108th CONGRESS
2d Session
S. 2217
To improve the health of health disparity populations.
IN THE SENATE OF THE UNITED STATES
March 12, 2004
Mr. FRIST introduced the following bill; which was read twice and referred
to the Committee on Finance
A BILL
To improve the health of health disparity populations.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE- This Act may be cited as the `Closing the Health Care Gap
Act of 2004'.
(b) TABLE OF CONTENTS- The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I--IMPROVED HEALTH CARE QUALITY AND EFFECTIVE DATA COLLECTION AND
ANALYSIS
Sec. 101. Standardized measures of quality health care.
Sec. 102. Data collection.
TITLE II--EXPANDED ACCESS TO QUALITY HEALTH CARE
Subtitle A--Access, Awareness, and Outreach
Sec. 201. Access and awareness grants.
Sec. 202. Innovative outreach programs.
Subtitle B--Refundable Health Insurance Credit
Sec. 211. Refundable health insurance costs credit.
Sec. 212. Advance payment of credit to issuers of qualified health insurance.
TITLE III--STRONG NATIONAL LEADERSHIP, COOPERATION, AND COORDINATION
Sec. 301. Office of Minority Health and Health Disparities.
TITLE IV--PROFESSIONAL EDUCATION, AWARENESS, AND TRAINING
Sec. 401. Workforce diversity and training.
Sec. 402. Higher education technical amendments.
Sec. 403. Model cultural competency curriculum development.
Sec. 404. Internet cultural competency clearinghouse.
TITLE V--ENHANCED RESEARCH
Sec. 501. Agency for Healthcare Research and Quality.
Sec. 502. National Institutes of Health.
TITLE VI--MISCELLANEOUS PROVISIONS
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) The overall health of Americans has dramatically improved over the last
century, and Americans are justifiably proud of the great strides that have
been made in the health and medical sciences.
(2) As medical science and technology have advanced at a rapid pace, however,
the health care delivery system has not been able to provide consistently
high quality care to all Americans.
(3) In particular, people of lower socioeconomic status, racial and ethnic
minorities, and medically underserved populations have experienced poor
health and challenges in accessing high quality health care.
(4) Recent studies have raised significant questions regarding differences
in clinical care provided to racial and ethnic minorities and other health
disparity populations. These differences are often grouped together under
the broad heading of `health disparities'.
(5) Studies indicate that a gap exists between ideal health care and the
actual health care that some Americans receive.
(6) Data collection, analysis, and reporting by race, ethnicity, and primary
language across federally supported health programs are essential for identifying,
understanding the causes of, monitoring, and eventually eliminating health
disparities.
(7) Current health related data collection and reporting activities largely
reflect the efforts of the Department of Health and Human Services. Despite
considerable efforts by the Department, data collection efforts governing
racial, ethnic, and health disparity populations remain inconsistent and
inadequate. They often quantify disparities but shed little light on their
causes.
(8) Many Americans, and particularly racial and ethnic minorities and other
health disparity populations, miss opportunities for preventive medical
care. Similarly, management of chronic illnesses in these populations presents
unique challenges to the nation's health care system.
(9) The largest numbers of the medically underserved are white individuals,
and many of them have the same health care access problems as do members
of minority groups. Nearly 22,000,000 white individuals live below the poverty
line with many living in nonmetropolitan, rural areas such as Appalachia,
where the high percentage of countries designated as health professional
shortage areas (47 percent) and the high rate of poverty contribute to disparity
outcomes. However, there is a higher proportion of racial and ethnic minorities
in the United States represented among the medically underserved.
(10) While much research examines the question of racial and ethnic differences
in health care, less is known about the magnitude and extent of differences
in the quality of health care related to nonsocioeconomic factors. Only
recently have scientists and quality improvement experts begun to address
the issue of how best to measure, track, and improve quality of health care
in diverse populations. Additional research in order to understand the causes
of disparities and develop effective approaches to eliminate these gaps
in health care quality will be necessary.
(11) There is a need to ensure appropriate representation of racial and
ethnic minorities, and other health disparity populations, in the health
care professions and in the fields of biomedical, clinical, behavioral,
and health services research.
(12) Preventable disparities in access to and quality of health care are
unacceptable. Health care delivered in the United States should be care
that is as safe, effective, patient-centered, timely, efficient and equitable
as possible.
TITLE I--IMPROVED HEALTH CARE QUALITY AND EFFECTIVE DATA COLLECTION AND
ANALYSIS
SEC. 101. STANDARDIZED MEASURES OF QUALITY HEALTH CARE.
(1) COLLABORATION- The Secretary of Health and Human Services, the Secretary
of Defense, the Secretary of Veterans Affairs, the Director of the
Indian Health Service, and the Director of the Office of Personnel Management
(referred to in this section as the `Secretaries') shall work collaboratively
to establish uniform, standardized health care quality measures across all
Federal Government health programs. Such measures shall be designed to assess
quality improvement efforts with regard to the safety, timeliness, effectiveness,
patient-centeredness, and efficiency of health care delivered across all federally
supported health care delivery programs including those in which health care
services are delivered to health disparity populations.
(2) DEVELOPMENT OF MEASURES- Relying on earlier work by the Secretary of
Health and Human Services or others (including work such as the Healthy
People 2010 or the IOM Quality Chasm reports) and with an emphasis on health
conditions disproportionately affecting health disparity populations and
taking into account health literacy and primary language and cultural factors,
the Secretaries shall develop standardized sets of quality measures for--
(A) 5 common health conditions by not later than January 1, 2006; and
(B) an additional 10 common health conditions by not later than January
1, 2007.
(3) PILOT TESTING- Each federally administered health care program may conduct
a pilot test of the quality measures developed under paragraph (2) that
shall include a collection of patient-level data and a public release of
comparative performance reports.
(b) PUBLIC REPORTING REQUIREMENTS- The Secretaries shall work collaboratively
to establish standardized public reporting requirements for clinicians, institutional
providers, and health plans in each of the health programs described in subsection
(a).
(c) FULL IMPLEMENTATION- The Secretaries shall work collaboratively to prepare
for the full implementation of all standardized sets of quality measures and
reporting systems developed under subsections (a) and (b) by not later than
January 1, 2009.
(d) PROGRESS REPORT- The Secretary of Health and Human Services shall prepare
an annual progress report that details the collaborative efforts carried out
under subsection (a).
(e) COMPARATIVE QUALITY REPORTS- Beginning on January 1, 2008, in order to
make comparative quality information available to health care consumers, including
members of health disparity populations, health professionals, public health
officials, researchers, and other appropriate individuals and entities, the
Secretaries shall provide for the pooling and analysis of quality measures
collected under this section. Nothing in this section shall be construed as
modifying the privacy standards under the Health Insurance Portability and
Accountability Act of 1996 (Public Law 104-191).
(f) ONGOING EVALUATION OF USE- The Secretary of Health and Human Services
shall ensure the ongoing evaluation of the use of the health care quality
measures established under this section.
(g) EXISTING ACTIVITIES- Notwithstanding any other provision of law, the standardized
measures and reporting activities described in this section shall replace,
to the extent practicable and appropriate, any existing measurement and reporting
activities currently utilized by federally supported health care delivery
programs.
(1) INSTITUTE OF MEDICINE-
(A) IN GENERAL- The Secretary of Health and Human Services shall request
the Institute of Medicine to conduct an evaluation of the collaborative
efforts of the Secretaries to establish uniform, standardized health care
quality measures and reporting requirements for federally supported health
care delivery programs as required under this section.
(B) REPORT- Not later than 2 years after the date of enactment of this
Act, the Institute of Medicine shall submit a report concerning the results
of the evaluation under subparagraph (A) to the Secretary.
(A) PROPOSED- Not later than 18 months after the date on which the report
is submitted under paragraph (1)(B), the Secretary shall publish proposed
regulations regarding the uniform, standardized health care quality measures
and reporting requirements described in this section.
(B) FINAL REGULATIONS- Not later than 3 years after the date on which
the report is submitted under paragraph (1)(B), the Secretary shall publish
final regulations regarding the uniform, standardized health care quality
measures and reporting requirements described in this section.
SEC. 102. DATA COLLECTION.
(a) IN GENERAL- The Secretary of Health and Human Services (referred to in
this section as the `Secretary') shall--
(1) ensure that data collected under the medicare program under title XVIII
of the Social Security Act (42 U.S.C. 1395 et seq.) are accurate by race,
ethnicity, and primary language and available for inclusion in the National
Health Disparities Report;
(2) enforce State data collection and reporting by race, ethnicity, and
primary language for enrollees in the medicaid program under title XIX of
the Social Security Act (42 U.S.C. 1396 et seq.) and the State Children's
Health Insurance Program under title XXI of such Act (42 U.S.C. 1397aa et
seq.) and ensure that such data are available for inclusion in the National
Health Disparities Report;
(3) ensure that ongoing and any new program initiatives--
(A) collect and report data by race, ethnicity, and primary language and
provide technical assistance to promote compliance;
(B) address technological difficulties;
(C) ensure privacy and confidentiality of data collected; and
(D) implement effective educational strategies;
(4) expand educational programs to inform insurers, providers, agencies
and the public of the importance of data collection by race, ethnicity,
and primary language to improving health care access and quality;
(5) raise awareness that these data are critical for achieving Healthy People
2010 goals and essential to the nondiscrimination requirements of title
VI of the Civil Rights Act (42 U.S.C. 2000d et seq.); and
(6) support research on existing best practices for data collection.
(b) GRANTS FOR DATA COLLECTION BY HEALTH PLANS, HEALTH CENTERS, AND HOSPITALS-
(1) IN GENERAL- The Secretary, acting through the Director of the Agency
for Healthcare Research and Quality, may support or conduct not to exceed
20 demonstration programs to enhance the collection, analysis, and reporting
of the data required under this section.
(2) ELIGIBILITY- To be eligible to receive a grant under this section an
entity shall--
(A) be a health plan, federally qualified health center or health center
network, or hospital; and
(B) prepare and submit to the Secretary an application at such time, in
such manner, and containing such as information as the Secretary may require.
(3) USE OF FUNDS- A grantee shall use amounts received under a grant under
this subsection to--
(A) collect, analyze, and report data by race, ethnicity, or other health
disparity category for patients served by the grantee, including--
(i) in the case of a hospital, emergency room patients and patients
served on an inpatient or outpatient basis;
(ii) in the case of a health plan, data for enrollees; and
(iii) in the case of a federally qualified health center or health center
network, primary care, specialty care, and referrals;
(B) provide analyses of racial, ethnic and other disparities in health
and health care, including specific disease conditions, diagnostic and
therapeutic procedures, or outcomes;
(C) improve health data collection and analysis for additional population
groups beyond the Office of Management and Budget categories if such groups
can be aggregated into the minimum race and ethnicity categories;
(D) develop mechanisms for sharing collected data, subject to applicable
privacy and confidentiality regulations;
(E) develop educational programs to inform health insurance issuers, health
plans, health providers, health-related agencies, patients, enrollees,
and the general public that data collection, analysis, and reporting by
race, ethnicity, and preferred language are legal and essential for eliminating
disparities in health and health care; and
(F) ensure the evaluation of activities conducted under this section.
TITLE II--EXPANDED ACCESS TO QUALITY HEALTH CARE
Subtitle A--Access, Awareness, and Outreach
SEC. 201. ACCESS AND AWARENESS GRANTS.
(a) DEMONSTRATION PROJECTS- The Secretary of Health and Human Services (in
this section referred to as the `Secretary') may award contracts or competitive
grants to eligible entities to support demonstration projects designed to
improve the health and health care of health disparity populations through
improved access to health care, health care navigation assistance, and health
literacy education.
(b) ELIGIBLE ENTITY DEFINED- In this section the term `eligible entity' means--
(2) an academic institution;
(3) a State health agency;
(4) an Indian Health Service hospital or clinic, Indian tribal health facility,
or urban Indian facility;
(5) a nonprofit organization including a faith-based organization or consortia,
to the extent that a grant awarded to such an entity is consistent with
the requirements of section 1955 of the Public Health Service Act (42 U.S.C.
300x-65) relating to grant award to nongovernmental entities;
(6) a primary care practice-based research network as defined by the Director
of the Agency for Healthcare Research and Quality;
(7) 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))); or
(8) any other entity determined to be appropriate by the Secretary.
(c) APPLICATION- An eligible entity seeking a grant under this section shall
submit an application to the Secretary at such time, in such manner, and containing
such information as the Secretary may require, including assurances that the
eligible entity will--
(1) target patient populations that are members of racial and ethnic minority
groups or health disparity populations through specific outreach activities;
(2) coordinate with appropriate community organizations and include appropriate
community participation in planning and implementation of activities;
(3) coordinate culturally competent and appropriate care;
(4) include a plan to ensure that the entity will become self-sustaining
when funding under the grant terminates; and
(5) include quality and outcomes performance measures to evaluate the effectiveness
of activities funded under this section to ensure that the activities are
meeting their goals, and disseminate findings from such evaluations.
(d) PRIORITIES- In awarding contracts and grants under this section, the Secretary
shall give priority to applicants that intend to use amounts received under
this section to carry out all programs specified under subsection (e).
(e) USE OF FUNDS- An eligible entity shall use amounts received under this
section to carry out programs that involve at least 2 of the following:
(1) Providing resources and guidance to individuals regarding sources of
health insurance coverage, as well as information on how to obtain health
coverage in the private insurance market, through Federal and State programs,
and through other available coverage options.
(2) Providing patient navigator services to help individuals better utilize
their health coverage by working through the health system to obtain appropriate
quality care, including programs in which--
(A) trained individuals (such as representatives from the community, nurses,
social workers, physicians, or patient advocates) are assigned to act
as contacts--
(i) within the community; or
(ii) within the health care system, to facilitate access to health care
services;
(B) partnerships are created with community organizations (which may include
hospitals, federally qualified health centers or health center networks,
faith-based organizations, primary care providers, home care, nonprofit
organizations, health plans, or other health providers determined appropriate
by the Secretary) to help facilitate access or to improve the quality
of care;
(C) activities are conducted to coordinate care and preventive services
and referrals;
(D) services are provided for translation, interpretation, and other such
linguistic services for patients with limited English proficiency; or
(E) an entity receiving a grant under this section negotiates on behalf
of the patient with relevant entities, or provides referrals and guides
the patient through the mediation or arbitration process, to resolve issues
that impede access to care.
(3) Promoting broad health awareness and prevention efforts, including patient
education and health literacy programs to help increase a patient's knowledge
of how to best participate in such patient's and such patient's children's
treatment decisions.
(4) Enhancing preventive services and coordinated, multidisciplinary disease
management of chronic conditions, such as diabetes mellitus, HIV/AIDS, asthma,
cancer, cardiovascular disease, and obesity.
(f) REPORT- Not later than 3 years after the date an entity receives a grant
under this section and annually thereafter, the entity shall provide to the
Secretary a report containing the results of any evaluation conducted pursuant
to subsection (c)(5).
(g) 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 2005 through 2009.
SEC. 202. INNOVATIVE OUTREACH PROGRAMS.
(a) GRANTS TO PROMOTE INNOVATIVE OUTREACH AND ENROLLMENT UNDER MEDICAID AND
SCHIP- Section 2104(e) of the Social Security Act (42 U.S.C. 1397dd(e)) is
amended--
(1) by striking `Amounts allotted' and inserting the following:
`(1) IN GENERAL- Subject to paragraph (2), amounts allotted'; and
(2) by adding at the end the following:
`(2) GRANTS TO PROMOTE INNOVATIVE OUTREACH AND ENROLLMENT EFFORTS-
`(A) IN GENERAL- Prior to September 30 of each fiscal year, beginning
with fiscal year 2004, the Secretary shall reserve from any unexpended
allotments made to States under subsection (b) or (c) (including any portion
of such allotments that were redistributed under subsection (f) or (g))
for a fiscal year that would revert to the Treasury on October 1 of the
succeeding fiscal year but for the application of this paragraph, the
lesser of $50,000,000 or the total amount of such unexpended allotments
for purposes of awarding grants under this paragraph for such succeeding
fiscal year to States or national, local, and community-based public or
nonprofit private organizations to conduct innovative outreach and enrollment
efforts that are designed to increase the enrollment and participation
of eligible children under this title and title XIX.
`(B) PRIORITY FOR GRANTS IN CERTAIN AREAS- In making grants under subparagraph
(A)(ii), the Secretary shall give priority to grant applicants that propose
to target geographic areas--
`(i) with high rates of eligible but unenrolled children, including
such children who reside in rural areas;
`(ii) with high rates of families for whom English is not their primary
language; or
`(iii) with high rates of racial and ethnic minorities and health disparity
populations.
`(C) APPLICATION- An organization that desires to receive a grant under
this paragraph shall submit an application to the Secretary in such form
and manner, and containing such information, as the Secretary may decide.
Such application shall include quality and outcomes
performance measures to evaluate the effectiveness of activities funded by
a grant under this paragraph to ensure that the activities are meeting their
goals, and disseminate findings from such evaluations.'.
(b) DEMONSTRATIONS TO REDUCE HEALTH DISPARITIES-
(1) IN GENERAL- The Secretary of Health and Human Services shall, through
contracts or grants to public and private entities, support demonstration
programs for the purpose of conducting interventions among health disparity
populations to--
(A) target, identify, and reduce or prevent behavioral risk factors that
contribute to health disparities;
(B) promote translation, interpretation, and other such linguistic services
for patients with limited English speaking proficiency;
(C) promote preventive services; or
(D) enhance coordinated, multidisciplinary disease management of chronic
conditions, such as diabetes mellitus, HIV/AIDS, asthma, cancer, and obesity.
(2) APPLICATION- An entity desiring a contract or grant under paragraph
(1) shall submit an application to the Secretary of Health and Human Services
in such form and manner, and containing such information, as the Secretary
may require.
(3) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
to carry out this subsection such sums as may be necessary for each of fiscal
years 2005 through 2009.
Subtitle B--Refundable Health Insurance Credit
SEC. 211. REFUNDABLE HEALTH INSURANCE COSTS CREDIT.
(1) IN GENERAL- Subpart C of part IV of subchapter A of chapter 1 of the
Internal Revenue Code of 1986 (relating to refundable personal credits)
is amended by redesignating section 36 as section 37 and by inserting after
section 35 the following new section:
`SEC. 36. HEALTH INSURANCE COSTS FOR UNINSURED INDIVIDUALS.
`(a) ALLOWANCE OF CREDIT- In the case of an individual, there shall be allowed
as a credit against the tax imposed by this subtitle for the taxable year
an amount equal to the amount paid by the taxpayer during such taxable year
for qualified health insurance for the taxpayer and the taxpayer's spouse
and dependents.
`(1) IN GENERAL- The amount allowed as a credit under subsection (a) to
the taxpayer for the taxable year shall not exceed the lesser of--
`(A) the sum of the monthly limitations for coverage months during such
taxable year for the individuals referred to in subsection (a) for whom
the taxpayer paid during the taxable year any amount for coverage under
qualified health insurance, or
`(B) 90 percent of the sum of the amounts paid by the taxpayer for qualified
health insurance for each such individual for coverage months of the individual
during the taxable year.
`(A) IN GENERAL- The monthly limitation for an individual for each coverage
month of such individual during the taxable year is the amount equal to
1/12 of--
`(i) $1,000 if such individual is the taxpayer,
`(I) such individual is the spouse of the taxpayer,
`(II) the taxpayer and such spouse are married as of the first day
of such month, and
`(III) the taxpayer files a joint return for the taxable year, and
`(iii) $500 if such individual is an individual for whom a deduction
under section 151(c) is allowable to the taxpayer for such taxable year.
`(B) LIMITATION TO 2 DEPENDENTS- Not more than 2 individuals may be taken
into account by the taxpayer under subparagraph (A)(iii).
`(C) SPECIAL RULE FOR MARRIED INDIVIDUALS- In the case of a taxpayer--
`(i) who is married (within the meaning of section 7703) as of the close
of the taxable year but does not file a joint return for such year,
and
`(ii) who does not live apart from such taxpayer's spouse at all times
during the taxable year,
the dollar limitation imposed under subparagraph (A)(iii) shall be divided
equally between the taxpayer and the taxpayer's spouse unless they agree
on a different division.
`(3) INCOME PHASEOUT OF CREDIT PERCENTAGE-
`(A) PHASEOUT FOR SINGLE COVERAGE- If a taxpayer with self-only coverage
has modified adjusted gross income in excess of $15,000 for a taxable
year, the 90 percent under paragraph (1)(B) shall be reduced (but not
below zero) by--
`(i) 2 percentage points for each $250 of such income in excess of $15,000
but not in excess of $20,000, and
`(ii) 1.25 percentage points for each $250 of such income in excess
of $20,000.
`(B) AMOUNT OF REDUCTION FOR FAMILY COVERAGE- If a taxpayer with family
coverage has modified adjusted gross income in excess of $25,000 for a
taxable year, the 90 percent under paragraph (1)(B) shall be reduced (but
not below zero) by--
`(i) in the case of family coverage covering only 1 adult, 1.5 percentage
points for each $250 of such excess, and
`(ii) in the case of family coverage covering more than 1 adult, 0.643
percentage points for each $250 of such excess.
Any percentage resulting from a reduction under clause (ii) shall be rounded
to the nearest one-tenth of a percent.
`(C) MODIFIED ADJUSTED GROSS INCOME- The term `modified adjusted gross
income' means adjusted gross income determined--
`(i) without regard to this section and sections 911, 931, and 933,
and
`(ii) after application of sections 86, 135, 137, 219, 221, and 469.
`(c) COVERAGE MONTH- For purposes of this section--
`(1) IN GENERAL- The term `coverage month' means, with respect to an individual,
any month if--
`(A) as of the first day of such month such individual is covered by qualified
health insurance, and
`(B) the premium for coverage under such insurance for such month is paid
by the taxpayer.
`(2) EMPLOYER-SUBSIDIZED COVERAGE-
`(A) IN GENERAL- The term `coverage month' shall not include any month
for which such individual is eligible to participate in any subsidized
health plan (within the meaning of section 162(l)(2)) maintained by any
employer of the taxpayer or of the spouse of the taxpayer. A subsidized
health plan shall not include a plan substantially all of the coverage
of which is of excepted benefits described in section 9832(c).
`(B) PREMIUMS TO NONSUBSIDIZED PLANS- If an employer of the taxpayer or
the spouse of the taxpayer maintains a health plan which is not a subsidized
health plan (as so defined) and which constitutes qualified health insurance,
employee contributions to the plan shall be treated as amounts paid for
qualified health insurance.
`(3) CAFETERIA PLAN AND FLEXIBLE SPENDING ACCOUNT BENEFICIARIES- The term
`coverage month' shall not include any month during a taxable year if any
amount is not includible in the gross income of the taxpayer for such year
under section 106 with respect to--
`(A) a benefit chosen under a cafeteria plan (as defined in section 125(d)),
or
`(B) a benefit provided under a flexible spending or similar arrangement.
`(4) MEDICARE, MEDICAID, AND SCHIP- The term `coverage month' shall not
include any month with respect to an individual if, as of the first day
of such month, such individual--
`(A) is entitled to any benefits under part A of title XVIII of the Social
Security Act or is enrolled under part B of such title, or
`(B) is enrolled in the program under title XIX or XXI of such Act (other
than under section 1928 of such Act).
`(5) CERTAIN OTHER COVERAGE- The term `coverage month' shall not include
any month during a taxable year with respect to an individual if, at any
time during such year, any benefit is provided to such individual under--
`(A) chapter 89 of title 5, United States Code,
`(B) chapter 55 of title 10, United States Code,
`(C) chapter 17 of title 38, United States Code, or
`(D) any medical care program under the Indian Health Care Improvement
Act.
`(6) PRISONERS- The term `coverage month' shall not include any month with
respect to an individual if, as of the first day of such month, such individual
is imprisoned under Federal, State, or local authority.
`(7) INSUFFICIENT PRESENCE IN UNITED STATES- The term `coverage month' shall
not include any month during a taxable year with respect to an individual
if such individual is present in the United States on fewer than 183 days
during such year (determined in accordance with section 7701(b)(7)).
`(d) QUALIFIED HEALTH INSURANCE- For purposes of this section--
`(1) IN GENERAL- The term `qualified health insurance' means health insurance
coverage (as defined in section 9832(b)(1)) which--
`(A) is coverage described in paragraph (2), and
`(B) meets the requirements of paragraph (3).
`(2) ELIGIBLE COVERAGE- Coverage described in this paragraph is the following:
`(A) Coverage under individual health insurance.
`(B) Coverage under a group health plan (as defined in section 5000 without
regard to subsection (d)).
`(C) Coverage through a private sector health care coverage purchasing
pool.
`(D) Coverage under a State high risk pool described in subparagraph (C)
of section 35(e)(1).
`(E) Continuation coverage described in subparagraph (A) or (B) of section
35(a)(1).
`(F) Coverage under an eligible State buyin program.
`(3) REQUIREMENTS- The requirements of this paragraph are as follows:
`(A) COST LIMITS- Under the coverage, the sum of the annual deductible
and the other annual out-of-pocket expenses required to be paid (other
than premiums) for covered benefits does not exceed--
`(i) $5,000 for self-only coverage, and
`(ii) twice the dollar amount in clause (i) for family coverage, or
`(B) MAXIMUM BENEFITS- Under the coverage, the annual and lifetime maximum
benefits are not less than $700,000.
`(4) ELIGIBLE STATE BUYIN PROGRAM- For purposes of paragraph (2)(F)--
`(A) IN GENERAL- The term `eligible State buyin program' means a State
program under which an individual not otherwise eligible for assistance
under the State medicaid program under title XIX of the Social Security
Act or the State children's health insurance program under title XXI of
such Act is able to buy health insurance coverage through a purchasing
arrangement entered into between the State and a private sector health
care purchasing group or health plan for purposes of providing health
insurance coverage to recipients of assistance under such program or for
purposes of providing such coverage to State employees.
`(B) REQUIREMENTS- Subparagraph (A) shall only apply to a State program
if--
`(i) the program uses private sector health care purchasing groups or
health plans, and
`(ii) the State maintains separate risk pools for participants under
the State program.
`(e) ARCHER MSA CONTRIBUTIONS; HSA CONTRIBUTIONS- If a deduction would be
allowed under section 220 to the taxpayer for a payment for the taxable year
to the Archer MSA of an individual or under section 223 to the taxpayer for
a payment for the taxable year to the Health Savings Account of such individual,
subsection (a) shall not apply to the taxpayer for any month during such taxable
year for which the taxpayer, spouse, or dependent is an eligible individual
for purposes of either such section.
`(f) INFLATION ADJUSTMENT-
`(1) IN GENERAL- In the case of any taxable year beginning after 2004, each
dollar amount referred to in subsections (b)(2)(A) and (d)(3) shall be increased
by an amount equal to--
`(A) such dollar amount, multiplied by
`(B) the cost-of-living adjustment determined under section 213(d)(10)(B)(ii)
for the calendar year in which the taxable year begins, except that `2003'
shall be substituted for `1996' in subclause (II) thereof.
`(2) ROUNDING- If any amount as adjusted under paragraph (1) is not a multiple
of $10, such amount shall be rounded to the next lowest multiple of $10.
`(1) COORDINATION WITH MEDICAL EXPENSE DEDUCTION- The amount which would
(but for this paragraph) be taken into account by the taxpayer under section
213 for the taxable year shall be reduced by the credit (if any) allowed
by this section to the taxpayer for such year.
`(2) COORDINATION WITH DEDUCTION FOR HEALTH INSURANCE COSTS OF SELF-EMPLOYED
INDIVIDUALS- In the case of a taxpayer who is eligible to deduct any amount
under section 162(l) for the taxable year, this section shall apply only
if the taxpayer elects not to claim any amount as a deduction under such
section for such year.
`(3) DENIAL OF CREDIT TO DEPENDENTS- No credit shall be allowed under this
section to any individual with respect to whom a deduction under section
151 is allowable to another taxpayer for a taxable year beginning in the
calendar year in which such individual's taxable year begins.
`(4) COORDINATION WITH ADVANCE PAYMENT- Rules similar to the rules of section
35(g)(1) shall apply to any credit to which this section applies.
`(5) COORDINATION WITH SECTION 35- If a taxpayer is eligible for the credit
allowed under this section and section 35 for any taxable year, the taxpayer
shall elect which credit is to be allowed.
`(h) EXPENSES MUST BE SUBSTANTIATED- A payment for insurance to which subsection
(a) applies may be taken into account under this section only if the taxpayer
substantiates such payment in such form as the Secretary may prescribe.
`(i) REGULATIONS- The Secretary shall prescribe such regulations as may be
necessary to carry out the purposes of this section.'.
(b) INFORMATION REPORTING-
(1) IN GENERAL- Subpart B of part III of subchapter A of chapter 61 of the
Internal Revenue Code of 1986 (relating to information concerning transactions
with other persons) is amended by inserting after section 6050T the following:
`SEC. 6050U. RETURNS RELATING TO PAYMENTS FOR QUALIFIED HEALTH INSURANCE.
`(a) IN GENERAL- Any person who, in connection with a trade or business conducted
by such person, receives payments during any calendar year from any individual
for coverage of such individual or any other individual under creditable health
insurance, shall make the return described in subsection (b) (at such time
as the Secretary may by regulations prescribe) with respect to each individual
from whom such payments were received.
`(b) FORM AND MANNER OF RETURNS- A return is described in this subsection
if such return--
`(1) is in such form as the Secretary may prescribe, and
`(A) the name, address, and TIN of the individual from whom payments described
in subsection (a) were received,
`(B) the name, address, and TIN of each individual who was provided by
such person with coverage under creditable health insurance by reason
of such payments and the period of such coverage,
`(C) the aggregate amount of payments described in subsection (a), and
`(D) such other information as the Secretary may reasonably prescribe.
`(c) CREDITABLE HEALTH INSURANCE- For purposes of this section, the term `creditable
health insurance' means qualified health insurance (as defined in section
36(d)).
`(d) STATEMENTS TO BE FURNISHED TO INDIVIDUALS WITH RESPECT TO WHOM INFORMATION
IS REQUIRED- Every person required to make a return under subsection (a) shall
furnish to each individual whose name is required under subsection (b)(2)(A)
to be set forth in such return a written statement showing--
`(1) the name and address of the person required to make such return and
the phone number of the information contact for such person,
`(2) the aggregate amount of payments described in subsection (a) received
by the person required to make such return from the individual to whom the
statement is required to be furnished, and
`(3) the information required under subsection (b)(2)(B) with respect to
such payments.
The written statement required under the preceding sentence shall be furnished
on or before January 31 of the year following the calendar year for which
the return under subsection (a) is required to be made.
`(e) RETURNS WHICH WOULD BE REQUIRED TO BE MADE BY 2 OR MORE PERSONS- Except
to the extent provided in regulations prescribed by the Secretary, in the
case of any amount received by any person on behalf of another person, only
the person first receiving such amount shall be required to make the return
under subsection (a).'.
(2) ASSESSABLE PENALTIES-
(A) Subparagraph (B) of section 6724(d)(1) of such Code (relating to definitions)
is amended by redesignating clauses (xii) through (xviii) as clauses (xiii)
through (xix), respectively, and by inserting after clause (xi) the following:
`(xii) section 6050U (relating to returns relating to payments for qualified
health insurance),'.
(B) Paragraph (2) of section 6724(d) of such Code is amended by striking
`or' at the end of subparagraph (AA), by striking the period at the end
of the subparagraph (BB) and inserting `, or', and by adding at the end
the following:
`(CC) section 6050U(d) (relating to returns relating to payments for qualified
health insurance).'.
(3) CLERICAL AMENDMENT- The table of sections for subpart B of part III
of subchapter A of chapter 61 of such Code is amended by inserting after
the item relating to section 6050T the following:
`Sec. 6050U. Returns relating to payments for qualified health insurance.'.
(c) CRIMINAL PENALTY FOR FRAUD- Subchapter B of chapter 75 of the Internal
Revenue Code of 1986 (relating to other offenses) is amended by adding at
the end the following:
`SEC. 7276. PENALTIES FOR OFFENSES RELATING TO HEALTH INSURANCE TAX CREDIT.
`Any person who knowingly misuses Department of the Treasury names, symbols,
titles, or initials to convey the false impression of association with, or
approval or endorsement by, the Department of the Treasury of any insurance
products or group health coverage in connection with the credit for health
insurance costs under section 36 shall on conviction thereof be fined not
more than $10,000, or imprisoned not more than 1 year, or both.'.
(d) CONFORMING AMENDMENTS-
(1) Section 162(l) of the Internal Revenue Code of 1986 is amended by adding
at the end the following:
`(6) ELECTION TO HAVE SUBSECTION APPLY- No deduction shall be allowed under
paragraph (1) for a taxable year unless the taxpayer elects to have this
subsection apply for such year.'.
(2) Paragraph (2) of section 1324(b) of title 31, United States Code, is
amended by inserting before the period `, or from section 36 of such Code'.
(3) The table of sections for subpart C of part IV of subchapter A of chapter
1 of the Internal Revenue Code of 1986 is amended by striking the last item
and inserting the following:
`Sec. 36. Health insurance costs for uninsured individuals.
`Sec. 37. Overpayments of tax.'
(4) The table of sections for subchapter B of chapter 75 of such Code is
amended by adding at the end the following:
`Sec. 7276. Penalties for offenses relating to health insurance tax credit.'
(1) IN GENERAL- Except as provided in paragraph (2), the amendments made
by this section shall apply to taxable years beginning after December 31,
2003, without regard to whether final regulations to carry out such amendments
have been promulgated by such date.
(2) PENALTIES- The amendments made by subsections (c) and (d)(4) shall take
effect on the date of the enactment of this Act.
SEC. 212. ADVANCE PAYMENT OF CREDIT TO ISSUERS OF QUALIFIED HEALTH INSURANCE.
(a) IN GENERAL- Chapter 77 of the Internal Revenue Code of 1986 (relating
to miscellaneous provisions) is amended by adding at the end the following:
`SEC. 7529. ADVANCE PAYMENT OF CREDIT FOR HEALTH INSURANCE COSTS OF ELIGIBLE
INDIVIDUALS.
`(a) GENERAL RULE- Not later than January 1, 2005, the Secretary shall establish
a program for making payments on behalf of certified individuals to providers
of qualified health insurance (as defined in section 36(d)) for such individuals.
`(b) PROGRAM OPTIONS- The program under subsection (a) may--
`(1) provide that payments may be made on the basis of modified adjusted
gross income of certified individuals for the preceding taxable year, and
`(2) provide that, in lieu of payments to providers, the following amounts
may be offset:
`(A) Amounts required to be deposited by the provider as estimated income
tax under section 6654 or 6655.
`(B) Amounts required to be deducted and withheld under section 3401 (relating
to wage withholding).
`(C) Taxes imposed under section 3111(a) or 50 percent of taxes imposed
under section 1401(a) (relating to FICA employer taxes).
`(D) Amounts required to be deducted under section 3102 with respect to
taxes imposed under section 3101(a) or 50 percent of taxes imposed under
section 1401(a) (relating to FICA employee taxes).
`(c) CERTIFIED INDIVIDUAL- For purposes of this section, the term `certified
individual' means any individual for whom a qualified health insurance credit
eligibility certificate is in effect.
`(d) QUALIFIED HEALTH INSURANCE CREDIT ELIGIBILITY CERTIFICATE- For purposes
of this section, a qualified health insurance credit eligibility certificate
is a statement furnished by an individual to a provider of qualified health
insurance which--
`(1) certifies that the individual will be eligible to receive the credit
provided by section 36 for the taxable year,
`(2) estimates the amount of such credit for such taxable year, and
`(3) provides such other information as the Secretary may require for purposes
of this section.'
(b) CLERICAL AMENDMENT- The table of sections for chapter 77 of the Internal
Revenue Code of 1986 is amended by adding at the end the following:
`Sec. 7529. Advance payment of health insurance credit for purchasers of
qualified health insurance.'
(c) EFFECTIVE DATE- The amendments made by this section shall take effect
on July 1, 2005, without regard to whether final regulations to carry out
such amendments have been promulgated by such date.
TITLE III--STRONG NATIONAL LEADERSHIP, COOPERATION, AND COORDINATION
SEC. 301. OFFICE OF MINORITY HEALTH AND HEALTH DISPARITIES.
(a) IN GENERAL- Section 1707 of the Public Health Service Act (42 U.S.C. 300u-6)
is amended--
(1) by striking the section heading and inserting the following:
`OFFICE OF MINORITY HEALTH AND HEALTH DISPARITIES'; AND
(A) by striking `Office of Minority Health' each place that such appears
and inserting `Office of Minority Health and Health Disparities'; and
(B) by striking `for Minority Health' and inserting `for Minority Health
and Health Disparities'.
(b) DUTIES- Section 1707(b) of the Public Health Service Act (42 U.S.C. 300u-6(b))
is amended--
(1) in the matter preceding paragraph (1)--
(A) by inserting `and health disparity populations' after `groups' and
(B) by striking `for Minority Health' and inserting `for Minority Health
and Health Disparities';
(A) by striking `Establish' and all that follows through `coordinate'
and inserting `Coordinate'; and
(B) by striking `such individuals' and inserting `health disparities';
(3) in paragraph (5), by inserting `or health disparity populations' after
`minority groups';
(4) in paragraph (6), by inserting `or health disparity population' after
`minority group';
(5) by striking paragraphs (7) and (9);
(6) by redesignating paragraphs (1), (2), (3), (4), (5), (6), (8), and (10)
as paragraphs (3), (4), (6), (7), (9), (10), (11), and (12), respectively;
(7) by inserting before paragraph (3) (as so redesignated) the following:
`(1) Establish specific short- and long-term goals and objectives for analyzing
the causes of health disparities and addressing them, with a particular
focus on the areas of health promotion, disease prevention, chronic care
and research.
`(2) Work with agencies within the Department of Health and Human Services
and with the Surgeon General to establish a strategic plan to analyze and
address the causes of health disparities. The plan shall include recommendations
to improve the collection, analysis, and reporting of data at the Federal,
State, territorial, Tribal, and local levels, including how to--
`(A) implement data collection while minimizing the cost and administrative
burdens of data collection and reporting;
`(B) expand awareness of the importance of such data collection to improving
health care quality; and
`(C) provide researchers with greater access to racial, ethnic, and other
health disparity data.';
(8) by inserting after paragraph (4) (as so redesignated), the following:
`(5) Increase awareness of disparities in health care among health care
providers, health plans, and the public.';
(9) in paragraph (6) (as so redesignated)--
(A) by striking `Support' and inserting `In cooperation with the appropriate
agencies, support';
(B) by inserting before the period the following: `for--
`(A) expanding health care access;
`(B) improving health care quality; and
`(C) increasing health care educational opportunity.';
(10) by inserting after paragraph (7) (as so redesignated), the following:
`(8) Consistent with section 102 of the Closing the Health Care Gap Act
of 2004, coordinate the classification and collection of health care data
to allow for the ongoing analysis of the causes of disparities and monitoring
of progress toward the elimination of disparities.'; and
(11) by inserting after paragraph (12), as so redesignated, the following:
`(13) Work with Federal agencies and departments outside of the Department
of Health and Human Services to maximize program resources available to
understand why disparities exist, and effective ways to reduce and eliminate
disparities.
`(14) Support a center for linguistic and cultural competence to carry out
the following:
`(A) With respect to individuals who lack proficiency in speaking the
English language, enter into contracts with public and nonprofit private
providers of primary health services for the purpose of increasing the
access of such individuals to such services by developing and carrying
out programs to provide bilingual or interpretive services.
`(B) Carry out programs to improve access to health care services for
individuals with limited proficiency in speaking the English language.
Activities under this subparagraph shall include developing and evaluating
model projects.'.
(c) ADVISORY COMMITTEE- Section 1707(c) of the Public Health Service Act (42
U.S.C. 300u-6(c)) is amended--
(1) in paragraph (1), by inserting `and Health Disparities' after `Minority
Health';
(2) in paragraph (2), by inserting `and health disparity populations' after
`minority group'; and
(3) in paragraph (4)(B)--
(A) by inserting `and health disparities' after `minority health'; and
(B) by inserting `and health disparity populations' after `minority groups'.
(d) DUTY REQUIREMENTS- Section 1707(d) of the Public Health Service Act (42
U.S.C. 300u-6(d)) is amended--
(1) in paragraph (1)(A), by striking `(b)(9)' and inserting `(b)(14);
(2) in paragraph (1)(B), by striking `(b)(10)' and inserting `(b)(13)';
and
(3) in paragraph (3), insert `take into account the unique cultural or linguistic
issues facing such populations and' after `subsection (b)'.
(e) REPORTS- Section 1707(f) of the Public Health Service Act (42 U.S.C. 300u-6(f))
is amended--
(A) by striking the subsection heading and inserting `REPORT ON ACTIVITIES-
';
(B) by striking `1999' and inserting `2006';
(C) by striking `Committee on Energy and Commerce of the House of Representatives,
and to the Committee on Labor and Human Resources of the Senate' and inserting
`appropriate committees of Congress'; and
(D) by inserting `and health disparity populations' after `racial and
ethnic minority groups';
(A) by striking `1999' and inserting `2005'; and
(B) by inserting `and health disparity' after `minority health';
(3) by redesignating paragraph (1) and (2) as paragraphs (2) and (3), respectively;
and
(4) by inserting after the subsection heading, the following:
`(1) IN GENERAL- Not later than 1 year after the date of enactment of the
Closing the Health Care Gap Act of 2004, the Secretary shall submit to the
appropriate committees of Congress, a report on the plan developed under
subsection (b)(2).'.
(f) AUTHORIZATION OF APPROPRIATIONS- Section 1707(h) of the Public Health
Service Act (42 U.S.C. 300u-6(h)) is amended--
(1) by striking `FUNDING- ' and all that follows through the paragraph designation
in paragraph (1); and
(2) by striking `$30,000,000' and all that follows through the period and
inserting `$50,000,000 for fiscal year 2005, such sums as may be necessary
for each of fiscal years 2006 through 2009.'.
TITLE IV--PROFESSIONAL EDUCATION, AWARENESS, AND TRAINING
SEC. 401. WORKFORCE DIVERSITY AND TRAINING.
(a) PURPOSE- Part B of title VII of the Public Health Service Act (42 U.S.C.
293 et seq.) is amended by inserting before section 736 the following:
`SEC. 736A. PURPOSE OF PROGRAM.
`It is the purpose of this part to improve health care quality and access
in medically underserved communities, to improve the cultural competence of
health care providers by increasing minority representation in the health
professions, and to strengthen the research and education programs of designated
health professions schools that disproportionately serve health disparity
populations.'.
(b) CENTERS OF EXCELLENCE- Section 736 of the Public Health Service Act (42
U.S.C. 293) is amended--
(1) by striking subsection (a) and inserting the following:
`(a) IN GENERAL- The Secretary shall make grants to, and enter into contracts
with, public and nonprofit private health or educational entities, including
designated health professions schools described in subsection (c), for the
purpose of assisting the schools in supporting programs of excellence in health
professions education for racial or ethnic minority or health disparity populations.';
(A) in paragraph (2), by striking `under-represented minority' and inserting
`racial or ethnic minority';
(B) in paragraph (3), by striking `under-represented minority' and inserting
`racial or ethnic minority';
(C) in paragraph (4), by striking `minority health' and inserting `health
disparity';
(D) in paragraph (5), by striking `under-represented minority groups'
and inserting `racial or ethnic minorities and health disparity populations';
(i) in the matter preceding subparagraph (A), by striking `under-represented
minority' and inserting `individuals from racial or ethnic minorities
or health disparity populations'; and
(ii) by striking `and' at the end;
(F) in paragraph (7), by striking the period and inserting `; and'; and
(G) by adding at the end the following:
`(8) to conduct accountability and other reporting activities, as required
by the Secretary.';
(A) in paragraph (1)(B)--
(i) in clause (i), by striking `under-represented minority' and inserting
`individuals from racial or ethnic minorities or health disparity populations';
(ii) in clause (ii), by striking `under-represented minority' and inserting
`such';
(I) by striking `under-represented minority individuals' the first
place that such appears and inserting `such students';
(II) by striking `such individuals' and inserting `such students';
and
(III) by striking `under-represented minority' the second place that
such appears and inserting `such'; and
(iv) in clause (iv), by striking `under-represented minority individuals'
and inserting `individuals from racial or ethnic minorities or health
disparity populations'; and
(B) in paragraph (2)(B)--
(i) in clause (i), by striking `under-represented' and inserting `racial
or'; and
(C) in paragraph (5)(B)--
(i) by striking `under-represented' and inserting `racial or'; and
(ii) by inserting `or a health disparity population' after `minorities';
(4) in subsection (d)(1), by striking `Under-Represented Minority Health'
and inserting `Minority Health and Health Disparity';
(A) in paragraph (1), by striking `$26,000,000' and all that follows and
inserting `$50,000,000 for fiscal year 2005, and such sums as may be necessary
for each of fiscal years 2006 through 2009'; and
(i) in subparagraph (C)--
(I) in the matter preceding clause (i), by striking `are $30,000,000
or more' and inserting `exceed $30,000,000 but are less than $40,000,000';
and
(II) in clause (iv), by striking `any remaining funds' and inserting
`any remaining excess amount'; and
(ii) by adding at the end the following:
`(D) FUNDING IN EXCESS OF $40,000,000- If amounts appropriated under paragraph
(1) for a fiscal year are $40,000,000 or more, the Secretary shall make
available--
`(i) not less than $16,000,000 for grants under subsection (a) to health
professions schools that meet the conditions described in subsection
(c)(2)(A);
`(ii) not less than $16,000,000 for grants under subsection (a) to health
professions schools that meet the conditions described in paragraph
(3) or (4) of subsection (c) (including meeting conditions pursuant
to subsection (e));
`(iii) not less than $8,000,000 for grants under subsection (a) to health
professions schools that meet the conditions described in subsection
(c)(5); and
`(iv) after grants are made with funds under clauses (i) through (iii),
any remaining funds for grants under subsection (a) to health professions
schools that meet the conditions described in paragraph (2)(A), (3),
(4), or (5) of subsection (c).'; and
(6) by adding at the end the following:
`(1) IN GENERAL- Not later than 1 year after the date of enactment of the
Closing the Health Care Gap Act of 2004, the Secretary shall request that
the Institute of Medicine evaluate the effectiveness of the programs under
this section in meeting the purpose of this part. The Institute of Medicine
shall submit a report on the evaluation to the Secretary.
`(2) WORKING GROUP- Upon submission of the report under paragraph (1), the
Secretary shall convene a working group composed of stakeholders, including
designated health professions schools described in subsection (c), to define
quality performance measures and reporting requirements of grant recipients
that shall be tied to the purpose of this part.
`(3) REGULATIONS- Not later than 18 months after the date the Institute
of Medicine submits the report under paragraph (1), the Secretary shall
publish proposed regulations regarding the quality performance measures
and reporting requirements described in paragraph (2). Not later than 3
years after the date the Institute of Medicine submits the report under
paragraph (1), the Secretary shall publish final regulations regarding the
quality performance measures and reporting requirements described in paragraph
(2).'.
(c) SCHOLARSHIPS FOR DISADVANTAGED STUDENTS- Section 737 of the Public Health
Service Act (42 U.S.C. 293a) is amended--
(1) in subsection (c), by striking `under-represented minority' and inserting
`minority and health disparity'; and
(2) in subsection (d)(1)(B), by inserting `or health disparity' after `minority'.
(d) LOAN REPAYMENTS AND FELLOWSHIPS REGARDING FACULTY POSITIONS- Section 738(b)
of the Public Health Service Act (42 U.S.C. 293b(b)) is amended--
(1) in paragraph (1), by striking `underrepresented';
(2) in paragraph (3)(A), by striking `underrepresented minority individuals'
and inserting `individuals from racial or ethnic minorities or health disparity
populations'; and
(3) by striking paragraph (5).
(e) NATIONAL HEALTH SERVICE CORPS-
(1) ASSIGNMENT- Section 333(a)(3) of the Public Health Service Act (42 U.S.C.
254f(a)(3)) is amended--
(A) in the second sentence--
(i) by striking `shall give preference' and inserting the following:
`shall--
`(A) give preference'; and
(ii) by striking the period and inserting `; and'; and
(B) by adding at the end the following:
`(B) give preference to applications from entities described in subparagraph
(A) that serve individuals a majority of whom are members of a racial or
ethnic minority or other health disparity population with annual incomes
at or below twice those set forth in the most recent poverty guidelines
issued by the Secretary pursuant to section 402(2) of the Community Services
Block Grant Act.'.
(2) PRIORITIES- Section 333A(a) of the Public Health Service Act (42 U.S.C.
254f-1(a)) is amended--
(A) by redesignating paragraphs (1) through (3) as paragraphs (2) through
(4), respectively; and
(B) by inserting before paragraph (2) (as so redesignated), the following:
`(1) give preference to applications as described in section 333(a)(3);'.
(e) AUTHORIZATION OF APPROPRIATIONS- Section 740 of the Public Health Service
Act (42 U.S.C. 293d) is amended--
(1) in subsection (a), by striking `2002' and inserting `2009';
(2) in subsection (b), by striking `2002' and inserting `2009';
(3) in subsection (c), by striking `2002' and inserting `2009'; and
(4) by striking subsection (d).
(f) GRANTS FOR HEALTH PROFESSIONS EDUCATION- Section 741 of the Public Health
Service Act (42 U.S.C. 293e) is amended--
(1) in subsection (a)(2), in the first sentence by striking `Unless' and
all that follows through `the Secretary' and inserting `The Secretary';
and
(2) in subsection (b), by striking `$3,500,000' and all that follows through
the period and inserting `such sums as may be necessary for each of fiscal
years 2005 through 2009.'.
(g) HEALTH CAREERS OPPORTUNITY PROGRAM- Subpart 2 of part E of title VII of
the Public Health Service Act (42 U.S.C. 295 et seq.) is amended--
(1) in section 770 by inserting `(other than section 771)' after `this subpart';
(2) by redesignating section 770 as section 771; and
(3) by inserting after section 769 the following:
`SEC. 770. HEALTH CAREERS OPPORTUNITY PROGRAM.
`(a) IN GENERAL- The Secretary may make grants and enter into cooperative
agreements and contracts with eligible entities for any of the following purposes:
`(1) Identifying and recruiting students who--
`(A) are from disadvantaged backgrounds or health disparity populations;
and
`(B) are interested in a career in the health professions.
`(2) Providing counseling or other services designed to assist such individuals
in entering a health professions school and successfully completing their
education at such a school.
`(3) Providing, for a period prior to the entry of such individuals into
the regular course of education of such a school, preliminary education
designed to assist the individuals in successfully completing such regular
course of education at such a school, or referring such individuals to institutions
providing such preliminary education.
`(1) ELIGIBLE ENTITIES; REQUIREMENT OF CONSORTIUM- The Secretary may make
an award under subsection (a) only if an eligible entity meets the following
conditions:
`(A) The eligible entity is a public or private entity, and such entity
has established a consortium consisting of private community-based organizations
and health professions schools.
`(B) The health professions schools in the consortium are schools of medicine
or osteopathic medicine, public health, nursing, dentistry, optometry,
pharmacy, allied health, or podiatric medicine, or graduate programs in
mental health practice (including programs in clinical psychology).
`(C)(i) Except as provided in clause (ii), the membership of the consortium
includes not less than 1 nonprofit private community-based organization
and not less than 3 health professions schools.
`(ii) In the case of an eligible entity whose exclusive activity under
the award will be carrying out 1 or more programs described in subsection
(a)(5), the membership of the consortium includes not less than 1 nonprofit
private community-based organization and not less than 1 health professions
school.
`(D) The members of the consortium have entered into an agreement specifying--
`(i) that each of the members will comply with the conditions upon which
the award is made; and
`(ii) whether and to what extent the award will be allocated among the
members.
`(2) REQUIREMENT OF COMPETITIVE AWARDS- Awards under subsection (a) shall
be made on a competitive basis.
`(c) REQUIREMENTS- The Secretary may make an award under subsection (a) only
if the Secretary determines that, in the case of activities carried out under
the award that prove to be effective toward achieving the purposes of the
activities--
`(1) the members of the consortium involved have or will have the financial
capacity to continue
the activities, regardless of whether financial assistance under subsection
(a) continues to be available; and
`(2) the members of the consortium demonstrate to the satisfaction of the
Secretary a commitment to continue such activities, regardless of whether
such assistance continues to be available.
`(d) OBJECTIVES UNDER AWARDS- Before making a first award to an eligible entity
under subsection (a), the Secretary shall establish objectives regarding the
activities to be carried out under the award, which objectives are applicable
until the next fiscal year for which such award is made after a competitive
process of review. In making an award after such a review, the Secretary shall
establish additional objectives for the applicant.
`(e) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this
section, there are authorized to be appropriated, such sums as may be necessary
for each of fiscal years 2005 through 2009.'.
SEC. 402. HIGHER EDUCATION TECHNICAL AMENDMENTS.
Section 326(c) of the Higher Education Act of 1965 (20 U.S.C. 1063b(c)) is
amended--
(1) in paragraph (2), by inserting before the semicolon, the following:
`, and for the acquisition and development of real property that is adjacent
to the campus to improve the academic environment';
(2) in paragraph (6), by striking `and' at the end;
(3) in paragraph (7), by striking the period and inserting a semicolon;
and
(4) by adding at the end the following:
`(8) Support of faculty exchanges, development, and fellowship to enable
attainment of advanced degrees in their field of instruction; and
`(9) Tutoring, counseling, and student service programs designed to improve
academic success.'.
SEC. 403. MODEL CULTURAL COMPETENCY CURRICULUM DEVELOPMENT.
(a) CURRICULA DEVELOPMENT AND MODEL CURRICULA- The Secretary of Health and
Human Services (in this section referred to as the `Secretary') may award
grants to eligible entities for curricula development for the training of
health care providers and health professions students regarding cultural competency,
and for demonstration projects to test new innovations for cultural competence
education model curricula for and identify additional barriers to culturally
appropriate care.
(b) APPLICATION- Each eligible entity desiring a grant under subsection (a)
shall submit an application to the Secretary at such time, in such manner,
and containing such information as the Secretary may require.
(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 2005 through 2009.
SEC. 404. INTERNET CULTURAL COMPETENCY CLEARINGHOUSE.
(a) DEVELOPMENT- The Director of the Office of Minority Health and Health
Disparities, with assistance from the Administrator of the Agency for Healthcare
Research and Quality, shall develop and maintain an Internet clearinghouse
to improve health care quality for individuals with specific cultural needs
or with limited English proficiency or low functional health literacy and
to reduce or eliminate the duplication of effort to translate materials.
(b) TEMPLATES- In developing the clearinghouse under subsection (a), the Director
of the Office of Minority Health and Health Disparities shall develop, test,
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--
(1) administrative and legal documents;
(2) clinical information such as how to take medications, how to prevent
transmission of a contagious disease, and other prevention and treatment
instructions; and
(3) patient education and outreach materials such as immunization notices,
health warnings, or screening notices.
(c) ONLINE LIBRARY OR DATABASE- The Director of the Office of Minority Health
and Health Disparities shall develop a readily accessible online library or
database with searchable clinically relevant cultural information that is
important for health care providers to have on hand in the direct provision
of medical care to individuals from specific minority, ethnic, or other health
disparity groups.
TITLE V--ENHANCED RESEARCH
SEC. 501. AGENCY FOR HEALTHCARE RESEARCH AND QUALITY.
Part B of title IX of the Public Health Service Act (42 U.S.C. 299b) is amended
by adding at the end the following:
`SEC. 918. ENHANCED RESEARCH WITH RESPECT TO HEALTH DISPARITIES.
`(a) ACCELERATING THE ELIMINATION OF DISPARITIES-
`(1) IN GENERAL- The Secretary, acting through the Director, may award grants
or contracts to eligible entities (as defined in paragraph (4)) for short-term
research to analyze the causes of disparities and identify or develop and
evaluate effective strategies in closing the health care gap between minority
and health disparity populations and nonminority populations or non-health
disparity populations.
`(2) PROMPT USE OF RESEARCH- To ensure that research described in paragraph
(1) is effective and is disseminated and applied promptly, the Director
shall--
`(A) expand practice-based research networks (primary care and larger
delivery systems) to include networks of delivery sites serving large
numbers of minority and health disparity populations including--
`(ii) health centers; and
`(iii) other sites as determined appropriate by the Director;
`(B) work with health care providers to identify and develop those interventions
for minority and health disparity populations for
which effective implementation strategies are not clear; and
`(C) develop a broad virtual network of continuous learning among health
care providers (including institutions that did not receive a grant or
contract under paragraph (1)) so that those participating in research
can share findings and experience throughout the duration of such research
and to facilitate interest in and prompt adoption of such findings and
experience.
`(3) TECHNICAL ASSISTANCE- The Director of the Agency for Healthcare Research
and Quality shall provide technical assistance to assist in the implementation
of strategies of evidence-based practices that will reduce health care disparities.
`(4) ELIGIBLE ENTITIES- In paragraph (1), the term `eligible entities' means
institutions with researchers who have experience in conducting research
relating to minority health and health disparity populations.
`(5) PUBLIC HOSPITALS- In this subsection, the term `public hospitals' means
a hospital (as defined in section 1886(d)(1)(B) of the Social Security Act)
that--
`(A) is owned or operated by a unit of State or local government, is a
public or private non-profit corporation which is formally granted governmental
powers by a unit of State or local government, or is a private non-profit
hospital that has a contract with a State or local government to provide
health care services to low income individuals who are not entitled to
benefits under title XVIII of the Social Security Act or eligible for
assistance under the State plan under title XIX of the Social Security
Act; and
`(B) for the most recent cost reporting period that ended before the calendar
quarter involved, had a disproportionate share adjustment percentage (as
determined under section 1886(d)(5)(F) of the Social Security Act) greater
than 11.75 percent or was described in section 1886(d)(5)F)(i)(II) of
such Act.
`(b) REALIZING THE POTENTIAL OF DISEASE MANAGEMENT-
`(1) PUBLIC-PRIVATE SECTOR PARTNERSHIP TO ASSESS EFFECTIVENESS OF EXISTING
DATA MANAGEMENT STRATEGIES- The Director shall establish a public-private
partnership to assess the effectiveness of disease management strategies
and identify effective interventions and support strategies with respect
to minority and health disparity populations.
`(2) EFFECTIVE MANAGEMENT OF PATIENTS WITH MULTIPLE CHRONIC DISEASES-
`(A) INITIATIVE FOR DISEASE MANAGEMENT STRATEGIES- The Director shall
coordinate an initiative to identify those chronic conditions for which
disease-specific disease management strategies pose conflicts in preferred
clinical interventions.
`(B) RESEARCH- The Director, with support from other agencies within the
Department of Health and Human Services shall conduct a program of research
based in community and primary-care settings to test and evaluate the
implications for patient outcomes of alternative approaches for reconciling
conflicts from disease-specific disease management initiatives.
`(c) DEVELOPMENT OF EFFECTIVE MEASUREMENT OF DISPARITIES-
`(1) IN GENERAL- The Director shall conduct a demonstration project to--
`(A) assess alternative strategies for identifying population subgroups
at highest risk of poor quality and poor health;
`(B) improve data collection for health care priority populations (as
described in section 901(c)(1)(B));
`(C) improve the ability to identify the causes of disparities; and
`(D) track progress in reducing health care disparities with a focus on--
`(i) the minimum data set necessary to track such progress; and
`(ii) the identification of measures for which data currently being
collected are insufficient.
`(2) REPORT- Not later than 3 years after the date the demonstration project
described in paragraph (1) receives funding, the Director shall submit to
the appropriate committees of Congress a report containing the findings
of the demonstration project together with any policy recommendations.
`(d) ANALYSIS OF RACIAL, ETHNIC, AND OTHER 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 and the Director of the Centers for Disease Control and
Prevention, shall provide technical assistance to agencies of the Department
of Health and Human Services in meeting Federal standards for race, ethnicity,
and other health disparity data collection and analysis of racial, ethnic,
and other disparities in health and health care in Federally-administered
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, ethnic, or other
health disparities;
`(4) identifying the level at which data analysis should be conducted; and
`(5) sharing data with external organizations for research and quality improvement
purposes.'.
SEC. 502. NATIONAL INSTITUTES OF HEALTH.
The Director of the National Institutes of Health, in consultation with the
Director of the National Center on Minority Health and Health Disparities,
shall expand and intensify research at the National Institutes of Health relating
to the sources of health and health care disparities, and increase efforts
to recruit minority scientists and research professionals into the field of
health disparity research.
TITLE VI--MISCELLANEOUS PROVISIONS
SEC. 601. DEFINITIONS.
(a) IN GENERAL- In this Act, including the amendments made by this Act:
(1) CULTURALLY COMPETENT-
(A) IN GENERAL- The term `culturally competent', with respect to the manner
in which health-related services, education, and training are provided,
means providing the services, education, and training in the language
and cultural context that is most appropriate for the individuals for
whom the services, education, and training are intended, including as
necessary the provision of bilingual services.
(B) MODIFICATION- The definition established in subparagraph (A) may be
modified as needed at the discretion of the Secretary after providing
a 30-day notice to Congress.
(2) MINORITY HEALTH CONDITIONS- The term `minority health conditions', with
respect to individuals who are members of minority groups, means all diseases,
disorders, and conditions (including with respect to mental health and substance
abuse)--
(A) unique to, more serious, or more prevalent in such groups;
(B) for which the factors of medical risk or types of medical intervention
may be different for such groups, or for which it is unknown whether such
factors or types are different for such individuals; or
(C) with respect to which there has been insufficient research involving
such individual members of such groups as subjects or insufficient data
on such individuals.
(3) MINORITY HEALTH DISPARITIES RESEARCH- The term `minority health disparities
research' means basic, clinical, behavioral and health services research
on minority health conditions (as defined in paragraph (2)), including research
to prevent, diagnose, and treat such conditions.
(4) MINORITY- The terms `minority' and `minorities' refer to individuals
from a minority group.
(5) MINORITY GROUP- The term `minority group' has the meaning given the
term `racial and ethnic minority group' in section 1707 of the Public Health
Service Act (42 U.S.C. 300u-6).
(b) HEALTH DISPARITY POPULATIONS- In this Act, including the amendments made
by this Act:
(1) HEALTH DISPARITY POPULATION- The term `health disparity population'
has the meaning given such term in section 903(d)(1) of the Public Health
Service Act (42 U.S.C. 299a-1(d)(1)).
(2) HEALTH DISPARITIES RESEARCH- The term `health disparities research'
shall include basic, clinical, behavioral, and health services research
on health disparity populations (including individual members and communities
of such populations) that relates to health disparities as defined under
paragraph (1), including the causes of such disparities and methods to prevent,
diagnose, and treat such disparities.
END
