie Tubbs Jones Uterine Fibroid Research and Education
Act.
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Subtitle E—HIV/AIDS
Sec. 7201. Statement of policy.
Sec. 7202. Findings.
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Sec. 7203. Additional funding for AIDS drug assistance program treatments.
Sec. 7204. Enhancing the national HIV surveillance system.
Sec. 7205. Evidence-based strategies for improving linkage to, and retention in,
appropriate care.
Sec. 7206. Improving entry into, and retention in, care and antiretroviral ad-
herence for persons with HIV.
Sec. 7207. Services to reduce HIV/AIDS in racial and ethnic minority commu-
nities.
Sec. 7208. Minority AIDS initiative.
Sec. 7209. Health care professionals treating individuals with HIV.
Sec. 7210. HIV/AIDS provider loan repayment program.
Sec. 7211. Dental education loan repayment program.
Sec. 7212. Reducing new HIV infections among injecting drug users.
Sec. 7213. Report on impact of HIV/AIDS in vulnerable populations.
Sec. 7214. National HIV/AIDS observance days.
Sec. 7215. Review of all Federal and State laws, policies, and regulations re-
garding the criminal prosecution of individuals for HIV-related
offenses.
Sec. 7216. Expanding support for condoms in prisons.
Sec. 7217. Automatic reinstatement or enrollment in Medicaid for people who
test positive for HIV before reentering communities.
Sec. 7218. Stop HIV in prison.
Sec. 7219. Transfer of funds for implementation of Ending the HIV Epidemic:
A Plan for America.
Sec. 7220. PrEP access and coverage.
Subtitle F—Diabetes
Sec. 7251. Research, treatment, and education.
Sec. 7252. Research, education, and other activities.
Sec. 7253. Programs to educate health providers on the causes and effects of
diabetes in minority populations.
Sec. 7254. Research, education, and other activities regarding diabetes in
American Indian populations.
Sec. 7255. Updated report on health disparities.
Subtitle G—Lung Disease
Sec. 7301. National asthma burden.
Sec. 7302. Asthma-related activities of the Centers for Disease Control and
Prevention.
Sec. 7303. Influenza and pneumonia vaccination campaign.
Sec. 7304. Chronic obstructive pulmonary disease.
Subtitle H—Tuberculosis
Sec. 7351. Elimination of all forms of tuberculosis.
Sec. 7352. Additional funding for States in combating and eliminating tuber-
culosis.
Sec. 7353. Strengthening clinical research funding for tuberculosis.
Subtitle I—Osteoarthritis and Musculoskeletal Diseases
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Sec. 7401. Findings.
Sec. 7402. Osteoarthritis and other musculoskeletal health-related activities of
the Centers for Disease Control and Prevention.
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Sec. 7403. Grants for comprehensive osteoarthritis and musculoskeletal disease
health education within health professions schools.
Subtitle J—Sleep and Circadian Rhythm Disorders
Sec. 7451. Short title; findings.
Sec. 7452. Sleep and circadian rhythm disorders research activities of the Na-
tional Institutes of Health.
Sec. 7453. Sleep and circadian rhythm health disparities-related activities of
the Centers for Disease Control and Prevention.
Sec. 7454. Grants for comprehensive sleep and circadian health education with-
in health professions schools.
Sec. 7455. Report on impact of sleep and circadian health disorders in vulner-
able and racial/ethnic populations.
Subtitle K—Kidney Disease Research, Surveillance, Prevention, and
Treatment
Sec. 7501. Kidney disease, research, surveillance, prevention, and treatment.
Sec. 7502. Kidney disease research in minority populations.
Sec. 7503. Kidney disease action plan.
Sec. 7504. Home dialysis and increasing end-stage renal disease treatment mo-
dalities in minority communities action plan.
Sec. 7505. Increasing kidney transplants in minority populations.
Sec. 7506. Environmental and occupational health programs.
Sec. 7507. Understanding the treatment patterns associated with providing
care and treatment of kidney failure in minority populations.
Sec. 7508. Improving access in underserved areas.
Sec. 7509. The Jack Reynolds Memorial Medigap Expansion Act; Medigap cov-
erage for beneficiaries with end-stage renal disease.
Subtitle L—Diversity in Clinical Trials
Sec. 7551. FDA review of clinical trial best practices.
Sec. 7552. Diversifying Investigations Via Equitable Research Studies for Ev-
eryone Trials Act.
Sec. 7553. Clinical trial diversity.
Sec. 7554. Patient experience data.
Subtitle M—Additional Provisions Addressing High-Impact Minority Diseases
Sec. 7601. Medicare coverage of multi-cancer early detection screening tests.
Sec. 7602. Amputation Reduction and Compassion Act.
Sec. 7603. Eliminating the coinsurance requirement for certain colorectal can-
cer screening tests furnished under the Medicare program.
Sec. 7604. Expanding the availability of medical nutrition therapy services
under the Medicare program.
Sec. 7605. Encouraging the development and use of DISARM antimicrobial
drugs.
Sec. 7606. Treat and Reduce Obesity Act.
Sec. 7607. Incentives, improvements, and outreach to increase diversity in Alz-
heimer’s disease research.
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TITLE VIII—HEALTH INFORMATION TECHNOLOGY
Sec. 8001. Definitions.
Subtitle A—Reducing Health Disparities Through Health IT
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Sec. 8101. HRSA assistance to health centers for promotion of Health IT.
Sec. 8102. Assessment of impact of Health IT on racial and ethnic minority
communities; outreach and adoption of Health IT in such com-
munities.
Sec. 8103. Nondiscrimination and health equity in health information tech-
nology.
Sec. 8104. Language access in health information technology.
Subtitle B—Modifications To Achieve Parity in Existing Programs
Sec. 8201. Extending funding to strengthen the Health IT infrastructure in ra-
cial and ethnic minority communities.
Sec. 8202. Extending competitive grants for the development of loan programs
to facilitate adoption of certified EHR technology by providers
serving racial and ethnic minority groups.
Sec. 8203. Authorization of appropriations.
Subtitle C—Additional Research and Studies
Sec. 8301. Data collection and assessments conducted in coordination with mi-
nority-serving institutions.
Sec. 8302. Study of health information technology in medically underserved
communities.
Sec. 8303. Assessment of use and misuse of de-identified health data.
Subtitle D—Closing Gaps in Funding To Adopt Certified EHRs
Sec. 8401. Extending Medicaid EHR incentive payments to rehabilitation facili-
ties, long-term care facilities, and home health agencies.
Sec. 8402. Extending physician assistant eligibility for Medicaid electronic
health record incentive payments.
Subtitle E—Expanding Access to Telehealth Services
Sec. 8501. Removing geographic requirements for telehealth services.
Sec. 8502. Expanding originating sites.
TITLE IX—ACCOUNTABILITY AND EVALUATION
Sec. 9001. Prohibition on discrimination in Federal assisted health care serv-
ices and research on the basis of sex (including sexual orienta-
tion, gender identity, and pregnancy, including termination of
pregnancy), race, color, national origin, marital status, familial
status, or disability status.
Sec. 9002. Treatment of Medicare payments under title VI of the Civil Rights
Act of 1964.
Sec. 9003. Accountability and transparency within the Department of Health
and Human Services.
Sec. 9004. United States Commission on Civil Rights.
Sec. 9005. Sense of Congress concerning full funding of activities to eliminate
racial and ethnic health disparities.
Sec. 9006. GAO and NIH reports.
Sec. 9007. Investigative and enforcement actions.
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Sec. 9008. Federal Health Equity Commission.
TITLE X—ADDRESSING SOCIAL DETERMINANTS AND IMPROVING
ENVIRONMENTAL JUSTICE
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Subtitle A—In General
Sec. 10001. Definitions.
Sec. 10002. Findings.
Sec. 10003. Health impact assessments.
Sec. 10004. Grant program to conduct environmental health improvement ac-
tivities and to improve social determinants of health.
Sec. 10005. Additional research on the relationship between the built environ-
ment and the health of community residents.
Sec. 10006. Environment and public health restoration.
Sec. 10007. GAO report on health effects of Deepwater Horizon oil rig explo-
sion in the Gulf Coast.
Sec. 10008. Establish an interagency counsel and grant programs on social de-
terminants of health.
Sec. 10009. Correcting Hurtful and Alienating Names in Government Expres-
sion (CHANGE).
Sec. 10010. Andrew Kearse Accountability for Denial of Medical Care.
Sec. 10011. Investing in community healing.
Sec. 10012. Environmental justice mapping and data collection.
Sec. 10013. Antiracism in public health.
Sec. 10014. LGBTQ essential data.
Sec. 10015. Social determinants accelerator.
Sec. 10016. Improving social determinants of health.
Subtitle B—Gun Violence
Sec. 10101. Reaffirming research authority of the Centers for Disease Control
and Prevention.
Sec. 10102. National Violent Death Reporting System.
Sec. 10103. Report on effects of gun violence on public health.
Sec. 10104. Report on effects of gun violence on mental health in minority
communities.
1 SEC. 3. FINDINGS.
2 The Congress finds as follows:
3 (1) The population of racial and ethnic minori-
4 ties is expected to increase over the next few dec-
5 ades, yet racial and ethnic minorities have the poor-
6 est health status and face substantial cultural, so-
7 cial, and economic barriers to obtaining high-quality
8 health care.
9 (2) Health disparities are a function of not only
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10 access to health care, but also the social deter-
11 minants of health—including the environment, the
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1 physical structure of communities, nutrition and
2 food options, educational attainment, employment,
3 race, ethnicity, sex, geography, language preference,
4 immigrant or citizenship status, sexual orientation,
5 gender identity, socioeconomic status, or disability
6 status—that directly and indirectly affect the health,
7 health care, and wellness of individuals and commu-
8 nities.
9 (3) Over the next few decades, the United
10 States will face a shortage of health care providers
11 and allied health workers.
12 (4) All efforts to reduce health disparities and
13 barriers to high-quality health services require better
14 and more consistent data, and better and more con-
15 sistent collection of and access to data.
16 (5) A full range of culturally and linguistically
17 appropriate health care and public health services
18 must be available and accessible in every community.
19 (6) Racial and ethnic minorities and under-
20 served populations must be included early and equi-
21 tably in health reform innovations.
22 (7) Efforts to improve minority health have
23 been limited by inadequate resources in funding,
24 staffing, stewardship, and accountability. Targeted
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25 investments that are focused on disparities elimi-
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1 nation must be made in providing care and services
2 that are community-based, including prevention and
3 policies addressing social determinants of health.
4 (8) In 2011, the Department of Health and
5 Human Services developed the HHS Action Plan to
6 Reduce Racial and Ethnic Health Disparities and
7 the National Stakeholder Strategy for Achieving
8 Health Equity, which are 2 strategic plans that rep-
9 resent the first coordinated roadmap in the United
10 States to reducing health disparities. These com-
11 prehensive plans, along with the National Prevention
12 Strategy issued by the National Prevention Council
13 of the Department of Health and Human Services,
14 Healthy People 2030, and the National Quality
15 Strategy of the Agency for Healthcare Research and
16 Quality, as well as critical resources such as the
17 2012 National Healthcare Quality and Disparities
18 Reports, will work to increase the number of people
19 in the United States who are healthy at every stage
20 of life.
21 (9) The Secretary of Health and Human Serv-
22 ices has also reviewed and advanced updated clinical
23 guidelines and developed other strategic planning
24 documents to combat health disparities with a high
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25 impact on minority populations and to provide high-
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1 quality family planning services. Such guidelines and
2 documents include the National HIV/AIDS Strategy,
3 the Action Plan for the Prevention, Care, and Treat-
4 ment of Viral Hepatitis, and recommendations of the
5 Centers for Disease Control and Prevention and the
6 Office of Population Affairs.
7 (10) The Patient Protection and Affordable
8 Care Act (Public Law 111–148), as amended by the
9 Health Care and Education Reconciliation Act of
10 2010 (Public Law 111–152), represents the biggest
11 advancement for minority health in the 40 years im-
12 mediately preceding the enactment of this Act.
13 (11) The Health Information Technology for
14 Economic and Clinical Health Act, part of the
15 American Recovery and Reinvestment Act of 2009
16 (Public Law 111–5), provides that the nationwide
17 health information exchange infrastructure be devel-
18 oped and used to reduce health disparities, among
19 other purposes.
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1 TITLE I—DATA COLLECTION
2 AND REPORTING
3 SEC. 1001. STRENGTHENING DATA COLLECTION, IMPROV-
4 ING DATA ANALYSIS, AND EXPANDING DATA
5 REPORTING.
6 (a) AMENDMENTS TO THE PUBLIC HEALTH SERVICE
7 ACT.—
8 (1) PURPOSE.—The purpose of the amend-
9 ments made by this subsection is to promote cul-
10 turally and linguistically appropriate data collection,
11 analysis, and reporting by race, ethnicity, sex, pri-
12 mary language, sexual orientation, disability status,
13 gender identity, age, and socioeconomic status in
14 federally supported health programs.
15 (2) AHRQ GENERAL AUTHORITIES.—Section
16 902(a) of the Public Health Service Act (42 U.S.C.
17 299a(a)) is amended—
18 (A) in paragraph (8), by striking ‘‘and’’ at
19 the end;
20 (B) in paragraph (9), by striking the pe-
21 riod at the end and inserting ‘‘; and’’; and
22 (C) by adding at the end the following:
23 ‘‘(10) cultural and linguistic competence of
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24 health care services and of data collection activities
25 described under section 3101.’’.
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1 (3) OFFICE OF MINORITY HEALTH.—Section
2 1707(g)(1) of the Public Health Service Act (42
3 U.S.C. 300u–6(g)(1)) is amended by inserting ‘‘Mid-
4 dle Easterners and North Africans;’’ after
5 ‘‘Blacks;’’.
6 (4) OFFICE OF THE NATIONAL COORDINATOR
7 FOR HEALTH INFORMATION TECHNOLOGY.—Section
8 3001 of the Public Health Service Act (42 U.S.C.
9 300jj–11) is amended—
10 (A) in subsection (b)—
11 (i) in paragraph (10), by striking
12 ‘‘and’’ at the end;
13 (ii) in paragraph (11), by striking the
14 period at the end and inserting ‘‘; and’’;
15 and
16 (iii) by adding at the end the fol-
17 lowing:
18 ‘‘(12) ensures the interoperability of health in-
19 formation systems among federally conducted or
20 supported health care or public health programs,
21 State health agencies, and social service agencies.’’;
22 and
23 (B) by amending clause (vii) in subsection
24 (c)(3)(A) to read as follows:
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1 ‘‘(vii) Strategies to enhance the use of
2 health information technology in improving
3 the quality of health care; reducing medical
4 errors; reducing health disparities and en-
5 suring the provision of equitable health
6 services; improving public health; increas-
7 ing prevention and coordination with com-
8 munity resources; ensuring interoperability
9 among federally conducted or supported
10 health care or public health programs,
11 State health agencies, and social service
12 agencies; and improving the continuity of
13 care among health care settings.’’.
14 (5) DATA COLLECTION, ANALYSIS, AND QUAL-
15 ITY.—Section 3101 of the Public Health Service Act
16 (42 U.S.C. 300kk) is amended—
17 (A) in subsections (a)(1)(A), (a)(1)(C),
18 (a)(2)(B), and (a)(2)(E), by striking ‘‘and dis-
19 ability status’’ and inserting ‘‘sexual orienta-
20 tion, gender identity, age, disability status, and
21 socioeconomic status’’;
22 (B) in subsection (a)(1), by amending sub-
23 paragraph (D) to read as follows:
24 ‘‘(D) data for additional population groups
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25 if such groups can be aggregated into the data
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1 collection standards described under paragraph
2 (2).’’;
3 (C) in subsection (a)(2)—
4 (i) in subparagraph (C)—
5 (I) in clause (i), by striking
6 ‘‘and’’ at the end;
7 (II) in clause (ii)—
8 (aa) by striking ‘‘is a minor
9 or legally incapacitated’’ and in-
10 serting ‘‘is a minor, requires as-
11 sistance with communication in
12 speech or writing, or is legally in-
13 capacitated’’; and
14 (bb) by striking the semi-
15 colon at the end and inserting ‘‘;
16 and’’; and
17 (III) by adding at the end the
18 following:
19 ‘‘(iii) collects data in a manner that is
20 culturally and linguistically appropriate;’’;
21 (ii) in subparagraph (D)(iii), by strik-
22 ing ‘‘and’’ at the end;
23 (iii) in subparagraph (E), by striking
24 the period at the end and inserting ‘‘;
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25 and’’; and
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1 (iv) by adding at the end the fol-
2 lowing:
3 ‘‘(F) use, where practicable, the standards
4 developed by the Health and Medicine Division
5 of the National Academies of Sciences, Engi-
6 neering, and Medicine (formerly known as the
7 ‘Institute of Medicine’) in the 2009 publication
8 titled ‘Race, Ethnicity, and Language Data:
9 Standardization for Health Care Quality Im-
10 provement’.’’; and
11 (6) in subsection (a)(3), by amending subpara-
12 graph (B) to read as follows:
13 ‘‘(B) develop interoperability and security
14 systems for data management among federally
15 conducted or supported health care or public
16 health programs, State health agencies, and so-
17 cial service agencies.’’.
18 (b) COROLLARY PROVISIONS.—
19 (1) RECOMMENDATIONS BY THE DATA COUN-
20 CIL.—The Data Council of the Department of
21 Health and Human Services, in consultation with
22 the Director of the National Center for Health Sta-
23 tistics, the Deputy Assistant Secretary for Minority
24 Health, the Deputy Assistant Secretary for Women’s
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25 Health, the Administrator of the Centers for Medi-
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1 care & Medicaid, the National Coordinator for
2 Health Information Technology, and other appro-
3 priate public and private entities and officials, shall
4 make recommendations to the Secretary of Health
5 and Human Services concerning how to—
6 (A) implement the amendments made by
7 this section, while minimizing the cost and ad-
8 ministrative burdens of data collection and re-
9 porting on all parties, including patients and
10 providers;
11 (B) expand awareness among Federal
12 agencies, States, territories, Indian Tribes,
13 counties, municipalities, health providers, health
14 plans, and the general public that data collec-
15 tion, analysis, and reporting by race, ethnicity,
16 sex, primary language, sexual orientation, gen-
17 der identity, age, socioeconomic status, and dis-
18 ability status is legal and necessary to ensure
19 equity and nondiscrimination in the quality of
20 health care services;
21 (C) ensure that future patient record sys-
22 tems follow Federal standards promulgated
23 under the HITECH Act (42 U.S.C. 201 note)
24 for the collection and meaningful use of elec-
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25 tronic health data on race, ethnicity, sex, pri-
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1 mary language, sexual orientation, gender iden-
2 tity, age, socioeconomic status, and disability
3 status;
4 (D) improve health and health care data
5 collection and analysis for more population
6 groups if such groups can be aggregated into
7 minimum race and ethnicity categories, includ-
8 ing exploring the feasibility of enhancing collec-
9 tion efforts in States, counties, and municipali-
10 ties for racial and ethnic groups that comprise
11 a significant proportion of the population of the
12 State, county, or municipality;
13 (E) provide researchers with greater access
14 to racial, ethnic, primary language, sex, sexual
15 orientation, gender identity, age, socioeconomic
16 status, and disability status data, subject to all
17 applicable privacy and confidentiality require-
18 ments, including HIPAA privacy and security
19 law as defined in section 3009(a) of the Public
20 Health Service Act (42 U.S.C. 300jj–19(a));
21 (F) ensure the cultural and linguistic com-
22 petence of entities that receive Federal support
23 to collect and report data pursuant to the
24 amendments made by subsection (a); and
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1 (G) safeguard and prevent the misuse of
2 data collected under section 3101 of the Public
3 Health Service Act (42 U.S.C. 300kk), as
4 amended by subsection (a)(5).
5 (2) RULES OF CONSTRUCTION.—Nothing in
6 this section shall be construed to—
7 (A) permit the use of information collected
8 under this section or any provision amended by
9 this section in a manner that would adversely
10 affect any individual providing any such infor-
11 mation; or
12 (B) diminish any requirements on health
13 care providers to collect data, including such re-
14 quirements in effect on or after the date of en-
15 actment of this Act.
16 (3) TECHNICAL ASSISTANCE FOR THE ANALYSIS
17 OF HEALTH DISPARITY DATA.—The Secretary of
18 Health and Human Services, acting through the Di-
19 rector of the Agency for Healthcare Research and
20 Quality, and in coordination with the Assistant Sec-
21 retary for Planning and Evaluation, the Adminis-
22 trator of the Centers for Medicare & Medicaid Serv-
23 ices, the Director of the National Center for Health
24 Statistics, the Director of the National Institutes of
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25 Health, and the National Coordinator for Health In-
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1 formation Technology, shall provide technical assist-
2 ance to agencies of the Department of Health and
3 Human Services in meeting Federal standards for
4 health disparity data collection and for analysis of
5 racial, ethnic, and other disparities in health and
6 health care in programs conducted or supported by
7 such agencies by—
8 (A) identifying appropriate quality assur-
9 ance mechanisms to monitor for health dispari-
10 ties;
11 (B) specifying the clinical, diagnostic, or
12 therapeutic measures which should be mon-
13 itored;
14 (C) developing new quality measures relat-
15 ing to racial and ethnic disparities and their
16 overlap with other disparity factors in health
17 and health care;
18 (D) identifying the level at which data
19 analysis should be conducted;
20 (E) sharing data with external organiza-
21 tions for research and quality improvement pur-
22 poses; and
23 (F) identifying and addressing issues relat-
24 ing to the interoperability of Federal- and
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25 State-level health information systems which
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1 undermine the ability of health-related pro-
2 grams collecting data under this section to
3 achieve the purpose described in subsection
4 (a)(1).
5 (4) REFERENCES.—Except as otherwise speci-
6 fied, any reference to the term ‘‘racial and ethnic
7 minority group’’ in any Federal regulation, guid-
8 ance, order, or document for establishment or imple-
9 mentation of any federally conducted or supported
10 health care or public health program, activity, or
11 survey shall be treated as having the definition given
12 to such term in section 1707(g) of the Public Health
13 Service Act (42 U.S.C. 300u–6(g)).
14 (5) AUTHORIZATION OF APPROPRIATIONS.—To
15 carry out this subsection, subsection (a), and the
16 amendments made by subsection (a), there are au-
17 thorized to be appropriated such sums as may be
18 necessary for each of fiscal years 2023 through
19 2027.
20 (c) ADDITIONS TO THE PUBLIC HEALTH SERVICE
21 ACT.—Title XXXIV of the Public Health Service Act, as
22 added by titles II and III of this Act, is further amended
23 by inserting after subtitle B the following:
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1 ‘‘Subtitle C—Strengthening Data
2 Collection, Improving Data
3 Analysis, and Expanding Data
4 Reporting
5 ‘‘SEC. 3431. ESTABLISHING GRANTS FOR DATA COLLECTION
6 IMPROVEMENT ACTIVITIES.
7 ‘‘(a) IN GENERAL.—The Secretary, acting through
8 the Director of the Agency for Healthcare Research and
9 Quality and in consultation with the Deputy Assistant
10 Secretary for Minority Health, the Director of the Na-
11 tional Institutes of Health, the Assistant Secretary for
12 Planning and Evaluation, the National Coordinator for
13 Health Information Technology, and the Director of the
14 National Center for Health Statistics, shall establish a
15 technical assistance program under which the Secretary
16 provides grants to eligible entities to assist such entities
17 in complying with section 3101.
18 ‘‘(b) TYPES OF ASSISTANCE.—A grant provided
19 under this section may be used to—
20 ‘‘(1) enhance or upgrade computer technology
21 that will facilitate collection, analysis, and reporting
22 of racial, ethnic, primary language, sexual orienta-
23 tion, sex, gender identity, socioeconomic status, and
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24 disability status data;
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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;
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 and
17 ‘‘(5) develop educational programs to train
18 health providers, health care organizations, health
19 plans, health-related agencies, and frontline health
20 care workers on how to collect and report
21 disaggregated data in a culturally and linguistically
22 appropriate manner.
23 ‘‘(c) ELIGIBLE ENTITY.—To be eligible for grants
24 under this section, an entity shall be a State, territory,
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25 Indian Tribe, municipality, county, health provider, health
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1 care organization, or health plan making a demonstrated
2 effort to bring data collections into compliance with sec-
3 tion 3101.
4 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There
5 are authorized to be appropriated to carry out this section
6 such sums as may be necessary for each of fiscal years
7 2023 through 2027.
8 ‘‘SEC. 3432. OVERSAMPLING OF UNDERREPRESENTED
9 GROUPS IN FEDERAL HEALTH SURVEYS.
10 ‘‘(a) NATIONAL STRATEGY.—
11 ‘‘(1) IN GENERAL.—The Secretary, acting
12 through the Director of the National Center for
13 Health Statistics, and other officials within the De-
14 partment of Health and Human Services as the Sec-
15 retary determines appropriate, shall develop and im-
16 plement a sustainable national strategy for oversam-
17 pling underrepresented populations within the cat-
18 egories of race, ethnicity, sex, primary language, sex-
19 ual orientation, disability status, gender identity,
20 and socioeconomic status as determined appropriate
21 by the Secretary in Federal health surveys and pro-
22 gram data collections. Such national strategy shall
23 include a strategy for oversampling of Middle East-
24 erners and North Africans, Asian Americans, Native
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25 Hawaiians, and Pacific Islanders.
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1 ‘‘(2) CONSULTATION.—In developing and imple-
2 menting a national strategy, as described in para-
3 graph (1), not later than 180 days after the date of
4 the enactment of this section, the Secretary shall—
5 ‘‘(A) consult with representatives of com-
6 munity groups, nonprofit organizations, non-
7 governmental organizations, and government
8 agencies working with underrepresented popu-
9 lations;
10 ‘‘(B) solicit the participation of representa-
11 tives from other Federal departments and agen-
12 cies, including subagencies of the Department
13 of Health and Human Services; and
14 ‘‘(C) consult on, and use as models, the
15 2014 National Health Interview Survey over-
16 sample of Native Hawaiian and Pacific Islander
17 populations, the 2016 Behavioral Risk Factor
18 Survey of Health Risk Behaviors Among Arab
19 Adults Within the State of Michigan, and the
20 2017 Behavioral Risk Factor Surveillance Sys-
21 tem oversample of American Indian and Alaska
22 Native communities.
23 ‘‘(b) PROGRESS REPORT.—Not later than 2 years
24 after the date of enactment of this section, the Secretary
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25 shall submit to the Congress a progress report, which shall
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1 include the national strategy required by subsection
2 (a)(1).
3 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To
4 carry out this section, there are authorized to be appro-
5 priated such sums as may be necessary for fiscal years
6 2023 through 2027.’’.
7 SEC. 1002. ELIMINATION OF PREREQUISITE OF DIRECT AP-
8 PROPRIATIONS FOR DATA COLLECTION AND
9 ANALYSIS.
10 Section 3101 of the Public Health Service Act (42
11 U.S.C. 300kk), as amended by section 1001(a), is further
12 amended—
13 (1) by striking subsection (h); and
14 (2) by redesignating subsection (i) as subsection
15 (h).
16 SEC. 1003. COLLECTION OF DATA FOR THE MEDICARE PRO-
17 GRAM.
18 Part A of title XI of the Social Security Act (42
19 U.S.C. 1301 et seq.) is amended by adding at the end
20 the following:
21 ‘‘COLLECTION OF DATA FOR THE MEDICARE PROGRAM
22 ‘‘SEC. 1150D.
23 ‘‘(a) REQUIREMENT.—
24 ‘‘(1) IN GENERAL.—The Commissioner of So-
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25 cial Security, in consultation with the Administrator
26 of the Centers for Medicare & Medicaid Services,
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1 shall collect data on the race, ethnicity, sex, primary
2 language, sexual orientation, gender identity, socio-
3 economic status, and disability status of all appli-
4 cants for social security benefits under title II or
5 Medicare benefits under title XVIII.
6 ‘‘(2) DATA COLLECTION STANDARDS.—In col-
7 lecting data under paragraph (1), the Commissioner
8 of Social Security shall at least use the standards
9 for data collection developed under section 3101 of
10 the Public Health Service Act or the standards de-
11 veloped by the Office of Management and Budget,
12 whichever is more disaggregated. In the event there
13 are no standards for the demographic groups listed
14 under paragraph (1), the Commissioner shall consult
15 with stakeholder groups representing the various
16 identities as well as with the Office of Minority
17 Health within the Centers for Medicare & Medicaid
18 Services to develop appropriate standards.
19 ‘‘(3) DATA FOR ADDITIONAL POPULATION
20 GROUPS.—Where practicable, the information col-
21 lected by the Commissioner of Social Security under
22 paragraph (1) shall include data for additional popu-
23 lation groups if such groups can be aggregated into
24 the race and ethnicity categories outlined by the
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25 data collection standards described in paragraph (2).
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1 ‘‘(4) COLLECTION OF DATA FOR MINORS AND
2 LEGALLY INCAPACITATED INDIVIDUALS.—With re-
3 spect to the collection of the data described in para-
4 graph (1) of applicants who are under 18 years of
5 age or otherwise legally incapacitated, the Commis-
6 sioner of Social Security shall require that—
7 ‘‘(A) such data be collected from the par-
8 ent or legal guardian of such an applicant; and
9 ‘‘(B) the primary language of the parent
10 or legal guardian of such an applicant or recipi-
11 ent be used in collecting the data.
12 ‘‘(5) QUALITY OF DATA.—The Commissioner of
13 Social Security shall periodically review the quality
14 and completeness of the data collected under para-
15 graph (1) and make adjustments as necessary to im-
16 prove both.
17 ‘‘(6) TRANSMISSION OF DATA.—Upon enroll-
18 ment in Medicare benefits under title XVIII, the
19 Commissioner of Social Security shall transmit an
20 individual’s demographic data as collected under
21 paragraph (1) to the Centers for Medicare & Med-
22 icaid Services.
23 ‘‘(7) ANALYSIS AND REPORTING OF DATA.—
24 With respect to data transmitted under paragraph
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25 (5), the Administrator of the Centers for Medicare
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1 & Medicaid Services, in consultation with the Com-
2 missioner of Social Security, shall—
3 ‘‘(A) require that such data be uniformly
4 analyzed and that such analysis be reported at
5 least annually to Congress;
6 ‘‘(B) incorporate such data in other anal-
7 ysis and reporting on health disparities and the
8 provision of inequitable health care services by
9 a health care provider, as appropriate;
10 ‘‘(C) make such data available to research-
11 ers, under the protections outlined in paragraph
12 (7);
13 ‘‘(D) provide opportunities to individuals
14 enrolled in Medicare to submit updated data;
15 and
16 ‘‘(E) ensure that the provision of assist-
17 ance or benefits to an applicant is not denied
18 or otherwise adversely affected because of the
19 failure of the applicant to provide any of the
20 data collected under paragraph (1).
21 ‘‘(8) PROTECTION OF DATA.—The Commis-
22 sioner of Social Security shall ensure (through the
23 promulgation of regulations or otherwise) that all
24 data collected pursuant to subsection (a) is pro-
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25 tected—
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1 ‘‘(A) under the same privacy protections as
2 the Secretary applies to health data under the
3 regulations promulgated under section 264(c) of
4 the Health Insurance Portability and Account-
5 ability Act of 1996 (relating to the privacy of
6 individually identifiable health information and
7 other protections); and
8 ‘‘(B) from all inappropriate internal use by
9 any entity that collects, stores, or receives the
10 data, including use of such data in determina-
11 tions of eligibility (or continued eligibility) in
12 health plans, and from other inappropriate
13 uses, as defined by the Secretary.
14 ‘‘(b) RULE OF CONSTRUCTION.—Nothing in this sec-
15 tion shall be construed to permit the use of information
16 collected under this section in a manner that would ad-
17 versely affect any individual providing any such informa-
18 tion.
19 ‘‘(c) TECHNICAL ASSISTANCE.—The Secretary of
20 Health and Human Services may, either directly or by
21 grant or contract, provide technical assistance to enable
22 any entity to comply with the requirements of this section
23 or with regulations implementing this section.
24 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There
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25 are authorized to be appropriated to carry out this section
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1 $500 million for 2022 and $100 million for each fiscal
2 year thereafter.’’.
3 SEC. 1004. REVISION OF HIPAA CLAIMS STANDARDS.
4 (a) IN GENERAL.—Not later than 1 year after the
5 date of enactment of this Act, the Secretary of Health and
6 Human Services shall revise the regulations promulgated
7 under part C of title XI of the Social Security Act (42
8 U.S.C. 1320d et seq.) (relating to the collection of data
9 on demographics in a health-related transaction) to re-
10 quire—
11 (1) the use, at a minimum, of standards for
12 data collection on race, ethnicity, sex, primary lan-
13 guage, sexual orientation, gender identity, age, dis-
14 ability status, and socioeconomic status developed
15 under section 3101 of the Public Health Service Act
16 (42 U.S.C. 300kk), as amended by section
17 1001(a)(5); and
18 (2) in consultation with the Office of the Na-
19 tional Coordinator for Health Information Tech-
20 nology, the designation of the appropriate racial,
21 ethnic, primary language, disability, sex, and other
22 code sets as required for claims and enrollment data.
23 (b) DISSEMINATION.—The Secretary of Health and
24 Human Services shall disseminate the new standards de-
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25 veloped under subsection (a) to all entities that are subject
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1 to the regulations described in such subsection and provide
2 technical assistance with respect to the collection of the
3 data involved.
4 (c) COMPLIANCE.—The Secretary of Health and
5 Human Services shall require that entities comply with the
6 new standards developed under subsection (a) not later
7 than 2 years after the final promulgation of such stand-
8 ards.
9 SEC. 1005. NATIONAL CENTER FOR HEALTH STATISTICS.
10 Section 306(n) of the Public Health Service Act (42
11 U.S.C. 242k(n)) is amended—
12 (1) in paragraph (1), by striking ‘‘2003’’ and
13 inserting ‘‘2024’’;
14 (2) in paragraph (2), in the first sentence, by
15 striking ‘‘2003’’ and inserting ‘‘2024’’; and
16 (3) in paragraph (3), by striking ‘‘2002’’ and
17 inserting ‘‘2024’’.
18 SEC. 1006. DISPARITIES DATA COLLECTED BY THE FED-
19 ERAL GOVERNMENT.
20 (a) REPOSITORY OF GOVERNMENT DATA.—The Sec-
21 retary of Health and Human Services, in coordination
22 with the officials referenced in subsection (b), shall estab-
23 lish a centralized electronic repository of Federal Govern-
24 ment data on factors related to the health and well-being
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25 of the population of the United States.
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1 (b) COLLECTION; SUBMISSION.—Not later than 180
2 days after the date of enactment of this Act, and January
3 31 of each year thereafter, each department, agency, and
4 office of the Federal Government that has collected data
5 on race, ethnicity, sex, primary language, sexual orienta-
6 tion, gender identity, age, disability status, or socio-
7 economic status during the preceding calendar year shall
8 submit such data to the repository of Federal Government
9 data established under subsection (a).
10 (c) ANALYSIS; PUBLIC AVAILABILITY; REPORTING.—
11 Not later than April 30, 2021, and April 30 of each year
12 thereafter, the Secretary of Health and Human Services,
13 acting through the Assistant Secretary for Planning and
14 Evaluation, the Assistant Secretary for Health, the Direc-
15 tor of the Agency for Healthcare Research and Quality,
16 the Director of the National Center for Health Statistics,
17 the Administrator of the Centers for Medicare & Medicaid
18 Services, the Director of the National Institute on Minor-
19 ity Health and Health Disparities, and the Deputy Assist-
20 ant Secretary for Minority Health, shall—
21 (1) prepare and make available datasets for
22 public use that relate to disparities in health status,
23 health care access, health care quality, health out-
24 comes, public health, the provision of equitable
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25 health services, and other areas of health and well-
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1 being by factors that include race, ethnicity, sex, pri-
2 mary language, sexual orientation, gender identity,
3 disability status, and socioeconomic status;
4 (2) ensure that these datasets are publicly iden-
5 tified on the repository established under subsection
6 (a) as ‘‘disparities’’ data; and
7 (3) submit a report to the Congress on the
8 availability and use of such data by public stake-
9 holders.
10 SEC. 1007. DATA COLLECTION AND ANALYSIS GRANTS TO
11 MINORITY-SERVING INSTITUTIONS.
12 (a) AUTHORITY.—The Secretary of Health and
13 Human Services, acting through the Director of the Na-
14 tional Institute on Minority Health and Health Disparities
15 and the Deputy Assistant Secretary for Minority Health,
16 shall award grants to eligible entities to access and analyze
17 racial and ethnic data on disparities in health and health
18 care, and where possible other data on disparities in health
19 and health care, to monitor and report on progress to re-
20 duce and eliminate disparities in health and health care.
21 (b) ELIGIBLE ENTITY.—In this section, the term ‘‘el-
22 igible entity’’ means an entity that has an accredited pub-
23 lic health, health policy, or health services research pro-
24 gram and is any of the following:
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1 (1) A part B institution, as defined in section
2 322 of the Higher Education Act of 1965 (20
3 U.S.C. 1061).
4 (2) A Hispanic-serving institution, as defined in
5 section 502 of such Act (20 U.S.C. 1101a).
6 (3) A Tribal College or University, as defined in
7 section 316 of such Act (20 U.S.C. 1059c).
8 (4) An Asian American and Native American
9 Pacific Islander-serving institution, as defined in
10 section 371(c) of such Act (20 U.S.C. 1067q(c)).
11 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry
12 out this section, there are authorized to be appropriated
13 such sums as may be necessary for fiscal years 2023
14 through 2027.
15 SEC. 1008. SAFETY AND EFFECTIVENESS OF DRUGS WITH
16 RESPECT TO RACIAL AND ETHNIC BACK-
17 GROUND.
18 (a) IN GENERAL.—Chapter V of the Federal Food,
19 Drug, and Cosmetic Act (21 U.S.C. 351 et seq.) is amend-
20 ed by inserting after section 505G (21 U.S.C. 355h) the
21 following:
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1 ‘‘SEC. 505H. SAFETY AND EFFECTIVENESS OF DRUGS WITH
2 RESPECT TO RACIAL AND ETHNIC BACK-
3 GROUND.
4 ‘‘(a) PREAPPROVAL STUDIES.—If there is evidence of
5 a racial or ethnic disparity in safety or effectiveness with
6 respect to a drug or biological product, then—
7 ‘‘(1)(A) in the case of a drug, the investigations
8 required under section 505(b)(1)(A) shall include
9 adequate and well-controlled investigations of the
10 disparity; or
11 ‘‘(B) in the case of a biological product, the evi-
12 dence required under section 351(a) of the Public
13 Health Service Act for approval of a biologics license
14 application for the biological product shall include
15 adequate and well-controlled investigations of the
16 disparity; and
17 ‘‘(2) if the investigations described in subpara-
18 graph (A) or (B) of paragraph (1) confirm that
19 there is such a disparity, the labeling of the drug or
20 biological product shall include appropriate informa-
21 tion about the disparity.
22 ‘‘(b) POSTMARKET STUDIES.—
23 ‘‘(1) IN GENERAL.—If there is evidence of a ra-
24 cial or ethnic disparity in safety or effectiveness with
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25 respect to a drug for which there is an approved ap-
26 plication under section 505 of this Act or of a bio-
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1 logical product for which there is an approved li-
2 cense under section 351 of the Public Health Service
3 Act, the Secretary may by order require the holder
4 of the approved application or license to conduct, by
5 a date specified by the Secretary, postmarket studies
6 to investigate the disparity.
7 ‘‘(2) LABELING.—If the Secretary determines
8 that the postmarket studies confirm that there is a
9 disparity described in paragraph (1), the labeling of
10 the drug or biological product shall include appro-
11 priate information about the disparity.
12 ‘‘(3) STUDY DESIGN.—The Secretary may, in
13 an order under paragraph (1), specify all aspects of
14 the design of the postmarket studies required under
15 such paragraph for a drug or biological product, in-
16 cluding the number of studies and study partici-
17 pants, and the other demographic characteristics of
18 the study participants.
19 ‘‘(4) MODIFICATIONS OF STUDY DESIGN.—The
20 Secretary may, by order and as necessary, modify
21 any aspect of the design of a postmarket study re-
22 quired in an order under paragraph (1) after issuing
23 such order.
24 ‘‘(5) STUDY RESULTS.—The results from a
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1 mitted to the Secretary as a supplement to the drug
2 application or biologics license application.
3 ‘‘(c) APPLICATIONS UNDER SECTION 505(j).—
4 ‘‘(1) IN GENERAL.—A drug for which an appli-
5 cation has been submitted or approved under section
6 505(j) shall not be considered ineligible for approval
7 under that section or misbranded under section 502
8 on the basis that the labeling of the drug omits in-
9 formation relating to a disparity on the basis of ra-
10 cial or ethnic background as to the safety or effec-
11 tiveness of the drug, whether derived from investiga-
12 tions or studies required under this section or de-
13 rived from other sources, when the omitted informa-
14 tion is protected by patent or by exclusivity under
15 section 505(j)(5)(F).
16 ‘‘(2) LABELING.—Notwithstanding paragraph
17 (1), the Secretary may require that the labeling of
18 a drug approved under section 505(j) that omits in-
19 formation relating to a disparity on the basis of ra-
20 cial or ethnic background as to the safety or effec-
21 tiveness of the drug include a statement of any ap-
22 propriate contraindications, warnings, or precautions
23 related to the disparity that the Secretary considers
24 necessary.
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1 ‘‘(d) DEFINITION.—In this section, the term ‘evi-
2 dence of a racial or ethnic disparity in safety or effective-
3 ness’, with respect to a drug or biological product, in-
4 cludes—
5 ‘‘(1) evidence that there is a disparity on the
6 basis of racial or ethnic background as to safety or
7 effectiveness of a drug or biological product in the
8 same chemical class as the drug or biological prod-
9 uct;
10 ‘‘(2) evidence that there is a disparity on the
11 basis of racial or ethnic background in the way the
12 drug or biological product is metabolized; and
13 ‘‘(3) other evidence as the Secretary may deter-
14 mine appropriate.’’.
15 (b) ENFORCEMENT.—Section 502 of the Federal
16 Food, Drug, and Cosmetic Act (21 U.S.C. 352) is amend-
17 ed by adding at the end the following:
18 ‘‘(gg) If it is a drug and the holder of the approved
19 application under section 505 or license under section 351
20 of the Public Health Service Act for the drug has failed
21 to complete the investigations or studies required under
22 section 505H, or comply with any other requirement of
23 such section 505H.’’.
24 (c) DRUG FEES.—Section 736(a)(1)(A)(ii) of the
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25 Federal Food, Drug, and Cosmetic Act (21 U.S.C.
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1 379h(a)(1)(A)(ii)) is amended by inserting after ‘‘are not
2 required’’ the following: ‘‘, including postmarket studies
3 required under section 505H,’’.
4 SEC. 1009. IMPROVING HEALTH DATA REGARDING NATIVE
5 HAWAIIANS AND PACIFIC ISLANDERS.
6 Part B of title III of the Public Health Service Act
7 (42 U.S.C. 243 et seq.) is amended by inserting after sec-
8 tion 317U the following:
9 ‘‘SEC. 317V. NATIVE HAWAIIAN AND PACIFIC ISLANDER
10 HEALTH DATA.
11 ‘‘(a) DEFINITIONS.—In this section:
12 ‘‘(1) INSULAR AREA.—The term ‘insular area’
13 means Guam, the Commonwealth of the Northern
14 Mariana Islands, American Samoa, the United
15 States Virgin Islands, the Federated States of Mi-
16 cronesia, the Republic of Palau, or the Republic of
17 the Marshall Islands.
18 ‘‘(2) NATIVE HAWAIIANS AND PACIFIC ISLAND-
19 ERS (NHPI).—The term ‘Native Hawaiians and Pa-
20 cific Islanders’ or ‘NHPI’ means people having ori-
21 gins in any of the original peoples of American
22 Samoa, the Commonwealth of the Northern Mariana
23 Islands, the Federated States of Micronesia, Guam,
24 Hawaii, the Republic of the Marshall Islands, the
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25 Republic of Palau, or any other Pacific Island.
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1 ‘‘(3) NHPI STAKEHOLDER GROUPS.—The term
2 ‘NHPI stakeholder group’ includes each of the fol-
3 lowing:
4 ‘‘(A) COMMUNITY GROUP.—A group of
5 NHPI who are organized at the community
6 level, and may include a church group, social
7 service group, national advocacy organization,
8 or cultural group.
9 ‘‘(B) NONPROFIT, NONGOVERNMENTAL
10 ORGANIZATION.—A group of NHPI with a dem-
11 onstrated history of addressing NHPI issues,
12 including a NHPI coalition.
13 ‘‘(C) DESIGNATED ORGANIZATION.—An
14 entity established to represent NHPI popu-
15 lations and which has statutory responsibilities
16 to provide, or has community support for pro-
17 viding, health care.
18 ‘‘(D) GOVERNMENT REPRESENTATIVES OF
19 NHPI POPULATIONS.—Representatives from Ha-
20 waii, American Samoa, the Commonwealth of
21 the Northern Mariana Islands, the Federated
22 States of Micronesia, Guam, the Republic of
23 Palau, and the Republic of the Marshall Is-
24 lands.
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25 ‘‘(b) PRELIMINARY HEALTH SURVEY.—
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1 ‘‘(1) IN GENERAL.—The Secretary, acting
2 through the Director of the National Center for
3 Health Statistics of the Centers for Disease Control
4 and Prevention (referred to in this section as
5 ‘NCHS’), shall conduct a preliminary health survey
6 in order to identify the major areas and regions in
7 the continental United States, Hawaii, American
8 Samoa, the Commonwealth of the Northern Mariana
9 Islands, the Federated States of Micronesia, Guam,
10 the Republic of Palau, and the Republic of the Mar-
11 shall Islands in which NHPI people reside.
12 ‘‘(2) CONTENTS.—The health survey described
13 in paragraph (1) shall include health data and any
14 other data the Secretary determines to be—
15 ‘‘(A) useful in determining health status
16 and health care needs of NHPI populations; or
17 ‘‘(B) required for developing or imple-
18 menting the national strategy under subsection
19 (c).
20 ‘‘(3) METHODOLOGY.—Methodology for the
21 health survey described in paragraph (1), including
22 plans for designing questions, implementation, sam-
23 pling, and analysis, shall be developed in consulta-
24 tion with NHPI stakeholder groups.
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1 ‘‘(4) TIMEFRAME.—The survey required under
2 this subsection shall be completed not later than 18
3 months after the date of enactment of the Health
4 Equity and Accountability Act of 2022.
5 ‘‘(c) NATIONAL STRATEGY.—
6 ‘‘(1) IN GENERAL.—The Secretary, acting
7 through the Director of the NCHS and other agen-
8 cies within the Department of Health and Human
9 Services as the Secretary determines appropriate,
10 shall develop and implement a sustainable national
11 strategy for identifying and evaluating the health
12 status and health care needs of NHPI populations
13 living in the continental United States, Hawaii,
14 American Samoa, the Commonwealth of the North-
15 ern Mariana Islands, the Federated States of Micro-
16 nesia, Guam, the Republic of Palau, and the Repub-
17 lic of the Marshall Islands.
18 ‘‘(2) CONSULTATION.—In developing and imple-
19 menting a national strategy, as described in para-
20 graph (1), not later than 180 days after the date of
21 enactment of the Health Equity and Accountability
22 Act of 2022, the Secretary—
23 ‘‘(A) shall consult with representatives of
24 NHPI stakeholder groups; and
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1 ‘‘(B) may solicit the participation of rep-
2 resentatives from other Federal agencies.
3 ‘‘(d) PROGRESS REPORT.—Not later than 2 years
4 after the date of enactment of the Health Equity and Ac-
5 countability Act of 2022, the Secretary shall submit to
6 Congress a progress report, which shall include the na-
7 tional strategy described in subsection (c)(1).
8 ‘‘(e) STUDY AND REPORT BY THE HEALTH AND
9 MEDICINE DIVISION.—
10 ‘‘(1) IN GENERAL.—The Secretary shall seek to
11 enter into an agreement with the Health and Medi-
12 cine Division of the National Academies of Sciences,
13 Engineering, and Medicine to conduct a study, with
14 input from stakeholders in insular areas, on each of
15 the following:
16 ‘‘(A) The standards and definitions of
17 health care applied to health care systems in in-
18 sular areas and the appropriateness of such
19 standards and definitions.
20 ‘‘(B) The status and performance of health
21 care systems in insular areas, evaluated based
22 upon standards and definitions, as the Sec-
23 retary determines appropriate.
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1 ‘‘(C) The effectiveness of donor aid in ad-
2 dressing health care needs and priorities in in-
3 sular areas.
4 ‘‘(D) The progress toward implementation
5 of recommendations of the Committee on
6 Health Care Services in the United States—As-
7 sociated Pacific Basin that are set forth in the
8 1998 report entitled ‘Pacific Partnerships for
9 Health: Charting a New Course’.
10 ‘‘(2) REPORT.—An agreement described in
11 paragraph (1) shall require the Health and Medicine
12 Division to submit to the Secretary and to Congress,
13 not later than 2 years after the date of the enact-
14 ment of the Health Equity and Accountability Act of
15 2022, a report containing a description of the results
16 of the study conducted under paragraph (1), includ-
17 ing the conclusions and recommendations of the
18 Health and Medicine Division for each of the items
19 described in subparagraphs (A) through (D) of such
20 paragraph.
21 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To
22 carry out this section, there are authorized to be appro-
23 priated such sums as may be necessary for fiscal years
24 2023 through 2027.’’.
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1 SEC. 1010. CLARIFICATION OF SIMPLIFIED ADMINISTRA-
2 TIVE REPORTING REQUIREMENT.
3 Section 11(a) of the Food and Nutrition Act of 2008
4 (7 U.S.C. 2020(a)) is amended by adding at the end the
5 following:
6 ‘‘(5) SIMPLIFIED ADMINISTRATIVE REPORTING
7 REQUIREMENT.—With respect to any obligation of a
8 State agency to comply with the notification require-
9 ment under paragraph (2) of section 421(e) of the
10 Personal Responsibility and Work Opportunity Rec-
11 onciliation Act of 1996 (8 U.S.C. 1631(e)), notwith-
12 standing the requirement to include in that notifica-
13 tion the names of the sponsor and the sponsored
14 alien involved, the State agency shall be considered
15 to have complied with the notification requirement if
16 the State agency submits to the Attorney General a
17 report that includes the aggregate number of excep-
18 tions granted by the State agency under paragraph
19 (1) of that section.’’.
20 SEC. 1011. DATA COLLECTION REGARDING PANDEMIC PRE-
21 PAREDNESS, TESTING, INFECTIONS, AND
22 DEATHS.
23 (a) SKILLED NURSING FACILITIES QUALITY RE-
24 PORTING.—Section 1819 of the Social Security Act (42
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25 U.S.C. 1395i–3) is amended by adding at the end the fol-
26 lowing new subsection:
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1 ‘‘(l) REQUIREMENTS RELATING TO REPORTING DUR-
2 ING PUBLIC HEALTH EMERGENCIES.—During a public
3 health emergency declared by the Secretary pursuant to
4 section 319 of the Public Health Service Act, a skilled
5 nursing facility shall, not later than one year after the first
6 day of such declaration, and monthly thereafter during the
7 application of such declaration, submit to the Secretary
8 the following information, with respect to such facility and
9 the residents of such facility:
10 ‘‘(1) Information described in section
11 483.80(g)(1) of title 42, Code of Federal Regula-
12 tions.
13 ‘‘(2) The age, race, ethnicity, sex, sexual ori-
14 entation, gender identity, socioeconomic status, dis-
15 ability status, and preferred language of the resi-
16 dents of such skilled nursing facility.’’.
17 (b) TRANSPARENCY OF DEMOGRAPHIC INFORMATION
18 IN CERTAIN SETTINGS.—
19 (1) DEMOGRAPHIC INFORMATION.—The Sec-
20 retary of Health and Human Services shall post the
21 following information with respect to skilled nursing
22 facilities (as defined in section 1819(a) of the Social
23 Security Act (42 U.S.C. 1395i–3(a))), congregate
24 care settings (including skilled nursing facilities, as-
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1 behavioral health care and psychiatric facilities, and
2 facilities providing services for aging adults and peo-
3 ple with disabilities), and nursing facilities (as de-
4 fined in section 1919(a) of such Act (42 U.S.C.
5 1396r(a))) on the Nursing Home Compare website
6 (as described in section 1819(i) of the Social Secu-
7 rity Act (42 U.S.C. 1395i–3(i))), or a successor
8 website, aggregated by State:
9 (A) The age, race, ethnicity, sex, sexual
10 orientation, gender identity, socioeconomic sta-
11 tus, disability status, and preferred language of
12 the residents of such skilled nursing facilities,
13 congregate care settings (including skilled nurs-
14 ing facilities, assisted living facilities, prisons
15 and jails, residential behavioral health care and
16 psychiatric facilities, and facilities providing
17 services for aging adults and people with dis-
18 abilities), and nursing facilities with suspected
19 or confirmed infections, including residents pre-
20 viously treated for COVID–19.
21 (B) The age, race, ethnicity, sex, sexual
22 orientation, gender identity, socioeconomic sta-
23 tus, disability status, and preferred language
24 relating to total deaths and public health emer-
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25 gency-related deaths among residents of such
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1 skilled nursing facilities, congregate settings
2 (including skilled nursing facilities, assisted liv-
3 ing facilities, prisons and jails, residential be-
4 havioral health care and psychiatric facilities,
5 and facilities providing services for aging adults
6 and people with disabilities), and nursing facili-
7 ties.
8 (2) CONFIDENTIALITY.—Any information re-
9 ported under this subsection that is made available
10 to the public shall be made so available in a manner
11 that protects the identity of residents of skilled nurs-
12 ing facilities, congregate care settings (including
13 skilled nursing facilities, assisted living facilities,
14 prisons and jails, residential behavioral health care
15 and psychiatric facilities, and facilities providing
16 services for aging adults and people with disabil-
17 ities), and nursing facilities.
18 (3) IMPLEMENTATION.—Notwithstanding any
19 other provision of law, the Secretary of Health and
20 Human Services may implement the provisions of
21 this subsection by program instruction or otherwise.
22 (c) EQUITABLE DATA COLLECTION AND DISCLOSURE
23 REGARDING PANDEMICS.—Part A of title XI of the Social
24 Security Act (42 U.S.C. 1301 et seq.) as amended by sec-
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1 tion 1003, is further amended by adding at the end the
2 following new section:
3 ‘‘SEC. 1150E. EQUITABLE DATA COLLECTION AND DISCLO-
4 SURE REGARDING PANDEMICS.
5 ‘‘(a) IN GENERAL.—Not later than 60 days after the
6 Secretary submits to Congress written notification of the
7 determination that a disease or disorder presents a public
8 health emergency or that a public health emergency other-
9 wise exists, subject to the succeeding subsections, the Sec-
10 retary, acting through the Director of the Centers for Dis-
11 ease Control and Prevention and the Administrator of the
12 Centers for Medicare & Medicaid Services and in consulta-
13 tion with the Director of the Indian Health Service, shall
14 collect and make publicly available on the website of the
15 Centers for Disease Control and Prevention and the Cen-
16 ters for Medicare & Medicaid Services, and update every
17 day during a pandemic, data collected across all surveil-
18 lance systems relating to a public health emergency de-
19 clared under section 319 of the Public Health Service Act
20 that is caused by a disease (as determined by the Sec-
21 retary), disaggregated by race, ethnicity, sex, sexual ori-
22 entation, gender identity, age, preferred language, socio-
23 economic status, disability status, and county, including
24 the following:
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1 ‘‘(1) Data relating to all testing for the patho-
2 gen or pathogens causing the pandemic, including
3 the number of individuals tested and the number of
4 tests that were positive.
5 ‘‘(2) Data relating to treatment for the patho-
6 gen causing the pandemic, including hospitalizations
7 and intensive care unit admissions.
8 ‘‘(3) Data relating to pandemic outcomes, in-
9 cluding total fatalities and case fatality rates (ex-
10 pressed as the proportion of individuals who were in-
11 fected with the pathogen causing the pandemic and
12 died from the pathogen).
13 ‘‘(4) In the case a vaccine is developed in re-
14 sponse to a pandemic, data relating to such vaccina-
15 tion, including—
16 ‘‘(A) the number of vaccines administered;
17 ‘‘(B) the number of vaccinations offered,
18 accepted, and refused;
19 ‘‘(C) the most common reasons for refusal;
20 and
21 ‘‘(D) the percentage of vaccine doses allo-
22 cated and administered to each priority group.
23 ‘‘(b) APPLICATION OF CERTAIN STANDARDS WITH
24 RESPECT TO DATA COLLECTION.—To the extent prac-
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1 standards developed by the Department of Health and
2 Human Services Office of Minority Health and be col-
3 lected, analyzed, and reported in accordance with the
4 standards promulgated by the Assistant Secretary for
5 Planning and Evaluation under title XXXI of the Public
6 Health Service Act.
7 ‘‘(c) PRIVACY.—In publishing data pursuant to sub-
8 section (a), the Secretary shall take all necessary steps to
9 protect the privacy of individuals whose information is in-
10 cluded in such data, including—
11 ‘‘(1) complying with privacy protections pro-
12 vided under the regulations promulgated under sec-
13 tion 264(c) of the Health Insurance and Account-
14 ability Act of 1996; and
15 ‘‘(2) protections from all inappropriate internal
16 use by an entity that collects, stores, or receives the
17 data, including use of such data in determinations of
18 eligibility (or continued eligibility) in health plans,
19 and from inappropriate uses.’’.
20 (d) REPORT REQUIREMENTS FOLLOWING PUBLIC
21 HEALTH EMERGENCIES.—
22 (1) PUBLICLY AVAILABLE SUMMARY.—Not later
23 than 60 days after the date on which the Secretary
24 of Health and Human Services certifies that a public
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25 health emergency declared under section 319 of the
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1 Public Health Service Act has ended, the Secretary
2 shall make publicly available on the website of the
3 Department of Health and Human Services a sum-
4 mary of the final statistics related to such emer-
5 gency.
6 (2) REPORT TO CONGRESS.—Not later than 60
7 days after the date on which the Secretary of Health
8 and Human Services certifies that a public health
9 emergency declared under section 319 of the Public
10 Health Service Act has ended, the Secretary shall
11 submit to the Committee on Health, Education,
12 Labor, and Pensions and the Committee on Finance
13 of the Senate and the Committee on Energy and
14 Commerce and the Committee on Ways and Means
15 of the House of Representatives a report—
16 (A) describing the testing, hospitalization,
17 mortality rates, vaccination rates, and preferred
18 language of patients associated with the pan-
19 demic by race and ethnicity, rural and urban
20 areas (as defined in section 1886(d)(2)(D) of
21 the Social Security Act (42 U.S.C.
22 1395ww(d)(2)(D)), and congregate care set-
23 tings (including skilled nursing facilities, as-
24 sisted living facilities, prisons and jails, residen-
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25 tial behavioral health care and psychiatric facili-
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1 ties, and facilities providing services for aging
2 adults and people with disabilities) and noncon-
3 gregate care settings (as such terms are defined
4 by the Secretary); and
5 (B) proposing evidenced-based response
6 strategies to safeguard the health of these com-
7 munities in future pandemics.
8 SEC. 1012. COMMISSION ON ENSURING DATA FOR HEALTH
9 EQUITY.
10 (a) IN GENERAL.—Not later than 30 days after the
11 date of enactment of this Act, the Secretary of Health and
12 Human Services (referred to in this section as the ‘‘Sec-
13 retary’’) shall establish a commission, to be known as the
14 ‘‘Commission on Ensuring Data for Health Equity’’ (re-
15 ferred to in this section as the ‘‘Commission’’) to provide
16 clear and robust guidance to improve the collection, anal-
17 ysis, and use of demographic data in responding to future
18 public health emergencies.
19 (b) MEMBERSHIP AND CHAIRPERSON.—
20 (1) MEMBERSHIP.—The Commission shall be
21 composed of—
22 (A) the Assistant Secretary for Prepared-
23 ness and Response;
24 (B) the Director of the Centers for Disease
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25 Control and Prevention;
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1 (C) the Director of the National Institutes
2 of Health;
3 (D) the Commissioner of Food and Drugs;
4 (E) the Administrator of the Federal
5 Emergency Management Agency;
6 (F) the Director of the National Institute
7 on Minority Health and Health Disparities;
8 (G) the Director of the Indian Health
9 Service;
10 (H) the Administrator of the Centers for
11 Medicare & Medicaid Services;
12 (I) the Director of the Agency for
13 Healthcare Research and Quality;
14 (J) the Surgeon General;
15 (K) the Administrator of the Health Re-
16 sources and Services Administration;
17 (L) the Director of the Office of Minority
18 Health;
19 (M) the Director of the Office of Women’s
20 Health;
21 (N) the Chairperson of the National Coun-
22 cil on Disability;
23 (O) at least 4 State, local, territorial, and
24 Tribal public health officials representing de-
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25 partments of public health, or an Urban Indian
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1 health representative, who shall represent juris-
2 dictions from different regions of the United
3 States with relatively high concentrations of
4 historically marginalized populations and rural
5 populations, to be appointed by the Secretary;
6 (P) the National Coordinator for Health
7 Information Technology;
8 (Q) at least 3 independent individuals with
9 expertise on racially and ethnically diverse rep-
10 resentation with knowledge or field experience
11 with community-based participatory research on
12 racial and ethnic disparities in public health, to
13 be appointed by the Secretary; and
14 (R) at least 4 individuals with expertise on
15 health equity and demographic data disparities
16 with knowledge of, or field experience in, lan-
17 guage, disability status, sex, sexual orientation,
18 gender identity, or socioeconomic status.
19 (2) CHAIRPERSON.—The Assistant Secretary
20 for Preparedness and Response shall serve as the
21 Chairperson of the Commission.
22 (c) DUTIES.—The Commission shall—
23 (1) examine barriers to collecting, analyzing,
24 and using demographic data in public health;
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1 (2) determine how to best use such data to pro-
2 mote health equity across the United States and re-
3 duce racial, Tribal, and other demographic dispari-
4 ties in health outcomes;
5 (3)(A) gather available data related to treat-
6 ment of individuals with disabilities during the
7 COVID–19 pandemic and other public health emer-
8 gencies, including access to vaccinations, denial of
9 treatment for preexisting conditions, removal or de-
10 nial of disability related equipment (including ven-
11 tilators and continuous positive airway pressure
12 (commonly referred to as ‘‘CPAP’’) machines), and
13 data on completion of do-not-resuscitate orders; and
14 (B) identify barriers to obtaining accurate and
15 timely data related to treatment of such individuals;
16 (4) solicit input from public health officials,
17 community-connected organizations, health care pro-
18 viders, State and local agency officials, Tribal offi-
19 cials, and other experts on barriers to, and best
20 practices for, collecting demographic data; and
21 (5) recommend policy changes that the data in-
22 dicates are necessary to reduce demographic dispari-
23 ties in health outcomes.
24 (d) REPORT.—Not later than 1 year after the date
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25 of the enactment of this Act, the Commission shall submit
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1 to Congress, and publish on the website of the Department
2 of Health and Human Services, a report containing—
3 (1) the findings of the Commission pursuant to
4 subsection (c);
5 (2) to the extent possible, an analysis of—
6 (A) racial and other demographic dispari-
7 ties in COVID–19 mortality, including an anal-
8 ysis of comorbidities and case fatality rates;
9 (B) sex, sexual orientation, and gender
10 identity disparities in COVID–19 treatment and
11 mortality; and
12 (C) Federal Government policies that dis-
13 parately exacerbate the COVID–19 impact, and
14 recommendations to improve racial and other
15 demographic disparities in health outcomes;
16 (3) an analysis of COVID–19 treatment of indi-
17 viduals with disabilities, including equity of access to
18 treatment and equipment and intersections of dis-
19 ability status with other demographic factors, includ-
20 ing race;
21 (4) an analysis of what demographic data is
22 currently being collected, the accuracy of that data
23 and any gaps, how this data is currently being used
24 to inform efforts to combat COVID–19, and what
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1 resources are needed to supplement existing public
2 health data collection; and
3 (5) the Commission’s recommendations with re-
4 spect to—
5 (A) how to enhance State, local, territorial,
6 and Tribal capacity to conduct public health re-
7 search on COVID–19 and in future public
8 health emergencies, with a focus on expanded
9 capacity to analyze data on disparities cor-
10 related with race, ethnicity, income, sex, sexual
11 orientation, gender identity, age, disability sta-
12 tus, specific geographic areas, and other rel-
13 evant demographic characteristics;
14 (B) how to collect, process, and disclose to
15 the public the data described in subparagraph
16 (A) in a way that maintains individual privacy
17 while helping direct the State, local, and Tribal
18 response to public health emergencies;
19 (C) how to improve demographic data col-
20 lection related to COVID–19 and other public
21 health emergencies in the short-term and long-
22 term, including how to continue to grow and
23 value the Tribal sovereignty of data and infor-
24 mation concerning urban and rural Tribal com-
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1 (D) how to improve transparency and eq-
2 uity of treatment for individuals with disabil-
3 ities during the COVID–19 public health emer-
4 gency and future public health emergencies; and
5 (E) how to support State, local, and Tribal
6 capacity to eliminate barriers to vaccinations,
7 testing, and treatment during the COVID–19
8 public health emergency and future public
9 health emergencies.
10 (e) STAFF OF COMMISSION.—
11 (1) ADDITIONAL STAFF.—The Chairperson of
12 the Commission may appoint and fix the pay of ad-
13 ditional staff to the Commission as the Chairperson
14 considers appropriate.
15 (2) APPLICABILITY OF CERTAIN CIVIL SERVICE
16 LAWS.—The staff of the Commission may be ap-
17 pointed without regard to the provisions of title 5,
18 United States Code, governing appointments in the
19 competitive service, and may be paid without regard
20 to the provisions of chapter 51 and subchapter III
21 of chapter 53 of that title relating to classification
22 and General Schedule pay rates.
23 (3) DETAILEES.—Any Federal Government em-
24 ployee may be detailed to the Commission without
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25 reimbursement from the Commission, and the
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1 detailee shall retain the rights, status, and privileges
2 of his or her regular employment without interrup-
3 tion.
4 (f) COORDINATION WITH OTHER EFFORTS.—The
5 Secretary shall, in establishing the Commission under this
6 section, take such steps as may be necessary to ensure
7 that the work of the Commission does not overlap with,
8 or otherwise duplicate, other Federal Government efforts
9 with respect to ensuring health equity in data collection
10 in public health emergencies.
11 (g) AUTHORIZATION OF APPROPRIATIONS.—There
12 are authorized to be appropriated such sums as may be
13 necessary to carry out this section.
14 SEC. 1013. TASK FORCE ON PREVENTING BIAS IN AI AND
15 ALGORITHMS.
16 (a) IN GENERAL.—Not later than 30 days after the
17 date of enactment of this Act, the Secretary of Health and
18 Human Services (referred to in this section as the ‘‘Sec-
19 retary’’) shall establish a Task Force to be known as the
20 ‘‘Task Force on Preventing AI and Algorithmic Bias in
21 Healthcare’’ (referred to in this section as the ‘‘Task
22 Force’’) to provide clear and robust guidance on how to
23 ensure that the development and integration of artificial
24 intelligence and algorithmic technologies within the health
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1 care service delivery process does not exacerbate health
2 disparities and expands access to health care services.
3 (b) MEMBERSHIP AND CHAIRPERSON.—
4 (1) MEMBERSHIP.—The Task Force shall be
5 composed of—
6 (A) the Chief Information Officer of the
7 Department of Health and Human Services;
8 (B) the Director of the Centers for Disease
9 Control and Prevention;
10 (C) the Director of the National Institutes
11 of Health;
12 (D) the Commissioner of Food and Drugs;
13 (E) the Administrator of the Federal
14 Emergency Management Agency;
15 (F) the Director of the National Institute
16 on Minority Health and Health Disparities;
17 (G) the Director of the Indian Health
18 Service;
19 (H) the Administrator of the Centers for
20 Medicare & Medicaid Services;
21 (I) the Director of the Agency for
22 Healthcare Research and Quality;
23 (J) the Surgeon General;
24 (K) the Administrator of the Health Re-
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25 sources and Services Administration;
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1 (L) the Director of the Office of Minority
2 Health;
3 (M) the Director of the Office of Women’s
4 Health;
5 (N) the Chairperson of the National Coun-
6 cil on Disability;
7 (O) the National Coordinator for Health
8 Information Technology;
9 (P) at least 4 State, local, territorial, and
10 Tribal public health officials representing de-
11 partments of public health, or an Urban Indian
12 health representative, who shall represent juris-
13 dictions from different regions of the United
14 States with relatively high concentrations of
15 historically marginalized populations, to be ap-
16 pointed by the Secretary;
17 (Q) at least 3 independent individuals with
18 expertise on racially and ethnically diverse rep-
19 resentation with knowledge or field experience
20 with community-based participatory research on
21 racial and ethnic disparities in public health, to
22 be appointed by the Secretary; and
23 (R) at least 4 individuals with expertise on
24 health equity and demographic data disparities
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25 with knowledge of, or field experience in, lan-
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1 guage, disability status, sex, sexual orientation,
2 gender identity, or socioeconomic status.
3 (2) CHAIRPERSON.—The Chief Information Of-
4 ficer of the Department of Health and Human Serv-
5 ices (or the Chief Information Officer’s designee)
6 shall serve as the Chairperson of the Task Force.
7 (c) DUTIES.—The Task Force shall—
8 (1) examine where to place artificial intelligence
9 and algorithms in the health care service delivery
10 process relative to the use of autonomous human de-
11 cision makers;
12 (2) identify the risks of health care system utili-
13 zation of artificial intelligence and algorithms in
14 terms of civil rights, civil liberties, and discrimina-
15 tory bias in health care access, quality, and out-
16 comes; and
17 (3) prepare and submit the report under sub-
18 section (d).
19 (d) REPORT.—Not later than 1 year after the date
20 of enactment of this Act, the Task Force shall—
21 (1) submit a written report of the findings of
22 the examination under paragraph (1) and rec-
23 ommendations to Congress with respect to imple-
24 mentation of artificial intelligence and algorithms in
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1 health care delivery and mitigation of the risks asso-
2 ciated with that implementation; and
3 (2) publish such report on the website of the
4 Department of Health and Human Services.
5 (e) PUBLIC COMMENT.—Not later than 60 days after
6 the date of the enactment of this Act, the Task Force shall
7 publish in the Federal Register a notice providing for a
8 public comment period on the duties and activities of the
9 Task Force of not less than 90 days, beginning on the
10 date of that publication.
11 (f) STAFF OF COMMISSION.—
12 (1) ADDITIONAL STAFF.—The Chairperson of
13 the Task Force may appoint and fix the pay of addi-
14 tional staff to the Task Force as the Chairperson
15 considers appropriate.
16 (2) APPLICABILITY OF CERTAIN CIVIL SERVICE
17 LAWS.—The staff of the Task Force may be ap-
18 pointed without regard to the provisions of title 5,
19 United States Code, governing appointments in the
20 competitive service, and may be paid without regard
21 to the provisions of chapter 51 and subchapter III
22 of chapter 53 of that title relating to classification
23 and General Schedule pay rates.
24 (3) DETAILEES.—Any Federal Government em-
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25 ployee may be detailed to the Task Force without re-
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1 imbursement from the Task Force, and the detailee
2 shall retain the rights, status, and privileges of his
3 or her regular employment without interruption.
4 TITLE II—CULTURALLY AND LIN-
5 GUISTICALLY APPROPRIATE
6 HEALTH AND HEALTH CARE
7 SEC. 2001. DEFINITIONS; FINDINGS.
8 (a) DEFINITIONS.—In this title, the definitions in
9 section 3400 of the Public Health Service Act, as added
10 by section 2004, shall apply.
11 (b) FINDINGS.—Congress finds the following:
12 (1) Effective communication is essential to
13 meaningful access to quality physical and mental
14 health care.
15 (2) Research indicates that the lack of appro-
16 priate language services creates language barriers
17 that result in increased risk of misdiagnosis, ineffec-
18 tive treatment plans, and poor health outcomes for
19 individuals with limited English proficiency and indi-
20 viduals with communication disabilities such as cog-
21 nitive, hearing, vision, or print impairments.
22 (3) The number of limited English speaking
23 residents in the United States who speak English
24 less than very well and, therefore, cannot effectively
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1 communicate with health and social service providers
2 continues to increase significantly.
3 (4) The responsibility to fund language services
4 in the provision of health care and health care-re-
5 lated services to individuals with limited English
6 proficiency and individuals with communication dis-
7 abilities such as cognitive, hearing, vision, or print
8 impairments is a societal one that cannot fairly be
9 placed solely upon the health care, public health, or
10 social services community.
11 (5) Title VI of the Civil Rights Act of 1964 (42
12 U.S.C. 2000d et seq.) prohibits discrimination based
13 on the grounds of race, color, or national origin by
14 any entity receiving Federal financial assistance. In
15 order to avoid discrimination on the grounds of na-
16 tional origin, all programs or activities administered
17 by the Federal Government must take adequate
18 steps to ensure that their policies and procedures do
19 not deny or have the effect of denying individuals
20 with limited English proficiency with equal access to
21 benefits and services for which such persons qualify.
22 (6) Both the Americans with Disabilities Act of
23 1990 (42 U.S.C. 12101 et seq.) and the Rehabilita-
24 tion Act of 1973 (29 U.S.C. 701 et seq.) prohibit
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25 discrimination on the basis of disability and require
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1 the provision of appropriate auxiliary aids and serv-
2 ices necessary to ensure effective communication
3 with individuals with disabilities. The type of auxil-
4 iary aid or service necessary to ensure effective com-
5 munication will vary in accordance with the method
6 of communication used by the individual, the nature,
7 length, and complexity of the communication in-
8 volved, and the context in which the communication
9 is taking place. A public accommodation should con-
10 sult with individuals with disabilities whenever pos-
11 sible to determine what type of auxiliary aid is need-
12 ed to ensure effective communication. The public ac-
13 commodation should use the individual’s preferred
14 method of communication whenever possible, unless
15 it would be an undue burden to the public accommo-
16 dation and an alternative would provide an equally
17 effective means of communication. The ultimate de-
18 cision as to what measures to take rests with the
19 public accommodation, provided that the method
20 chosen results in effective communication.
21 (7) Section 1557 of the Patient Protection and
22 Affordable Care Act (42 U.S.C. 18116) builds on
23 title VI of the Civil Rights Act of 1964 (42 U.S.C.
24 2000d et seq.) and section 504 of the Rehabilitation
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25 Act of 1973 (29 U.S.C. 794), prohibits discrimina-
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1 tion on the basis of race, color, national origin, dis-
2 ability, sex, and age, requires the provision of lan-
3 guage services to ensure effective communication
4 with individuals with limited English proficiency,
5 and requires the provision of appropriate auxiliary
6 aids and services necessary to ensure effective com-
7 munication with individuals with disabilities.
8 (8) Linguistic diversity in the health care and
9 health care-related services workforce is important
10 for providing all patients the environment most con-
11 ducive to positive health outcomes.
12 (9) All members of the health care and health
13 care-related services community should continue to
14 educate their staff and constituents about limited
15 English proficient and disability communication
16 issues and help them identify resources to improve
17 access to quality care for individuals with limited
18 English proficiency and individuals with communica-
19 tion disabilities such as cognitive, hearing, vision, or
20 print impairments.
21 (10) Access to English as a second language,
22 foreign language, and sign language interpreters,
23 translated and alternative format documents, read-
24 ers, and other auxiliary aids and services, are essen-
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1 the language barriers that impede access to health
2 care.
3 (11) Culturally competent language services in
4 health care settings should be available as a matter
5 of course.
6 SEC. 2002. IMPROVING ACCESS TO SERVICES FOR INDIVID-
7 UALS WITH LIMITED ENGLISH PROFICIENCY.
8 (a) PURPOSE.—Consistent with the goals provided in
9 Executive Order 13166 (42 U.S.C. 2000d–1 note; relating
10 to improving access to services for persons with limited
11 English proficiency), it is the purpose of this section—
12 (1) to improve Federal agency performance re-
13 garding access to federally conducted and federally
14 assisted programs and activities for individuals with
15 limited English proficiency;
16 (2) to require each Federal agency to examine
17 the services it provides and develop and implement
18 a system by which individuals with limited English
19 proficiency can obtain culturally competent services
20 and meaningful access to those services consistent
21 with, and without substantially burdening, the fun-
22 damental mission of the agency;
23 (3) to require each Federal agency to translate
24 any English language written material prepared for
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25 the general public relating to a public health emer-
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1 gency, including vaccine distribution and education,
2 into the top 15 non-English languages in the United
3 States (according to the most recent data from the
4 American Community Survey or its replacement) not
5 later than 7 days after any such material is made
6 available in English;
7 (4) to require each Federal agency to ensure
8 that recipients of Federal financial assistance pro-
9 vide culturally competent services and meaningful
10 access to applicants and beneficiaries who are indi-
11 viduals with limited English proficiency;
12 (5) to ensure that recipients of Federal finan-
13 cial assistance take reasonable steps, consistent with
14 the guidelines set forth in the ‘‘Guidance to Federal
15 Financial Assistance Recipients Regarding Title VI
16 Prohibition Against National Origin Discrimination
17 Affecting Limited English Proficient Persons’’ (67
18 Fed. Reg. 41455 (June 18, 2002)), to ensure cul-
19 turally and linguistically appropriate access to their
20 programs and activities by individuals with limited
21 English proficiency; and
22 (6) to ensure compliance with title VI of the
23 Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.)
24 and section 1557 of the Patient Protection and Af-
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25 fordable Care Act (42 U.S.C. 18116) (prohibiting
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1 health care providers and organizations from dis-
2 criminating in the provision of services).
3 (b) FEDERALLY CONDUCTED PROGRAMS AND AC-
4 TIVITIES.—
5 (1) IN GENERAL.—Not later than 120 days
6 after the date of enactment of this Act, each Federal
7 agency providing financial assistance to, or admin-
8 istering, a health program or activity described in
9 section 2003(a) shall prepare a plan or update a
10 plan to improve culturally and linguistically appro-
11 priate access to such program or activity with re-
12 spect to individuals with limited English proficiency.
13 Not later than 1 year after the date of enactment
14 of this title, each such Federal agency shall ensure
15 that such plan is fully implemented.
16 (2) PLAN REQUIREMENT.—Each plan under
17 paragraph (1) shall include—
18 (A) the steps the agency will take to en-
19 sure that individuals with limited English pro-
20 ficiency have access to each health program or
21 activity supported or administered by the agen-
22 cy;
23 (B) the policies and procedures for identi-
24 fying, assessing, and meeting the culturally and
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25 linguistically appropriate language needs of its
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1 beneficiaries that are individuals with limited
2 English proficiency served by such program or
3 activity;
4 (C) the steps the agency will take for such
5 program or activity to be culturally and linguis-
6 tically appropriate by—
7 (i) providing a range of language as-
8 sistance options;
9 (ii) giving notice to individuals with
10 limited English proficiency of the right to
11 competent language services;
12 (iii) training staff (at least annually);
13 and
14 (iv) monitoring and assessing the
15 quality of the language services (at least
16 annually);
17 (D) the steps the agency will take for such
18 program or activity to provide reasonable ac-
19 commodations necessary for individuals with
20 limited English proficiency, including those in-
21 dividuals with a communication disability, to
22 understand communications from the agency;
23 (E) the steps the agency will take to en-
24 sure that applications, forms, and other signifi-
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1 are competently translated into the primary
2 language of a client that is an individual with
3 limited English proficiency where such mate-
4 rials are needed to improve access of such client
5 to such program or activity;
6 (F) the resources the agency will provide
7 to improve cultural and linguistic appropriate-
8 ness to assist recipients of Federal funds to im-
9 prove access to health care-related programs
10 and activities for individuals with limited
11 English proficiency;
12 (G) the resources the agency will provide
13 to ensure that competent language assistance is
14 provided to patients that are individuals with
15 limited English proficiency by interpreters or
16 trained bilingual staff;
17 (H) the resources the agency will provide
18 to ensure that family, particularly minor chil-
19 dren, and friends are not used to provide inter-
20 pretation services, except as permitted under
21 section 1557 of the Patient Protection and Af-
22 fordable Care Act (42 U.S.C. 18116); and
23 (I) the steps the agency will take and re-
24 sources the agency will provide to ensure that
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1 individuals know their rights, including the abil-
2 ity to file a complaint.
3 (3) SUBMISSION OF PLAN TO DOJ.—Each agen-
4 cy that is required to prepare a plan under para-
5 graph (1) shall—
6 (A) consult with populations who are di-
7 rectly impacted by policies in the plan and their
8 representatives in the development of the plan;
9 and
10 (B) when the plan is finalized, send a copy
11 of such plan to the Attorney General, to serve
12 as the central repository of all such plans.
13 SEC. 2003. ENSURING STANDARDS FOR CULTURALLY AND
14 LINGUISTICALLY APPROPRIATE SERVICES IN
15 HEALTH CARE.
16 (a) APPLICABILITY.—This section shall apply to any
17 health program or activity—
18 (1) of which any part is receiving Federal fi-
19 nancial assistance, including credits, subsidies, or
20 contracts of insurance; or
21 (2) that is carried out (including indirectly
22 through contracts, subcontracts, or other support)
23 by an executive agency or any entity established
24 under title I of the Patient Protection and Afford-
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1 able Care Act (42 U.S.C. 18001 et seq.) (or amend-
2 ments made thereby).
3 (b) STANDARDS.—Each program or activity de-
4 scribed in subsection (a)—
5 (1) shall implement strategies to recruit, retain,
6 and promote individuals at all levels to maintain a
7 diverse staff and leadership that can provide cul-
8 turally and linguistically appropriate health care to
9 patient populations of the service area of the pro-
10 gram or activity;
11 (2) shall educate and train governance, leader-
12 ship, and workforce at all levels and across all dis-
13 ciplines of the program or activity in culturally and
14 linguistically appropriate policies and practices on an
15 ongoing basis at least yearly;
16 (3) shall offer and provide language assistance,
17 including trained and competent bilingual staff and
18 interpreter services, to individuals with limited
19 English proficiency or who have other communica-
20 tion needs, at no cost to the individual at all points
21 of contact, and during all hours of operation, to fa-
22 cilitate timely access to health care services and
23 health care-related services;
24 (4) shall for each language group consisting of
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1 stitutes 5 percent or 500 individuals, whichever is
2 less, of the population of persons eligible to be
3 served or likely to be affected or encountered in the
4 service area of the program or activity, make avail-
5 able at a fifth grade reading level—
6 (A) easily understood patient-related mate-
7 rials, including print and multimedia materials,
8 in the language of such language group;
9 (B) information or notices about termi-
10 nation of benefits in such language;
11 (C) signage; and
12 (D) any other documents or types of docu-
13 ments designated by the Secretary;
14 (5) shall develop and implement clear goals,
15 policies, operational plans, and management, ac-
16 countability, and oversight mechanisms to provide
17 culturally and linguistically appropriate services and
18 infuse them throughout the planning and operations
19 of the program or activity;
20 (6) shall conduct initial and ongoing, at least
21 annually, organizational assessments of culturally
22 and linguistically appropriate services-related activi-
23 ties and integrate valid linguistic, competence-related
24 National Standards for Culturally and Linguistically
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1 ternal audits, performance improvement programs,
2 patient satisfaction assessments, continuous quality
3 improvement activities, and outcomes-based evalua-
4 tions of the program or activity and develop ways to
5 standardize assessments;
6 (7) shall ensure that, consistent with the pri-
7 vacy protections provided for under the regulations
8 promulgated under section 264(c) of the Health In-
9 surance Portability and Accountability Act of 1996,
10 data on an individual required to be collected pursu-
11 ant to section 3101, including the individual’s alter-
12 native format preferences and policy modification
13 needs, are—
14 (A) collected in health records;
15 (B) integrated into the management infor-
16 mation systems of the program or activity;
17 (C) reported in such a way as to be inter-
18 operable with health information systems at the
19 Federal and State levels; and
20 (D) periodically updated;
21 (8) shall maintain a current demographic, cul-
22 tural, and epidemiological profile of the community,
23 conduct regular assessments of community health
24 assets and needs, and use the results of such assess-
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1 that respond to the cultural and linguistic character-
2 istics of the service area of the program or activity;
3 (9) shall develop participatory, collaborative
4 partnerships with community-based organizations
5 and utilize a variety of formal and informal mecha-
6 nisms to facilitate community and patient involve-
7 ment in designing, implementing, and evaluating
8 policies and practices to ensure culturally and lin-
9 guistically appropriate service-related activities;
10 (10) shall ensure that conflict and grievance
11 resolution processes are culturally and linguistically
12 appropriate and capable of identifying, preventing,
13 and resolving cross-cultural conflicts or complaints
14 by patients;
15 (11) shall annually make available to the public
16 information about their progress and successful in-
17 novations in implementing the standards under this
18 section, translated materials of such information
19 that is culturally and linguistically appropriate to
20 the communities served under this section, and pro-
21 vide public notice in such communities about the
22 availability of this information; and
23 (12) shall, if requested, regularly make avail-
24 able to the head of each Federal entity from which
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25 Federal funds are provided, information about the
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1 progress and successful innovations of the program
2 or activity in implementing the standards under this
3 section as required by the head of such entity.
4 (c) COMMENTS ACCEPTED THROUGH NOTICE AND
5 COMMENT RULEMAKING.—An agency carrying out a pro-
6 gram or activity described in subsection (a)—
7 (1) shall ensure that comments with respect to
8 such program or activity that are accepted through
9 notice and comment rulemaking are accepted in all
10 languages;
11 (2) may not require such comments to be sub-
12 mitted only in English; and
13 (3) shall ensure that any such comments that
14 are not submitted in English are considered, during
15 the agency’s review of such comments, equally as
16 such comments that are submitted in English.
17 SEC. 2004. CULTURALLY AND LINGUISTICALLY APPRO-
18 PRIATE HEALTH CARE IN THE PUBLIC
19 HEALTH SERVICE ACT.
20 The Public Health Service Act (42 U.S.C. 201 et
21 seq.) is amended by adding at the end the following:
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1 ‘‘TITLE XXXIV—CULTURALLY
2 AND LINGUISTICALLY APPRO-
3 PRIATE HEALTH CARE
4 ‘‘SEC. 3400. DEFINITIONS.
5 ‘‘(a) IN GENERAL.—In this title:
6 ‘‘(1) BILINGUAL.—The term ‘bilingual’, with
7 respect to an individual, means an individual who
8 has a sufficient degree of proficiency in 2 languages.
9 ‘‘(2) CULTURAL.—The term ‘cultural’ means
10 relating to integrated patterns of human behavior
11 that include the language, thoughts, communica-
12 tions, actions, customs, beliefs, values, age, and in-
13 stitutions of racial, ethnic, religious, or social
14 groups, including lesbian, gay, bisexual, transgender,
15 queer, and questioning individuals, and individuals
16 with physical and mental disabilities.
17 ‘‘(3) CULTURALLY AND LINGUISTICALLY AP-
18 PROPRIATE.—The term ‘culturally and linguistically
19 appropriate’ means being respectful of and respon-
20 sive to the cultural and linguistic needs of all indi-
21 viduals.
22 ‘‘(4) EFFECTIVE COMMUNICATION.—The term
23 ‘effective communication’ means an exchange of in-
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25 health care-related services and the recipient of such
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1 services who is limited in English proficiency, or has
2 a communication impairment such as a hearing, vi-
3 sion, speaking, or cognitive disability, that enables
4 access to, understanding of, and benefit from health
5 care or health care-related services, and full partici-
6 pation in the development of their treatment plan.
7 ‘‘(5) GRIEVANCE RESOLUTION PROCESS.—The
8 term ‘grievance resolution process’ means all aspects
9 of dispute resolution including filing complaints,
10 grievance and appeal procedures, and court action.
11 ‘‘(6) HEALTH CARE GROUP.—The term ‘health
12 care group’ means a group of physicians organized,
13 at least in part, for the purposes of providing physi-
14 cian services under the Medicaid program under title
15 XIX of the Social Security Act, the State Children’s
16 Health Insurance Program under title XXI of such
17 Act, or the Medicare program under title XVIII of
18 such Act, including a provider of services under part
19 B of such title XVIII, and may include a hospital,
20 a hospice provider, a palliative care provider, and
21 any other individual or entity furnishing services
22 covered under any such program that is affiliated
23 with the health care group.
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1 ‘‘(7) HEALTH CARE.—The term ‘health care’
2 includes all health care needed throughout the life
3 cycle and the end of life.
4 ‘‘(8) HEALTH CARE SERVICES.—The term
5 ‘health care services’ means services that address
6 physical and mental health conditions, as well as
7 conditions impacted by social determinants of health,
8 in all care settings throughout the life cycle and the
9 end of life.
10 ‘‘(9) HEALTH CARE-RELATED SERVICES.—The
11 term ‘health care-related services’ means human or
12 social services programs or activities that provide ac-
13 cess, referrals, or links to health care services.
14 ‘‘(10) HEALTH EDUCATOR.—The term ‘health
15 educator’ includes a professional with a bacca-
16 laureate degree who is responsible for designing, im-
17 plementing, and evaluating individual and population
18 health promotion, health education (including edu-
19 cation on end-of-life care options), end-of-life care,
20 or chronic disease prevention programs.
21 ‘‘(11) INDIAN; INDIAN TRIBE.—The terms ‘In-
22 dian’ and ‘Indian Tribe’ have the meanings given
23 such terms in section 4 of the Indian Self-Deter-
24 mination and Education Assistance Act.
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1 ‘‘(12) INDIVIDUAL WITH A DISABILITY.—The
2 term ‘individual with a disability’ means any indi-
3 vidual who has a disability as defined for the pur-
4 pose of section 504 of the Rehabilitation Act of
5 1973.
6 ‘‘(13) INDIVIDUAL WITH LIMITED ENGLISH
7 PROFICIENCY.—The term ‘individual with limited
8 English proficiency’ means an individual who self-
9 identifies on the Census as speaking English less
10 than ‘very well’.
11 ‘‘(14) INTEGRATED HEALTH CARE DELIVERY
12 SYSTEM.—The term ‘integrated health care delivery
13 system’ means an interdisciplinary system that
14 brings together providers from the primary health,
15 mental health, substance use disorder, hospice and
16 palliative care, and related disciplines to improve the
17 health outcomes of an individual and the community.
18 Such providers may include hospitals, health, mental
19 health, or substance use prevention and treatment
20 clinics and providers, home health agencies, home-
21 and community-based services providers, congregate
22 care settings (including any skilled nursing facilities,
23 assisted living facilities, prisons and jails, residential
24 behavioral health care and psychiatric facilities, and
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1 ple with disabilities), ambulatory surgery centers, re-
2 habilitation centers, and employed, independent, or
3 contracted physicians.
4 ‘‘(15) INTERPRETING; INTERPRETATION.—The
5 terms ‘interpreting’ and ‘interpretation’ mean the
6 transmission of a spoken, written, or signed message
7 from one language or format into another, faithfully,
8 accurately, and objectively.
9 ‘‘(16) LANGUAGE ACCESS.—The term ‘language
10 access’ means the provision of language services to
11 an individual with limited English proficiency or an
12 individual with communication disabilities designed
13 to enhance that individual’s access to, understanding
14 of, or benefit from health care services or health
15 care-related services.
16 ‘‘(17) LANGUAGE ASSISTANCE SERVICES.—The
17 term ‘language assistance services’ includes—
18 ‘‘(A) oral language assistance, including in-
19 terpretation in non-English languages provided
20 in person or remotely by a qualified interpreter
21 for an individual with limited English pro-
22 ficiency, and the use of qualified bilingual or
23 multilingual staff to communicate directly with
24 individuals with limited English proficiency;
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1 ‘‘(B) written translation, performed by a
2 qualified translator, of written content in paper
3 or electronic form into languages other than
4 English; and
5 ‘‘(C) taglines.
6 ‘‘(18) MINORITY.—
7 ‘‘(A) IN GENERAL.—The terms ‘minority’
8 and ‘minorities’ refer to individuals from a mi-
9 nority group.
10 ‘‘(B) POPULATIONS.—The term ‘minority’,
11 with respect to populations, refers to racial and
12 ethnic minority groups, members of sexual and
13 gender minority groups, and individuals with a
14 disability.
15 ‘‘(19) MINORITY GROUP.—The term ‘minority
16 group’ means a racial and ethnic minority group as
17 defined in this section.
18 ‘‘(20) ONSITE INTERPRETATION.—The term
19 ‘onsite interpretation’ means a method of inter-
20 preting or interpretation for which the interpreter is
21 in the physical presence of the provider of health
22 care services or health care-related services and the
23 recipient of such services who is limited in English
24 proficiency or has a communication impairment such
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25 as an impairment in hearing, vision, or learning.
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1 ‘‘(21) QUALIFIED INDIVIDUAL WITH A DIS-
2 ABILITY.—The term ‘qualified individual with a dis-
3 ability’ means, with respect to a health program or
4 activity, an individual with a disability who, with or
5 without reasonable modifications to policies, prac-
6 tices, or procedures, the removal of architectural,
7 communication, or transportation barriers, or the
8 provision of auxiliary aids and services, meets the es-
9 sential eligibility requirements for the receipt of aids,
10 benefits, or services offered or provided by the health
11 program or activity.
12 ‘‘(22) QUALIFIED INTERPRETER FOR AN INDI-
13 VIDUAL WITH A DISABILITY.—The term ‘qualified
14 interpreter for an individual with a disability’, with
15 respect to an individual with a disability—
16 ‘‘(A) means an interpreter for such indi-
17 vidual who by means of a remote interpreting
18 service or an onsite appearance—
19 ‘‘(i) adheres to generally accepted in-
20 terpreter ethics principles, including client
21 confidentiality; and
22 ‘‘(ii) is able to interpret effectively, ac-
23 curately, and impartially, both receptively
24 and expressively, using any necessary spe-
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1 cialized vocabulary, terminology, and phra-
2 seology; and
3 ‘‘(B) may include—
4 ‘‘(i) sign language interpreters;
5 ‘‘(ii) oral transliterators, which are in-
6 dividuals who represent or spell in the
7 characters of another alphabet; and
8 ‘‘(iii) cued language transliterators,
9 which are individuals who represent or
10 spell by using a small number of
11 handshapes.
12 ‘‘(23) QUALIFIED INTERPRETER FOR AN INDI-
13 VIDUAL WITH LIMITED ENGLISH PROFICIENCY.—
14 The term ‘qualified interpreter for an individual with
15 limited English proficiency’ means an interpreter
16 who by means of a remote interpreting service or an
17 onsite appearance—
18 ‘‘(A) adheres to generally accepted inter-
19 preter ethics principles, including client con-
20 fidentiality;
21 ‘‘(B) has demonstrated proficiency in
22 speaking and understanding both spoken
23 English and one or more other spoken lan-
24 guages; and
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1 ‘‘(C) is able to interpret effectively, accu-
2 rately, and impartially, both receptively and ex-
3 pressly, to and from such languages and
4 English, using any necessary specialized vocab-
5 ulary, terminology, and phraseology.
6 ‘‘(24) QUALIFIED TRANSLATOR.—The term
7 ‘qualified translator’ means a translator who—
8 ‘‘(A) adheres to generally accepted trans-
9 lator ethics principles, including client confiden-
10 tiality;
11 ‘‘(B) has demonstrated proficiency in writ-
12 ing and understanding both written English
13 and one or more other written non-English lan-
14 guages; and
15 ‘‘(C) is able to translate effectively, accu-
16 rately, and impartially to and from such lan-
17 guages and English, using any necessary spe-
18 cialized vocabulary, terminology, and phrase-
19 ology.
20 ‘‘(25) RACIAL AND ETHNIC MINORITY GROUP.—
21 The term ‘racial and ethnic minority group’ means
22 Indians and Alaska Natives, African Americans (in-
23 cluding Caribbean Blacks, Africans, and other
24 Blacks), Asian Americans, Hispanics (including
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1 Latinos), Middle Easterners and North Africans,
2 and Native Hawaiians and other Pacific Islanders.
3 ‘‘(26) SECRETARY.—The term ‘Secretary’
4 means the Secretary of Health and Human Services,
5 acting through the Director of the Agency for
6 Healthcare Research and Quality.
7 ‘‘(27) SEXUAL AND GENDER MINORITY
8 GROUP.—The term ‘sexual and gender minority
9 group’ encompasses lesbian, gay, bisexual, and
10 transgender populations, as well as those whose sex-
11 ual orientation, gender identity and expression, or
12 reproductive development varies from traditional, so-
13 cietal, cultural, or physiological norms.
14 ‘‘(28) SIGHT TRANSLATION.—The term ‘sight
15 translation’ means the transmission of a written
16 message in one language into a spoken or signed
17 message in another language, or an alternative for-
18 mat in English or another language.
19 ‘‘(29) STATE.—Notwithstanding section 2, the
20 term ‘State’ means each of the several States, the
21 District of Columbia, the Commonwealth of Puerto
22 Rico, the United States Virgin Islands, Guam,
23 American Samoa, and the Commonwealth of the
24 Northern Mariana Islands.
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1 ‘‘(30) TELEPHONIC INTERPRETATION.—The
2 term ‘telephonic interpretation’ (also known as ‘over
3 the phone interpretation’ or ‘OPI’) means, with re-
4 spect to interpretation for an individual with limited
5 English proficiency, a method of interpretation in
6 which the interpreter is not in the physical presence
7 of the provider of health care services or health care-
8 related services and such individual receiving such
9 services, but the interpreter is connected via tele-
10 phone.
11 ‘‘(31) TRANSLATION.—The term ‘translation’
12 means the transmission of a written message in one
13 language into a written or signed message in an-
14 other language, and includes translation into an-
15 other language or alternative format, such as large
16 print font, Braille, audio recording, or CD.
17 ‘‘(32) UNDERSERVED COMMUNITIES.—The
18 term ‘underserved communities’ means populations
19 sharing a particular characteristic, as well as geo-
20 graphic communities, who have been systematically
21 denied a full opportunity to participate in aspects of
22 economic, social, and civic life, such as—
23 ‘‘(A) Black, Latino, and Indigenous and
24 Native American persons, Asian Americans and
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1 Pacific Islanders, Middle Easterners and North
2 Africans, and other persons of color;
3 ‘‘(B) members of religious minorities;
4 ‘‘(C) lesbian, gay, bisexual, transgender,
5 and queer persons;
6 ‘‘(D) persons with disabilities;
7 ‘‘(E) persons who live in rural areas; and
8 ‘‘(F) persons otherwise adversely affected
9 by persistent poverty or inequality as defined in
10 Executive Order 13985.
11 ‘‘(33) UNDERSERVED POPULATIONS.—The
12 term ‘underserved populations’ means populations
13 sharing a particular characteristic, as well as geo-
14 graphic communities, who have been systematically
15 denied a full opportunity to participate in aspects of
16 economic, social, and civic life, as defined in Execu-
17 tive Order 13985.
18 ‘‘(34) VIDEO REMOTE INTERPRETING SERV-
19 ICES.—The term ‘video remote interpreting services’
20 means the provision, in health care services or health
21 care-related services, through a qualified interpreter
22 for an individual with limited English proficiency, of
23 video remote interpreting services that are—
24 ‘‘(A) in real-time, full-motion video, and
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1 width video connection or wireless connection
2 that delivers high-quality video images that do
3 not produce lags, choppy, blurry, or grainy im-
4 ages, or irregular pauses in communication; and
5 ‘‘(B) in a sharply delineated image that is
6 large enough to display.
7 ‘‘(35) VITAL DOCUMENT.—The term ‘vital doc-
8 ument’ includes applications for government pro-
9 grams that provide health care services, medical or
10 financial consent forms, financial assistance docu-
11 ments, letters containing important information re-
12 garding patient instructions (such as prescriptions,
13 referrals to other providers, and discharge plans)
14 and participation in a program (such as a Medicaid
15 managed care program), notices pertaining to the
16 reduction, denial, or termination of services or bene-
17 fits, notices of the right to appeal such actions, and
18 notices advising individuals with limited English pro-
19 ficiency with communication disabilities of the avail-
20 ability of free language services, alternative formats,
21 and other outreach materials.
22 ‘‘(b) REFERENCE.—In any reference in this title to
23 a regulatory provision applicable to a ‘handicapped indi-
24 vidual’, the term ‘handicapped individual’ in such provi-
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1 sion shall have the same meaning as the term ‘individual
2 with a disability’ as defined in subsection (a).
3 ‘‘Subtitle A—Resources and Innova-
4 tion for Culturally and Linguis-
5 tically Appropriate Health Care
6 ‘‘SEC. 3401. ROBERT T. MATSUI CENTER FOR CULTURALLY
7 AND LINGUISTICALLY APPROPRIATE HEALTH
8 CARE.
9 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab-
10 lish and support a center to be known as the ‘Robert T.
11 Matsui Center for Culturally and Linguistically Appro-
12 priate Health Care’ (referred to in this section as the
13 ‘Center’) to carry out each of the following activities:
14 ‘‘(1) INTERPRETATION SERVICES.—
15 ‘‘(A) IN GENERAL.—The Center shall pro-
16 vide resources via the internet to identify and
17 link health care providers to competent and
18 qualified interpreter and translation services.
19 ‘‘(B) TRAINING.—For purposes of pro-
20 viding the services described in subparagraph
21 (A), the Center shall adopt a language access
22 plan that includes training requirements for
23 Center staff to provide such services.
24 ‘‘(2) TRANSLATION OF WRITTEN MATERIAL.—
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1 ‘‘(A) VITAL DOCUMENTS.—The Center
2 shall provide, directly or through contract, to
3 providers of health care services and health
4 care-related services, at no cost to such pro-
5 viders and in a timely and reasonable manner,
6 vital documents—
7 ‘‘(i) which may be submitted by cov-
8 ered entities (as defined in section 92.4 of
9 title 45, Code of Federal Regulations, as in
10 effect on May 18, 2016) for translation
11 into non-English languages or alternative
12 formats at a fifth-grade reading level; and
13 ‘‘(ii) from competent translation serv-
14 ices, the quality of which shall be mon-
15 itored and reported publicly.
16 ‘‘(B) FORMS.—For each form developed or
17 revised by the Secretary that will be used by in-
18 dividuals with limited English proficiency in
19 health care or health care-related settings, the
20 Center shall, not later than 45 calendar days of
21 the Secretary receiving final approval of the
22 form from the Office of Management and
23 Budget—
24 ‘‘(i) translate the form, at a min-
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1 guages in the United States according to
2 the most recent data from the American
3 Community Survey or its replacement; and
4 ‘‘(ii) post all translated forms on the
5 Center’s website.
6 ‘‘(3) TOLL-FREE CUSTOMER SERVICE TELE-
7 PHONE NUMBER.—The Center shall provide,
8 through a toll-free number, a customer service line
9 for individuals with limited English proficiency that
10 is linked to the toll-free telephone number 1–800–
11 MEDICARE and a toll-free telephone hotline pro-
12 vided for pursuant to section 1311(d)(4)(B) of the
13 Patient Protection and Affordable Care Act by an
14 Exchange established under title I of such Act—
15 ‘‘(A) to obtain information about federally
16 conducted or funded health programs, including
17 the Medicare program under title XVIII of the
18 Social Security Act, the Medicaid program
19 under title XIX of such Act, and the State Chil-
20 dren’s Health Insurance Program under title
21 XXI of such Act, and coverage available
22 through an Exchange established under title I
23 of the Patient Protection and Affordable Care
24 Act, and other sources of free or reduced care
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25 including federally qualified health centers, enti-
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1 ties receiving assistance under title X, and pub-
2 lic health departments;
3 ‘‘(B) to obtain assistance with applying for
4 or accessing these programs and understanding
5 Federal notices written in English; and
6 ‘‘(C) to learn how to access language serv-
7 ices.
8 ‘‘(4) HEALTH INFORMATION CLEARING-
9 HOUSE.—
10 ‘‘(A) IN GENERAL.—The Center shall de-
11 velop and maintain, and make available on the
12 internet and in print, an information clearing-
13 house that includes the information described in
14 subparagraphs (B) through (F)—
15 ‘‘(i) to facilitate the provision of lan-
16 guage services by providers of health care
17 services and health care-related services to
18 reduce medical errors;
19 ‘‘(ii) to improve medical outcomes, im-
20 prove cultural competence, reduce health
21 care costs caused by miscommunication
22 with individuals with limited English pro-
23 ficiency; and
24 ‘‘(iii) to reduce or eliminate the dupli-
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1 ‘‘(B) DOCUMENT TEMPLATES.—The Cen-
2 ter shall collect and evaluate for accuracy, de-
3 velop, and make available templates for stand-
4 ard documents that are necessary for patients
5 and consumers to access and make educated de-
6 cisions about their health care, including tem-
7 plates for each of the following:
8 ‘‘(i) Administrative and legal docu-
9 ments, including—
10 ‘‘(I) intake forms;
11 ‘‘(II) forms related to the Medi-
12 care program under title XVIII of the
13 Social Security Act, the Medicaid pro-
14 gram under title XIX of such Act,
15 and the State Children’s Health In-
16 surance Program under title XXI of
17 such Act, including eligibility informa-
18 tion for such programs;
19 ‘‘(III) forms informing patients
20 of the compliance and consent re-
21 quirements pursuant to the regula-
22 tions under section 264(c) of the
23 Health Insurance Portability and Ac-
24 countability Act of 1996 (42 U.S.C.
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25 1320–2 note); and
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1 ‘‘(IV) documents concerning in-
2 formed consent, advanced directives,
3 and waivers of rights.
4 ‘‘(ii) Clinical information, such as how
5 to take medications, how to prevent trans-
6 mission of a contagious disease, and other
7 prevention and treatment instructions.
8 ‘‘(iii) Public health, patient education,
9 and outreach materials, such as immuniza-
10 tion notices, health warnings, or screening
11 notices.
12 ‘‘(iv) Additional health or health care-
13 related materials as determined appro-
14 priate by the Director of the Center.
15 ‘‘(C) STRUCTURE OF FORMS.—In oper-
16 ating the clearinghouse, the Center shall—
17 ‘‘(i) ensure that the documents posted
18 in English and non-English languages are
19 culturally and linguistically appropriate;
20 ‘‘(ii) allow public review of the docu-
21 ments before dissemination in order to en-
22 sure that the documents are understand-
23 able and culturally and linguistically ap-
24 propriate for the target populations;
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1 ‘‘(iii) allow health care providers to
2 customize the documents for their use;
3 ‘‘(iv) facilitate access to such docu-
4 ments;
5 ‘‘(v) provide technical assistance with
6 respect to the access and use of such infor-
7 mation; and
8 ‘‘(vi) carry out any other activities the
9 Secretary determines to be useful to fulfill
10 the purposes of the clearinghouse.
11 ‘‘(D) LANGUAGE ASSISTANCE PRO-
12 GRAMS.—The Center shall provide for the col-
13 lection and dissemination of information on cur-
14 rent examples of language assistance programs
15 and strategies to improve language services for
16 individuals with limited English proficiency, in-
17 cluding case studies using de-identified patient
18 information, program summaries, and program
19 evaluations.
20 ‘‘(E) CULTURALLY AND LINGUISTICALLY
21 APPROPRIATE MATERIALS.—The Center shall
22 provide, at no cost, to all health care providers
23 and all providers of health care-related services,
24 information relating to culturally and linguis-
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1 ulations residing in the United States, includ-
2 ing—
3 ‘‘(i) tenets of culturally and linguis-
4 tically appropriate care;
5 ‘‘(ii) culturally and linguistically ap-
6 propriate self-assessment tools;
7 ‘‘(iii) culturally and linguistically ap-
8 propriate training tools;
9 ‘‘(iv) strategic plans to increase cul-
10 tural and linguistic appropriateness in dif-
11 ferent types of providers of health care
12 services and health care-related services,
13 including regional collaborations among
14 health care organizations for health care
15 services and health care-related services;
16 and
17 ‘‘(v) culturally and linguistically ap-
18 propriate information for educators, practi-
19 tioners, students, and researchers.
20 ‘‘(F) TRANSLATION GLOSSARIES.—The
21 Center shall—
22 ‘‘(i) develop and publish on its website
23 translation glossaries that provide stand-
24 ardized translations of commonly used
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1 terms and phrases utilized in documents
2 translated by the Center; and
3 ‘‘(ii) make such glossaries available—
4 ‘‘(I) free of charge;
5 ‘‘(II) in each language in which
6 the Center translates forms under
7 paragraph (2)(B);
8 ‘‘(III) in alternative formats in
9 accordance with the Americans with
10 Disabilities Act of 1990 (42 U.S.C.
11 12101 et seq.); and
12 ‘‘(IV) in paper format upon re-
13 quest.
14 ‘‘(G) INFORMATION ABOUT PROGRESS.—
15 The Center shall—
16 ‘‘(i) regularly collect and make pub-
17 licly available information about the
18 progress of entities receiving grants under
19 section 3402 regarding successful innova-
20 tions in implementing the requirements of
21 this subsection; and
22 ‘‘(ii) provide public notice in the enti-
23 ties’ communities about the availability of
24 such information.
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1 ‘‘(b) DIRECTOR.—The Center shall be headed by a
2 Director who shall be appointed by, and who shall report
3 to, the Director of the Agency for Healthcare Research
4 and Quality.
5 ‘‘(c) AVAILABILITY OF LANGUAGE ACCESS.—The Di-
6 rector of the Center shall collaborate with the Deputy As-
7 sistant Secretary for Minority Health, the Administrator
8 of the Centers for Medicare & Medicaid Services, and the
9 Administrator of the Health Resources and Services Ad-
10 ministration to notify health care providers and health
11 care organizations about the availability of language ac-
12 cess services by the Center.
13 ‘‘(d) EDUCATION.—The Secretary, directly or
14 through contract, shall undertake a national education
15 campaign to inform providers, individuals with limited
16 English proficiency, individuals with hearing or vision im-
17 pairments, health professionals, graduate schools, commu-
18 nity health centers, social service providers, and commu-
19 nity-based organizations about—
20 ‘‘(1) Federal and State laws and guidelines gov-
21 erning access to language services;
22 ‘‘(2) the value of using trained and competent
23 interpreters and the risks associated with using fam-
24 ily members, friends, minors, and untrained bilin-
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1 ‘‘(3) funding sources for developing and imple-
2 menting language services; and
3 ‘‘(4) promising practices to effectively provide
4 language services.
5 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There
6 are authorized to be appropriated to carry out this section
7 $5,000,000 for each of fiscal years 2023 through 2027.
8 ‘‘SEC. 3402. INNOVATIONS IN CULTURALLY AND LINGUIS-
9 TICALLY APPROPRIATE HEALTH CARE
10 GRANTS.
11 ‘‘(a) IN GENERAL.—
12 ‘‘(1) GRANTS.—The Secretary shall award
13 grants to eligible entities to enable such entities to
14 design, implement, and evaluate innovative, cost-ef-
15 fective programs to improve culturally and linguis-
16 tically appropriate access to health care services for
17 individuals with limited English proficiency and com-
18 munication disabilities.
19 ‘‘(2) COORDINATION.—In making grants under
20 this section, and in the design and implementation
21 of the program established under this section, the
22 Secretary shall coordinate with, and ensure the par-
23 ticipation of, other agencies including the Health Re-
24 sources and Services Administration, the National
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25 Institute on Minority Health and Health Disparities
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1 at the National Institutes of Health, and the Office
2 of Minority Health.
3 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant
4 under subsection (a), an entity shall be—
5 ‘‘(1) a city, county, Indian Tribe, State, or sub-
6 division thereof;
7 ‘‘(2) an organization described in section
8 501(c)(3) of the Internal Revenue Code of 1986 and
9 exempt from tax under section 501(a) of such Code;
10 ‘‘(3) a community health, mental health, or
11 substance use disorder center or clinic;
12 ‘‘(4) a solo or group physician practice;
13 ‘‘(5) an integrated health care delivery system;
14 ‘‘(6) a public hospital;
15 ‘‘(7) a health care group, university, or college;
16 or
17 ‘‘(8) any other entity designated by the Sec-
18 retary.
19 ‘‘(c) APPLICATION.—An eligible entity seeking a
20 grant under this section shall prepare and submit to the
21 Secretary an application, at such time, in such manner,
22 and containing such additional information as the Sec-
23 retary may reasonably require.
24 ‘‘(d) USE OF FUNDS.—An entity shall use funds re-
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25 ceived through a grant under this section to—
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1 ‘‘(1) develop, implement, and evaluate models of
2 providing competent interpretation services through
3 onsite interpretation, telephonic interpretation, or
4 video remote interpreting services;
5 ‘‘(2) implement strategies to recruit, retain, and
6 promote individuals at all levels of the organization
7 to maintain a diverse staff and leadership that can
8 promote and provide language services to patient
9 populations of the service area of the entity;
10 ‘‘(3) develop and maintain a needs assessment
11 that identifies the current demographic, cultural,
12 and epidemiological profile of the community to ac-
13 curately plan for and implement language services
14 needed in the service area of the entity;
15 ‘‘(4) develop a strategic plan to implement lan-
16 guage services;
17 ‘‘(5) develop participatory, collaborative part-
18 nerships with communities encompassing the patient
19 populations of individuals with limited English pro-
20 ficiency served by the grant to gain input in design-
21 ing and implementing language services;
22 ‘‘(6) develop and implement grievance resolu-
23 tion processes that are culturally and linguistically
24 appropriate and capable of identifying, preventing,
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1 and resolving complaints by individuals with limited
2 English proficiency;
3 ‘‘(7) develop short-term medical and mental
4 health interpretation training courses and incentives
5 for bilingual health care staff who are asked to pro-
6 vide interpretation services in the workplace;
7 ‘‘(8) develop formal training programs, includ-
8 ing continued professional development and edu-
9 cation programs as well as supervision, for individ-
10 uals interested in becoming dedicated health care in-
11 terpreters and culturally and linguistically appro-
12 priate providers;
13 ‘‘(9) provide staff language training instruction,
14 which shall include information on the practical limi-
15 tations of such instruction for nonnative speakers;
16 ‘‘(10) develop policies that address compensa-
17 tion in salary for staff who receive training to be-
18 come either a staff interpreter or bilingual provider;
19 ‘‘(11) develop other language assistance services
20 as determined appropriate by the Secretary;
21 ‘‘(12) develop, implement, and evaluate models
22 of improving cultural competence, including cultural
23 competence programs for community health workers;
24 ‘‘(13) ensure that, consistent with the privacy
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1 mulgated under section 264(c) of the Health Insur-
2 ance Portability and Accountability Act of 1996 and
3 any applicable State privacy laws, data on the indi-
4 vidual patient or recipient’s race, ethnicity, and pri-
5 mary language are collected (and periodically up-
6 dated) in health records and integrated into the or-
7 ganization’s information management systems or
8 any similar system used to store and retrieve data;
9 and
10 ‘‘(14) ensure that culturally competent care and
11 language assistance are available to individuals with
12 limited English proficiency.
13 ‘‘(e) PRIORITY.—In awarding grants under this sec-
14 tion, the Secretary shall give priority to entities that pri-
15 marily engage in providing direct care and that have devel-
16 oped partnerships with community organizations or with
17 agencies with experience in improving language access.
18 ‘‘(f) EVALUATION.—
19 ‘‘(1) BY GRANTEES.—An entity that receives a
20 grant under this section shall submit to the Sec-
21 retary an evaluation that describes, in the manner
22 and to the extent required by the Secretary, the ac-
23 tivities carried out with funds received under the
24 grant, and how such activities improved access to
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1 and the quality of health care for individuals with
2 limited English proficiency. Such evaluation shall be
3 collected and disseminated through the Robert T.
4 Matsui Center for Culturally and Linguistically Ap-
5 propriate Health Care established under section
6 3401. The Director of the Agency for Healthcare
7 Research and Quality shall notify grantees of the
8 availability of technical assistance for the evaluation
9 and provide such assistance upon request.
10 ‘‘(2) BY SECRETARY.—The Director of the
11 Agency for Healthcare Research and Quality shall
12 evaluate or arrange with other individuals or organi-
13 zations to evaluate projects funded under this sec-
14 tion.
15 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There
16 is authorized to be appropriated to carry out this section
17 $5,000,000 for each of fiscal years 2023 through 2027.
18 ‘‘SEC. 3403. RESEARCH ON CULTURAL AND LANGUAGE COM-
19 PETENCE.
20 ‘‘(a) IN GENERAL.—The Secretary shall expand re-
21 search concerning language access in the provision of
22 health care services.
23 ‘‘(b) ELIGIBILITY.—The Secretary may conduct the
24 research described in subsection (a) or enter into contracts
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1 with other individuals or organizations to conduct such re-
2 search.
3 ‘‘(c) USE OF FUNDS.—Research conducted under
4 this section shall be designed to do one or more of the
5 following:
6 ‘‘(1) To identify the barriers to mental and be-
7 havioral services that are faced by individuals with
8 limited English proficiency.
9 ‘‘(2) To identify health care providers’ and
10 health administrators’ knowledge and awareness of
11 the barriers to quality health care services that are
12 faced by individuals with limited English proficiency
13 and communication disabilities.
14 ‘‘(3) To identify optimal approaches for deliv-
15 ering language access.
16 ‘‘(4) To identify best practices for data collec-
17 tion, including—
18 ‘‘(A) the collection by providers of health
19 care services and health care-related services of
20 data on the race, ethnicity, and primary lan-
21 guage of recipients of such services, taking into
22 account existing research conducted by the Gov-
23 ernment or private sector;
24 ‘‘(B) the development and implementation
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1 ‘‘(C) effective privacy safeguards for col-
2 lected data.
3 ‘‘(5) To develop a minimum data collection set
4 for primary language.
5 ‘‘(6) To evaluate the most effective ways in
6 which the Secretary can create or coordinate, and
7 subsidize or otherwise fund, telephonic interpretation
8 services for health care providers, taking into consid-
9 eration, among other factors, the flexibility necessary
10 for such a system to accommodate variations in—
11 ‘‘(A) provider type;
12 ‘‘(B) languages needed and their frequency
13 of use;
14 ‘‘(C) type of encounter;
15 ‘‘(D) time of encounter, including whether
16 the encounter occurs during regular business
17 hours and after hours; and
18 ‘‘(E) location of encounter.
19 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There
20 are authorized to be appropriated to carry out this section
21 $5,000,000 for each of fiscal years 2023 through 2027.’’.
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1 SEC. 2005. PILOT PROGRAM FOR IMPROVEMENT AND DE-
2 VELOPMENT OF STATE MEDICAL INTER-
3 PRETING SERVICES.
4 (a) GRANTS AUTHORIZED.—The Secretary of Health
5 and Human Services (referred to in this section as the
6 ‘‘Secretary’’) shall award 1 grant in accordance with this
7 section to each of 3 States (to be selected by the Sec-
8 retary) to assist each such State in designing, imple-
9 menting, and evaluating a statewide program to provide
10 onsite interpreter services under the State Medicaid plan.
11 (b) GRANT PERIOD.—A grant awarded under this
12 section is authorized for the period of 3 fiscal years begin-
13 ning on October 1, 2023, and ending on September 30,
14 2026.
15 (c) PREFERENCE.—In awarding a grant under this
16 section, the Secretary shall give preference to a State—
17 (1) that has a high proportion of qualified LEP
18 enrollees, as determined by the Secretary;
19 (2) that has a large number of qualified LEP
20 enrollees, as determined by the Secretary;
21 (3) that has a high growth rate of the popu-
22 lation of individuals with limited English proficiency,
23 as determined by the Secretary; and
24 (4) that has a population of qualified LEP en-
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25 rollees that is linguistically diverse, requiring inter-
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1 preter services in at least 200 non-English lan-
2 guages.
3 (d) USE OF FUNDS.—A State receiving a grant under
4 this section shall use the grant funds to—
5 (1) ensure that all health care providers in the
6 State participating in the State Medicaid plan have
7 access to onsite interpreter services, for the purpose
8 of enabling effective communication between such
9 providers and qualified LEP enrollees during the
10 furnishing of items and services and administrative
11 interactions;
12 (2) establish, expand, procure, or contract for—
13 (A) a statewide health care information
14 technology system that is designed to achieve
15 efficiencies and economies of scale with respect
16 to onsite interpreter services provided to health
17 care providers in the State participating in the
18 State Medicaid plan; and
19 (B) an entity to administer such system,
20 the duties of which shall include—
21 (i) procuring and scheduling inter-
22 preter services for qualified LEP enrollees;
23 (ii) procuring and scheduling inter-
24 preter services for individuals with limited
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1 English proficiency seeking to enroll in the
2 State Medicaid plan;
3 (iii) ensuring that interpreters receive
4 payment for interpreter services rendered
5 under the system; and
6 (iv) consulting regularly with organi-
7 zations representing LEP consumers, in-
8 terpreters, and health care providers; and
9 (3) develop mechanisms to establish, improve,
10 and strengthen the competency of the medical inter-
11 pretation workforce that serves qualified LEP enroll-
12 ees in the State, including a national certification
13 process that is valid, credible, and vendor-neutral.
14 (e) APPLICATION.—To receive a grant under this sec-
15 tion, a State shall submit an application at such time and
16 containing such information as the Secretary may require,
17 which shall include the following:
18 (1) A description of the language access needs
19 of individuals in the State enrolled in the State Med-
20 icaid plan.
21 (2) A description of the extent to which the
22 program will—
23 (A) use the grant funds for the purposes
24 described in subsection (d);
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1 (B) meet the health care needs of rural
2 populations of the State; and
3 (C) collect information that accurately
4 tracks the language services requested by con-
5 sumers as compared to the language services
6 provided by health care providers in the State
7 participating in the State Medicaid plan.
8 (3) A description of how the program will be
9 evaluated, including a proposal for collaboration with
10 organizations representing interpreters, consumers,
11 and individuals with limited English proficiency.
12 (f) DEFINITIONS.—In this section:
13 (1) QUALIFIED LEP ENROLLEE.—The term
14 ‘‘qualified LEP enrollee’’ means an individual—
15 (A) who is limited English proficient; and
16 (B) who is enrolled in a State Medicaid
17 plan.
18 (2) STATE.—The term ‘‘State’’ has the mean-
19 ing given the term in section 1101(a)(1) of the So-
20 cial Security Act (42 U.S.C. 1301(a)(1)), for pur-
21 poses of title XIX of such Act (42 U.S.C. 1396 et
22 seq.).
23 (3) STATE MEDICAID PLAN.—The term ‘‘State
24 Medicaid plan’’ means a State plan under title XIX
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1 of the Social Security Act (42 U.S.C. 1396 et seq.)
2 or a waiver of such a plan.
3 (4) UNITED STATES.—The term ‘‘United
4 States’’ has the meaning given the term in section
5 1101(a)(2) of the Social Security Act (42 U.S.C.
6 1301(a)(2)), for purposes of title XIX of such Act
7 (42 U.S.C. 1396 et seq.).
8 (g) CONTINUATION PAST DEMONSTRATION.—Any
9 State receiving a grant under this section must agree to
10 directly pay for language services in Medicaid for all Med-
11 icaid providers by the end of the grant period.
12 (h) FUNDING.—
13 (1) AUTHORIZATION OF APPROPRIATIONS.—
14 There is authorized to be appropriated $5,000,000
15 to carry out this section.
16 (2) AVAILABILITY OF FUNDS.—Amounts appro-
17 priated pursuant to the authorization in paragraph
18 (1) are authorized to remain available without fiscal
19 year limitation.
20 (3) INCREASED FEDERAL FINANCIAL PARTICI-
21 PATION.—Section 1903(a)(2)(E) of the Social Secu-
22 rity Act (42 U.S.C. 1396b(a)(2)(E)) is amended by
23 inserting ‘‘(or, in the case of a State that was
24 awarded a grant under section 2005 of the Health
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25 Equity and Accountability Act of 2022, 100 percent
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1 for each quarter occurring during the grant period
2 specified in subsection (b) of such section)’’ after
3 ‘‘75 percent’’.
4 (i) LIMITATION.—No Federal funds awarded under
5 this section may be used to provide interpreter services
6 from a location outside the United States.
7 SEC. 2006. TRAINING TOMORROW’S DOCTORS FOR CUL-
8 TURALLY AND LINGUISTICALLY APPRO-
9 PRIATE CARE: GRADUATE MEDICAL EDU-
10 CATION.
11 (a) DIRECT GRADUATE MEDICAL EDUCATION.—Sec-
12 tion 1886(h)(4) of the Social Security Act (42 U.S.C.
13 1395ww(h)(4)) is amended by adding at the end the fol-
14 lowing new subparagraph:
15 ‘‘(L) TREATMENT OF CULTURALLY AND
16 LINGUISTICALLY APPROPRIATE TRAINING.—In
17 determining a hospital’s number of full-time
18 equivalent residents for purposes of this sub-
19 section, all the time that is spent by an intern
20 or resident in an approved medical residency
21 training program for education and training in
22 culturally and linguistically appropriate service
23 delivery, which shall include all medically under-
24 served populations (as defined in section
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25 330(b)(3) of the Public Health Service Act),
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1 shall be counted toward the determination of
2 full-time equivalency.’’.
3 (b) INDIRECT MEDICAL EDUCATION.—Section
4 1886(d)(5)(B) of the Social Security Act (42 U.S.C.
5 1395ww(d)(5)(B)) is amended—
6 (1) by moving the left margin of clause (xii) 4
7 ems to the left; and
8 (2) by adding at the end the following new
9 clause:
10 ‘‘(xiii) The provisions of subparagraph (L) of
11 subsection (h)(4) shall apply under this subpara-
12 graph in the same manner as they apply under such
13 subsection.’’.
14 (c) EFFECTIVE DATE.—The amendments made by
15 subsections (a) and (b) shall apply with respect to pay-
16 ments made to hospitals on or after the date that is one
17 year after the date of the enactment of this Act.
18 SEC. 2007. FEDERAL REIMBURSEMENT FOR CULTURALLY
19 AND LINGUISTICALLY APPROPRIATE SERV-
20 ICES UNDER THE MEDICARE, MEDICAID, AND
21 STATE CHILDREN’S HEALTH INSURANCE
22 PROGRAMS.
23 (a) LANGUAGE ACCESS GRANTS FOR MEDICARE
24 PROVIDERS.—
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25 (1) ESTABLISHMENT.—
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1 (A) IN GENERAL.—Not later than 6
2 months after the date of the enactment of this
3 Act, the Secretary of Health and Human Serv-
4 ices (in this subsection referred to as the ‘‘Sec-
5 retary’’), acting through the Centers for Medi-
6 care & Medicaid Services and in consultation
7 with the Center for Medicare and Medicaid In-
8 novation (as referred to in section 1115A of the
9 Social Security Act (42 U.S.C. 1315a)), shall
10 establish a demonstration program under which
11 the Secretary shall award grants to eligible
12 Medicare service providers to provide culturally
13 and linguistically appropriate services to Medi-
14 care beneficiaries who are limited English pro-
15 ficient, including beneficiaries who live in di-
16 verse and underserved communities.
17 (B) APPLICATION OF INNOVATION
18 RULES.—The demonstration project under sub-
19 paragraph (A) shall be conducted in a manner
20 that is consistent with the applicable provisions
21 of subsections (b), (c), and (d) of section 1115A
22 of the Social Security Act (42 U.S.C. 1315a).
23 (C) NUMBER OF GRANTS.—To the extent
24 practicable, the Secretary shall award not less
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1 (D) GRANT PERIOD.—Except as provided
2 in paragraph (2)(D), each grant awarded under
3 this subsection shall be for a 3-year period.
4 (2) ELIGIBILITY REQUIREMENTS.—To be eligi-
5 ble for a grant under this subsection, an entity must
6 meet the following requirements:
7 (A) MEDICARE PROVIDER.—The entity
8 must be—
9 (i) a provider of services under part A
10 of title XVIII of the Social Security Act
11 (42 U.S.C. 1395c et seq.);
12 (ii) a provider of services under part
13 B of such title (42 U.S.C. 1395j et seq.);
14 (iii) a Medicare Advantage organiza-
15 tion offering a Medicare Advantage plan
16 under part C of such title (42 U.S.C.
17 1395w–21 et seq.); or
18 (iv) a PDP sponsor offering a pre-
19 scription drug plan under part D of such
20 title (42 U.S.C. 1395w–101 et seq.).
21 (B) UNDERSERVED COMMUNITIES.—The
22 entity must serve a community that, with re-
23 spect to necessary language services for improv-
24 ing access and utilization of health care among
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1 individuals with limited English proficiency, is
2 disproportionally underserved.
3 (C) APPLICATION.—The entity must pre-
4 pare and submit to the Secretary an applica-
5 tion, at such time, in such manner, and accom-
6 panied by such additional information as the
7 Secretary may require.
8 (D) REPORTING.—In the case of a grantee
9 that received a grant under this subsection in
10 a previous year, such grantee is only eligible for
11 continued payments under a grant under this
12 subsection if the grantee met the reporting re-
13 quirements under paragraph (9) for such year.
14 If a grantee fails to meet the requirements of
15 such paragraph for the first year of a grant, the
16 Secretary may terminate the grant and solicit
17 applications from new grantees to participate in
18 the demonstration program.
19 (3) DISTRIBUTION.—To the extent feasible, the
20 Secretary shall award—
21 (A) at least 10 grants to providers of serv-
22 ices described in paragraph (2)(A)(i);
23 (B) at least 10 grants to service providers
24 described in paragraph (2)(A)(ii);
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1 (C) at least 10 grants to organizations de-
2 scribed in paragraph (2)(A)(iii); and
3 (D) at least 10 grants to sponsors de-
4 scribed in paragraph (2)(A)(iv).
5 (4) CONSIDERATIONS IN AWARDING GRANTS.—
6 (A) VARIATION AMONG GRANTEES.—In
7 awarding grants under this subsection, the Sec-
8 retary shall select grantees to ensure the fol-
9 lowing:
10 (i) The grantees provide many dif-
11 ferent types of language services.
12 (ii) The grantees serve Medicare bene-
13 ficiaries who speak different languages,
14 and who, as a population, have differing
15 needs for language services.
16 (iii) The grantees serve Medicare
17 beneficiaries in both urban and rural set-
18 tings.
19 (iv) The grantees represent each Cen-
20 ters for Medicare & Medicaid Services re-
21 gion, as defined by the Secretary.
22 (v) The grantees serve Medicare bene-
23 ficiaries in at least two large metropolitan
24 statistical areas with racial, ethnic, sexual,
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1 gender, disability, and economically diverse
2 populations.
3 (B) PRIORITY FOR PARTNERSHIPS WITH
4 COMMUNITY ORGANIZATIONS AND AGENCIES.—
5 In awarding grants under this subsection, the
6 Secretary shall give priority to eligible entities
7 that have a partnership with—
8 (i) a community organization; or
9 (ii) a consortium of community orga-
10 nizations, State agencies, and local agen-
11 cies;
12 that has experience in providing language serv-
13 ices.
14 (5) USE OF FUNDS FOR COMPETENT LANGUAGE
15 SERVICES.—
16 (A) IN GENERAL.—Subject to subpara-
17 graph (E), a grantee may only use grant funds
18 received under this subsection to pay for the
19 provision of competent language services to
20 Medicare beneficiaries who are individuals with
21 limited English proficiency.
22 (B) COMPETENT LANGUAGE SERVICES DE-
23 FINED.—For purposes of this subsection, the
24 term ‘‘competent language services’’ means—
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1 (i) interpreter and translation services
2 that—
3 (I) subject to the exceptions
4 under subparagraph (C)—
5 (aa) if the grantee operates
6 in a State that has statewide
7 health care interpreter standards,
8 meet the State standards cur-
9 rently in effect; or
10 (bb) if the grantee operates
11 in a State that does not have
12 statewide health care interpreter
13 standards, utilize competent in-
14 terpreters who follow the Na-
15 tional Council on Interpreting in
16 Health Care’s Code of Ethics and
17 Standards of Practice and com-
18 ply with the requirements of sec-
19 tion 1557 of the Patient Protec-
20 tion and Affordable Care Act (42
21 U.S.C. 18116) as published in
22 the Federal Register on May 18,
23 2016; and
24 (II) in the case of interpreter
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1 (aa) onsite interpretation;
2 (bb) telephonic interpreta-
3 tion; or
4 (cc) video interpretation;
5 and
6 (ii) the direct provision of health care
7 or health care-related services by a com-
8 petent bilingual health care provider.
9 (C) EXCEPTIONS.—The requirements of
10 subparagraph (B)(i)(I) do not apply, with re-
11 spect to interpreter and translation services and
12 a grantee—
13 (i) in the case of a Medicare bene-
14 ficiary who is limited English proficient,
15 if—
16 (I) such beneficiary has been in-
17 formed, in the beneficiary’s primary
18 language, of the availability of free in-
19 terpreter and translation services and
20 the beneficiary instead requests that a
21 family member, friend, or other per-
22 son provide such services; and
23 (II) the grantee documents such
24 request in the beneficiary’s medical
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25 record; or
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1 (ii) in the case of a medical emergency
2 where the delay directly associated with ob-
3 taining a competent interpreter or trans-
4 lation services would jeopardize the health
5 of the patient.
6 Clause (ii) shall not be construed to exempt
7 emergency rooms or similar entities that regu-
8 larly provide health care services in medical
9 emergencies to patients who are individuals
10 with limited English proficiency from any appli-
11 cable legal or regulatory requirements related to
12 providing competent interpreter and translation
13 services without undue delay.
14 (D) MEDICARE ADVANTAGE ORGANIZA-
15 TIONS AND PDP SPONSORS.—A grantee that is
16 a Medicare Advantage organization or a pre-
17 scription drug plan sponsor must provide at
18 least 50 percent of the grant funds that the
19 grantee receives under this subsection directly
20 to the entity’s network providers (including all
21 health providers and pharmacists) for the pur-
22 pose of providing support for such providers to
23 provide competent language services to Medi-
24 care beneficiaries who are individuals with lim-
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25 ited English proficiency.
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1 (E) ADMINISTRATIVE AND REPORTING
2 COSTS.—A grantee may use up to 10 percent of
3 the grant funds to pay for administrative costs
4 associated with the provision of competent lan-
5 guage services and for reporting required under
6 paragraph (9).
7 (6) DETERMINATION OF AMOUNT OF GRANT
8 PAYMENTS.—
9 (A) IN GENERAL.—Payments to grantees
10 under this subsection shall be calculated based
11 on the estimated numbers of Medicare bene-
12 ficiaries who are limited English proficiency in
13 a grantee’s service area utilizing—
14 (i) data on the numbers of English
15 learners who speak English less than ‘‘very
16 well’’ from the most recently available data
17 from the Bureau of the Census or other
18 State-based study the Secretary determines
19 is likely to yield accurate data regarding
20 the number of such individuals in such
21 service area; or
22 (ii) data provided by the grantee, if
23 the grantee routinely collects data on the
24 primary language of the Medicare bene-
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25 ficiaries that the grantee serves and the
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1 Secretary determines that the data is accu-
2 rate and shows a greater number of indi-
3 viduals with limited English proficiency
4 than would be estimated using the data
5 under clause (i).
6 (B) DISCRETION OF SECRETARY.—Subject
7 to subparagraph (C), the amount of payment
8 made to a grantee under this subsection may be
9 modified annually at the discretion of the Sec-
10 retary, based on changes in the data under sub-
11 paragraph (A) with respect to the service area
12 of a grantee for the year.
13 (C) LIMITATION ON AMOUNT.—The
14 amount of a grant made under this subsection
15 to a grantee may not exceed $500,000 for the
16 period under paragraph (1)(D).
17 (7) ASSURANCES.—Grantees under this sub-
18 section shall, as a condition of receiving a grant
19 under this subsection—
20 (A) ensure that clinical and support staff
21 receive appropriate ongoing education and
22 training in linguistically appropriate service de-
23 livery;
24 (B) ensure the linguistic competence of bi-
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1 (C) offer and provide appropriate language
2 services at no additional charge to each patient
3 who is limited English proficient for all points
4 of contact between the patient and the grantee,
5 in a timely manner during all hours of oper-
6 ation;
7 (D) notify Medicare beneficiaries of their
8 right to receive language services in their pri-
9 mary language at least annually;
10 (E) post signage in the primary languages
11 commonly used by the patient population in the
12 service area of the organization; and
13 (F) ensure that—
14 (i) primary language data are col-
15 lected for recipients of language services
16 and such data are consistent with stand-
17 ards developed under title XXXIV of the
18 Public Health Service Act, as added by
19 section 2002 of this Act, to the extent such
20 standards are available upon the initiation
21 of the demonstration program; and
22 (ii) consistent with the privacy protec-
23 tions provided under the regulations pro-
24 mulgated pursuant to section 264(c) of the
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25 Health Insurance Portability and Account-
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1 ability Act of 1996 (42 U.S.C. 1320d–2
2 note), if the recipient of language services
3 is a minor or is incapacitated, primary lan-
4 guage data must also be collected on the
5 parent or legal guardian of such recipient.
6 (8) NO COST SHARING.—Medicare beneficiaries
7 who are limited English proficient shall not have to
8 pay cost sharing or co-payments for competent lan-
9 guage services provided under this demonstration
10 program.
11 (9) REPORTING REQUIREMENTS FOR GRANT-
12 EES.—Not later than the end of each calendar year,
13 a grantee that receives funds under this subsection
14 in such year shall submit to the Secretary a report
15 that includes the following information:
16 (A) The number of Medicare beneficiaries
17 to whom competent language services are pro-
18 vided, disaggregated by age and entitlement
19 basis (on the basis of age, disability, or deter-
20 mination of end stage renal disease).
21 (B) The primary languages of those Medi-
22 care beneficiaries.
23 (C) The types of language services pro-
24 vided to such beneficiaries.
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1 (D) Whether such language services were
2 provided by employees of the grantee or
3 through a contract with external contractors or
4 agencies.
5 (E) The types of interpretation services
6 provided to such beneficiaries, and the approxi-
7 mate length of time such service is provided to
8 such beneficiaries.
9 (F) The costs of providing competent lan-
10 guage services.
11 (G) An account of the training or accredi-
12 tation of bilingual staff, interpreters, and trans-
13 lators providing services funded by the grant
14 under this subsection.
15 (10) EVALUATION AND REPORT TO CON-
16 GRESS.—Not later than 1 year after the completion
17 of a 3-year grant under this subsection, the Sec-
18 retary shall conduct an evaluation of the demonstra-
19 tion program under this subsection and shall submit
20 to the Congress a report that includes the following:
21 (A) An analysis of the patient outcomes
22 and the costs of furnishing care to the Medicare
23 beneficiaries who are individuals with limited
24 English proficiency participating in the project
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25 as compared to such outcomes and costs for
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1 such Medicare beneficiaries not participating,
2 based on the data provided under paragraph (9)
3 and any other information available to the Sec-
4 retary.
5 (B) The effect of delivering language serv-
6 ices on—
7 (i) Medicare beneficiary access to care
8 and utilization of services;
9 (ii) the efficiency and cost-effective-
10 ness of health care delivery;
11 (iii) patient satisfaction with respect
12 to both health service delivery and lan-
13 guage assistance;
14 (iv) health outcomes; and
15 (v) the provision of culturally appro-
16 priate services provided to such bene-
17 ficiaries.
18 (C) The extent to which bilingual staff, in-
19 terpreters, and translators providing services
20 under such demonstration were trained or ac-
21 credited and the nature of accreditation or
22 training needed by type of provider, service, or
23 other category as determined by the Secretary
24 to ensure the provision of high-quality interpre-
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25 tation, translation, or other language services to
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1 Medicare beneficiaries if such services are ex-
2 panded pursuant to section 1115A(c) of the So-
3 cial Security Act (42 U.S.C. 1315a(c)).
4 (D) Recommendations, if any, regarding
5 the extension of such project to the entire Medi-
6 care Program, subject to the provisions of such
7 section 1115A(c).
8 (11) APPROPRIATIONS.—There is appropriated
9 to carry out this subsection, in equal parts from the
10 Federal Hospital Insurance Trust Fund under sec-
11 tion 1817 of the Social Security Act (42 U.S.C.
12 1395i) and the Federal Supplementary Medical In-
13 surance Trust Fund under section 1841 of such Act
14 (42 U.S.C. 1395t), $16,000,000 for each fiscal year
15 of the demonstration program.
16 (12) LIMITED ENGLISH PROFICIENT DE-
17 FINED.—In this subsection, the term ‘‘limited
18 English proficient’’ refers to individuals who self-
19 identify on the Census as speaking English less than
20 ‘‘very well’’.
21 (b) LANGUAGE ASSISTANCE SERVICES UNDER THE
22 MEDICARE PROGRAM.—
23 (1) INCLUSION AS RURAL HEALTH CLINIC
24 SERVICES.—Section 1861 of the Social Security Act
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25 (42 U.S.C. 1395x) is amended—
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1 (A) in subsection (aa)(1)—
2 (i) in subparagraph (B), by striking
3 ‘‘and’’ at the end;
4 (ii) in subparagraph (C), by adding
5 ‘‘and’’ at the end; and
6 (iii) by inserting after subparagraph
7 (C) the following new subparagraph:
8 ‘‘(D) language assistance services as defined in
9 subsection (lll),’’; and
10 (B) by adding at the end the following new
11 subsection:
12 ‘‘Language Assistance Services and Related Terms
13 ‘‘(lll) The term ‘language assistance services’ means
14 ‘language access’ or ‘language assistance services’ (as
15 those terms are defined in section 3400 of the Public
16 Health Service Act) furnished by a ‘qualified interpreter
17 for an individual with limited English proficiency’ or a
18 ‘qualified translator’ (as those terms are defined in such
19 section 3400) to an ‘individual with limited English pro-
20 ficiency’ (as defined in such section 3400).’’.
21 (2) COVERAGE.—Section 1832(a)(2) of the So-
22 cial Security Act (42 U.S.C. 1395k(a)(2)) is amend-
23 ed—
24 (A) in subparagraph (I), by striking ‘‘and’’
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25 at the end;
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1 (B) in subparagraph (J), by striking the
2 period at the end and inserting ‘‘; and’’; and
3 (C) by adding at the end the following new
4 subparagraph:
5 ‘‘(K) language assistance services (as de-
6 fined in section 1861(lll)).’’.
7 (3) PAYMENT.—Section 1833(a) of the Social
8 Security Act (42 U.S.C. 1395l(a)) is amended—
9 (A) in paragraph (9), by striking ‘‘and’’ at
10 the end;
11 (B) in paragraph (10), by striking the pe-
12 riod at the end and inserting ‘‘; and’’; and
13 (C) by inserting after paragraph (10) the
14 following new paragraph:
15 ‘‘(11) in the case of language assistance serv-
16 ices (as defined in section 1861(lll)), 100 percent of
17 the reasonable charges for such services, as deter-
18 mined in consultation with the Medicare Payment
19 Advisory Commission.’’.
20 (4) WAIVER OF BUDGET NEUTRALITY.—For
21 the 3-year period beginning on the date of enact-
22 ment of this section, the budget neutrality provision
23 of section 1848(c)(2)(B)(ii) of the Social Security
24 Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not
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1 apply with respect to language assistance services
2 (as defined in section 1861(lll) of such Act).
3 (c) MEDICARE PARTS C AND D.—
4 (1) IN GENERAL.—Medicare Advantage plans
5 under part C of title XVIII of the Social Security
6 Act (42 U.S.C. 1395w–21 et seq.) and prescription
7 drug plans under part D of such title (42 U.S.C.
8 1395q–101) shall comply with title VI of the Civil
9 Rights Act of 1964 (42 U.S.C. 2000d et seq.) and
10 section 1557 of the Patient Protection and Afford-
11 able Care Act (42 U.S.C. 18116) to provide effective
12 language services to enrollees of such plans.
13 (2) MEDICARE ADVANTAGE PLANS AND PRE-
14 SCRIPTION DRUG PLANS REPORTING REQUIRE-
15 MENT.—Section 1857(e) of the Social Security Act
16 (42 U.S.C. 1395w–27(e)) is amended by adding at
17 the end the following new paragraph:
18 ‘‘(6) REPORTING REQUIREMENTS RELATING TO
19 EFFECTIVE LANGUAGE SERVICES.—A contract under
20 this part shall require a Medicare Advantage organi-
21 zation (and, through application of section 1860D–
22 12(b)(3)(D), a contract under section 1860D–12
23 shall require a PDP sponsor) to annually submit
24 (for each year of the contract) a report that contains
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25 information on the internal policies and procedures
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1 of the organization (or sponsor) related to recruit-
2 ment and retention efforts directed to workforce di-
3 versity and linguistically and culturally appropriate
4 provision of services in each of the following con-
5 texts:
6 ‘‘(A) The collection of data in a manner
7 that meets the requirements of title I of the
8 Health Equity and Accountability Act of 2022,
9 regarding the enrollee population.
10 ‘‘(B) Education of staff and contractors
11 who have routine contact with enrollees regard-
12 ing the various needs of the diverse enrollee
13 population.
14 ‘‘(C) Evaluation of the language services
15 programs and services offered by the organiza-
16 tion (or sponsor) with respect to the enrollee
17 population, such as through analysis of com-
18 plaints or satisfaction survey results.
19 ‘‘(D) Methods by which the plan provides
20 to the Secretary information regarding the eth-
21 nic diversity of the enrollee population.
22 ‘‘(E) The periodic provision of educational
23 information to plan enrollees on the language
24 services and programs offered by the organiza-
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25 tion (or sponsor).’’.
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1 (d) IMPROVING LANGUAGE SERVICES IN MEDICAID
2 AND CHIP.—
3 (1) PAYMENTS TO STATES.—Section
4 1903(a)(2)(E) of the Social Security Act (42 U.S.C.
5 1396b(a)(2)(E)), as amended by section 2005(h)(3),
6 is further amended by—
7 (A) striking ‘‘75’’ and inserting ‘‘95’’;
8 (B) striking ‘‘translation or interpretation
9 services’’ and inserting ‘‘language assistance
10 services’’; and
11 (C) striking ‘‘children of families’’ and in-
12 serting ‘‘individuals’’.
13 (2) STATE PLAN REQUIREMENTS.—Section
14 1902(a)(10)(A) of the Social Security Act (42
15 U.S.C. 1396a(a)(10)(A)) is amended by striking
16 ‘‘and (30)’’ and inserting ‘‘(30), and (31)’’.
17 (3) DEFINITION OF MEDICAL ASSISTANCE.—
18 (A) IN GENERAL.—Section 1905(a) of the
19 Social Security Act (42 U.S.C. 1396d(a)) is
20 amended—
21 (i) in paragraph (30), by striking
22 ‘‘and’’ at the end;
23 (ii) by redesignating paragraph (31)
24 as paragraph (32); and
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1 (iii) by inserting after paragraph (30)
2 the following new paragraph:
3 ‘‘(31) language assistance services, as such
4 term is defined in section 1861(lll), provided in a
5 timely manner to individuals with limited English
6 proficiency as defined in section 3400 of the Public
7 Health Service Act; and’’.
8 (B) CONFORMING AMENDMENTS.—
9 (i) Section 1902(nn)(3) of the Social
10 Security Act (42 U.S.C. 1396a(nn)(3)) is
11 amended by striking ‘‘paragraph (30)’’ and
12 inserting ‘‘the last paragraph’’.
13 (ii) Section 1905(a) of the Social Se-
14 curity Act (42 U.S.C. 1396d(a)) is amend-
15 ed, in the 5th sentence, by striking ‘‘para-
16 graph (30)’’ and inserting ‘‘the last para-
17 graph’’.
18 (4) USE OF DEDUCTIONS AND COST SHAR-
19 ING.—Subsections (a)(2) and (b)(2) of section
20 1916(a)(2) of the Social Security Act (42 U.S.C.
21 1396o(a)(2)) are each amended—
22 (A) in subparagraph (G), by inserting a
23 comma after ‘‘plan’’;
24 (B) in subparagraph (H), by striking ‘‘;
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25 or’’ and inserting a comma;
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1 (C) in subparagraph (I), by striking ‘‘;
2 and’’ and inserting ‘‘, or’’; and
3 (D) by adding at the end the following new
4 subparagraph:
5 ‘‘(J) language assistance services described
6 in section 1905(a)(31); and’’.
7 (5) CHIP COVERAGE REQUIREMENTS.—Section
8 2103 of the Social Security Act (42 U.S.C. 1397cc)
9 is amended—
10 (A) in subsection (a), in the matter before
11 paragraph (1), by striking ‘‘(7) and (8)’’ and
12 inserting ‘‘(7), (8), (9), (10), (11), and (12)’’;
13 (B) in subsection (c), by adding at the end
14 the following new paragraph:
15 ‘‘(12) LANGUAGE ASSISTANCE SERVICES.—The
16 child health assistance provided to a targeted low-in-
17 come child shall include coverage of language assist-
18 ance services, as such term is defined in section
19 1861(lll), provided in a timely manner to individuals
20 with limited English proficiency (as defined in sec-
21 tion 3400 of the Public Health Service Act).’’; and
22 (C) in subsection (e)(2)—
23 (i) in the heading, by striking ‘‘PRE-
24 VENTIVE’’ and inserting ‘‘CERTAIN’’; and
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1 (ii) by inserting ‘‘language assistance
2 services described in subsection (c)(12),’’
3 before ‘‘visits described in’’.
4 (6) DEFINITION OF CHILD HEALTH ASSIST-
5 ANCE.—Section 2110(a)(27) of the Social Security
6 Act (42 U.S.C. 1397jj(a)(27)) is amended by strik-
7 ing ‘‘translation’’ and inserting ‘‘language assistance
8 services as described in section 2103(c)(12)’’.
9 (7) STATE DATA COLLECTION.—Pursuant to
10 the reporting requirement described in section
11 2107(b)(1) of the Social Security Act (42 U.S.C.
12 1397gg(b)(1)), the Secretary of Health and Human
13 Services shall require that States collect data on—
14 (A) the primary language of individuals re-
15 ceiving child health assistance under title XXI
16 of the Social Security Act (42 U.S.C. 1397aa et
17 seq.); and
18 (B) in the case of such individuals who are
19 minors or incapacitated, the primary language
20 of the individual’s parent or guardian.
21 (8) CHIP PAYMENTS TO STATES.—Section
22 2105 of the Social Security Act (42 U.S.C. 1397ee)
23 is amended—
24 (A) in subsection (a)(1)—
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1 (i) in the matter preceding subpara-
2 graph (A), by striking ‘‘75’’ and inserting
3 ‘‘95’’; and
4 (ii) in subparagraph (D)(iv), by strik-
5 ing ‘‘translation or interpretation services’’
6 and inserting ‘‘language assistance serv-
7 ices’’; and
8 (B) in subsection (c)(2)(A), by inserting
9 before the period at the end the following: ‘‘,
10 except that expenditures pursuant to clause (iv)
11 of subparagraph (D) of such paragraph shall
12 not count towards this total’’.
13 (e) FUNDING LANGUAGE ASSISTANCE SERVICES
14 FURNISHED BY PROVIDERS OF HEALTH CARE AND
15 HEALTH CARE-RELATED SERVICES THAT SERVE HIGH
16 RATES OF UNINSURED LEP INDIVIDUALS.—
17 (1) PAYMENT OF COSTS.—
18 (A) IN GENERAL.—Subject to subpara-
19 graph (B), the Secretary of Health and Human
20 Services (referred to in this subsection as the
21 ‘‘Secretary’’) shall make payments (on a quar-
22 terly basis) directly to eligible entities to sup-
23 port the provision of language assistance serv-
24 ices to individuals with limited English pro-
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25 ficiency in an amount equal to an eligible enti-
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1 ty’s eligible costs for providing such services for
2 the quarter.
3 (B) FUNDING.—Out of any funds in the
4 Treasury not otherwise appropriated, there are
5 appropriated to the Secretary such sums as
6 may be necessary for each of fiscal years 2022
7 through 2026.
8 (C) RELATION TO MEDICAID DSH.—Pay-
9 ments under this subsection shall not offset or
10 reduce payments under section 1923 of the So-
11 cial Security Act (42 U.S.C. 1396r–4), nor
12 shall payments under such section be consid-
13 ered when determining uncompensated costs as-
14 sociated with the provision of language assist-
15 ance services for the purposes of this sub-
16 section.
17 (2) METHODOLOGY FOR PAYMENT OF
18 CLAIMS.—
19 (A) IN GENERAL.—The Secretary shall es-
20 tablish a methodology to determine the average
21 per person cost of language assistance services.
22 (B) DIFFERENT ENTITIES.—In estab-
23 lishing such methodology, the Secretary may es-
24 tablish different methodologies for different
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25 types of eligible entities.
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1 (C) NO INDIVIDUAL CLAIMS.—The Sec-
2 retary may not require eligible entities to sub-
3 mit individual claims for language assistance
4 services for individual patients as a requirement
5 for payment under this subsection.
6 (3) DATA COLLECTION INSTRUMENT.—For pur-
7 poses of this subsection, the Secretary shall create a
8 standard data collection instrument that is con-
9 sistent with any existing reporting requirements by
10 the Secretary or relevant accrediting organizations
11 regarding the number of individuals to whom lan-
12 guage access is provided.
13 (4) GUIDELINES.—Not later than 6 months
14 after the date of enactment of this Act, the Sec-
15 retary shall establish and distribute guidelines con-
16 cerning the implementation of this subsection.
17 (5) REPORTING REQUIREMENTS.—
18 (A) REPORT TO SECRETARY.—Entities re-
19 ceiving payment under this subsection shall pro-
20 vide the Secretary with a quarterly report on
21 how the entity used such funds. Such report
22 shall contain aggregate (and may not contain
23 individualized) data collected using the instru-
24 ment under paragraph (3) and shall otherwise
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1 be in a form and manner determined by the
2 Secretary.
3 (B) REPORT TO CONGRESS.—Not later
4 than 2 years after the date of enactment of this
5 Act, and every 2 years thereafter, the Secretary
6 shall submit a report to Congress concerning
7 the implementation of this subsection.
8 (6) DEFINITIONS.—In this subsection:
9 (A) ELIGIBLE COSTS.—The term ‘‘eligible
10 costs’’ means, with respect to an eligible entity
11 that provides language assistance services to
12 limited English proficient individuals, the prod-
13 uct of—
14 (i) the average per person cost of lan-
15 guage assistance services, determined ac-
16 cording to the methodology devised under
17 paragraph (2); and
18 (ii) the number of individuals with
19 limited English proficiency who are pro-
20 vided language assistance services by the
21 entity and for whom no reimbursement is
22 available for such services under the
23 amendments made by subsection (a), (b),
24 (c), or (d) or by private health insurance.
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1 (B) ELIGIBLE ENTITY.—The term ‘‘eligible
2 entity’’ means an entity that—
3 (i) is a Medicaid provider that is—
4 (I) a physician;
5 (II) a hospital with a low-income
6 utilization rate (as defined in section
7 1923(b)(3) of the Social Security Act
8 (42 U.S.C. 1396r–4(b)(3))) of greater
9 than 25 percent;
10 (III) a federally qualified health
11 center (as defined in section
12 1905(l)(2)(B) of the Social Security
13 Act (42 U.S.C. 1396d(l)(2)(B)));
14 (IV) a hospice provider; or
15 (V) a palliative care provider;
16 (ii) not later than 6 months after the
17 date of the enactment of this Act, provides
18 language assistance services to not less
19 than 8 percent of the entity’s total number
20 of patients; and
21 (iii) prepares and submits an applica-
22 tion to the Secretary, at such time, in such
23 manner, and accompanied by such infor-
24 mation as the Secretary may require, to
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1 ascertain the entity’s eligibility for funding
2 under this subsection.
3 (C) LANGUAGE ASSISTANCE SERVICES.—
4 The term ‘‘language assistance services’’ has
5 the meaning given such term in section
6 1861(lll) of the Social Security Act, as added by
7 subsection (b).
8 (f) APPLICATION OF CIVIL RIGHTS ACT OF 1964,
9 SECTION 1557 OF THE AFFORDABLE CARE ACT, AND
10 OTHER LAWS.—Nothing in this section shall be construed
11 to limit otherwise existing obligations of recipients of Fed-
12 eral financial assistance under title VI of the Civil Rights
13 Act of 1964 (42 U.S.C. 2000d et seq.), section 1557 of
14 the Affordable Care Act, or other laws that protect the
15 civil rights of individuals.
16 (g) EFFECTIVE DATE.—
17 (1) IN GENERAL.—Except as otherwise pro-
18 vided and subject to paragraph (2), the amendments
19 made by this section shall take effect on January 1,
20 2023.
21 (2) EXCEPTION IF STATE LEGISLATION RE-
22 QUIRED.—In the case of a State plan for medical as-
23 sistance under title XIX of the Social Security Act
24 (42 U.S.C. 1396 et seq.) or a State plan for child
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25 health assistance under title XXI of such Act (42
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1 U.S.C. 1397aa et seq.) which the Secretary of
2 Health and Human Services determines requires
3 State legislation (other than legislation appro-
4 priating funds) in order for the plan to meet the ad-
5 ditional requirement imposed by the amendments
6 made by this section, such State plan shall not be
7 regarded as failing to comply with the requirements
8 of such title solely on the basis of its failure to meet
9 this additional requirement before the first day of
10 the first calendar quarter beginning after the close
11 of the first regular session of the State legislature
12 that begins after the date of the enactment of this
13 Act. For purposes of the previous sentence, in the
14 case of a State that has a 2-year legislative session,
15 each year of such session shall be deemed to be a
16 separate regular session of the State legislature.
17 SEC. 2008. INCREASING UNDERSTANDING OF AND IMPROV-
18 ING HEALTH LITERACY.
19 (a) IN GENERAL.—The Secretary, in consultation
20 with the Director of the National Institute on Minority
21 Health and Health Disparities and the Deputy Assistant
22 Secretary for Minority Health, shall award grants to eligi-
23 ble entities to improve health care for patient populations
24 that have low health literacy.
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1 (b) ELIGIBILITY.—To be eligible to receive a grant
2 under subsection (a), an entity shall—
3 (1) be a hospital, health center or clinic, health
4 plan, or other health entity (including a nonprofit
5 minority health organization or association); and
6 (2) prepare and submit to the Secretary an ap-
7 plication at such time, in such manner, and con-
8 taining such information as the Secretary may rea-
9 sonably require.
10 (c) USE OF FUNDS.—
11 (1) AGENCY FOR HEALTHCARE RESEARCH AND
12 QUALITY.—A grant under subsection (a) that is
13 awarded through the Director of the Agency for
14 Healthcare Research and Quality shall be used—
15 (A) to define and increase the under-
16 standing of health literacy across all areas of
17 health care, including end of life care;
18 (B) to investigate the correlation between
19 low health literacy and health and health care;
20 (C) to clarify which aspects of health lit-
21 eracy have an effect on health outcomes; and
22 (D) for any other activity determined ap-
23 propriate by the Director.
24 (2) HEALTH RESOURCES AND SERVICES ADMIN-
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25 ISTRATION.—A grant under subsection (a) that is
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1 awarded through the Administrator of the Health
2 Resources and Services Administration shall be used
3 to conduct demonstration projects for interventions
4 for patients with low health literacy that may in-
5 clude—
6 (A) the development of new disease man-
7 agement and end of life care programs for pa-
8 tients with low health literacy;
9 (B) the tailoring of disease management
10 programs and end of life care addressing men-
11 tal, physical, oral, and behavioral health condi-
12 tions for patients with low health literacy;
13 (C) the translation of written health mate-
14 rials for patients with low health literacy;
15 (D) the identification, implementation, and
16 testing of low health literacy screening tools;
17 (E) the conduct of educational campaigns
18 for patients and providers about low health lit-
19 eracy;
20 (F) the conduct of educational campaigns
21 concerning health directed specifically at pa-
22 tients with mental disabilities, including those
23 with cognitive and intellectual disabilities, de-
24 signed to reduce the incidence of low health lit-
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25 eracy among these populations, which shall
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1 have instructional materials in the plain lan-
2 guage standards promulgated under the Plain
3 Writing Act of 2010 (5 U.S.C. 301 note) for
4 Federal agencies; and
5 (G) other activities determined appropriate
6 by the Administrator.
7 (d) DEFINITIONS.—In this section:
8 (1) LOW HEALTH LITERACY.—The term ‘‘low
9 health literacy’’ means the inability of an individual
10 to obtain, process, and understand basic health in-
11 formation and services needed to make appropriate
12 health decisions.
13 (2) SECRETARY.—The term ‘‘Secretary’’ means
14 the Secretary of Health and Human Services—
15 (A) acting through the Director of the
16 Agency for Healthcare Research and Quality,
17 with respect to grants under subsection (c)(1);
18 and
19 (B) acting through the Administrator of
20 the Health Resources and Services Administra-
21 tion with respect to grants under subsection
22 (c)(2).
23 (e) AUTHORIZATION OF APPROPRIATIONS.—There
24 are authorized to be appropriated to carry out this section
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1 such sums as may be necessary for each of fiscal years
2 2023 through 2027.
3 SEC. 2009. REQUIREMENTS FOR HEALTH PROGRAMS OR
4 ACTIVITIES RECEIVING FEDERAL FUNDS.
5 (a) COVERED ENTITY; COVERED PROGRAM OR AC-
6 TIVITY.—In this section—
7 (1) the term ‘‘covered entity’’ has the meaning
8 given such term in section 92.4 of title 45, Code of
9 Federal Regulations, as in effect on May 18, 2016
10 (81 Fed. Reg. 31466); and
11 (2) the term ‘‘health program or activity’’ has
12 the meaning given such term in section 92.4 of title
13 45, Code of Federal Regulations, as in effect on May
14 18, 2016 (81 Fed. Reg. 31466).
15 (b) REQUIREMENTS.—A covered entity, in order to
16 ensure the right of individuals with limited English pro-
17 ficiency to receive access to high-quality health care
18 through the covered program or activity, shall—
19 (1) ensure that appropriate clinical and support
20 staff receive ongoing education and training in cul-
21 turally and linguistically appropriate service delivery
22 at least annually;
23 (2) offer and provide appropriate language as-
24 sistance services at no additional charge to each pa-
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1 ficiency at all points of contact, in a timely manner
2 during all hours of operation;
3 (3) notify patients of their right to receive lan-
4 guage services in their primary language; and
5 (4) utilize only qualified interpreters for an in-
6 dividual with limited English proficiency or qualified
7 translators, except as provided in subsection (c).
8 (c) EXEMPTIONS.—The requirements of subsection
9 (b)(4) shall not apply as follows:
10 (1) When a patient requests the use of family,
11 friends, or other persons untrained in interpretation
12 or translation if each of the following conditions are
13 met:
14 (A) The interpreter requested by the pa-
15 tient is over the age of 18.
16 (B) The covered entity informs the patient
17 in the primary language of the patient that he
18 or she has the option of having the entity pro-
19 vide to the patient an interpreter and trans-
20 lation services without charge.
21 (C) The covered entity informs the patient
22 that the entity may not require an individual
23 with a limited English proficiency to use a fam-
24 ily member or friend as an interpreter.
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1 (D) The covered entity evaluates whether
2 the person the patient wishes to use as an in-
3 terpreter is competent. If the covered entity has
4 reason to believe that such person is not com-
5 petent as an interpreter, the entity provides its
6 own interpreter to protect the covered entity
7 from liability if the patient’s interpreter is later
8 found not competent.
9 (E) If the covered entity has reason to be-
10 lieve that there is a conflict of interest between
11 the interpreter and patient, the covered entity
12 may not use the patient’s interpreter.
13 (F) The covered entity has the patient sign
14 a waiver, witnessed by at least 1 individual not
15 related to the patient, that includes the infor-
16 mation stated in subparagraphs (A) through
17 (E) and is translated into the patient’s primary
18 language.
19 (2) When a medical emergency exists and the
20 delay directly associated with obtaining competent
21 interpreter or translation services would jeopardize
22 the health of the patient, but only until a competent
23 interpreter or translation service is available.
24 (d) RULE CONSTRUCTION.—Subsection (c)(2)
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25 shall not be construed to mean that emergency rooms or
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1 similar entities that regularly provide health care services
2 in medical emergencies are exempt from legal or regu-
3 latory requirements related to competent interpreter serv-
4 ices.
5 SEC. 2010. REPORT ON FEDERAL EFFORTS TO PROVIDE
6 CULTURALLY AND LINGUISTICALLY APPRO-
7 PRIATE HEALTH CARE SERVICES.
8 (a) REPORT.—Not later than 1 year after the date
9 of enactment of this Act, and annually thereafter, the Sec-
10 retary of Health and Human Services shall enter into a
11 contract with the National Academy of Medicine for the
12 preparation and publication of a report that describes
13 Federal efforts to ensure that all individuals with limited
14 English proficiency have meaningful access to health care
15 services and health care-related services that are culturally
16 and linguistically appropriate. Such report shall include—
17 (1) a description and evaluation of the activities
18 carried out under this Act;
19 (2) a description and analysis of best practices,
20 model programs, guidelines, and other effective
21 strategies for providing access to culturally and lin-
22 guistically appropriate health care services;
23 (3) recommendations on the development and
24 implementation of policies and practices by providers
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1 ices for individuals with limited English proficiency,
2 including people with cognitive, hearing, vision, or
3 print impairments;
4 (4) recommend guidelines or standards for
5 health literacy and plain language, informed consent,
6 discharge instructions, and written communications,
7 and for improvement of health care access;
8 (5) a description of the effect of providing lan-
9 guage services on quality of health care and access
10 to care; and
11 (6) a description of the costs associated with or
12 savings related to the provision of language services.
13 (b) AUTHORIZATION OF APPROPRIATIONS.—There
14 are authorized to be appropriated to carry out this section
15 such sums as may be necessary for each of fiscal years
16 2023 through 2027.
17 SEC. 2011. ENGLISH INSTRUCTION FOR INDIVIDUALS WITH
18 LIMITED ENGLISH PROFICIENCY.
19 (a) GRANTS AUTHORIZED.—The Secretary of Edu-
20 cation is authorized to provide grants to eligible entities
21 for the provision of English as a second language (in this
22 section referred to as ‘‘ESL’’) instruction to individuals
23 with limited English proficiency, including health care-re-
24 lated English instruction, and shall determine, after con-
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1 sultation with appropriate stakeholders, the mechanism
2 for administering and distributing such grants.
3 (b) ELIGIBLE ENTITY.—In this section, the term ‘‘el-
4 igible entity’’ means—
5 (1) a State; or
6 (2) a community-based organization that pre-
7 dominantly employs and serves racial and ethnic mi-
8 nority groups (as defined in section 1707(g) of the
9 Public Health Service Act (42 U.S.C. 300u–6(g)).
10 (c) APPLICATION.—An eligible entity that desires to
11 receive a grant under this section shall apply by submit-
12 ting to the Secretary of Education an application at such
13 time, in such manner, and containing such information as
14 the Secretary may require.
15 (d) USE OF GRANT.—An eligible entity shall use
16 grant funds provided under this section to—
17 (1) develop and implement a plan for assuring
18 the availability of ESL instruction, free of charge, to
19 the community served by the eligible entity, that ef-
20 fectively integrates information about the nature of
21 the United States health care system, how to access
22 care, and any special language skills that may be re-
23 quired for individuals with limited English pro-
24 ficiency to access and regularly negotiate the health
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1 (2) develop a plan for making ESL instruction
2 available free to charge to individuals with limited
3 English proficiency in the community served by the
4 eligible entity who are seeking instruction, including,
5 where appropriate, through the use of public-private
6 partnerships; and
7 (3) provide ESL instruction to individuals with
8 limited English proficiency in the community served
9 by the eligible entity.
10 (e) SUPPLEMENT, NOT SUPPLANT.—An eligible enti-
11 ty awarded a grant under this section shall use funds
12 made available under this section to supplement, and not
13 supplant, other Federal, State, and local funds that would
14 otherwise be expended to carry out activities under this
15 section.
16 (f) DUTIES OF THE SECRETARY.—The Secretary of
17 Education shall—
18 (1) collect and make publicly available annual
19 data on how much Federal, State, and local govern-
20 ments spend annually on ESL instruction;
21 (2) collect data from eligible entities awarded a
22 grant under this section to identify the unmet needs
23 of individuals with limited English proficiency for
24 appropriate ESL instruction, including—
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1 (A) the preferred written and spoken lan-
2 guage of such individuals;
3 (B) the availability of enrollment in ESL
4 instruction programs in the communities served
5 by each eligible entity awarded a grant under
6 this section, including the extent of waiting lists
7 for ESL instruction, how many programs main-
8 tain waiting lists, and, for programs that do not
9 have waiting lists, the reasons why such a list
10 is unnecessary or otherwise not maintained;
11 (C) the availability of programs to geo-
12 graphically isolated communities;
13 (D) the impact of course enrollment poli-
14 cies, including open enrollment, on the avail-
15 ability of ESL instruction;
16 (E) the number of individuals with limited
17 English proficiency and the number of individ-
18 uals enrolled in ESL instruction programs in
19 the communities served by each eligible entity
20 awarded a grant under this section;
21 (F) the effectiveness of the ESL instruc-
22 tion provided through grants awarded under
23 this section in meeting the needs of individuals
24 receiving such instruction; and
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1 (G) an assessment of the need for pro-
2 grams that integrate job training and ESL in-
3 struction, to assist individuals with limited
4 English proficiency in obtaining better jobs;
5 (3) determine the cost and most appropriate
6 methods of making ESL instruction available to all
7 individuals with limited English proficiency in the
8 United States who are seeking instruction; and
9 (4) not later than 1 year after the date of en-
10 actment of this Act, issue a report to Congress
11 that—
12 (A) assesses the information collected in
13 paragraphs (1), (2), and (3) and makes rec-
14 ommendations on steps that should be taken to
15 realize the goal of making ESL instruction
16 available to all individuals with limited English
17 proficiency in the United States who are seek-
18 ing instruction; and
19 (B) evaluates the impact of the grant pro-
20 gram authorized under this section on the ac-
21 cessibility of, and ability to effectively negotiate,
22 the health care system for individuals with lim-
23 ited English proficiency who have received ESL
24 instruction funded by a grant under this sec-
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1 (g) AUTHORIZATION OF APPROPRIATIONS.—There
2 are authorized to be appropriated to the Secretary of Edu-
3 cation $250,000,000 for each of fiscal years 2023 through
4 2027 to carry out this section.
5 SEC. 2012. IMPLEMENTATION.
6 (a) GENERAL PROVISIONS.—
7 (1) IMMUNITY.—A person injured by a violation
8 of this title (including an amendment made by this
9 title) by a State may bring a civil action in the ap-
10 propriate Federal court for such injury in accord-
11 ance with this section.
12 (2) REMEDIES.—In a civil action under this
13 section for a violation of this title, such remedies
14 shall be available as would be available in a civil ac-
15 tion for such violation against any party other than
16 a State.
17 (b) RULE OF CONSTRUCTION.—Nothing in this title
18 may be construed to limit otherwise existing obligations
19 of recipients of Federal financial assistance under title VI
20 of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.)
21 or any other Federal statute.
22 SEC. 2013. LANGUAGE ACCESS SERVICES.
23 (a) ESSENTIAL BENEFITS.—Section 1302(b)(1) of
24 the Patient Protection and Affordable Care Act (42
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1 U.S.C. 18022(b)(1)) is amended by adding at the end the
2 following:
3 ‘‘(K) Language access services, including
4 oral interpretation and written translations.’’.
5 (b) EMPLOYER-SPONSORED MINIMUM ESSENTIAL
6 COVERAGE.—
7 (1) IN GENERAL.—Section 36B(c)(2)(C) of the
8 Internal Revenue Code of 1986 is amended by redes-
9 ignating clauses (iii) and (iv) as clauses (iv) and (v),
10 respectively, and by inserting after clause (ii) the fol-
11 lowing new clause:
12 ‘‘(iii) COVERAGE MUST INCLUDE LAN-
13 GUAGE ACCESS AND SERVICES.—Except as
14 provided in clause (iv), an employee shall
15 not be treated as eligible for minimum es-
16 sential coverage if such coverage consists
17 of an eligible employer-sponsored plan (as
18 defined in section 5000A(f)(2)) and the
19 plan does not provide coverage for lan-
20 guage access services, including oral inter-
21 pretation and written translations.’’.
22 (2) CONFORMING AMENDMENTS.—
23 (A) Section 36B(c)(2)(C) of such Code is
24 amended by striking ‘‘clause (iii)’’ each place it
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1 appears in clauses (i) and (ii) and inserting
2 ‘‘clause (iv)’’.
3 (B) Section 36B(c)(2)(C)(iv) of such Code,
4 as redesignated by this subsection, is amended
5 by striking ‘‘(i) and (ii)’’ and inserting ‘‘(i), (ii),
6 and (iii)’’.
7 (c) QUALITY REPORTING.—Section 2717(a)(1) of the
8 Public Health Service Act (42 U.S.C. 300gg–17(a)(1)) is
9 amended—
10 (1) by striking ‘‘and’’ at the end of subpara-
11 graph (C);
12 (2) by striking the period at the end of sub-
13 paragraph (D) and inserting ‘‘; and’’; and
14 (3) by adding at the end the following new sub-
15 paragraph:
16 ‘‘(E) reduce health disparities through the
17 provision of language access services, including
18 oral interpretation and written translations.’’.
19 (d) REGULATIONS REGARDING INTERNAL CLAIMS
20 AND APPEALS AND EXTERNAL REVIEW PROCESSES FOR
21 HEALTH PLANS AND HEALTH INSURANCE ISSUERS.—
22 The Secretary of the Treasury, the Secretary of Labor,
23 and the Secretary of Health and Human Services shall
24 amend the regulations in section 54.9815–2719(e) of title
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1 2719(e) of title 29, Code of Federal Regulations, and sec-
2 tion 147.136(e) of title 45, Code of Federal Regulations
3 (or a successor regulation), respectively, to require group
4 health plans and health insurance issuers offering group
5 or individual health insurance coverage to which such sec-
6 tions apply—
7 (1) to provide oral interpretation services with-
8 out any threshold requirements;
9 (2) to provide in the English versions of all no-
10 tices a statement prominently displayed in not less
11 than 15 non-English languages clearly indicating
12 how to access the language services provided by the
13 plan or issuer; and
14 (3) with respect to the requirements for pro-
15 viding relevant notices in a culturally and linguis-
16 tically appropriate manner in the applicable non-
17 English languages, to apply a threshold that 5 per-
18 cent of the population, or not less than 500 individ-
19 uals, in the county is literate only in the same non-
20 English language in order for the language to be
21 considered an applicable non-English language.
22 (e) DATA COLLECTION AND REPORTING.—The Sec-
23 retary of Health and Human Services shall—
24 (1) amend the single streamlined application
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1 tient Protection and Affordable Care Act (42 U.S.C.
2 18083) to collect the preferred spoken and written
3 language for each household member applying for
4 coverage under a qualified health plan through an
5 Exchange under title I of such Act (42 U.S.C.
6 18001 et seq.);
7 (2) require navigators, certified application
8 counselors, and other individuals assisting with en-
9 rollment to collect and report requests for language
10 assistance; and
11 (3) require the toll-free telephone hotlines es-
12 tablished pursuant to section 1311(d)(4)(B) of the
13 Patient Protection and Affordable Care Act (42
14 U.S.C. 18031(d)(4)(B)) to submit an annual report
15 documenting the number of language assistance re-
16 quests, the types of languages requested, the range
17 and average wait time for a consumer to speak with
18 an interpreter, the number of complaints and any
19 steps the hotline, and any entity contracting with
20 the Secretary to provide language services, have
21 taken to actively address some of the consumer com-
22 plaints.
23 (f) EFFECTIVE DATE.—The amendments made by
24 this section shall not apply to plans beginning prior to the
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1 SEC. 2014. MEDICALLY UNDERSERVED POPULATIONS.
2 Section 330(b)(3) of the Public Health Service Act
3 (42 U.S.C. 254b(b)(3)) is amended to read as follows:
4 ‘‘(3) MEDICALLY UNDERSERVED.—The term
5 ‘medically underserved’, with respect to a popu-
6 lation, refers to—
7 ‘‘(A) the population of an urban or rural
8 area designated by the Secretary as—
9 ‘‘(i) an area with a shortage of per-
10 sonal health services; or
11 ‘‘(ii) a population group having a
12 shortage of such services; or
13 ‘‘(B) a population of individuals, not con-
14 fined to a particular urban or rural area, who
15 are designated by the Secretary as having a
16 shortage of personal health services due to a
17 specific demographic trait.’’.
18 TITLE III—HEALTH WORKFORCE
19 DIVERSITY
20 SEC. 3001. AMENDMENT TO THE PUBLIC HEALTH SERVICE
21 ACT.
22 Title XXXIV of the Public Health Service Act, as
23 added by section 2004, is amended by adding at the end
24 the following:
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1 ‘‘Subtitle B—Diversifying the
2 Health Care Workplace
3 ‘‘SEC. 3411. NATIONAL WORKING GROUP ON WORKFORCE
4 DIVERSITY.
5 ‘‘(a) IN GENERAL.—The Secretary, acting through
6 the Bureau of Health Workforce of the Health Resources
7 and Services Administration, shall award a grant to an
8 entity determined appropriate by the Secretary for the es-
9 tablishment of a national working group on workforce di-
10 versity.
11 ‘‘(b) REPRESENTATION.—In establishing the national
12 working group under subsection (a):
13 ‘‘(1) The grantee shall ensure that the group
14 has representatives of each of the following:
15 ‘‘(A) The Health Resources and Services
16 Administration.
17 ‘‘(B) The Department of Health and
18 Human Services Data Council.
19 ‘‘(C) The Office of Minority Health of the
20 Department of Health and Human Services.
21 ‘‘(D) The Substance Abuse and Mental
22 Health Services Administration.
23 ‘‘(E) The Bureau of Labor Statistics of
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1 ‘‘(F) The National Institute on Minority
2 Health and Health Disparities.
3 ‘‘(G) The Agency for Healthcare Research
4 and Quality.
5 ‘‘(H) The Institute of Medicine Study
6 Committee for the 2004 workforce diversity re-
7 port.
8 ‘‘(I) The Indian Health Service.
9 ‘‘(J) The Department of Education.
10 ‘‘(K) Minority-serving academic institu-
11 tions.
12 ‘‘(L) Consumer organizations.
13 ‘‘(M) Health professional associations, in-
14 cluding those that represent underrepresented
15 minority populations.
16 ‘‘(N) Researchers in the area of health
17 workforce.
18 ‘‘(O) Health workforce accreditation enti-
19 ties.
20 ‘‘(P) Private (including nonprofit) founda-
21 tions that have sponsored workforce diversity
22 initiatives.
23 ‘‘(Q) Local and State health departments.
24 ‘‘(R) Representatives of community mem-
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1 for health profession schools pursuant to sub-
2 section (c)(9).
3 ‘‘(S) National community-based organiza-
4 tions that serve as a national intermediary to
5 their urban affiliate members and have dem-
6 onstrated capacity to train health care profes-
7 sionals.
8 ‘‘(T) The Veterans Health Administration.
9 ‘‘(U) Other entities determined appropriate
10 by the Secretary.
11 ‘‘(2) The grantee shall ensure that, in addition
12 to the representatives under paragraph (1), the
13 working group has not less than 5 health professions
14 students representing various health profession fields
15 and levels of training.
16 ‘‘(c) ACTIVITIES.—The working group established
17 under subsection (a) shall convene at least twice each year
18 to complete the following activities:
19 ‘‘(1) Review public and private health workforce
20 diversity initiatives.
21 ‘‘(2) Identify successful health workforce diver-
22 sity programs and practices.
23 ‘‘(3) Examine challenges relating to the devel-
24 opment and implementation of health workforce di-
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1 ‘‘(4) Draft a national strategic work plan for
2 health workforce diversity, including recommenda-
3 tions for public and private sector initiatives.
4 ‘‘(5) Develop a framework and methods for the
5 evaluation of current and future health workforce di-
6 versity initiatives.
7 ‘‘(6) Develop recommended standards for work-
8 force diversity that could be applicable to all health
9 professions programs and programs funded under
10 this Act.
11 ‘‘(7) Develop guidelines to train health profes-
12 sionals to care for a diverse population.
13 ‘‘(8) Develop a workforce data collection or
14 tracking system to identify where racial and ethnic
15 minority health professionals practice.
16 ‘‘(9) Develop a strategy for the inclusion of
17 community members on admissions committees for
18 health profession schools.
19 ‘‘(10) Help with monitoring of standards for di-
20 versity, equity, and inclusion.
21 ‘‘(11) Other activities determined appropriate
22 by the Secretary.
23 ‘‘(d) ANNUAL REPORT.—Not later than 1 year after
24 the establishment of the working group under subsection
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1 pare and make available to the general public for com-
2 ment, an annual report on the activities of the working
3 group. Such report shall include the recommendations of
4 the working group for improving health workforce diver-
5 sity.
6 ‘‘(e) COORDINATION WITH OTHER EFFORTS.—In
7 providing for the establishment of the working group
8 under subsection (a), the Secretary shall take such steps
9 as may be necessary to ensure that the work of the work-
10 ing group does not overlap with, or otherwise duplicate,
11 other Federal Government efforts with respect to ensuring
12 health equity in data collection in public health emer-
13 gencies.
14 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There
15 are authorized to be appropriated to carry out this section
16 such sums as may be necessary for each of fiscal years
17 2023 through 2027.
18 ‘‘SEC. 3412. TECHNICAL CLEARINGHOUSE FOR HEALTH
19 WORKFORCE DIVERSITY.
20 ‘‘(a) IN GENERAL.—The Secretary, acting through
21 the Deputy Assistant Secretary for Minority Health, and
22 in collaboration with the Bureau of Health Workforce
23 within the Health Resources and Services Administration
24 and the National Institute on Minority Health and Health
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1 health workforce diversity within the Office of Minority
2 Health and coordinate current and future clearinghouses
3 related to health workforce diversity.
4 ‘‘(b) INFORMATION AND SERVICES.—The clearing-
5 house established under subsection (a) shall offer the fol-
6 lowing information and services:
7 ‘‘(1) Information on the importance of health
8 workforce diversity.
9 ‘‘(2) Statistical information relating to under-
10 represented minority representation in health and al-
11 lied health professions and occupations.
12 ‘‘(3) Model health workforce diversity practices
13 and programs, including integrated models of care.
14 ‘‘(4) Admissions policies that promote health
15 workforce diversity and are in compliance with Fed-
16 eral and State laws.
17 ‘‘(5) Retainment policies that promote comple-
18 tion of health profession degrees for underserved
19 populations.
20 ‘‘(6) Lists of scholarship, loan repayment, and
21 loan cancellation grants as well as fellowship infor-
22 mation for underserved populations for health pro-
23 fessions schools.
24 ‘‘(7) Foundation and other large organizational
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25 initiatives relating to health workforce diversity.
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1 ‘‘(c) CONSULTATION.—In carrying out this section,
2 the Secretary shall consult with non-Federal entities which
3 may include minority health professional associations and
4 minority sections of major health professional associations
5 to ensure the adequacy and accuracy of information.
6 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There
7 are authorized to be appropriated to carry out this section
8 such sums as may be necessary for each of fiscal years
9 2023 through 2027.
10 ‘‘SEC. 3413. SUPPORT FOR INSTITUTIONS COMMITTED TO
11 WORKFORCE DIVERSITY, EQUITY, AND IN-
12 CLUSION.
13 ‘‘(a) IN GENERAL.—The Secretary, acting through
14 the Administrator of the Health Resources and Services
15 Administration and the Director of the Centers for Dis-
16 ease Control and Prevention, shall award grants to eligible
17 entities that demonstrate a commitment to health work-
18 force diversity.
19 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant
20 under subsection (a), an entity shall—
21 ‘‘(1) be an educational institution or entity that
22 historically produces or trains meaningful numbers
23 of underrepresented minority health professionals,
24 including—
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1 ‘‘(A) part B institutions, as defined in sec-
2 tion 322 of the Higher Education Act of 1965;
3 ‘‘(B) historically Black professional or
4 graduate institutions eligible for grants under
5 section 326 of the Higher Education Act of
6 1965;
7 ‘‘(C) Hispanic-serving health professions
8 schools;
9 ‘‘(D) Hispanic-serving institutions, as de-
10 fined in section 502 of such Act;
11 ‘‘(E) Tribal Colleges or Universities, as de-
12 fined in section 316 of such Act;
13 ‘‘(F) Asian American and Native American
14 Pacific Islander-serving institutions, as defined
15 in section 371(c) of such Act;
16 ‘‘(G) institutions that have programs to re-
17 cruit and retain underrepresented minority
18 health professionals, in which a significant
19 number of the enrolled participants are under-
20 represented minorities;
21 ‘‘(H) health professional associations,
22 which may include underrepresented minority
23 health professional associations; and
24 ‘‘(I) institutions, including national and re-
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25 gional community-based organizations with
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1 demonstrated commitment to a diversified
2 workforce—
3 ‘‘(i) located in communities with pre-
4 dominantly underrepresented minority pop-
5 ulations;
6 ‘‘(ii) with whom partnerships have
7 been formed for the purpose of increasing
8 workforce diversity; and
9 ‘‘(iii) in which at least 20 percent of
10 the enrolled participants are underrep-
11 resented minorities; and
12 ‘‘(2) submit to the Secretary an application at
13 such time, in such manner, and containing such in-
14 formation as the Secretary may require.
15 ‘‘(c) USE OF FUNDS.—Amounts received under a
16 grant under subsection (a) shall be used to expand existing
17 workforce diversity programs, implement new workforce
18 diversity programs, or evaluate existing or new workforce
19 diversity programs, including with respect to mental
20 health care professions. Such programs shall enhance di-
21 versity by considering minority status as part of an indi-
22 vidualized consideration of qualifications. Possible activi-
23 ties may include—
24 ‘‘(1) educational outreach programs relating to
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25 opportunities in the health professions;
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1 ‘‘(2) scholarship, fellowship, grant, loan repay-
2 ment, and loan cancellation programs;
3 ‘‘(3) postbaccalaureate programs;
4 ‘‘(4) academic enrichment programs, particu-
5 larly targeting those who would not be competitive
6 for health professions schools;
7 ‘‘(5) supporting workforce diversity in kinder-
8 garten through 12th grade and other health pipeline
9 programs;
10 ‘‘(6) mentoring programs;
11 ‘‘(7) internship or rotation programs involving
12 hospitals, health systems, health plans, and other
13 health entities;
14 ‘‘(8) community partnership development for
15 purposes relating to workforce diversity; or
16 ‘‘(9) leadership training.
17 ‘‘(d) REPORTS.—Not later than 1 year after receiving
18 a grant under this section, and annually for the term of
19 the grant, a grantee shall submit to the Secretary a report
20 that summarizes and evaluates all activities conducted
21 under the grant.
22 ‘‘(e) 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 2023 through 2027.
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1 ‘‘SEC. 3414. CAREER DEVELOPMENT FOR SCIENTISTS AND
2 RESEARCHERS.
3 ‘‘(a) IN GENERAL.—The Secretary, acting through
4 the Director of the National Institutes of Health, the Di-
5 rector of the Centers for Disease Control and Prevention,
6 the Commissioner of Food and Drugs, the Director of the
7 Agency for Healthcare Research and Quality, and the Ad-
8 ministrator of the Health Resources and Services Admin-
9 istration, shall award grants that expand existing opportu-
10 nities for scientists and researchers and promote the inclu-
11 sion of underrepresented minorities in the health profes-
12 sions.
13 ‘‘(b) RESEARCH FUNDING.—The head of each agency
14 listed in subsection (a) shall establish or expand existing
15 programs to provide research funding to scientists and re-
16 searchers in training. Under such programs, the head of
17 each such entity shall give priority in allocating research
18 funding to support health research in traditionally under-
19 served communities, including underrepresented minority
20 communities, and research classified as community or
21 participatory.
22 ‘‘(c) DATA COLLECTION.—The head of each agency
23 listed in subsection (a) shall collect data on the number
24 (expressed as an absolute number and a percentage) of
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25 underrepresented minority and nonminority applicants
26 who receive and are denied agency funding at every stage
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1 of review. Such data shall be reported annually to the Sec-
2 retary and the appropriate committees of Congress.
3 ‘‘(d) STUDENT LOAN REIMBURSEMENT.—The Sec-
4 retary shall establish a student loan reimbursement pro-
5 gram to provide student loan reimbursement assistance to
6 researchers who focus on racial and ethnic disparities in
7 health. The Secretary shall promulgate regulations to de-
8 fine the scope and procedures for the program under this
9 subsection.
10 ‘‘(e) STUDENT LOAN CANCELLATION.—The Sec-
11 retary shall establish a student loan cancellation program
12 to provide student loan cancellation assistance to research-
13 ers who focus on racial and ethnic disparities in health.
14 Students participating in the program shall make a min-
15 imum 5-year commitment to work at an accredited health
16 professions school. The Secretary shall promulgate addi-
17 tional regulations to define the scope and procedures for
18 the program under this subsection.
19 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There
20 are authorized to be appropriated to carry out this section
21 such sums as may be necessary for each of fiscal years
22 2023 through 2027.
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1 ‘‘SEC. 3415. CAREER SUPPORT FOR NONRESEARCH HEALTH
2 PROFESSIONALS.
3 ‘‘(a) IN GENERAL.—The Secretary, acting through
4 the Director of the Centers for Disease Control and Pre-
5 vention, the Assistant Secretary for Mental Health and
6 Substance Use, the Administrator of the Health Resources
7 and Services Administration, and the Administrator of the
8 Centers for Medicare & Medicaid Services, shall establish
9 a program to award grants to universities and other insti-
10 tutions to enter into agreements with eligible individuals
11 under which—
12 ‘‘(1) the university or institution supports the
13 eligible individual’s career in a nonresearch-related
14 health and wellness profession; and
15 ‘‘(2) the eligible individual commits to per-
16 forming a period of obligated service in such a ca-
17 reer to serve, or to work on health issues affecting,
18 underserved communities, such as racial and ethnic
19 minority communities.
20 ‘‘(b) ELIGIBLE INDIVIDUALS.—To be an eligible indi-
21 vidual for purposes of subsection (a), an individual shall
22 be a student in a health professions school, a graduate
23 of such a school who is working in a health profession,
24 an individual working in a health or wellness profession
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25 (including mental and behavioral health), or a faculty
26 member of such a school.
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1 ‘‘(c) APPLICATION.—To seek a grant under this sec-
2 tion, a university or other institution shall submit to the
3 Secretary an application at such time, in such manner,
4 and containing such information as the Secretary may re-
5 quire.
6 ‘‘(d) USE OF FUNDS.—A university or other institu-
7 tion receiving a grant under this section shall use the
8 grant for agreements described in subsection (a). Such
9 agreements may—
10 ‘‘(1) support an eligible individual’s health ac-
11 tivities or projects that involve underserved commu-
12 nities, including racial and ethnic minority commu-
13 nities;
14 ‘‘(2) support an eligible individual’s health-re-
15 lated career advancement activities;
16 ‘‘(3) pay, or reimburse for payment of, student
17 loans or training or credentialing costs for eligible
18 individuals who are health professionals and are fo-
19 cused on health issues affecting underserved commu-
20 nities, including racial and ethnic minority commu-
21 nities; and
22 ‘‘(4) establish and promote leadership training
23 programs for eligible individuals to decrease health
24 disparities and to increase cultural competence with
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1 the goal of increasing diversity in leadership posi-
2 tions.
3 ‘‘(e) DEFINITION.—In this section, the term ‘career
4 in a nonresearch-related health and wellness profession’
5 means employment or intended employment in the field
6 of public health, health policy, health management, health
7 administration, medicine, nursing, pharmacy, psychology,
8 social work, psychiatry, other mental and behavioral
9 health, allied health, community health, social work, or
10 other fields determined appropriate by the Secretary,
11 other than in a position that involves research.
12 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There
13 are authorized to be appropriated to carry out this section
14 such sums as may be necessary for each of fiscal years
15 2023 through 2027.
16 ‘‘SEC. 3416. RESEARCH ON THE EFFECT OF WORKFORCE DI-
17 VERSITY ON QUALITY.
18 ‘‘(a) IN GENERAL.—The Director of the Agency for
19 Healthcare Research and Quality (in this section referred
20 to as the ‘Director’), in collaboration with the Deputy As-
21 sistant Secretary for Minority Health and the Director of
22 the National Institute on Minority Health and Health Dis-
23 parities, shall award grants to eligible entities to expand
24 research on the link between health workforce diversity
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25 and quality health care.
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1 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant
2 under subsection (a), an entity shall—
3 ‘‘(1) be a clinical, public health, or health serv-
4 ices research entity or other entity determined ap-
5 propriate by the Director; and
6 ‘‘(2) submit to the Secretary an application at
7 such time, in such manner, and containing such in-
8 formation as the Secretary may require.
9 ‘‘(c) USE OF FUNDS.—Amounts received under a
10 grant awarded under subsection (a) shall be used to sup-
11 port research that investigates the effect of health work-
12 force diversity on—
13 ‘‘(1) language access;
14 ‘‘(2) cultural competence;
15 ‘‘(3) patient satisfaction;
16 ‘‘(4) timeliness of care;
17 ‘‘(5) safety of care;
18 ‘‘(6) effectiveness of care;
19 ‘‘(7) efficiency of care;
20 ‘‘(8) patient outcomes;
21 ‘‘(9) community engagement;
22 ‘‘(10) resource allocation;
23 ‘‘(11) organizational structure;
24 ‘‘(12) compliance of care; or
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1 ‘‘(13) other topics determined appropriate by
2 the Director.
3 ‘‘(d) PRIORITY.—In awarding grants under sub-
4 section (a), the Director shall give individualized consider-
5 ation to all relevant aspects of the applicant’s background.
6 Consideration of prior research experience involving the
7 health of underserved communities shall be such a factor.
8 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There
9 are authorized to be appropriated to carry out this section
10 such sums as may be necessary for each of fiscal years
11 2023 through 2027.
12 ‘‘SEC. 3417. HEALTH DISPARITIES EDUCATION PROGRAM.
13 ‘‘(a) ESTABLISHMENT.—The Secretary, acting
14 through the Office of Minority Health, in collaboration
15 with the National Institute on Minority Health and Health
16 Disparities, the Office for Civil Rights, the Centers for
17 Disease Control and Prevention, the Centers for Medicare
18 & Medicaid Services, the Health Resources and Services
19 Administration, and other appropriate public and private
20 entities, shall establish and coordinate a health and health
21 care disparities education program to support, develop,
22 and implement educational initiatives and outreach strate-
23 gies that inform health care professionals and the public
24 about the existence of and methods to reduce racial and
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25 ethnic disparities in health and health care.
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1 ‘‘(b) ACTIVITIES.—The Secretary, through the edu-
2 cation program established under subsection (a), shall,
3 through the use of public awareness and outreach cam-
4 paigns targeting the general public and the medical com-
5 munity at large—
6 ‘‘(1) disseminate scientific evidence for the ex-
7 istence and extent of racial and ethnic disparities in
8 health care, including disparities that are not other-
9 wise attributable to known factors such as access to
10 care, patient preferences, or appropriateness of
11 intervention, as described in the 2002 report of the
12 National Academy of Medicine (formerly the ‘Insti-
13 tute of Medicine’) entitled ‘Unequal Treatment: Con-
14 fronting Racial and Ethnic Disparities in Health
15 Care’, as well as the impact of disparities related to
16 age, disability status, socioeconomic status, sex, gen-
17 der identity, and sexual orientation on racial and
18 ethnic minorities;
19 ‘‘(2) disseminate new research findings to
20 health care providers and patients to assist them in
21 understanding, reducing, and eliminating health and
22 health care disparities;
23 ‘‘(3) disseminate information about the impact
24 of linguistic and cultural barriers on health care
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25 quality and the obligation of health providers who
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1 receive Federal financial assistance to ensure that
2 individuals with limited English proficiency have ac-
3 cess to language access services;
4 ‘‘(4) disseminate information about the impor-
5 tance and legality of racial, ethnic, disability status,
6 socioeconomic status, sex, gender identity, and sex-
7 ual orientation, and primary language data collec-
8 tion, analysis, and reporting;
9 ‘‘(5) design and implement specific educational
10 initiatives to health care providers relating to health
11 and health care disparities;
12 ‘‘(6) assess the impact of the programs estab-
13 lished under this section in raising awareness of
14 health and health care disparities and providing in-
15 formation on available resources; and
16 ‘‘(7) design and implement specific educational
17 initiatives to educate the health care workforce relat-
18 ing to unconscious bias.
19 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There
20 are authorized to be appropriated to carry out this section
21 such sums as may be necessary for each of fiscal years
22 2023 through 2027.’’.
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1 SEC. 3002. HISPANIC-SERVING INSTITUTIONS, HISTORI-
2 CALLY BLACK COLLEGES AND UNIVERSITIES,
3 HISTORICALLY BLACK PROFESSIONAL OR
4 GRADUATE INSTITUTIONS, ASIAN AMERICAN
5 AND NATIVE AMERICAN PACIFIC ISLANDER-
6 SERVING INSTITUTIONS, TRIBAL COLLEGES,
7 REGIONAL COMMUNITY-BASED ORGANIZA-
8 TIONS, AND NATIONAL MINORITY MEDICAL
9 ASSOCIATIONS.
10 Part B of title VII of the Public Health Service Act
11 (42 U.S.C. 293 et seq.) is amended by adding at the end
12 the following:
13 ‘‘SEC. 742. HISPANIC-SERVING INSTITUTIONS, HISTORI-
14 CALLY BLACK COLLEGES AND UNIVERSITIES,
15 HISTORICALLY BLACK PROFESSIONAL OR
16 GRADUATE INSTITUTIONS, ASIAN AMERICAN
17 AND NATIVE AMERICAN PACIFIC ISLANDER-
18 SERVING INSTITUTIONS, AND TRIBAL COL-
19 LEGES.
20 ‘‘(a) IN GENERAL.—The Secretary, acting through
21 the Administrator of the Health Resources and Services
22 Administration and in consultation with the Secretary of
23 Education, shall award grants to Hispanic-serving institu-
24 tions, historically Black colleges and universities, histori-
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25 cally Black professional or graduate institutions eligible
26 for grants under section 326 of the Higher Education Act
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1 of 1965, Asian American and Native American Pacific Is-
2 lander-serving institutions, Tribal Colleges or Universities,
3 regional community-based organizations, and national mi-
4 nority medical associations, for counseling, mentoring, and
5 providing information on financial assistance to prepare
6 underrepresented minority individuals to enroll in and
7 graduate from health professional schools and to increase
8 services for underrepresented minority students includ-
9 ing—
10 ‘‘(1) mentoring with underrepresented health
11 professionals;
12 ‘‘(2) providing financial assistance information
13 for continued education and applications to health
14 professional schools; and
15 ‘‘(3) retaining existing enrolled underrep-
16 resented minority students in a health professions
17 school.
18 ‘‘(b) DEFINITIONS.—In this section:
19 ‘‘(1) ASIAN AMERICAN AND NATIVE AMERICAN
20 PACIFIC ISLANDER-SERVING INSTITUTION.—The
21 term ‘Asian American and Native American Pacific
22 Islander-serving institution’ has the meaning given
23 such term in section 320(b) of the Higher Education
24 Act of 1965.
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1 ‘‘(2) HISPANIC-SERVING INSTITUTION.—The
2 term ‘Hispanic-serving institution’ means an entity
3 that—
4 ‘‘(A) is a school or program for which
5 there is a definition under section 799B;
6 ‘‘(B) has an enrollment of full-time equiva-
7 lent students that is made up of at least 9 per-
8 cent Hispanic students;
9 ‘‘(C) has been effective in carrying out pro-
10 grams to recruit Hispanic individuals to enroll
11 in and graduate from the school;
12 ‘‘(D) has been effective in recruiting and
13 retaining Hispanic faculty members;
14 ‘‘(E) has a significant number of graduates
15 who are providing health services to medically
16 underserved populations or to individuals in
17 health professional shortage areas; and
18 ‘‘(F) is a Hispanic Center of Excellence in
19 Health Professions Education designated under
20 section 736(d)(2) of the Public Health Service
21 Act (42 U.S.C. 293(d)(2)).
22 ‘‘(3) HISTORICALLY BLACK COLLEGE AND UNI-
23 VERSITY.—The term ‘historically Black college and
24 university’ has the meaning given the term ‘part B
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1 institution’ as defined in section 322 of the Higher
2 Education Act of 1965.
3 ‘‘(4) TRIBAL COLLEGE OR UNIVERSITY.—The
4 term ‘Tribal College or University’ has the meaning
5 given such term in section 316(b) of the Higher
6 Education Act of 1965.
7 ‘‘(c) CERTAIN LOAN REPAYMENT PROGRAMS.—In
8 carrying out the National Health Service Corps Loan Re-
9 payment Program established under subpart III of part
10 D of title III and the loan repayment program under sec-
11 tion 317F, the Secretary shall ensure, notwithstanding
12 such subpart or section, that loan repayments of not less
13 than $50,000 per year per person are awarded for repay-
14 ment of loans incurred for enrollment or participation of
15 underrepresented minority individuals in health profes-
16 sional schools and other health programs described in this
17 section.
18 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There
19 are authorized to be appropriated to carry out this section
20 such sums as may be necessary for each of fiscal years
21 2023 through 2027.’’.
22 SEC. 3003. LOAN REPAYMENT PROGRAM OF CENTERS FOR
23 DISEASE CONTROL AND PREVENTION.
24 Section 317F(c)(1) of the Public Health Service Act
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25 (42 U.S.C. 247b–7(c)(1)) is amended by striking
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1 ‘‘$500,000 for fiscal year 1994, and such sums as may
2 be necessary for each of the fiscal years 1995 through
3 2002’’ and inserting ‘‘such sums as may be necessary for
4 each of fiscal years 2023 through 2027’’.
5 SEC. 3004. ALLIED HEALTH WORKFORCE DIVERSITY.
6 (a) INCREASING WORKFORCE DIVERSITY IN THE
7 PROFESSIONS OF PHYSICAL THERAPY, OCCUPATIONAL
8 THERAPY, RESPIRATORY THERAPY, AUDIOLOGY, AND
9 SPEECH-LANGUAGE PATHOLOGY.—Title VII of the Public
10 Health Service Act is amended—
11 (1) by redesignating part G (42 U.S.C. 295j et
12 seq.) as part H; and
13 (2) by inserting after part F (42 U.S.C. 295h)
14 the following new part:
15 ‘‘PART G—INCREASING WORKFORCE DIVERSITY
16 IN THE PROFESSIONS OF PHYSICAL THER-
17 APY, OCCUPATIONAL THERAPY, RES-
18 PIRATORY THERAPY, AUDIOLOGY, AND
19 SPEECH-LANGUAGE PATHOLOGY
20 ‘‘SEC. 783. SCHOLARSHIPS AND STIPENDS.
21 ‘‘(a) IN GENERAL.—The Secretary may award grants
22 and contracts to eligible entities to increase educational
23 opportunities in the professions of physical therapy, occu-
24 pational therapy, respiratory therapy, audiology, and
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25 speech-language pathology for eligible individuals by—
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1 ‘‘(1) providing student scholarships or stipends,
2 including for—
3 ‘‘(A) completion of an accelerated degree
4 program;
5 ‘‘(B) completion of an associate’s, bach-
6 elor’s, master’s, or doctoral degree program;
7 and
8 ‘‘(C) entry by a diploma or associate’s de-
9 gree practitioner into a bridge or degree com-
10 pletion program;
11 ‘‘(2) providing assistance for completion of pre-
12 requisite courses or other preparation necessary for
13 acceptance for enrollment in the eligible entity; and
14 ‘‘(3) carrying out activities to increase the re-
15 tention of students in one or more programs in the
16 professions of physical therapy, occupational ther-
17 apy, respiratory therapy, audiology, and speech-lan-
18 guage pathology.
19 ‘‘(b) CONSIDERATION OF RECOMMENDATIONS.—In
20 carrying out subsection (a), the Secretary shall take into
21 consideration the recommendations of national organiza-
22 tions representing the professions of physical therapy, oc-
23 cupational therapy, respiratory therapy, audiology, and
24 speech-language pathology, including the American Phys-
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25 ical Therapy Association, the American Occupational
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1 Therapy Association, the American Speech-Language-
2 Hearing Association, the American Association for Res-
3 piratory Care, the American Academy of Audiology, and
4 the Academy of Doctors of Audiology.
5 ‘‘(c) REQUIRED INFORMATION AND CONDITIONS FOR
6 AWARD RECIPIENTS.—
7 ‘‘(1) IN GENERAL.—The Secretary may require
8 recipients of awards under this section to report to
9 the Secretary concerning the annual admission, re-
10 tention, and graduation rates for eligible individuals
11 in programs of the recipient leading to a degree in
12 any of the professions of physical therapy, occupa-
13 tional therapy, respiratory therapy, audiology, and
14 speech-language pathology.
15 ‘‘(2) FALLING RATES.—If any of the rates re-
16 ported by a recipient under paragraph (1) fall below
17 the average for such recipient over the 2 years pre-
18 ceding the year covered by the report, the recipient
19 shall provide the Secretary with plans for imme-
20 diately improving such rates.
21 ‘‘(3) INELIGIBILITY.—A recipient described in
22 paragraph (2) shall be ineligible for continued fund-
23 ing under this section if the plan of the recipient
24 fails to improve the rates within the 1-year period
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25 beginning on the date such plan is implemented.
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1 ‘‘(d) DEFINITIONS.—In this section:
2 ‘‘(1) ELIGIBLE ENTITIES.—The term ‘eligible
3 entity’ means an accredited education program that
4 is carrying out a program for recruiting and retain-
5 ing students underrepresented in the professions of
6 physical therapy, occupational therapy, respiratory
7 therapy, audiology, and speech-language pathology
8 (including racial or ethnic minorities, or students
9 from disadvantaged backgrounds).
10 ‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible
11 individual’ means an individual who—
12 ‘‘(A) is a member of a class of persons who
13 are underrepresented in the professions of phys-
14 ical therapy, occupational therapy, respiratory
15 therapy, audiology, and speech-language pathol-
16 ogy, including individuals who are—
17 ‘‘(i) racial or ethnic minorities;
18 ‘‘(ii) from disadvantaged backgrounds;
19 or
20 ‘‘(iii) individuals with a disability (as
21 defined in section 3(1) of the Americans
22 with Disabilities Act of 1990), or who have
23 an individualized education program (as
24 defined in section 602 of the Individuals
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25 with Disabilities Education Act), are cov-
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1 ered under section 504 of the Rehabilita-
2 tion Act of 1973, or have other documenta-
3 tion establishing the student’s disability
4 (as such term is defined in section 3(1) of
5 the Americans with Disabilities Act of
6 1990);
7 ‘‘(B) has a financial need for a scholarship
8 or stipend; and
9 ‘‘(C) is enrolled (or accepted for enroll-
10 ment) at an audiology, speech-language pathol-
11 ogy, respiratory therapy, physical therapy, or
12 occupational therapy program as a full-time
13 student at an eligible entity.
14 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There
15 is authorized to be appropriated to carry out this section
16 $8,000,000 for the first fiscal year commencing after the
17 date of enactment of the Health Equity and Accountability
18 Act of 2022 and each of the 4 succeeding fiscal years.’’.
19 (b) ELIGIBILITY CLARIFICATION REGARDING STU-
20 DENTS SUPPORTED THROUGH MENTAL AND BEHAV-
21 IORAL HEALTH EDUCATION AND TRAINING GRANTS.—
22 Section 756(a)(1) of the Public Health Service Act (42
23 U.S.C. 294e–1(a)(1)) is amended by inserting after ‘‘occu-
24 pational therapy’’ the following: ‘‘(which may include mas-
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25 ter’s and doctoral level programs)’’.
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1 SEC. 3005. COOPERATIVE AGREEMENTS FOR ONLINE DE-
2 GREE PROGRAMS AT SCHOOLS OF PUBLIC
3 HEALTH AND SCHOOLS OF ALLIED HEALTH.
4 Part D of title VII of the Public Health Service Act
5 (42 U.S.C. 294 et seq.) is amended by inserting after sec-
6 tion 755 of such Act (42 U.S.C. 294e) the following:
7 ‘‘SEC. 755A. COOPERATIVE AGREEMENTS FOR ONLINE DE-
8 GREE PROGRAMS.
9 ‘‘(a) COOPERATIVE AGREEMENTS.—The Secretary,
10 acting through the Administrator of the Health Resources
11 and Services Administration, in consultation with the Di-
12 rector of the Centers for Disease Control and Prevention,
13 the Director of the Agency for Healthcare Research and
14 Quality, and the Deputy Assistant Secretary for Minority
15 Health, shall enter into cooperative agreements with
16 schools of public health and schools of allied health to de-
17 sign and implement online degree programs.
18 ‘‘(b) PRIORITY.—In entering into cooperative agree-
19 ments under this section, the Secretary shall give priority
20 to any school of public health or school of allied health
21 that has an established track record of serving medically
22 underserved communities.
23 ‘‘(c) REQUIREMENTS.—As a condition of entering
24 into a cooperative agreement with the Secretary under this
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25 section, a school of public health or school of allied health
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1 shall agree to design and implement an online degree pro-
2 gram that meets the following restrictions:
3 ‘‘(1) Enrollment of individuals who have ob-
4 tained a secondary school diploma or its recognized
5 equivalent.
6 ‘‘(2) Maintaining a significant enrollment of
7 underrepresented minority or disadvantaged stu-
8 dents.
9 ‘‘(3) Achieving a high completion rate of en-
10 rolled underrepresented minority or disadvantaged
11 students.
12 ‘‘(d) PERIOD OF COOPERATIVE AGREEMENTS.—The
13 period during which payments are made through a cooper-
14 ative agreement entered into under this section may not
15 exceed 3 years.
16 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There
17 are authorized to be appropriated to carry out this section
18 such sums as may be necessary for each of fiscal years
19 2023 through 2027.’’.
20 SEC. 3006. NATIONAL HEALTH CARE WORKFORCE COMMIS-
21 SION.
22 (a) SENSE OF CONGRESS.—It is the sense of Con-
23 gress that the National Health Care Workforce Commis-
24 sion established by section 5101 of the Patient Protection
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25 and Affordable Care Act (42 U.S.C. 294q) should, in car-
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1 rying out its assigned duties under that section, give at-
2 tention to the needs of racial and ethnic minorities, indi-
3 viduals with lower socioeconomic status, individuals with
4 mental, developmental, and physical disabilities, lesbian,
5 gay, bisexual, transgender, queer, and questioning popu-
6 lations, and individuals who are members of multiple mi-
7 nority or special population groups.
8 (b) REAUTHORIZATION.—Section 5101(h)(2) of the
9 Patient Protection and Affordable Care Act (42 U.S.C.
10 294q(h)(2)) is amended by striking ‘‘such sums as may
11 be necessary’’ and inserting ‘‘$3,000,000 for each of fiscal
12 years 2023 through 2025’’.
13 SEC. 3007. SCHOLARSHIP AND FELLOWSHIP PROGRAMS.
14 Subtitle B of title XXXIV of the Public Health Serv-
15 ice Act, as added by section 3001, is further amended by
16 inserting after section 3417 the following:
17 ‘‘SEC. 3418. DAVID SATCHER PUBLIC HEALTH AND HEALTH
18 SERVICES CORPS.
19 ‘‘(a) IN GENERAL.—The Director of the Centers for
20 Disease Control and Prevention, in collaboration with the
21 Administrator of the Health Resources and Services Ad-
22 ministration and the Deputy Assistant Secretary for Mi-
23 nority Health, shall award grants to eligible entities to in-
24 crease awareness among secondary and postsecondary stu-
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25 dents of career opportunities in the health professions.
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1 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant
2 under subsection (a), an entity shall—
3 ‘‘(1) be a clinical, public health, or health serv-
4 ices organization, community-based or nonprofit en-
5 tity, or other entity determined appropriate by the
6 Director of the Centers for Disease Control and Pre-
7 vention;
8 ‘‘(2) serve a health professional shortage area,
9 as determined by the Secretary;
10 ‘‘(3) work with students, including those from
11 racial and ethnic minority backgrounds, that have
12 expressed an interest in the health professions; and
13 ‘‘(4) submit to the Secretary an application at
14 such time, in such manner, and containing such in-
15 formation as the Secretary may require.
16 ‘‘(c) USE OF FUNDS.—Grant awards under sub-
17 section (a) shall be used to support internships that will
18 increase awareness among students of non-research-based,
19 career opportunities in the following health professions:
20 ‘‘(1) Medicine.
21 ‘‘(2) Nursing.
22 ‘‘(3) Public health.
23 ‘‘(4) Pharmacy.
24 ‘‘(5) Health administration and management.
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25 ‘‘(6) Health policy.
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1 ‘‘(7) Psychology.
2 ‘‘(8) Dentistry.
3 ‘‘(9) International health.
4 ‘‘(10) Social work.
5 ‘‘(11) Allied health.
6 ‘‘(12) Psychiatry.
7 ‘‘(13) Hospice care.
8 ‘‘(14) Community health, patient navigation,
9 and peer support.
10 ‘‘(15) Other professions determined appropriate
11 by the Director of the Centers for Disease Control
12 and Prevention.
13 ‘‘(d) PRIORITY.—In awarding grants under sub-
14 section (a), the Director of the Centers for Disease Con-
15 trol and Prevention shall give priority to those entities
16 that—
17 ‘‘(1) serve a high proportion of individuals from
18 disadvantaged backgrounds;
19 ‘‘(2) have experience in health disparity elimi-
20 nation programs;
21 ‘‘(3) facilitate the entry of disadvantaged indi-
22 viduals into institutions of higher education; and
23 ‘‘(4) provide counseling or other services de-
24 signed to assist disadvantaged individuals in success-
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1 fully completing their education at the postsecondary
2 level.
3 ‘‘(e) STIPENDS.—
4 ‘‘(1) IN GENERAL.—Subject to paragraph (2),
5 an entity receiving a grant under this section may
6 use the funds made available through such grant to
7 award stipends for educational and living expenses
8 to students participating in the internship supported
9 by the grant.
10 ‘‘(2) LIMITATIONS.—A stipend awarded under
11 paragraph (1) to an individual—
12 ‘‘(A) may not be provided for a period that
13 exceeds 6 months; and
14 ‘‘(B) may not exceed $20 per day for an
15 individual (notwithstanding any other provision
16 of law regarding the amount of a stipend).
17 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There
18 are authorized to be appropriated to carry out this section
19 such sums as may be necessary for each of fiscal years
20 2023 through 2027.
21 ‘‘SEC. 3419. LOUIS STOKES PUBLIC HEALTH SCHOLARS
22 PROGRAM.
23 ‘‘(a) IN GENERAL.—The Director of the Centers for
24 Disease Control and Prevention, in collaboration with the
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25 Deputy Assistant Secretary for Minority Health, shall
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1 award scholarships to eligible individuals under subsection
2 (b) who seek a career in public health.
3 ‘‘(b) ELIGIBILITY.—To be eligible to receive a schol-
4 arship under subsection (a), an individual shall—
5 ‘‘(1) have interest, knowledge, or skill in public
6 health research or public health practice, or other
7 health professions as determined appropriate by the
8 Director of the Centers for Disease Control and Pre-
9 vention;
10 ‘‘(2) reside in a health professional shortage
11 area as determined by the Secretary;
12 ‘‘(3) demonstrate promise for becoming a leader
13 in public health;
14 ‘‘(4) secure admission to a 4-year institution of
15 higher education; and
16 ‘‘(5) submit to the Secretary an application at
17 such time, in such manner, and containing such in-
18 formation as the Secretary may require.
19 ‘‘(c) USE OF FUNDS.—Amounts received under an
20 award under subsection (a) shall be used to support oppor-
21 tunities for students to become public health professionals.
22 ‘‘(d) PRIORITY.—In awarding grants under sub-
23 section (a), the Director shall give priority to those stu-
24 dents that—
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25 ‘‘(1) are from disadvantaged backgrounds;
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1 ‘‘(2) have secured admissions to a minority-
2 serving institution; and
3 ‘‘(3) have identified a health professional as a
4 mentor at their school or institution and an aca-
5 demic advisor to assist in the completion of their
6 baccalaureate degree.
7 ‘‘(e) SCHOLARSHIPS.—The Secretary may approve
8 payment of scholarships under this section for such indi-
9 viduals for any period of education in student under-
10 graduate tenure, except that such a scholarship may not
11 be provided to an individual for more than 4 years, and
12 such a scholarship may not exceed $10,000 per academic
13 year for an individual (notwithstanding any other provi-
14 sion of law regarding the amount of a scholarship).
15 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There
16 are authorized to be appropriated to carry out this section
17 such sums as may be necessary for each of fiscal years
18 2023 through 2027.
19 ‘‘SEC. 3420. PATSY MINK HEALTH AND GENDER RESEARCH
20 FELLOWSHIP PROGRAM.
21 ‘‘(a) IN GENERAL.—The Director of the Centers for
22 Disease Control and Prevention, in collaboration with the
23 Deputy Assistant Secretary for Minority Health, the As-
24 sistant Secretary for Mental Health and Substance Use,
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25 and the Director of the Indian Health Service, shall award
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1 research fellowships to eligible individuals under sub-
2 section (b) to conduct research that will examine gender
3 and health disparities and to pursue a career in the health
4 professions.
5 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow-
6 ship under subsection (a), an individual shall—
7 ‘‘(1) have experience in health research or pub-
8 lic health practice;
9 ‘‘(2) reside in a health professional shortage
10 area designated by the Secretary under section 332;
11 ‘‘(3) have expressed an interest in the health
12 professions;
13 ‘‘(4) demonstrate promise for becoming a leader
14 in the field of women’s sexual and reproductive
15 health, including family planning;
16 ‘‘(5) secure admission to a health professions
17 school or graduate program with an emphasis in
18 gender studies; and
19 ‘‘(6) submit to the Secretary an application at
20 such time, in such manner, and containing such in-
21 formation as the Secretary may require.
22 ‘‘(c) USE OF FUNDS.—A fellowship awarded under
23 subsection (a) to an eligible individual under subsection
24 (b) shall be used to support an opportunity for the indi-
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1 vidual to become a researcher and advance the research
2 base on the intersection between gender and health.
3 ‘‘(d) PRIORITY.—In awarding fellowships under sub-
4 section (a), the Director of the Centers for Disease Con-
5 trol and Prevention shall give priority to those applicants
6 that—
7 ‘‘(1) are from disadvantaged backgrounds; and
8 ‘‘(2) have identified a mentor and academic ad-
9 visor who will assist in the completion of their grad-
10 uate or professional degree and have secured a re-
11 search assistant position with a researcher working
12 in the area of gender and health.
13 ‘‘(e) FELLOWSHIPS.—The Director of the Centers for
14 Disease Control and Prevention may approve fellowships
15 for individuals under this section for any period of edu-
16 cation in the student’s graduate or health profession ten-
17 ure, except that such a fellowship may not be provided
18 to an individual for more than 3 years, and such a fellow-
19 ship may not exceed $18,000 per academic year for an
20 individual (notwithstanding any other provision of law re-
21 garding the amount of a fellowship).
22 ‘‘(f) 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 2023 through 2027.
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1 ‘‘SEC. 3421. PAUL DAVID WELLSTONE INTERNATIONAL
2 HEALTH FELLOWSHIP PROGRAM.
3 ‘‘(a) IN GENERAL.—The Director of the Agency for
4 Healthcare Research and Quality, in collaboration with
5 the Deputy Assistant Secretary for Minority Health, shall
6 award research fellowships to eligible individuals under
7 subsection (b) to advance their understanding of inter-
8 national health.
9 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow-
10 ship under subsection (a), an individual shall—
11 ‘‘(1) have educational experience in the field of
12 international health;
13 ‘‘(2) reside in a health professional shortage
14 area as determined by the Secretary;
15 ‘‘(3) demonstrate promise for becoming a leader
16 in the field of international health;
17 ‘‘(4) be in the fourth year of a 4-year institu-
18 tion of higher education or a recent graduate of a
19 4-year institution of higher education; and
20 ‘‘(5) submit to the Secretary an application at
21 such time, in such manner, and containing such in-
22 formation as the Secretary may require.
23 ‘‘(c) USE OF FUNDS.—A fellowship awarded under
24 subsection (a) to an eligible individual under subsection
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25 (b) shall be used to support an opportunity for the indi-
26 vidual to become a health professional and to advance the
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1 knowledge of the individual about international issues re-
2 lating to health care access and quality.
3 ‘‘(d) PRIORITY.—In awarding fellowships under sub-
4 section (a), the Director of the Agency for Healthcare Re-
5 search and Quality shall give priority to eligible individuals
6 under subsection (b) that—
7 ‘‘(1) are from a disadvantaged background; and
8 ‘‘(2) have identified a mentor at a health pro-
9 fessions school or institution, an academic advisor to
10 assist in the completion of their graduate or profes-
11 sional degree, and an advisor from an international
12 health non-governmental organization, private volun-
13 teer organization, or other international institution
14 or program that focuses on increasing health care
15 access and quality for residents in developing coun-
16 tries.
17 ‘‘(e) FELLOWSHIPS.—A fellowship awarded under
18 this section may not—
19 ‘‘(1) be provided to an eligible individual for
20 more than a period of 6 months;
21 ‘‘(2) be awarded to a graduate of a 4-year insti-
22 tution of higher education that has not been enrolled
23 in such institution for more than 1 year; or
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1 ‘‘(3) exceed $4,000 per academic year (notwith-
2 standing any other provision of law regarding the
3 amount of a fellowship).
4 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There
5 are authorized to be appropriated to carry out this section
6 such sums as may be necessary for each of fiscal years
7 2023 through 2027.
8 ‘‘SEC. 3422. EDWARD R. ROYBAL HEALTH SCHOLAR PRO-
9 GRAM.
10 ‘‘(a) IN GENERAL.—The Director of the Agency for
11 Healthcare Research and Quality, the Administrator of
12 the Centers for Medicare & Medicaid Services, and the Ad-
13 ministrator of the Health Resources and Services Admin-
14 istration, in collaboration with the Deputy Assistant Sec-
15 retary for Minority Health, shall award grants to eligible
16 entities under subsection (b) to expose entering graduate
17 students to the health professions.
18 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant
19 under subsection (a), an entity shall—
20 ‘‘(1) be a clinical, public health, or health serv-
21 ices organization, community-based, academic, or
22 nonprofit entity, or other entity determined appro-
23 priate by the Director of the Agency for Healthcare
24 Research and Quality;
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1 ‘‘(2) serve in a health professional shortage
2 area designated by the Secretary under section 332;
3 ‘‘(3) work with students obtaining a degree in
4 the health professions; and
5 ‘‘(4) submit to the Secretary an application at
6 such time, in such manner, and containing such in-
7 formation as the Secretary may require.
8 ‘‘(c) USE OF FUNDS.—Amounts received under a
9 grant awarded under subsection (a) shall be used to sup-
10 port opportunities that expose students to non-research-
11 based health professions, including—
12 ‘‘(1) public health policy;
13 ‘‘(2) health care and pharmaceutical policy;
14 ‘‘(3) health care administration and manage-
15 ment;
16 ‘‘(4) health economics; and
17 ‘‘(5) other professions determined appropriate
18 by the Director of the Agency for Healthcare Re-
19 search and Quality, the Administrator of the Centers
20 for Medicare & Medicaid Services, or the Adminis-
21 trator of the Health Resources and Services Admin-
22 istration.
23 ‘‘(d) PRIORITY.—In awarding grants under sub-
24 section (a), the Director of the Agency for Healthcare Re-
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25 search and Quality, the Administrator of the Centers for
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1 Medicare & Medicaid Services, and the Administrator of
2 the Health Resources and Services Administration, in col-
3 laboration with the Deputy Assistant Secretary for Minor-
4 ity Health, shall give priority to entities that—
5 ‘‘(1) have experience with health disparity elimi-
6 nation programs;
7 ‘‘(2) facilitate training in the fields described in
8 subsection (c); and
9 ‘‘(3) provide counseling or other services de-
10 signed to assist students in successfully completing
11 their education at the postsecondary level.
12 ‘‘(e) STIPENDS.—
13 ‘‘(1) IN GENERAL.—Subject to paragraph (2),
14 an entity receiving a grant under this section may
15 use the funds made available through such grant to
16 award stipends for educational and living expenses
17 to students participating in the opportunities sup-
18 ported by the grant.
19 ‘‘(2) LIMITATIONS.—A stipend awarded under
20 paragraph (1) to an individual—
21 ‘‘(A) may not be provided for a period that
22 exceeds 2 months; and
23 ‘‘(B) may not exceed $100 per day (not-
24 withstanding any other provision of law regard-
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25 ing the amount of a stipend).
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1 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There
2 are authorized to be appropriated to carry out this section
3 such sums as may be necessary for each of fiscal years
4 2023 through 2027.
5 ‘‘SEC. 3423. LEADERSHIP FELLOWSHIP PROGRAMS.
6 ‘‘(a) IN GENERAL.—The Secretary shall award
7 grants to national minority medical or health professional
8 associations to develop leadership fellowship programs for
9 underrepresented health professionals in order to—
10 ‘‘(1) assist such professionals in becoming fu-
11 ture leaders in public health and health care delivery
12 institutions; and
13 ‘‘(2) increase diversity in decision-making posi-
14 tions that can improve the health of underserved
15 communities.
16 ‘‘(b) USE OF FUNDS.—A leadership fellowship pro-
17 gram supported under this section shall—
18 ‘‘(1) focus on training mid-career physicians
19 and health care executives who have documented
20 leadership experience and a commitment to public
21 health services in underserved communities; and
22 ‘‘(2) support Federal public health policy and
23 budget programs, and priorities that impact health
24 equity, through activities such as didactic lectures
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25 and leader site visits.
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1 ‘‘(c) PERIOD OF GRANTS.—The period during which
2 payments are made under a grant awarded under sub-
3 section (a) may not exceed 3 years.
4 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There
5 are authorized to be appropriated to carry out this section
6 such sums as may be necessary for each of fiscal years
7 2023 through 2027.’’.
8 SEC. 3008. MCNAIR POSTBACCALAUREATE ACHIEVEMENT
9 PROGRAM.
10 Section 402E of the Higher Education Act of 1965
11 (20 U.S.C. 1070a–15) is amended by striking subsection
12 (g) and inserting the following:
13 ‘‘(g) COLLABORATION IN HEALTH PROFESSION DI-
14 VERSITY TRAINING PROGRAMS.—The Secretary shall co-
15 ordinate with the Secretary of Health and Human Serv-
16 ices to ensure that there is collaboration between the goals
17 of the program under this section and programs of the
18 Health Resources and Services Administration that pro-
19 mote health workforce diversity. The Secretary of Edu-
20 cation shall take such measures as may be necessary to
21 encourage students participating in projects assisted
22 under this section to consider health profession careers.
23 ‘‘(h) FUNDING.—From amounts appropriated pursu-
24 ant to the authority of section 402A(g), the Secretary
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25 shall, to the extent practicable, allocate funds for projects
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1 authorized by this section in an amount that is not less
2 than $31,000,000 for each of the fiscal years 2023
3 through 2027.’’.
4 SEC. 3009. RULES FOR DETERMINATION OF FULL-TIME
5 EQUIVALENT RESIDENTS FOR COST-REPORT-
6 ING PERIODS.
7 (a) DGME DETERMINATIONS.—Section 1886(h)(4)
8 of the Social Security Act (42 U.S.C. 1395ww(h)(4)), as
9 amended by section 2006(a), is amended—
10 (1) in subparagraph (E), by striking ‘‘Subject
11 to subparagraphs (J) and (K), such rules’’ and in-
12 serting ‘‘Subject to subparagraphs (J), (K), and
13 (M), such rules’’;
14 (2) in subparagraph (J), by striking ‘‘Such
15 rules’’ and inserting ‘‘Subject to subparagraph (M),
16 such rules’’;
17 (3) in subparagraph (K), by striking ‘‘In deter-
18 mining’’ and inserting ‘‘Subject to subparagraph
19 (M), in determining’’; and
20 (4) by adding at the end the following new sub-
21 paragraph:
22 ‘‘(M) TREATMENT OF CERTAIN RESIDENTS
23 AND INTERNS.—For purposes of cost-reporting
24 periods beginning on or after October 1, 2022,
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1 time equivalent residents for purposes of this
2 paragraph, all time spent by an intern or resi-
3 dent in an approved medical residency training
4 program shall be counted toward the determina-
5 tion of full-time equivalency if the hospital—
6 ‘‘(i) is recognized as a subsection (d)
7 hospital;
8 ‘‘(ii) is recognized as a subsection (d)
9 Puerto Rico hospital;
10 ‘‘(iii) is reimbursed under a reim-
11 bursement system authorized under section
12 1814(b)(3); or
13 ‘‘(iv) is a provider-based hospital out-
14 patient department.’’.
15 (b) IME DETERMINATIONS.—Section
16 1886(d)(5)(B)(xi) of the Social Security Act (42 U.S.C.
17 1395ww(d)(5)(B)(xi)) is amended—
18 (1) in subclause (II), by striking ‘‘In deter-
19 mining’’ and inserting ‘‘Subject to subclause (IV), in
20 determining’’;
21 (2) in subclause (III), by striking ‘‘In deter-
22 mining’’ and inserting ‘‘Subject to subclause (IV), in
23 determining’’; and
24 (3) by inserting after subclause (III) the fol-
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25 lowing new subclause:
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1 ‘‘(IV) For purposes of cost-reporting peri-
2 ods beginning on or after October 1, 2022, the
3 provisions of subparagraph (M) of subsection
4 (h)(4) shall apply under this subparagraph in
5 the same manner as they apply under such sub-
6 section.’’.
7 SEC. 3010. DEVELOPING AND IMPLEMENTING STRATEGIES
8 FOR LOCAL HEALTH EQUITY.
9 (a) GRANTS.—The Secretary of Health and Human
10 Services, acting jointly with the Secretary of Education
11 and the Secretary of Labor, shall make grants to an eligi-
12 ble institution of higher education for the purposes of—
13 (1) in accordance with subsection (b), devel-
14 oping capacity—
15 (A) to build an evidence base for successful
16 strategies for increasing local health equity; and
17 (B) to serve as national models of driving
18 local health equity; and
19 (2) in accordance with subsection (c), devel-
20 oping a strategic partnership with the community in
21 which the institution is located.
22 (b) DEVELOPING CAPACITY FOR INCREASING LOCAL
23 HEALTH EQUITY.—As a condition on receipt of a grant
24 under subsection (a), an institution of higher education
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25 shall agree to use such grant to build an evidence base
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1 for successful strategies for increasing local health equity,
2 and to serve as a national model of driving local health
3 equity, by supporting—
4 (1) resources to strengthen institutional metrics
5 and capacity to execute institution-wide health work-
6 force goals that can serve as models for increasing
7 health equity in communities across the United
8 States;
9 (2) collaborations among a cohort of institu-
10 tions in implementing systemic change, partnership
11 development, and programmatic efforts supportive of
12 health equity goals across disciplines and popu-
13 lations; and
14 (3) enhanced or newly developed data systems
15 and research infrastructure capable of informing
16 current and future workforce efforts and building a
17 foundation for a broader research agenda targeting
18 urban health disparities.
19 (c) STRATEGIC PARTNERSHIPS.—As a condition on
20 receipt of a grant under subsection (a), an institution of
21 higher education shall agree to use the grant to develop
22 a strategic partnership with the community in which such
23 institution is located for the purposes of—
24 (1) strengthening connections between such in-
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25 stitution and the community—
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1 (A) to improve evaluation of, and address,
2 the health and health workforce needs of such
3 community; and
4 (B) to engage such community in health
5 workforce development;
6 (2) developing, enhancing, or accelerating inno-
7 vative undergraduate and graduate programs in the
8 biomedical sciences and health professions; and
9 (3) strengthening pipeline programs in the bio-
10 medical sciences and health professions, including by
11 developing partnerships between institutions of high-
12 er education and elementary schools and secondary
13 schools to recruit the next generation of health pro-
14 fessionals earlier in the pipeline to a health care ca-
15 reer.
16 (d) ELIGIBLE INSTITUTION OF HIGHER EDUCATION
17 DEFINED.—For purposes of this section, an ‘‘eligible in-
18 stitution of higher education’’ includes—
19 (1) a program authorized under section 317(a)
20 of the Higher Education Act of 1965 (20 U.S.C.
21 1059d(a)); or
22 (2) a professional or graduate institution de-
23 scribed in section 326 of such Act (20 U.S.C.
24 1063b).
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1 (e) AUTHORIZATION OF APPROPRIATIONS.—There
2 are authorized to be appropriated to carry out this section
3 such sums as may be necessary for each of fiscal years
4 2023 through 2027.
5 SEC. 3011. HEALTH PROFESSIONS WORKFORCE FUND.
6 (a) ESTABLISHMENT.—There is established in the
7 Health Resources and Services Administration of the De-
8 partment of Health and Human Services a Health Profes-
9 sions Workforce Fund to provide for expanded and sus-
10 tained national investment in the health professions and
11 nursing workforce development programs under title VII
12 and title VIII of the Public Health Service Act (42 U.S.C.
13 292 et seq.; 42 U.S.C. 296 et seq.).
14 (b) FUNDING.—
15 (1) IN GENERAL.—There is authorized to be
16 appropriated, and there is appropriated, out of any
17 monies in the Treasury not otherwise appropriated,
18 to the Health Professions Workforce Fund—
19 (A) $392,000,000 for fiscal year 2023;
20 (B) $412,000,000 for fiscal year 2024;
21 (C) $432,000,000 for fiscal year 2025;
22 (D) $454,000,000 for fiscal year 2026;
23 (E) $476,000,000 for fiscal year 2027;
24 (F) $500,000,000 for fiscal year 2028;
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25 (G) $525,000,000 for fiscal year 2029; and
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1 (H) $552,000,000 for fiscal year 2030.
2 (2) HEALTH PROFESSIONS EDUCATION PRO-
3 GRAMS.—For the purpose of carrying out health
4 professions education programs authorized under
5 title VII of the Public Health Service Act (42 U.S.C.
6 292 et seq.), in addition to any other amounts au-
7 thorized to be appropriated for such purpose, there
8 is authorized to be appropriated out of any monies
9 in the Health Professions Workforce Fund, the fol-
10 lowing:
11 (A) $265,000,000 for fiscal year 2023.
12 (B) $278,000,000 for fiscal year 2024.
13 (C) $292,000,000 for fiscal year 2025.
14 (D) $307,000,000 for fiscal year 2026.
15 (E) $322,000,000 for fiscal year 2027.
16 (F) $338,000,000 for fiscal year 2028.
17 (G) $355,000,000 for fiscal year 2029.
18 (H) $373,000,000 for fiscal year 2030.
19 (3) NURSING WORKFORCE DEVELOPMENT PRO-
20 GRAMS.—For the purpose of carrying out nursing
21 workforce development programs authorized under
22 title VIII of the Public Health Service Act (42
23 U.S.C. 296 et seq.), in addition to any other
24 amounts authorized to be appropriated for such pur-
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25 pose, there is authorized to be appropriated out of
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1 any monies in the Health Professions Workforce
2 Fund, the following:
3 (A) $127,000,000 for fiscal year 2023.
4 (B) $134,000,000 for fiscal year 2024.
5 (C) $140,000,000 for fiscal year 2025.
6 (D) $147,000,000 for fiscal year 2026.
7 (E) $154,000,000 for fiscal year 2027.
8 (F) $162,000,000 for fiscal year 2028.
9 (G) $170,000,000 for fiscal year 2029.
10 (H) $179,000,000 for fiscal year 2030.
11 SEC. 3012. FUTURE ADVANCEMENT OF ACADEMIC NURS-
12 ING.
13 (a) SUPPORT FOR NURSING EDUCATION AND THE
14 FUTURE NURSING WORKFORCE.—Part D of title VIII of
15 the Public Health Service Act (42 U.S.C. 296p et seq.)
16 is amended by adding at the end the following:
17 ‘‘SEC. 832. NURSING EDUCATION ENHANCEMENT AND MOD-
18 ERNIZATION GRANTS IN UNDERSERVED
19 AREAS.
20 ‘‘(a) IN GENERAL.—The Secretary, acting through
21 the Administrator of the Health Resources and Services
22 Administration, may award grants to schools of nursing
23 for—
24 ‘‘(1) increasing the number of faculty and stu-
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25 dents at such schools in order to enhance the pre-
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1 paredness of the United States for, and the ability
2 of the United States to address and quickly respond
3 to, public health emergencies declared under section
4 319 and pandemics; or
5 ‘‘(2) the enhancement and modernization of
6 nursing education programs.
7 ‘‘(b) PRIORITY.—In selecting grant recipients under
8 this section, the Secretary shall give priority to schools of
9 nursing that—
10 ‘‘(1) are located in a medically underserved
11 community;
12 ‘‘(2) are located in a health professional short-
13 age area as defined under section 332(a); or
14 ‘‘(3) are institutions of higher education listed
15 under section 371(a) of the Higher Education Act of
16 1965.
17 ‘‘(c) CONSIDERATION.—In awarding grants under
18 this section, the Secretary, to the extent practicable, may
19 ensure equitable distribution of awards among the geo-
20 graphic regions of the United States.
21 ‘‘(d) USE OF FUNDS.—A school of nursing that re-
22 ceives a grant under this section may use the funds award-
23 ed through such grant for activities that include—
24 ‘‘(1) enhancing enrollment and retention of stu-
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25 dents at such school, with a priority for students
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1 from disadvantaged backgrounds (including racial or
2 ethnic groups underrepresented in the nursing work-
3 force), individuals from rural and underserved areas,
4 low-income individuals, and first generation college
5 students (as defined in section 402A(h)(3) of the
6 Higher Education Act of 1965);
7 ‘‘(2) creating, supporting, or modernizing edu-
8 cational programs and curriculum at such school;
9 ‘‘(3) retaining current faculty, and hiring new
10 faculty, with an emphasis on faculty from racial or
11 ethnic groups who are underrepresented in the nurs-
12 ing workforce;
13 ‘‘(4) modernizing infrastructure at such school,
14 including audiovisual or other equipment, personal
15 protective equipment, simulation and augmented re-
16 ality resources, telehealth technologies, and virtual
17 and physical laboratories;
18 ‘‘(5) partnering with a health care facility,
19 nurse-managed health clinic, community health cen-
20 ter, or other facility that provides health care in
21 order to provide educational opportunities for the
22 purpose of establishing or expanding clinical edu-
23 cation;
24 ‘‘(6) enhancing and expanding nursing pro-
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25 grams that prepare nurse researchers and scientists;
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1 ‘‘(7) establishing nurse-led intradisciplinary and
2 interprofessional educational partnerships; and
3 ‘‘(8) other activities that the Secretary deter-
4 mines further the development, improvement, and
5 expansion of schools of nursing.
6 ‘‘(e) REPORTS FROM ENTITIES.—Each school of
7 nursing awarded a grant under this section shall submit
8 an annual report to the Secretary on the activities con-
9 ducted under such grant, and other information as the
10 Secretary may require.
11 ‘‘(f) REPORT TO CONGRESS.—Not later than 5 years
12 after the date of the enactment of this section, the Sec-
13 retary shall submit to the Committee on Health, Edu-
14 cation, Labor, and Pensions of the Senate and the Com-
15 mittee on Energy and Commerce of the House of Rep-
16 resentatives a report that provides a summary of the ac-
17 tivities and outcomes associated with grants made under
18 this section. Such report shall include—
19 ‘‘(1) a list of schools of nursing receiving grants
20 under this section, including the primary geographic
21 location of any school of nursing that was improved
22 or expanded through such a grant;
23 ‘‘(2) the total number of students who are en-
24 rolled at or who have graduated from any school of
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1 nursing that was improved or expanded through a
2 grant under this section, which such statistic shall—
3 ‘‘(A) to the extent such information is
4 available, be deidentified and disaggregated by
5 race, ethnicity, age, sex, geographic region, dis-
6 ability status, and other relevant factors; and
7 ‘‘(B) include an indication of the number
8 of such students who are from racial or ethnic
9 groups underrepresented in the nursing work-
10 force, such students who are from rural or un-
11 derserved areas, such students who are low-in-
12 come students, and such students who are first
13 generation college students (as defined in sec-
14 tion 402A(h)(3) of the Higher Education Act of
15 1965);
16 ‘‘(3) to the extent such information is available,
17 the effects of the grants awarded under this section
18 on retaining and hiring of faculty, including any in-
19 crease in diverse faculty, the number of clinical edu-
20 cation partnerships, the modernization of nursing
21 education infrastructure, and other ways this section
22 helps address and quickly respond to public health
23 emergencies and pandemics;
24 ‘‘(4) recommendations for improving the grants
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25 awarded under this section; and
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1 ‘‘(5) any other considerations as the Secretary
2 determines appropriate.
3 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—To
4 carry out this section, there is authorized to be appro-
5 priated $1,000,000,000, to remain available until ex-
6 pended.’’.
7 (b) STRENGTHENING NURSE EDUCATION.—The
8 heading of part D of title VIII of the Public Health Serv-
9 ice Act (42 U.S.C. 296p et seq.) is amended by striking
10 ‘‘BASIC’’.
11 SEC. 3013. FINDINGS; SENSE OF CONGRESS RELATING TO
12 GRADUATE MEDICAL EDUCATION.
13 (a) FINDINGS.—Congress finds the following:
14 (1) Projections by the Association of American
15 Medical Colleges and other expert entities, such as
16 the Health Resources and Services Administration,
17 have indicated a nationwide shortage of up to
18 121,900 physicians, split evenly between primary
19 care and specialists, by 2032.
20 (2) Primarily due to the growing and aging
21 population, over the next decade, physician demand
22 is expected to grow up to 17 percent.
23 (3) The United States Census Bureau estimates
24 that the United States population will grow from
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25 321,000,000 in 2015 to 347,000,000 in 2025. Fur-
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1 ther, the number of Medicare beneficiaries is esti-
2 mated to increase from 47,800,000 in 2015 to ap-
3 proximately 66,000,000 in 2025.
4 (4) Approximately 36 percent of practicing phy-
5 sicians are over the age of 55 and are likely to retire
6 within the next decade.
7 (5) A nationwide physician shortage will result
8 in many individuals in the United States waiting
9 longer and traveling farther for health care; seeking
10 nonemergent care in emergency departments; and
11 delaying treatment until the health care needs of
12 such individuals become more serious, complex, and
13 costly.
14 (6) Changing demographics (such as an aging
15 population), new health care delivery models (such
16 as medical homes), and other factors (such as dis-
17 aster preparedness) are contributing to a shortage of
18 both generalist and specialist physicians.
19 (7) These shortages will have the most severe
20 impact on vulnerable and underserved populations,
21 including racial and ethnic minorities and the ap-
22 proximately 20 percent of people in the United
23 States who live in rural or inner-city locations des-
24 ignated as health professional shortage areas.
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1 (8) The health care utilization equity model of
2 the Association of American Medical Colleges esti-
3 mates that if racial and ethnic minorities and indi-
4 viduals from rural areas utilized health care in a
5 similar way to their Caucasian counterparts living in
6 metropolitan areas, the physician shortage would re-
7 quire an additional 96,000 physicians.
8 (9) To address the physician shortage in rural
9 and medically underserved areas, medical education
10 and training need to be accessible to underrep-
11 resented minorities (including individuals who are
12 African American, Hispanic, Native American, or
13 Native Hawaiian), and need to increase pathway
14 programs for such underrepresented minorities who
15 make up less than 12 percent of individuals enrolled
16 in graduate medical education and for international
17 students who make up 25 percent of individuals en-
18 rolled in graduate medical education. Immigration
19 pathways like student, exchange-visitor, and employ-
20 ment visas, and programs like the National Interest
21 Waiver and Conrad State 30 J–1 Visa Waiver, help
22 improve health access across the United States.
23 (10) United States medical school enrollment
24 was expected to grow by 30 percent from 2018 to
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1 2019 to help reduce the shortage of quality physi-
2 cians in the United States.
3 (11) An increase in United States medical
4 school graduates must be accompanied by an in-
5 crease of 4,000 graduate medical education training
6 positions each year.
7 (12) Graduate medical education programs and
8 teaching hospitals provide venues in which the next
9 generation of physicians learns to work collabo-
10 ratively with other physicians and health profes-
11 sionals, adopt more efficient care delivery models
12 (such as care coordination and medical homes), in-
13 corporate health information technology and elec-
14 tronic health records in every aspect of their work,
15 apply new methods of assuring quality and safety,
16 and participate in groundbreaking clinical and public
17 health research.
18 (13) The Medicare program under title XVIII
19 of the Social Security Act (42 U.S.C. 1395 et seq.)
20 (having more beneficiaries than any other health
21 care program), supports its ‘‘fair share’’ of the costs
22 associated with graduate medical education.
23 (14) In general, the level of support of graduate
24 medical education by the Medicare program has
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25 been capped since 1997 and has not been increased
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1 to support the expansion of graduate medical edu-
2 cation programs needed to avert the projected physi-
3 cian shortage or to accommodate the increase in
4 United States medical school graduates.
5 (b) SENSE OF CONGRESS.—It is the sense of Con-
6 gress that eliminating the limit of the number of residency
7 positions that receive some level of Medicare support
8 under section 1886(h) of the Social Security Act (42
9 U.S.C. 1395ww(h)), also referred to as the Medical grad-
10 uate medical education cap, is critical to—
11 (1) ensuring an appropriate supply of physi-
12 cians to meet the health care needs in the United
13 States;
14 (2) facilitating equitable access for all who seek
15 health care;
16 (3) increasing the racial and ethnic diversity of
17 physicians in the United States; and
18 (4) mitigating disparities in health and health
19 care.
20 SEC. 3014. CAREER SUPPORT FOR SKILLED, INTERNATION-
21 ALLY EDUCATED HEALTH PROFESSIONALS.
22 (a) FINDINGS.—Congress finds the following:
23 (1) According to a 2018 study, the State and
24 local public health workforce has shrunk by more
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25 than 50,000 individuals since the beginning of the
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1 2008 Great Recession, and almost one quarter of in-
2 dividuals comprising the governmental public health
3 workforce plan to leave or retire in the coming years.
4 (2) Shortages are projected for other health
5 professions, including within the fields of nursing
6 (500,000 by 2025), dentistry (15,000 by 2025),
7 pharmacy (38,000 by 2030), mental and behavioral
8 health (236,880 by 2025), and primary care (46,000
9 by 2025).
10 (3) A nationwide health workforce shortage will
11 result in serious health threats and more severe and
12 costly health care needs, due to, in part, a delayed
13 response to food-borne outbreaks, emerging infec-
14 tious diseases, natural disasters, fewer cancer
15 screenings, and delayed treatment.
16 (4) Vulnerable and underserved populations and
17 health professional shortage areas will be most se-
18 verely impacted by the health workforce shortage.
19 (5) According to the Migration Policy Institute,
20 more than 2,000,000 college-educated immigrants in
21 the United States today are unemployed or under-
22 employed in low- or semi-skilled jobs that fail to
23 draw on their education and expertise.
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1 (6) Approximately 2 out of every 5 internation-
2 ally educated immigrants are unemployed or under-
3 employed.
4 (7) According to the Drexel University Center
5 for Labor Markets and Policy, underemployment for
6 internationally educated immigrant women is 28 per-
7 cent higher than for their male counterparts.
8 (8) According to the Drexel University Center
9 for Labor Markets and Policy, the mean annual
10 earnings of underemployed immigrants were
11 $32,000, or 43 percent less than United States-born
12 college graduates employed in the college labor mar-
13 ket.
14 (9) According to Upwardly Global and the Wel-
15 come Back Initiative, with proper guidance and sup-
16 port, underemployed skilled immigrants typically in-
17 crease their income by 215 percent to 900 percent.
18 (10) According to the Brookings Institution and
19 the Partnership for a New American Economy, im-
20 migrants working in the health workforce are, on av-
21 erage, better educated than United States-born
22 workers in the health workforce.
23 (b) GRANTS TO ELIGIBLE ENTITIES.—
24 (1) AUTHORITY GRANTS.—The
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25 Secretary of Health and Human Services acting
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1 through the Bureau of Health Workforce within the
2 Health Resources and Services Administration, the
3 National Institute on Minority Health and Health
4 Disparities, or the Office of Minority Health (in this
5 section referred to as the ‘‘Secretary’’) may award
6 grants to eligible entities under paragraph (2) to
7 carry out activities described in subsection (c).
8 (2) ELIGIBILITY.—To be eligible to receive a
9 grant under this section, an entity shall—
10 (A) be a clinical, public health, or health
11 services organization, a community-based or
12 nonprofit entity, an academic institution, a
13 faith-based organization, a State, county, or
14 local government, an area health education cen-
15 ter, or another entity determined appropriate by
16 the Secretary; and
17 (B) submit to the Secretary an application
18 at such time, in such manner, and containing
19 such information as the Secretary may require.
20 (c) AUTHORIZED ACTIVITIES.—A grant awarded
21 under this section shall be used—
22 (1) to provide services to assist unemployed and
23 underemployed skilled immigrants, residing in the
24 United States, who have legal, permanent work au-
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25 thorization and who are internationally educated
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1 health professionals, enter into the health workforce
2 of the United States with employment matching
3 their health professional skills and education, and
4 advance in employment to positions that better
5 match their health professional education and exper-
6 tise;
7 (2) to provide training opportunities to reduce
8 barriers to entry and advancement in the health
9 workforce for skilled, internationally educated immi-
10 grants;
11 (3) to educate employers regarding the abilities
12 and capacities of internationally educated health
13 professionals;
14 (4) to assist in the evaluation of foreign creden-
15 tials;
16 (5) to support preceptorships for international
17 medical graduates in hospital primary care training;
18 and
19 (6) to facilitate access to contextualized and ac-
20 celerated courses on English as a second language.
21 SEC. 3015. STUDY AND REPORT ON STRATEGIES FOR IN-
22 CREASING DIVERSITY.
23 (a) STUDY.—The Comptroller General of the United
24 States shall conduct a study on strategies for increasing
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1 study shall include an analysis of strategies for increasing
2 the number of health professionals from rural, lower in-
3 come, and underrepresented minority communities, includ-
4 ing which strategies are most effective for achieving such
5 goal.
6 (b) REPORT.—Not later than 2 years after the date
7 of enactment of this Act, the Comptroller General shall
8 submit to Congress a report on the study conducted under
9 subsection (a), together with recommendations for such
10 legislation and administrative action as the Comptroller
11 General determines appropriate.
12 SEC. 3016. CONRAD STATE 30 PROGRAM; PHYSICIAN RETEN-
13 TION.
14 (a) CONRAD STATE 30 PROGRAM EXTENSION.—Sec-
15 tion 220(c) of the Immigration and Nationality Technical
16 Corrections Act of 1994 (Public Law 103–416; 8 U.S.C.
17 1182 note) is amended by striking ‘‘September 30, 2015’’
18 and inserting ‘‘September 30, 2022’’.
19 (b) RETAINING PHYSICIANS WHO HAVE PRACTICED
20 IN MEDICALLY UNDERSERVED COMMUNITIES.—Section
21 201(b)(1) of the Immigration and Nationality Act (8
22 U.S.C. 1151(b)(1)) is amended by adding at the end the
23 following:
24 ‘‘(F)(i) Alien physicians who have com-
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25 pleted service requirements for a national inter-
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1 est waiver requested under section
2 203(b)(2)(B)(ii), including—
3 ‘‘(I) alien physicians who completed
4 such service before the date of the enact-
5 ment of the Health Equity and Account-
6 ability Act of 2022; and
7 ‘‘(II) the spouse or children of an
8 alien physician described in subclause (I).
9 ‘‘(ii) Nothing in this subparagraph may be
10 construed—
11 ‘‘(I) to prevent the filing of a petition
12 with the Secretary of Homeland Security
13 for classification under section 204(a) or
14 the filing of an application for adjustment
15 of status under section 245 by an alien
16 physician described in clause (i) before the
17 date on which such alien physician com-
18 pletes the service described in section
19 214(l) or worked full-time as a physician
20 for an aggregate of 5 years at the location
21 identified in the waiver of the 2-year for-
22 eign residence requirement under section
23 214(l) or in an area or areas designated by
24 the Secretary of Health and Human Serv-
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1 ices as having a shortage of health care
2 professionals; or
3 ‘‘(II) to permit the Secretary of
4 Homeland Security to grant a petition or
5 application described in subclause (I) until
6 the alien has satisfied all of the require-
7 ments of the waiver received under section
8 214(l).’’.
9 (c) EMPLOYMENT PROTECTIONS FOR PHYSICIANS.—
10 (1) EXCEPTIONS TO 2-YEAR FOREIGN RESI-
11 DENCY REQUIREMENT.—Section 214(l)(1) of the
12 Immigration and Nationality Act (8 U.S.C.
13 1184(l)(1)) is amended—
14 (A) in the matter preceding subparagraph
15 (A), by striking ‘‘Attorney General shall not’’
16 and inserting ‘‘Secretary of Homeland Security
17 may not’’;
18 (B) in subparagraph (A), by striking ‘‘Di-
19 rector of the United States Information Agen-
20 cy’’ and inserting ‘‘Secretary of State’’;
21 (C) in subparagraph (B), by inserting ‘‘,
22 except as provided in paragraphs (7) and (8)’’
23 before the semicolon at the end;
24 (D) in subparagraph (C), by amending
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25 clauses (i) and (ii) to read as follows:
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1 ‘‘(i) the alien demonstrates a bona
2 fide offer of full-time employment at a
3 health facility or health care organization,
4 which employment has been determined by
5 the Secretary of Homeland Security to be
6 in the public interest; and
7 ‘‘(ii) the alien—
8 ‘‘(I) has accepted employment
9 with the health facility or health care
10 organization in a geographic area or
11 areas which are designated by the
12 Secretary of Health and Human Serv-
13 ices as having a shortage of health
14 care professionals;
15 ‘‘(II) begins employment by the
16 later of the date that is—
17 ‘‘(aa) 120 days after receiv-
18 ing such waiver;
19 ‘‘(bb) 120 days after com-
20 pleting graduate medical edu-
21 cation or training under a pro-
22 gram approved pursuant to sec-
23 tion 212(j)(1); or
24 ‘‘(cc) 120 days after receiv-
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25 ing nonimmigrant status or em-
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1 ployment authorization, if the
2 alien or the alien’s employer peti-
3 tions for such nonimmigrant sta-
4 tus or employment authorization
5 not later than 120 days after the
6 date on which the alien completes
7 his or her graduate medical edu-
8 cation or training under a pro-
9 gram approved pursuant to sec-
10 tion 212(j)(1); and
11 ‘‘(III) agrees to continue to work
12 for a total of not less than 3 years in
13 the status authorized for such employ-
14 ment under this subsection, except as
15 provided in paragraph (8); and’’; and
16 (E) in subparagraph (D), in the matter
17 preceding clause (i), by inserting ‘‘, subject to
18 paragraph (8),’’ before ‘‘in the case’’.
19 (2) ALLOWABLE VISA STATUS FOR PHYSICIANS
20 FULFILLING WAIVER REQUIREMENTS IN MEDICALLY
21 UNDERSERVED AREAS.—Section 214(l)(2)(A) of
22 such Act (8 U.S.C. 1184(l)(2)(A)) is amended to
23 read as follows:
24 ‘‘(A) Upon the request of an interested
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25 Federal agency or an interested State agency
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1 for recommendation of a waiver under this sec-
2 tion by a physician who is maintaining valid
3 nonimmigrant status under section
4 101(a)(15)(J) and received a favorable rec-
5 ommendation by the Secretary of State, the
6 Secretary of Homeland Security may change
7 the status of such physician to any status au-
8 thorized for employment under this Act. The
9 numerical limitations set forth in subsection
10 (g)(1)(A) shall not apply to any alien whose
11 status is changed under this subparagraph.’’.
12 (3) VIOLATION OF AGREEMENTS.—Section
13 214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is
14 amended by inserting ‘‘substantial requirement of
15 an’’ before ‘‘agreement entered into’’.
16 (4) PHYSICIAN EMPLOYMENT IN UNDERSERVED
17 AREAS.—Section 214(l) of such Act (8 U.S.C.
18 1184(l)), as amended by this section, is further
19 amended by adding at the end the following:
20 ‘‘(4)(A) If an interested State agency denies the
21 application for a waiver under paragraph (1)(B)
22 from a physician pursuing graduate medical edu-
23 cation or training pursuant to section 101(a)(15)(J)
24 because the State has requested the maximum num-
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25 ber of waivers permitted for that fiscal year, the
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1 physician’s nonimmigrant status shall be extended
2 for up to 6 months if the physician agrees to seek
3 a waiver under this subsection (except for paragraph
4 (1)(D)(ii)) to work for an employer described in
5 paragraph (1)(C) in a State that has not yet re-
6 quested the maximum number of waivers.
7 ‘‘(B) A physician described in subparagraph (A)
8 may only work for the employer referred to in sub-
9 paragraph (A) during the period beginning on the
10 date on which a new waiver application is filed with
11 such State and ending on the earlier of—
12 ‘‘(i) the date on which the Secretary of
13 Homeland Security denies such waiver; or
14 ‘‘(ii) the date on which the Secretary ap-
15 proves an application for change of status
16 under paragraph (2)(A) pursuant to the ap-
17 proval of such waiver.’’.
18 (5) CONTRACT REQUIREMENTS.—Section 214(l)
19 of such Act, as amended by this section, is further
20 amended by adding at the end the following:
21 ‘‘(5) An alien granted a waiver under para-
22 graph (1)(C) shall enter into an employment agree-
23 ment with the contracting health facility or health
24 care organization that—
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1 ‘‘(A) specifies the maximum number of on-
2 call hours per week (which may be a monthly
3 average) that the alien will be expected to be
4 available and the compensation the alien will re-
5 ceive for on-call time;
6 ‘‘(B) specifies—
7 ‘‘(i) whether the contracting facility or
8 organization will pay the alien’s mal-
9 practice insurance premiums;
10 ‘‘(ii) whether the employer will provide
11 malpractice insurance; and
12 ‘‘(iii) the amount of such insurance
13 that will be provided;
14 ‘‘(C) describes all of the work locations
15 that the alien will work including a statement
16 that the contracting facility or organization will
17 not add additional work locations without the
18 approval of the Federal agency or State agency
19 that requested the waiver; and
20 ‘‘(D) does not include a non-compete provi-
21 sion.
22 ‘‘(6) An alien granted a waiver under this sub-
23 section whose employment relationship with a health
24 facility or health care organization terminates under
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1 required under paragraph (1) shall be considered to
2 be maintaining lawful status in an authorized period
3 of stay during the 120-day period referred to in
4 items (aa) and (bb) of subclause (III) of paragraph
5 (1)(C)(ii) or the 45-day period referred to in sub-
6 clause (III)(cc) of such paragraph.’’.
7 (6) RECAPTURING WAIVER SLOTS LOST TO
8 OTHER STATES.—Section 214(l) of such Act, as
9 amended by this section, is further amended by add-
10 ing at the end the following:
11 ‘‘(7) If a recipient of a waiver under this sub-
12 section terminates the recipient’s employment with a
13 health facility or health care organization pursuant
14 to paragraph (1)(C)(ii), including termination of em-
15 ployment because of circumstances described in
16 paragraph (1)(C)(ii)(III), and accepts new employ-
17 ment with such a facility or organization in a dif-
18 ferent State, the State from which the alien is de-
19 parting may be accorded an additional waiver by the
20 Secretary of State for use in the fiscal year in which
21 the alien’s employment was terminated.’’.
22 (7) EXCEPTION TO 3-YEAR WORK REQUIRE-
23 MENT.—Section 214(l) of such Act, as amended by
24 this section, is further amended by adding at the
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1 ‘‘(8) The 3-year work requirement set forth in
2 subparagraphs (C) and (D) of paragraph (1) shall
3 not apply if—
4 ‘‘(A)(i) the Secretary of Homeland Secu-
5 rity determines that extenuating circumstances,
6 including violations by the employer of the em-
7 ployment agreement with the alien or of labor
8 and employment laws, exist that justify a lesser
9 period of employment at such facility or organi-
10 zation; and
11 ‘‘(ii) not later than 120 days after the em-
12 ployment termination date (unless the Secretary
13 determines that extenuating circumstances
14 would justify an extension), the alien dem-
15 onstrates another bona fide offer of employment
16 at a health facility or health care organization
17 in a geographic area or areas which are des-
18 ignated by the Secretary of Health and Human
19 Services as having a shortage of health care
20 professionals, for the remainder of such 3-year
21 period;
22 ‘‘(B)(i) the interested State agency that re-
23 quested the waiver attests that extenuating cir-
24 cumstances, including violations by the em-
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1 alien or of labor and employment laws, exist
2 that justify a lesser period of employment at
3 such facility or organization; and
4 ‘‘(ii) the alien demonstrates, not later than
5 120 days after the employment termination
6 date (unless the Secretary determines that ex-
7 tenuating circumstances would justify an exten-
8 sion), another bona fide offer of employment at
9 a health facility or health care organization in
10 a geographic area or areas which are designated
11 by the Secretary of Health and Human Services
12 as having a shortage of health care profes-
13 sionals, for the remainder of such 3-year period;
14 or
15 ‘‘(C) the alien—
16 ‘‘(i) elects not to pursue a determina-
17 tion of extenuating circumstances pursuant
18 to subparagraph (A) or (B);
19 ‘‘(ii) terminates the alien’s employ-
20 ment relationship with the health facility
21 or health care organization at which the
22 alien was employed;
23 ‘‘(iii) not later than 45 days after the
24 employment termination date, dem-
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1 ployment at a health facility or health care
2 organization in a geographic area or areas,
3 in the State that requested the alien’s
4 waiver, which are designated by the Sec-
5 retary of Health and Human Services as
6 having a shortage of health care profes-
7 sionals; and
8 ‘‘(iv) agrees to be employed for the re-
9 mainder of such 3-year period, and 1 addi-
10 tional year for each termination under
11 clause (ii).’’.
12 (d) ALLOTMENT OF CONRAD STATE 30 WAIVERS.—
13 (1) IN GENERAL.—Section 214(l) of the Immi-
14 gration and Nationality Act (8 U.S.C. 1184(l)), as
15 amended by subsection (c), is further amended by
16 adding at the end the following:
17 ‘‘(9)(A)(i) All States shall be allotted 35 waivers
18 under paragraph (1)(B) for each fiscal year if 90 percent
19 of the waivers available to the States receiving at least
20 5 waivers were used in the previous fiscal year.
21 ‘‘(ii) When an allotment occurs under clause (i), all
22 States shall be allotted an additional 5 waivers under
23 paragraph (1)(B) for each subsequent fiscal year if 90
24 percent of the waivers available to the States receiving at
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25 least 5 waivers were used in the previous fiscal year. If
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1 the States are allotted 45 or more waivers for a fiscal year,
2 the States will only receive an additional increase of 5
3 waivers the following fiscal year if 95 percent of the waiv-
4 ers available to the States receiving at least 1 waiver were
5 used in the previous fiscal year.
6 ‘‘(B) Any increase in allotments under subparagraph
7 (A) shall be maintained indefinitely, unless in a fiscal year
8 the total number of such waivers granted is 5 percent
9 lower than in the last year in which there was an increase
10 in the number of waivers allotted pursuant to this para-
11 graph. In such case—
12 ‘‘(i) the number of waivers allotted beginning in
13 the next fiscal year shall be decreased by 5 for all
14 States; and
15 ‘‘(ii) each additional 5 percent decrease in such
16 waivers granted from the last year in which there
17 was an increase in the allotment, shall result in an
18 additional decrease of 5 waivers allotted for all
19 States, provided that the number of waivers allotted
20 for all States shall not drop below 30.’’.
21 (2) ACADEMIC MEDICAL CENTERS.—Section
22 214(l)(1)(D) of such Act, as amended by subsection
23 (c)(1)(E), is further amended—
24 (A) in clause (ii), by striking ‘‘and’’ at the
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1 (B) in clause (iii), by striking the period at
2 the end and inserting ‘‘; and’’; and
3 (C) by adding at the end the following:
4 ‘‘(iv) in the case of a request by an inter-
5 ested State agency—
6 ‘‘(I) the head of such agency deter-
7 mines that the alien is to practice medicine
8 in, or be on the faculty of a residency pro-
9 gram at, an academic medical center (as
10 defined in section 411.355(e)(2) of title 42,
11 Code of Federal Regulations), without re-
12 gard to whether such facility is located
13 within an area designated by the Secretary
14 of Health and Human Services as having
15 a shortage of health care professionals; and
16 ‘‘(II) the head of such agency deter-
17 mines that—
18 ‘‘(aa) the alien physician’s work
19 is in the public interest; and
20 ‘‘(bb) subject to paragraph (6),
21 the grant of such waiver would not
22 cause the number of the waivers
23 granted on behalf of aliens for such
24 State for a fiscal year to exceed 3,
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1 within the limitation under subpara-
2 graph (B).’’.
3 (e) AMENDMENTS TO THE PROCEDURES, DEFINI-
4 TIONS, AND OTHER PROVISIONS RELATED TO PHYSICIAN
5 IMMIGRATION.—
6 (1) DUAL INTENT FOR PHYSICIANS SEEKING
7 GRADUATE MEDICAL TRAINING.—Section 214(b) of
8 the Immigration and Nationality Act (8 U.S.C.
9 1184(b)) is amended by striking ‘‘and other than a
10 nonimmigrant described in any provision of section
11 101(a)(15)(H)(i) except subclause (b1) of such sec-
12 tion)’’ and inserting ‘‘a nonimmigrant described in
13 any provision of section 101(a)(15)(H)(i) (except
14 subclause (b1) of such section), and an alien coming
15 to the United States to receive graduate medical
16 education or training as described in section 212(j)
17 or to take examinations required to receive graduate
18 medical education or training as described in section
19 212(j))’’.
20 (2) PHYSICIAN NATIONAL INTEREST WAIVER
21 CLARIFICATIONS.—
22 (A) PRACTICE AND GEOGRAPHIC AREA.—
23 Section 203(b)(2)(B)(ii)(I) of the Immigration
24 and Nationality Act (8 U.S.C.
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1 1153(b)(2)(B)(ii)(I)) is amended by striking
2 items (aa) and (bb) and inserting the following:
3 ‘‘(aa) the alien physician agrees to
4 work on a full-time basis practicing pri-
5 mary care, specialty medicine, or a com-
6 bination thereof, in an area or areas des-
7 ignated by the Secretary of Health and
8 Human Services as having a shortage of
9 health care professionals, or at a health
10 care facility under the jurisdiction of the
11 Secretary of Veterans Affairs; or
12 ‘‘(bb) the alien physician is pursuing
13 such waiver based upon service at a facility
14 or facilities that serve patients who reside
15 in a geographic area or areas designated
16 by the Secretary of Health and Human
17 Services as having a shortage of health
18 care professionals (without regard to
19 whether such facility or facilities are lo-
20 cated within such an area) and a Federal
21 agency, or a local, county, regional, or
22 State department of public health deter-
23 mines the alien physician’s work was or
24 will be in the public interest.’’.
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1 (B) FIVE-YEAR SERVICE REQUIREMENT.—
2 Section 203(b)(2)(B)(ii) of such Act is amend-
3 ed—
4 (i) by moving subclauses (II), (III),
5 and (IV) 4 ems to the left; and
6 (ii) in subclause (II)—
7 (I) by inserting ‘‘(aa)’’ after
8 ‘‘(II)’’; and
9 (II) by adding at the end the fol-
10 lowing:
11 ‘‘(bb) The 5-year service requirement
12 described in item (aa) shall begin on the
13 date on which the alien physician begins
14 work in the shortage area in any legal sta-
15 tus and not on the date on which an immi-
16 grant visa petition is filed or approved.
17 Such service shall be aggregated without
18 regard to when such service began and
19 without regard to whether such service
20 began during or in conjunction with a
21 course of graduate medical education.
22 ‘‘(cc) An alien physician shall not be
23 required to submit an employment contract
24 with a term exceeding the balance of the 5-
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1 employment contract dated within a min-
2 imum time period before filing a visa peti-
3 tion under this subsection.
4 ‘‘(dd) An alien physician shall not be
5 required to file additional immigrant visa
6 petitions upon a change of work location
7 from the location approved in the original
8 national interest immigrant petition.’’.
9 (3) TECHNICAL CLARIFICATION REGARDING AD-
10 VANCED DEGREE FOR PHYSICIANS.—Section
11 203(b)(2)(A) of such Act is amended by adding at
12 the end the following: ‘‘An alien physician holding a
13 foreign medical degree that has been deemed suffi-
14 cient for acceptance by an accredited United States
15 medical residency or fellowship program shall be
16 considered a member of the professions holding an
17 advanced degree or its equivalent for purposes of
18 this paragraph.’’.
19 (4) SHORT-TERM WORK AUTHORIZATION FOR
20 PHYSICIANS COMPLETING THEIR RESIDENCIES.—
21 (A) IN GENERAL.—A physician completing
22 graduate medical education or training de-
23 scribed in section 212(j) of the Immigration
24 and Nationality Act (8 U.S.C. 1182(j)) as a
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