< Back to H.R. 2954 (112th Congress, 2011–2013)

Text of the Health Equity and Accountability Act of 2011

This bill was introduced on September 15, 2011, in a previous session of Congress, but was not enacted. The text of the bill below is as of Sep 15, 2011 (Introduced).

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I

112th CONGRESS

1st Session

H. R. 2954

IN THE HOUSE OF REPRESENTATIVES

September 15, 2011

(for herself, Mrs. Christensen, Ms. Roybal-Allard, Ms. Bass of California, Mr. Bishop of Georgia, Ms. Bordallo, Mr. Brooks, Ms. Brown of Florida, Mr. Butterfield, Mr. Carson of Indiana, Ms. Chu, Mr. Clarke of Michigan, Ms. Clarke of New York, Mr. Clay, Mr. Cleaver, Mr. Cohen, Mr. Conyers, Mr. Cummings, Mr. Davis of Illinois, Ms. DeGette, Ms. DeLauro, Ms. Edwards, Mr. Ellison, Mr. Faleomavaega, Mr. Fattah, Ms. Fudge, Mr. Gonzalez, Mr. Al Green of Texas, Mr. Grijalva, Mr. Gutierrez, Ms. Hahn, Ms. Hanabusa, Mr. Hastings of Florida, Ms. Hirono, Mr. Honda, Mr. Jackson of Illinois, Ms. Jackson Lee of Texas, Mr. Johnson of Georgia, Ms. Eddie Bernice Johnson of Texas, Mr. Lewis of Georgia, Mr. Kucinich, Ms. Matsui, Mr. McGovern, Mr. Meeks, Ms. Moore, Mrs. Napolitano, Ms. Norton, Mr. Olver, Mr. Payne, Mr. Pierluisi, Mr. Rangel, Mr. Reyes, Ms. Richardson, Mr. Richmond, Mr. Rush, Mr. Sablan, Ms. Linda T. Sánchez of California, Ms. Schakowsky, Mr. Scott of Virginia, Mr. David Scott of Georgia, Mr. Serrano, Mr. Sires, Ms. Slaughter, Mr. Thompson of Mississippi, Mr. Towns, Ms. Waters, Mr. Watt, Ms. Wilson of Florida, and Ms. Woolsey) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and the Workforce, the Budget, Veterans’ Affairs, Armed Services, Agriculture, the Judiciary, and Natural Resources, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

A BILL

To improve the health of minority individuals, and for other purposes.

1.

Short title

This Act may be cited as the Health Equity and Accountability Act of 2011.

2.

Table of contents

The table of contents of this Act is as follows:

Sec. 1. Short title.

Sec. 2. Table of contents.

Sec. 3. Findings.

Title I—Data Collection and Reporting

Sec. 101. Amendment to the Public Health Service Act.

Sec. 102. Elimination of prerequisite of direct appropriations for data collection and analysis.

Sec. 103. Collection of race and ethnicity data by the Social Security Administration.

Sec. 104. Revision of HIPAA claims standards.

Sec. 105. National Center for Health Statistics.

Sec. 106. Oversampling of Asian-Americans, Native Hawaiians, or Pacific Islanders and other underrepresented groups in Federal health surveys.

Sec. 107. Geo-access study.

Sec. 108. Racial, ethnic, and linguistic data collected by the Federal Government.

Sec. 109. Data collection and analysis grants to minority-serving institutions.

Sec. 110. Standards for measuring sexual orientation and gender identity in collection of health data.

Sec. 111. Optional collection of health data on immigrants and individuals in their households.

Sec. 112. Standards for measuring socioeconomic status in collection of health data.

Sec. 113. Safety and effectiveness of drugs with respect to racial and ethnic background.

Sec. 114. GAO study on compliance with existing FDA requirements to present drug and device safety and effectiveness data by sex, age, and racial and ethnic subgroups.

Sec. 115. Improving health data regarding Native Hawaiians and other Pacific Islanders.

Title II—Culturally and Linguistically Appropriate Health Care

Sec. 201. Definitions.

Sec. 202. Amendment to the Public Health Service Act.

Sec. 203. Federal reimbursement for culturally and linguistically appropriate services under the Medicare, Medicaid, and State Children’s Health Insurance Programs.

Sec. 204. Increasing understanding of and improving health literacy.

Sec. 205. Assurances for receiving Federal funds.

Sec. 206. Report on Federal efforts to provide culturally and linguistically appropriate health care services.

Sec. 207. English for speakers of other languages.

Sec. 208. Implementation.

Sec. 209. Language access services.

Title III—Health Workforce Diversity

Sec. 301. Amendment to the Public Health Service Act.

Sec. 302. Hispanic-serving health professions schools.

Sec. 303. Loan repayment program of Centers for Disease Control and Prevention.

Sec. 304. Cooperative agreements for online degree programs at schools of public health and schools of allied health.

Sec. 305. National report on the preparedness of health professionals to care for diverse populations.

Sec. 306. Scholarship and fellowship programs.

Sec. 307. Advisory Committee on Health Professions Training for Diversity.

Sec. 308. McNair Postbaccalaureate Achievement Program.

Sec. 309. Rules for determination of full-time equivalent residents for cost reporting periods.

Sec. 310. Developing and implementing strategies for local health equity.

Sec. 311. Loan forgiveness for mental and behavioral health social workers.

Title IV—Improvement of Health Care Services

Subtitle A—Health Empowerment Zones

Sec. 401. Short title.

Sec. 402. Findings.

Sec. 403. Designation of health empowerment zones.

Sec. 404. Assistance to those seeking designation.

Sec. 405. Benefits of designation.

Sec. 406. Definition.

Sec. 407. Authorization of appropriations.

Subtitle B—Other Improvements of Health Care Services

Chapter 1—Expansion of Coverage

Sec. 411. Amendment to the Public Health Service Act.

Sec. 412. Removing barriers to unsubsidized purchase of private insurance in American Health Benefit Exchanges.

Sec. 413. Study on the uninsured.

Sec. 414. Medicaid payment parity for the territories.

Sec. 415. Clarification of Medicaid coverage for citizens of Freely Associated States.

Sec. 416. Extension of Medicare secondary payer.

Sec. 417. Border health grants.

Sec. 418. Removing Medicare barrier to health care.

Sec. 419. 100 percent FMAP for medical assistance provided by urban Indian health centers.

Sec. 420. 100 percent FMAP for medical assistance provided to a Native Hawaiian through a federally qualified health center or a Native Hawaiian health care system under the Medicaid program.

Chapter 2—Expansion of Access

Sec. 421. Grants for racial and ethnic approaches to community health.

Sec. 422. Critical access hospital improvements.

Sec. 423. Establishment of Rural Community Hospital (RCH) Program.

Sec. 424. Medicare remote monitoring pilot projects.

Sec. 425. Rural health quality advisory commission and demonstration projects.

Sec. 426. Rural health care services.

Sec. 427. Community health center collaborative access expansion.

Sec. 428. Facilitating the provision of telehealth services across State lines.

Sec. 429. Scoring of preventive health savings.

Sec. 430. Sense of Congress.

Sec. 431. Repeal of requirement for documentation evidencing citizenship or nationality under the Medicaid program.

Sec. 432. Office of Minority Health in Veterans Health Administration of Department of Veterans Affairs.

Sec. 433. Access for Native Americans under PPACA.

Title V—Improving Health Outcomes for Women, Children, and Families

Sec. 501. Grants to promote positive health behaviors in women and children.

Sec. 502. Removing barriers to health care and nutrition assistance for children, pregnant women, and lawfully present individuals.

Sec. 503. Repeal of denial of benefits.

Sec. 504. Birth defects prevention, risk reduction, and awareness.

Sec. 505. Uniform State maternal mortality review committees on pregnancy-related deaths.

Sec. 506. Eliminating disparities in maternity health outcomes.

Sec. 507. Decreasing the risk factors for sudden unexpected infant death and sudden unexplained death in childhood.

Sec. 508. Reducing teenage pregnancies.

Sec. 509. Gestational diabetes.

Sec. 510. Emergency contraception education and information programs.

Sec. 511. Supporting healthy adolescent development.

Title VI—Mental Health

Sec. 601. Coverage of marriage and family therapist services and mental health counselor services under part B of the Medicare program.

Sec. 602. Community Mental Health and Addiction Safety Net Equity Act.

Sec. 603. Minority Fellowship Program.

Sec. 604. Integrated Health Care Demonstration Program.

Sec. 605. Addressing racial and ethnic minority mental health disparities research gaps.

Title VII—Addressing High Impact Minority Diseases

Subtitle A—Cancer

Sec. 701. Lung Cancer Mortality Reduction Program.

Sec. 702. Expanding prostate cancer research, outreach, screening, testing, access, and treatment effectiveness.

Sec. 703. Improved Medicaid coverage for certain breast and cervical cancer patients in the territories.

Sec. 704. Cancer prevention and treatment demonstration for ethnic and racial minorities.

Sec. 705. Reducing cancer disparities within Medicare.

Subtitle B—Viral Hepatitis and Liver Cancer Control and Prevention

Sec. 711. Viral hepatitis and liver cancer control and prevention.

Subtitle C—Acquired Bone Marrow Failure Diseases

Sec. 721. Acquired Bone Marrow Failure Diseases.

Subtitle D—Cardiovascular Disease, Chronic Disease, and Other Disease Issues

Sec. 731. Guidelines for disease screening for minority patients.

Sec. 732. Coverage of the shingles vaccine under the Medicare program.

Sec. 733. CDC Wisewoman Screening Program.

Sec. 734. Report on cardiovascular care for women and minorities.

Sec. 735. Coverage of comprehensive tobacco cessation services in Medicaid.

Sec. 736. Clinical research funding for oral health.

Subtitle E—HIV/AIDS

Sec. 741. Findings.

Sec. 742. Addressing HIV/AIDS in communities of color.

Sec. 743. HIV/AIDS reduction in racial and ethnic minority communities.

Sec. 744. Repealing ineffective and incomplete abstinence-only education program.

Sec. 745. Dental Education Loan Repayment Program.

Sec. 746. Report on the implementation of the national HIV/AIDS strategy.

Sec. 747. Addressing HIV/AIDS in the African-American community.

Sec. 748. National Black Clergy for the Elimination of HIV/AIDS.

Sec. 749. Reducing the spread of sexually transmitted infections in correctional facilities.

Sec. 750. Stop AIDS in prison.

Sec. 751. Services to reduce HIV/AIDS in racial and ethnic minority communities.

Sec. 752. Health care professionals treating individuals with HIV/AIDS.

Sec. 753. Report on impact of HIV/AIDS in racial and ethnic minority communities.

Sec. 754. Study on status of HIV/AIDS epidemic among African-Americans.

Subtitle F—Diabetes

Sec. 755. Treatment of diabetes in minority communities.

Sec. 756. Eliminating disparities in diabetes prevention access and care.

Subtitle G—Lung Disease

Sec. 761. Expansion of the National Asthma Education and Prevention Program.

Sec. 762. Asthma-related activities of the centers for disease control and prevention.

Sec. 763. Influenza and pneumonia vaccination campaign.

Sec. 764. Chronic obstructive pulmonary disease action plan.

Title VIII—Health Information Technology

Subtitle A—Reducing Health Disparities through Health IT

Sec. 801. HRSA assistance to health centers for promotion of Health IT.

Sec. 802. Assessment of impact of Health IT on racial and ethnic minority communities; outreach and adoption of Health IT in such communities.

Subtitle B—Modifications to Achieve Parity in Existing Programs

Sec. 811. Extending funding to strengthen the Health IT infrastructure in racial and ethnic minority communities.

Sec. 812. Prioritizing regional extension center assistance to racial and ethnic minority groups.

Sec. 813. Extending competitive grants for the development of loan programs to facilitate adoption of certified EHR technology by providers serving racial and ethnic minority groups.

Subtitle C—Additional Research and Studies

Sec. 831. Data collection and assessments conducted in coordination with minority-serving institutions.

Sec. 832. IOM study and report on privacy concerns of certain minority populations.

Sec. 833. Study of health information technology in medically underserved communities.

Subtitle D—Closing Gaps in Funding To Adopt Certified EHRs

Sec. 841. Application of Medicare HITECH payments to hospitals in Puerto Rico.

Sec. 842. Extending Medicaid EHR incentive payments to long-term care facilities and home health agencies.

Sec. 843. Extending physician assistant eligibility for Medicaid electronic health record incentive payments.

Title IX—Accountability and Evaluation

Sec. 901. Prohibition on discrimination in Federal assisted health care services and research programs on the basis of sex, race, color, national origin, sexual orientation, gender identity, or disability status.

Sec. 902. Treatment of Medicare payments under Title VI of the Civil Rights Act of 1964.

Sec. 903. Accountability and transparency within the Department of Health and Human Services.

Sec. 904. United States Commission on Civil Rights.

Sec. 905. Sense of Congress concerning full funding of activities to eliminate racial and ethnic health disparities.

Sec. 906. GAO and NIH reports.

Title X—Addressing Social Determinants and Improving Environmental Justice

Sec. 1001. Codification of Executive Order 12898.

Sec. 1002. Implementation of recommendations by Environmental Protection Agency.

Sec. 1003. Grant program.

Sec. 1004. Additional research on the relationship between the built environment and the health of community residents.

Sec. 1005. Environment and public health restoration.

Sec. 1006. Healthy Food Financing Initiative.

Sec. 1007. GAO report on health effects of Deepwater Horizon oil rig explosion in the Gulf Coast.

3.

Findings

The Congress finds as follows:

(1)

The population of racial and ethnic minorities is expected to increase over the next few decades, yet racial and ethnic minorities have the poorest health status and face substantial cultural, social, and economic barriers to obtaining quality health care.

(2)

Health disparities are a function of not only access to health care, but also the social determinants of health—including the environment, the physical structure of communities, nutrition and food options, educational attainment, employment, race, ethnicity, sex, geography, language preference, immigrant or citizenship status, sexual orientation, gender identity, socioeconomic status, or disability status—that directly and indirectly affect the health, health care, and wellness of individuals and communities.

(3)

By 2020, the Nation will face a shortage of health care providers and allied health workers and this shortage disproportionately affects health professional shortage areas where many racial and ethnic minority populations reside.

(4)

All efforts to reduce health disparities and barriers to quality health services require better and more consistent data.

(5)

A full range of culturally and linguistically appropriate health care and public health services must be available and accessible in every community.

(6)

Racial and ethnic minorities and underserved populations must be included early and equitably in health reform innovations.

(7)

Efforts to improve minority health have been limited by inadequate resources in funding, staffing, stewardship and accountability. Targeted investments that are focused on disparities elimination must be made in providing care and services that are community-based, including prevention and policies addressing social determinants of health.

(8)

In 2011, the Department of Health and Human Services developed the HHS Action Plan to Reduce Racial and Ethnic Health Disparities and the National Stakeholder Strategy for Achieving Health Equity, two strategic plans that represent the country’s first coordinated roadmap to reducing health disparities. Along with the National Prevention Strategy and the National Health Care Quality Strategy, these comprehensive plans will work to increase the number of Americans who are healthy at every stage of life.

(9)

The Department of Health and Human Services also developed other strategic planning documents to combat disease disparities with a high impact on minority populations including the National HIV/AIDS Strategy, and the Action Plan for the Prevention, Care and Treatment of Viral Hepatitis.

(10)

The Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act, represents the biggest advancement for minority health in the last 40 years.

I

Data collection and reporting

101.

Amendment to the Public Health Service Act

(a)

Purpose

It is the purpose of this section to promote data collection, analysis, and reporting by race, ethnicity, sex, primary language, sexual orientation, disability status, gender identity, and socioeconomic status among federally supported health programs.

(b)

Amendment

Title XXXIV of the Public Health Service Act, as amended by titles II and III of this Act, is further amended by inserting after subtitle A the following:

B

Strengthening data collection, improving data analysis, and expanding data reporting

3431.

Health disparity data

(a)

Requirements

(1)

In general

Each health-related program operated by or that receives funding or reimbursement, in whole or in part, either directly or indirectly from the Department of Health and Human Services shall—

(A)

require the collection, by the agency or program involved, of data on the race, ethnicity, sex, primary language, sexual orientation, disability status, gender identity, and socioeconomic status of each applicant for and recipient of health-related assistance under such program—

(i)

using, at a minimum, the standards for data collection on race, ethnicity, sex, primary language, sexual orientation, disability status, gender identity, and socioeconomic status developed under section 3101;

(ii)

collecting data for additional population groups if such groups can be aggregated into the minimum race and ethnicity categories;

(iii)

additionally referring, where practicable, to the standards developed by the Institute of Medicine in Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement; and

(iv)

where practicable, through self-reporting;

(B)

with respect to the collection of the data described in subparagraph (A), for applicants and recipients who are minors, require communication assistance in speech or writing, and for applicants and recipients who are otherwise legally incapacitated, require that—

(i)

such data be collected from the parent or legal guardian of such an applicant or recipient; and

(ii)

the primary language of the parent or legal guardian of such an applicant or recipient be collected;

(C)

systematically analyze such data using the smallest appropriate units of analysis feasible to detect racial and ethnic disparities, as well as disparities along the lines of primary language, sex, disability status, sexual orientation, gender identity, and socioeconomic status in health and health care, and report the results of such analysis to the Secretary, the Director of the Office for Civil Rights, each agency listed in section 3101(c)(1), the Committee on Health, Education, Labor, and Pensions and the Committee on Finance of the Senate, and the Committee on Energy and Commerce and the Committee on Ways and Means of the House of Representatives;

(D)

provide such data to the Secretary on at least an annual basis; and

(E)

ensure that the provision of assistance to an applicant or recipient of assistance is not denied or otherwise adversely affected because of the failure of the applicant or recipient to provide race, ethnicity, primary language, sex, sexual orientation, disability status, gender identity, and socioeconomic status data.

(2)

Rules of construction

Nothing in this subsection shall be construed to—

(A)

permit the use of information collected under this subsection in a manner that would adversely affect any individual providing any such information; and

(B)

diminish existing or future requirements on health care providers to collect data.

(b)

Protection of data

The Secretary shall ensure (through the promulgation of regulations or otherwise) that all data collected pursuant to subsection (a) are protected—

(1)

under the same privacy protections as the Secretary applies to other health data under the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (Public Law 104–191; 110 Stat. 2033) relating to the privacy of individually identifiable health information and other protections; and

(2)

from all inappropriate internal use by any entity that collects, stores, or receives the data, including use of such data in determinations of eligibility (or continued eligibility) in health plans, and from other inappropriate uses, as defined by the Secretary.

(c)

National plan of the data Council

The Secretary shall develop and implement a national plan to ensure the collection of data in a culturally appropriate and competent manner, to improve the collection, analysis, and reporting of racial, ethnic, sex, primary language, sexual orientation, disability status, gender identity, and socioeconomic status data at the Federal, State, territorial, tribal, and local levels, including data to be collected under subsection (a), and to ensure that data collection activities carried out under this section are in compliance with the standards developed under section 3101. The Data Council of the Department of Health and Human Services, in consultation with the National Committee on Vital Health Statistics, the Office of Minority Health, Office on Women’s Health, and other appropriate public and private entities, shall make recommendations to the Secretary concerning the development, implementation, and revision of the national plan. Such plan shall include recommendations on how to—

(1)

implement subsection (a) while minimizing the cost and administrative burdens of data collection and reporting;

(2)

expand awareness among Federal agencies, States, territories, Indian tribes, health providers, health plans, health insurance issuers, and the general public that data collection, analysis, and reporting by race, ethnicity, primary language, sexual orientation, disability status, gender identity, and socioeconomic status is legal and necessary to assure equity and nondiscrimination in the quality of health care services;

(3)

ensure that future patient record systems have data code sets for racial, ethnic, primary language, sexual orientation, disability status, gender identity, and socioeconomic status identifiers and that such identifiers can be retrieved from clinical records, including records transmitted electronically;

(4)

improve health and health care data collection and analysis for more population groups if such groups can be aggregated into the minimum race and ethnicity categories, including exploring the feasibility of enhancing collection efforts in States for racial and ethnic groups that comprise a significant proportion of the population of the State;

(5)

provide researchers with greater access to racial, ethnic, primary language, sexual orientation, disability status, gender identity, and socioeconomic status data, subject to privacy and confidentiality regulations; and

(6)

safeguard and prevent the misuse of data collected under subsection (a).

(d)

Compliance with Standards

Data collected under subsection (a) shall be obtained, maintained, and presented (including for reporting purposes) in accordance with the 1997 Office of Management and Budget Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity (at a minimum).

(e)

Technical assistance for the collection and reporting of data

(1)

In general

The Secretary may, either directly or through grant or contract, provide technical assistance to enable a health care program or an entity operating under such program to comply with the requirements of this section.

(2)

Types of assistance

Assistance provided under this subsection may include assistance to—

(A)

enhance or upgrade computer technology that will facilitate racial, ethnic, primary language, sexual orientation, disability status, gender identity, and socioeconomic status data collection and analysis;

(B)

improve methods for health data collection and analysis including additional population groups beyond the Office of Management and Budget categories if such groups can be aggregated into the minimum race and ethnicity categories;

(C)

develop mechanisms for submitting collected data subject to existing privacy and confidentiality regulations; and

(D)

develop educational programs to inform health insurance issuers, health plans, health providers, health-related agencies, and the general public that data collection and reporting by race, ethnicity, primary language, sexual orientation, disability status, gender identity, and socioeconomic status are legal and essential for eliminating health and health care disparities.

(f)

Analysis of health disparity data

The Secretary, acting through the Director of the Agency for Healthcare Research and Quality and in coordination with the Administrator of the Centers for Medicare & Medicaid Services, shall provide technical assistance to agencies of the Department of Health and Human Services in meeting Federal standards for health disparity data collection and for analysis of racial and ethnic disparities in health and health care in public programs by—

(1)

identifying appropriate quality assurance mechanisms to monitor for health disparities;

(2)

specifying the clinical, diagnostic, or therapeutic measures which should be monitored;

(3)

developing new quality measures relating to racial and ethnic disparities and their overlap with other disparity factors in health and health care;

(4)

identifying the level at which data analysis should be conducted; and

(5)

sharing data with external organizations for research and quality improvement purposes.

(g)

Definition

In this section, the term health-related program mean a program—

(1)

under the Social Security Act (42 U.S.C. 301 et seq.) that pays for health care and services; and

(2)

under this Act that provides Federal financial assistance for health care, biomedical research, or health services research and or is designed to improve the public’s health.

(h)

Authorization of appropriations

There are authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2012 through 2017.

3432.

Provisions relating to Native Americans

(a)

Establishment of epidemiology centers

The Secretary shall establish an epidemiology center in each service area to carry out the functions described in subsection (b). Any new center established after the date of the enactment of the Health Equity and Accountability Act of 2011 may be operated under a grant authorized by subsection (d), but funding under such a grant shall not be divisible.

(b)

Functions of centers

In consultation with and upon the request of Indian tribes, tribal organizations, and urban indian organizations, each service area epidemiology center established under this subsection shall, with respect to such service area—

(1)

collect data relating to, and monitor progress made toward meeting, each of the health status objectives of the service, the Indian tribes, tribal organizations, and urban indian organizations in the service area;

(2)

evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health;

(3)

assist Indian tribes, tribal organizations, and urban indian organizations in identifying their highest priority health status objectives and the services needed to achieve such objectives, based on epidemiological data;

(4)

make recommendations for the targeting of services needed by the populations served;

(5)

make recommendations to improve health care delivery systems for Indians and urban Indians;

(6)

provide requested technical assistance to Indian tribes, tribal organizations, and urban indian organizations in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community; and

(7)

provide disease surveillance and assist Indian tribes, tribal organizations, and urban Indian organizations to promote public health.

(c)

Technical assistance

The Director of the Centers for Disease Control and Prevention shall provide technical assistance to the centers in carrying out the requirements of this subsection.

(d)

Grants for studies

(1)

In general

The Secretary may make grants to Indian tribes, tribal organizations, urban indian organizations, and eligible intertribal consortia to conduct epidemiological studies of Indian communities.

(2)

Eligible intertribal consortia

An intertribal consortium is eligible to receive a grant under this subsection if—

(A)

the intertribal consortium is incorporated for the primary purpose of improving Indian health; and

(B)

the intertribal consortium is representative of the Indian tribes or urban Indian communities in which the intertribal consortium is located.

(3)

Applications

An application for a grant under this subsection shall be submitted in such manner and at such time as the Secretary shall prescribe.

(4)

Requirements

An applicant for a grant under this subsection shall—

(A)

demonstrate the technical, administrative, and financial expertise necessary to carry out the functions described in paragraph (5);

(B)

consult and cooperate with providers of related health and social services in order to avoid duplication of existing services; and

(C)

demonstrate cooperation from Indian tribes or urban Indian organizations in the area to be served.

(5)

Use of funds

A grant awarded under paragraph (1) may be used—

(A)

to carry out the functions described in subsection (b);

(B)

to provide information to and consult with tribal leaders, urban Indian community leaders, and related health staff on health care and health service management issues; and

(C)

in collaboration with Indian tribes, tribal organizations, and urban Indian communities, to provide the service with information regarding ways to improve the health status of Indians.

(e)

Access to information

An epidemiology center operated by a grantee pursuant to a grant awarded under subsection (d) shall be treated as a public health authority for purposes of the Health Insurance Portability and Accountability Act of 1996 (Public Law 104–191; 110 Stat. 2033), as such entities are defined in part 164.501 of title 45, Code of Federal Regulations (or a successor regulation). The Secretary shall grant such grantees access to and use of data, data sets, monitoring systems, delivery systems, and other protected health information in the possession of the Secretary.

.

102.

Elimination of prerequisite of direct appropriations for data collection and analysis

Section 3101 of the Public Health Service Act (42 U.S.C. 300kk) is amended—

(1)

by striking subsection (h); and

(2)

by redesignating subsection (i) as subsection (h).

103.

Collection of race and ethnicity data by the Social Security Administration

Part A of title XI of the Social Security Act (42 U.S.C. 1301 et seq.) is amended by adding at the end the following:

1150C.

Collection of race and ethnicity data by the Social Security Administration

(a)

Requirement

The Commissioner of Social Security, in consultation with the Administrator of the Centers for Medicare & Medicaid Services, shall—

(1)

require the collection of data on the race, ethnicity, primary language, and disability status of all applicants for Social Security account numbers or benefits under title II or part A of title XVIII and all individuals with respect to whom the Commissioner maintains records of wages and self-employment income in accordance with reports received by the Commissioner or the Secretary of the Treasury—

(A)

using, at a minimum, the standards for data collection on race, ethnicity, primary language, and disability status developed under section 3101 of the Public Health Service Act;

(B)

where practicable, collecting data for additional population groups if such groups can be aggregated into the minimum race and ethnicity categories; and

(C)

additionally referring, where practicable, to the standards developed by the Institute of Medicine in Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement (released August 31, 2009);

(2)

with respect to the collection of the data described in paragraph (1) for applicants who are under 18 years of age or otherwise legally incapacitated, require that—

(A)

such data be collected from the parent or legal guardian of such an applicant; and

(B)

the primary language of the parent or legal guardian of such an applicant or recipient be used;

(3)

require that such data be uniformly analyzed and reported at least annually to the Commissioner of Social Security;

(4)

be responsible for storing the data reported under paragraph (3);

(5)

ensure transmission to the Centers for Medicare & Medicaid Services and other Federal health agencies;

(6)

provide such data to the Secretary on at least an annual basis; and

(7)

ensure that the provision of assistance to an applicant is not denied or otherwise adversely affected because of the failure of the applicant to provide race, ethnicity, primary language, and disability status data.

(b)

Protection of data

The Commissioner of Social Security shall ensure (through the promulgation of regulations or otherwise) that all data collected pursuant to subsection (a) are protected—

(1)

under the same privacy protections as the Secretary applies to health data under the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (Public Law 104–191; 110 Stat. 2033) relating to the privacy of individually identifiable health information and other protections; and

(2)

from all inappropriate internal use by any entity that collects, stores, or receives the data, including use of such data in determinations of eligibility (or continued eligibility) in health plans, and from other inappropriate uses, as defined by the Secretary.

(c)

Rule of construction

Nothing in this section shall be construed to permit the use of information collected under this section in a manner that would adversely affect any individual providing any such information.

(d)

Technical assistance

The Secretary may, either directly or by grant or contract, provide technical assistance to enable any health entity to comply with the requirements of this section.

(e)

Authorization of appropriations

There are authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2012 through 2017.

.

104.

Revision of HIPAA claims standards

(a)

In general

Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services shall revise the regulations promulgated under part C of title XI of the Social Security Act (42 U.S.C. 1320d et seq.), relating to the collection of data on race, ethnicity, and primary language in a health-related transaction, to require—

(1)

the use, at a minimum, of the standards for data collection on race, ethnicity, primary language, disability, and sex developed under section 3101 of the Public Health Service Act (42 U.S.C. 300kk); and

(2)

the designation of the racial, ethnic, primary language, disability, and sex code sets as required for claims and enrollment data.

(b)

Dissemination

The Secretary of Health and Human Services shall disseminate the new standards developed under subsection (a) to all health entities that are subject to the regulations described in such subsection and provide technical assistance with respect to the collection of the data involved.

(c)

Compliance

The Secretary of Health and Human Services shall require that health entities comply with the new standards developed under subsection (a) not later than 2 years after the final promulgation of such standards.

105.

National Center for Health Statistics

Section 306(n) of the Public Health Service Act (42 U.S.C. 242k(n)) is amended—

(1)

in paragraph (1), by striking 2003 and inserting 2016;

(2)

in paragraph (2), in the first sentence, by striking 2003 and inserting 2016; and

(3)

in paragraph (3), by striking 2002 and inserting 2016.

106.

Oversampling of Asian-Americans, Native Hawaiians, or Pacific Islanders and other underrepresented groups in Federal health surveys

Part B of title III of the Public Health Service Act (42 U.S.C. 243 et seq.) is amended by inserting after section 317T the following:

317U.

Oversampling of Asian-Americans, Native Hawaiians, or Pacific Islanders and other underrepresented groups in Federal health surveys

(a)

National strategy

(1)

In general

The Secretary of Health and Human Services, acting through the Director of the National Center for Health Statistics (referred to in this section as NCHS) of the Centers for Disease Control and Prevention, and other agencies within the Department of Health and Human Services as the Secretary determines appropriate, shall develop and implement an ongoing and sustainable national strategy for oversampling Asian-Americans, Native Hawaiians, or Pacific Islanders, and other underrepresented populations as determined appropriate by the Secretary in Federal health surveys.

(2)

Consultation

In developing and implementing a national strategy, as described in paragraph (1), not later than 180 days after the date of the enactment of the this section, the Secretary—

(A)

shall consult with representatives of community groups, nonprofit organizations, nongovernmental organizations, and government agencies working with Asian-Americans, Native Hawaiians, or Pacific Islanders, and other underrepresented populations; and

(B)

may solicit the participation of representatives from other Federal departments and agencies.

(b)

Progress report

Not later than 2 years after the date of the enactment of this section, the Secretary shall submit to the Congress a progress report, which shall include the national strategy described in subsection (a)(1).

(c)

Authorization of appropriations

To carry out this section, there are authorized to be appropriated such sums as may be necessary for fiscal years 2012 through 2017.

.

107.

Geo-access study

The Administrator of the Substance Abuse and Mental Health Services Administration shall—

(1)

conduct a study to—

(A)

determine which geographic areas of the United States have shortages of specialty mental health providers; and

(B)

assess the preparedness of speciality mental health providers to deliver culturally and linguistically appropriate, affordable, and accessible services; and

(2)

submit a report to the Congress on the results of such study.

108.

Racial, ethnic, and linguistic data collected by the Federal Government

(a)

Collection; submission

Not later than 90 days after the date of the enactment of this Act, and January 31 of each year thereafter, each department, agency, and office of the Federal Government that has collected racial, ethnic, or linguistic data during the preceding calendar year shall submit such data to the Secretary of Health and Human Services.

(b)

Analysis; public availability; reporting

Not later than April 30, 2012, and each April 30 thereafter, the Secretary of Health and Human Services, acting through the Director of the National Institute on Minority Health and Health Disparities and the Deputy Assistant Secretary for Minority Health, shall—

(1)

collect and analyze the racial, ethnic, and linguistic data submitted under subsection (a) for the preceding calendar year;

(2)

make publicly available such data and the results of such analysis; and

(3)

submit a report to the Congress on such data and analysis.

109.

Data collection and analysis grants to minority-serving institutions

(a)

Authority

The Secretary of Health and Human Services, acting through the National Institute on Minority Health and Health Disparities and the Office of Minority Health, may award grants to access and analyze racial and ethnic, and where possible other health disparity data, to monitor and report on progress to reduce and eliminate disparities in health and health care.

(b)

Eligible entity

In this section, the term eligible entity means a historically Black college or university, an Hispanic-serving institution, a tribal college or university, or an Asian-American, Native American, or Pacific Islander-serving institution with an accredited public health, health policy, or health services research program.

110.

Standards for measuring sexual orientation and gender identity in collection of health data

Section 3101(a) of the Public Health Service Act (42 U.S.C. 300kk(a)) is amended—

(1)

in paragraph (1)(A), by inserting sexual orientation, gender identity, before and disability status;

(2)

in paragraph (1)(C), by inserting sexual orientation, gender identity, before and disability status; and

(3)

in paragraph (2)(B), by inserting sexual orientation, gender identity, before and disability status.

111.

Optional collection of health data on immigrants and individuals in their households

Section 3101(a) of the Public Health Service Act (42 U.S.C. 300k(a)) is amended by adding at the end the following:

(4)

Optional uniform categories

Not later than 12 months after the date of the enactment of this paragraph, the Secretary shall—

(A)

enter into an arrangement with the Institute of Medicine of the National Academies (or, if the Institute of Medicine declines to enter into such an arrangement, another appropriate entity) to—

(i)

conduct a study and develop recommended standards for the optional collection of data on immigrants, as well as citizens living within immigrant households (mixed-status households), in order to measure disparities in health coverage, health care access and quality, and health status among these populations, and

(ii)

include ensuing recommendations and results in a report to the Secretary that includes best practices to protect the privacy of respondents to the full extent of applicable law;

(B)

promulgate standards based on the recommendations and results of subparagraph (A) for the optional collection of data in major health surveys and research; and

(C)

provide clear guidance that immigrant and mixed-status households are optional uniform categories and data concerning such households shall—

(i)

not be required to be collected by the standards under subparagraph (B);

(ii)

be collected only in accordance with—

(I)

the Tri-Agency Guidance issued by the Food and Nutrition Service of the Department of Agriculture, the Centers for Medicare & Medicaid Services, the Administration for Children and Families, and Office for Civil Rights; and

(II)

other applicable law; and

(iii)

not be collected for program application and enrollment processes beyond statutory requirements.

.

112.

Standards for measuring socioeconomic status in collection of health data

Section 3101(a) of the Public Health Service Act (42 U.S.C. 300kk(a)), as amended, is amended—

(1)

in paragraph (1)(A), by inserting socioeconomic status, before and disability status;

(2)

in paragraph (1)(C), by inserting socioeconomic status, before and disability status; and

(3)

in paragraph (2)(B), by inserting socioeconomic status, before and disability status.

113.

Safety and effectiveness of drugs with respect to racial and ethnic background

(a)

In general

Chapter V of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 351 et seq.) is amended by adding after section 505D the following:

505E.

Safety and effectiveness of drugs with respect to racial and ethnic background

(a)

Preapproval studies

If there is evidence that there may be a disparity on the basis of racial or ethnic background as to the safety or effectiveness of a drug, then—

(1)
(A)

the investigations required under section 505(b)(1)(A) shall include adequate and well-controlled investigations of the disparity; or

(B)

the evidence required under section 351(a) of the Public Health Service Act for approval of a biologics license application for the drug shall include adequate and well-controlled investigations of the disparity; and

(2)

if the investigations confirm that there is a disparity, the labeling of the drug shall include appropriate information about the disparity.

(b)

Postmarket studies

(1)

In general

If there is evidence that there may be a disparity on the basis of racial or ethnic background as to the safety or effectiveness of a drug for which there is an approved application under section 505 or a license under section 351 of the Public Health Service Act, the Secretary may by order require the holder of the approved application or license to conduct, by a date specified by the Secretary, postmarketing studies to investigate the disparity.

(2)

Labeling

If the Secretary determines that the postmarket studies confirm that there is a disparity described in paragraph (1), the labeling of the drug shall include appropriate information about the disparity.

(3)

Study design

The Secretary may specify all aspects of study design, including the number of studies and study participants, and the other demographic characteristics of study participants included, in the order requiring postmarket studies of the drug.

(4)

Modifications of study design

The Secretary may by order modify any aspect of the study design as necessary after issuing an order under paragraph (1).

(5)

Study results

The results from studies required under paragraph (1) shall be submitted to the Secretary as supplements to the drug application or biological license application.

(c)

Disparity

The term evidence that there may be a disparity on the basis of racial or ethnic background for adult and pediatric populations as to the safety or effectiveness of a drug includes—

(1)

evidence that there is a disparity on the basis of racial or ethnic background as to safety or effectiveness of a drug in the same chemical class as the drug;

(2)

evidence that there is a disparity on the basis of racial or ethnic background in the way the drug is metabolized; and

(3)

other evidence as the Secretary may determine.

(d)

Applications under sections 505(b)(2) and 505(j)

(1)

In general

A drug for which an application has been submitted or approved under section 505(j) shall not be considered ineligible for approval under that section or misbranded under section 502 on the basis that the labeling of the drug omits information relating to a disparity on the basis of racial or ethnic background as to the safety or effectiveness of the drug, whether derived from investigations or studies required under this section or derived from other sources, when the omitted information is protected by patent or by exclusivity under clause (iii) or (iv) of section 505(j)(5)(B).

(2)

Labeling

Notwithstanding clauses (iii) and (iv) of section 505(j)(5)(B), the Secretary may require that the labeling of a drug approved under section 505(j) that omits information relating to a disparity on the basis of racial or ethnic background as to the safety or effectiveness of the drug include a statement of any appropriate contraindications, warnings, or precautions related to the disparity that the Secretary considers necessary.

.

(b)

Enforcement

Section 502 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 352) is amended by adding at the end the following:

(aa)

If it is a drug and the holder of the approved application under section 505 or license under section 351 of the Public Health Service Act for the drug has failed to complete the investigations or studies, or comply with any other requirement, of section 505E.

.

(c)

Drug fees

Section 736(a)(1)(A)(ii) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379h) is amended by adding after are required the following: , including supplements required under section 505E.

114.

GAO study on compliance with existing FDA requirements to present drug and device safety and effectiveness data by sex, age, and racial and ethnic subgroups

(a)

In general

The Comptroller General of the United States shall conduct a study investigating the extent to which sponsors of clinical studies of investigational drugs, biologics, and devices and sponsors of applications for approval or licensure of new drugs, biologics, and devices comply with Food and Drug Administration requirements and follow guidance for presentation of clinical study safety and effectiveness data by sex, age, and racial and ethnic subgroups.

(b)

Report by GAO

(1)

Submission

Not later than 18 months after the date of the enactment of this Act, the Comptroller General shall complete the study under subsection (a) and submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report on the results of such study.

(2)

Contents

The report required by paragraph (1) shall include each of the following:

(A)

An assessment of the extent to which the Food and Drug Administration assists sponsors in complying with the requirements and following the guidance referred to in subsection (a).

(B)

An assessment of the effectiveness of the Food and Drug Administration’s enforcement of compliance with such requirements.

(C)

An analysis of the extent to which females, racial and ethnic minorities, and adults of all ages are adequately represented in Food and Drug Administration-approved clinical studies (at all phases) so that product safety and effectiveness data can be evaluated by sex, age, and racial and ethnic subgroup.

(D)

An analysis of the extent to which a summary of product safety and effectiveness data disaggregated by sex, age, and racial and ethnic subgroup is readily available to the public in a timely manner by means of the product label or the Food and Drug Administration’s Web site.

(E)

Recommendations for—

(i)

modifications to the requirements and guidance referred to in subsection (a); or

(ii)

oversight by the Food and Drug Administration of such requirements.

(c)

Report by HHS

Not later than 6 months after the submission by the Comptroller General of the report required under subsection (b), the Secretary of Health and Human Services shall submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a response to that report, including a corrective action plan as needed to respond to the recommendations in that report.

(d)

Definitions

In this section:

(1)

The term biologic has the meaning given to the term biological product in section 351(i) of the Public Health Service Act (42 U.S.C. 262(i)).

(2)

The term device has the meaning given to such term in section 201(h) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321(h)).

(3)

The term drug has the meaning given to such term in section 201(g) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321(g)).

115.

Improving health data regarding Native Hawaiians and other Pacific Islanders

Part B of title III of the Public Health Service Act (42 U.S.C. 243 et seq.) is amended by inserting after section 317U, as added, the following:

317V.

Native Hawaiian and other Pacific Islander health data

(a)

Definitions

In this section:

(1)

Community group

The term community group means a group of NHOPI who are organized at the community level, and may include a church group, social service group, national advocacy organization, or cultural group.

(2)

Nonprofit, nongovernmental organization

The term nonprofit, nongovernmental organization means a group of NHOPI with a demonstrated history of addressing NHOPI issues, including a NHOPI coalition.

(3)

Designated organization

The term designated organization means an entity established to represent NHOPI populations and which has statutory responsibilities to provide, or has community support for providing, health care.

(4)

Government representatives

The term government representatives means representatives from Hawaii, American Samoa, the Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia, Guam, the Republic of Palau, and the Republic of the Marshall Islands.

(5)

Native Hawaiians and other Pacific Islanders (NHOPI)

The term Native Hawaiians and Other Pacific Islanders or NHOPI means people having origins in any of the original peoples of American Samoa, the Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia, Guam, Hawaii, the Republic of the Marshall Islands, the Republic of Palau, or any other Pacific island.

(6)

Insular area

The term insular area means Guam, the Commonwealth of Northern Mariana Islands, American Samoa, the United States Virgin Islands, the Federated States of Micronesia, the Republic of Palau, or the Republic of the Marshall Islands.

(b)

National strategy

(1)

In general

The Secretary, acting through the Director of the National Center for Health Statistics (referred to in this section as NCHS) of the Centers for Disease Control and Prevention, and other agencies within the Department of Health and Human Services as the Secretary determines appropriate, shall develop and implement an ongoing and sustainable national strategy for identifying and evaluating the health status and health care needs of NHOPI populations living in the continental United States, Hawaii, American Samoa, the Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia, Guam, the Republic of Palau, and the Republic of the Marshall Islands.

(2)

Consultation

In developing and implementing a national strategy, as described in paragraph (1), not later than 180 days after the date of enactment of the Health Equity and Accountability Act of 2011, the Secretary—

(A)

shall consult with representatives of community groups, designated organizations, and nonprofit, nongovernmental organizations and with government representatives of NHOPI populations; and

(B)

may solicit the participation of representatives from other Federal departments.

(c)

Preliminary health survey

(1)

In general

The Secretary, acting through the Director of NCHS, shall conduct a preliminary health survey in order to identify the major areas and regions in the continental United States, Hawaii, American Samoa, the Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia, Guam, the Republic of Palau, and the Republic of the Marshall Islands in which NHOPI people reside.

(2)

Contents

The health survey described in paragraph (1) shall include health data and any other data the Secretary determines to be—

(A)

useful in determining health status and health care needs; or

(B)

required for developing or implementing a national strategy.

(3)

Methodology

Methodology for the health survey described in paragraph (1), including plans for designing questions, implementation, sampling, and analysis, shall be developed in consultation with community groups, designated organizations, nonprofit, nongovernmental organizations, and government representatives of NHOPI populations, as determined by the Secretary.

(4)

Timeframe

The survey required under this subsection shall be completed not later than 18 months after the date of enactment of the Health Equity and Accountability Act of 2011.

(d)

Progress report

Not later than 2 years after the date of enactment of the Health Equity and Accountability Act of 2011, the Secretary shall submit to Congress a progress report, which shall include the national strategy described in subsection (b)(1).

(e)

Study and report by the IOM

(1)

In general

The Secretary shall enter into an agreement with the Institute of Medicine to conduct a study, with input from stakeholders in insular areas, on the following:

(A)

The standards and definitions of health care applied to health care systems in insular areas and the appropriateness of such standards and definitions.

(B)

The status and performance of health care systems in insular areas, evaluated based upon standards and definitions, as the Secretary determines.

(C)

The effectiveness of donor aid in addressing health care needs and priorities in insular areas.

(D)

The progress toward implementation of recommendations of the Committee on Health Care Services in the United States—Associated Pacific Basin of the Institute of Medicine that are set forth in the 1998 report, Pacific Partnerships for Health: Charting a New Course for the 21st Century.

(2)

Report

An agreement described in paragraph (1) shall require the Institute of Medicine to submit to the Secretary and to Congress, not later than 2 years after the date of the enactment of the Health Equity and Accountability Act of 2011, a report containing a description of the results of the study conducted under paragraph (1), including the conclusions and recommendations of the Institute of Medicine for each of the items described in subparagraphs (A) through (D) of such paragraph.

(f)

Authorization of appropriations

To carry out this section, there are authorized to be appropriated such sums as may be necessary for fiscal years 2012 through 2017.

.

II

Culturally and linguistically appropriate health care

201.

Definitions

In this title, the definitions contained in section 3400 of the Public Health Service Act, as added by section 202, shall apply.

202.

Amendment to the Public Health Service Act

(a)

Findings

Congress finds the following:

(1)

Effective communication is essential to meaningful access to quality physical and mental health care.

(2)

Research indicates that the lack of appropriate language services creates languages barriers that result in increased risk of misdiagnosis, ineffective treatment plans and poor health outcomes for limited-English-proficient individuals and individuals with communication disabilities such as hearing, vision or print impairments.

(3)

The number of limited-English-speaking residents in the United States who speak English less than very well and, therefore, cannot effectively communicate with health and social service providers continues to increase significantly.

(4)

The responsibility to fund language services in the provision of health care and health care-related services to limited-English-proficient individuals and individuals with communication disabilities such as hearing, vision, or print impairments is a societal one that cannot fairly be visited solely upon the health care, public health or social services community.

(5)

Title VI of the Civil Rights Act of 1964 prohibits discrimination based on the grounds of race, color or national origin by any entity receiving Federal financial assistance. In order to avoid discrimination on the grounds of national origin, all programs or activities administered by the Department must take adequate steps to ensure that their policies and procedures do not deny or have the effect of denying limited-English-proficient individuals with equal access to benefits and services for which such persons qualify.

(6)

Linguistic diversity in the healthcare and health-care-related-services workforce is important for providing all patients the environment most conducive to positive health outcomes.

(7)

All members of the health care and health-care-related-services community should continue to educate their staff and constituents about limited-English proficient and disability communication issues and help them identify resources to improve access to quality care for limited-English-proficient individuals and individuals with communication disabilities such as hearing, vision, or print impairments.

(8)

Access to English as a second language and sign language instructions is an important mechanism for ensuring effective communication and eliminating the language barriers that impede access to health care.

(9)

Competent languages services in health care settings should be available as a matter of course.

(b)

Amendment

The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by adding at the end the following:

XXXIV

CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH CARE

3400.

Definitions

In this title:

(1)

Bilingual

The term bilingual with respect to an individual means a person who has sufficient degree of proficiency in two languages.

(2)

Community health worker

The term community health worker includes a community health advocate, a lay health educator, a community health representative, a peer health promoter, a community health outreach worker, and in Spanish, promotores de salud.

(3)

Competent interpreter services

The term competent interpreter services means a translanguage rendition of a spoken or signed message in which the interpreter comprehends the source language and can communicate comprehensively in the target language to convey the meaning intended in the source language. The interpreter knows health and health-related terminology and provides accurate interpretations by choosing equivalent expressions that convey the best matching and meaning to the source language and captures, to the greatest possible extent, all nuances intended in the source message.

(4)

Competent translation services

The term competent translation services means a translanguage rendition of a written document in which the translator comprehends the source language and can write or sign comprehensively in the target language to convey the meaning intended in the source language. The translator knows health and health-related terminology and provides accurate translations by choosing equivalent expressions that convey the best matching and meaning to the source language and captures, to the greatest possible extent, all nuances intended in the source document.

(5)

Cultural competence

The term cultural competence means a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. In the preceding sentence—

(A)

the term cultural refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups, including lesbian, gay, bisexual, transgender and intersex individuals, and individuals with physical and mental disabilities; and

(B)

the term competence implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities.

(6)

Effective communication

The term effective communication means an exchange of information between the provider of health care or health-care-related services and the recipient of such services who is limited in English proficiency, or has a communication impairment such as a hearing, vision, or learning impairment, that enables access, understanding, and benefit from health care or health-care-related services, and full participation in the development of their treatment plan.

(7)

Grievance resolution process

The term grievance resolution process means all aspects of dispute resolution including filing complaints, grievance and appeal procedures, and court action.

(8)

Health care group

The term health care group means a group of physicians organized, at least in part, for the purposes of providing physicians’ services under the Medicaid, SCHIP, or Medicare programs and may include a hospital and any other individual or entity furnishing services covered under the Medicaid, SCHIP, or Medicare programs that is affiliated with the health care group.

(9)

Health-care services

The term health care services means services that address physical as well as mental health conditions in all care settings.

(10)

Health care-related services

The term health-care-related services means human or social services programs or activities that provide access, referrals or links to health care.

(11)

Indian tribe

The term Indian tribe means any Indian tribe, band, nation, or other organized group or community, including any Alaska Native village or group or regional or village corporation as defined in or established pursuant to the Alaska Native Claims Settlement Act (85 Stat. 688) (43 U.S.C. 1601 et seq.), which is recognized as eligible for the special programs and services provided by the United States to Indians because of their status as Indians.

(12)

Integrated health care delivery system

The term integrated health care delivery system means an interdisciplinary system that brings together providers from the primary health, mental health, substance use and related disciplines to improve the health outcomes of an individual. Providers may include but are not limited to hospitals, health, mental health or substance use clinics and providers, home health agencies, ambulatory surgery centers, skilled nursing facilities, rehabilitation centers, and employed, independent or contracted physicians.

(13)

Interpreting/interpretation

The terms interpreting and interpretation mean the transmission of a spoken, written, or signed message from one language or format into another, faithfully, accurately, and objectively.

(14)

Language access

The term language access means the provision of language services to an LEP individual or individual with communication disabilities designed to enhance that individual’s access to, understanding of or benefit from health care or health-care-related services.

(15)

Language or language access services

The term language or language access services means provision of health care services directly in a non-English language, interpretation, translation, signage, video recording, and English or non-English alternative formats.

(16)

LEP

The term LEP means limited-English proficient.

(17)

LEP related data collection activities

The term LEP related data collection activities includes identifying, collecting, storing, tracking, and analyzing primary language data, and information on the methods used to meet the language access needs of limited-English-proficient individuals.

(18)

Medicare, Medicaid, and SCHIP

The terms Medicare, Medicaid, and SCHIP means the respective programs under titles XVIII, XIX, and XXI of the Social Security Act.

(19)

Minority

(A)

In general

The terms minority and minorities refer to individuals from a minority group.

(B)

Populations

The term minority, with respect to populations, refers to racial and ethnic minority groups.

(20)

Minority group

The term minority group has the meaning given the term racial and ethnic minority group.

(21)

Racial and ethnic minority group

The term racial and ethnic minority group means American Indians and Alaska Natives, African-Americans (including Caribbean Blacks, Africans and other Blacks), Asian-Americans, Hispanics (including Latinos), and Native Hawaiians and other Pacific Islanders.

(22)

On-site interpreting/interpretation

The term on-site interpreting/interpretation means a method of interpreting or interpretation for which the interpreter is in the physical presence of the provider of health care or health-care-related services and the recipient of such services who is limited in English proficiency or has a communication impairment such as hearing, vision, or learning.

(23)

Secretary

The term Secretary means the Secretary of Health and Human Services.

(24)

Sight translation

The term sight translation means the transmission of a written message in one language into a spoken or signed message in another language, or an alternative format in English or another language.

(25)

State

The term State means each of the several States, the District of Columbia, the Commonwealth of Puerto Rico, the Indian tribes, the United States Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands.

(26)

Telephonic interpretation

The term telephonic interpretation (also known as over the phone interpretation or OPI) means a method of interpreting/interpretation for which the interpreter is not in the physical presence of the provider of health care or related services and the limited-English-proficient recipient of such services but is connected via telephone.

(27)

Translation

The term translation means the transmission of a written message in one language into a written or signed message in another language, and includes translation into another language or alternative format, such as large print font, Braille, audio recording, or CD.

(28)

Video interpretation

The term video interpretation means a method of interpreting/interpretation for which the interpreter is not in the physical presence of the provider of health care or related services and the limited-English-proficient recipient of such services but is connected via a video hook-up that includes both audio and video transmission.

(29)

Vital document

The term vital document includes but is not limited to applications for government programs that provide health care services, medical or financial consent forms, financial assistance documents, letters containing important information regarding patient instructions (such as prescriptions, referrals to other providers, and discharge plans) and participation in a program (such as a Medicaid managed care program), notices pertaining to the reduction, denial, or termination of services or benefits, notices of the right to appeal such actions, and notices advising limited-English-proficient individuals and individuals with communication disabilities of the availability of free language services, alternative formats, and other outreach materials.

3401.

Improving access to services for individuals with limited English proficiency

(a)

Purpose

As provided in Executive Order 13166, it is the purpose of this section—

(1)

to improve Federal agency performance regarding access to federally conducted and federally assisted programs and activities for individuals who are limited in their English proficiency;

(2)

to require each Federal agency to examine the services it provides and develop and implement a system by which limited-English-proficient individuals can obtain cultural competence and meaningful access to those services consistent with, and without substantially burdening, the fundamental mission of the agency;

(3)

to require each Federal agency to ensure that recipients of Federal financial assistance provide cultural competence and meaningful access to their limited-English-proficient applicants and beneficiaries;

(4)

to ensure that recipients of Federal financial assistance take reasonable steps, consistent with the guidelines set forth in the Limited English Proficient Guidance of the Department of Justice (as issued on June 12, 2002), to ensure cultural competence and meaningful access to their programs and activities by limited-English-proficient individuals; and

(5)

to ensure compliance with title VI of the Civil Rights Act of 1964 and that health care providers and organizations do not discriminate in the provision of services.

(b)

Federally conducted programs and activities

(1)

In general

Not later than 120 days after the date of enactment of this title, each Federal agency that carries out health-care-related activities shall prepare a plan to improve access cultural competence to the federally conducted, health-are-related programs and activities of the agency by limited-English-proficient individuals. Each Federal agency must ensure that such plan is fully implemented not later than one year after the date of enactment of this Act.

(2)

Plan requirement

Each plan under paragraph (1) shall include—

(A)

the steps the agency will take to ensure that limited-English-proficient individuals have access to the agency’s federally conducted health care and health-care-related programs and activities;

(B)

the policies and procedures for identifying, assessing, and meeting the language needs and cultural competence needs of its limited-English-proficient beneficiaries served by federally conducted programs and activities;

(C)

the steps the agency will take for its federally conducted programs and activities to improve cultural competence to provide a range of language assistance options, notice to limited-English-proficient individuals of the right to competent language services, periodic training of staff, monitoring and quality assessment of the language services and, in appropriate circumstances, the translation of written materials;

(D)

the steps the agency will take to ensure that applications, forms, and other relevant documents for its federally conducted programs and activities are competently translated into the primary language of a limited-English-proficient client where such materials are needed to improve access to federally conducted and federally assisted programs and activities for such a limited-English-proficient individual; and

(E)

the resources the agency will provide to improve cultural competence to assist recipients of Federal funds to improve access to health care or health-care-related programs and activities for limited-English-proficient individuals.

Each agency shall send a copy of such plan to the Department of Justice, which shall serve as the central repository of the Agency’s plans.
(c)

Federally assisted programs and activities

(1)

In general

Not later than 120 days after the date of enactment of this title, each Federal agency providing health-care-related Federal financial assistance shall ensure that the guidance for recipients of Federal financial assistance developed by the agency to ensure compliance with title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) is specifically tailored to the recipients of such assistance. Each agency shall send a copy of such guidance to the Department of Justice which shall serve as the central repository of the Agency’s plans. After approval by the Department of Justice, each agency shall publish its guidance document in the Federal Register for public comment.

(2)

Requirements

The agency-specific guidance developed under paragraph (1) shall take into account the types of health care services provided by the recipients, the individuals served by the recipients, and other factors set out in such standards.

(3)

Existing guidances

A Federal agency that has developed a guidance for purposes of title VI of the Civil Rights Act of 1964 shall examine such existing guidance, as well as the programs and activities to which such guidance applies, to determine if modification of such guidance is necessary to comply with this subsection.

(4)

Consultation

Each Federal agency shall consult with the Department of Justice in establishing the guidances under this subsection.

(d)

Consultations

(1)

In general

In carrying out this section, each Federal agency that carriers out health care and health-care-related activities shall ensure that stakeholders, such as limited-English-proficient individuals and their representative organizations, recipients of Federal assistance, and other appropriate individuals or entities, have an adequate opportunity to provide input with respect to the actions of the agency.

(2)

Evaluation

Each Federal agency described in paragraph (1) shall evaluate the—

(A)

particular needs of the limited-English-proficient individuals served by the agency;

(B)

particular needs of the limited-English-proficient individuals served by the agency’s recipients of Federal financial assistance; and

(C)

burdens of compliance with the agency guidance and this section for the agency and its recipients.

3402.

National standards for culturally and linguistically appropriate services in health care

Recipients of Federal financial assistance from the Secretary shall, to the extent reasonable and practicable after applying the 4-factor analysis described in title V of the Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited-English Proficient Persons (June 12, 2002)—

(1)

implement strategies to recruit, retain, and promote individuals at all levels of the organization to maintain a diverse staff and leadership that can provide culturally and linguistically appropriate health care to patient populations of the service area of the organization;

(2)

ensure that staff at all levels and across all disciplines of the organization receive ongoing education and training in culturally and linguistically appropriate service delivery;

(3)

offer and provide language assistance services, including trained bilingual staff and interpreter services, at no cost to each patient with limited-English proficiency at all points of contact, in a timely manner during all hours of operation;

(4)

notify patients, in a culturally appropriate manner, of their right to receive language assistance services in their primary language;

(5)

ensure the competence of language assistance provided to limited-English-proficient patients by interpreters and bilingual staff, and ensure that family, particularly minor children, and friends are not used to provide interpretation services—

(A)

except in case of emergency; or

(B)

except on request of the patient, who has been informed in his or her preferred language of the availability of free interpretation services;

(6)

make available easily understood patient-related materials, if such materials exist for non-limited-English-proficient patients, including information or notices about termination of benefits and post signage in the languages of the commonly encountered groups or groups represented in the service area of the organization;

(7)

develop and implement clear goals, policies, operational plans, and management accountability and oversight mechanisms to provide culturally and linguistically appropriate services;

(8)

conduct initial and ongoing organizational assessments of culturally and linguistically appropriate services-related activities and integrate valid linguistic, competence-related measures into the internal audits, performance improvement programs, patient satisfaction assessments, and outcomes-based evaluations of the organization;

(9)

ensure that, consistent with the privacy protections provided for under the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1320d–2 note)—

(A)

data on the individual patient’s race, ethnicity, primary language, alternative format preferences, and policy modification needs are collected in health records, integrated into the organization’s management information systems, and periodically updated; and

(B)

if the patient is a minor or is incapacitated, the primary language of the parent or legal guardian is collected;

(10)

maintain a current demographic, cultural, and epidemiological profile of the community as well as a needs assessment to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service area of the organization;

(11)

develop participatory, collaborative partnerships with communities and utilize a variety of formal and informal mechanisms to facilitate community and patient involvement in designing and implementing culturally and linguistically appropriate services-related activities;

(12)

ensure that conflict and grievance resolution processes are culturally and linguistically sensitive and capable of identifying, preventing, and resolving cross-cultural conflicts or complaints by patients;

(13)

regularly make available to the public information about their progress and successful innovations in implementing the standards under this section and provide public notice in their communities about the availability of this information; and

(14)

if requested, regularly make available to the head of each Federal entity from which Federal funds are received, information about their progress and successful innovations in implementing the standards under this section as required by the head of such entity.

3403.

Robert T. Matsui Center for Cultural and Linguistic Competence in Health Care

(a)

Establishment

The Secretary, acting through the Director of the Agency for Healthcare Research and Quality, shall establish and support a center to be known as the Robert T. Matsui Center for Cultural and Linguistic Competence in Health Care (referred to in this section as the Center) to carry out the following activities:

(1)

Interpretation services

The Center shall provide resources via the Internet to identify and link health care providers to competent interpreter and translation services.

(2)

Translation of written material

(A)

The Center shall provide, directly or through contract, vital documents from competent translation services for providers of health care and health-care-related services at no cost to such providers. Materials may be submitted for translation into non-English languages. Translation services shall be provided in a timely and reasonable manner and in accordance with the guidelines and standards set forth in subsection (c) when such standards become available. The quality of such translation services shall be monitored and reported publicly.

(B)

For each form developed or revised by the Secretary that will be used by LEP individuals in health care or health-care-related settings, the Center shall translate the form, at a minimum, into the top 15 non-English languages in the United States according to the most recent data from the American Community Survey or its replacement. The translation must be completed within 45 days of the Secretary receiving final approval of the form from the Office of Management and Budget.

(3)

Toll-free customer service telephone number

The Center shall provide, through a toll-free number, a customer service line for LEP individuals—

(A)

to obtain information about federally conducted or funded health programs, including Medicare, Medicaid, and SCHIP;

(B)

to obtain assistance with applying for or accessing these programs and understanding Federal notices written in English; and

(C)

to learn how to access language services.

(4)

Health information clearinghouse

(A)

In general

The Center shall develop and maintain an information clearinghouse to facilitate the provision of language services by providers of health care and health-care-related services to reduce medical errors, improve medical outcomes, to improve cultural competence, reduce health care costs caused by miscommunication with individuals with limited-English proficiency, and reduce or eliminate the duplication of effort to translate materials. The clearinghouse shall make such information available on the Internet and in print. Such information shall include the information described in the succeeding provisions of this paragraph.

(B)

Document templates

The Center shall collect and evaluate for accuracy, develop, and make available templates for standard documents that are necessary for patients and consumers to access and make educated decisions about their health care, including the following:

(i)

Administrative and legal documents, including—

(I)

intake forms;

(II)

Medicare, Medicaid, and SCHIP forms, including eligibility information;

(III)

forms informing patient of HIPAA compliance and consent; and

(IV)

documents concerning informed consent, advanced directives, and waivers of rights.

(ii)

Clinical information, such as how to take medications, how to prevent transmission of a contagious disease, and other prevention and treatment instructions.

(iii)

Public health, patient education, and outreach materials, such as immunization notices, health warnings, or screening notices.

(iv)

Additional health or health-care-related materials as determined appropriate by the Director of the Center.

(C)

Structure of forms

The operating the clearinghouse, the Center shall—

(i)

ensure that the documents posted in English and non-English languages are culturally appropriate;

(ii)

allow public review of the documents before dissemination in order to ensure that the documents are understandable and culturally appropriate for the target populations;

(iii)

allow health care providers to customize the documents for their use;

(iv)

facilitate access to these documents;

(v)

provide technical assistance with respect to the access and use of such information; and

(vi)

carry out any other activities the Secretary determines to be useful to fulfill the purposes of the clearinghouse.

(D)

Language assistance programs

The Center shall provide for the collection and dissemination of information on current examples of language assistance programs and strategies to improve language services for LEP individuals, including case studies using de-identified patient information, program summaries, and program evaluations.

(E)

Cultural and linguistic competence materials

The Center shall provide information relating to culturally and linguistically competent health care for minority populations residing in the United States to all health care providers and health-care-related services at no cost. Such information shall include—

(i)

tenets of culturally and linguistically competent care;

(ii)

cultural and linguistic competence self-assessment tools;

(iii)

cultural and linguistic competence training tools;

(iv)

strategic plans to increase cultural and linguistic competence in different types of providers of health care and health-care-related services, including regional collaborations among health care organizations; and

(v)

cultural and linguistic competence information for educators, practitioners, and researchers.

(F)

Information about progress

The Center shall regularly collect and make publicly available information about the progress of entities receiving grants under section 3404 regarding successful innovations in implementing the obligations under this subsection and provide public notice in the entities’ communities about the availability of this information;

(b)

Director

The Center shall be headed by a Director who shall be appointed by, and who shall report to, the Director of the Agency for Healthcare Research and Quality.

(c)

Interpretation and translation guidelines and standards

The Center shall convene a working group to develop and adopt interpretation and translation quality guidelines and standards for use by the Center. The guidelines and standards must be sufficient to ensure that LEP individuals have the equal opportunity to benefit from health care services to the same extent as non-LEP individuals. The guidelines and standards shall address the training, assessment, and certification of individuals to provide competent interpreter and translator services to work in health care and health-care-related settings and of bilingual staff who provide services directly in non-English languages. The working group may develop different guidelines and standards for bilingual staff, interpreters, and translators.

(d)

Membership

(1)

Qualifications

The Working Group shall consist of 14 members as follows:

(A)

Four members from organizations that advocate on behalf of LEP individuals.

(B)

One member who represents a professional interpreter association (that is not the National Council on Interpreting in Health Care) or translator association.

(C)

One member from a nonprofit community-based organization that provides language services.

(D)

Three members recommended by the National Council on Interpreting in Health Care, including one who individual who is a professional interpreter.

(E)

Four members who are health care or mental health providers or represent health care provider associations, including one individual who represents a health care practice of fewer than 5 clinicians.

(F)

One member who works in or has extensive knowledge of issues related to health care risk management.

(2)

Geographic representation

The membership of the Working Group shall reflect a broad geographic representation including both urban and rural representatives, including representatives of the United States territories.

(3)

Prohibited appointments

Members of the Working Group shall not include Members of Congress or other elected Federal, State, or local government officials.

(4)

Vacancies

Any vacancies in the Working Group shall not affect the power and duties of the Working Group but shall be filled in the same manner as the original appointment.

(5)

Subcommittees

The Working Group may establish subcommittees if doing so increases the efficiency of the Working Group in completing its tasks, including subcommittees to develop different guidelines and standards for interpreters, translators, and bilingual staff.

(6)

Advisory panel to the working group

The Working Group shall consult with the Advisory Panel in the development of the guidelines and standards. The Advisory Panel shall include—

(A)

representatives from the American Translators Association, Association of Language Companies, the National Center for State Courts, and States which have developed interpreter standards such as California, Massachusetts, and Oregon who have experience in the development or implementation of their organizations’ interpreter and translator certification programs;

(B)

Federal agencies including the Office for Civil Rights, the Office of Minority Health, the Centers for Medicare & Medicaid Services, and the National Institute on Minority Health and Health Disparities; and

(C)

other individuals or entities determined appropriate by the Secretary who have specific expertise that will be useful to the Working Group.

(7)

Publication

(A)

Draft standards

Not later than 18 months after the date of enactment of this title, the Working Group shall—

(i)

prepare and make available to the public through the Internet, the Federal Register, and other appropriate public channels, a proposed set of interpretation and translation guidelines and standards for training, assessment, and certification; and

(ii)

accept public comment on such guidelines and standards for a period of not less than 90 days.

(B)

Final standards

Not later than 120 days after the expiration of the public comment period described in subparagraph (A), the Director of the Agency for Healthcare Research and Quality shall publish, after consultation with and the approval of the Working Group, final guidelines and standards in the Federal Register and on the Internet.

(C)

Testing development

Not later than 120 days after the publication of the final recommendations described in subparagraph (B), the Director of the Agency for Healthcare Research and Quality shall, if deemed necessary by the Working Group, enter into a contract with an entity experienced in the development of designing certification tests in language related fields to develop such tests as may be necessary to implement the guidelines and standards.

(D)

Pilot project

(i)

Not later than 120 days after completion of the test development described in subparagraph (C) or after publication of the final guidelines and standards, whichever is later, the Secretary shall design, fund, and implement a pilot project in up to 50 geographically and demographically diverse sites, two of which must be in the United States territories, to test and evaluate implementation of the recommendations.

(ii)

The Secretary shall consult with the Working Group and the Advisory Panel in development of the pilot project and report progress to the Working Group on an ongoing basis.

(iii)

The pilot project shall include interpreters and translators working with various provider types, including small group practices, hospitals, mental health and substance use clinics, and community health clinics, and shall include broad geographic representation including both urban and rural representatives.

(iv)

The pilot project shall operate for not less than 2 nor more than 4 years, as determined by the Secretary.

(v)

If the Working Group determines that any revisions to guidelines and standards are necessary as a result of the pilot project, it shall revise such guidelines and standards and the Director of the Agency for Healthcare Research and Quality shall publish the revisions in the Federal Register for notice and comment. Not later than 120 days after the expiration of the public comment period on such revisions, the Director of the Agency for Healthcare Research and Quality shall publish, after consultation with and the approval of the Working Group, final revisions to the guidelines and standards in the Federal Register and on the Internet.

(8)

Administration

(A)

Chairperson

Not later than 15 days after the date on which all members of the Working Group have been appointed under subsection (d), the Working Group shall designate its chairperson.

(B)

Compensation

While serving on the business of the Working Group (including travel time), a member of the Working Group or the Advisory Panel shall be entitled to compensation at the per diem equivalent of the rate provided for level IV of the Executive Schedule under section 5315 of title 5, United States Code, and while so serving away from home and the member’s regular place of business, a member may be allowed travel expenses, as authorized by the chairperson of the Working Group. For purposes of pay and employment benefits, rights, and privileges, all personnel of the Working Group shall be treated as if they were employees of the House of Representatives.

(C)

Information from Federal agencies

The Working Group may secure directly from any Federal department or agency such information as the Working Group considers necessary to carry out this section. Upon request of the Working Group, the head of such department or agency shall furnish such information. Any information that contains individually identifiable information received by the Working Group shall not be disseminated or disclosed outside of the Working Group and shall not be used except by the Working Group.

(D)

Detail

Not more than 10 Federal Government employees employed by the Department of Health and Human Services may be detailed to staff the Working Group under this section without further reimbursement. Any detail of an employee shall be without interruption or loss of civil service status or privilege.

(E)

Temporary and intermittent services

The Working Group may procure temporary and intermittent services under section 3109(b) of title 5, United States Code, at rates for individuals which do not exceed the daily equivalent of the annual rate of basic pay prescribed for level V of the Executive Schedule under section 5316 of such title.

(F)

Authorization of appropriations

There are authorized to be appropriated to carry out this section such sums as may be necessary for the activities of the Working Group and Advisory Panel for each of fiscal years 2012 through 2016, and for the funding of the pilot project.

(9)

Deemed status

(A)

Certification by private organization

If a private accreditation organization establishes training, assessment, or certification standards for interpreters or translators in health care which the Secretary determines are at least equivalent to the training, assessment, or certification standards promulgated by the Secretary as described in subsection (c), the Secretary shall find that all organizations or individuals accredited by such organization comply also with the standard described in subsection (c) if—

(i)

such organization or individual authorizes the organization to release to the Secretary upon the Secretary’s request (or such State agency as the Secretary may designate) a copy of the most current accreditation survey of such organization or individual made by the organization, together with any other information directly related to the survey as the Secretary may require (including corrective action plans); and

(ii)

such organization releases such a copy and any such information to the Secretary.

(B)

Certification by a state or locality

If a State or locality has or establishes training, assessment, or certification standards for interpreters or translators in health care which the Secretary determines are at least equivalent to the training, assessment, or certification standards promulgated by the Secretary as described in subsection (c), the Secretary shall find that all organizations or individuals accredited by such State or locality comply also with the standard described in subsection (c) if—

(i)

such organization or individual authorizes the State or locality to release to the Secretary upon his request (or such State agency as the Secretary may designate) a copy of the most current accreditation survey of such organization or individual made by such State or locality, together with any other information directly related to the survey as the Secretary may require (including corrective action plans); and

(ii)

such State or locality releases such a copy and any such information to the Secretary.

(C)

Timely action on application

The Secretary shall determine, within 210 days after the date the Secretary receives an application by a private accrediting organization, State, or locality whether the process of the private accrediting organization, State, or locality meets the requirements with respect to training, assessment, or certification standards for interpreters or translators with respect to which standards the application is made. The Secretary may not deny an application on the basis that it seeks to meet the requirements with respect to only one, or more than one, training, assessment, or certification standards for interpreters or translators.

(D)

Disclosure of accreditation survey

The Secretary may not disclose any accreditation survey made and released to him by the National Council on Interpreting in Health Care or any State or locality of an accredited organization or individual, except that the Secretary may disclose such a survey and information related to such a survey to the extent such survey and information relate to an enforcement action taken by the Secretary.

(E)

Deficiencies

If the Secretary finds that an accredited organization or individual has significant deficiencies (as defined in regulations pertaining to the training, assessment, or certification standards), the organization or individual shall, after the date of notice of such finding to the organization and for such period as may be prescribed in regulations, be deemed not to meet the conditions or requirements the organization or individual has been treated as meeting pursuant to subparagraph (A).

(e)

Availability of language access

The Director shall collaborate with the Administrator of the Office of Minority Health, the Administrator of the Centers for Medicare & Medicaid Services, and the Administrator of the Health Resources and Services Administration to notify health care providers and health care organizations about the availability of language access services by the Center.

(f)

Education

The Secretary, directly or through contract, shall undertake a national education campaign to inform providers, LEP individuals, health professionals, graduate schools, and community health centers about—

(1)

Federal and State laws and guidelines governing access to language services;

(2)

the value of using trained interpreters and the risks associated with using family members, friends, minors, and untrained bilingual staff;

(3)

funding sources for developing and implementing language services; and

(4)

promising practices to effectively provide language services.

(g)

Authorization of appropriations

In addition to the amounts authorized under subsection (e)(8)(F), there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2012 through 2016.

3404.

Innovations in cultural and linguistic competence grants

(a)

In general

The Secretary, acting through the Director of the Agency for Healthcare Research and Quality, shall award grants to eligible entities to enable such entities to design, implement, and evaluate innovative, cost-effective programs to improve cultural competence and language access in health care for individuals with limited-English proficiency. The Director of the Agency for Healthcare Research and Quality shall coordinate with, and ensure the participation of, other agencies including but not limited to the Health Resources and Services Administration, the Center on Minority Health and Health Disparities at the National Institutes of Health, and the Office of Minority Health, regarding the design and evaluation of the grants program.

(b)

Eligibility

To be eligible to receive a grant under subsection (a) an entity shall—

(1)

be—

(A)

a city, county, Indian tribe, State, territory or subdivision thereof;

(B)

an organization described in section 501(c)(3) of the Internal Revenue Code of 1986;

(C)

a community health, mental health, or substance use center or clinic;

(D)

a solo or group physician practice;

(E)

an integrated health care delivery system;

(F)

a public hospital;

(G)

a health care group, university, or college; or

(H)

other entity designated by the Secretary; and

(2)

prepare and submit to the Secretary an application, at such time, in such manner, and accompanied by such additional information as the Secretary may require.

(c)

Use of funds

An entity shall use funds received under a grant under this section to—

(1)

develop, implement, and evaluate models of providing competent interpretation services through on-site interpretation, telephonic interpretation, or video interpretation;

(2)

implement strategies to recruit, retain, and promote individuals at all levels of the organization to maintain a diverse staff and leadership that can promote and provide language services to patient populations of the service area of the organization;

(3)

develop and maintain a needs assessment that identifies the current demographic, cultural, and epidemiological profile of the community to accurately plan for and implement language services needed in service area of the organization;

(4)

develop a strategic plan to implement language services;

(5)

develop participatory, collaborative partnerships with communities encompassing the LEP patient populations being served to gain input in designing and implementing language services;

(6)

develop and implement grievance resolution processes that are culturally and linguistically sensitive and capable of identifying, preventing, and resolving complaints by LEP individuals; or

(7)

develop short-term medical mental health interpretation training courses and incentives for bilingual health care staff who are asked to interpret in the workplace;

(8)

develop formal training programs, including continued professional development and education programs as well as supervision, for individuals interested in becoming dedicated health care interpreters and culturally competent providers;

(9)

provide staff language training instruction, which shall include information on the practical limitations of such instruction for non-native speakers;

(10)

develop policies that address compensation in salary for staff who receive training to become either a staff interpreter or bi-lingual provider;

(11)

develop other language assistance services as determined appropriate by the Secretary;

(12)

develop, implement, and evaluate models of improving cultural competence; and

(13)

ensure that, consistent with the privacy protections provided for under the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1320d–2 note), and any applicable State privacy laws, data on the individual patient or recipient’s race, ethnicity, and primary language are collected (and periodically updated) in health records and integrated into the organization’s information management systems or any similar system used to store and retrieve data.

(d)

Priority

In awarding grants under this section, the Secretary shall give priority to entities that primarily engage in providing direct care and that have developed partnerships with community organizations or with agencies with experience language access.

(e)

Evaluation

(1)

An entity that receives a grant under this section shall submit to the Secretary an evaluation that describes, in the manner and to the extent required by the Secretary, the activities carried out with funds received under the grant, and how such activities improved access to health and health-care-related services and the quality of health care for individuals with limited-English proficiency. Such evaluation shall be collected and disseminated through the Robert T. Matsui Center for Cultural and Linguistic Competence in Health Care established under section 3403. The Director of the Agency for Healthcare Research and Quality shall notify grantees of the availability of technical assistance for the evaluation and provide such assistance upon request.

(2)

The Director of the Agency for Healthcare Research and Quality shall evaluate or arrange with other individuals or organizations to evaluate projects funded under this section.

(f)

Authorization of appropriations

There is authorized to be appropriated to carry out this section, $5,000,000 for each of fiscal years 2012 through 2016.

3405.

Research on cultural and language competence

(a)

In general

The Secretary, acting through the Director of the Agency for Healthcare Research and Quality, shall expand research concerning language access in the provision of health care.

(b)

Eligibility

The Director of the Agency for Healthcare Research and Quality may conduct the research described in subsection (a) or enter into contracts with other individuals or organizations to do so.

(c)

Use of funds

Research under this section shall be designed to do one or more of the following:

(1)

To identify the barriers to mental and behavioral services that are faced by LEP individuals.

(2)

To identify health care providers’ and health administrators’ attitudes, knowledge, and awareness of the barriers to quality health care services that are faced by LEP individuals.

(3)

To identify optimal approaches for delivering language access.

(4)

To identify best practices for data collection, including—

(A)

the collection by providers of health care and health-care-related services of data on the race, ethnicity, and primary language of recipients of such services, taking into account existing research conducted by the Government or private sector;

(B)

the development and implementation of data collection and reporting systems; and

(C)

effective privacy safeguards for collected data.

(5)

To develop a minimum data collection set for primary language.

(6)

To evaluate the most effective ways in which the Department can create or coordinate, and then subsidize or otherwise fund telephonic interpretation providers for health care providers, taking into consideration, among other factors, the flexibility necessary for such a system to accommodate variations in—

(A)

provider type;

(B)

languages needed and their frequency of use;

(C)

type of encounter;

(D)

time of encounter, including regular business hours and after hours; and

(E)

location of encounter.

(d)

Authorization of appropriations

There are authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2012 through 2016.

.

203.

Federal reimbursement for culturally and linguistically appropriate services under the Medicare, Medicaid, and State Children’s Health Insurance Programs

(a)

Language Access grants for Medicare Providers

(1)

Establishment

(A)

In general

Not later than 6 months after the date of the enactment of this Act, the Secretary of Health and Human Services, acting through the Centers for Medicare & Medicaid Services and in consultation with the Center for Medicare and Medicaid Innovation, shall establish demonstration program under which the Secretary shall award grants to eligible Medicare service providers to improve communication between such providers and limited-English-proficient Medicare beneficiaries, including beneficiaries who live in diverse and underserved communities.

(B)

Application of innovation rules

The demonstration project under subparagraph (A) shall be conducted in a manner that is consistent with the applicable provisions of subsections (b), (c), and (d) of section 1115A of the Social Security Act.

(C)

Number of grants

To the extent practicible, the Secretary shall award not less than 24 grants under this subsection.

(D)

Grant period

Except as provided under paragraph (2)(D), each grant awarded under this subsection shall be for a 3-year period.

(2)

Eligibility requirements

To be eligible for a grant under this subsection, an entity must meet the following requirements:

(A)

Medicare provider

The entity must be—

(i)

a provider of services under part A of title XVIII of the Social Security Act;

(ii)

a provider of services under part B of such title;

(iii)

a Medicare Advantage organization offering a Medicare Advantage plan under part C of such title; or

(iv)

a PDP sponsor offering a prescription drug plan under part D of such title.

(B)

Underserved communities

The entity must serve a community that with respect to necessary langauge services for improving access and utilization of health care amoung limited-English proficienct individuals, is disproportinaly underserved.

(C)

Application

The entity must prepare and submit to the Secretary an application, at such time, in such manner, and accompanied by such additional information as the Secretary may require.

(D)

Reporting

In the case of a grantee that received a grant under this subsection in a previous year, such grantee is only eligible for continued payments under a grant under this subsection if the grantee met the reporting requirements under paragraph (9) for such year. If a grantee fails to meet the requirement of such paragraph for the first year of a grant, the Secretary may terminate the grant and solicit applications from new grantees to participate in the demonstration program.

(3)

Distribution

To the extent feasible, the Secretary shall award—

(A)

at least 6 grants to providers of services described in paragraph (2)(A)(i);

(B)

at least 6 grants to service providers described in paragraph (2)(A)(ii);

(C)

at least 6 grants to organizations described in paragraph (2)(A)(iii); and

(D)

at least 6 grants to sponsors described in paragraph (2)(A)(iv).

(4)

Considerations in awarding grants

(A)

Variation in grantees

In awarding grants under this subsection, the Secretary shall select grantees to ensure the following:

(i)

The grantees provide many different types of language services.

(ii)

The grantees serve Medicare beneficiaries who speak different languages, and who, as a population, have differing needs for language services.

(iii)

The grantees serve Medicare beneficiaries in both urban and rural settings.

(iv)

The grantees serve Medicare beneficiaries in at least two geographic regions, as defined by the Secretary.

(v)

The grantees serve Medicare beneficiaries in at least two large metropolitan statistical areas with racial, ethnic, and economicly diverse populations.

(B)

Priority for partnerships with community organizations and agencies

In awarding grants under this subsection, the Secretary shall give priority to eligible entities that have a partnership with—

(i)

a community organization; or

(ii)

a consortia of community origanizations, state agecenices, and local agencies,

that has experience in providing language services.
(5)

Use of funds for competent language services

(A)

In general

Subject to subparagraph (E), a grantee may only use grant funds received under this subsection to pay for the provision of competent language services to Medicare beneficiaries who are limited-English proficient.

(B)

Competent language services defined

For purposes of this subsection, the term competent language services means—

(i)

interpreter and translation services that—

(I)

subject to the exceptions under subparagraph (C)

(aa)

if the grantee operates in a State that has statewide health care interpreter standards, meet the State standards currently in effect; or

(bb)

if the grantee operates in a State that does not have statewide health care interpreter standards, utilizes competent interpreters who follow the National Council on Interpreting in Health Care’s Code of Ethics and Standards of Practice; and

(II)

that, in the case of interpreter services, are provided through—

(aa)

on-site interpretation;

(bb)

telephonic interpretation; or

(cc)

video interpretation; and

(ii)

the direct provision of health care or health-care-related services by a competent bilingual health care provider.

(C)

Exceptions

The requirements of subparagraph (B)(i)(I) do not apply—

(i)

to a Medicare beneficiary who is limited-English-proficient who has been informed, in the beneficiary’s primary language, of the availability of free interpreter and translation services and who, instead, requests that a family member, friend, or other person provide such services, if the grantee documents such request in the beneficiary’s medical record; or

(ii)

in the case of a medical emergency where the delay directly associated with obtaining a competent interpreter or translation services would jeopardize the health of the patient.

Subparagraph (C)(ii) shall not be construed to exempt emergency rooms or similar entities that regularly provide health care services in medical emergencies to limited-English-proficient patients from any applicable legal or regulatory requirements related to providing competent interpreter and translation services without undue delay.
(D)

MA organizations and PDP sponsors

If a grantee is a MA organization or a PDP sponsor, such entity must provide at least 50 percent of the grant funds that the entity receives under this subsection directly to the entity’s network providers (including physicians and pharmacies) for the purpose of providing support for such providers to provide competent language services to Medicare beneficiaries who are limited-English proficient.

(E)

Administrative and reporting costs

A grantee may use up to 10 percent of the grant funds to pay for administrative costs associated with the provision of competent language services and for reporting required under paragraph (9).

(6)

Determination of amount of grant payments

(A)

In general

Payments to grantees under this subsection shall be calculated based on the estimated numbers of limited-English-proficient Medicare beneficiaries in a grantee’s service area utilizing—

(i)

data on the numbers of limited-English-proficient individuals who speak English less than very well from the most recently available data from the Bureau of the Census or other State-based study the Secretary determines likely to yield accurate data regarding the number of such individuals in such service area; or

(ii)

data provided by the grantee, if the grantee routinely collects data on the primary language of the Medicare beneficiaries that the grantee serves and the Secretary determines that the data is accurate and shows a greater number of limited-English-proficient individuals than would be estimated using the data under clause (i).

(B)

Discretion of Secretary

Subject to subparagraph (C), the amount of payment made to a grantee under this subsection may be modified annually at the discretion of the Secretary, based on changes in the data under subparagraph (A) with respect to the service area of a grantee for the year.

(C)

Limitation on amount

The amount of a grant made under this subsection to a grantee may not exceed $500,000 for the period under paragraph (1)(D).

(7)

Assurances

Grantees under this subsection shall—

(A)

ensure that clinical and support staff receive appropriate ongoing education and training in linguistically appropriate service delivery;

(B)

ensure the linguistic competence of bilingual providers;

(C)

offer and provide appropriate language services at no additional charge to each patient with limited-English proficiency for all points of contact between the patient and the grantee, in a timely manner during all hours of operation;

(D)

notify Medicare beneficiaries of their right to receive language services in their primary language;

(E)

post signage in the primary languages commonly used by the patient population in the service area of the organization; and

(F)

ensure that—

(i)

primary language data is collected for recipients of language services and such data is consistent with standards developed under title XXXIV of the Public Health Service Act, as added by section 202 of this Act, to the extent such standards are available upon the initiation of the demonstration program; and

(ii)

consistent with the privacy protections provided under the regulations promulgated pursuant to section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1320d–2 note), if the recipient of language services is a minor or is incapacitated, primary language data is collected on the parent or legal guardian of such recipient.

(8)

No Cost Sharing

Limited-English-proficient Medicare beneficiaries shall not have to pay cost-sharing or co-payments for competent language services provided under this demonstration program.

(9)

Reporting Requirements for grantees

Not later than the end of each calendar year, a grantee that receives funds under this subsection in such year shall submit to the Secretary a report that includes the following information:

(A)

The number of Medicare beneficiaries to whom competent language services are provided.

(B)

The primary languages of those Medicare beneficiaries.

(C)

The types of language services provided to such beneficiaries.

(D)

Whether such language services were provided by employees of the grantee or through a contract with external contractors or agencies).

(E)

The types of interpretation services provided to such beneficiaries, and the approximate length of time such service is provided to such beneficiaries.

(F)

The costs of providing competent language services.

(G)

An account of the training or accreditation of bilingual staff, interpreters, and translators providing services funded by the grant under this subsection.

(10)

Evaluation and report to Congress

Not later than 1 year after the completion of a 3-year grant under this subsection, the Secretary shall conduct an evaluation of the demonstration program under this subsection and shall submit to the Congress a report that includes the following:

(A)

An analysis of the patient outcomes and the costs of furnishing care to the limited-English-proficient Medicare beneficiaries participating in the project as compared to such outcomes and costs for limited-English-proficient Medicare beneficiaries not participating, based on the data provided under paragraph (9) and any other information available to the Secretary.

(B)

The effect of delivering langauge services on—

(i)

Medicare beneficiary access to care and utilization of services;

(ii)

the efficiency and cost effectiveness of health care delivery;

(iii)

patient satisfaction;

(iv)

health outcomes; and

(v)

the provision of culturally appropriate services provided to such benificiaries.

(C)

The extent to which bilingual staff, interpreters, and translators providing services under such demonstration were trained or accredited and the nature of accreditation or training needed by type of provider, service, or other category as determined by the Secretary to ensure the provision of high-quality interpretation, translation, or other language services to Medicare beneficiaries if such services are expanded pursuant to subsection (c) of section 1907 of this Act.

(D)

Recommendations, if any, regarding the extension of such project to the entire Medicare program, subject the to provision of section 1115A(c) of the Social Security Act.

(11)

Appropriations

There is appropriated to carry out this subsection, in equal parts from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, $16,000,000 for each fiscal year of the demonstration program.

(b)

Language services under the Medicare program

(1)

Subsection (aa)(1) of section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended—

(A)

in subparagraph (B), by striking the and at the end;

(B)

in subparagrpah (C), by inserting and after the comma at the end; and

(C)

by inserting after subparagraph (C) the following:

(D)

language services as defined in subsection (iii),

.

(2)

Section 1833(a) of the Social Security Act (42 U.S.C. 1395l(a)) is amended—payment

(A)

by striking and at the end of paragraph (8);

(B)

by edesignating paragraph (9) as paragraph (10); and

(C)

by inserting after paragraph (8) the following new paragraph:

(9)

in the case of language services described in section 1861(iii), 100 percent of the reasonable charges for such services, as determined in consultation with the Medicare Payment Advisory Commission; and

.

(3)

Section 1832(a)(2) of such Act (42 U.S.C. 1395k(a)(2)) is amended—covered service

(A)

by striking and at the end of subparagraph (I);

(B)

by striking the period at the end of subparagraph (J) and inserting ; and; and

(C)

by adding at the end of subparagraph (J) the following:

(K)

language services (as defined in section 1861(iii)) furnished by a interpreter or translator.

.

(4)

Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection:

(iii)

Language services and related terms

(1)

Language services defined

The term language services has the same meaning given language or langauge access services in section 3400 of the Public Health Service Act.

(2)

Interpreter services defined

For the purposes of this subsection, the term interpreter services has the meaning given competent interpreter services under section 3400(3) of the Public Health Service Act.

(3)

Interpreter defined

The term interpreter

(A)

means an individual—

(i)

who faithfully, accurately, and objectively transmits a spoken message from one language into another language; and

(ii)

who knows health and health-related terminology in both languages; and

(B)

includes individuals who provide in-person, telephonic, and video interpretation.

(4)

Translation defined

The term translation means the transmission of a written message in one language into a written message in another language that retains the intended meaning of the original message.

(5)

Limited-English-proficient and LEP defined

The terms Limited-English-proficient and LEP have the meaning given the term limited english proficient under section 9101(25) of the Elementary and Secondary Education Act of 1965, except that subparagraphs (A), (B), and (D) of such section not apply.

.

(5)

Waiver of budget neutrality

For the 3-year period beginning on the date of enactment of this section, the budget neutrality provision of section 1848(c)(2)(B)(ii) of the Social Security Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not apply to language services (as such term is defined in section 1861(iii) of such Act).

(c)

Medicare Part C and Part D

(1)

In general

Medicare Advantage plans under part C of the Social Security Act and Prescription Drug Plans under part D of such Act shall provide effective language services to enrollees of such plans.

(2)

Reporting requirements

Medicare Advantage and Prescription Drug plans shall annually submit to the Secretary of Health and Human Services a report that contains information on the plan’s internal policies and procedures related to recruitment and retention efforts directed to workforce diversity and linquistically and culturally appropriate provision of services in each of the following contexts:

(A)

The collection of data in a manner that meets the requirements of title I of this Act, regarding the enrollee population.

(B)

Education of staff and contractors who have routine contact with enrollees regarding the various needs of the diverse enrollee population.

(C)

Evaluation of the health plan’s language services programs and services with respect to the plan’s enrollee population, such as through analysis of complaints or satisfaction survey results.

(D)

Methods by which the plan provides to the Secretary information regarding the ethnic diversity of the plan’s enrollee population.

(E)

The periodic provision of educational information to plan enrollees on the plan’s language services and programs.

(d)

Improving language services in Medicaid and SCHIP

(1)

Section 1903(a)(2)(E) of the Social Security Act (42 U.S.C. 1396b(a)(2)(E)) is amended by—

(A)

striking 75 and inserting 90;

(B)

striking translation or interpretation services and inserting language services; and

(C)

striking children of families and inserting individuals.

(2)

Section 1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended by striking and (28) and inserting (28), and (29).

(3)

Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended by—

(A)

in paragraph (28), by striking and at the end;

(B)

by redesignating paragraph (29) as paragraph (30); and

(C)

by inserting after paragraph (28) the following new paragraph:

(29)

language services, as such term is defined in section 1861(iii), provided in a timely manner to limited-English-proficient individuals who need such services; and

.

(4)

Section 1916(a)(2) of the Social Security Act (42 U.S.C. 1396o(2)) is amended by—

(A)

by striking or at the end of subparagraph (D);

(B)

by striking ; and at the end of subparagraph (E) and inserting , or; and

(C)

by adding at the end the following new subparagraph:

(F)

language services described in section 1905(a)(29); and

.

(5)

Section 2103 of the Social Security Act (42 U.S.C. 1397cc) is amended—

(A)

in subsection (a), in the matter before paragraph (1), by striking and (7) and inserting (7), and (9); and

(B)

in subsection (c), by adding at the end the following new paragraph:

(9)

Language services

The child health assistance provided to a targeted low-income child shall include coverage of language services, as such term is defined in section 1861(iii), provided in a timely manner to limited-English-proficient individuals who need such services.

; and

(C)

in subsection (e)(2)—

(i)

in the heading, by striking Preventive and inserting Certain; and

(ii)

by inserting , subsection (c)(9), after subsection (c)(1)(C).

(6)

Section 2110(a)(27) of the Social Security Act (42 U.S.C. 1397jj) is amended by striking translation and inserting language services as described in section 2103(c)(9).

(7)

Pursuant to the reporting requirement described in section 2107(b)(1) of the Social Security Act (42 U.S.C. 1397gg(b)(1)), the Secretary of Health and Human Services shall require that States collect data on—

(A)

the primary language of individuals receiving child health assistance under title XXI of the Social Security Act; and

(B)

in the case of such individuals who are minors or incapacitated, the primary language of the individual’s parent or guardian.

(8)

Section 2105 of the Social Security Act (42 U.S.C. 1397ee(c)) is amended—

(A)

in subsection (a)(1) by striking 75 and inserting 90; and

(B)

in subsection (c)(2)(A), by inserting before the period , except that expenditures pursuant to clause (iv) of subparagraph (D) of such paragraph shall not count towards this total.

(e)

Funding language services furnished by providers of health care and health-Care-Related services that serve high rates of uninsured LEP individuals

(1)

Payment of costs

(A)

In general

Subject to subparagraph (B), the Secretary of Health and Human Services shall make payments (on a quarterly basis) directly to eligible entities to support the provision of language services to limited-English-proficient individuals in an amount equal to an entity’s eligible costs (as defined under paragraph (3)) for such services for the quarter.

(B)

Funding

Out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary of Health and Human Services such sums as may be necessary for each of fiscal years 2012 through 2016.

(C)

Relation to Medicaid DSH

Payments under this subsection shall not offset or reduce payments under section 1923 of the Social Security Act, nor shall payments under such section be considered when determining uncompensated costs associated with the provision of language services.

(2)

Eligible entity

In order to receive grants under this paragraph, an entity must—

(A)

be a Medicaid provider that is—

(i)

a physician;

(ii)

a hospital with a low-income utilization rate (as defined in section 1923(b)(3) of the Social Security Act (42 U.S.C. 1396r–4(b)(3))) of greater than 25 percent; or

(iii)

a federally qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 1396d(l)(2)(B)));

(B)

provide language services to at least 8 percent of the entity’s total number of patients, not later than 6 months after the date of the enactment of the Act; and

(C)

prepare and submit an application to the Secretary, at such time, in such manner, and accompanied by such information as the Secretary may require to ascertain the entity’s eligibility for funding under this subsection.

(3)

Eligible costs defined

(A)

In general

In this subsection, the term eligible costs means, with respect to an eligible entity that provides language services to LEP individuals, the product of—

(i)

the average per person cost of language services, determined according to the methodology devised under subparagraph (B); and

(ii)

the number of limited-English-proficient individuals who are provided language services by the entity and for whom no reimbursement is available for such services under the amendments made by subsections (a), (b), (c), or (d) or by private health insurance.

(B)

Methodology

(i)

In general

The Secretary shall establish a methodology to determine the average per person cost of language services.

(ii)

Different entities

In establishing such methodology, the Secretary may establish different methodologies for different types of eligible entities.

(iii)

No individual claims

The Secretary may not require eligible entities to submit individual claims for language services for individual patients as a requirement for payment under this subsection.

(4)

Data collection instrument

For purposes of this subsection, the Secretary shall create a standard data collection instrument that is consistent with any existing reporting requirements by the Secretary or relevant accrediting organizations regarding the number of individuals to whom language access are provided.

(5)

Reporting requirements

Entities receiving payment under this subsection shall provide the Secretary with a quarterly report on how the entity used such funds. Such report shall contain aggregate (and may not contain individualized) data collected using the instrument under paragraph (4) and shall otherwise be in a form and manner determined by the Secretary.

(6)

Language services

For purposes of this subsection, the term language services has the meaning given such term in section 1861(iii) of the Social Security Act.

(7)

Guidelines and report

(A)

Establishment

Not later than 6 months after the date of enactment of this Act, the Secretary of Health and Human Services shall establish and distribute guidelines concerning the implementation of this subsection.

(B)

Report

Not later than 2 years after the date of enactment of this Act, and every 2 years thereafter, the Secretary shall submit a report to Congress concerning the implementation of this subsection.

(f)

Application of Civil Rights Act of 1964 and other laws

Nothing in this section shall be construed to limit otherwise existing obligations of recipients of Federal financial assistance under title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d) et seq.) or other laws that protect the civil rights of individuals.

(g)

Effective date

The amendments made by this section shall take effect on October 1, 2011.

204.

Increasing understanding of and improving health literacy

(a)

In general

The Secretary, acting through the Director of the Agency for Healthcare Research and Quality and the Administrator of the Health Resources and Services Administration, in consultation with the Director of the National Institute on Minority Health and Health Disparities and the Office of Minority Health, shall award grants to eligible entities to improve health care for patient populations that have low functional health literacy.

(b)

Eligibility

To be eligible to receive a grant under subsection (a), an entity shall—

(1)

be a hospital, health center or clinic, health plan, or other health entity (including a nonprofit minority health organization or association); and

(2)

prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.

(c)

Use of funds

(1)

Agency for healthcare research and quality

Grants awarded under subsection (a) through the Agency for Healthcare Research and Quality shall be used—

(A)

to define and increase the understanding of health literacy;

(B)

to investigate the correlation between low health literacy and health and health care;

(C)

to clarify which aspects of health literacy have an effect on health outcomes; and

(D)

for any other activity determined appropriate by the Director of the Agency.

(2)

Health resources and services administration

Grants awarded under subsection (a) through the Health Resources and Services Administration shall be used to conduct demonstration projects for interventions for patients with low health literacy that may include—

(A)

the development of new disease management programs for patients with low health literacy;

(B)

the tailoring of existing disease management programs addressing mental, physical, oral, and behavioral health conditions for patients with low health literacy;

(C)

the translation of written health materials for patients with low health literacy;

(D)

the identification, implementation, and testing of low health literacy screening tools;

(E)

the conduct of educational campaigns for patients and providers about low health literacy; and

(F)

other activities determined appropriate by the Administrator of the Health Resources and Services Administration.

(d)

Definitions

In this section, the term low health literacy means the inability of an individual to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

(e)

Authorization of appropriations

There are authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2012 through 2016.

205.

Assurances for receiving Federal funds

(a)

In general

Entities that receive Federal funds under sections 201 or 202 (including under the amendments made by such section), in order to ensure the right of LEP individuals to receive access to quality health care, shall—

(1)

ensure that appropriate clinical and support staff receive ongoing education and training in linguistically appropriate service delivery;

(2)

offer and provide appropriate language services at no additional charge to each patient with limited-English proficiency at all points of contact, in a timely manner during all hours of operation;

(3)

notify patients of their right to receive language services in their primary language; and

(4)

utilize only competent interpreter or translation services which—

(A)

until adoption of the Interpreter and Translator Guidelines and Standards described in section 3403(c) of the Public Health Service Act, are defined in section 3400 of the Public Health Service Act; and

(B)

after adoption of the Interpreter and Translator Guidelines and Standards described in section 3403(c) of the Public Health Service Act, meet those guidelines and standards;

(b)

Exemptions

The requirements of subsection (a)(4) shall not apply as follows:

(1)

When a patient (who has been informed in his or her primary language of the availability of free interpreter and translation services) requests the use of family, friends, or other persons untrained in interpretation or translation if the following conditions are met:

(A)

The interpreter requested by the patient is over the age of 18.

(B)

The recipient informs the patient that he or she has the option of having the recipient provide an interpreter for him/her without charge, or of using his/her own interpreter.

(C)

The recipient informs the patient that the recipient may not require an LEP person to use a family member or friend as an interpreter.

(D)

The recipient evaluates whether the person the patient wishes to use as an interpreter is competent. If the recipient has reason to believe that the interpreter is not competent, the recipient provides the recipient’s own interpreter to protect the recipient from liability if the patient’s interpreter is later found not competent.

(E)

If the recipient has reason to believe that there is a conflict of interest between the interpreter and patient, the recipient may not use the patient’s interpreter.

(F)

The recipient has the patient sign a waiver, witnessed by at least 1 individual not related to the patient, that includes the information stated in subparagraphs (A) through (E) and is translated into the patient’s language.

(2)

When a medical emergency exists and the delay directly associated with obtaining competent interpreter or translation services would jeopardize the health of the patient but only until a competent interpreter or translation service is available; however, nothing in this subsection shall exempt emergency rooms or similar entities that regularly provide health care services in medical emergencies from having in place systems to provide competent interpreter and translation services without undue delay.

206.

Report on Federal efforts to provide culturally and linguistically appropriate health care services

(a)

Report

Not later than 1 year after the date of enactment of this Act and annually thereafter, the Secretary of Health and Human Services shall enter into a contract with the Institute of Medicine for the preparation and publication of a report that describes Federal efforts to ensure that all individuals with limited-English proficiency have meaningful access culturally competent to health care and health-care-related services. Such report shall include—

(1)

a description and evaluation of the activities carried out under this Act;

(2)

a description and analysis of best practices, model programs, guidelines, and other effective strategies for providing access to culturally and linguistically appropriate health care services;

(3)

recommendations on the development and implementation of policies and practices by providers of health care and health-care-related services for limited-English-proficient individuals;

(4)

a description of the effect of providing language services on quality of health care and access to care; and

(5)

a description of the costs associated with or savings related to the provision of language services.

(b)

Authorization of appropriations

There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2012 through 2016.

207.

English for speakers of other languages

(a)

Grants authorized

The Secretary of Education is authorized to provide grants to eligible entities for the provision of English as a second language (hereafter referred to as ESL) instruction and shall determine, after consultation with appropriate stakeholders, the mechanism for administering and distributing such grants.

(b)

Eligible entity defined

For purposes of this section, the term eligible entity means a State or community-based organization that employs, and serves, minority populations.

(c)

Application

An eligible entity may apply for a grant under this section by submitting such information as the Secretary may require and in such form and manner as the Secretary may require.

(d)

Use of grant

As a condition of receiving a grant under this section, an eligible entity shall—

(1)

develop and implement a plan for assuring the availability of ESL instruction that effectively integrates information about the nature of the United States health care system, how to access care, and any special language skills that may be required for them to access and regularly negotiate the system effectively;

(2)

develop a plan, including, where appropriate, public-private partnerships, for making ESL instruction progressively available to all individuals seeking instruction; and

(3)

maintain current ESL instruction efforts by using the additional funds to supplement rather than supplant any funds expended for ESL instruction in the State as of January 1, 2006.

(e)

Additional duties of the secretary

The Secretary of Education shall—

(1)

collect and publicize annual data on how much Federal, State, and local governments spend on ESL instruction;

(2)

collect data from State and local governments to identify the unmet needs of English language learners for appropriate ESL instruction, including—

(A)

the preferred written and spoken language of such English language learners;

(B)

the extent of waiting lists including how many programs maintain waiting lists and, for programs that do not have waiting lists, the reasons why not;

(C)

the availability of programs to geographically isolated communities;

(D)

the impact of course enrollment policies, including open enrollment, on the availability of ESL instruction;

(E)

the number individuals in the State and each participating locality;

(F)

the effectiveness of the instruction in meeting the needs of individuals receiving instruction and those needing instruction;

(G)

as assessment of the need for programs that integrate job training and ESL instruction, to assist individuals to obtain better jobs; and

(H)

the availability of ESL slots by State and locality;

(3)

determine the cost and most appropriate methods of making ESL instruction available to all English language learners seeking instruction; and

(4)

within 1 year of the date of enactment of this Act, issue a report to Congress that assesses the information collected in paragraphs (1), (2), and (3) and makes recommendations on steps that should be taken to progressively realize the goal of making ESL instruction available to all English language learners seeking instruction.

(f)

Authorization of Appropriations

There are authorized to be appropriated to the Secretary of Education for each of fiscal years 2012 through 2015 $250,000,000 to carry out this section.

208.

Implementation

(a)

General provisions

(1)

A State shall not be immune under the Eleventh Amendment of the Constitution of the United States from suit in Federal court for failing to provide the language access funded pursuant to this title.

(2)

In a suit against a State for a violation of this title, remedies (including remedies at both at law and in equity) are available for such a violation to the same extent as such remedies are available for such a violation in the suit against any public or private entity other than a State.

(b)

Rule of construction

Nothing in this title shall be construed to limit otherwise existing obligations of recipients of Federal financial assistance under title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d) et seq.) or any other statute.

209.

Language access services

(a)

Essential benefits

Section 1302(b)(1) of the Patient Protection and Affordable Care Act (42 U.S.C. 18022(b)(1)) is amended by adding at the end the following:

(K)

Language access services, including oral interpretation and written translations.

.

(b)

Employer-Sponsored minimum essential coverage

Section 36B(c)(2)(C) of the Internal Revenue Code of 1986 is amended by adding at the end the following:

(v)

Coverage must include language access and services

Except as provided in clause (iii), an employee shall not be treated as eligible for minimum essential coverage if such coverage consists of an eligible employer-sponsored plan (as defined in section 5000A(f)(2)) and the plan does not provide coverage for language access services, including oral interpretation and written translations.

.

(c)

Quality Reporting

Section 2717(a)(1) of the Public Health Service Act (42 U.S.C. 300gg–17(a)(1)) is amended—

(1)

by striking and at the end of subparagraph (C);

(2)

by striking the period at the end of subparagraph (D) and inserting ; and; and

(3)

by adding at the end the following new subparagraph:

(E)

reduce health disparities through the provision of language access services, including oral interpretation and written translations.

.

III

Health workforce Diversity

301.

Amendment to the Public Health Service Act

Title XXXIV of the Public Health Service Act, as added by section 202, is amended by adding at the end the following:

A

Diversifying the Health care workplace

3411.

Report on workforce Diversity

(a)

In general

Not later than July 1, 2012, and biannually thereafter, the Secretary, acting through the director of each entity within the Department of Health and Human Services, shall prepare and submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report on health workforce diversity.

(b)

Requirement

The report under subsection (a) shall contain the following information:

(1)

A description of any grant support that is provided by each entity for workforce diversity initiatives with the following information—

(A)

the number of grants made;

(B)

the purpose of the grants;

(C)

the populations served through the grants;

(D)

the organizations and institutions receiving the grants; and

(E)

the tracking efforts that were used to follow the progress of participants.

(2)

A description of the entity’s plan to achieve workforce diversity goals that includes, to the extent relevant to such entity—

(A)

the number of underrepresented minority health professionals that will be needed in various disciplines over the next 10 years to achieve population parity;

(B)

the level of funding needed to fully expand and adequately support health professions pipeline programs;

(C)

the impact such programs have had on the admissions practices and policies of health professions schools;

(D)

the management strategy necessary to effectively administer and institutionalize health profession pipeline programs; and

(E)

the impact that the Government Performance and Results Act (GPRA) has had on evaluating the performance of grantees and whether the GPRA is the best assessment tool for programs under titles VII and VIII.

(3)

A description of measurable objectives of each entity relating to workforce diversity initiatives.

(c)

Public availability

The report under subsection (a) shall be made available for public review and comment.

3412.

National Working Group on Workforce Diversity

(a)

In general

The Secretary, acting through the Bureau of Health Professions within the Health Resources and Services Administration, shall award a grant to an entity determined appropriate by the Secretary for the establishment of a national working group on workforce diversity.

(b)

Representation

In establishing the national working group under subsection (a):

(1)

The grantee shall ensure that the group has representatives of the following:

(A)

The Health Resources and Services Administration.

(B)

The Department of Health and Human Services Data Council.

(C)

The Office of Minority Health.

(D)

The Bureau of Labor Statistics of the Department of Labor.

(E)

The Public Health Practice Program Office—Office of Workforce Policy and Planning.

(F)

The National Institute on Minority Health and Health Disparities.

(G)

The Agency for Healthcare Research and Quality.

(H)

The Institute of Medicine Study Committee for the 2004 workforce diversity report.

(I)

The Indian Health Service.

(J)

Minority-serving academic institutions.

(K)

Consumer organizations.

(L)

Health professional associations, including those that represent underrepresented minority populations.

(M)

Researchers in the area of health workforce.

(N)

Health workforce accreditation entities.

(O)

Private foundations that have sponsored workforce diversity initiatives.

(2)

The grantee shall ensure that, in addition to the representatives under paragraph (1), the group has not less than 5 health professions students representing various health profession fields and levels of training.

(c)

Activities

The working group established under subsection (a) shall convene at least twice each year to complete the following activities:

(1)

Review current public and private health workforce diversity initiatives.

(2)

Identify successful health workforce diversity programs and practices.

(3)

Examine challenges relating to the development and implementation of health workforce diversity initiatives.

(4)

Draft a national strategic work plan for health workforce diversity, including recommendations for public and private sector initiatives.

(5)

Develop a framework and methods for the evaluation of current and future health workforce diversity initiatives.

(6)

Develop recommended standards for workforce diversity that could be applicable to all health professions programs and programs funded under this Act.

(7)

Develop curriculum guidelines for diversity training.

(8)

Develop a strategy for the inclusion of community members on admissions committees for health profession schools.

(9)

Other activities determined appropriate by the Secretary.

(d)

Annual report

Not later than 1 year after the establishment of the working group under subsection (a), and annually thereafter, the working group shall prepare and make available to the general public for comment, an annual report on the activities of the working group. Such report shall include the recommendations of the working group for improving health workforce diversity.

(e)

Authorization of appropriations

There is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2012 through 2017.

3413.

Technical Clearinghouse for Health workforce Diversity

(a)

In general

The Secretary, acting through the Office of Minority Health, and in collaboration with the Bureau of Health Professions within the Health Resources and Services Administration, the National Institute on Minority Health and Health Disparities, shall establish a technical clearinghouse on health workforce diversity within the Office of Minority Health and coordinate current and future clearinghouses.

(b)

Information and services

The clearinghouse established under subsection (a) shall offer the following information and services:

(1)

Information on the importance of health workforce diversity.

(2)

Statistical information relating to underrepresented minority representation in health and allied health professions and occupations.

(3)

Model health workforce diversity practices and programs.

(4)

Admissions policies that promote health workforce diversity and are in compliance with Federal and State laws.

(5)

Lists of scholarship, loan repayment, and loan cancellation grants as well as fellowship information for underserved populations for health professions schools.

(6)

Foundation and other large organizational initiatives relating to health workforce diversity.

(c)

Consultation

In carrying out this section, the Secretary shall consult with non-Federal entities which may include minority health professional associations to ensure the adequacy and accuracy of information.

(d)

Authorization of appropriations

There is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2012 through 2017.

3414.

Support for Institutions committed to workforce Diversity

(a)

In general

The Secretary, acting through the Administrator of the Health Resources and Services Administration and the Centers for Disease Control and Prevention, shall award grants to eligible entities that demonstrate a commitment to health workforce diversity.

(b)

Eligibility

To be eligible to receive a grant under subsection (a), an entity shall—

(1)

be an educational institution or entity that historically produces or trains meaningful numbers of underrepresented minority health professionals, including—

(A)

historically Black colleges and universities;

(B)

Hispanic-serving health professions schools;

(C)

Hispanic-serving institutions;

(D)

tribal colleges and universities;

(E)

Asian-American, Native American, and Pacific Islander-serving institutions;

(F)

institutions that have programs to recruit and retain underrepresented minority health professionals, in which a significant number of the enrolled participants are underrepresented minorities;

(G)

health professional associations, which may include underrepresented minority health professional associations; and

(H)

institutions—

(i)

located in communities with predominantly underrepresented minority populations;

(ii)

with whom partnerships have been formed for the purpose of increasing workforce diversity; and

(iii)

in which at least 20 percent of the enrolled participants are underrepresented minorities; and

(2)

submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.

(c)

Use of funds

Amounts received under a grant under subsection (a) shall be used to expand existing workforce diversity programs, implement new workforce diversity programs, or evaluate existing or new workforce diversity programs, including with respect to mental health care professions. Such programs shall enhance diversity by considering minority status as part of an individualized consideration of qualifications. Possible activities may include—

(1)

educational outreach programs relating to opportunities in the health professions;

(2)

scholarship, fellowship, grant, loan repayment, and loan cancellation programs;

(3)

postbaccalaureate programs;

(4)

academic enrichment programs, particularly targeting those who would not be competitive for health professions schools;

(5)

kindergarten through 12th grade and other health pipeline programs;

(6)

mentoring programs;

(7)

internship or rotation programs involving hospitals, health systems, health plans and other health entities;

(8)

community partnership development for purposes relating to workforce diversity; or

(9)

leadership training.

(d)

Reports

Not later than 1 year after receiving a grant under this section, and annually for the term of the grant, a grantee shall submit to the Secretary a report that summarizes and evaluates all activities conducted under the grant.

(e)

Definition

In this section, the term Asian-American, Native American, and Pacific Islander-serving institutions has the same meaning as the term Asian American and Native American Pacific Islander-serving institution as defined in section 371(c) of the Higher Education Act of 1965 (20 U.S.C. 1067q(c)).

(f)

Authorization of appropriations

There is authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2012 through 2017.

3415.

Career development for scientists and researchers

(a)

In general

The Secretary, acting through the Director of the National Institutes of Health, the Director of the Centers for Disease Control and Prevention, the Commissioner of Food and Drugs, and the Director of the Agency for Healthcare Research and Quality, shall award grants that expand existing opportunities for scientists and researchers and promote the inclusion of underrepresented minorities in the health professions.

(b)

Research funding

The head of each entity within the Department of Health and Human Services shall establish or expand existing programs to provide research funding to scientists and researchers in training. Under such programs, the head of each such entity shall give priority in allocating research funding to support health research in traditionally underserved communities, including underrepresented minority communities, and research classified as community or participatory.

(c)

Data collection

The head of each entity within the Department of Health and Human Services shall collect data on the number (expressed as an absolute number and a percentage) of underrepresented minority and nonminority applicants who receive and are denied agency funding at every stage of review. Such data shall be reported annually to the Secretary and the appropriate committees of Congress.

(d)

Student loan reimbursement

The Secretary shall establish a student loan reimbursement program to provide student loan reimbursement assistance to researchers who focus on racial and ethnic disparities in health. The Secretary shall promulgate regulations to define the scope and procedures for the program under this subsection.

(e)

Student loan cancellation

The Secretary shall establish a student loan cancellation program to provide student loan cancellation assistance to researchers who focus on racial and ethnic disparities in health. Students participating in the program shall make a minimum 5-year commitment to work at an accredited health profession school. The Secretary shall promulgate additional regulations to define the scope and procedures for the program under this subsection.

(f)

Authorization of appropriations

There is authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2012 through 2017.

3416.

Career support for non-research Health professionals

(a)

In general

The Secretary, acting through the Director of the Centers for Disease Control and Prevention, the Administrator of the Substance Abuse and Mental Health Services Administration, the Administrator of the Health Resources and Services Administration, and the Administrator of the Centers for Medicare and Medicaid Services shall establish a program to award grants to eligible individuals for career support in non-research-related health care.

(b)

Eligibility

To be eligible to receive a grant under subsection (a) an individual shall—

(1)

be a student in a health professions school, a graduate of such a school who is working in a health profession, or a faculty member of such a school; and

(2)

submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.

(c)

Use of funds

An individual shall use amounts received under a grant under this section to—

(1)

support the individual’s health activities or projects that involve underserved communities, including racial and ethnic minority communities;

(2)

support health-related career advancement activities;

(3)

to pay, or as reimbursement for payments of, student loans for individuals who are health professionals and are focused on health issues affecting underserved communities, including racial and ethnic minority communities; and

(4)

to establish and promote leadership training programs to decrease health disparities and to increase cultural competence with the goal of increasing diversity in leadership positions.

(d)

Definition

In this section, the term career in non-research-related health care means employment or intended employment in the field of public health, health policy, health management, health administration, medicine, nursing, pharmacy, psychology, social work, psychiatry, other mental and behavioral health, allied health, community health, social work, or other fields determined appropriate by the Secretary, other than in a position that involves research.

(e)

Authorization of appropriations

There is authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2012 through 2017.

3417.

Research on the effect of workforce Diversity on quality

(a)

In general

The Director of the Agency for Healthcare Research and Quality, in collaboration with the Deputy Assistant Secretary for Minority Health and the Director of the National Institute on Minority Health and Health Disparities, shall award grants to eligible entities to expand research on the link between health workforce diversity and quality health care.

(b)

Eligibility

To be eligible to receive a grant under subsection (a) an entity shall—

(1)

be a clinical, public health, or health services research entity or other entity determined appropriate by the Director; and

(2)

submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.

(c)

Use of funds

Amounts received under a grant awarded under subsection (a) shall be used to support research that investigates the effect of health workforce diversity on—

(1)

language access;

(2)

cultural competence;

(3)

patient satisfaction;

(4)

timeliness of care;

(5)

safety of care;

(6)

effectiveness of care;

(7)

efficiency of care;

(8)

patient outcomes;

(9)

community engagement;

(10)

resource allocation;

(11)

organizational structure;

(12)

compliance of care; or

(13)

other topics determined appropriate by the Director.

(d)

Priority

In awarding grants under subsection (a), the Director shall give individualized consideration to all relevant aspects of the applicant’s background. Consideration of prior research experience involving the health of underserved communities shall be such a factor.

(e)

Authorization of appropriations

There is authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2012 through 2017.

3418.

Health disparities education Program

(a)

Establishment

The Secretary, acting through the National Institute on Minority Health and Health Disparities and in collaboration with the Office of Minority Health, the Office for Civil Rights, the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, the Health Resources and Services Administration, and other appropriate public and private entities, shall establish and coordinate a health and health care disparities education program to support, develop, and implement educational initiatives and outreach strategies that inform health care professionals and the public about the existence of and methods to reduce racial and ethnic disparities in health and health care.

(b)

Activities

The Secretary, through the education program established under subsection (a) shall, through the use of public awareness and outreach campaigns targeting the general public and the medical community at large—

(1)

disseminate scientific evidence for the existence and extent of racial and ethnic disparities in health care, including disparities that are not otherwise attributable to known factors such as access to care, patient preferences, or appropriateness of intervention, as described in the 2002 Institute of Medicine Report entitled Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, as well as the impact of disparities related to age, disability status, socioeconomic status, sex, gender identity, and sexual orientation on racial and ethnic minorities;

(2)

disseminate new research findings to health care providers and patients to assist them in understanding, reducing, and eliminating health and health care disparities;

(3)

disseminate information about the impact of linguistic and cultural barriers on health care quality and the obligation of health providers who receive Federal financial assistance to ensure that people with limited-English proficiency have access to language access services;

(4)

disseminate information about the importance and legality of racial, ethnic, disability status, socioeconomic status, sex, gender identity, and sexual orientation, and primary language data collection, analysis, and reporting;

(5)

design and implement specific educational initiatives to health care providers relating to health and health care disparities; and

(6)

assess the impact of the programs established under this section in raising awareness of health and health care disparities and providing information on available resources.

(c)

Authorization of appropriations

There is authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2012 through 2017.

.

302.

Hispanic-serving health professions schools

Part B of title VII of the Public Health Service Act (42 U.S.C. 293 et seq.) is amended by adding at the end the following:

742.

Hispanic-serving health professions schools

(a)

In general

The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall award grants to Hispanic-serving health professions schools for the purpose of carrying out programs to recruit Hispanic individuals to enroll in and graduate from such schools, which may include providing scholarships and other financial assistance as appropriate.

(b)

Eligibility

In subsection (a), the term Hispanic-serving health professions school means an entity that—

(1)

is a school or program under section 799B;

(2)

has an enrollment of full-time equivalent students that is made up of at least 9 percent Hispanic students;

(3)

has been effective in carrying out programs to recruit Hispanic individuals to enroll in and graduate from the school;

(4)

has been effective in recruiting and retaining Hispanic faculty members;

(5)

has a significant number of graduates who are providing health services to medically underserved populations or to individuals in health professional shortage areas; and

(6)

Regional Hispanic Centers of Excellence.

.

303.

Loan repayment program of Centers for Disease Control and Prevention

Section 317F(c) of the Public Health Service Act (42 U.S.C. 247b–7(c)) is amended—

(1)

by striking and after 1994,; and

(2)

by inserting before the period the following: $750,000 for fiscal year 2012, and such sums as may be necessary for each of the fiscal years 2013 through 2017..

304.

Cooperative agreements for online degree programs at schools of public health and schools of allied health

Part B of title VII of the Public Health Service Act (42 U.S.C. 293 et seq.), as amended by section 302, is further amended by adding at the end the following:

743.

Cooperative agreements for online degree programs

(a)

Cooperative agreements

The Secretary, acting through the Administrator of the Health Resources and Services Administration, in consultation with the Director of the Centers for Disease Control and Prevention, the Director of the Agency for Healthcare Research and Quality, and the Deputy Assistant Secretary for Minority Health, shall award cooperative agreements to schools of public health and schools of allied health to design and implement online degree programs.

(b)

Priority

In awarding cooperative agreements under this section, the Secretary shall give priority to any school of public health or school of allied health that has an established track record of serving medically underserved communities.

(c)

Requirements

Awardees must design and implement an online degree program, that meet the following restrictions:

(1)

Enrollment of individuals who have obtained a secondary school diploma or its recognized equivalent.

(2)

Maintaining a significant enrollment of underrepresented minority or disadvantaged students.

(d)

Authorization of appropriations

There are authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2012 through 2017.

.

305.

National report on the preparedness of health professionals to care for diverse populations

The Secretary of Health and Human Services, in collaboration with the Bureau of Health Professions, the Office of Minority Health and the National Institute on Minority Health and Health Disparities, shall prepare and disseminate a report that details and assesses the preparedness of health professionals to care for racially and ethnically diverse populations. Such information, which shall be collected by the Bureau of Health Professions, shall include—

(1)

with respect to health professions education, the number and percentage of hours of classroom discussion relating to minority health issues, including cultural competence;

(2)

a description of the coursework involved in such education;

(3)

a description of the results of an evaluation of the preparedness of students in such education;

(4)

a description of the types of exposure that students have during their education to minority patient populations; and

(5)

a description of model programs and practices.

306.

Scholarship and fellowship programs

Subtitle A of title XXXIV of the Public Health Service Act, as amended by section 301, is further amended by inserting after section 3418 the following:

3419.

David Satcher Public Health and Health Services Corps

(a)

In general

The Administrator of the Health Resources and Services Administration and the Director of the Centers for Disease Control and Prevention, in collaboration with the Deputy Assistant Secretary for Minority Health, shall award grants to eligible entities to increase awareness among postprimary and postsecondary students of career opportunities in the health professions.

(b)

Eligibility

To be eligible to receive a grant under subsection (a) an entity shall—

(1)

be a clinical, public health or health services organization, community-based or nonprofit entity, or other entity determined appropriate by the Director of the Centers for Disease Control and Prevention;

(2)

serve a health professional shortage area, as determined by the Secretary;

(3)

work with students, including those from racial and ethnic minority backgrounds, that have expressed an interest in the health professions; and

(4)

submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.

(c)

Use of funds

Grant awards under subsection (a) shall be used to support internships that will increase awareness among students of non-research-based and career opportunities in the following health professions:

(1)

Medicine.

(2)

Nursing.

(3)

Public Health.

(4)

Pharmacy.

(5)

Health administration and management.

(6)

Health policy.

(7)

Psychology.

(8)

Dentistry.

(9)

International health.

(10)

Social work.

(11)

Allied health.

(12)

Psychiatry.

(13)

Hospice care.

(14)

Other professions deemed appropriate by the Director of the Centers for Disease Control and Prevention.

(d)

Priority

In awarding grants under subsection (a), the Director of the Centers for Disease Control and Prevention shall give priority to those entities that—

(1)

serve a high proportion of individuals from disadvantaged backgrounds;

(2)

have experience in health disparity elimination programs;

(3)

facilitate the entry of disadvantaged individuals into institutions of higher education; and

(4)

provide counseling or other services designed to assist disadvantaged individuals in successfully completing their education at the postsecondary level.

(e)

Stipends

The Secretary may approve stipends under this section for individuals for any period of education in student-enhancement programs (other than regular courses) at health professions schools, programs, or entities, except that such a stipend may not be provided to an individual for more than 6 months, and such a stipend may not exceed $20 per day (notwithstanding any other provision of law regarding the amount of stipends).

(f)

Authorization of appropriations

There is authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2012 through 2017.

3420.

Louis Stokes Public Health Scholars Program

(a)

In general

The Director of the Centers for Disease Control and Prevention, in collaboration with the Deputy Assistant Secretary for Minority Health, shall award scholarships to postsecondary students who seek a career in public health.

(b)

Eligibility

To be eligible to receive a scholarship under subsection (a) an individual shall—

(1)

have experience in public health research or public health practice, or other health professions as determined appropriate by the Director of the Centers for Disease Control and Prevention;

(2)

reside in a health professional shortage area as determined by the Secretary;

(3)

have expressed an interest in public health;

(4)

demonstrate promise for becoming a leader in public health;

(5)

secure admission to a 4-year institution of higher education;

(6)

comply with subsection (f); and

(7)

submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.

(c)

Use of funds

Amounts received under an award under subsection (a) shall be used to support opportunities for students to become public health professionals.

(d)

Priority

In awarding grants under subsection (a), the Director shall give priority to those students that—

(1)

are from disadvantaged backgrounds;

(2)

have secured admissions to a minority-serving institution; and

(3)

have identified a health professional as a mentor at their school or institution and an academic advisor to assist in the completion of their baccalaureate degree.

(e)

Scholarships

The Secretary may approve payment of scholarships under this section for such individuals for any period of education in student undergraduate tenure, except that such a scholarship may not be provided to an individual for more than 4 years, and such scholarships may not exceed $10,000 per academic year (notwithstanding any other provision of law regarding the amount of scholarship).

(f)

Authorization of appropriations

There is authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2012 through 2017.

3420A.

Patsy Mink Health and Gender Research Fellowship Program

(a)

In general

The Director of the Centers for Disease Control and Prevention, in collaboration with the Deputy Assistant Secretary for Minority Health, the Administrator of the Substance Abuse and Mental Health Services Administration, and the Director of the Indian Health Services, shall award research fellowships to post-baccalaureate students to conduct research that will examine gender and health disparities and to pursue a career in the health professions.

(b)

Eligibility

To be eligible to receive a fellowship under subsection (a) an individual shall—

(1)

have experience in health research or public health practice;

(2)

reside in a health professional shortage area as determined by the Secretary;

(3)

have expressed an interest in the health professions;

(4)

demonstrate promise for becoming a leader in the field of women’s health;

(5)

secure admission to a health professions school or graduate program with an emphasis in gender studies;

(6)

comply with subsection (f); and

(7)

submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.

(c)

Use of funds

Amounts received under an award under subsection (a) shall be used to support opportunities for students to become researchers and advance the research base on the intersection between gender and health.

(d)

Priority

In awarding grants under subsection (a), the Director of the Centers for Disease Control and Prevention shall give priority to those applicants that—

(1)

are from disadvantaged backgrounds; and

(2)

have identified a mentor and academic advisor who will assist in the completion of their graduate or professional degree and have secured a research assistant position with a researcher working in the area of gender and health.

(e)

Fellowships

The Director of the Centers for Disease Control and Prevention may approve fellowships for individuals under this section for any period of education in the student’s graduate or health profession tenure, except that such a fellowship may not be provided to an individual for more than 3 years, and such a fellowship may not exceed $18,000 per academic year (notwithstanding any other provision of law regarding the amount of fellowship).

(f)

Authorization of appropriations

There is authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2012 through 2017.

3420B.

Paul David Wellstone International Health Fellowship Program

(a)

In general

The Director of the Agency for Healthcare Research and Quality, in collaboration with the Deputy Assistant Secretary for Minority Health, shall award research fellowships to college students or recent graduates to advance their understanding of international health.

(b)

Eligibility

To be eligible to receive a fellowship under subsection (a) an individual shall—

(1)

have educational experience in the field of international health;

(2)

reside in a health professional shortage area as determined by the Secretary;

(3)

demonstrate promise for becoming a leader in the field of international health;

(4)

be a college senior or recent graduate of a four-year higher education institution;

(5)

comply with subsection (f); and

(6)

submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.

(c)

Use of funds

Amounts received under an award under subsection (a) shall be used to support opportunities for students to become health professionals and to advance their knowledge about international issues relating to health care access and quality.

(d)

Priority

In awarding grants under subsection (a), the Director shall give priority to those applicants that—

(1)

are from a disadvantaged background; and

(2)

have identified a mentor at a health professions school or institution, an academic advisor to assist in the completion of their graduate or professional degree, and an advisor from an international health non-governmental organization, private volunteer organization, or other international institution or program that focuses on increasing health care access and quality for residents in developing countries.

(e)

Fellowships

The Secretary shall approve fellowships for college seniors or recent graduates, except that such a fellowship may not be provided to an individual for more than 6 months, may not be awarded to a graduate that has not been enrolled in school for more than 1 year, and may not exceed $4,000 per academic year (notwithstanding any other provision of law regarding the amount of fellowship).

(f)

Authorization of appropriations

There is authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2012 through 2017.

3420C.

Edward R. Roybal Health Care Scholar Program

(a)

In general

The Director of the Agency for Healthcare Research and Quality, the Director of the Centers for Medicaid & Medicare, and the Administrator for Health Resources and Services Administration, in collaboration with the Deputy Assistant Secretary for Minority Health, shall award grants to eligible entities to expose entering graduate students to the health professions.

(b)

Eligibility

To be eligible to receive a grant under subsection (a) an entity shall—

(1)

be a clinical, public health or health services organization, community-based or nonprofit entity, or other entity determined appropriate by the Director of the Agency for Healthcare Research and Quality;

(2)

serve in a health professional shortage area as determined by the Secretary;

(3)

work with students obtaining a degree in the health professions; and

(4)

submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.

(c)

Use of funds

Amounts received under a grant awarded under subsection (a) shall be used to support opportunities that expose students to non-research-based health professions, including—

(1)

public health policy;

(2)

health care and pharmaceutical policy;

(3)

health care administration and management;

(4)

health economics; and

(5)

other professions determined appropriate by the Director of the Agency for Healthcare Research and Quality.

(d)

Priority

In awarding grants under subsection (a), the Director of the Agency for Healthcare Research and Quality shall give priority to those entities that—

(1)

have experience with health disparity elimination programs;

(2)

facilitate training in the fields described in subsection (c); and

(3)

provide counseling or other services designed to assist such individuals in successfully completing their education at the postsecondary level.

(e)

Stipends

The Secretary may approve the payment of stipends for individuals under this section for any period of education in student-enhancement programs (other than regular courses) at health professions schools or entities, except that such a stipend may not be provided to an individual for more than 2 months, and such a stipend may not exceed $100 per day (notwithstanding any other provision of law regarding the amount of stipends).

(f)

Authorization of appropriations

There is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2012 through 2017.

.

307.

Advisory Committee on Health Professions Training for Diversity

(a)

Establishment

The Secretary of Health and Human Services (referred to in this section as the Secretary) shall establish an advisory committee to be known as the Advisory Committee on Health Professions Training for Diversity (in this section referred to as the Advisory Committee).

(b)

Composition

(1)

In general

The Secretary shall determine the appropriate number of individuals to serve on the Advisory Committee. Such individuals shall not be officers or employees of the Federal Government.

(2)

Appointment

Not later than 60 days after the date of enactment of this section, the Secretary shall appoint the members of the Advisory Committee from among individuals who are health professionals. In making such appointments, the Secretary shall ensure a fair balance between the health professions, that at least 75 percent of the members of the Advisory Committee are health professionals, a broad geographic representation of members and a balance between urban and rural members. Members shall be appointed based on their competence, interest, and knowledge of the mission of the profession involved.

(3)

Minority representation

In appointing the members of the Advisory Committee under paragraph (2), the Secretary shall ensure the adequate representation of women and minorities.

(c)

Terms

(1)

In general

A member of the Advisory Committee shall be appointed for a term of 3 years, except that of the members first appointed—

(A)

1/3 of such members shall serve for a term of 1 year;

(B)

1/3 of such members shall serve for a term of 2 years; and

(C)

1/3 of such members shall serve for a term of 3 years.

(2)

Vacancies

(A)

In general

A vacancy on the Advisory Committee shall be filled in the manner in which the original appointment was made and shall be subject to any conditions which applied with respect to the original appointment.

(B)

Filling unexpired term

An individual chosen to fill a vacancy shall be appointed for the unexpired term of the member replaced.

(d)

Duties

(1)

In general

The Advisory Committee shall—

(A)

provide advice and recommendations to the Secretary concerning policy and program development and other matters of significance concerning activities under this part; and

(B)

not later than 2 years after the date of enactment of this section, and annually thereafter, prepare and submit to the Secretary, and the Committee on Health, Education, Labor, and Pensions of the Senate, and the Committee on Energy and Commerce of the House of Representatives, a report describing the activities of the Committee.

(2)

Consultation with students

In carrying out duties under paragraph (1), the Advisory Committee shall consult with individuals who are attending health professions schools with which this part is concerned.

(e)

Meetings and documents

(1)

Meetings

The Advisory Committee shall meet not less than 2 times each year. Such meetings shall be held jointly with other related entities established under this title where appropriate.

(2)

Documents

Not later than 14 days prior to the convening of a meeting under paragraph (1), the Advisory Committee shall prepare and make available an agenda of the matters to be considered by the Advisory Committee at such meeting. At any such meeting, the Advisory Committee shall distribute materials with respect to the issues to be addressed at the meeting. Not later than 30 days after the adjourning of such a meeting, the Advisory Committee shall prepare and make available a summary of the meeting and any actions taken by the Committee based upon the meeting.

(f)

Compensation and expenses

(1)

Compensation

Each member of the Advisory Committee shall be compensated at a rate equal to the daily equivalent of the annual rate of basic pay prescribed for level IV of the Executive Schedule under section 5315 of title 5, United States Code, for each day (including travel time) during which such member is engaged in the performance of the duties of the Committee.

(2)

Expenses

The members of the Advisory Committee shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for employees of agencies under subchapter I of chapter 57 of title 5, United States Code, while away from their homes or regular places of business in the performance of services for the Committee.

(g)

FACA

The Federal Advisory Committee Act shall apply to the Advisory Committee under this section only to the extent that the provisions of such Act do not conflict with the requirements of this section.

308.

McNair Postbaccalaureate Achievement Program

Section 402E of the Higher Education Act of 1965 (20 U.S.C. 1070a–15) is amended by striking subsection (g) and inserting the following:

(g)

Collaboration in Health profession Diversity training programs

The Secretary shall coordinate with the Secretary of Health and Human Services to ensure that there is collaboration between the goals of the program under this section and programs of the Health Resources and Services Administration that promote health workforce diversity. The Secretary of Education shall take such measures as may be necessary to encourage participants in programs under this section to consider health profession careers.

(h)

Funding

From amounts appropriated pursuant to the authority of section 402A(g), the Secretary shall, to the extent practicable, allocate funds for projects authorized by this section in an amount which is not less than $31,000,000 for each of the fiscal years 2012 through 2018.

.

309.

Rules for determination of full-time equivalent residents for cost reporting periods

(a)

DGME determinations

Section 1886(h)(4) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended—

(1)

in subparagraph (E), by striking Subject to subparagraphs (J) and (K), such rules and inserting Subject to subparagraphs (J), (K), and (L), such rules;

(2)

in subparagraph (J), by striking Such rules and inserting Subject to subparagraph (L), such rules;

(3)

in subparagraph (K), by striking In determining and inserting Subject to subparagraph (L), in determining; and

(4)

by adding at the end the following new subparagraph:

(L)

For purposes of cost-reporting periods beginning on or after October 1, 2011, in determining the hospital’s number of full-time equivalent residents for purposes of this subparagraph, all the time spent by an intern or resident in an approved medical residency training program shall be counted toward the determination of full-time equivalency if the hospital—

(i)

is recognized as a subsection (d) hospital;

(ii)

is recognized as a subsection (d) Puerto Rico hospital;

(iii)

is reimbursed under a reimbursement system authorized under section 1814(b)(3); or

(iv)

is a provider-based hospital outpatient department.

.

(b)

IME determinations

Section 1886(d)(5)(B) of such Act (42 U.S.C. 1395ww(d)(5)(B)) is amended—

(1)

in clause (x)(II), by striking In determining and inserting Subject to subclause (x)(IV), in determining;

(2)

in clause (x)(III), by striking In determining and inserting Subject to subclause (x)(IV), in determining; and

(3)

by adding at the end the following new subclause:

(IV)

The provisions of subparagraph (L) of subsection (h)(4) shall apply under this subparagraph in the same manner as they apply under such subsection.

.

310.

Developing and implementing strategies for local health equity

(a)

Grants

The Secretaries of Health and Human Services, Education, and Labor, acting jointly, shall make grants to academic institutions for the purposes of—

(1)

in accordance with subsection (b), developing capacity—

(A)

to build an evidence base for successful strategies for increasing local health equity; and

(B)

to serve as national models of driving local health equity;

(2)

in accordance with subsection (c), developing a strategic partnership with the community in which the academic institution is located; and

(3)

collecting data on, and periodically evaluating, the effectiveness of the institution’s programs funded through this section to enable the institution to adapt accordingly for maximum efficiency and success.

(b)

Developing capacity for increasing local health equity

As a condition on receipt of a grant under subsection (a), an academic institution shall agree to use the grant to build an evidence base for successful strategies for increasing local health equity, and to serve as a national model of driving local health equity, by supporting—

(1)

resources to strengthen institutional metrics and capacity to execute institutionwide health workforce goals that can serve as models for increasing health equity in communities across the country ;

(2)

collaborations among a cohort of institutions in implementing systemic change, partnership development, and programmatic efforts supportive of health equity goals across disciplines and populations; and

(3)

enhanced or newly developed data systems and research infrastructure capable of informing current and future workforce efforts and building a foundation for a broader research agenda targeting urban health disparities.

(c)

Strategic partnerships

As a condition on receipt of a grant under subsection (a), an academic institution shall agree to use the grant to develop a strategic partnership with the community in which the institution is located for the purposes of—

(1)

strengthening connections between the institution and the community—

(A)

to improve evaluation of and address the community’s health and health workforce needs; and

(B)

to engage the community in health workforce development;

(2)

developing, enhancing, or accelerating innovative undergraduate and graduate programs in the biomedical sciences and health professions; and

(3)

strengthening the birth to career pipeline in the biomedical sciences and health professions, including by developing partnerships between institutions of higher education and elementary and secondary schools to recruit the next generation of health professionals earlier in the pipeline to a health care career.

311.

Loan forgiveness for mental and behavioral health social workers

Section 455 of the Higher Education Act of 1965 (20 U.S.C. 1087e) is amended by adding at the end the following new subsection:

(q)

Repayment plan for mental and behavioral health social workers

(1)

In general

The Secretary shall cancel the balance of interest and principal due on any eligible Federal Direct Loan not in default for a borrower who—

(A)

has made 120 monthly payments on the eligible Federal Direct Loan after October 1, 2012, pursuant to any one or a combination of the following—

(i)

payments under an income-based repayment plan under section 493C;

(ii)

payments under a standard repayment plan under subsection (d)(1)(A), based on a 10-year repayment period;

(iii)

monthly payments under a repayment plan under subsection (d)(1) or (g) of not less than the monthly amount calculated under subsection (d)(1)(A), based on a 10-year repayment period; or

(iv)

payments under an income contingent repayment plan under subsection (d)(1)(D); and

(B)
(i)

is employed as a mental health or behavioral health social worker, as defined by the Secretary by regulation, at the time of such forgiveness; and

(ii)

has been employed as such a mental health or behavioral health social worker during the period in which the borrower makes each of the 120 payments as described in subparagraph (A).

(2)

Loan cancellation amount

After the conclusion of the employment period described in paragraph (1), the Secretary shall cancel the obligation to repay the balance of principal and interest due as of the time of such cancellation, on the eligible Federal Direct Loans made to the borrower under this part.

(3)

Definition of eligible Federal Direct Loan

In this subsection, the term eligible Federal Direct Loan means a Federal Direct Stafford Loan, Federal Direct PLUS Loan, Federal Direct Unsubsidized Stafford Loan, or a Federal Direct Consolidation Loan.

.

IV

Improvement of Health Care Services

A

Health Empowerment Zones

401.

Short title

This subtitle may be cited as the Health Empowerment Zone Act of 2011.

402.

Findings

The Congress finds the following:

(1)

Numerous studies and reports, including the National Healthcare Disparities Report and Unequal Treatment, the 2002 Institute of Medicine Report, document the extensiveness to which health disparities exist across the country.

(2)

These studies have found that, on average, racial and ethnic minorities are disproportionately afflicted with chronic and acute conditions—such as cancer, diabetes, and hypertension—and suffer worse health outcomes, worse health status, and higher mortality rates than their White counterparts.

(3)

Several recent studies also show that health disparities are a function of not only access to health care, but also the social determinants of health—including the environment, the physical structure of communities, nutrition and food options, educational attainment, employment, race, ethnicity, geography, and language preference—that directly and indirectly affect the health, health care, and wellness of individuals and communities.

(4)

Integrally involving and fully supporting the communities most affected by health inequities in the assessment, planning, launch, and evaluation of health disparity elimination efforts is among the leading recommendations made to adequately address and ultimately reduce health disparities.

(5)

Recommendations also include supporting the efforts of community stakeholders from a broad crosssection—including, but not limited to local businesses, local departments of commerce, education, labor, urban planning, and transportation, and community-based and other nonprofit organizations—to find areas of common ground around health disparity elimination and collaborate to improve the overall health and wellness of a community and its residents.

403.

Designation of health empowerment zones

(a)

In general

At the request of an eligible community partnership, the Secretary may designate an eligible area as a health empowerment zone.

(b)

Eligibility criteria

(1)

Eligible community partnership

A community partnership is eligible to submit a request under this section if the partnership—

(A)

demonstrates widespread public support from key individuals and entities in the eligible area, including State and local governments, nonprofit organizations, and community and industry leaders, for designation of the eligible area as a health empowerment zone; and

(B)

includes representatives of—

(i)

a broad cross section of stakeholders and residents from communities in the eligible area experiencing disproportionate disparities in health status and health care; and

(ii)

organizations, facilities, and institutions that have a history of working within and serving such communities.

(2)

Eligible area

An area is eligible to be designated as a health empowerment zone under this section if one or more communities in the area experience disproportionate disparities in health status and health care. In determining whether a community experiences such disparities, the Secretary shall consider the data collected by the Department of Health and Human Services focusing on the following areas:

(A)

Access to affordable high-quality health services.

(B)

Arthritis, osteoporosis, and chronic back conditions.

(C)

Cancer.

(D)

Chronic kidney disease.

(E)

Diabetes.

(F)

Injury and violence prevention.

(G)

Maternal, infant, and child health.

(H)

Medical product safety.

(I)

Mental health and mental disorders.

(J)

Nutrition and overweight.

(K)

Disability and secondary conditions.

(L)

Educational and community-based health programs.

(M)

Environmental health.

(N)

Family planning.

(O)

Food safety.

(P)

Health communication.

(Q)

Health disease and stroke.

(R)

HIV/AIDS.

(S)

Immunization and infectious diseases.

(T)

Occupational safety and health.

(U)

Oral health.

(V)

Physical activity and fitness.

(W)

Public health infrastructure.

(X)

Respiratory diseases.

(Y)

Sexually transmitted diseases.

(Z)

Substance abuse.

(AA)

Tobacco use.

(BB)

Vision and hearing.

(CC)

The degree to which those who have disabilities have access to health services, including physical activity and fitness, including the ability to physically access the locations where such services are provided.

(c)

Procedure

(1)

Request

A request under subsection (a) shall—

(A)

describe the bounds of the area to be designated as a health empowerment zone and the process used to select those bounds;

(B)

demonstrate that the partnership submitting the request is an eligible community partnership described in subsection (b)(1);

(C)

demonstrate that the area is an eligible area described in subsection (b)(2);

(D)

include a comprehensive assessment of disparities in health status and health care experience by one or more communities in the area;

(E)

set forth—

(i)

a vision and a set of values for the area; and

(ii)

a comprehensive and holistic set of goals to be achieved in the area through designation as a health empowerment zone; and

(F)

include a strategic plan for achieving the goals described in subparagraph (E)(ii).

(2)

Approval

Not later than 60 days after the receipt of a request for designation of an area as a health empowerment zone under this section, the Secretary shall approve or disapprove the request.

(d)

Minimum number

The Secretary—

(1)

shall designate not more than 110 health empowerment zones under this section; and

(2)

shall designate at least one health empowerment zone in each of the several States, the District of Columbia, and each territory or possession of the United States.

404.

Assistance to those seeking designation

At the request of any organization or entity seeking to submit a request under section 403(a), the Secretary shall provide technical assistance, and may award a grant, to assist such organization or entity—

(1)

to form an eligible community partnership described in section 403(b)(1);

(2)

to complete a health assessment, including an assessment of health disparities under section 403(c)(1)(D); or

(3)

to prepare and submit a request, including a strategic plan, in accordance with section 403.

405.

Benefits of designation

(a)

Priority

In awarding any competitive grant, a Federal official shall give priority to any applicant that—

(1)

meets the eligibility criteria for the grant;

(2)

proposes to use the grant for activities in a health empowerment zone; and

(3)

demonstrates that such activities will directly and significantly further the goals of the strategic plan approved for such zone under section 403.

(b)

Grants for initial implementation of strategic plan

(1)

In general

Upon designating an eligible area as a health empowerment zone at the request of an eligible community partnership, the Secretary shall, subject to the availability of appropriations, make a grant to the community partnership for implementation of the strategic plan for such zone.

(2)

Grant period

A grant under paragraph (1) for a health empowerment zone shall be for a period of 2 years and may be renewed, except that the total period of grants under paragraph (1) for such zone may not exceed 10 years.

(3)

Limitation

In awarding grants under this subsection, the Secretary shall not give less priority to an applicant or reduce the amount of a grant because the Secretary rendered technical assistance or made a grant to the same applicant under section 404.

(4)

Reporting

The Secretary shall require each recipient of a grant under this subsection to report to the Secretary not less than every 6 months on the progress in implementing the strategic plan for the health empowerment zone.

406.

Definition

In this subtitle, the term Secretary means the Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration and the Deputy Assistant Secretary for Minority Health, and in cooperation with the Director of the Office of Community Services and the Director of the National Institute for Minority Health and Health Disparities.

407.

Authorization of appropriations

To carry out this subtitle, there is authorized to be appropriated $100,000,000 for fiscal year 2012.

B

Other Improvements of Health Care Services

1

Expansion of Coverage

411.

Amendment to the Public Health Service Act

Title XXXIV of the Public Health Service Act, as amended by titles I, II, III, and IX of this Act, is further amended by inserting after subtitle C the following:

D

Reconstruction and Improvement Grants for Public Health Care Facilities Serving Pacific Islanders and the Insular Areas

3451.

Grant support for quality improvement initiatives

(a)

In general

The Secretary, in collaboration with the Administrator of the Health Resources and Services Administration, the Director of the Agency for Healthcare Research and Quality, and the Administrator of the Centers for Medicare & Medicaid Services, shall award grants to eligible entities for the conduct of demonstration projects to improve the quality of and access to health care.

(b)

Eligibility

To be eligible to receive a grant under subsection (a), an entity shall—

(1)

be a health center, hospital, health plan, health system, community clinic. or other health entity determined appropriate by the Secretary—

(A)

that, by legal mandate or explicitly adopted mission, provides patients with access to services regardless of their ability to pay;

(B)

that provides care or treatment for a substantial number of patients who are uninsured, are receiving assistance under a State program under title XIX of the Social Security Act, or are members of vulnerable populations, as determined by the Secretary; and

(C)
(i)

with respect to which, not less than 50 percent of the entity’s patient population is made up of racial and ethnic minorities; or

(ii)

that—

(I)

serves a disproportionate percentage of local, minority racial and ethnic patients, or that has a patient population, at least 50 percent of which is limited-English proficient; and

(II)

provides an assurance that amounts received under the grant will be used only to support quality improvement activities in the racial and ethnic population served; and

(2)

prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.

(c)

Priority

In awarding grants under subsection (a), the Secretary shall give priority to applicants under subsection (b)(2) that—

(1)

demonstrate an intent to operate as part of a health care partnership, network, collaborative, coalition, or alliance where each member entity contributes to the design, implementation, and evaluation of the proposed intervention; or

(2)

intend to use funds to carry out systemwide changes with respect to health care quality improvement, including—

(A)

improved systems for data collection and reporting;

(B)

innovative collaborative or similar processes;

(C)

group programs with behavioral or self-management interventions;

(D)

case management services;

(E)

physician or patient reminder systems;

(F)

educational interventions; or

(G)

other activities determined appropriate by the Secretary.

(d)

Use of funds

An entity shall use amounts received under a grant under subsection (a) to support the implementation and evaluation of health care quality improvement activities or minority health and health care disparity reduction activities that include—

(1)

with respect to health care systems, activities relating to improving—

(A)

patient safety;

(B)

timeliness of care;

(C)

effectiveness of care;

(D)

efficiency of care;

(E)

patient centeredness; and

(F)

health information technology; and

(2)

with respect to patients, activities relating to—

(A)

staying healthy;

(B)

getting well;

(C)

living with illness or disability; and

(D)

coping with end-of-life issues.

(e)

Common data systems

The Secretary shall provide financial and other technical assistance to grantees under this section for the development of common data systems.

(f)

Authorization of appropriations

There are authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2010 through 2015.

3452.

Centers of excellence

(a)

In general

The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall designate centers of excellence at public hospitals, and other health systems serving large numbers of minority patients, that—

(1)

meet the requirements of section 3451(b)(1);

(2)

demonstrate excellence in providing care to minority populations; and

(3)

demonstrate excellence in reducing disparities in health and health care.

(b)

Requirements

A hospital or health system that serves as a Center of Excellence under subsection (a) shall—

(1)

design, implement, and evaluate programs and policies relating to the delivery of care in racially, ethnically, and linguistically diverse populations;

(2)

provide training and technical assistance to other hospitals and health systems relating to the provision of quality health care to minority populations; and

(3)

develop activities for graduate or continuing medical education that institutionalize a focus on cultural competence training for health care providers.

(c)

Authorization of appropriations

There are authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2010 through 2015.

3453.

Reconstruction and improvement grants for Public Health care facilities serving Pacific Islanders and the insular areas

(a)

In general

The Secretary shall provide direct financial assistance to designated health care providers and community health centers in American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the United States Virgin Islands, Puerto Rico, and Hawaii for the purposes of reconstructing and improving health care facilities and services.

(b)

Eligibility

To be eligible to receive direct financial assistance under subsection (a), an entity shall be a public health facility or community health center located in American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the United States Virgin Islands, Puerto Rico, or Hawaii that—

(1)

is owned or operated by—

(A)

the Government of American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the United States Virgin Islands, Puerto Rico, or Hawaii or a unit of local government; or

(B)

a nonprofit organization; and

(2)
(A)

provides care or treatment for a substantial number of patients who are uninsured, receiving assistance under a State program under a title XVIII of the Social Security Act, or a State program under title XIX of such Act, or who are members of a vulnerable population, as determined by the Secretary; or

(B)

serves a disproportionate percentage of local, minority racial and ethnic patients.

(c)

Report

Not later than 180 days after the date of enactment of this title and annually thereafter, the Secretary shall submit to the Congress and the President a report that includes an assessment of health resources and facilities serving populations in American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the United States Virgin Islands, Puerto Rico, and Hawaii. In preparing such report, the Secretary shall—

(1)

consult with and obtain information on all health care facilities needs from the entities described in subsection (b);

(2)

include all amounts of Federal assistance received by each entity in the preceding fiscal year;

(3)

review the total unmet needs of each jurisdiction for health care facilities, including needs for renovation and expansion of existing facilities; and

(4)

include a strategic plan for addressing the needs of each jurisdiction identified in the report.

(d)

Authorization of appropriations

There are authorized to be appropriated such sums as necessary to carry out this section.

.

412.

Removing barriers to unsubsidized purchase of private insurance in American Health Benefit Exchanges

(a)

In general

Section 1312(f) of the Patient Protection and Affordable Care Act (42 U.S.C.18032(f)) is amended—

(1)

in the subsection heading, by striking the semicolon and all that follows through Residents; and

(2)

by striking paragraph (3).

(b)

Conforming amendment

Section 1411(a)(1) of such Act (42 U.S.C. 18081(a)(1)) is amended by striking 1312(f)(3),.

413.

Study on the uninsured

(a)

In general

The Secretary of Health and Human Services shall—

(1)

conduct a study on the demographic characteristics of the population of individuals who do not have health insurance coverage; and

(2)

predict, based on such study, the demographic characteristics of the population of individuals who will not have health insurance coverage after January 1, 2014.

(b)

Reporting requirements

(1)

In general

Not later than 12 months after the date of the enactment of this Act, the Secretary shall submit to the Congress the results of the study under subsection (a)(1) and the prediction made under subsection (a)(2).

(2)

Reporting of demographic characteristics

The Secretary shall report the demographic characteristics under paragraphs (1) and (2) of subsection (a) on the basis of racial and ethnic group, and shall stratify the reporting on each racial and ethnic group by other demographic characteristics that can impact access to health insurance coverage, such as sexual orientation, gender identity, primary language, disability status, sex, socioeconomic status, and citizenship and immigration status, in a manner consistent with title I of this Act.

414.

Medicaid payment parity for the territories

(a)

Elimination of funding limitations for Puerto Rico, the United States Virgin Islands, Guam, the Commonwealth of the Northern Mariana Islands, and American Samoa

(1)

In general

Section 1108 of the Social Security Act (42 U.S.C. 1308) is amended—

(A)

in subsection (f), in the matter before paragraph (1), by striking subsection (g) and inserting subsections (g) and (h);

(B)

in subsection (g)(2), in the matter before subparagraph (A), by inserting and subsection (h) after paragraphs (3) and (5); and

(C)

by adding at the end the following new subsection:

(h)

Sunset of funding limitations for Puerto Rico, the United States Virgin Islands, Guam, the Commonwealth of the Northern Mariana Islands, and American Samoa

Subsections (f) and (g) shall not apply to Puerto Rico, the United States Virgin Islands, Guam, the Commonwealth of the Northern Mariana Islands, and American Samoa for any fiscal year after fiscal year 2011.

.

(2)

Conforming amendment

Section 1903(u) of such Act (42 U.S.C. 1396c(u)) is amended by striking paragraph (4).

(3)

Effective date

The amendments made by this subsection shall apply beginning with fiscal year 2012.

(b)

Parity in FMAP

(1)

In general

Section 1905(b)(2) of such Act (42 U.S.C. 1396d(b)(2)) is amended by inserting after 50 per centum the following: (except that, beginning with fiscal year 2014, the Federal medical assistance percentage for Puerto Rico, the United States Virgin Islands, Guam, the Commonwealth of the Northern Mariana Islands, and American Samoa shall be the Federal medical assistance percentage determined by the Secretary in consultation (for the United States Virgin Islands, Guam, the Commonwealth of the Northern Mariana Islands, and American Samoa) with the Secretary of the Interior).

(2)

2-fiscal-year transition

Notwithstanding any other provision of law, during fiscal years 2012 and 2013, the Federal medical assistance percentage established under section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) for Puerto Rico, the United States Virgin Islands, Guam, the Commonwealth of the Northern Mariana Islands, and American Samoa shall be the highest such Federal medical assistance percentage applicable to any of the 50 States or the District of Columbia for the fiscal year involved, taking into account the application of subsections (a) and (b)(1) of 5001 of division B of the American Recovery and Reinvestment Act of 2009 (Public Law 111–5) to such States and District of Columbia for calendar quarters during such fiscal years for which such subsections apply respectively.

(3)

Per capita income data

(A)

Report to Congress

Not later than October 1, 2012, the Secretary of Health and Human Services shall submit to Congress a report that describes the per capita income data used to promulgate the Federal medical assistance percentage in the territories and how such data differ from the per capita income data used to promulgate Federal medical assistance percentages for the 50 States and the District of Columbia. The report should include recommendations on how the Federal medical assistance percentages can be calculated for the territories to ensure parity with the 50 States and the District of Columbia.

(B)

Application

Section 1101(a)(8)(B) of the Social Security Act (42 U.S.C. 1308(a)(8)(B)) is amended—

(i)

by striking (other than Puerto Rico, the United States Virgin Islands, and Guam) and inserting (including Puerto Rico, the United States Virgin Islands, Guam, the Commonwealth of the Northern Mariana Islands, and American Samoa); and

(ii)

by inserting (or, if such satisfactory data are not available in the case of the Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa, satisfactory data available from the Department of the Interior for the same period, or if such satisfactory data are not available in the case of Puerto Rico, satisfactory data available from the government of the Commonwealth of Puerto Rico for the same period) after Department of Commerce.

(4)

Relation to American Recovery and Reinvestment Act of 2009

For any period and territory in which the provisions of this subsection apply to a territory, the provisions of section 5001(b)(2) of division B of the American Recovery and Reinvestment Act of 2009 (Public Law 111–5) shall not apply (except as otherwise specifically provided in paragraph (2)).

415.

Clarification of Medicaid coverage for citizens of Freely Associated States

(a)

In general

Section 402(b)(2) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1612(b)(2)) is amended by adding at the end the following:

(G)

Medicaid exception for citizens of Freely Associated States

With respect to eligibility for benefits for the program defined in paragraph (3)(C) (relating to the Medicaid program), paragraph (1) shall not apply to any individual who lawfully resides in the United States (including territories and possessions of the United States) in accordance with the Compacts of Free Association between the Government of the United States and the Governments of the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.

.

(b)

Conforming definition of qualified alien

Section 431(b) of such Act (8 U.S.C. 1641(b)) is amended—

(1)

in paragraph (6), by striking or at the end;

(2)

in paragraph (7), by striking the period at the end and inserting ; or; and

(3)

by adding at the end the following:

(8)

an individual who lawfully resides in the United States (including territories and possessions of the United States) in accordance with a Compact of Free Association referred to in section 402(b)(2)(G), but only with respect to the program defined in section 402(b)(3)(C) (relating to the Medicaid program).

.

(c)

Setting FMAP at 100 percent

The third sentence of section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) is amended by inserting before the period at the end the following: ; with respect to medical assistance for individuals described in section 402(b)(2)(G) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.

(d)

Effective date

The amendments made by this Act take effect on October 1, 2011, and apply to benefits and assistance provided on or after that date.

416.

Extension of Medicare secondary payer

(a)

In general

Section 1862(b)(1)(C) of the Social Security Act (42 U.S.C. 1395y(b)(1)(C)) is amended—

(1)

in the last sentence, by inserting , and before January 1, 2012 after prior to such date); and

(2)

by adding at the end the following new sentence: Effective for items and services furnished on or after January 1, 2012 (with respect to periods beginning on or after the date that is 42 months prior to such date), clauses (i) and (ii) shall be applied by substituting 42-month for 12-month each place it appears in the first sentence..

(b)

Effective date

The amendments made by this subsection shall take effect on the date of enactment of this Act. For purposes of determining an individual’s status under section 1862(b)(1)(C) of the Social Security Act (42 U.S.C. 1395y(b)(1)(C)), as amended by paragraph (1), an individual who is within the coordinating period as of the date of enactment of this Act shall have that period extended to the full 42 months described in the last sentence of such section, as added by the amendment made by paragraph (1)(B).

417.

Border health grants

(a)

Eligible entity defined

In this section, the term eligible entity means a State, public institution of higher education, local government, tribal government, nonprofit health organization, community health center, or community clinic receiving assistance under section 330 of the Public Health Service Act (42 U.S.C. 254b), that is located in the border area.

(b)

Authorization

From funds appropriated under subsection (f), the Secretary of Health and Human Services (in this section referred to as the Secretary), acting through the United States members of the United States-Mexico Border Health Commission, shall award grants to eligible entities to address priorities and recommendations to improve the health of border area residents that are established by—

(1)

the United States members of the United States-Mexico Border Health Commission;

(2)

the State border health offices; and

(3)

the Secretary.

(c)

Application

An eligible entity that desires a grant under subsection (b) shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.

(d)

Use of funds

An eligible entity that receives a grant under subsection (b) shall use the grant funds for—

(1)

programs relating to—

(A)

maternal and child health;

(B)

primary care and preventative health;

(C)

public health and public health infrastructure;

(D)

health education and promotion;

(E)

oral health;

(F)

mental and behavioral health;

(G)

substance abuse;

(H)

health conditions that have a high prevalence in the border area;

(I)

medical and health services research;

(J)

workforce training and development;

(K)

community health workers or promotoras;

(L)

health care infrastructure problems in the border area (including planning and construction grants);

(M)

health disparities in the border area;

(N)

environmental health; and

(O)

outreach and enrollment services with respect to Federal programs (including programs authorized under titles XIX and XXI of the Social Security Act (42 U.S.C. 1396 and 1397aa)); and

(2)

other programs determined appropriate by the Secretary.

(e)

Supplement, not supplant

Amounts provided to an eligible entity awarded a grant under subsection (b) shall be used to supplement and not supplant other funds available to the eligible entity to carry out the activities described in subsection (d).

(f)

Authorization of appropriations

There are authorized to be appropriated to carry out this section, $200,000,000 for fiscal year 2012, and such sums as may be necessary for each succeeding fiscal year.

418.

Removing Medicare barrier to health care

Section 1818(a)(3) of the Social Security Act (42 U.S.C. 1395i–2(a)(3)) is amended by amending subparagraph (B) to read as follows: (B) an individual who is lawfully present in the United States.

419.

100 percent FMAP for medical assistance provided by urban Indian health centers

(a)

In general

Section 1905(b) of the Social Security Act (42 U.S.C. 1396(b)), as amended by section 415(c), is amended by inserting or are received through a program operated by an urban Indian organization through a grant or contract under title V of such Act.

(b)

Effective date

The amendment made by this section shall apply to medical assistance provided on or after the date of enactment of this Act.

420.

100 percent FMAP for medical assistance provided to a Native Hawaiian through a federally qualified health center or a Native Hawaiian health care system under the Medicaid program

(a)

In general

The third sentence of section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)), as amended by section 419, is amended by inserting ; and, with respect to medical assistance provided to a Native Hawaiian (as defined in section 12(2) of the Native Hawaiian Health Care Improvement Act) through a federally qualified health center or a Native Hawaiian health care system (as defined in section 12(6) of such Act), whether directly, by referral, or under contract or other arrangement between such federally qualified health center or Native Hawaiian health care system and another health care provider before the period.

(b)

Effective date

The amendment made by this section shall apply to medical assistance provided on or after the date of enactment of this Act.

2

Expansion of Access

421.

Grants for racial and ethnic approaches to community health

(a)

Purpose

It is the purpose of this section to provide for the awarding of grants to assist communities in mobilizing and organizing resources in support of effective and sustainable programs that will reduce or eliminate disparities in health and health care experienced by racial and ethnic minority individuals.

(b)

Authority To Award Grants

The Secretary, acting through the Centers for Disease Control and Prevention, shall award grants to eligible entities to assist in designing, implementing, and evaluating culturally and linguistically appropriate, science-based, and community-driven sustainable strategies to eliminate racial and ethnic health and health care disparities.

(c)

Eligible Entities

To be eligible to receive a grant under this section, an entity shall—

(1)

represent a coalition—

(A)

whose principal purpose is to develop and implement interventions to reduce or eliminate a health or health care disparity in a targeted racial or ethnic minority group in the community served by the coalition; and

(B)

that includes—

(i)

members selected from among—

(I)

public health departments;

(II)

community-based organizations;

(III)

university and research organizations;

(IV)

American Indian tribal organizations, national American Indian organizations, Indian Health Service, or organizations serving Alaska Natives; and

(V)

interested public or private health care providers or organizations as deemed appropriate by the Secretary; and

(ii)

at least 1 member from a community-based organization that represents the targeted racial or ethnic minority group; and

(2)

submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require, which shall include—

(A)

a description of the targeted racial or ethnic populations in the community to be served under the grant;

(B)

a description of at least 1 health disparity that exists in the racial or ethnic targeted populations, including health issues such as infant mortality, breast and cervical cancer screening and management, cardiovascular disease, diabetes, child and adult immunization levels, or other health priority areas as designated by the Secretary; and

(C)

a demonstration of a proven record of accomplishment of the coalition members in serving and working with the targeted community.

(d)

Sustainability

The Secretary shall give priority to an eligible entity under this section if the entity agrees that, with respect to the costs to be incurred by the entity in carrying out the activities for which the grant was awarded, the entity (and each of the participating partners in the coalition represented by the entity) will maintain its expenditures of non-Federal funds for such activities at a level that is not less than the level of such expenditures during the fiscal year immediately preceding the first fiscal year for which the grant is awarded.

(e)

Nonduplication

Funds provided through this grant program should supplement, not supplant, existing Federal funding, and the funds should not be used to duplicate the activities of the other health disparity grant programs in this Act.

(f)

Technical Assistance

The Secretary may, either directly or by grant or contract, provide any entity that receives a grant under this section with technical and other nonfinancial assistance necessary to meet the requirements of this section.

(g)

Dissemination

The Secretary shall encourage and enable grantees to share best practices, evaluation results, and reports with communities not affiliated with grantees using the Internet, conferences, and other pertinent information regarding the projects funded by this section, including the outreach efforts of the Office of Minority Health and Health Disparity Elimination and the Centers for Disease Control and Prevention.

(h)

Administrative Burdens

The Secretary shall make every effort to minimize duplicative or unnecessary administrative burdens on grantees.

(i)

Authorization of appropriations

There are authorized to be appropriated such sums as may be necessary to carry out this section.

422.

Critical access hospital improvements

(a)

Elimination of isolation Test for cost-based ambulance reimbursement

(1)

In general

Section 1834(l)(8) of the Social Security Act (42 U.S.C. 1395m(l)(8)) is amended—

(A)

in subparagraph (B)—

(i)

by striking owned and; and

(ii)

by inserting (including when such services are provided by the entity under an arrangement with the hospital) after hospital; and

(B)

by striking the comma at the end of subparagraph (B) and all that follows and inserting a period.

(2)

Effective date

The amendments made by this subsection shall apply to services furnished on or after January 1, 2012.

(b)

Provision of a more flexible alternative to the CAH designation 25 inpatient bed limit requirement

(1)

In general

Section 1820(c)(2) of the Social Security Act (42 U.S.C. 1395i–4(c)(2)) is amended—

(A)

in subparagraph (B)(iii), by striking provides not more than and inserting subject to subparagraph (F), provides not more than; and

(B)

by adding at the end the following new subparagraph:

(F)

Alternative to 25 inpatient bed limit requirement

(i)

In general

A State may elect to treat a facility, with respect to the designation of the facility for a cost reporting period, as satisfying the requirement of subparagraph (B)(iii) relating to a maximum number of acute care inpatient beds if the facility elects, in accordance with a method specified by the Secretary and before the beginning of the cost reporting period, to meet the requirement under clause (ii).

(ii)

Alternate requirement

The requirement under this clause, with respect to a facility and a cost reporting period, is that the total number of inpatient bed days described in subparagraph (B)(iii) during such period will not exceed 7,300. For purposes of this subparagraph, an individual who is an inpatient in a bed in the facility for a single day shall be counted as one inpatient bed day.

(iii)

Withdrawal of election

The option described in clause (i) shall not apply to a facility for a cost reporting period if the facility (for any two consecutive cost-reporting periods during the previous 5 cost-reporting periods) was treated under such option and had a total number of inpatient bed days for each of such two cost-reporting periods that exceeded the number specified in such clause.

.

(2)

Effective date

The amendments made by paragraph (1) shall apply to cost-reporting periods beginning on or after the date of the enactment of this Act.

423.

Establishment of Rural Community Hospital (RCH) Program

(a)

In general

Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by section 203(b)(1)(A), is amended by adding at the end of the following new subsection:

(jjj)

Rural Community Hospital; Rural Community Hospital Services

(1)

The term rural community hospital means a hospital (as defined in subsection (e)) that—

(A)

is located in a rural area (as defined in section 1886(d)(2)(D)) or treated as being so located pursuant to section 1886(d)(8)(E);

(B)

subject to paragraph (2), has less than 51 acute care inpatient beds, as reported in its most recent cost report;

(C)

makes available 24-hour emergency care services;

(D)

subject to paragraph (3), has a provider agreement in effect with the Secretary and is open to the public as of January 1, 2010; and

(E)

applies to the Secretary for such designation.

(2)

For purposes of paragraph (1)(B), beds in a psychiatric or rehabilitation unit of the hospital which is a distinct part of the hospital shall not be counted.

(3)

Paragraph (1)(D) shall not be construed to prohibit any of the following from qualifying as a rural community hospital:

(A)

A replacement facility (as defined by the Secretary in regulations in effect on January 1, 2012) with the same service area (as defined by the Secretary in regulations in effect on such date).

(B)

A facility obtaining a new provider number pursuant to a change of ownership.

(C)

A facility which has a binding written agreement with an outside, unrelated party for the construction, reconstruction, lease, rental, or financing of a building as of January 1, 2012.

(4)

Nothing in this subsection shall be construed as prohibiting a critical access hospital from qualifying as a rural community hospital if the critical access hospital meets the conditions otherwise applicable to hospitals under subsection (e) and section 1866.

(5)

Nothing in this subsection shall be construed as prohibiting a rural community hospital participating in the demonstration program under section 410A of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173; 117 Stat. 2313) from qualifying as a rural community hospital if the rural community hospital meets the conditions otherwise applicable to hospitals under subsection (e) and section 1866.

.

(b)

Payment

(1)

Inpatient hospital services

Section 1814 of the Social Security Act (42 U.S.C. 1395f) is amended by adding at the end the following new subsection:

(m)

Payment for Inpatient Services Furnished in Rural Community Hospitals

The amount of payment under this part for inpatient hospital services furnished in a rural community hospital, other than such services furnished in a psychiatric or rehabilitation unit of the hospital which is a distinct part, is, at the election of the hospital in the application referred to in section 1861(jjj)(1)(E)—

(1)

101 percent of the reasonable costs of providing such services, without regard to the amount of the customary or other charge, or

(2)

the amount of payment provided for under the prospective payment system for inpatient hospital services under section 1886(d).

.

(2)

Outpatient services

Section 1834 of such Act (42 U.S.C. 1395m) is amended by adding at the end the following new subsection:

(p)

Payment for outpatient services furnished in rural community hospitals

The amount of payment under this part for outpatient services furnished in a rural community hospital is, at the election of the hospital in the application referred to in section 1861(jjj)(1)(E)—

(1)

101 percent of the reasonable costs of providing such services, without regard to the amount of the customary or other charge and any limitation under section 1861(v)(1)(U), or

(2)

the amount of payment provided for under the prospective payment system for covered OPD services under section 1833(t).

.

(3)

Exemption from 30-percent reduction in reimbursement for bad debt

Section 1861(v)(1)(T) of such Act (42 U.S.C. 1395x(v)(1)(T)) is amended by inserting (other than for a rural community hospital) after In determining such reasonable costs for hospitals.

(c)

Beneficiary cost-Sharing for outpatient services

Section 1834(p) of such Act (as added by subsection (b)(2)) is amended—

(1)

by redesignating paragraphs (1) and (2) as subparagraphs (A) and (B), respectively;

(2)

by inserting (1) after (p); and

(3)

by adding at the end the following:

(2)

The amounts of beneficiary costsharing for outpatient services furnished in a rural community hospital under this part shall be as follows:

(A)

For items and services that would have been paid under section 1833(t) if provided by a hospital, the amount of costsharing determined under paragraph (8) of such section.

(B)

For items and services that would have been paid under section 1833(h) if furnished by a provider or supplier, no costsharing shall apply.

(C)

For all other items and services, the amount of costsharing that would apply to the item or service under the methodology that would be used to determine payment for such item or service if provided by a physician, provider, or supplier, as the case may be.

.

(d)

Conforming amendments

(1)

Part A payment

Section 1814(b) of such Act (42 U.S.C. 1395f(b)) is amended in the matter preceding paragraph (1) by inserting other than inpatient hospital services furnished by a rural community hospital, after critical access hospital services,.

(2)

Part B payment

Section 1833(a) of such Act (42 U.S.C. 1395l(a)), as amended by section 203(b)(2), is amended—

(A)

in paragraph (2), in the matter before subparagraph (A), by striking and (I) and inserting (I), and (K);

(B)

by striking and at the end of paragraph (9);

(C)

by striking the period at the end of paragraph (10) and inserting ; and; and

(D)

by adding at the end the following:

(11)

in the case of outpatient services furnished by a rural community hospital, the amounts described in section 1834(p).

.

(3)

Technical amendments

(A)

Consultation with state agencies

Section 1863 of such Act (42 U.S.C. 1395z) is amended by striking and (dd)(2) and inserting (dd)(2), (mm)(1), and (jjj)(1).

(B)

Provider agreements

Section 1866(a)(2)(A) of such Act (42 U.S.C. 1395cc(a)(2)(A)) is amended by inserting section 1834(p)(2), after section 1833(b),.

(e)

Effective date

The amendments made by this section shall apply to items and services furnished on or after October 1, 2011.

424.

Medicare remote monitoring pilot projects

(a)

Pilot projects

(1)

In general

Not later than 9 months after the date of enactment of this Act, the Secretary of Health and Human Services (in this section referred to as the Secretary) shall conduct pilot projects under title XVIII of the Social Security Act for the purpose of providing incentives to home health agencies to utilize home monitoring and communications technologies that—

(A)

enhance health outcomes for Medicare beneficiaries; and

(B)

reduce expenditures under such title.

(2)

Site requirements

(A)

Urban and Rural

The Secretary shall conduct the pilot projects under this section in both urban and rural areas.

(B)

Site in a small state

The Secretary shall conduct at least 3 of the pilot projects in a State with a population of less than 1,000,000.

(3)

Definition of home health agency

In this section, the term home health agency has the meaning given that term in section 1861(o) of the Social Security Act (42 U.S.C. 1395x(o)).

(b)

Medicare beneficiaries within the scope of projects

The Secretary shall specify the criteria for identifying those Medicare beneficiaries who shall be considered within the scope of the pilot projects under this section for purposes of the application of subsection (c) and for the assessment of the effectiveness of the home health agency in achieving the objectives of this section. Such criteria may provide for the inclusion in the projects of Medicare beneficiaries who begin receiving home health services under title XVIII of the Social Security Act after the date of the implementation of the projects.

(c)

Incentives

(1)

Performance targets

The Secretary shall establish for each home health agency participating in a pilot project under this section a performance target using one of the following methodologies, as determined appropriate by the Secretary:

(A)

Adjusted historical performance target

The Secretary shall establish for the agency—

(i)

a base expenditure amount equal to the average total payments made to the agency under parts A and B of title XVIII of the Social Security Act for Medicare beneficiaries determined to be within the scope of the pilot project in a base period determined by the Secretary; and

(ii)

an annual per capita expenditure target for such beneficiaries, reflecting the base expenditure amount adjusted for risk and adjusted growth rates.

(B)

Comparative performance target

The Secretary shall establish for the agency a comparative performance target equal to the average total payments under such parts A and B during the pilot project for comparable individuals in the same geographic area that are not determined to be within the scope of the pilot project.

(2)

Incentive

Subject to paragraph (3), the Secretary shall pay to each participating home care agency an incentive payment for each year under the pilot project equal to a portion of the Medicare savings realized for such year relative to the performance target under paragraph (1).

(3)

Limitation on expenditures

The Secretary shall limit incentive payments under this section in order to ensure that the aggregate expenditures under title XVIII of the Social Security Act (including incentive payments under this subsection) do not exceed the amount that the Secretary estimates would have been expended if the pilot projects under this section had not been implemented.

(d)

Waiver authority

The Secretary may waive such provisions of titles XI and XVIII of the Social Security Act as the Secretary determines to be appropriate for the conduct of the pilot projects under this section.

(e)

Report to Congress

Not later than 5 years after the date that the first pilot project under this section is implemented, the Secretary shall submit to Congress a report on the pilot projects. Such report shall contain a detailed description of issues related to the expansion of the projects under subsection (f) and recommendations for such legislation and administrative actions as the Secretary considers appropriate.

(f)

Expansion

If the Secretary determines that any of the pilot projects under this section enhance health outcomes for Medicare beneficiaries and reduce expenditures under title XVIII of the Social Security Act, the Secretary may initiate comparable projects in additional areas.

(g)

Incentive payments have no effect on other Medicare payments to agencies

An incentive payment under this section—

(1)

shall be in addition to the payments that a home health agency would otherwise receive under title XVIII of the Social Security Act for the provision of home health services; and

(2)

shall have no effect on the amount of such payments.

425.

Rural health quality advisory commission and demonstration projects

(a)

Rural Health Quality Advisory Commission

(1)

Establishment

Not later than 6 months after the date of the enactment of this section, the Secretary of Health and Human Services (in this section referred to as the Secretary) shall establish a commission to be known as the Rural Health Quality Advisory Commission (in this section referred to as the Commission).

(2)

Duties of commission

(A)

National plan

The Commission shall develop, coordinate, and facilitate implementation of a national plan for rural health quality improvement. The national plan shall—

(i)

identify objectives for rural health quality improvement;

(ii)

identify strategies to eliminate known gaps in rural health system capacity and improve rural health quality; and

(iii)

provide for Federal programs to identify opportunities for strengthening and aligning policies and programs to improve rural health quality.

(B)

Demonstration projects

The Commission shall design demonstration projects to test alternative models for rural health quality improvement, including with respect to both personal and population health.

(C)

Monitoring

The Commission shall monitor progress toward the objectives identified pursuant to paragraph (1)(A).

(3)

Membership

(A)

Number

The Commission shall be composed of 11 members appointed by the Secretary.

(B)

Selection

The Secretary shall select the members of the Commission from among individuals with significant rural health care and health care quality expertise, including expertise in clinical health care, health care quality research, population or public health, or purchaser organizations.

(4)

Contracting authority

Subject to the availability of funds, the Commission may enter into contracts and make other arrangements, as may be necessary to carry out the duties described in paragraph (2).

(5)

Staff

Upon the request of the Commission, the Secretary may detail, on a reimbursable basis, any of the personnel of the Office of Rural Health Policy of the Health Resources and Services Administration, the Agency for Health care Quality and Research, or the Centers for Medicare & Medicaid Services to the Commission to assist in carrying out this subsection.

(6)

Reports to congress

Not later than 1 year after the establishment of the Commission, and annually thereafter, the Commission shall submit a report to the Congress on rural health quality. Each such report shall include the following:

(A)

An inventory of relevant programs and recommendations for improved coordination and integration of policy and programs.

(B)

An assessment of achievement of the objectives identified in the national plan developed under paragraph (2) and recommendations for realizing such objectives.

(C)

Recommendations on Federal legislation, regulations, or administrative policies to enhance rural health quality and outcomes.

(b)

Rural Health Quality Demonstration Projects

(1)

In general

Not later than 270 days after the date of the enactment of this section, the Secretary, in consultation with the Rural Health Quality Advisory Commission, the Office of Rural Health Policy of the Health Resources and Services Administration, the Agency for Healthcare Research and Quality, and the Centers for Medicare & Medicaid Services, shall make grants to eligible entities for 5 demonstration projects to implement and evaluate methods for improving the quality of health care in rural communities. Each such demonstration project shall include—

(A)

alternative community models that—

(i)

will achieve greater integration of personal and population health services; and

(ii)

address safety, effectiveness, patient- or community-centeredness, timeliness, efficiency, and equity (the 6 aims identified by the Institute of Medicine of the National Academies in its report entitled Crossing the Quality Chasm: A New Health System for the 21st Century released on March 1, 2001);

(B)

innovative approaches to the financing and delivery of health services to achieve rural health quality goals; and

(C)

development of quality improvement support structures to assist rural health systems and professionals (such as workforce support structures, quality monitoring and reporting, clinical care protocols, and information technology applications).

(2)

Eligible entities

In this subsection, the term eligible entity means a consortium that—

(A)

shall include—

(i)

at least one health care provider or health care delivery system located in a rural area; and

(ii)

at least one organization representing multiple community stakeholders; and

(B)

may include other partners such as rural research centers.

(3)

Consultation

In developing the program for awarding grants under this subsection, the Secretary shall consult with the Administrator of the Agency for Healthcare Research and Quality, rural health care providers, rural health care researchers, and private and nonprofit groups (including national associations) which are undertaking similar efforts.

(4)

Expedited waivers

The Secretary shall expedite the processing of any waiver that—

(A)

is authorized under title XVIII or XIX of the Social Security Act (42 U.S.C. 1395 et seq.); and

(B)

is necessary to carry out a demonstration project under this subsection.

(5)

Demonstration project sites

The Secretary shall ensure that the 5 demonstration projects funded under this subsection are conducted at a variety of sites representing the diversity of rural communities in the Nation.

(6)

Duration

Each demonstration project under this subsection shall be for a period of 4 years.

(7)

Independent evaluation

The Secretary shall enter into an arrangement with an entity that has experience working directly with rural health systems for the conduct of an independent evaluation of the program carried out under this subsection.

(8)

Report

Not later than 1 year after the conclusion of all of the demonstration projects funded under this subsection, the Secretary shall submit a report to the Congress on the results of such projects. The report shall include—

(A)

an evaluation of patient access to care, patient outcomes, and an analysis of the cost effectiveness of each such project; and

(B)

recommendations on Federal legislation, regulations, or administrative policies to enhance rural health quality and outcomes.

(c)

Appropriation

(1)

In general

Out of funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary to carry out this section $30,000,000 for the period of fiscal years 2012 through 2016.

(2)

Availability

(A)

In general

Funds appropriated under paragraph (1) shall remain available for expenditure through fiscal year 2016.

(B)

Report

For purposes of carrying out subsection (b)(8), funds appropriated under paragraph (1) shall remain available for expenditure through fiscal year 2017.

(3)

Reservation

Of the amount appropriated under paragraph (1), the Secretary shall reserve—

(A)

$5,000,000 to carry out subsection (a); and

(B)

$25,000,000 to carry out subsection (b), of which—

(i)

2 percent shall be for the provision of technical assistance to grant recipients; and

(ii)

5 percent shall be for independent evaluation under subsection (b)(7).

426.

Rural health care services

Section 330A of the Public Health Service Act (42 U.S.C. 254c) is amended to read as follows:

330A.

Rural health care services outreach, rural health network development, Delta rural disparities and health systems development, and small rural health care provider quality improvement grant programs

(a)

Purpose

The purpose of this section is to provide for grants—

(1)

under subsection (b), to promote rural health care services outreach;

(2)

under subsection (c), to provide for the planning and implementation of integrated health care networks in rural areas;

(3)

under subsection (d), to assist rural communities in the Delta Region to reduce health disparities and to promote and enhance health system development; and

(4)

under subsection (e), to provide for the planning and implementation of small rural health care provider quality improvement activities.

(b)

Rural health care services outreach grants

(1)

Grants

The Director of the Office of Rural Health Policy of the Health Resources and Services Administration may award grants to eligible entities to promote rural health care services outreach by expanding the delivery of health care services to include new and enhanced services in rural areas. The Director may award the grants for periods of not more than 3 years.

(2)

Eligibility

To be eligible to receive a grant under this subsection for a project, an entity—

(A)

shall be a rural public or rural nonprofit private entity, a facility that qualifies as a rural health clinic under title XVIII of the Social Security Act, a public or nonprofit entity existing exclusively to provide services to migrant and seasonal farm workers in rural areas, or a tribal government whose grant-funded activities will be conducted within federally recognized tribal areas;

(B)

shall represent a consortium composed of members—

(i)

that include 3 or more independently owned health care entities; and

(ii)

that may be nonprofit or for-profit entities; and

(C)

shall not previously have received a grant under this subsection for the same or a similar project, unless the entity is proposing to expand the scope of the project or the area that will be served through the project.

(3)

Applications

To be eligible to receive a grant under this subsection, an eligible entity shall prepare and submit to the Director an application at such time, in such manner, and containing such information as the Director may require, including—

(A)

a description of the project that the eligible entity will carry out using the funds provided under the grant;

(B)

a description of the manner in which the project funded under the grant will meet the health care needs of rural populations in the local community or region to be served;

(C)

a plan for quantifying how health care needs will be met through identification of the target population and benchmarks of service delivery or health status, such as—

(i)

quantifiable measurements of health status improvement for projects focusing on health promotion; or

(ii)

benchmarks of increased access to primary care, including tracking factors such as the number and type of primary care visits, identification of a medical home, or other general measures of such access;

(D)

a description of how the local community or region to be served will be involved in the development and ongoing operations of the project;

(E)

a plan for sustaining the project after Federal support for the project has ended;

(F)

a description of how the project will be evaluated;

(G)

the administrative capacity to submit annual performance data electronically as specified by the Director; and

(H)

other such information as the Director determines to be appropriate.

(c)

Rural health network development grants

(1)

Grants

(A)

In general

The Director may award rural health network development grants to eligible entities to promote, through planning and implementation, the development of integrated health care networks that have combined the functions of the entities participating in the networks in order to—

(i)

achieve efficiencies and economies of scale;

(ii)

expand access to, coordinate, and improve the quality of the health care delivery system through development of organizational efficiencies;

(iii)

implement health information technology to achieve efficiencies, reduce medical errors, and improve quality;

(iv)

coordinate care and manage chronic illness; and

(v)

strengthen the rural health care system as a whole in such a manner as to show a quantifiable return on investment to the participants in the network.

(B)

Grant periods

The Director may award such a rural health network development grant—

(i)

for a period of 3 years for implementation activities; or

(ii)

for a period of 1 year for planning activities to assist in the initial development of an integrated health care network, if the proposed participants in the network do not have a history of collaborative efforts and a 3-year grant would be inappropriate.

(2)

Eligibility

To be eligible to receive a grant under this subsection, an entity—

(A)

shall be a rural public or rural nonprofit private entity, a facility that qualifies as a rural health clinic under title XVIII of the Social Security Act, a public or nonprofit entity existing exclusively to provide services to migrant and seasonal farm workers in rural areas, or a tribal government whose grant-funded activities will be conducted within federally recognized tribal areas;

(B)

shall represent a network composed of participants—

(i)

that include 3 or more independently owned health care entities; and

(ii)

that may be nonprofit or for-profit entities; and

(C)

shall not previously have received a grant under this subsection (other than a 1-year grant for planning activities) for the same or a similar project.

(3)

Applications

To be eligible to receive a grant under this subsection, an eligible entity, in consultation with the appropriate State office of rural health or another appropriate State entity, shall prepare and submit to the Director an application at such time, in such manner, and containing such information as the Director may require, including—

(A)

a description of the project that the eligible entity will carry out using the funds provided under the grant;

(B)

an explanation of the reasons why Federal assistance is required to carry out the project;

(C)

a description of—

(i)

the history of collaborative activities carried out by the participants in the network;

(ii)

the degree to which the participants are ready to integrate their functions; and

(iii)

how the local community or region to be served will benefit from and be involved in the activities carried out by the network;

(D)

a description of how the local community or region to be served will experience increased access to quality health care services across the continuum of care as a result of the integration activities carried out by the network, including a description of—

(i)

return on investment for the community and the network members; and

(ii)

other quantifiable performance measures that show the benefit of the network activities;

(E)

a plan for sustaining the project after Federal support for the project has ended;

(F)

a description of how the project will be evaluated;

(G)

the administrative capacity to submit annual performance data electronically as specified by the Director; and

(H)

other such information as the Director determines to be appropriate.

(d)

Delta rural disparities and health systems development grants

(1)

Grants

The Director may award grants to eligible entities to support reduction of health disparities, improve access to health care, and enhance rural health system development in the Delta Region.

(2)

Eligibility

To be eligible to receive a grant under this subsection, an entity shall be a rural public or rural nonprofit private entity, a facility that qualifies as a rural health clinic under title XVIII of the Social Security Act, a public or nonprofit entity existing exclusively to provide services to migrant and seasonal farm workers in rural areas, or a tribal government whose grant-funded activities will be conducted within federally recognized tribal areas.

(3)

Applications

To be eligible to receive a grant under this subsection, an eligible entity shall prepare and submit to the Director an application at such time, in such manner, and containing such information as the Director may require, including—

(A)

a description of the project that the eligible entity will carry out using the funds provided under the grant;

(B)

an explanation of the reasons why Federal assistance is required to carry out the project;

(C)

a description of the manner in which the project funded under the grant will meet the health care needs of the Delta Region;

(D)

a description of how the local community or region to be served will experience increased access to quality health care services as a result of the activities carried out by the entity;

(E)

a description of how health disparities will be reduced or the health system will be improved;

(F)

a plan for sustaining the project after Federal support for the project has ended;

(G)

a description of how the project will be evaluated including process and outcome measures related to the quality of care provided or how the health care system improves its performance;

(H)

a description of how the grantee will develop an advisory group made up of representatives of the communities to be served to provide guidance to the grantee to best meet community need; and

(I)

other such information as the Director determines to be appropriate.

(e)

Small rural health care provider quality improvement grants

(1)

Grants

The Director may award grants to provide for the planning and implementation of small rural health care provider quality improvement activities. The Director may award the grants for periods of 1 to 3 years.

(2)

Eligibility

To be eligible for a grant under this subsection, an entity—

(A)

shall be—

(i)

a rural public or rural nonprofit private health care provider or provider of health care services, such as a rural health clinic; or

(ii)

another rural provider or network of small rural providers identified by the Director as a key source of local care; and

(B)

shall not previously have received a grant under this subsection for the same or a similar project.

(3)

Preference

In awarding grants under this subsection, the Director shall give preference to facilities that qualify as rural health clinics under title XVIII of the Social Security Act.

(4)

Applications

To be eligible to receive a grant under this subsection, an eligible entity shall prepare and submit to the Director an application at such time, in such manner, and containing such information as the Director may require, including—

(A)

a description of the project that the eligible entity will carry out using the funds provided under the grant;

(B)

an explanation of the reasons why Federal assistance is required to carry out the project;

(C)

a description of the manner in which the project funded under the grant will assure continuous quality improvement in the provision of services by the entity;

(D)

a description of how the local community or region to be served will experience increased access to quality health care services as a result of the activities carried out by the entity;

(E)

a plan for sustaining the project after Federal support for the project has ended;

(F)

a description of how the project will be evaluated including process and outcome measures related to the quality of care provided; and

(G)

other such information as the Director determines to be appropriate.

(f)

General requirements

(1)

Prohibited uses of funds

An entity that receives a grant under this section may not use funds provided through the grant—

(A)

to build or acquire real property; or

(B)

for construction.

(2)

Coordination with other agencies

The Director shall coordinate activities carried out under grant programs described in this section, to the extent practicable, with Federal and State agencies and nonprofit organizations that are operating similar grant programs, to maximize the effect of public dollars in funding meritorious proposals.

(g)

Report

Not later than September 30, 2014, the Secretary shall prepare and submit to the appropriate committees of Congress a report on the progress and accomplishments of the grant programs described in subsections (b), (c), (d), and (e).

(h)

Definitions

In this section:

(1)

The term Delta Region has the meaning given to the term region in section 382A of the Consolidated Farm and Rural Development Act (7 U.S.C. 2009aa).

(2)

The term Director means the Director of the Office of Rural Health Policy of the Health Resources and Services Administration.

(i)

Authorization of appropriations

There are authorized to be appropriated to carry out this section $40,000,000 for fiscal year 2012, and such sums as may be necessary for each of fiscal years 2013 through 2016.

.

427.

Community health center collaborative access expansion

Section 330 of the Public Health Service Act (42 U.S.C. 254b) is amended by adding at the end the following:

(t)

Miscellaneous Provisions

(1)

Rule of construction with respect to rural health clinics

(A)

In general

Nothing in this section shall be construed to prevent a community health center from contracting with a federally certified rural health clinic (as defined by section 1861(aa)(2) of the Social Security Act) for the delivery of primary health care services that are available at the rural health clinic to individuals who would otherwise be eligible for free or reduced cost care if that individual were able to obtain that care at the community health center. Such services may be limited in scope to those primary health care services available in that rural health clinic.

(B)

Assurances

In order for a rural health clinic to receive funds under this section through a contract with a community health center under paragraph (1), such rural health clinic shall establish policies to ensure—

(i)

nondiscrimination based upon the ability of a patient to pay; and

(ii)

the establishment of a sliding fee scale for low-income patients.

.

428.

Facilitating the provision of telehealth services across State lines

(a)

In general

For purposes of expediting the provision of telehealth services, for which payment is made under the Medicare program, across State lines, the Secretary of Health and Human Services shall, in consultation with representatives of States, physicians, health care practitioners, and patient advocates, encourage and facilitate the adoption of provisions allowing for multistate practitioner practice across State lines.

(b)

Definitions

In subsection (a):

(1)

Telehealth service

The term telehealth service has the meaning given that term in subparagraph (F) of section 1834(m)(4) of the Social Security Act (42 U.S.C. 1395m(m)(4)).

(2)

Physician, practitioner

The terms physician and practitioner have the meaning given those terms in subparagraphs (D) and (E), respectively, of such section.

(3)

Medicare program

The term Medicare program means the program of health insurance administered by the Secretary of Health and Human Services under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).

429.

Scoring of preventive health savings

Section 202 of the Congressional Budget and Impoundment Control Act of 1974 (2 U.S.C. 602) is amended by adding at the end the following new subsection:

(h)

Scoring of preventive health savings

(1)

Determination by the Director

Upon a request by the chairman or ranking minority member of the Committee on the Budget of the Senate, or by the chairman or ranking minority member of the Committee on the Budget of the House of Representatives, the Director shall determine if a proposed measure would result in reductions in budget outlays in budgetary outyears through the use of preventive health and preventive health services.

(2)

Projections

If the Director determines that a measure would result in substantial reductions in budget outlays as described in paragraph (1), the Director—

(A)

shall include, in any projection prepared by the Director, a description and estimate of the reductions in budget outlays in the budgetary outyears and a description of the basis for such conclusions; and

(B)

may prepare a budget projection that includes some or all of the budgetary outyears, notwithstanding the time periods for projections described in subsection (e) and sections 308, 402, and 424.

(3)

Definitions

As used in this subsection—

(A)

the term preventive health means an action that focuses on the health of the public, individuals, and defined populations in order to protect, promote, and maintain health, wellness, and functional ability, and prevent disease, disability, and premature death that is demonstrated by credible and publicly available epidemiological projection models, incorporating clinical trials or observational studies in humans, to avoid future health care costs; and

(B)

the term budgetary outyears means the 2 consecutive 10-year periods beginning with the first fiscal year that is 10 years after the budget year provided for in the most recently agreed to concurrent resolution on the budget.

.

430.

Sense of Congress

It is the sense of the Congress that—

(1)

the maintenance of effort (MOE) provisions added to sections 1902 and 2105(d) of the Social Security Act by sections 2001(b) and 2101(b) of the Patient Protection and Affordable Care Act were written to maintain the eligibility standards for the Medicaid program and Children’s Health Insurance Program until the American Health Benefit Exchanges in the States are fully operational;

(2)

it is imperative that the MOE provisions are enforced to the strict standard intended by the Congress;

(3)

waiving the MOE provisions should not be permitted, except in the case of a request for a waiver that meets the explicit nonapplication requirements;

(4)

the MOE provisions ensure the continued success of the Medicaid program and CHIP and were written deliberately to specifically protect vulnerable and disabled individuals, children, and senior citizens, many of whom are also members of communities of color; and

(5)

the MOE provisions must be strictly enforced and proposals to weaken the MOE provisions must not be considered in this time of recession.

431.

Repeal of requirement for documentation evidencing citizenship or nationality under the Medicaid program

(a)

Repeal

Subsections (i)(22) and (x) of section 1903 of the Social Security Act (42 U.S.C. 1396b), as added by section 6036 of the Deficit Reduction Act of 2005, are each repealed.

(b)

Conforming amendments

(1)

Section 1903 of the Social Security Act (42 U.S.C. 1396b) is amended—

(A)

in subsection (i)—

(i)

in paragraph (20), by adding or after the semicolon at the end; and

(ii)

in paragraph (21), by striking ; or and inserting a period;

(B)

by redesignating subsection (y), as added by section 6043(b) of the Deficit Reduction Act of 2005, as subsection (x); and

(C)

by redesignating subsection (z), as added by section 6081(a) of the Deficit Reduction Act of 2005, as subsection (y).

(2)

Subsection (c) of section 6036 of the Deficit Reduction Act of 2005 is repealed.

(c)

Effective date

The repeals and amendments made by this section shall take effect as if included in the enactment of the Deficit Reduction Act of 2005.

432.

Office of Minority Health in Veterans Health Administration of Department of Veterans Affairs

(a)

Establishment and functions

Subchapter I of chapter 73 of title 38, United States Code, is amended by adding at the end the following new section:

7309.

Office of Minority Health

(a)

Establishment

There is established in the Department within the Office of the Under Secretary for Health an office to be known as the Office of Minority Health (in this section referred to as the Office).

(b)

Head

The Director of the Office of Minority Health shall be the head of the Office. The Director of the Office of Minority Health shall be appointed by the Under Secretary of Health from among individuals qualified to perform the duties of the position.

(c)

Functions

The functions of the Office are as follows:

(1)

To establish short-range and long-range goals and objectives and coordinate all other activities within the Veterans Health Administration that relate to disease prevention, health promotion, health care services delivery, and health care research concerning veterans who are members of a racial or ethnic minority group.

(2)

To support research, demonstrations, and evaluations to test new and innovative models for the discharge of activities described in paragraph (1).

(3)

To increase knowledge and understanding of health risk factors for veterans who are members of a racial or ethnic minority group.

(4)

To develop mechanisms that support better health care information dissemination, education, prevention, and services delivery to veterans from disadvantaged backgrounds, including veterans who are members of a racial or ethnic minority group.

(5)

To enter into contracts or agreements with appropriate public and nonprofit private entities to develop and carry out programs to provide bilingual or interpretive services to assist veterans who are members of a racial or ethnic minority group and who lack proficiency in speaking the English language in accessing and receiving health care services through the Veterans Health Administration.

(6)

To carry out programs to improve access to health care services through the Veterans Health Administration for veterans with limited proficiency in speaking the English language, including the development and evaluation of demonstration and pilot projects for that purpose.

(7)

To advise the Under Secretary of Health on matters relating to the development, implementation, and evaluation of health professions education in decreasing disparities in health care outcomes between veterans who are members of a racial or ethnic minority group and other veterans, including cutural competency as a method of eliminating such health disparities.

(8)

To perform such other functions and duties as the Secretary or the Under Secretary for Health considers appropriate.

(d)

Definitions

In this section:

(1)

The term racial or ethnic minority group means the following:

(A)

American Indians (including Alaska Natives, Eskimos, and Aleuts).

(B)

Asian Americans.

(C)

Native Hawaiians and other Pacific Islanders.

(D)

Blacks.

(E)

Hispanics.

(2)

The term Hispanic means individuals whose origin is Mexican, Puerto Rican, Cuban, Central or South American, or any other Spanish-speaking country.

.

433.

Access for Native Americans under PPACA

(a)

In general

Title I of the Patient Protection and Affordable Care Act is amended—

(1)

in section 1311(c)(6)(D), by striking (as defined in section 4 of the Indian Health Care Improvement Act) and inserting (as defined in section 447.50(b)(1) of title 42 of the Code of Federal Regulations, as in effect on July 1, 2010); and

(2)

in section 1402(d)(1), by striking (as defined in section 4(d) of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b(d))) and inserting (f) (as defined in section 447.50(b)(1) of title 42 of the Code of Federal Regulations, as in effect on July 1, 2010).

(b)

Individual mandate

In section 5000A(e)(3) of the Internal Revenue Code of 1986, by striking (as defined in section 45A(c)(6)) and inserting (as defined in section 447.50(b)(1) of title 42 of the Code of Federal Regulations, as in effect on July 1, 2010).

V

IMPROVING HEALTH OUTCOMES FOR WOMEN, CHILDREN, AND FAMILIES

501.

Grants to promote positive health behaviors in women and children

Part Q of title III of the Public Health Service Act (42 U.S.C. 280g et seq.) is amended by adding at the end the following:

399Z–2.

Grants to promote positive health behaviors in women and children

(a)

Grants Authorized

The Secretary, in collaboration with the Director of the Centers for Disease Control and Prevention and other Federal officials determined appropriate by the Secretary, is authorized to award grants to eligible entities to promote positive health behaviors for women and children in target populations, especially racial and ethnic minority women and children in medically underserved communities.

(b)

Use of Funds

Grants awarded pursuant to subsection (a) may be used to support community health workers—

(1)

to educate and provide outreach regarding enrollment in health insurance including the State Children’s Health Insurance Program under title XXI of the Social Security Act, Medicare under title XVIII of such Act, and Medicaid under title XIX of such Act;

(2)

to educate, guide, and provide outreach in a community setting regarding health problems prevalent among women and children and especially among racial and ethnic minority women and children;

(3)

to educate, guide, and provide experiential learning opportunities that target behavioral risk factors including—

(A)

poor nutrition;

(B)

physical inactivity;

(C)

being overweight or obese;

(D)

tobacco use;

(E)

alcohol and substance use;

(F)

injury and violence;

(G)

risky sexual behavior;

(H)

mental health problems;

(I)

musculoskeletal health;

(J)

dental and oral health problems; and

(K)

understanding informed consent;

(4)

to educate and guide regarding effective strategies to promote positive health behaviors within the family;

(5)

to promote community wellness and awareness; and

(6)

to educate and refer target populations to appropriate health care agencies and community-based programs and organizations in order to increase access to quality health care services, including preventive health services.

(c)

Application

(1)

In general

Each eligible entity that desires to receive a grant under subsection (a) shall submit an application to the Secretary, at such time, in such manner, and accompanied by such additional information as the Secretary may require.

(2)

Contents

Each application submitted pursuant to paragraph (1) shall—

(A)

describe the activities for which assistance under this section is sought;

(B)

contain an assurance that with respect to each community health worker program receiving funds under the grant awarded, such program provides training and supervision to community health workers to enable such workers to provide authorized program services;

(C)

contain an assurance that the applicant will evaluate the effectiveness of community health worker programs receiving funds under the grant;

(D)

contain an assurance that each community health worker program receiving funds under the grant will provide services in the cultural context most appropriate for the individuals served by the program;

(E)

contain a plan to document and disseminate project description and results to other States and organizations as identified by the Secretary; and

(F)

describe plans to enhance the capacity of individuals to utilize health services and health-related social services under Federal, State, and local programs by—

(i)

assisting individuals in establishing eligibility under the programs and in receiving the services or other benefits of the programs; and

(ii)

providing other services as the Secretary determines to be appropriate, that may include transportation and translation services.

(d)

Priority

In awarding grants under subsection (a), the Secretary shall give priority to those applicants—

(1)

who propose to target geographic areas—

(A)

with a high percentage of residents who are eligible for health insurance but are uninsured or underinsured; and

(B)

with a high percentage of families for whom English is not their primary language;

(2)

with experience in providing health or health-related social services to individuals who are underserved with respect to such services; and

(3)

with documented community activity and experience with community health workers.

(e)

Collaboration With Academic Institutions

The Secretary shall encourage community health worker programs receiving funds under this section to collaborate with academic institutions, including minority-serving institutions. Nothing in this section shall be construed to require such collaboration.

(f)

Quality Assurance and Costeffectiveness

The Secretary shall establish guidelines for assuring the quality of the training and supervision of community health workers under the programs funded under this section and for assuring the costeffectiveness of such programs.

(g)

Monitoring

The Secretary shall monitor community health worker programs identified in approved applications and shall determine whether such programs are in compliance with the guidelines established under subsection (f).

(h)

Technical Assistance

The Secretary may provide technical assistance to community health worker programs identified in approved applications with respect to planning, developing, and operating programs under the grant.

(i)

Report to Congress

(1)

In general

Not later than 4 years after the date on which the Secretary first awards grants under subsection (a), the Secretary shall submit to Congress a report regarding the grant project.

(2)

Contents

The report required under paragraph (1) shall include the following:

(A)

A description of the programs for which grant funds were used.

(B)

The number of individuals served.

(C)

An evaluation of—

(i)

the effectiveness of these programs;

(ii)

the cost of these programs; and

(iii)

the impact of the project on the health outcomes of the community residents.

(D)

Recommendations for sustaining the community health worker programs developed or assisted under this section.

(E)

Recommendations regarding training to enhance career opportunities for community health workers.

(j)

Definitions

In this section:

(1)

Community health worker

The term community health worker means an individual who promotes health or nutrition within the community in which the individual resides—

(A)

by serving as a liaison between communities and health care agencies;

(B)

by providing guidance and social assistance to community residents;

(C)

by enhancing community residents’ ability to effectively communicate with health care providers;

(D)

by providing culturally and linguistically appropriate health or nutrition education;

(E)

by advocating for individual and community health, including dental, oral, mental, and environmental health, or nutrition needs; and

(F)

by providing referral and followup services.

(2)

Community setting

The term community setting means a home or a community organization located in the neighborhood in which a participant resides.

(3)

Eligible entity

The term eligible entity means—

(A)

a unit of State, territorial, local, or tribal government (including a federally recognized tribe or Alaska Native village); or

(B)

a community-based organization.

(4)

Medically underserved community

The term medically underserved community means a community—

(A)

that has a substantial number of individuals who are members of a medically underserved population, as defined by section 330(b)(3); and

(B)

a significant portion of which is a health professional shortage area as designated under section 332.

(5)

Support

The term support means the provision of training, supervision, and materials needed to effectively deliver the services described in subsection (b), reimbursement for services, and other benefits.

(6)

Target population

The term target population means women of reproductive age, regardless of their current childbearing status and children under 21 years of age.

(k)

Authorization of Appropriations

There are authorized to be appropriated to carry out this section $15,000,000 for each of fiscal years 2012 through 2016.

.

502.

Removing barriers to health care and nutrition assistance for children, pregnant women, and lawfully present individuals

(a)

Medicaid

Section 1903(v) of the Social Security Act (42 U.S.C. 1396b(v)) is amended by striking paragraph (4) and inserting the following new paragraph:

(4)
(A)

Notwithstanding sections 401(a), 402(b), 403, and 421 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, payment shall be made under this section for care and services that are furnished to aliens, including those described in paragraph (1), if they otherwise meet the eligibility requirements for medical assistance under the State plan approved under this subchapter (other than the requirement of the receipt of aid or assistance under title IV, supplemental security income benefits under title XVI, or a State supplementary payment), and are—

(i)

lawfully present in the United States;

(ii)

children under 21 years of age, including any optional targeted low-income child (as such term is defined in section 1905(u)(2)(B)); or

(iii)

pregnant women during pregnancy and during the 60-day period beginning on the last day of the pregnancy.

(B)

No debt shall accrue under an affidavit of support against any sponsor of such an alien on the basis of provision of assistance to such alien under this paragraph and the cost of such assistance shall not be considered as an unreimbursed cost.

.

(b)

SCHIP

Section 2107(e)(1) of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended by amending subparagraph (J) to read as follows:

(J)

Paragraph (4) of section 1903(v) (relating to individuals who, but for sections 401(a), 403, and 421 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, would be eligible for medical assistance under title XXI).

.

(c)

Supplemental nutrition assistance

Notwithstanding sections 401(a), 402(a), and 403(a) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1611(a); 1612(a); 1613(a)) and section 6(f) of the Food and Nutrition Act of 2008 (7 U.S.C. 2015(f)), persons who are lawfully present in the United States shall be not be ineligible for benefits under the supplemental nutrition assistance program on the basis of their immigration status or date of entry into the United States.

(d)

Eligibility for families with children

Section of the 421(d)(3) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1631(d)(3)) is amended by striking to the extent that a qualified alien is eligible under section 402(a)(2)(J) and inserting, to the extent that a child is a member of a household under the supplemental nutrition assistance program.

(e)

Ensuring proper screening

Section 11(e)(2)(B) of the Food and Nutrition Act of 2008 (7 U.S.C. 2020(e)(2)(B)) is amended—

(1)

by redesignating clauses (vi) and (vii) as clauses (vii) and (viii); and

(2)

by inserting after clause (v) the following:

(vi)

shall provide a method for implementing section 421 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1631) that does not require any unnecessary information from persons who may be exempt from that provision;

.

503.

Repeal of denial of benefits

Section 115 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (21 U.S.C. 862a) is amended—

(1)

in subsection (a) by striking paragraph (2);

(2)

in subsection (b) by striking paragraph (2); and

(3)

in subsection (e) by striking paragraph (2).

504.

Birth defects prevention, risk reduction, and awareness

(a)

In general

The Secretary shall establish and implement a birth defects prevention and public awareness program, consisting of the activities described in subsections (c) and (d).

(b)

Definitions

In this section:

(1)

The term pregnancy and breastfeeding information services includes only—

(A)

information services to provide accurate, evidence-based, clinical information regarding maternal exposures during pregnancy that may be associated with birth defects or other health risks, such as exposures to medications, chemicals, infections, foodborne pathogens, illnesses, nutrition, or lifestyle factors;

(B)

information services to provide accurate, evidence-based, clinical information regarding maternal exposures during breast­feeding that may be associated with health risks to a breast-fed infant, such as exposures to medications, chemicals, infections, foodborne pathogens, illnesses, nutrition, or lifestyle factors;

(C)

the provision of accurate, evidence-based information weighing risks of exposures during breast­feeding against the benefits of breast­feeding; and

(D)

the provision of information described in subparagraph (A), (B), or (C) through counselors, Web sites, fact sheets, telephonic or electronic communication, community outreach efforts, or other appropriate means.

(2)

The term Secretary means the Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention.

(c)

Nationwide media campaign

In carrying out subsection (a), the Secretary shall conduct or support a nationwide media campaign to increase awareness among health care providers and at-risk populations about pregnancy and breastfeeding information services.

(d)

Grants for pregnancy and breastfeeding information services

(1)

In general

In carrying out subsection (a), the Secretary shall award grants to State or regional agencies or organizations for any of the following:

(A)

Information services

The provision of, or campaigns to increase awareness about, pregnancy and breastfeeding information services.

(B)

Surveillance and research

The conduct or support of—

(i)

surveillance of or research on—

(I)

maternal exposures and maternal health conditions that may influence the risk of birth defects, prematurity, or other adverse pregnancy outcomes; and

(II)

maternal exposures that may influence health risks to a breastfed infant; or

(ii)

networking to facilitate surveillance or research described in this subparagraph.

(2)

Preference for certain States

The Secretary, in making any grant under this subsection, shall give preference to States, otherwise equally qualified, that have or had a pregnancy and breastfeeding information service in place on or after January 1, 2006.

(3)

Matching funds

The Secretary may only award a grant under this subsection to a State or regional agency or organization that agrees, with respect to the costs to be incurred in carrying out the grant activities, to make available (directly or through donations from public or private entities) non-Federal funds toward such costs in an amount equal to not less than 25 percent of the amount of the grant.

(4)

Coordination

The Secretary shall ensure that activities funded through a grant under this subsection are coordinated, to the maximum extent practicable, with other birth defects prevention and environmental health activities of the Federal Government, including with respect to pediatric environmental health specialty units and children’s environmental health centers.

(e)

Evaluation

In furtherance of the program under subsection (a), the Secretary shall provide for an evaluation of pregnancy and breastfeeding information services to identify efficient and effective models of—

(1)

providing information;

(2)

raising awareness and increasing knowledge about birth defects prevention measures;

(3)

modifying risk behaviors; or

(4)

other outcome measures as determined appropriate by the Secretary.

(f)

Authorization of appropriations

To carry out this section, there are authorized to be appropriated $5,000,000 for fiscal year 2012, $6,000,000 for fiscal year 2013, $7,000,000 for fiscal year 2014, $8,000,000 for fiscal year 2015, and $9,000,000 for fiscal year 2016.

505.

Uniform State maternal mortality review committees on pregnancy-related deaths

(a)

Condition of receipt of payments from allotment under Maternal and Child Health Service Block Grant

Title V of the Social Security Act (42 U.S.C. 701 et seq.) is amended by adding at the end the following new section:

514.

Uniform State maternal mortality review committees on pregnancy-related deaths

(a)

Grants

(1)

In general

Notwithstanding any other provision of this title, for each of fiscal years 2012 through 2018, in addition to payments from allotments for States under section 502 for such year, the Secretary shall, subject to paragraph (3) and in accordance with the criteria established under paragraph (2), award grants to States to—

(A)

carry out the activities described in subsection (b)(1);

(B)

establish a State maternal mortality review committee, in accordance with subsection (b)(2), to carry out the activities described in subsection (b)(2)(A), and to establish the processes described in subsection (b)(1);

(C)

ensure the State department of health carries out the applicable activities described in subsection (b)(3), with respect to pregnancy-related deaths occurring within the State during such fiscal year;

(D)

implement and use the comprehensive case abstraction form developed under subsection (c), in accordance with such subsection; and

(E)

provide for public disclosure of information, in accordance with subsection (e).

(2)

Criteria

The Secretary shall establish criteria for determining eligibility for and the amount of a grant awarded to a State under paragraph (1). Such criteria shall provide that in the case of a State that receives such a grant for a fiscal year and is determined by the Secretary to have not used such grant in accordance with this section, such State shall not be eligible for such a grant for any subsequent fiscal year.

(3)

Authorization of appropriations

For purposes of carrying out the grant program under this section, including for administrative purposes, there is authorized to be appropriated $10,000,000 for each of fiscal years 2012 through 2018.

(b)

Pregnancy-Related death review

(1)

Review of pregnancy-related death and pregnancy-associated death cases

For purposes of subsection (a), with respect to a State that receives a grant under subsection (a), the following shall apply:

(A)

Mandatory reporting of pregnancy-related deaths

(i)

In general

The State shall, through the State maternal mortality review committee, develop a process, separate from any reporting process established by the State department of health prior to the date of the enactment of this section, that provides for mandatory and confidential case reporting by individuals and entities described in clause (ii) of pregnancy-related deaths to the State department of health.

(ii)

Individuals and Entities described

Individuals and entities described in this clause include each of the following:

(I)

Health care providers.

(II)

Medical examiners.

(III)

Medical coroners.

(IV)

Hospitals.

(V)

Free-standing birth centers.

(VI)

Other health care facilities.

(VII)

Any other individuals responsible for completing death certificates.

(VIII)

Any other appropriate individuals or entities specified by the Secretary.

(B)

Voluntary reporting of pregnancy-related and pregnancy-associated deaths

(i)

The State shall, through the State maternal mortality review committee, develop a process for and encourage, separate from any reporting process established by the State department of health prior to the date of the enactment of this section, voluntary and confidential case reporting by individuals described in clause (ii) of pregnancy-associated deaths to the State department of health.

(ii)

The State shall, through the State maternal mortality review committee, develop a process for voluntary and confidential reporting by family members of the deceased and by other individuals on possible pregnancy-related and pregnancy-associated deaths to the State department of health. Such process shall include—

(I)

making publicly available on the Internet Web site of the State department of health a telephone number, Internet Web link, and email address for such reporting; and

(II)

publicizing to local professional organizations, community organizations, and social services agencies the availability of the telephone number, Internet Web link, and email address made available under subclause (I).

(C)

Development of case-finding

The State, through the vital statistics unit of the State, shall annually identify pregnancy-related and pregnancy-associated deaths occurring in such State during the year involved by—

(i)

matching all death records, with respect to such year, for women of childbearing age to live birth certificates and infant death certificates to identify deaths of women that occurred during pregnancy and within one year after the end of a pregnancy;

(ii)

identifying deaths reported during such year as having an underlying or contributing cause of death related to pregnancy, regardless of the time that has passed between the end of the pregnancy and the death;

(iii)

collecting data from medical examiner and coroner reports; and

(iv)

any other methods the States may devise to identify maternal deaths, such as through review of a random sample of reported deaths of women of childbearing age to ascertain cases of pregnancy-related and pregnancy-associated deaths that are not discernable from a review of death certificates alone.

When feasible and for purposes of effectively collecting and obtaining data on pregnancy-related and pregnancy-associated deaths, the State shall adopt the most recent standardized birth and death certificates, as issued by the National Center for Vital Health Statistics, including the recommended checkbox section for pregnancy on the death certificates.
(D)

Case investigation and development of case summaries

Following receipt of reports by the State department of health pursuant to subparagraph (A) or (B) and collection by the vital statistics unit of the State of possible cases of pregnancy-related and pregnancy-associated deaths pursuant to subparagraph (C), the State, through the State maternal mortality review committee established under subsection (a), shall investigate each case, utilizing the case abstraction form described in subsection (c), and prepare de-identified case summaries, which shall be reviewed by the committee and included in applicable reports. For purposes of subsection (a), under the processes established under subparagraphs (A), (B), and (C), a State department of health or vital statistics unit of a State shall provide to the State maternal mortality review committee access to information collected pursuant to such subparagraphs as necessary to carry out this subparagraph. Data and information collected for the case summary and review are for purposes of public health activities, in accordance with HIPAA privacy and security law (as defined in section 3009(a)(2) of the Public Health Service Act). Such case investigations shall include data and information obtained through—

(i)

medical examiner and autopsy reports of the woman involved;

(ii)

medical records of the woman, including such records related to health care prior to pregnancy, prenatal and postnatal care, labor and delivery care, emergency room care, hospital discharge records, and any care delivered up until the time of death of the woman for purposes of public health activities, in accordance with HIPAA privacy and security law (as defined in section 3009(a)(2) of the Public Health Service Act);

(iii)

oral and written interviews of individuals directly involved in the maternal care of the woman during and immediately following the pregnancy of the woman, including health care, mental health, and social service providers, as applicable;

(iv)

optional oral or written interviews of the family of the woman;

(v)

socioeconomic and other relevant background information about the woman;

(vi)

information collected in subparagraph (C)(i); and

(vii)

other information on the cause of death of the woman, such as social services and child welfare reports.

(2)

State maternal mortality review committees

(A)

Duties

(i)

Required committee activities

For purposes of subsection (a), a maternal mortality review committee established by a State pursuant to a grant under such subsection shall carry out the following pregnancy-related death and pregnancy-associated death review activities and shall include all information relevant to the death involved on the case abstraction form developed under subsection (d):

(I)

With respect to a case of pregnancy-related or pregnancy-associated death of a woman, review the case summaries prepared under subparagraphs (A), (B), (C), and (D) of paragraph (1).

(II)

Review aggregate statistical reports developed by the vital statistics unit of the State under paragraph (1)(C) regarding pregnancy-related and pregnancy-associated deaths to identify trends, patterns, and disparities in adverse outcomes and address medical, non-medical, and system-related factors that may have contributed to such pregnancy-related and pregnancy-associated deaths and disparities.

(III)

Develop recommendations, based on the review of the case summaries under paragraph (1)(D) and aggregate statistical reports under subclause (II), to improve maternal care, social and health services, and public health policy and institutions, including with respect to improving access to maternal care, improving the availability of social services, and eliminating disparities in maternal care and outcomes.

(ii)

Optional committee activities

For purposes of subsection (a), a maternal mortality review committee established by a State under such subsection may present findings and recommendations regarding a specific case or set of circumstances directly to a health care facility or its local or State professional organization for the purpose of instituting policy changes, educational activities, or otherwise improving the quality of care provided by the facilities.

(B)

Composition of maternal mortality review committees

(i)

In General

Each State maternal mortality review committee established pursuant to a grant under subsection (a) shall be multi-disciplinary, consisting of health care and social service providers, public health officials, other persons with professional expertise on maternal health and mortality, and patient and community advocates who represent those communities within such State that are the most affected by maternal mortality. Membership on such a committee of a State shall be reviewed annually by the State department of health to ensure that membership representation requirements are being fulfilled in accordance with this paragraph.

(ii)

Required membership

Each such review committee shall include—

(I)

representatives from medical specialities providing care to pregnant and postpartum patients, including obstetricians (including generalists and maternal fetal medicine specialists), and family practice physicians;

(II)

certified nurse midwives, certified midwives, and advanced practice nurses;

(III)

hospital-based nurses;

(IV)

representatives of the State department of health maternal and child health department;

(V)

social service providers or social workers;

(VI)

the chief medical examiners or designees;

(VII)

facility representatives, such as from hospitals or free-standing birth centers; and

(VIII)

community or patient advocates who represent those communities within the State that are the most affected by maternal mortality.

(iii)

Additional members

Each such review committee may also include representatives from other relevant academic, health, social service, or policy professions, or community organizations, on an ongoing basis, or as needed, as determined beneficial by the review committee, including—

(I)

anesthesiologists;

(II)

emergency physicians;

(III)

pathologists;

(IV)

epidemiologists or biostatisticians;

(V)

intensivists;

(VI)

vital statistics officers;

(VII)

nutritionists;

(VIII)

mental health professionals;

(IX)

substance abuse treatment specialists;

(X)

representatives of relevant advocacy groups;

(XI)

academics;

(XII)

representatives of beneficiaries of the State plan under the Medicaid program under title XIX;

(XIII)

paramedics;

(XIV)

lawyers;

(XV)

risk management specialists;

(XVI)

representatives of the departments of health or public health of major cities in the State involved; and

(XVII)

policy makers.

(iv)

Diverse community membership

The composition of such a committee, with respect to a State, shall include—

(I)

representatives from diverse communities, particularly those communities within such State most severely affected by pregnancy-related deaths or pregnancy-associated deaths and by a lack of access to relevant maternal care services, from community maternal child health organizations, and from minority advocacy groups;

(II)

members, including health care providers, from different geographic regions in the State, including any rural, urban, and tribal areas; and

(III)

health care and social service providers who work in communities that are diverse with regard to race, ethnicity, immigration status, Indigenous status, and English proficiency.

(v)

Maternal mortality review staff

Staff of each such review committee shall include—

(I)

vital health statisticians, maternal child health statisticians, or epidemiologists;

(II)

a coordinator of the State maternal mortality review committee, to be designated by the State; and

(III)

administrative staff.

(C)

Option for States to form regional maternal mortality reviews

States with a low rate of occurrence of pregnancy-associated or pregnancy-related deaths may choose to partner with one or more neighboring States to fulfill the activities described in paragraph (1)(C). In such a case, with respect to States in such a partnership, any requirement under this section relating to the reporting of information related to such activities shall be deemed to be fulfilled by each such State if a single such report is submitted for the partnership.

(3)

State Department of Health Activities

For purposes of subsection (a), a State department of health of a State receiving a grant under such subsection shall—

(A)

in consultation with the maternal mortality review committee of the State and in conjunction with relevant professional organizations, develop a plan for ongoing health care provider education, based on the findings and recommendations of the committee, in order to improve the quality of maternal care; and

(B)

take steps to widely disseminate the findings and recommendations of the State maternal mortality review committees of the State and to implement the recommendations of such committee.

(c)

Case abstraction form

(1)

Development

The Director of the Centers for Disease Control and Prevention shall develop a uniform, comprehensive case abstraction form and make such form available to States for State maternal mortality review committees for use by such committees in order to—

(A)

ensure that the cases and information collected and reviewed by such committees can be pooled for review by the Department of Health and Human Services and its agencies; and

(B)

preserve the uniformity of the information and its use for Federal public health purposes.

(2)

Permissible State modification

Each State may modify the form developed under paragraph (1) for implementation and use by such State or by the State maternal mortality review committee of such State by including on such form additional information to be collected, but may not alter the standard questions on such form, in order to ensure that the information can be collected and reviewed centrally at the Federal level.

(d)

Treatment as public health authority for purposes of HIPAA

For purposes of applying HIPAA privacy and security law (as defined in section 3009(a)(2) of the Public Health Service Act), a State maternal mortality review committee of a State established pursuant to this section to carry out activities described in subsection (b)(2)(A) shall be deemed to be a public health authority described in section 164.501 (and referenced in section 164.512(b)(1)(i)) of title 45, Code of Federal Regulations (or any successor regulation), carrying out public health activities and purposes described in such section 164.512(b)(1)(i) (or any such successor regulation).

(e)

Public disclosure of information

(1)

In general

For fiscal year 2012 or a subsequent fiscal year, each State receiving a grant under this section for such year shall, subject to paragraph (3), provide for the public disclosure, and submission to the information clearinghouse established under paragraph (2), of the information included in the report of the State under section 506(a)(2)(F) for such year (relating to the findings for such year of the State maternal mortality review committee established by the State under this section).

(2)

Information clearinghouse

The Secretary of Health and Human Services shall establish an information clearinghouse, that shall be administered by the Director of the Centers for Disease Control and Prevention, that will maintain findings and recommendations submitted pursuant to paragraph (1) and provide such findings and recommendations for public review and research purposes by State health departments, maternal mortality review committees, and health providers and institutions.

(3)

Confidentiality of information

In no case shall any individually identifiable health information be provided to the public, or submitted to the information clearinghouse, under paragraph (1).

(f)

Confidentiality of review committee proceedings

(1)

In general

All proceedings and activities of a State maternal mortality review committee under this section, opinions of members of such a committee formed as a result of such proceedings and activities, and records obtained, created, or maintained pursuant to this section, including records of interviews, written reports, and statements procured by the Department of Health and Human Services or by any other person, agency, or organization acting jointly with the Department, in connection with morbidity and mortality reviews under this section, shall be confidential, and not subject to discovery, subpoena, or introduction into evidence in any civil, criminal, legislative, or other proceeding. Such records shall not be open to public inspection.

(2)

Testimony of members of committee

(A)

In general

Members of a State maternal mortality review committee under this section may not be questioned in any civil, criminal, legislative, or other proceeding regarding information presented in, or opinions formed as a result of, a meeting or communication of the committee.

(B)

Clarification

Nothing in this subsection shall be construed to prevent a member of such a committee from testifying regarding information that was obtained independent of such member’s participation on the committee, or that is public information.

(3)

Availability of information for research purposes

Nothing in this subsection shall prohibit the publishing by such a committee or the Department of Health and Human Services of statistical compilations and research reports that—

(A)

are based on confidential information, relating to morbidity and mortality review; and

(B)

do not contain identifying information or any other information that could be used to ultimately identify the individuals concerned.

(g)

Definitions

For purposes of this section:

(1)

The term pregnancy-associated death means the death of a woman while pregnant or during the one-year period following the date of the end of pregnancy, irrespective of the cause of such death.

(2)

The term pregnancy-related death means the death of a woman while pregnant or during the one-year period following the date of the end of pregnancy, irrespective of the duration or site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from any accidental or incidental cause.

(3)

The term woman of childbearing age means a woman who is at least 10 years of age and not more than 54 years of age.

.

(b)

Inclusion of findings of review committees in required reports

(1)

State triennial reports

Paragraph (2) of section 506(a) of such Act (42 U.S.C. 706(a)) is amended by inserting after subparagraph (E) the following new subparagraph:

(F)

In the case of a State receiving a grant under section 514, beginning for the first fiscal year beginning after 3 years after the date of establishment of the State maternal mortality review committee established by the State pursuant to such grant and once every 3 years thereafter, information containing the findings and recommendations of such committee and information on the implementation of such recommendations during the period involved.

.

(2)

Annual reports to Congress

Paragraph (3) of such section is amended—

(A)

in subparagraph (D), at the end, by striking and;

(B)

in subparagraph (E), at the end, by striking the period and inserting ; and; and

(C)

by adding at the end the following new subparagraph:

(F)

For fiscal year 2012 and each subsequent fiscal year, taking into account the findings, recommendations, and implementation information submitted by States pursuant to paragraph (2)(F), on the status of pregnancy-related deaths and pregnancy-associated deaths in the United States and including recommendations on methods to prevent such deaths in the United States.

.

506.

Eliminating disparities in maternity health outcomes

Part B of title III of the Public Health Service Act is amended by inserting after section 317V, as added, the following new section:

317W.

Eliminating disparities in maternity health outcomes

(a)

In general

The Secretary shall, in consultation with relevant national stakeholder organizations, such as national medical specialty organizations, national maternal child health organizations, and national health disparity organizations, carry out the following activities to eliminate disparities in maternal health outcomes:

(1)

Conduct research into the determinants and the distribution of disparities in maternal care, health risks, and health outcomes, and improve the capacity of the performance measurement infrastructure to measure such disparities.

(2)

Expand access to services that have been demonstrated to improve the quality and outcomes of maternity care for vulnerable populations.

(3)

Establish a demonstration project to compare the effectiveness of interventions to reduce disparities in maternity services and outcomes, and implement and assess effective interventions.

(b)

Scope and selection of States for demonstration project

The demonstration project under subsection (a)(3) shall be conducted in no more than 8 States, which shall be selected by the Secretary based on—

(1)

applications submitted by States, which specify which regions and populations the State involved will serve under the demonstration project;

(2)

criteria designed by the Secretary to ensure that, as a whole, the demonstration project is, to the greatest extent possible, representative of the demographic and geographic composition of communities most affected by disparities;

(3)

criteria designed by the Secretary to ensure that a variety of type of models are tested through the demonstration project and that such models include interventions that have an existing evidence base for effectiveness; and

(4)

criteria designed by the Secretary to assure that the demonstration projects and models will be carried out in consultation with local and regional provider organizations, such as community health centers, hospital systems, and medical societies representing providers of maternity services.

(c)

Duration of demonstration project

The demonstration project under subsection (a)(3) shall begin on January 1, 2012, and end on December 31, 2016.

(d)

Grants for evaluation and monitoring

The Secretary may make grants to States and health care providers participating in the demonstration project under subsection (a)(3) for the purpose of collecting data necessary for the evaluation and monitoring of such project.

(e)

Reports

(1)

State reports

Each State that participates in the demonstration project under subsection (a)(3) shall report to the Secretary, in a time, form, and manner specified by the Secretary, the data necessary to—

(A)

monitor the—

(i)

outcomes of the project;

(ii)

costs of the project; and

(iii)

quality of maternity care provided under the project; and

(B)

evaluate the rationale for the selection of the items and services included in any bundled payment made by the State under the project.

(2)

Final report

Not later than December 31, 2017, the Secretary shall submit to Congress a report on the results of the demonstration project under subsection (a)(3).

.

507.

Decreasing the risk factors for sudden unexpected infant death and sudden unexplained death in childhood

(a)

Establishment

The Secretary of Health and Human Services acting through the Administrator of the Health Resources and Services Administration and in consultation with the Director of the Centers for Disease Control and Prevention and the Director of the National Institutes of Health (in this section referred to as the Secretary) shall establish and implement a culturally competent public health awareness and education campaign to provide information that is focused on decreasing the risk factors for sudden unexpected infant death and sudden unexplained death in childhood, including educating individuals about safe sleep environments, sleep positions, and reducing exposure to smoking during pregnancy and after birth.

(b)

Targeted Populations

The campaign under subsection (a) shall be designed to reduce health disparities through the targeting of populations with high rates of sudden unexpected infant death and sudden unexplained death in childhood.

(c)

Consultation

In establishing and implementing the campaign under subsection (a), the Secretary shall consult with national organizations representing health care providers, including nurses and physicians, parents, child care providers, children's advocacy and safety organizations, maternal and child health programs and women’s, infants, and children nutrition professionals, and other individuals and groups determined necessary by the Secretary for such establishment and implementation.

(d)

Grants

(1)

In general

In carrying out the campaign under subsection (a), the Secretary shall award grants to national organizations, State and local health departments, and community-based organizations for the conduct of education and outreach programs for nurses, parents, child care providers, public health agencies, and community organizations.

(2)

Application

To be eligible to receive a grant under paragraph (1), an entity shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.

(e)

Authorization of appropriations

There is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2012 through 2016.

508.

Reducing teenage pregnancies

Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) is amended by adding at the end the following new part:

W

Youth Pregnancy Prevention Programs

399OO.

Purpose

It is the purpose of this part to develop and carry out research and demonstration projects on new and existing program interventions to provide youth in racial or ethnic minority or immigrant communities the information and skills needed to reduce teenage pregnancies, build healthy relationships, and improve overall health and well-being.

399OO–1.

Demonstration grants to reduce teenage pregnancies

(a)

In general

The Secretary shall award competitive grants to eligible entities for establishing or expanding programs to provide youth in racial or ethnic minority or immigrant communities the information and skills needed to avoid teenage pregnancy and develop healthy relationships.

(b)

Priority

In awarding grants under this section, the Secretary shall give priority to applicants—

(1)

proposing to carry out projects in racial or ethnic minority or immigrant communities;

(2)

that have a demonstrated history of effectively working with such targeted communities; or

(3)

that have a demonstrated history of engaging in a meaningful and significant partnership with such targeted communities.

(c)

Program settings

Programs funded through a grant under subsection (a) shall be provided—

(1)

through classroom-based settings, such as school health education, humanities, language arts, or family and consumer science education; after-school programs; community-based programs; workforce development programs; and health care settings; or

(2)

in collaboration with systems that serve large numbers of at-risk youth such as juvenile justice or foster care systems.

(d)

Project requirements

As a condition of receipt of a grant under this section, an entity shall agree that, with respect to information and skills provided through the grant—

(1)

such information and skills will be—

(A)

age-appropriate;

(B)

evidence-based or evidence-informed;

(C)

provided in accordance with section 399OO–5(b); and

(D)

culturally sensitive and relevant to the target populations; and

(2)

any information provided about contraceptives shall include the health benefits and side effects of all contraceptives and barrier methods.

(e)

Evaluation

Of the total amount made available to carry out this section for a fiscal year, the Secretary, acting through the Director of the Centers for Disease Control and Prevention and other agencies as appropriate, shall allot up to 10 percent of such amount to carry out a rigorous, independent evaluation to determine the extent and the effectiveness of activities funded through this section during such fiscal year in changing attitudes and behavior of teenagers with respect to healthy relationships and childbearing.

(f)

Grants for Indian tribes or tribal organizations

Of the total amount made available to carry out this section for a fiscal year, the Secretary shall reserve 5 percent of such amount to award grants under this section to Indian tribes and tribal organizations in such manner, and subject to such requirements, as the Secretary, in consultation with Indian tribes and tribal organizations, determines appropriate.

(g)

Eligible entity defined

(1)

In general

In this section, the term eligible entity means a State, local, or tribal agency; a school or postsecondary institution; an after-school program; a nonprofit organization; or a community or faith-based organization.

(2)

Preventing exclusion of smaller community-based organizations

In carrying out this section, the Secretary shall ensure that the amounts and requirements of grants provided under this section do not preclude receipt of such grants by community-based organizations with a demonstrated history of effectively working with adolescents in racial or ethnic minority or immigrant communities or engaged in meaningful and significant partnership with such communities.

399OO–2.

Multimedia campaigns to reduce teenage pregnancies

(a)

In general

The Secretary shall award competitive grants to public and private entities to carry out multimedia campaigns to provide public education and increase public awareness regarding teenage pregnancy and related social and emotional issues, such as violence prevention.

(b)

Priority

In awarding grants under this section, the Secretary shall give priority to applicants proposing to carry out campaigns developed for racial or ethnic minority or immigrant communities.

(c)

Information To be provided

As a condition of receipt of a grant under this section, an entity shall agree to use the grant to carry out multimedia campaigns described in subsection (a) that—

(1)

at a minimum, shall provide information on—

(A)

the prevention of teenage pregnancy; and

(B)

healthy relationship development; and

(2)

may provide information on the prevention of dating violence.

399OO–3.

Research on reducing teenage pregnancies and teenage dating violence and improving healthy relationships

(a)

In general

The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall make grants to public and private entities to conduct, support, or coordinate research on teenage pregnancy, dating violence, and healthy relationships among racial or ethnic minority or immigrant communities that—

(1)

improves data collection on—

(A)

sexual and reproductive health, including teenage pregnancies and births, among all minority communities and subpopulations in which such data are not collected, including American Indian and Alaska Native youth;

(B)

sexual behavior, sexual or reproductive coercion, and teenage contraceptive use patterns at the State level, as appropriate; and

(C)

teenage pregnancies among youth in and aging out of foster care or juvenile justice systems and the underlying factors that lead to teenage pregnancy among youth in foster care or juvenile justice systems;

(2)

investigates—

(A)

the variance in the rates of teenage pregnancy by—

(i)

racial and ethnic group (such as Hispanic, Asian-American, African-American, Pacific Islander, American Indian, and Alaska Native); and

(ii)

socioeconomic status, including as based on the income of the family and education attainment;

(B)

factors affecting the risk for youth of teenage pregnancy or dating abuse, including the physical and social environment, level of acculturation, access to health care, aspirations for the future, and history of physical or sexual violence or abuse;

(C)

the role that violence and abuse play in teenage sex, pregnancy, and childbearing;

(D)

strategies to address the disproportionate rates of teenage pregnancies and dating violence in racial or ethnic minority or immigrant communities;

(E)

how effective interventions can be replicated or adapted in other settings to serve racial or ethnic minority or immigrant communities; and

(F)

the effectiveness of media campaigns in addressing healthy relationship development, dating violence prevention, and teenage pregnancy; and

(3)

tests research-based strategies for addressing high rates of unintended teenage pregnancy through programs that emphasize healthy relationships and violence prevention.

(b)

Priority

In carrying out this section, the Secretary shall give priority to research that incorporates—

(1)

interdisciplinary approaches;

(2)

a strong emphasis on community-based participatory research; or

(3)

translational research.

399OO–4.

HHS adolescent health work group

(a)

Purpose

Not later than 30 days after the date of the enactment of this part, the Secretary shall direct the interagency adolescent health workgroup within the Office of Adolescent Health of the Department of Health and Human Services to—

(1)

include in the work of the group strategies for teenage dating violence prevention and healthy teenage relationships with a particular focus among racial or ethnic minority or immigrant communities; and

(2)

with respect to including such strategies, consult, to the greatest extent possible, with the Federal Interagency Workgroup on Teen Dating Violence formed under the leadership of the National Institute of Justice of the Department of Justice.

(b)

Report Requirement

The Secretary, through the Office of Adolescent Health, shall periodically submit to Congress a report that—

(1)

includes a review of the evidence-based programs on preventing teenage pregnancy, which are carried out and identified by the Office; and

(2)

identifies the programs of the Department of Health and Human Services that include teenage dating violence prevention and the promotion of healthy teenage relationships as part of a strategy to prevent teenage pregnancy.

399OO–5.

General grant provisions

(a)

Applications

To seek a grant under this part, an entity shall submit an application to the Secretary in such form, in such manner, and containing such agreements, assurances, and information as the Secretary may require.

(b)

Additional requirements

A grant may be made under this part only if the applicant involved agrees that information, activities, and services provided under the grant—

(1)

will be evidence-based or evidence informed;

(2)

will be factually and medically accurate and complete; and

(3)

if directed to a particular population group, will be provided in an appropriate language and cultural context.

(c)

Training and technical assistance

(1)

In general

Of the total amount made available to carry out this part for a fiscal year, the Secretary shall use 10 percent to provide, directly or through a competitive grant process, training and technical assistance to the grant recipients under this part, including by disseminating research and information regarding effective and promising practices, providing consultation and resources on a broad array of teenage and unintended pregnancy and violence prevention strategies, and developing resources and materials.

(2)

Collaboration

In carrying out this subsection, the Secretary shall collaborate with entities that have expertise in the prevention of teenage pregnancy, healthy relationship development, minority health and health disparities, and violence prevention.

399OO–6.

Definitions

In this part:

(1)

Medically accurate and complete

The term medically accurate and complete means, with respect to information, activities, or services, verified or supported by the weight of research conducted in compliance with accepted scientific methods and—

(A)

published in peer-reviewed journals, where applicable; or

(B)

comprising information that leading professional organizations and agencies with relevant expertise in the field recognize as accurate, objective, and complete.

(2)

Racial or ethnic minority or immigrant communities

The term racial or ethnic minority or immigrant communities means communities with a substantial number of residents who are members of racial or ethnic minority groups or who are immigrants.

(3)

Reproductive coercion

The term reproductive coercion means, with respect to a person, coercive behavior that interferes with the ability of such person to control the reproductive decisionmaking of such person, such as intentionally exposing such person to sexually transmitted infections; in the case such person is a female, attempting to impregnate such person against her will; intentionally interfering with the person’s birth control; or threatening or acting violent if the person does not comply with the perpetrator’s wishes regarding contraception or the decision whether to terminate or continue a pregnancy.

(4)

Youth

The term youth means individuals who are 11 to 19 years of age.

399OO–7.

Reports

(a)

Report on use of funds

Not later than 1 year after the date of the enactment of this part, the Secretary shall submit to Congress a report on the use of funds provided pursuant to this part.

(b)

Report on impact of programs

Not later than March 1, 2016, the Secretary shall submit to Congress a report on the impact that the programs under this part had on reducing teenage pregnancies.

399OO–8.

Authorization of appropriations

(a)

In general

There are authorized to be appropriated to carry out this part such sums as may be necessary for each of the fiscal years 2012 through 2016.

(b)

Availability

Amounts appropriated pursuant to subsection (a)—

(1)

are authorized to remain available until expended; and

(2)

are in addition to amounts otherwise made available for such purposes.

.

509.

Gestational diabetes

Part B of title III of the Public Health Service Act (42 U.S.C. 243 et seq.) is amended by adding after section 317H the following:

317H–1.

Gestational diabetes

(a)

Understanding and monitoring gestational diabetes

(1)

In general

The Secretary, acting through the Director of the Centers for Disease Control and Prevention, in consultation with the Diabetes Mellitus Interagency Coordinating Committee established under section 429 and representatives of appropriate national health organizations, shall develop a multisite gestational diabetes research project within the diabetes program of the Centers for Disease Control and Prevention to expand and enhance surveillance data and public health research on gestational diabetes.

(2)

Areas to be addressed

The research project developed under paragraph (1) shall address—

(A)

procedures to establish accurate and efficient systems for the collection of gestational diabetes data within each State and commonwealth, territory, or possession of the United States;

(B)

the progress of collaborative activities with the National Vital Statistics System, the National Center for Health Statistics, and State health departments with respect to the standard birth certificate, in order to improve surveillance of gestational diabetes;

(C)

postpartum methods of tracking women with gestational diabetes after delivery as well as targeted interventions proven to lower the incidence of type 2 diabetes in that population;

(D)

variations in the distribution of diagnosed and undiagnosed gestational diabetes, and of impaired fasting glucose tolerance and impaired fasting glucose, within and among groups of women; and

(E)

factors and culturally sensitive interventions that influence risks and reduce the incidence of gestational diabetes and related complications during childbirth, including cultural, behavioral, racial, ethnic, geographic, demographic, socioeconomic, and genetic factors.

(3)

Report

Not later than 2 years after the date of the enactment of this section, and annually thereafter, the Secretary shall generate a report on the findings and recommendations of the research project including prevalence of gestational diabetes in the multisite area and disseminate the report to the appropriate Federal and non-Federal agencies.

(b)

Expansion of gestational diabetes research

(1)

In General

The Secretary shall expand and intensify public health research regarding gestational diabetes. Such research may include—

(A)

developing and testing novel approaches for improving postpartum diabetes testing or screening and for preventing type 2 diabetes in women with a history of gestational diabetes; and

(B)

conducting public health research to further understanding of the epidemiologic, socioenvironmental, behavioral, translation, and biomedical factors and health systems that influence the risk of gestational diabetes and the development of type 2 diabetes in women with a history of gestational diabetes.

(2)

Authorization of Appropriations

There is authorized to be appropriated to carry out this subsection $5,000,000 for each of fiscal years 2012 through 2016.

(c)

Demonstration grants To lower the rate of gestational diabetes

(1)

In General

The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall award grants, on a competitive basis, to eligible entities for demonstration projects that implement evidence-based interventions to reduce the incidence of gestational diabetes, the recurrence of gestational diabetes in subsequent pregnancies, and the development of type 2 diabetes in women with a history of gestational diabetes.

(2)

Priority

In making grants under this subsection, the Secretary shall give priority to projects focusing on—

(A)

helping women who have 1 or more risk factors for developing gestational diabetes;

(B)

working with women with a history of gestational diabetes during a previous pregnancy;

(C)

providing postpartum care for women with gestational diabetes;

(D)

tracking cases where women with a history of gestational diabetes developed type 2 diabetes;

(E)

educating mothers with a history of gestational diabetes about the increased risk of their child developing diabetes;

(F)

working to prevent gestational diabetes and prevent or delay the development of type 2 diabetes in women with a history of gestational diabetes; and

(G)

achieving outcomes designed to assess the efficacy and cost-effectiveness of interventions that can inform decisions on long-term sustainability, including third-party reimbursement.

(3)

Application

An eligible entity desiring to receive a grant under this subsection shall submit to the Secretary—

(A)

an application at such time, in such manner, and containing such information as the Secretary may require; and

(B)

a plan to—

(i)

lower the rate of gestational diabetes during pregnancy; or

(ii)

develop methods of tracking women with a history of gestational diabetes and develop effective interventions to lower the incidence of the recurrence of gestational diabetes in subsequent pregnancies and the development of type 2 diabetes.

(4)

Uses of Funds

An eligible entity receiving a grant under this subsection shall use the grant funds to carry out demonstration projects described in paragraph (1), including—

(A)

expanding community-based health promotion education, activities, and incentives focused on the prevention of gestational diabetes and development of type 2 diabetes in women with a history of gestational diabetes;

(B)

aiding State- and tribal-based diabetes prevention and control programs to collect, analyze, disseminate, and report surveillance data on women with, and at risk for, gestational diabetes, the recurrence of gestational diabetes in subsequent pregnancies, and, for women with a history of gestational diabetes, the development of type 2 diabetes; and

(C)

training and encouraging health care providers—

(i)

to promote risk assessment, high-quality care, and self-management for gestational diabetes and the recurrence of gestational diabetes in subsequent pregnancies; and

(ii)

to prevent the development of type 2 diabetes in women with a history of gestational diabetes, and its complications in the practice settings of the health care providers.

(5)

Report

Not later than 4 years after the date of the enactment of this section, the Secretary shall prepare and submit to the Congress a report concerning the results of the demonstration projects conducted through the grants awarded under this subsection.

(6)

Definition of Eligible Entity

In this subsection, the term eligible entity means a nonprofit organization (such as a nonprofit academic center or community health center) or a State, tribal, or local health agency.

(7)

Authorization of Appropriations

There is authorized to be appropriated to carry out this subsection $5,000,000 for each of fiscal years 2012 through 2016.

(d)

Postpartum follow-Up regarding gestational diabetes

The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall work with the State- and tribal-based diabetes prevention and control programs assisted by the Centers to encourage postpartum follow-up after gestational diabetes, as medically appropriate, for the purpose of reducing the incidence of gestational diabetes, the recurrence of gestational diabetes in subsequent pregnancies, the development of type 2 diabetes in women with a history of gestational diabetes, and related complications.

.

510.

Emergency contraception education and information programs

(a)

Emergency Contraception Public Education Program

(1)

In general

The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall develop and disseminate to the public information on emergency contraception.

(2)

Dissemination

The Secretary may disseminate information under paragraph (1) directly or through arrangements with nonprofit organizations, consumer groups, institutions of higher education, clinics, the media, and Federal, State, and local agencies.

(3)

Information

The information disseminated under paragraph (1) shall include, at a minimum, a description of emergency contraception and an explanation of the use, safety, efficacy, and availability of such contraception.

(b)

Emergency Contraception Information Program for Health Care Providers

(1)

In general

The Secretary, acting through the Administrator of the Health Resources and Services Administration and in consultation with major medical and public health organizations, shall develop and disseminate to health care providers information on emergency contraception.

(2)

Information

The information disseminated under paragraph (1) shall include, at a minimum—

(A)

information describing the use, safety, efficacy, and availability of emergency contraception;

(B)

a recommendation regarding the use of such contraception in appropriate cases; and

(C)

information explaining how to obtain copies of the information developed under subsection (a) for distribution to the patients of the providers.

(c)

Definitions

In this section:

(1)

Emergency contraception

The term emergency contraception means a drug or device (as the terms are defined in section 201 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321)) or a drug regimen that—

(A)

is used postcoitally;

(B)

prevents pregnancy primarily by preventing or delaying ovulation, and does not terminate an established pregnancy; and

(C)

is approved by the Food and Drug Administration.

(2)

Health care provider

The term health care provider means an individual who is licensed or certified under State law to provide health care services and who is operating within the scope of such license. Such term shall include a pharmacist.

(3)

Institution of higher education

The term institution of higher education has the same meaning given such term in section 101(a) of the Higher Education Act of 1965 (20 U.S.C. 1001(a)).

(4)

Secretary

The term Secretary means the Secretary of Health and Human Services.

(d)

Authorization of Appropriations

There are authorized to be appropriated to carry out this section such sums as may be necessary for each of the fiscal years 2012 through 2016.

511.

Supporting healthy adolescent development

(a)

In General

The Secretary may award a grant to each eligible State to conduct programs of sex education described in subsection (b), including education on both abstinence and contraception for the prevention of teenage pregnancy and sexually transmitted diseases, including HIV/AIDS.

(b)

Requirements for Sex Education Programs

A program of sex education described in this subsection is a program that—

(1)

is age appropriate and medically accurate;

(2)

stresses the value of abstinence while not ignoring those young people who have been or are sexually active;

(3)

provides information about the health benefits and side effects of contraceptive and barrier methods used—

(A)

as a means to prevent pregnancy; and

(B)

to reduce the risk of contracting sexually transmitted disease, including HIV/AIDS;

(4)

encourages family communication between parent and child about sexuality;

(5)

cultivates a respectful dialogue about sexuality, including sexual orientation and gender identity, and embraces the principles of nondiscrimination based on sexual orientation and gender identity;

(6)

counters the perpetuation of narrow gender roles, including the sexualization of female children, adolescents, and adults;

(7)

teaches young people the skills to make responsible decisions about sexuality, including how to avoid unwanted verbal, physical, and sexual advances and how to avoid making verbal, physical, and sexual advances that are not wanted by the other party;

(8)

develops healthy relationships, including the prevention of dating and sexual violence;

(9)

teaches young people how alcohol and drug use can affect responsible decisionmaking; and

(10)

does not teach or promote religion.

(c)

Additional Activities

In carrying out a program of sex education, a State may expend grant funds awarded under subsection (a) to carry out educational and motivational activities that help young people—

(1)

gain knowledge about the physical, emotional, biological, and hormonal changes of adolescence and subsequent stages of human maturation;

(2)

develop the knowledge and skills necessary to ensure and protect their sexual and reproductive health from unintended pregnancy and sexually transmitted disease, including HIV/AIDS, throughout their lifespan;

(3)

gain knowledge about the specific involvement and responsibility of each individual in sexual decisionmaking;

(4)

develop healthy attitudes and values about adolescent growth and development, body image, gender roles, racial and ethnic diversity, sexual orientation and gender identity, and other subjects;

(5)

develop and practice healthy life skills including goal-setting, decisionmaking, negotiation, communication, and stress management; and

(6)

promote self-esteem and positive interpersonal skills focusing on relationship dynamics, including friendships, dating, romantic involvement, marriage, and family interactions.

(d)

Matching funds

The Secretary may not make payments to a State under this section in an amount exceeding Federal medical assistance percentage for such State (as such term is defined in section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b))) of the costs of the programs conducted by the State under this section.

(e)

Evaluation of programs

(1)

In General

For the purpose of evaluating the effectiveness of programs of sex education carried out with a grant under this section, evaluations shall be carried out in accordance with paragraphs (2) and (3).

(2)

National Evaluation

(A)

Method

The Secretary shall provide for a national evaluation of a representative sample of programs of sex education carried out with grants under this section to determine—

(i)

the effectiveness of such programs in helping to delay the initiation of sexual intercourse and other high-risk behaviors;

(ii)

the effectiveness of such programs in preventing adolescent pregnancy;

(iii)

the effectiveness of such programs in preventing sexually transmitted disease, including HIV/AIDS;

(iv)

the effectiveness of such programs in increasing contraceptive knowledge and contraceptive behaviors when sexual intercourse occurs; and

(v)

a list of best practices based upon essential programmatic components of evaluated programs that have led to success described in clauses (i) through (iv).

(B)

Grant condition

A condition for the receipt of a grant to a State under this section is that the State cooperate with the evaluation under subparagraph (A).

(C)

Report

The Secretary shall submit to the Congress—

(i)

not later than the end of each fiscal year during the 5-year period beginning with fiscal year 2012, an interim report on the national evaluation under subparagraph (A); and

(ii)

not later than March 31, 2017, a final report providing the results of such national evaluation.

(3)

Individual State Evaluations

A condition for the receipt of a grant under this section is that the State evaluate of the programs of sex education funded through such grant in accordance with the following requirements:

(A)

The evaluation will be conducted by an external, independent entity.

(B)

The purposes of the evaluation will be the determination of—

(i)

the effectiveness of such programs in helping to delay the initiation of sexual intercourse and other high-risk behaviors;

(ii)

the effectiveness of such programs in preventing adolescent pregnancy;

(iii)

the effectiveness of such programs in preventing sexually transmitted disease, including HIV/AIDS; and

(iv)

the effectiveness of such programs in increasing contraceptive and barrier method knowledge and contraceptive behaviors when sexual intercourse occurs.

(f)

Limitations on use of funds

(1)

Limitations on Secretary

Of the amounts appropriated for a fiscal year for purposes of this section, the Secretary may not use more than—

(A)

7 percent of such amounts for administrative expenses related to carrying out this section for that fiscal year; and

(B)

10 percent of such amounts for the national evaluation under subsection (e)(2).

(2)

Limitations to states