Hispanic Health Improvement Act of 2003

        [Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1159 Introduced in Senate (IS)]

108th CONGRESS
1st Session
S. 1159

To provide for programs and activities to improve the health of
Hispanic individuals, and for other purposes.

_______________________________________________________________________

IN THE SENATE OF THE UNITED STATES

May 23, 2003

Mr. Bingaman (for himself, Mr. Daschle, Mrs. Boxer, and Mrs. Lincoln)
introduced the following bill; which was read twice and referred to the
Committee on Finance

_______________________________________________________________________

A BILL

To provide for programs and activities to improve the health of
Hispanic individuals, and for other purposes.

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 ``Hispanic Health
Improvement Act of 2003''.
(b) Table of Contents.--The table of contents of this Act is as
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
TITLE I--HEALTH CARE COVERAGE

Subtitle A--Coverage for Children, Parents, and Pregnant Women

Sec. 101. Coverage of parents and pregnant women under the medicaid
program and title XXI.
Sec. 102. Automatic enrollment of children born to title XXI parents.
Sec. 103. Optional coverage of children through age 20 under the
medicaid program and title XXI.
Sec. 104. Technical and conforming amendments to authority to pay
medicaid expansion costs from title XXI
appropriation.
Sec. 105. Extension of availability of SCHIP allotments for fiscal
years 1998 through 2001.
Subtitle B--State Option To Provide Coverage to All Individuals Below
100 Percent of Poverty

Sec. 111. State option to offer medicaid coverage based on need.
Subtitle C--Outreach and Enrollment

Sec. 121. Grants to promote innovative outreach and enrollment efforts
under SCHIP.
Subtitle D--Immigrant Children and Pregnant Women

Sec. 131. Optional coverage of legal immigrants under the medicaid
program and SCHIP.
Sec. 132. Permitting States and localities to provide health care to
all individuals.
Subtitle E--Eligibility Simplification

Sec. 141. State option to provide for simplified determinations of a
child's financial eligibility for medical
assistance under medicaid or child health
assistance under SCHIP.
Sec. 142. Application of simplified title XXI procedures under the
medicaid program.
Subtitle F--SCHIP Wrap-Around Benefits

Sec. 151. State option to provide wrap-around SCHIP coverage to
children who have other health coverage.
Subtitle G--Immunization Coverage Through SCHIP

Sec. 161. Eligibility of children enrolled in the State children's
health insurance program for the pediatric
vaccine distribution program.
Subtitle H--Limited English Proficient Communities

Sec. 171. Increased Federal reimbursement for language services under
the medicaid program and the State
children's health insurance program.
Subtitle I--Binational Public Health Infrastructure and Health
Insurance

Sec. 181. Binational public health infrastructure and health insurance.
Subtitle J--Migrant Workers and Farmworkers Health

Sec. 191. Demonstration project regarding continuity of coverage of
migrant workers and farmworkers under
medicaid and SCHIP.
TITLE II--HEALTH DISPARITIES

Subtitle A--Report on Programs for Improving the Health Status of
Hispanic Individuals

Sec. 201. Annual report regarding Hispanic health disparities for
chronic and communicable diseases.
Subtitle B--Diabetes Research, Control, and Prevention

Sec. 211. Treatment.
Sec. 212. Education.
Sec. 213. Health promotion, prevention activities, and access.
Subtitle C--HIV Prevention Activities Regarding Hispanic Individuals

Sec. 221. Programs of Centers for Disease Control and Prevention;
representation of Hispanic individuals in
membership of community planning groups.
Sec. 222. AIDS education and training centers funded by Health
Resources and Services Administration;
establishment of center directed toward
minority populations with HIV.
Subtitle D--Prevention of Latina Adolescent Suicides

Sec. 231. Short title.
Sec. 232. Establishment of program for prevention of Latina adolescent
suicides.
Subtitle E--Cancer Research, Training, and Awareness

Sec. 241. Redes En Accion: the National Hispanic/Latino Cancer Network
and other NCI special populations networks
initiatives targeting cancer; increased
authorization of appropriations for
activities regarding Hispanic individuals.
Subtitle F--Tuberculosis Control, Prevention, and Treatment

Sec. 251. Advisory Council for the Elimination of Tuberculosis.
Sec. 252. National program for tuberculosis elimination.
Sec. 253. Inclusion of inpatient hospital services for the treatment of
TB-infected individuals.
TITLE III--ACCESS AND AFFORDABILITY

Subtitle A--Dental Health Services

Sec. 301. Grants to improve the provision of dental health services
through community health centers and public
health departments.
Sec. 302. School-based dental sealant program.
Subtitle B--Border Health

Sec. 311. Short title.
Sec. 312. Definitions.
Sec. 313. Border health services grants.
Sec. 314. Border bioterrorism preparedness grants.
Sec. 315. United States-Mexico Border Health Commission Act amendments.
Subtitle C--Patient Navigator, Outreach, and Chronic Disease Prevention

Sec. 321. Short title.
Sec. 322. HRSA grants for model community cancer and chronic disease
care and prevention; HRSA grants for
patient navigators.
Sec. 323. NCI grants for model community cancer and chronic disease
care and prevention; NCI grants for patient
navigators.
Sec. 324. IHS grants for model community cancer and chronic disease
care and prevention; IHS grants for patient
navigators.
TITLE IV--STRENGTHENING OUR HEALTH CARE WORKFORCE

Subtitle A--Hispanic-Serving Health Professions Schools

Sec. 401. Hispanic-serving health professions schools.
Subtitle B--Health Career Opportunity Program and Centers of Excellence

Sec. 411. Educational assistance regarding undergraduates.
Sec. 412. Centers of excellence.
Subtitle C--Bilingual Health Professionals

Sec. 421. Training of bilingual health professionals with respect to
minority health conditions.
Subtitle D--Cultural Competence

Sec. 431. Definition.
Sec. 432. Activities of Office of Minority Health; Center for
Linguistic and Cultural Competence in
Health Care.
Sec. 433. Cultural competence demonstration projects.
TITLE V--ADDITIONAL PROGRAMS

Subtitle A--Data Regarding Race and Ethnicity

Sec. 501. Collection of data.
Sec. 502. Development of standards; study to measure patient outcomes
under medicare and medicaid programs.
Subtitle B--National Assessment of Status of Latino Health

Sec. 511. National assessment of status of Latino health.
Subtitle C--Office of Minority Health

Sec. 521. Revision and extension of programs of Office of Minority
Health.
Sec. 522. Establishment of individual Offices of Minority Health within
agencies of Public Health Service.
Sec. 523. Assistant Secretary of Health and Human Services for Civil
Rights.

SEC. 2. FINDINGS.

Congress makes the following findings:
(1) The uninsured rates of Hispanic adults and children is
almost two to three times those for non-Hispanic whites and
more than one-third of all Hispanics lack any form of health
insurance.
(2) Hispanics disproportionately suffer from conditions
like diabetes, cardiovascular disease, HIV/AIDS, and other
illnesses.
(3) Hispanic communities are underserved and continue to
have significantly less access to affordable quality medical
care.
(4) The under-representation of Hispanics in the health
professions and the educational pipeline of the health
professions affects the current and future delivery of
culturally competent and sensitive health care for Hispanics.
(5) Therefore there is a need for a comprehensive Federal
effort to address the unique health needs of the Hispanic
community.

TITLE I--HEALTH CARE COVERAGE

Subtitle A--Coverage for Children, Parents, and Pregnant Women

SEC. 101. COVERAGE OF PARENTS AND PREGNANT WOMEN UNDER THE MEDICAID
PROGRAM AND TITLE XXI.

(a) Incentives To Implement Coverage of Parents and Pregnant
Women.--
(1) Under medicaid.--
(A) Establishment of new optional eligibility
category.--Section 1902(a)(10)(A)(ii) of the Social
Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is
amended--
(i) by striking ``or'' at the end of
subclause (XVII);
(ii) by adding ``or'' at the end of
subclause (XVIII); and
(iii) by adding at the end the following:
``(XIX) who are individuals
described in subsection (k)(1)
(relating to parents of categorically
eligible children);''.
(B) Parents described.--Section 1902 of the Social
Security Act is further amended by inserting after
subsection (j) the following:
``(k)(1)(A) Individuals described in this paragraph are
individuals--
``(i) who are the parents of an individual who is under 19
years of age (or such higher age as the State may have elected
under section 1902(l)(1)(D)) and who is eligible for medical
assistance under subsection (a)(10)(A);
``(ii) who are not otherwise eligible for medical
assistance under such subsection or under a waiver approved
under section 1115 or otherwise (except under section 1931 or
under subsection (a)(10)(A)(ii)(XIX)); and
``(iii) whose family income exceeds the effective income
level or resource level applicable under the State plan under
part A of title IV as in effect as of July 16, 1996, but does
not exceed the highest effective income level applicable to a
child in the family under this title.
``(B) In establishing an income eligibility level for individuals
described in this paragraph, a State may vary such level consistent
with the various income levels established under subsection (l)(2)
based on the ages of children described in subsection (l)(1) in order
to ensure, to the maximum extent possible, that such individuals shall
be enrolled in the same program as their children.
``(C) An individual may not be treated as being described in this
paragraph unless, at the time of the individual's enrollment under this
title, the child referred to in subparagraph (A)(i) of the individual
is also enrolled under this title.
``(D) In this subsection, the term `parent' has the meaning given
the term `caretaker relative' for purposes of carrying out section
1931.
``(2) In the case of a parent described in paragraph (1) who is
also the parent of a child who is eligible for child health assistance
under title XXI, the State may elect (on a uniform basis) to cover all
such parents under section 2111 or under this title.''.
(C) Enhanced matching funds available if certain
conditions met.--Section 1905 of the Social Security
Act (42 U.S.C. 1396d) is amended--
(i) in the fourth sentence of subsection
(b), by striking ``or subsection (u)(3)'' and
inserting ``, (u)(3), or (u)(4)''; and
(ii) in subsection (u)--
(I) by redesignating paragraph (4)
as paragraph (6), and
(II) by inserting after paragraph
(3) the following:
``(4) For purposes of subsection (b) and section 2105(a)(1):
``(A) Parents and pregnant women.--The expenditures
described in this subparagraph are the expenditures described
in the following clauses (i) and (ii):
``(i) Parents.--If the conditions described in
clause (iii) are met, expenditures for medical
assistance for parents described in section 1902(k)(1)
and for parents who would be described in such section
but for the fact that they are eligible for medical
assistance under section 1931 or under a waiver
approved under section 1115.
``(ii) Certain pregnant women.--If the conditions
described in clause (iv) are met, expenditures for
medical assistance for pregnant women described in
subsection (n) or under section 1902(l)(1)(A) in a
family the income of which exceeds the effective income
level applicable under subsection (a)(10)(A)(i)(III)
or (l)(2)(A) of section 1902 to a family of the size involved as of
January 1, 2003.
``(iii) Conditions for expenditures for parents.--
The conditions described in this clause are the
following:
``(I) The State has a State child health
plan under title XXI which (whether implemented
under such title or under this title) has an
effective income level for children that is at
least 200 percent of the poverty line.
``(II) State child health plan does not
limit the acceptance of applications, does not
use a waiting list for children who meet
eligibility standards to qualify for
assistance, and provides benefits to all
children in the State who apply for and meet
eligibility standards.
``(III) The State plans under this title
and title XXI do not provide coverage for
parents with higher family income without
covering parents with a lower family income.
``(IV) The State does not apply an income
level for parents that is lower than the
effective income level (expressed as a percent
of the poverty line) that has been specified
under the State plan under title XIX (including
under a waiver authorized by the Secretary or
under section 1902(r)(2)), as of January 1,
2003, to be eligible for medical assistance as
a parent under this title.
``(iv) Conditions for expenditures for certain
pregnant women.--The conditions described in this
clause are the following:
``(I) The State plans under this title and
title XXI do not provide coverage for pregnant
women described in subparagraph (A)(ii) with
higher family income without covering such
pregnant women with a lower family income.
``(II) The State does not apply an income
level for pregnant women that is lower than the
effective income level (expressed as a percent
of the poverty line and considering applicable
income disregards) that has been specified
under the State plan under subsection
(a)(10)(A)(i)(III) or (l)(2)(A) of section
1902, as of January 1, 2003, to be eligible for
medical assistance as a pregnant woman.
``(III) The State satisfies the conditions
described in subclauses (I) and (II) of clause
(iii).
``(v) Definitions.--For purposes of this
subsection:
``(I) The term `parent' has the meaning
given such term for purposes of section
1902(k)(1).
``(II) The term `poverty line' has the
meaning given such term in section
2110(c)(5).''.
(D) Appropriation from title xxi allotment for
medicaid expansion costs for parents; elimination of
counting medicaid child presumptive eligibility costs
against title xxi allotment.--Subparagraph (B) of
section 2105(a)(1) of the Social Security Act, as
amended by section 104(a), is amended to read as
follows:
``(B) Parents and pregnant women.--Expenditures for
medical assistance that are attributable to
expenditures described in section 1905(u)(4)(A).''.
(E) Only counting enhanced portion for coverage of
additional pregnant women.--Section 1905 of the Social
Security Act (42 U.S.C. 1396d) is amended--
(i) in the fourth sentence of subsection
(b), by inserting ``(except in the case of
expenditures described in subsection (u)(5))''
after ``do not exceed'';
(ii) in subsection (u), by inserting after
paragraph (4) (as inserted by subparagraph
(C)), the following:
``(5) For purposes of the fourth sentence of subsection (b) and
section 2105(a), the following payments under this title do not count
against a State's allotment under section 2104:
``(A) Regular fmap for expenditures for pregnant women with
income above january 1, 2003 income level.--The portion of the
payments made for expenditures described in paragraph
(4)(A)(ii) that represents the amount that would have been paid
if the enhanced FMAP had not been substituted for the Federal
medical assistance percentage.''.
(2) Under title xxi.--
(A) Parents and pregnant women coverage.--Title XXI
of the Social Security Act (42 U.S.C. 1397aa et seq.)
is amended by adding at the end the following:

``SEC. 2111. OPTIONAL COVERAGE OF PARENTS OF TARGETED LOW-INCOME
CHILDREN OR TARGETED LOW-INCOME PREGNANT WOMEN.

``(a) Optional Coverage.--Notwithstanding any other provision of
this title, a State may provide for coverage, through an amendment to
its State child health plan under section 2102, of parent health
assistance for targeted low-income parents, pregnancy-related
assistance for targeted low-income pregnant women, or both, in
accordance with this section, but only if--
``(1) with respect to the provision of parent health
assistance, the State meets the conditions described in clause
(iii) of section 1905(u)(4)(A);
``(2) with respect to the provision of pregnancy-related
assistance, the State meets the conditions described in clause
(iv) of section 1905(u)(4)(A); and
``(3) in the case of parent health assistance for targeted
low-income parents, the State elects to provide medical
assistance under section 1902(a)(10)(A)(ii)(XIX), under section
1931, or under a waiver under section 1115 to individuals
described in section 1902(k)(1)(A)(i) and elects an effective income
level that, consistent with paragraphs (1)(B) and (2) of section
1902(k), ensures to the maximum extent possible, that such individuals
shall be enrolled in the same program as their children if their
children are eligible for coverage under title XIX (including under a
waiver authorized by the Secretary or under section 1902(r)(2)).''.
``(b) Definitions.--For purposes of this title:
``(1) Parent health assistance.--The term `parent health
assistance' has the meaning given the term child health
assistance in section 2110(a) as if any reference to targeted
low-income children were a reference to targeted low-income
parents.
``(2) Parent.--The term `parent' has the meaning given the
term `caretaker relative' for purposes of carrying out section
1931.
``(3) Pregnancy-related assistance.--The term `pregnancy-
related assistance' has the meaning given the term child health
assistance in section 2110(a) as if any reference to targeted
low-income children were a reference to targeted low-income
pregnant women, except that the assistance shall be limited to
services related to pregnancy (which include prenatal,
delivery, and postpartum services and services described in
section 1905(a)(4)(C)) and to other conditions that may
complicate pregnancy.
``(4) Targeted low-income parent.--The term `targeted low-
income parent' has the meaning given the term targeted low-
income child in section 2110(b) as if the reference to a child
were deemed a reference to a parent (as defined in paragraph
(3)) of the child; except that in applying such section--
``(A) there shall be substituted for the income
level described in paragraph (1)(B)(ii)(I) the
applicable income level in effect for a targeted low-
income child;
``(B) in paragraph (3), January 1, 2003, shall be
substituted for July 1, 1997; and
``(C) in paragraph (4), January 1, 2003, shall be
substituted for March 31, 1997.
``(5) Targeted low-income pregnant woman.--The term
`targeted low-income pregnant woman' has the meaning given the
term targeted low-income child in section 2110(b) as if any
reference to a child were a reference to a woman during
pregnancy and through the end of the month in which the 60-day
period beginning on the last day of her pregnancy ends; except
that in applying such section--
``(A) there shall be substituted for the income
level described in paragraph (1)(B)(ii)(I) the
applicable income level in effect for a targeted low-
income child;
``(B) in paragraph (3), January 1, 2003, shall be
substituted for July 1, 1997; and
``(C) in paragraph (4), January 1, 2003, shall be
substituted for March 31, 1997.
``(6) Parent.--The term `parent' has the meaning given the
term `caretaker relative' for purposes of carrying out section
1931.
``(c) References to Terms and Special Rules.--In the case of, and
with respect to, a State providing for coverage of parent health
assistance to targeted low-income parents or pregnancy-related
assistance to targeted low-income pregnant women under subsection (a),
the following special rules apply:
``(1) Any reference in this title (other than in subsection
(b)) to a targeted low-income child is deemed to include a
reference to a targeted low-income parent or a targeted low-
income pregnant woman (as applicable).
``(2) Any such reference to child health assistance--
``(A) with respect to such parents is deemed a
reference to parent health assistance; and
``(B) with respect to such pregnant women, is
deemed a reference to pregnancy-related assistance.
``(3) In applying section 2103(e)(3)(B) in the case of a
family or pregnant woman provided coverage under this section,
the limitation on total annual aggregate cost-sharing shall be
applied to the entire family or such pregnant woman.
``(4) In applying section 2110(b)(4), any reference to
`section 1902(l)(2) or 1905(n)(2) (as selected by a State)' is
deemed a reference to the effective income level applicable to
parents under section 1931 or under a waiver approved under
section 1115, or, in the case of a pregnant woman, the income
level established under section 1902(l)(2)(A).
``(5) In applying section 2102(b)(3)(B), any reference to
children found through screening to be eligible for medical
assistance under the State medicaid plan under title XIX is
deemed a reference to parents and pregnant women.''.
(B) Additional allotment for states providing
coverage of parents or pregnant women.--
(i) In general.--Section 2104 of the Social
Security Act (42 U.S.C. 1397dd) is amended by
inserting after subsection (c) the following:
``(d) Additional Allotments for State Coverage of Parents or
Pregnant Women.--
``(1) Appropriation; total allotment.--For the purpose of
providing additional allotments to States under this title,
there is appropriated, out of any money in the Treasury not
otherwise appropriated--
``(A) for fiscal year 2004, $3,000,000,000;
``(B) for fiscal year 2005, $3,000,000,000; and
``(C) for fiscal year 2006, $4,000,000,000;
``(D) for fiscal year 2007, $5,000,000,000.
``(2) State and territorial allotments.--
``(A) In general.--In addition to the allotments
provided under subsections (b) and (c), subject to
paragraphs (3) and (4), of the amount available for the
additional allotments under paragraph (1) for a fiscal
year, the Secretary shall allot to each State with a
State child health plan approved under this title--
``(i) in the case of such a State other
than a commonwealth or territory described in
subparagraph (B), the same proportion as the
proportion of the State's allotment under
subsection (b) (determined without regard to
subsection (f)) to the total amount of the
allotments under subsection (b) for such States
eligible for an allotment under this paragraph
for such fiscal year; and
``(ii) in the case of a commonwealth or
territory described in subsection (c)(3), the
same proportion as the proportion of the
commonwealth's or territory's allotment under
subsection (c) (determined without regard to
subsection (f)) to the total amount of the
allotments under subsection (c) for
commonwealths and territories eligible for an
allotment under this paragraph for such fiscal
year.
``(B) Availability and redistribution of unused
allotments.--In applying subsections (e) and (f) with
respect to additional allotments made available under
this subsection, the procedures established under such
subsections shall ensure such additional allotments are
only made available to States which have elected to
provide coverage under section 2111.
``(3) Use of additional allotment.--Additional allotments
provided under this subsection are not available for amounts
expended before October 1, 2003. Such amounts are available for
amounts expended on or after such date for child health
assistance for targeted low-income children, as well as for
parent health assistance for targeted low-income parents, and
pregnancy-related assistance for targeted low-income pregnant
women.
``(4) Requiring election to provide coverage.--No payments
may be made to a State under this title from an allotment
provided under this subsection unless the State has made an
election to provide parent health assistance for targeted low-
income parents, or pregnancy-related assistance for targeted
low-income pregnant women.''.
(ii) Conforming amendments.--Section 2104
of the Social Security Act (42 U.S.C. 1397dd)
is amended--
(I) in subsection (a), by inserting
``subject to subsection (d),'' after
``under this section,'';
(II) in subsection (b)(1), by
inserting ``and subsection (d)'' after
``Subject to paragraph (4)''; and
(III) in subsection (c)(1), by
inserting ``subject to subsection
(d),'' after ``for a fiscal year,''.
(C) No cost-sharing for pregnancy-related
benefits.--Section 2103(e)(2) of the Social Security
Act (42 U.S.C. 1397cc(e)(2)) is amended--
(i) in the heading, by inserting ``and
pregnancy-related services'' after ``preventive
services''; and
(ii) by inserting before the period at the
end the following: ``and for pregnancy-related
services''.
(b) Optional Application of Presumptive Eligibility Provisions to
Parents.--Section 1920A of the Social Security Act (42 U.S.C. 1396r-1a)
is amended by adding at the end the following:
``(e) A State may elect to apply the previous provisions of this
section to provide for a period of presumptive eligibility for medical
assistance for a parent (as defined for purposes of section 1902(k)(1))
of a child with respect to whom such a period is provided under this
section.''.
(c) Conforming Amendments.--
(1) Eligibility categories.--Section 1905(a) of the Social
Security Act (42 U.S.C. 1396d(a)) is amended, in the matter
before paragraph (1)--
(A) by striking ``or'' at the end of clause (xii);
(B) by inserting ``or'' at the end of clause
(xiii); and
(C) by inserting after clause (xiii) the following:
``(xiv) who are parents described (or treated as if
described) in section 1902(k)(1),''.
(2) Income limitations.--Section 1903(f)(4) of the Social
Security Act (42 U.S.C. 1396b(f)(4)) is amended by inserting
``1902(a)(10)(A)(ii)(XIX),'' after
``1902(a)(10)(A)(ii)(XVIII),''.
(3) Conforming amendment relating to no waiting period for
pregnant women.--Section 2102(b)(1)(B) of the Social Security
Act (42 U.S.C. 1397bb(b)(1)(B)) is amended--
(A) by striking ``, and'' at the end of clause (i)
and inserting a semicolon;
(B) by striking the period at the end of clause
(ii) and inserting ``; and''; and
(C) by adding at the end the following:
``(iii) may not apply a waiting period
(including a waiting period to carry out
paragraph (3)(C)) in the case of a targeted
low-income parent who is pregnant.''.
(d) Exemption for Puerto Rico.--Section 1108(g) of the Social
Security Act (42 U.S.C. 1308(g)) is amended by adding at the end the
following:
``(3) Certain payments disregarded.--Paragraph (2) shall be
applied without regard to any payments made under sections
1902(a)(10)(A)(ii)(XIX) and 1903(v).''.
(e) Effective Date.--The amendments made by this section take
effect on October 1, 2003, without regard to whether regulations
implementing such amendments have been issued.

SEC. 102. AUTOMATIC ENROLLMENT OF CHILDREN BORN TO TITLE XXI PARENTS.

(a) Title XXI.--Section 2102(b)(1) of the Social Security Act (42
U.S.C. 1397bb(b)(1)) is amended by adding at the end the following:
``(C) Automatic eligibility of children born to
pregnant women.--Such eligibility standards shall
provide for automatic coverage of a child born to an
individual who is provided assistance under this title
in the same manner as medical assistance would be
provided under section 1902(e)(4) to a child described
in such section.''.
(b) Conforming Amendment to Medicaid.--Section 1902(e)(4) of the
Social Security Act (42 U.S.C. 1396a(e)(4)) is amended in the first
sentence by striking ``so long as the child is a member of the woman's
household and the woman remains (or would remain if pregnant) eligible
for such assistance''.
(c) Effective Date.--The amendments made by this section take
effect on October 1, 2003, without regard to whether regulations
implementing such amendments have been issued.

SEC. 103. OPTIONAL COVERAGE OF CHILDREN THROUGH AGE 20 UNDER THE
MEDICAID PROGRAM AND TITLE XXI.

(a) Medicaid.--
(1) In general.--Section 1902(l)(1)(D) of the Social
Security Act (42 U.S.C. 1396a(l)(1)(D)) is amended by inserting
``(or, at the election of a State, 20 or 21 years of age)''
after ``19 years of age''.
(2) Conforming amendments.--
(A) Section 1902(e)(3)(A) of the Social Security
Act (42 U.S.C. 1396a(e)(3)(A)) is amended by inserting
``(or 1 year less than the age the State has elected
under subsection (l)(1)(D))'' after ``18 years of
age''.
(B) Section 1902(e)(12) of the Social Security Act
(42 U.S.C. 1396a(e)(12)) is amended by inserting ``or
such higher age as the State has elected under
subsection (l)(1)(D)'' after ``19 years of age''.
(C) Section 1920A(b)(1) of the Social Security Act
(42 U.S.C. 1396r-1a(b)(1)) is amended by inserting ``or
such higher age as the State has elected under section
1902(l)(1)(D)'' after ``19 years of age''.
(D) Section 1928(h)(1) of the Social Security Act
(42 U.S.C. 1396s(h)(1)) is amended by inserting ``or 1
year less than the age the State has elected under
section 1902(l)(1)(D)'' before the period at the end.
(E) Section 1932(a)(2)(A) of the Social Security
Act (42 U.S.C. 1396u-2(a)(2)(A)) is amended by
inserting ``(or such higher age as the State has
elected under section 1902(l)(1)(D))'' after ``19 years
of age''.
(b) Title XXI.--Section 2110(c)(1) of the Social Security Act (42
U.S.C. 1397jj(c)(1)) is amended by inserting ``(or such higher age as
the State has elected under section 1902(l)(1)(D))''.
(c) Effective Date.--The amendments made by this section take
effect on October 1, 2003, without regard to whether regulations
implementing such amendments have been issued.

SEC. 104. TECHNICAL AND CONFORMING AMENDMENTS TO AUTHORITY TO PAY
MEDICAID EXPANSION COSTS FROM TITLE XXI APPROPRIATION.

(a) Authority To Pay Medicaid Expansion Costs From Title XXI
Appropriation.--Section 2105(a) of the Social Security Act (42 U.S.C.
1397ee(a)) is amended to read as follows:
``(a) Allowable Expenditures.--
``(1) In general.--Subject to the succeeding provisions of
this section, the Secretary shall pay to each State with a plan
approved under this title, from its allotment under section
2104, an amount for each quarter equal to the enhanced FMAP of
the following expenditures in the quarter:
``(A) Child health assistance under medicaid.--
Expenditures for child health assistance under the plan
for targeted low-income children in the form of
providing medical assistance for expenditures described
in the fourth sentence of section 1905(b).
``(B) Reserved.--[reserved].
``(C) Child health assistance under this title.--
Expenditures for child health assistance under the plan
for targeted low-income children in the form of
providing health benefits coverage that meets the
requirements of section 2103.
``(D) Assistance and administrative expenditures
subject to limit.--Expenditures only to the extent
permitted consistent with subsection (c)--
``(i) for other child health assistance for
targeted low-income children;
``(ii) for expenditures for health services
initiatives under the plan for improving the
health of children (including targeted low-
income children and other low-income children);
``(iii) for expenditures for outreach
activities as provided in section 2102(c)(1)
under the plan; and
``(iv) for other reasonable costs incurred
by the State to administer the plan.
``(2) Order of payments.--Payments under a subparagraph of
paragraph (1) from a State's allotment for expenditures
described in each such subparagraph shall be made on a
quarterly basis in the order of such subparagraph in such
paragraph.
``(3) No duplicative payment.--In the case of expenditures
for which payment is made under paragraph (1), no payment shall
be made under title XIX.''.
(b) Conforming Amendments.--
(1) Section 1905(u).--Section 1905(u)(1)(B) of the Social
Security Act (42 U.S.C. 1396d(u)(1)(B)) is amended by inserting
``and section 2105(a)(1)'' after ``subsection (b)''.
(2) Section 2105(c).--Section 2105(c)(2)(A) of the Social
Security Act (42 U.S.C. 1397ee(c)(2)(A)) is amended by striking
``subparagraphs (A), (C), and (D) of''.
(c) Effective Date.--The amendments made by this section shall be
effective as if included in the enactment of the Balanced Budget Act of
1997 (Public Law 105-33; 111 Stat. 251), whether or not regulations
implementing such amendments have been issued.

SEC. 105. EXTENSION OF AVAILABILITY OF SCHIP ALLOTMENTS FOR FISCAL
YEARS 1998 THROUGH 2001.

(a) Extending Availability of SCHIP Allotments for Fiscal Years
1998 Through 2001.--
(1) Retained and redistributed allotments for fiscal years
1998 and 1999.--Paragraphs (2)(A)(i) and (2)(A)(ii) of section
2104(g) of the Social Security Act (42 U.S.C. 1397dd(g)) are
each amended by striking ``fiscal year 2002'' and inserting
``fiscal year 2004''.
(2) Extension and revision of retained and redistributed
allotments for fiscal year 2000.--
(A) Permitting and extending retention of portion
of fiscal year 2000 allotment.--Paragraph (2) of such
section 2104(g) is amended--
(i) in the heading, by striking ``and
1999'' and inserting ``through 2000''; and
(ii) by adding at the end of subparagraph
(A) the following:
``(iii) Fiscal year 2000 allotment.--Of the
amounts allotted to a State pursuant to this
section for fiscal year 2000 that were not
expended by the State by the end of fiscal year
2002, 50 percent of that amount shall remain
available for expenditure by the State through
the end of fiscal year 2004.''.
(B) Redistributed allotments.--Paragraph (1) of
such section 2104(g) is amended--
(i) in subparagraph (A), by inserting ``or
for fiscal year 2000 by the end of fiscal year
2002,'' after ``fiscal year 2001,'';
(ii) in subparagraph (A), by striking
``1998 or 1999'' and inserting ``1998, 1999, or
2000'';
(iii) in subparagraph (A)(i)--
(I) by striking ``or'' at the end
of subclause (I),
(II) by striking the period at the
end of subclause (II) and inserting ``;
or''; and
(III) by adding at the end the
following new subclause:
``(III) the fiscal year 2000
allotment, the amount specified in
subparagraph (C)(i) (less the total of
the amounts under clause (ii) for such
fiscal year), multiplied by the ratio
of the amount specified in subparagraph
(C)(ii) for the State to the amount
specified in subparagraph (C)(iii).'';
(iv) in subparagraph (A)(ii), by striking
``or 1999'' and inserting ``, 1999, or 2000'';
(v) in subparagraph (B), by striking ``with
respect to fiscal year 1998 or 1999'';
(vi) in subparagraph (B)(ii)--
(I) by inserting ``with respect to
fiscal year 1998, 1999, or 2000,''
after ``subsection (e),''; and
(II) by striking ``2002'' and
inserting ``2004''; and
(vii) by adding at the end the following
new subparagraph:
``(C) Amounts used in computing redistributions for
fiscal year 2000.--For purposes of subparagraph
(A)(i)(III)--
``(i) the amount specified in this clause
is the amount specified in paragraph
(2)(B)(i)(I) for fiscal year 2000, less the
total amount remaining available pursuant to
paragraph (2)(A)(iii);
``(ii) the amount specified in this clause
for a State is the amount by which the State's
expenditures under this title in fiscal years
2000, 2001, and 2002 exceed the State's
allotment for fiscal year 2000 under subsection
(b); and
``(iii) the amount specified in this clause
is the sum, for all States entitled to a
redistribution under subparagraph (A) from the
allotments for fiscal year 2000, of the amounts
specified in clause (ii).''.
(C) Conforming amendments.--Such section 2104(g) is
further amended--
(i) in its heading, by striking ``and
1999'' and inserting ``, 1999, and 2000''; and
(ii) in paragraph (3)--
(I) by striking ``or fiscal year
1999'' and inserting ``, fiscal year
1999, or fiscal year 2000''; and
(II) by striking ``or November 30,
2001'' and inserting ``November 30,
2001, or November 30, 2002'',
respectively.
(3) Extension and revision of retained and redistributed
allotments for fiscal year 2001.--
(A) Permitting and extending retention of portion
of fiscal year 2001 allotment.--Paragraph (2) of such
section 2104(g), as amended in paragraph (2)(A)(ii), is
further amended--
(i) in the heading, by striking ``2000''
and inserting ``2001''; and
(ii) by adding at the end of subparagraph
(A) the following:
``(iv) Fiscal year 2001 allotment.--Of the
amounts allotted to a State pursuant to this
section for fiscal year 2001 that were not
expended by the State by the end of fiscal year
2003, 50 percent of that amount shall remain
available for expenditure by the State through
the end of fiscal year 2005.''.
(B) Redistributed allotments.--Paragraph (1) of
such section 2104(g), as amended in paragraph (2)(B),
is further amended--
(i) in subparagraph (A), by inserting ``or
for fiscal year 2001 by the end of fiscal year
2003,'' after ``fiscal year 2002,'';
(ii) in subparagraph (A), by striking
``1999, or 2000'' and inserting ``1999, 2000,
or 2001'';
(iii) in subparagraph (A)(i)--
(I) by striking ``or'' at the end
of subclause (II),
(II) by striking the period at the
end of subclause (III) and inserting
``; or''; and
(III) by adding at the end the
following new subclause:
``(IV) the fiscal year 2001
allotment, the amount specified in
subparagraph (D)(i) (less the total of
the amounts under clause (ii) for such
fiscal year), multiplied by the ratio
of the amount specified in subparagraph
(D)(ii) for the State to the amount
specified in subparagraph (D)(iii).'';
(iv) in subparagraph (A)(ii), by striking
``or 2000'' and inserting ``2000, or 2001'';
(v) in subparagraph (B)--
(I) by striking ``and'' at the end
of clause (ii);
(II) by redesignating clause (iii)
as clause (iv); and
(III) by inserting after clause
(ii) the following new clause:
``(iii) notwithstanding subsection (e),
with respect to fiscal year 2001, shall remain
available for expenditure by the State through
the end of fiscal year 2005; and''; and
(vi) by adding at the end the following new
subparagraph:
``(D) Amounts used in computing redistributions for
fiscal year 2001.--For purposes of subparagraph
(A)(i)(IV)--
``(i) the amount specified in this clause
is the amount specified in paragraph
(2)(B)(i)(I) for fiscal year 2001, less the
total amount remaining available pursuant to
paragraph (2)(A)(iv);
``(ii) the amount specified in this clause
for a State is the amount by which the State's
expenditures under this title in fiscal years
2001, 2002, and 2003 exceed the State's
allotment for fiscal year 2001 under subsection
(b); and
``(iii) the amount specified in this clause
is the sum, for all States entitled to a
redistribution under subparagraph (A) from the
allotments for fiscal year 2001, of the amounts
specified in clause (ii).''.
(C) Conforming amendments.--Such section 2104(g) is
further amended--
(i) in its heading, by striking ``and
2000'' and inserting ``2000, and 2001''; and
(ii) in paragraph (3)--
(I) by striking ``or fiscal year
2000'' and inserting ``fiscal year
2000, or fiscal year 2001''; and
(II) by striking ``or November 30,
2002,'' and inserting ``November 30,
2002, or November 30, 2003,'',
respectively.
(4) Effective date.--This subsection, and the amendments
made by this subsection, shall be effective as if this
subsection had been enacted on September 30, 2002, and amounts
under title XXI of the Social Security Act (42 U.S.C. 1397aa et
seq.) from allotments for fiscal years 1998 through 2000 are
available for expenditure on and after October 1, 2002, under
the amendments made by this subsection as if this subsection
had been enacted on September 30, 2002.
(b) Authority for Qualifying States To Use Portion of SCHIP Funds
for Medicaid Expenditures.--Section 2105 of the Social Security Act (42
U.S.C. 1397ee) is amended by adding at the end the following:
``(g) Authority for Qualifying States To Use Certain Funds for
Medicaid Expenditures.--
``(1) State option.--
``(A) In general.--Notwithstanding any other
provision of law, with respect to allotments for fiscal
years 1998, 1999, 2000, 2001, for fiscal years in which
such allotments are available under subsections (e) and
(g) of section 2104, a qualifying State (as defined in
paragraph (2)) may elect to use not more than 20
percent of such allotments (instead of for expenditures under this
title) for payments for such fiscal year under title XIX in accordance
with subparagraph (B).
``(B) Payments to states.--
``(i) In general.--In the case of a
qualifying State that has elected the option
described in subparagraph (A), subject to the
total amount of funds described with respect to
the State in subparagraph (A), the Secretary
shall pay the State an amount each quarter
equal to the additional amount that would have
been paid to the State under title XIX for
expenditures of the State for the fiscal year
described in clause (ii) if the enhanced FMAP
(as determined under subsection (b)) had been
substituted for the Federal medical assistance
percentage (as defined in section 1905(b)) of
such expenditures.
``(ii) Expenditures described.--For
purposes of clause (i), the expenditures
described in this clause are expenditures for
such fiscal years for providing medical
assistance under title XIX to individuals who
have not attained age 19 and whose family
income exceeds 150 percent of the poverty line.
``(iii) No impact on determination of
budget neutrality for waivers.--In the case of
a qualifying State that uses amounts paid under
this subsection for expenditures described in
clause (ii) that are incurred under a waiver
approved for the State, any budget neutrality
determinations with respect to such waiver
shall be determined without regard to such
amounts paid.
``(2) Qualifying state.--In this subsection, the term
`qualifying State' means a State that--
``(A) as of April 15, 1997, has an income
eligibility standard with respect to any 1 or more
categories of children (other than infants) who are
eligible for medical assistance under section
1902(a)(10)(A) or under a waiver under section 1115
implemented on January 1, 1994, that is up to 185
percent of the poverty line or above; and
``(B) satisfies the requirements described in
paragraph (3).
``(3) Requirements.--The requirements described in this
paragraph are the following:
``(A) SCHIP income eligibility.--The State has a
State child health plan that (whether implemented under
title XIX or this title)--
``(i) as of January 1, 2001, has an income
eligibility standard that is at least 200
percent of the poverty line or has an income
eligibility standard that exceeds 200 percent
of the poverty line under a waiver under
section 1115 that is based on a child's lack of
health insurance;
``(ii) subject to subparagraph (B), does
not limit the acceptance of applications for
children; and
``(iii) provides benefits to all children
in the State who apply for and meet eligibility
standards on a statewide basis.
``(B) No waiting list imposed.--With respect to
children whose family income is at or below 200 percent
of the poverty line, the State does not impose any
numerical limitation, waiting list, or similar
limitation on the eligibility of such children for
child health assistance under such State plan.
``(C) Additional requirements.--The State has
implemented at least 3 of the following policies and
procedures (relating to coverage of children under
title XIX and this title):
``(i) Uniform, simplified application
form.--With respect to children who are
eligible for medical assistance under section
1902(a)(10)(A), the State uses the same
uniform, simplified application form
(including, if applicable, permitting
application other than in person) for purposes
of establishing eligibility for benefits under
title XIX and this title.
``(ii) Elimination of asset test.--The
State does not apply any asset test for
eligibility under section 1902(l) or this title
with respect to children.
``(iii) Adoption of 12-month continuous
enrollment.--The State provides that
eligibility shall not be regularly redetermined
more often than once every year under this
title or for children described in section
1902(a)(10)(A).
``(iv) Same verification and
redetermination policies; automatic
reassessment of eligibility.--With respect to
children who are eligible for medical
assistance under section 1902(a)(10)(A), the
State provides for initial eligibility
determinations and redeterminations of
eligibility using the same verification
policies (including with respect to face-to-
face interviews), forms, and frequency as the
State uses for such purposes under this title,
and, as part of such redeterminations, provides
for the automatic reassessment of the
eligibility of such children for assistance
under title XIX and this title.
``(v) Outstationing enrollment staff.--The
State provides for the receipt and initial
processing of applications for benefits under
this title and for children under title XIX at
facilities defined as disproportionate share
hospitals under section 1923(a)(1)(A) and
Federally-qualified health centers described in
section 1905(l)(2)(B) consistent with section
1902(a)(55).''.

Subtitle B--State Option To Provide Coverage To All Individuals Below
100 Percent of Poverty

SEC. 111. STATE OPTION TO OFFER MEDICAID COVERAGE BASED ON NEED.

(a) State Option To Provide Coverage.--Section 1902(a)(10)(A)(ii)
of the Social Security Act (42 U.S.C. 1396a), as amended by section
531(a)(1)(A), is amended--
(1) by striking ``or'' at the end of subclause (XIX);
(2) by adding ``or'' at the end of subclause (XX); and
(3) by adding at the end the following:
``(XXI) whose income does not
exceed 100 percent of the income
official poverty line (as defined by
the Office of Management and Budget,
and revised annually in accordance with
section 673(2) of the Omnibus Budget
Reconciliation Act of 1981) applicable
to a family of the size involved;''.
(b) Conforming Amendments.--Section 1905(a) of the Social Security
Act (42 U.S.C. 1396d(a)), as amended by section 501(d)(1), is amended
in the matter preceding paragraph (1)--
(1) by striking ``or'' at the end of clause (xiii);
(2) by adding ``or'' at the end of clause (xiv); and
(3) by inserting after clause (xiv) the following:
``(xv) individuals who are eligible for medical assistance
on the basis of section 1902(a)(10)(A)(ii)(XXI);''.
(c) Effective Date.--The amendments made by this section apply to
medical assistance provided on and after October 1, 2003.

Subtitle C--Outreach and Enrollment

SEC. 121. GRANTS TO PROMOTE INNOVATIVE OUTREACH AND ENROLLMENT EFFORTS
UNDER SCHIP.

(a) In General.--Section 2104(f) of the Social Security Act (42
U.S.C. 1397dd(f)) is amended--
(1) by striking ``The Secretary'' and inserting the
following:
``(1) In general.--Subject to paragraph (2), the
Secretary''; and
(2) by adding at the end the following:
``(2) Grants to promote innovative outreach and enrollment
efforts.--
``(A) In general.--Prior to any redistribution
under paragraph (1) of unexpended allotments made to
States under subsection (b) or (c) for fiscal year 2001
and any fiscal year thereafter, the Secretary shall--
``(i) reserve from such unexpended
allotments the lesser of $50,000,000 or the
total amount of such unexpended allotments for
grants under this paragraph for the fiscal year
in which the redistribution occurs; and
``(ii) subject to subparagraph (B), use
such reserved funds to make grants to national
local and community-based public or nonprofit
organizations (including organizations involved
in women's health, pediatric advocacy, local
and county governments, public health
departments, Federally-qualified health
centers, children's hospitals, and hospitals
defined as disproportionate share hospitals
under the State plan under title XIX) to
conduct innovative outreach and enrollment
efforts that are consistent with section
2102(c) and to promote understanding of the
importance of health insurance coverage for
prenatal care and children.
``(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 the outreach and enrollment efforts funded under
the grant to geographic areas--
``(i) with high rates of eligible but
unenrolled children, including such children
who reside in rural areas; or
``(ii) with high rates of families for whom
English is not their primary language.
``(C) Applications.--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.''.
(b) Extending Use of Outstationed Workers To Accept Title XXI
Applications.--Section 1902(a)(55) of such Act (42 U.S.C. 1396a(a)(55))
is amended by inserting ``, and applications for child health
assistance under title XXI'' after ``(a)(10)(A)(ii)(IX)''.

Subtitle D--Immigrant Children and Pregnant Women

SEC. 131. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS UNDER THE MEDICAID
PROGRAM AND SCHIP.

(a) Medicaid Program.--Section 1903(v) of the Social Security Act
(42 U.S.C. 1396b(v)) is amended--
(1) in paragraph (1), by striking ``paragraph (2)'' and
inserting ``paragraphs (2) and (4)''; and
(2) by adding at the end the following:
``(4)(A) A State may elect (in a plan amendment under this title)
to provide medical assistance under this title for aliens who are
lawfully residing in the United States (including battered aliens
described in section 431(c) of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996) and who are otherwise eligible
for such assistance, within any of the following eligibility
categories:
``(i) Pregnant women.--Women during pregnancy (and during
the 60-day period beginning on the last day of the pregnancy).
``(ii) Children.--Children (as defined under such plan),
including optional targeted low-income children described in
section 1905(u)(2)(B).
``(B)(i) In the case of a State that has elected to provide medical
assistance to a category of aliens under subparagraph (A), 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 category and
the cost of such assistance shall not be considered as an unreimbursed
cost.
``(ii) The provisions of sections 401(a), 402(b), 403, and 421 of
the Personal Responsibility and Work Opportunity Reconciliation Act of
1996 shall not apply to a State that makes an election under
subparagraph (A).''.
(b) Title XXI.--Section 2107(e)(1) of the Social Security Act (42
U.S.C. 1397gg(e)(1)) is amended by adding at the end the following:
``(E) Section 1903(v)(4) (relating to optional
coverage of permanent resident alien children), but
only if the State has elected to apply such section to
that category of children under title XIX.''.
(c) Effective Date.--The amendments made by this section take
effect on October 1, 2003, and apply to medical assistance and child
health assistance furnished on or after such date.

SEC. 132. PERMITTING STATES AND LOCALITIES TO PROVIDE HEALTH CARE TO
ALL INDIVIDUALS.

(a) In General.--Section 411 of the Personal Responsibility and
Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1621) is
amended--
(1) in subsection (b)--
(A) by striking paragraphs (1) and (3); and
(B) by redesignating paragraphs (2) and (4) as
paragraphs (1) and (2), respectively; and
(2) in subsection (c)--
(A) in paragraph (1)--
(i) in the matter preceding subparagraph
(A), by striking ``(2) and (3)'' and inserting
``(2), (3), and (4)''; and
(ii) in subparagraph (B), by striking
``health,''; and
(B) by adding at the end the following new
paragraph
``(4) Such term does not include any health benefit for
which payments or assistance are provided to an individual,
household, or family eligibility unit by an agency of a State
or local government or by appropriated funds of a State or
local government.''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to health care furnished before, on, or after the date of the
enactment of this Act.

Subtitle E--Eligibility Simplification

SEC. 141. STATE OPTION TO PROVIDE FOR SIMPLIFIED DETERMINATIONS OF A
CHILD'S FINANCIAL ELIGIBILITY FOR MEDICAL ASSISTANCE
UNDER MEDICAID OR CHILD HEALTH ASSISTANCE UNDER SCHIP.

(a) Medicaid.--Section 1902(e) of the Social Security Act (42
U.S.C. 1396a(e)) is amended by adding at the end the following:
``(13)(A) At the option of the State, the plan may provide
that financial eligibility requirements for medical assistance
are met for an individual who is under an age specified by the
State (not to exceed 21 years of age) by using a determination
(made within a reasonable period, as found by the State, before
its use for this purpose) of the individual's family or
household income or resources, notwithstanding any differences
in budget unit, disregard, deeming, or other methodology, by a
Federal or State agency (or a public or private entity making
such determination on behalf of such agency) specified by the
plan, including but not limited to the agencies administering
the Food Stamp Act of 1977, the Richard B. Russell National
School Lunch Act, and the Child Nutrition Act of 1966, provided
that such agency has fiscal liabilities or responsibilities
affected or potentially affected by such determinations and
provided that all information furnished by such agency pursuant
to this subparagraph is used solely for purposes of determining
eligibility for medical assistance under the State plan
approved under this title or for child health assistance under
a State plan approved under title XXI.
``(B) Nothing in subparagraph (A) shall be construed--
``(i) to authorize the denial of medical assistance
under a State plan approved under this title or of
child health assistance under a State plan approved
under title XXI to an individual who, without the
application of this paragraph or an option exercised
thereunder, would qualify for such assistance;
``(ii) to relieve a State of the obligation under
subsection (a)(8) to furnish assistance with reasonable
promptness after the submission of an initial
application that is evaluated or for which evaluation
is requested pursuant to this paragraph; or
``(iii) to relieve a State of the obligation to
determine eligibility on other grounds for an
individual found to be ineligible under this paragraph.
``(C) At the option of a State, the financial eligibility
process described in subparagraph (A) may apply to an
individual who is older than age 21 if such individual's
eligibility for medical assistance is based on pregnancy or if
such individual is a parent, guardian, or other caretaker
relative of an individual found eligible under subparagraph
(A).''.
(b) SCHIP.--Section 2107(e)(1) of the Social Security Act (42
U.S.C. 1397gg(e)(1)) is amended by adding at the end the following:
``(E) Section 1902(e)(13) (relating to the State
option to base a child's eligibility for assistance on
financial determinations made by a program providing
nutrition or other public assistance).''.
(c) Effective Date.--The amendments made by this section take
effect on October 1, 2003.

SEC. 142. APPLICATION OF SIMPLIFIED TITLE XXI PROCEDURES UNDER THE
MEDICAID PROGRAM.

(a) Presumptive Eligibility.--
(1) In general.--Section 1920A(b)(3)(A)(i) of the Social
Security Act (42 U.S.C. 1396r-1a(b)(3)(A)(i)) is amended by
inserting ``a child care resource and referral agency,'' after
``a State or tribal child support enforcement agency,''.
(2) Application to presumptive eligibility for pregnant
women under medicaid.--Section 1920(b) of the Social Security
Act (42 U.S.C. 1396r-1(b)) is amended by adding at the end
after and below paragraph (2) the following flush sentence:
``The term `qualified provider' includes a qualified entity as defined
in section 1920A(b)(3).''.
(3) Application under title xxi.--Section 2107(e)(1)(D) of
the Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended to
read as follows:
``(D) Sections 1920 and 1920A (relating to
presumptive eligibility).''.
(b) Automatic Reassessment of Eligibility for Title XXI and
Medicaid Benefits for Children Losing Medicaid or Title XXI
Eligibility.--
(1) Loss of medicaid eligibility.--Section 1902(a) of the
Social Security Act (42 U.S.C. 1396a(a)) is amended--
(A) by striking the period at the end of paragraph
(65) and inserting ``; and'', and
(B) by inserting after paragraph (65) the
following:
``(66) provide, in the case of a State with a State child
health plan under title XXI, that before medical assistance to
a child (or a parent of a child) is discontinued under this
title, a determination of whether the child (or parent) is
eligible for benefits under title XXI shall be made and, if
determined to be so eligible, the child (or parent) shall be
automatically enrolled in the program under such title without
the need for a new application.''.
(2) Loss of title xxi eligibility and coordination with
medicaid.--Section 2102(b) of the Social Security Act (42
U.S.C. 1397bb(b)) is amended--
(A) in paragraph (3), by redesignating
subparagraphs (D) and (E) as subparagraphs (E) and (F),
respectively, and by inserting after subparagraph (C)
the following:
``(D) that before health assistance to a child (or
a parent of a child) is discontinued under this title,
a determination of whether the child (or parent) is
eligible for benefits under title XIX is made and, if
determined to be so eligible, the child (or parent) is
automatically enrolled in the program under such title
without the need for a new application;'';
(B) by redesignating paragraph (4) as paragraph
(5); and
(C) by inserting after paragraph (3) the following
new paragraph:
``(4) Coordination with medicaid.--The State shall
coordinate the screening and enrollment of individuals under
this title and under title XIX consistent with the following:
``(A) Information that is collected under this
title or under title XIX which is needed to make an
eligibility determination under the other title shall
be transmitted to the appropriate administering entity
under such other title in a timely manner so that
coverage is not delayed and families do not have to
submit the same information twice. Families shall be
provided the information they need to complete the
application process for coverage under both titles and
be given appropriate notice of any determinations made
on their applications for such coverage.
``(B) If a State does not use a joint application
under this title and such title, the State shall--
``(i) promptly inform a child's parent or
caretaker in writing and, if appropriate,
orally, that a child has been found likely to
be eligible under title XIX;
``(ii) provide the family with an
application for medical assistance under such
title and offer information about what (if any)
further information, documentation, or other
steps are needed to complete such application
process;
``(iii) offer assistance in completing such
application process; and
``(iv) promptly transmit the separate
application under this title or the information
obtained through such application, and all
other relevant information and documentation,
including the results of the screening process,
to the State agency under title XIX for a final
determination on eligibility under such title.
``(C) Applicants are notified in writing of--
``(i) benefits (including restrictions on
cost-sharing) under title XIX; and
``(ii) eligibility rules that prohibit
children who have been screened eligible for
medical assistance under such title from being
enrolled under this title, other than
provisional temporary enrollment while a final
eligibility determination is being made under
such title.
``(D) If the agency administering this title is
different from the agency administering a State plan
under title XIX, such agencies shall coordinate the
screening and enrollment of applicants for such
coverage under both titles.
``(E) The coordination procedures established
between the program under this title and under title
XIX shall apply not only to the initial eligibility
determination of a family but also to any renewals or
redeterminations of such eligibility.''.
(3) Effective date.--The amendments made by paragraphs (1)
and (2) apply to individuals who lose eligibility under the
medicaid program under title XIX, or under a State child health
insurance plan under title XXI, respectively, of the Social
Security Act on or after October 1, 2003, without regard to
whether regulations implementing such amendments have been
issued.
(c) Provision of Medicaid and CHIP Applications and Information
Under the School Lunch Program.--Section 9(b)(2)(B) of the Richard B.
Russell National School Lunch Act (42 U.S.C. 1758(b)(2)(B)) is
amended--
(1) by striking ``(B) Applications'' and inserting ``(B)(i)
Applications''; and
(2) by adding at the end the following:
``(ii)(I) Applications for free and reduced price lunches that are
distributed pursuant to clause (i) to parents or guardians of children
in attendance at schools participating in the school lunch program
under this Act shall also contain information on the availability of
medical assistance under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) and of child health and other assistance under
title XXI of such Act, including information on how to obtain an
application for assistance under such programs.
``(II) Information on the programs referred to in subclause (I)
shall be provided on a form separate from the application form for free
and reduced price lunches under clause (i).''.

Subtitle F--SCHIP Wrap-Around Benefits

SEC. 151. STATE OPTION TO PROVIDE WRAP-AROUND SCHIP COVERAGE TO
CHILDREN WHO HAVE OTHER HEALTH COVERAGE.

(a) In General.--
(1) SCHIP.--
(A) State option to provide wrap-around coverage.--
Section 2110(b) of the Social Security Act (42 U.S.C.
1397jj(b)) is amended--
(i) in paragraph (1)(C), by inserting ``,
subject to paragraph (5),'' after ``under title
XIX or''; and
(ii) by adding at the end the following new
paragraph:
``(5) State option to provide wrap-around coverage.--A
State may waive the requirement of paragraph (1)(C) that a
targeted low-income child may not be covered under a group
health plan or under health insurance coverage, if the State
satisfies the conditions described in subsection (c)(8). The
State may waive such requirement in order to provide--
``(A) dental services;
``(B) cost-sharing protection; or
``(C) all services.
In waiving such requirement, a State may limit the application
of the waiver to children whose family income does not exceed a
level specified by the State, so long as the level so specified
does not exceed the maximum income level otherwise established
for other children under the State child health plan.''; and
(B) Conditions described.--Section 2105(c) of such
Act (42 U.S.C. 1397ee(c)) is amended by adding at the
end the following new paragraph:
``(8) Conditions for provision of wrap around coverage.--
For purposes of section 2110(b)(5), the conditions described in
this paragraph are the following:
``(A) Income eligibility.--The State child health
plan (whether implemented under title XIX or this
XXI)--
``(i) has an income eligibility standard
not less than that described in paragraph (4)
of such section;
``(ii) subject to subparagraph (B), does
not limit the acceptance of applications for
children; and
``(iii) provides benefits to all children
in the State who apply for and meet eligibility
standards.
``(B) No waiting list imposed.--With respect to
children whose family income is at or below 200 percent
of the poverty line, the State does not impose any
numerical limitation, waiting list, or similar
limitation on the eligibility of such children for
child health assistance under such State plan.
``(C) No more favorable treatment.--The State child
health plan may not provide more favorable coverage of
dental services to the children covered under section
2110(b)(5) than to children otherwise covered under
this title.''.
(C) State option to waive waiting period.--Section
2102(b)(1)(B) of such Act (42 U.S.C. 1397bb(b)(1)(B)),
as amended by section 101(c)(3), is amended--
(i) in clause (ii), by striking ``and'' at
the end;
(ii) in clause (iii), by striking the
period and inserting ``; and''; and
(iii) by adding at the end the following
new clause:
``(iv) at State option, may not apply a
waiting period in the case of child described
in section 2110(b)(5), if the State satisfies
the requirements of section 2105(c)(8).''.
(2) Application of enhanced match under medicaid.--Section
1905 of such Act (42 U.S.C. 1396d), as amended by section
101(a)(1)(C), is amended--
(A) in subsection (b), in the fourth sentence, by
striking ``or (u)(4)'' and inserting ``(u)(4), or
(u)(5)''; and
(B) in subsection (u), by inserting after paragraph
(4) the following new paragraph:
``(5) For purposes of subsection (b), the expenditures described in
this paragraph are expenditures for items and services for children
described in section 2110(b)(5), but only in the case of a State that
satisfies the requirements of section 2105(c)(8).''.
(3) Application of secondary payor provisions.--Section
2107(e)(1) of such Act (42 U.S.C. 1397gg(e)(1)), as amended by
section 121(b), is amended--
(A) by redesignating subparagraphs (B) through (E)
as subparagraphs (C) through (F), respectively; and
(B) by inserting after subparagraph (A) the
following new subparagraph:
``(B) Section 1902(a)(25) (relating to coordination
of benefits and secondary payor provisions) with
respect to children covered under a waiver described in
section 2110(b)(5).''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect on January 1, 2004, and shall apply to child health
assistance and medical assistance provided on or after that date.

Subtitle G--Immunization Coverage Through SCHIP

SEC. 161. ELIGIBILITY OF CHILDREN ENROLLED IN THE STATE CHILDREN'S
HEALTH INSURANCE PROGRAM FOR THE PEDIATRIC VACCINE
DISTRIBUTION PROGRAM.

(a) In General.--Section 1928(b)(2)(B)(ii)(I) of the Social
Security Act (42 U.S.C. 1396s(b)(2)(B)(ii)(I)) is amended by inserting
``(other than a State child health plan under title XXI)'' after
``policy or plan''.
(b) Effective Date.--The amendment made by subsection (a) applies
with respect to vaccines administered on or after the date of the
enactment of this Act.

Subtitle H--Limited English Proficient Communities

SEC. 171. INCREASED FEDERAL REIMBURSEMENT FOR LANGUAGE SERVICES UNDER
THE MEDICAID PROGRAM AND THE STATE CHILDREN'S HEALTH
INSURANCE PROGRAM.

(a) Medicaid.--Section 1903(a)(3) of the Social Security Act (42
U.S.C. 1396b(a)(3)) is amended--
(1) in subparagraph (D), by striking ``plus'' at the end
and inserting ``and''; and
(2) by adding at the end the following:
``(E) 90 percent of the sums expended with respect
to costs incurred during such quarter as are
attributable to the provision of language services,
including oral interpretation, translations of written
materials, and other language services, for individuals
with limited English proficiency who apply for, or
receive, medical assistance under the State plan;
plus''.
(b) SCHIP.--Section 2105(a)(1) of the Social Security Act (42
U.S.C.1397ee(a)(1)), as amended by section 104(a), is amended--
(1) in the matter preceding subparagraph (A), by inserting
``or, in the case of expenditures described in subparagraph
(D)(iv), 90 percent'' after ``enhanced FMAP''; and
(2) in subparagraph (D)--
(A) in clause (iii), by striking ``and'' at the
end;
(B) be redesignating clause (iv) as clause (v); and
(C) by inserting after clause (iii) the following:
``(iv) for expenditures attributable to the
provision of language services, including oral
interpretation, translations of written
materials, and other language services, for
individuals with limited English proficiency
who apply for, or receive, child health
assistance under the plan; and''.
(c) Effective Date.--The amendments made by this section shall take
effect on October 1, 2004.

Subtitle I--Binational Public Health Infrastructure and Health
Insurance

SEC. 181. BINATIONAL PUBLIC HEALTH INFRASTRUCTURE AND HEALTH INSURANCE.

(a) In General.--The Secretary of Health and Human Services shall
enter into a contract with the Institute of Medicine for the conduct of
a study concerning binational public health infrastructure and health
insurance efforts. In conducting such study, the Institute shall
solicit input from border health experts and health insurance
companies.
(b) Report.--Not later than 1 year after the date on which the
Secretary of Health and Human Services enters into the contract under
subsection (a), the Institute of Medicine shall submit to the Secretary
and the appropriate committees of Congress a report concerning the
study conducted under subsection (a). Such report shall include the
recommendations of the Institute on ways to expand or improve
binational public health infrastructure and health insurance efforts.

Subtitle J--Migrant Workers and Farmworkers Health

SEC. 191. DEMONSTRATION PROJECT REGARDING CONTINUITY OF COVERAGE OF
MIGRANT WORKERS AND FARMWORKERS UNDER MEDICAID AND SCHIP.

(a) Authority To Conduct Demonstration Project.--
(1) In general.--The Secretary of Health and Human Services
shall conduct a demonstration project for the purpose of
evaluating methods for strengthening the health coverage of,
and continuity of coverage of, migrant workers and farmworkers
under the medicaid and State children's health insurance
programs (42 U.S.C. 1396 et seq., 1397aa et seq.).
(2) Waiver authority.--The Secretary of Health and Human
Services shall waive compliance with the requirements of titles
XI, XIX, and XXI of the Social Security Act (42 U.S.C. 1301 et
seq, 1396 et seq., 1397aa et seq.) to such extent and for such
period as the Secretary determines is necessary to conduct the
demonstration project under this section.
(b) Requirements.--The demonstration project conducted under this
section shall provide for--
(1) uniform eligibility criteria under the medicaid and
State children's health insurance programs with respect to
migrant workers and farmworkers; and
(2) the portability of coverage of such workers under those
programs between participating States.
(c) Report.--Not later than March 31, 2005, the Secretary of Health
and Human Services shall submit a report to Congress on the
demonstration project conducted under this section that contains such
recommendations for legislative action as the Secretary determines is
appropriate.

TITLE II--HEALTH DISPARITIES

Subtitle A--Report on Programs for Improving the Health Status of
Hispanic Individuals

SEC. 201. ANNUAL REPORT REGARDING HISPANIC HEALTH DISPARITIES FOR
CHRONIC AND COMMUNICABLE DISEASES.

(a) In General.--The Secretary of Health and Human Services (in
this Act referred to as the ``Secretary'') shall annually submit to
Congress a report on programs carried out through the Public Health
Service with respect to improving the health status of Hispanic
individuals regarding diabetes, cancer, asthma, HIV infection, AIDS,
tuberculosis, injuries (unintentional and intentional), obesity,
immunization rates, oral health, substance abuse, and mental health,
including--
(1) prevention programs carried out through the Centers for
Disease Control and Prevention and the Substance Abuse and
Mental Health Services Administration;
(2) treatment programs carried out through the Health
Resources and Services Administration and the Substance Abuse
and Mental Health Services Administration;
(3) research programs carried out through the National
Institutes of Health, the National Center on Minority Health
and Health Disparities, the Agency for Healthcare Quality and
Research, the Maternal Child Health Bureau, and the Centers for
Medicare & Medicaid Services; and
(4) activities of the Office of Public Health and Science,
including activities of the Office of Minority Health.
(b) Data Collection.--Each report under subsection (a) shall
include information on programs carried out through the Public Health
Service to collect data that relates to the health status of Hispanic
individuals regarding diabetes, cancer, asthma, HIV infection, AIDS,
tuberculosis, injuries (unintentional and intentional), obesity,
immunization rates, oral health, substance abuse, and mental health.

Subtitle B--Diabetes Research, Control, and Prevention

SEC. 211. TREATMENT.

Part P 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:

``SEC. 399P. DIABETES; TREATMENT FOR MINORITY POPULATIONS.

``(a) In General.--The Secretary shall conduct and support programs
to treat diabetes in minority populations.
``(b) National Institutes of Health.--With respect to the National
Institutes of Health, activities under subsection (a) regarding the
treatment of diabetes in minority populations shall include the
following:
``(1) Through the National Institute of Mental Health,
providing for comprehensive mental health services and
treatment for individuals within such populations who
experience mental barriers to proper diabetes care.
``(2) Through the National Center on Minority Health and
Health Disparities, recommending and disseminating the
guidelines of the American Diabetes Association for nutrition
exercise and diet for diabetes treatment and prevention.
``(c) Other Agencies.--Activities under subsection (a) regarding
the treatment of diabetes in minority populations shall include the
following:
``(1) Through the Substance Abuse and Mental Health
Services Administration and the National Institute of Mental
Health, providing for comprehensive mental health services and
treatment for minorities who experience mental barriers to
proper diabetes care.
``(2) Promoting early detection as a cost-saving mechanism,
including making grants to community health centers and clinics
to specifically treat type 2 diabetes and complications,
including eye disease, kidney failure, heart disease and
stroke, nerve damage, and limb amputations.
``(3) Through the Health Resources and Services
Administration and the Centers for Disease Control and
Prevention, carrying out a collaborative program to encourage
preventive care. Such program shall not be limited to primary
prevention, and shall include secondary and tertiary prevention. Such
program shall include the award of grants to community health centers
and clinics to specifically treat diabetes, with an emphasis on type 2
diabetes, and diabetic complications, including eye disease, kidney
failure, heart disease and stroke, nerve damage, and limb amputation.
``(d) Definition.--For purposes of this section, the term `minority
populations' means racial and ethnic minority groups within the meaning
of section 1707.
``(e) Authorization of Appropriations.--
``(1) In general.--For the purpose of carrying out
subsections (a) and (c), there are authorized to be
appropriated such sums as may be necessary for fiscal year 2003
and each subsequent fiscal year.
``(2) National institutes of health.--For the purpose of
carrying out subsection (b), there are authorized to be
appropriated such sums as may be necessary for fiscal year 2004
and each subsequent fiscal year.''.

SEC. 212. EDUCATION.

Part P of title III of the Public Health Service Act (42 U.S.C.
280g et seq.), as amended by section 211, is further amended by adding
at the end the following:

``SEC. 399Q. DIABETES; EDUCATION REGARDING MINORITY POPULATIONS.

``(a) In General.--The Secretary shall conduct and support programs
to educate the public on the causes of effects of diabetes in minority
populations.
``(b) National Institutes of Health.--With respect to the National
Institutes of Health, activities under subsection (a) regarding
education on diabetes in minority populations shall include the
following:
``(1) Through the National Center on Minority Health and
Health Disparities--
``(A) making grants to programs funded under
section 485F (relating to centers of excellence) for
the purpose of establishing a mentoring program for
health care professionals to be more involved in weight
counseling, obesity research, and nutrition;
``(B) providing for the participation of minority
health professionals in diabetes-focused research
programs; and
``(C) providing for the participation of minority
health professionals in diabetes-focused research
programs.
``(2) Making grants for programs to establish a pipeline
from high school to professional school that will increase
minority representation in diabetes-focused health fields by
expanding Minority Access to Research Careers (MARC) program
internships and mentoring opportunities for recruitment.
``(c) Centers for Disease Control and Prevention.--With respect to
the Centers for Disease Control and Prevention, activities under
subsection (a) regarding education on diabetes in minority populations
shall include the following:
``(1) Making grants for diabetes-focused education classes
or training programs on cultural sensitivity and patient care
within such populations for health care providers.
``(2) Carrying out public awareness campaigns directed
toward such populations to aggressively emphasize the
importance and impact of physical activity and diet in regard
to diabetes and diabetes-related complications.
``(d) Health Resources and Services Administration.--With respect
to the Health Resources and Services Administration, activities under
subsection (a) regarding education on diabetes in minority populations
shall include the following:
``(1) Providing additional funds for the Health Careers
Opportunity Program, Centers for Excellence, and the Minority
Faculty Fellowship Program to partner with the Office of
Minority Health under section 1707 and the National Institutes of
Health to strengthen programs for career opportunities within minority
populations focused on diabetes treatment and care.
``(2) In partnership with the Health Resources and Services
Administration, develop a diabetes focus within, and provide
additional funds for, the National Health Service Corps
Scholarship program to place individuals in areas that are
disproportionately affected by diabetes, to provide health care
services.
``(3) Establishing a diabetes ambassador program for
recruitment efforts to increase the number of underrepresented
minorities currently serving in student, faculty, or
administrative positions in institutions of higher learning,
hospitals, and community health centers.
``(4) Establishing a loan repayment program that focuses on
diabetes care and prevention.
``(e) Additional Programs.--Activities under subsection (a)
regarding education on diabetes in minority populations shall include
the following:
``(1) Through collaboration between the Health Resources
and Services Administration and the Indian Health Service,
establishing a joint scholarship and loan-repayment program for
American Indians health profession students.
``(2) Providing funds for new and existing diabetes-focused
education grants and programs for present and future students
and clinicians in the medical field from minority populations,
including the following:
``(A) Federal and State loan repayment programs for
health profession students within communities of color.
``(B) Providing funds to the Office of Minority
Health under section 1707 for training health
profession students to focus on diabetes within such
populations.
``(C) Providing funds to State and local entities
to establish diabetes awareness week or day every month
in schools, nursing homes, and colleges through
partnerships with the Office of Minority Health under section 1707 and
the Health Resources and Services Administration.
``(f) Definition.--For purposes of this section, the term `minority
populations' means racial and ethnic minority groups within the meaning
of section 1707.
``(g) Authorization of Appropriations.--
``(1) In general.--For the purpose of carrying out
subsections (a) and (e), there are authorized to be
appropriated such sums as may be necessary for fiscal year 2004
and each subsequent fiscal year.
``(2) National institutes of health.--For the purpose of
carrying out subsection (b), there are authorized to be
appropriated such sums as may be necessary for fiscal year 2004
and each subsequent fiscal year.
``(3) Centers for disease control and prevention.--For the
purpose of carrying out subsection (c), there are authorized to
be appropriated such sums as may be necessary for fiscal year
2004 and each subsequent fiscal year.
``(4) Health resources and services administration.--For
the purpose of carrying out subsection (c), there are
authorized to be appropriated such sums as may be necessary for
fiscal year 2004 and each subsequent fiscal year.''.

SEC. 213. HEALTH PROMOTION, PREVENTION ACTIVITIES, AND ACCESS.

Part P of title III of the Public Health Service Act (42 U.S.C.
280g et seq.), as amended by section 212, is amended by adding at the
end the following:

``SEC. 399R. DIABETES; HEALTH PROMOTION, PREVENTION ACTIVITIES, AND
ACCESS REGARDING MINORITY POPULATIONS.

``(a) National Institutes of Health.
``(1) In general.--The Secretary, acting through the
Director of the National Institutes of Health, shall provide
access to proper care of diabetes for minority populations.
``(2) Certain activities.--Activities under paragraph (1)
regarding proper care of diabetes in minority populations shall
include the following:
``(A) Providing funds for research to assess and
identify the number of individuals affected by
socioeconomic and environmental barriers to diabetes
health care access, including research regarding
language, transportation, daily routine, lifestyle, and
housing.
``(B) Through the National Center on Minority
Health and Health Disparities, identifying the manner
in which health care providers, community health
centers, and hospitals provide proper options and
education on available services for diabetes care,
management, and prevention, including identifying the
effects of differences in the cultures of staff and
patients on clinical and other workforce encounters.
``(b) Centers for Disease Control and Prevention.
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall carry out culturally appropriate diabetes health
promotion and prevention programs for minority populations.
``(2) Certain activities.--Activities under paragraph (1)
regarding culturally appropriate diabetes health promotion and
prevention programs for minority populations shall include the
following:
``(A) Expanding the Diabetes Control Program
(currently existing in all the States and territories).
``(B) Providing funds for the Diabetes Today
program to adapt community planning tools within such
populations.
``(C) Providing funds for Racial and Ethnic
Approaches to Community Health (REACH 2010) grants to
develop and evaluate diabetes prevention and control
community programs focused on such populations.
``(D) Providing funds to community health centers
for a monthly diabetes week program of diabetes
services, including screenings.
``(E) Providing funds for free diabetes self-
management education classes in hospitals, clinics, and
community health centers.
``(F) Providing funds for education and community
outreach on diabetes.
``(G) Providing funds for the United States and
Mexico Border Diabetes project to develop culturally
appropriate diabetes prevention and control
interventions for Minority populations in the border
region.
``(H) Providing funds for an aggressive prevention
campaign that focuses on physical inactivity and diet
and its relation to type 2 diabetes within such
populations.
``(I) Providing funds for surveillance systems and
strategies for strengthening existing systems to
improve the quality, accuracy, and timelines of
morbidity and mortality diabetes data for such
populations.
``(c) Definition.--For purposes of this section, the term `minority
populations' means racial and ethnic minority groups within the meaning
of section 1707.
``(d) Authorization of Appropriations.--
``(1) National institutes of health.--For the purpose of
carrying out subsection (b), there are authorized to be
appropriated such sums as may be necessary for fiscal year 2004
and each subsequent fiscal year.
``(2) Centers for disease control and prevention.--For the
purpose of carrying out subsection (c), there are authorized to
be appropriated such sums as may be necessary for fiscal year
2004 and each subsequent fiscal year.''.

Subtitle C--HIV Prevention Activities Regarding Hispanic Individuals

SEC. 221. PROGRAMS OF CENTERS FOR DISEASE CONTROL AND PREVENTION;
REPRESENTATION OF HISPANIC INDIVIDUALS IN MEMBERSHIP OF
COMMUNITY PLANNING GROUPS.

(a) In General.--With respect to community planning groups that the
Centers for Disease Control and Prevention utilizes in carrying out
programs for the prevention of HIV infection, the Secretary, acting
through the Director of such Centers, shall carry out the following:
(1) The Secretary shall identify community planning groups
for which Hispanic individuals are underrepresented as members
in relation to the number of Hispanic individuals with HIV who
reside in the communities involved.
(2) The Secretary shall develop a plan to increase the
representation of Hispanic individuals in the membership of the
community planning groups identified under paragraph (1). Such
plan may provide for facilitating the participation of Hispanic
individuals as members in such groups by assisting the
individuals with the incidental costs incurred by the
individuals in being such members, such as the costs of
transportation and child-care services.
(3) The plan shall include a strategy and detailed timeline
for implementing the plan.
(b) Definition.--In this section, the term ``community planning
group'' has the meaning that applies for purposes of programs
established pursuant to the Ryan White Comprehensive AIDS Resources
Emergency Act of 1990 (including title XXVI of the Public Health
Service Act).

SEC. 222. AIDS EDUCATION AND TRAINING CENTERS FUNDED BY HEALTH
RESOURCES AND SERVICES ADMINISTRATION; ESTABLISHMENT OF
CENTER DIRECTED TOWARD MINORITY POPULATIONS WITH HIV.

(a) In General.--In carrying out section 2692 of the Public Health
Service Act (42 U.S.C. 300ff-111), the Secretary, acting through the
Administrator of the Health Resources and Services Administration,
shall make grants to eligible Hispanic-serving institutions for the
purpose of carrying out projects under such section with respect to HIV
in racial and ethnic minority groups.
(b) Cultural Competence.--A condition for grants under subsection
(a) is that the applicants involved agree that the education and
training provided through projects under such subsection will be
provided in a culturally competent manner (as defined in section 331).
(c) Eligible Institutions.--In this section:
(1) Eligible hispanic-serving institution.--The term
``eligible Hispanic-serving institution'' means a Hispanic-
serving institution that has a record of carrying out HIV-
related activities with respect to Hispanic individuals.
(2) Hispanic-serving institution.--The term ``Hispanic-
serving institution'' has the meaning given such term in
section 502 of the Higher Education Act of 1965 (20 U.S.C.
1101a).

Subtitle D--Prevention of Latina Adolescent Suicides

SEC. 231. SHORT TITLE.

This subtitle may be cited as the ``Latina Adolescent Suicide
Prevention Act''.

SEC. 232. ESTABLISHMENT OF PROGRAM FOR PREVENTION OF LATINA ADOLESCENT
SUICIDES.

Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.)
is amended by inserting after section 520A the following section:

``SEC. 520B. PREVENTION OF LATINA ADOLESCENT SUICIDES.

``(a) In General.--The Secretary shall carry out a program to make
awards of grants, cooperative agreements, or contracts to public and
nonprofit private entities for the purpose of reducing suicide attempts
and deaths among Latina adolescents and for the purpose of dealing with
depression and other related emotional conditions which may contribute
to suicide.
``(b) Collaboration.--The Secretary shall ensure that the program
carried out under this section is developed in collaboration with the
relevant institutes at the National Institutes of Health, the Health
Resources and Services Administration, the Centers for Disease Control
and Prevention, and the Administration on Children and Families.
``(c) Preference.--In making awards under subsection (a), the
Secretary shall give preference to applicants that--
``(1) demonstrate a strong linkage with schools and are
actually supported by and operated within a school facility or
associated setting;
``(2) provide direct services to Latina adolescents and
their family members when appropriate; and
``(3) serve geographic areas that already have a high
concentration of underserved adolescent Latinas or a rapidly
growing Hispanic population, based on the latest census data.
``(d) Requirements.--A condition for the receipt of an award under
subsection (a) is that the applicant involved demonstrate that the
project to be carried out with the award will--
``(1) provide for the timely assessment and treatment of
Latina adolescents at risk for suicide;
``(2) use evidenced-based strategies;
``(3) be based on exemplary practices that are adapted to
the unique characteristics and needs of the local community;
``(4) be integrated into the existing health care system in
the community, including primary health care, mental health
services, and substance abuse services as appropriate;
``(5) be integrated into other systems in the community to
address the needs of Latina adolescents including the
educational system, juvenile justice, and recreation;
``(6) provide support services to the families and friends
of those who plan, attempt, or actually commit suicide;
``(7) provide culturally, linguistically, and
developmentally appropriate services;
``(8) agree to outcomes evaluation to determine the success
of the program and the possibility of replication to other
adolescent girls at risk of suicide;
``(9) provide or ensure referral for mental health and
substance abuse services as needed; and
``(10) ensure that staff used in the program are trained in
suicide prevention and in the identification of conditions
which left untreated may lead to suicide, are capable of
providing culturally and linguistically appropriate services,
and that professionals involved in the system of care are given
training in identifying persons at risk of suicide.
``(e) Coordination.--A condition for the receipt of an award under
subsection (a) is that the applicant involved demonstrate that--
``(1) the application has the support of the local
communities and the approval of the political subdivision to be
served by the project to be carried out under the award; and
``(2) the applicant has discussed the application with
local and State mental health officials.
``(f) Matching Requirement.--With respect to the costs to be
incurred by an applicant in carrying out a project under subsection
(a), the Secretary may require as a condition of the receipt of the
award that the applicant make available (directly or through donations
from public or private entities) non-Federal contributions toward such
costs in an amount that is not less than 25 percent of such costs ($1
for each $3 of Federal funds provided under the award).
``(g) Evaluation.--The Secretary shall ensure that entities
receiving awards under subsection (a) submit an evaluation of the
project carried out under the award that includes an evaluation of--
``(1) the efficacy of project strategies; and
``(2) short, intermediate, and long-term outcomes,
including the overall impact of the project on the self-esteem
of Latina adolescents, their emotional well-being and
development, ability to deal in a positive and confident manner
with their families, peers, and social environment, and to make
constructive and personally fulfilling life choices.
``(h) Dissemination and Education.--The Secretary shall ensure that
the findings from the program carried out under this section are
disseminated to State and local governmental agencies and private
providers of mental health and substance abuse services.
``(i) Duration of Projects.--With respect to an award under
subsection (a), the period during which payments under such award are
made may not exceed 5 years.
``(j) Definition.--In this section, the term `adolescent' means an
individual between the ages of 11 and 17 (inclusive).
``(k) Funding.--
``(1) Authorization of appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated $10,000,000 for fiscal year 2004, and such sums as
may be necessary for each of the fiscal years 2005 and 2006.
``(2) Allocation for program management.--Of the amount
appropriated under paragraph (1) for a fiscal year, the
Secretary may reserve not more than 1 percent for administering
the program under this section.''.

Subtitle E--Cancer Research, Training, and Awareness

SEC. 241. REDES EN ACCION: THE NATIONAL HISPANIC/LATINO CANCER NETWORK
AND OTHER NCI SPECIAL POPULATIONS NETWORKS INITIATIVES
TARGETING CANCER; INCREASED AUTHORIZATION OF
APPROPRIATIONS FOR ACTIVITIES REGARDING HISPANIC
INDIVIDUALS.

(a) In General.--For the purpose of carrying out and increasing the
activities of the Special Populations Networks of the National Cancer
Institute's Center for Cancer Health Disparities, specifically Redes En
Accion: The National Hispanic/Latino Cancer Network, and other programs
in the Special Populations Network initiative promoting cancer
research, cancer research training, and cancer awareness among the
Hispanic/Latino population, there are authorized to be appropriated
$2,500,000 for fiscal year 2004, and for each of the fiscal years 2005
through 2008. Such authorization of appropriations is in addition to
any other authorizations of appropriations that are available for such
purposes.
(b) Purpose.--Amounts appropriated under subsection (a) shall be
used to continue to provide and increase support of Redes En Accion:
The National Hispanic/Latino Cancer Network and other Special
Populations Network initiatives targeting cancer among Hispanics to
achieve the following:
(1) Prioritize cancer issues impacting Hispanics.
(2) Foster cancer pilot and other research projects based
on these priorities.
(3) Establish cancer research training opportunities for
Hispanic undergraduate students, pre- and post-doctoral
individuals and junior faculty members.
(4) Develop and support cancer awareness activities among
Hispanic communities.

Subtitle F--Tuberculosis Control, Prevention, and Treatment

SEC. 251. ADVISORY COUNCIL FOR THE ELIMINATION OF TUBERCULOSIS.

Section 317E(f) of the Public Health Service Act (42 U.S.C. 247b-
6(f)) is amended--
(1) by redesignating paragraph (5) as paragraph (6); and
(2) by striking paragraphs (2) through (4), and inserting
the following:
``(2) Duties.--For the purpose of making progress toward
the goal of eliminating tuberculosis from the United States,
the Council shall provide to the Secretary and other appropriate
Federal officials advice on coordinating the activities of the Public
Health Service and other Federal agencies that relate to such disease
and on efficiently utilizing the Federal resources involved.
``(3) National plan.--In carrying out paragraph (2), the
Council, in consultation with appropriate public and private
entities, shall make recommendations on the development,
revision, and implementation of a national plan to eliminate
tuberculosis in the United States. In carrying out this
paragraph, the Council shall--
``(A) consider the recommendations of the Institute
of Medicine regarding the elimination of tuberculosis;
``(B) address the development and application of
new technologies; and
``(C) review the extent to which progress has been
made toward eliminating tuberculosis.
``(4) Global activities.--In carrying out paragraph (2),
the Council, in consultation with appropriate public and
private entities, shall make recommendations for the
development and implementation of a plan to guide the
involvement of the United States in global and cross border
tuberculosis-control activities, including recommendations
regarding policies, strategies, objectives, and priorities.
Such recommendations for the plan shall have a focus on
countries where a high incidence of tuberculosis directly
affects the United States, such as Mexico, and on access to a
comprehensive package of tuberculosis control measures, as
defined by the World Health Organization directly observed
treatment, short course strategy (commonly known as DOTS).
``(5) Composition.--The Council shall be composed of--
``(A) representatives from the Centers for Disease
Control and Prevention, the National Institutes of
Health, the Agency for Healthcare Research and Quality,
the Health Resources and Services Administration, the
U.S.-Mexico Border Health Commission, and other Federal
departments and agencies that carry out significant
activities relating to tuberculosis; and
``(B) members appointed from among individuals who
are not officers or employees of the Federal
Government.''.

SEC. 252. NATIONAL PROGRAM FOR TUBERCULOSIS ELIMINATION.

Section 317E of the Public Health Service Act (42 U.S.C. 247b-6) is
amended--
(1) by striking the heading for the section and inserting
the following:

``national program for tuberculosis elimination'';

(2) by amending subsection (b) to read as follows:
``(b) Research, Demonstration Projects, Education, and Training.--
With respect to the prevention, control, and elimination of
tuberculosis, the Secretary may, directly or through grants to public
or nonprofit private entities, carry out the following:
``(1) Research, with priority given to research
concerning--
``(A) diagnosis and treatment of latent infection
of tuberculosis;
``(B) strains of tuberculosis resistant to drugs;
``(C) cases of tuberculosis that affect certain
high-risk populations; and
``(D) clinical trials, including those conducted
through the Tuberculosis Trials Consortium.
``(2) Demonstration projects, including for--
``(A) the development of regional capabilities for
the prevention, control, and elimination of
tuberculosis particularly in low-incidence regions; and
``(B) collaboration with the Immigration and
Naturalization Service to identify and treat immigrants
with active or latent tuberculosis infection.
``(3) Public information and education programs.
``(4) Education, training and clinical skills improvement
activities for health professionals, including allied health
personnel.
``(5) Support of model centers to carry out activities
under paragraphs (2) through (4).
``(6) Collaboration with international organizations and
foreign countries, including Mexico, in coordination with the
United States Agency for International Development, in carrying
out such activities, including coordinating activities through
the Advisory Council for the Elimination of Tuberculosis.
``(7) Capacity support to States and large cities for
strengthening tuberculosis program to meet the Healthy People
objectives for Hispanics and other populations.''; and
(3) by striking subsection (g) and inserting the following:
``(g) Reports.--The Secretary, acting through the Director of the
Centers for Disease Control and Prevention and in consultation with the
Advisory Council for the Elimination of Tuberculosis, shall biennially
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 the activities carried out under
this section. Each report shall include the opinion of the Council on
the extent to which its recommendations under section 317E(f)(3)
regarding tuberculosis have been implemented.
``(h) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated $235,000,000
for fiscal year 2004, and such sums as may be necessary for each of the
fiscal years 2005 through 2008.''.

SEC. 253. INCLUSION OF INPATIENT HOSPITAL SERVICES FOR THE TREATMENT OF
TB-INFECTED INDIVIDUALS.

(a) In General.--Section 1902(z)(2) of the Social Security Act (42
U.S.C. 1396a(z)(2)) is amended by adding at the end the following:
``(G) Inpatient hospital services.''.
(b) Effective Date.--The amendment made by subsection (a) takes
effect on October 1, 2003.

TITLE III--ACCESS AND AFFORDABILITY

Subtitle A--Dental Health Services

SEC. 301. GRANTS TO IMPROVE THE PROVISION OF DENTAL HEALTH SERVICES
THROUGH COMMUNITY HEALTH CENTERS AND PUBLIC HEALTH
DEPARTMENTS.

Part D of title III of the Public Health Service Act (42 U.S.C.
254b et seq.) is amended by inserting before section 330, the
following:

``SEC. 329. GRANT PROGRAM TO EXPAND THE AVAILABILITY OF SERVICES.

``(a) In General.--The Secretary, acting through the Health
Resources and Services Administration, shall establish a program under
which the Secretary may award grants to eligible entities and eligible
individuals to expand the availability of primary dental care services
in dental health professional shortage areas or medically underserved
areas.
``(b) Eligibility.--
``(1) Entities.--To be eligible to receive a grant under
this section an entity--
``(A) shall be--
``(i) a health center receiving funds under
section 330 or designated as a Federally
qualified health center;
``(ii) a county or local public health
department, if located in a federally-
designated dental health professional shortage
area;
``(iii) an Indian tribe or tribal
organization (as defined in section 4 of the
Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450b)); or
``(iv) a dental education program
accredited by the Commission on Dental
Accreditation; and
``(B) shall prepare and submit to the Secretary an
application at such time, in such manner, and
containing such information as the Secretary may
require.
``(2) Individuals.--To be eligible to receive a grant under
this section an individual shall--
``(A) be a dental health professional licensed or
certified in accordance with the laws of the State in
which such individual provides dental services;
``(B) prepare and submit to the Secretary an
application at such time, in such manner, and
containing such information as the Secretary may
require; and
``(C) provide assurances that--
``(i) the individual will practice in a
federally-designated dental health professional
shortage area; and
``(ii) not less than 33 percent of the
patients of such individual are--
``(I) receiving assistance under a
State plan under title XIX of the
Social Security Act (42 U.S.C. 1396 et
seq.);
``(II) receiving assistance under a
State plan under title XXI of the
Social Security Act (42 U.S.C. 1397aa
et seq.); or
``(III) uninsured.
``(c) Use of Funds.--
``(1) Entities.--An entity shall use amounts received under
a grant under this section to provide for the increased
availability of primary dental services in the areas described
in subsection (a). Such amounts may be used to supplement the
salaries offered for individuals accepting employment as
dentists in such areas.
``(2) Individuals.--A grant to an individual under
subsection (a) shall be in the form of a $1,000 bonus payment
for each month in which such individual is in compliance with
the eligibility requirements of subsection (b)(2)(C).
``(d) Authorization of Appropriations.--
``(1) In general.--Notwithstanding any other amounts
appropriated under section 330 for health centers, there is
authorized to be appropriated $40,000,000 for each of fiscal
years 2004 through 2008 to hire and retain dental health care
providers under this section.
``(2) Use of funds.--Of the amount appropriated for a
fiscal year under paragraph (1), the Secretary shall use--
``(A) not less than 75 percent of such amount to
make grants to eligible entities; and
``(B) not more than 25 percent of such amount to
make grants to eligible individuals.''.

SEC. 302. SCHOOL-BASED DENTAL SEALANT PROGRAM.

Section 317M(c) of the Public Health Service Act (42 U.S.C. 247b-
14) is amended--
(1) in paragraph (1), by inserting ``and school-linked''
after ``school-based'';
(2) in the first sentence of paragraph (2)--
(A) by inserting ``and school-linked'' after
``school-based''; and
(B) by inserting ``or Indian tribe'' after
``State''; and
(3) by striking paragraph (3) and inserting the following:
``(3) Eligibility.--To be eligible to receive funds under
paragraph (1), an entity shall--
``(A) prepare and submit to the State or Indian
tribe an application at such time, in such manner and
containing such information as the State or Indian
tribe may require; and
``(B) be a--
``(i) public elementary or secondary
school--
``(I) that is located in an urban
area and in which more than 50 percent
of the student population is
participating in Federal or State free
or reduced meal programs; or
``(II) that is located in a rural
area and, with respect to the school
district in which the school is
located, the district involved has a
median income that is at or below 235
percent of the poverty line, as defined
in section 673(2) of the Community
Services Block Grant Act (42 U.S.C.
9902(2)); or
``(ii) public or non-profit health
organization, including a grantee under section
330, that is under contract with an elementary
or secondary school described in subparagraph
(B) to provide dental services to school-age
children.''.

Subtitle B--Border Health

SEC. 311. SHORT TITLE.

This subtitle may be cited as the ``Border Health Security Act of
2003''.

SEC. 312. DEFINITIONS.

In this subtitle:
(1) Border area.--The term ``border area'' has the meaning
given the term ``United States-Mexico Border Area'' in section
8 of the United States-Mexico Border Health Commission Act (22
U.S.C. 290n-6).
(2) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.

SEC. 313. BORDER HEALTH SERVICES 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, or
community health center 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, 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 promotion;
(E) oral health;
(F) behavioral and mental health;
(G) substance abuse;
(H) health conditions that have a high prevalence
in the border area;
(I) medical and health services research;
(J) community health workers or promotoras;
(K) health care infrastructure problems in the
border area (including planning and construction
grants);
(L) health disparities in the border area;
(M) environmental health;
(N) health education; 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 is authorized to be
appropriated to carry out this section, $200,000,000 for fiscal year
2004, and such sums as may be necessary for each succeeding fiscal
year.

SEC. 314. BORDER BIOTERRORISM PREPAREDNESS GRANTS.

(a) Eligible Entity Defined.--In this section, the term ``eligible
entity'' means a State, local government, or public health entity.
(b) Authorization.--From funds appropriated under subsection (e),
the Secretary shall award grants to eligible entities for bioterrorism
preparedness in the border area.
(c) Application.--An eligible entity that desires 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.
(d) Uses of Funds.--An eligible entity that receives a grant under
subsection (b) shall use the grant funds to--
(1) develop and implement bioterror preparedness plans and
readiness assessments and purchase items necessary for such
plans;
(2) coordinate bioterrorism and emergency preparedness
planning in the region;
(3) improve infrastructure, including surveillance and
laboratory capacity;
(4) create a health alert network, including risk
communication and information dissemination;
(5) educate and train clinicians, epidemiologists,
laboratories, and emergency personnel; and
(6) carry out such other activities identified by the
Secretary, State and local public health offices, and border
health offices.
(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $25,000,000 for fiscal year 2004
and such sums as may be necessary for each succeeding fiscal year.

SEC. 315. UNITED STATES-MEXICO BORDER HEALTH COMMISSION ACT AMENDMENTS.

The United States-Mexico Border Health Commission Act (22 U.S.C.
290n et seq.) is amended by adding at the end the following:

``SEC. 9. AUTHORIZATION OF APPROPRIATIONS.

``There is authorized to be appropriated to carry out this Act
$10,000,000 for fiscal year 2004 and such sums as may be necessary for
each succeeding fiscal year.''.

Subtitle C--Patient Navigator, Outreach, and Chronic Disease Prevention

SEC. 321. SHORT TITLE.

This title may be cited as the ``Patient Navigator, Outreach, and
Chronic Disease Prevention Act of 2003''.

SEC. 322. HRSA GRANTS FOR MODEL COMMUNITY CANCER AND CHRONIC DISEASE
CARE AND PREVENTION; HRSA GRANTS FOR PATIENT NAVIGATORS.

Subpart I of part D of title III of the Public Health Service Act
(42 U.S.C. 254b et seq.) is amended by adding at the end the following:

``SEC. 330I. MODEL COMMUNITY CANCER AND CHRONIC DISEASE CARE AND
PREVENTION; PATIENT NAVIGATORS.

``(a) Model Community Cancer and Chronic Disease Care and
Prevention.--
``(1) In general.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration, may make grants to public and nonprofit private
health centers (including health centers under section 330,
Indian Health Service Centers, tribal governments, urban Indian
organizations, tribal organizations, clinics serving Asian
Americans and Pacific Islanders and Alaskan Natives, and rural
health clinics and qualified nonprofit entities that partner
with one or more centers providing health care to provide
navigation services, which demonstrate the ability to perform
all of the functions outlined in this subsection and subsections (b)
and (c)) for the development and operation of model programs that--
``(A) provide to individuals of health disparity
populations prevention, early detection, treatment, and
appropriate follow-up care services for cancer and
chronic diseases;
``(B) ensure that the health services are provided
to such individuals in a culturally competent manner;
``(C) assign patient navigators, in accordance with
applicable criteria of the Secretary, for managing the
care of individuals of health disparity populations
to--
``(i) accomplish, to the extent possible,
the follow-up and diagnosis of an abnormal
finding and the treatment and appropriate
follow-up care of cancer or other chronic
disease; and
``(ii) facilitate access to appropriate
health care services within the health care
system to ensure optimal patient utilization of
such services, including aid in coordinating
and scheduling appointments and referrals,
community outreach, assistance with
transportation arrangements, and assistance
with insurance issues and other barriers to
care and providing information about clinical
trials;
``(D) require training for patient navigators
employed through such model programs to ensure the
ability of navigators to perform all of the duties
required in this subsection and in subsection (b),
including training to ensure that navigators are
informed about health insurance systems and are able to
aid patients in resolving access issues; and
``(E) ensure that consumers have direct access to
patient navigators during regularly scheduled hours of
business operation.
``(2) Outreach services.--A condition for the receipt of a
grant under paragraph (1) is that the applicant involved agree
to provide ongoing outreach activities while receiving the
grant, in a manner that is culturally competent for the health
disparity population served by the program, to inform the
public and the specific community that the program is serving
of the services of the model program under the grant. Such
activities shall include facilitating access to appropriate
health care services and patient navigators within the health
care system to ensure optimal patient utilization of these services.
``(3) Data collection and report.--In order to allow for
effective program evaluation, the grantee shall collect
specific patient data recording services provided to each
patient served by the program and shall establish and implement
procedures and protocols, consistent with applicable Federal
and State laws (including 45 C.F.R. 160 and 164) to ensure the
confidentiality of all information shared by a participant in
the program, or their personal representative and their health
care providers, group health plans, or health insurance
insurers with the program. The program may, consistent with
applicable Federal and State confidentiality laws, collect, use
or disclose aggregate information that is not individually
identifiable (as defined in 45 C.F.R. 160 and 164). With this
data, the grantee shall submit an annual report to the
Secretary that summarizes and analyzes these data, provides
information on needs for navigation services, types of access
difficulties resolved, sources of repeated resolution and flaws
in the system of access, including insurance barriers.
``(4) Application for grant.--A grant may be made under
paragraph (1) only if an application for the grant is submitted
to the Secretary and the application is in such form, is made
in such manner, and contains such agreements, assurances, and
information as the Secretary determines to be necessary to
carry out this section.
``(5) Evaluations.--
``(A) In general.--The Secretary, acting through
the Administrator of the Health Resources and Services
Administration, shall, directly or through grants or
contracts, provide for evaluations to determine which
outreach activities under paragraph (2) were most
effective in informing the public and the specific
community that the program is serving of the model
program services and to determine the extent to which
such programs were effective in providing culturally
competent services to the health disparity population
served by the programs.
``(B) Dissemination of findings.--The Secretary
shall as appropriate disseminate to public and private
entities the findings made in evaluations under
subparagraph (A).
``(6) Coordination with other programs.--The Secretary
shall coordinate the program under this subsection with the
program under subsection (b), with the program under section
417D, and to the extent practicable, with programs for
prevention centers that are carried out by the Director of the
Centers for Disease Control and Prevention.
``(b) Program for Patient Navigators.--
``(1) In general.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration, may make grants to public and nonprofit private
health centers (including health centers under section 330,
Indian Health Service Centers, tribal governments, urban Indian
organizations, tribal organizations, clinics serving Asian
Americans and Pacific Islanders and Alaskan Natives, and rural
health clinics and qualified nonprofit entities that partner
with one or more centers providing health care to provide
navigation services, which demonstrate the ability to perform
all of the functions outlined in this subsection and
subsections (a) and (c)) for the development and operation of
programs to pay the costs of such health centers in--
``(A) assigning patient navigators, in accordance
with applicable criteria of the Secretary, for managing
the care of individuals of health disparity populations
for the duration of receiving health services from the
health centers, including aid in coordinating and
scheduling appointments and referrals, community
outreach, assistance with transportation arrangements,
and assistance with insurance issues and other barriers
to care and providing information about clinical
trials;
``(B) ensuring that the services provided by the
patient navigators to such individuals include case
management and psychosocial assessment and care or
information and referral to such services;
``(C) ensuring that patient navigators with direct
knowledge of the communities they serve provide
services to such individuals in a culturally competent
manner;
``(D) developing model practices for patient
navigators, including with respect to--
``(i) coordination of health services,
including psychosocial assessment and care;
``(ii) appropriate follow-up care,
including psychosocial assessment and care;
``(iii) determining coverage under health
insurance and health plans for all services;
``(iv) ensuring the initiation,
continuation and/or sustained access to care
prescribed by the patients' health care
providers; and
``(v) aiding patients with health insurance
coverage issues;
``(E) requiring training for patient navigators to
ensure the ability of navigators to perform all of the
duties required in this subsection and in subsection
(a), including training to ensure that navigators are
informed about health insurance systems and are able to
aid patients in resolving access issues; and
``(F) ensuring that consumers have direct access to
patient navigators during regularly scheduled hours of
business operation.
``(2) Outreach services.--A condition for the receipt of a
grant under paragraph (1) is that the applicant involved agree
to provide ongoing outreach activities while receiving the
grant, in a manner that is culturally competent for the health
disparity population served by the program, to inform the
public and the specific community that the patient navigator is
serving of the services of the model program under the grant.
``(3) Data collection and report.--In order to allow for
effective patient navigator program evaluation, the grantee
shall collect specific patient data recording navigation
services provided to each patient served by the program and
shall establish and implement procedures and protocols,
consistent with applicable Federal and State laws (including 45
C.F.R. 160 and 164) to ensure the confidentiality of all
information shared by a participant in the program, or their
personal representative and their health care providers, group
health plans, or health insurance insurers with the program.
The patient navigator program may, consistent with applicable
Federal and State confidentiality laws, collect, use or
disclose aggregate information that is not individually
identifiable (as defined in 45 C.F.R. 160 and 164). With this
data, the grantee shall submit an annual report to the
Secretary that summarizes and analyzes these data, provides
information on needs for navigation services, types of access
difficulties resolved, sources of repeated resolution and flaws
in the system of access, including insurance barriers.
``(4) Application for grant.--A grant may be made under
paragraph (1) only if an application for the grant is submitted
to the Secretary and the application is in such form, is made
in such manner, and contains such agreements, assurances, and
information as the Secretary determines to be necessary to
carry out this section.
``(5) Evaluations.--
``(A) In general.--The Secretary, acting through
the Administrator of the Health Resources and Services
Administration, shall, directly or through grants or
contracts, provide for evaluations to determine the
effects of the services of patient navigators on the
individuals of health disparity populations for whom
the services were provided, taking into account the
matters referred to in paragraph (1)(C).
``(B) Dissemination of findings.--The Secretary
shall as appropriate disseminate to public and private
entities the findings made in evaluations under
subparagraph (A).
``(6) Coordination with other programs.--The Secretary
shall coordinate the program under this subsection with the
program under subsection (a) and with the program under section
417D.
``(c) Requirements Regarding Fees.--
``(1) In general.--A condition for the receipt of a grant
under subsection (a)(1) or (b)(1) is that the program for which
the grant is made have in effect--
``(A) a schedule of fees or payments for the
provision of its health care services related to the
prevention and treatment of disease that is consistent
with locally prevailing rates or charges and is
designed to cover its reasonable costs of operation;
and
``(B) a corresponding schedule of discounts to be
applied to the payment of such fees or payments, which
discounts are adjusted on the basis of the ability of
the patient to pay.
``(2) Rule of construction.--Nothing in this section shall
be construed to require payment for navigation services or to
require payment for health care services in cases where care is
provided free of charge, including the case of services
provided through programs of the Indian Health Service.
``(d) Model.--Not later than five years after the date of the
enactment of this section, the Secretary shall develop a peer-reviewed
model of systems for the services provided by this section. The
Secretary shall update such model as may be necessary to ensure that
the best practices are being utilized.
``(e) Duration of Grant.--The period during which payments are made
to an entity from a grant under subsection (a)(1) or (b)(1) may not
exceed five years. The provision of such payments are subject to annual
approval by the Secretary of the payments and subject to the
availability of appropriations for the fiscal year involved to make the
payments. This subsection may not be construed as establishing a
limitation on the number of grants under such subsection that may be
made to an entity.
``(f) Definitions.--For purposes of this section:
``(1) The term `culturally competent', with respect to
providing health-related services, means services that, in
accordance with standards and measures of the Secretary, are
designed to effectively and efficiently respond to the cultural
and linguistic needs of patients.
``(2) The term `appropriate follow-up care' includes
palliative and end-of-life care.
``(3) The term `health disparity population' means a
population where there exists a significant disparity in the
overall rate of disease incidence, morbidity, mortality, or
survival rates in the population as compared to the health
status of the general population. Such term includes--
``(A) racial and ethnic minority groups as defined
in section 1707; and
``(B) medically underserved groups, such as rural
and low-income individuals and individuals with low
levels of literacy.
``(4)(A) The term `patient navigator' means an individual
whose functions include--
``(i) assisting and guiding patients with a symptom
or an abnormal finding or diagnosis of cancer or other
chronic disease within the health care system to
accomplish the follow-up and diagnosis of an abnormal
finding as well as the treatment and appropriate
follow-up care of cancer or other chronic disease
including providing information about clinical trials;
and
``(ii) identifying, anticipating, and helping
patients overcome barriers within the health care
system to ensure prompt diagnostic and treatment
resolution of an abnormal finding of cancer or other
chronic disease.
``(B) Such term includes representatives of the target
health disparity population, such as nurses, social workers,
cancer survivors, and patient advocates.
``(g) Authorization of Appropriations.--
``(1) In general.--
``(A) Model programs.--For the purpose of carrying
out subsection (a) (other than the purpose described in
paragraph (2)(A)), there are authorized to be
appropriated such sums as may be necessary for each of
the fiscal years 2004 through 2008.
``(B) Patient navigators.--For the purpose of
carrying out subsection (b) (other than the purpose
described in paragraph (2)(B)), there are authorized to
be appropriated such sums as may be necessary for each
of the fiscal years 2004 through 2008.
``(C) Bureau of primary health care.--Amounts
appropriated under subparagraph (A) or (B) shall be
administered through the Bureau of Primary Health Care.
``(2) Programs in rural areas.--
``(A) Model programs.--For the purpose of carrying
out subsection (a) by making grants under such
subsection for model programs in rural areas, there are
authorized to be appropriated such sums as may be
necessary for each of the fiscal years 2004 through
2008.
``(B) Patient navigators.--For the purpose of
carrying out subsection (b) by making grants under such
subsection for programs in rural areas, there are
authorized to be appropriated such sums as may be
necessary for each of the fiscal years 2004 through
2008.
``(C) Office of rural health policy.--Amounts
appropriated under subparagraph (A) or (B) shall be
administered through the Office of Rural Health Policy.
``(3) Relation to other authorizations.--Authorizations of
appropriations under paragraphs (1) and (2) are in addition to
other authorizations of appropriations that are available for
the purposes described in such paragraphs.''.

SEC. 323. NCI GRANTS FOR MODEL COMMUNITY CANCER AND CHRONIC DISEASE
CARE AND PREVENTION; NCI GRANTS FOR PATIENT NAVIGATORS.

Subpart 1 of part C of title IV of the Public Health Service Act
(42 U.S.C. 285 et seq.) is amended by adding at the end following:

``SEC. 417D. MODEL COMMUNITY CANCER AND CHRONIC DISEASE CARE AND
PREVENTION; PATIENT NAVIGATORS.

``(a) Model Community Cancer and Chronic Disease Care and
Prevention.--
``(1) In general.--The Director of the Institute may make
grants to eligible entities for the development and operation
of model programs that--
``(A) provide to individuals of health disparity
populations prevention, early detection, treatment, and
appropriate follow-up care services for cancer and
chronic diseases;
``(B) ensure that the health services are provided
to such individuals in a culturally competent manner;
``(C) assign patient navigators, in accordance with
applicable criteria of the Secretary, for managing the
care of individuals of health disparity populations
to--
``(i) accomplish, to the extent possible,
the follow-up and diagnosis of an abnormal
finding and the treatment and appropriate
follow-up care of cancer or other chronic
disease; and
``(ii) facilitate access to appropriate
health care services within the health care
system to ensure optimal patient utilization of
such services, including aid in coordinating
and scheduling appointments and referrals,
community outreach, assistance with
transportation arrangements, and assistance
with insurance issues and other barriers to
care and providing information about clinical
trials;
``(D) require training for patient navigators
employed through such model programs to ensure the
ability of navigators to perform all of the duties
required in this subsection and in subsection (b),
including training to ensure that navigators are
informed about health insurance systems and are able to
aid patients in resolving access issues; and
``(E) ensure that consumers have direct access to
patient navigators during regularly scheduled hours of
business operation.
``(2) Eligible entities.--For purposes of this section, an
eligible entity is a designated cancer center of the Institute,
an academic institution, Indian Health Service Clinics, tribal
governments, urban Indian organizations, tribal organizations,
a hospital, a qualified nonprofit entity that partners with one
or more centers providing health care to provide navigation
services, which demonstrates the ability to perform all of the
functions outlined in this subsection and subsections (b) and
(c), or any other public or private entity determined to be
appropriate by the Director of the Institute, that provides
services described in paragraph (1)(A) for cancer and chronic
diseases.
``(3) Data collection and report.--In order to allow for
effective program evaluation, the grantee shall collect
specific patient data recording services provided to each
patient served by the program and shall establish and implement
procedures and protocols, consistent with applicable Federal
and State laws (including 45 C.F.R. 160 and 164) to ensure the
confidentiality of all information shared by a participant in
the program, or their personal representative and their health
care providers, group health plans, or health insurance
insurers with the program. The program may, consistent with
applicable Federal and State confidentiality laws, collect, use
or disclose aggregate information that is not individually
identifiable (as defined in 45 CFR 160 and 164). With this
data, the grantee shall submit an annual report to the
Secretary that summarizes and analyzes these data, provides
information on needs for navigation services, types of access
difficulties resolved, sources of repeated resolution and flaws
in the system of access, including insurance barriers.
``(4) Outreach services.--A condition for the receipt of a
grant under paragraph (1) is that the applicant involved agree
to provide ongoing outreach activities while receiving the
grant, in a manner that is culturally competent for the health
disparity population served by the program, to inform the
public and the specific community that the program is serving
of the services of the model program under the grant. Such
activities shall include facilitating access to appropriate
health care services and patient navigators within the health
care system to ensure optimal patient utilization of these
services.
``(5) Application for grant.--A grant may be made under
paragraph (1) only if an application for the grant is submitted
to the Director of the Institute and the application is in such
form, is made in such manner, and contains such agreements,
assurances, and information as the Director determines to be
necessary to carry out this section.
``(6) Evaluations.--
``(A) In general.--The Director of the Institute,
directly or through grants or contracts, shall provide
for evaluations to determine which outreach activities
under paragraph (3) were most effective in informing
the public and the specific community that the program
is serving of the model program services and to
determine the extent to which such programs were
effective in providing culturally competent services to
the health disparity population served by the programs.
``(B) Dissemination of findings.--The Director of
the Institute shall as appropriate disseminate to
public and private entities the findings made in
evaluations under subparagraph (A).
``(7) Coordination with other programs.--The Secretary
shall coordinate the program under this subsection with the
program under subsection (b), with the program under section
330I, and to the extent practicable, with programs for prevention
centers that are carried out by the Director of the Centers for Disease
Control and Prevention.
``(b) Program for Patient Navigators.--
``(1) In general.--The Director of the Institute may make
grants to eligible entities for the development and operation
of programs to pay the costs of such entities in--
``(A) assigning patient navigators, in accordance
with applicable criteria of the Secretary, for managing
the care of individuals of health disparity populations
for the duration of receiving health services from the
health centers, including aid in coordinating and
scheduling appointments and referrals, community
outreach, assistance with transportation arrangements,
and assistance with insurance issues and other barriers
to care and providing information about clinical
trials;
``(B) ensuring that the services provided by the
patient navigators to such individuals include case
management and psychosocial assessment and care or
information and referral to such services;
``(C) ensuring that the patient navigators with
direct knowledge of the communities they serve provide
services to such individuals in a culturally competent
manner;
``(D) developing model practices for patient
navigators, including with respect to--
``(i) coordination of health services,
including psychosocial assessment and care;
``(ii) follow-up services, including
psychosocial assessment and care;
``(iii) determining coverage under health
insurance and health plans for all services;
``(iv) ensuring the initiation,
continuation and/or sustained access to care
prescribed by the patients' health care
providers; and
``(v) aiding patients with health insurance
coverage issues;
``(E) requiring training for patient navigators to
ensure the ability of navigators to perform all of the
duties required in this subsection and in subsection
(a), including training to ensure that navigators are
informed about health insurance systems and are able to
aid patients in resolving access issues; and
``(F) ensuring that consumers have direct access to
patient navigators during regularly scheduled hours of
business operation.
``(2) Outreach services.--A condition for the receipt of a
grant under paragraph (1) is that the applicant involved agree
to provide ongoing outreach activities while receiving the
grant, in a manner that is culturally competent for the health
disparity population served by the program, to inform the
public and the specific community that the patient navigator is
serving of the services of the model program under the grant.
``(3) Data collection and report.--In order to allow for
effective patient navigator program evaluation, the grantee
shall collect specific patient data recording navigation
services provided to each patient served by the program and
shall establish and implement procedures and protocols,
consistent with applicable Federal and State laws (including 45
C.F.R. 160 and 164) to ensure the confidentiality of all
information shared by a participant in the program, or their
personal representative and their health care providers, group
health plans, or health insurance insurers with the program.
The patient navigator program may, consistent with applicable
Federal and State confidentiality laws, collect, use or
disclose aggregate information that is not individually
identifiable (as defined in 45 C.F.R. 160 and 164). With this
data, the grantee shall submit an annual report to the
Secretary that summarizes and analyzes these data, provides
information on needs for navigation services, types of access
difficulties resolved, sources of repeated resolution and flaws
in the system of access, including insurance barriers.
``(4) Application for grant.--A grant may be made under
paragraph (1) only if an application for the grant is submitted
to the Director of the Institute and the application is in such
form, is made in such manner, and contains such agreements,
assurances, and information as the Director determines to be
necessary to carry out this section.
``(5) Evaluations.--
``(A) In general.--The Director of the Institute,
directly or through grants or contracts, shall provide
for evaluations to determine the effects of the
services of patient navigators on the health disparity
population for whom the services were provided, taking
into account the matters referred to in paragraph
(1)(C).
``(B) Dissemination of findings.--The Director of
the Institute shall as appropriate disseminate to
public and private entities the findings made in
evaluations under subparagraph (A).
``(6) Coordination with other programs.--The Secretary
shall coordinate the program under this subsection with the
program under subsection (a) and with the program under section
330I.
``(c) Requirements Regarding Fees.--
``(1) In general.--A condition for the receipt of a grant
under subsection (a)(1) or (b)(1) is that the program for which
the grant is made have in effect--
``(A) a schedule of fees or payments for the
provision of its health care services related to the
prevention and treatment of disease that is consistent
with locally prevailing rates or charges and is
designed to cover its reasonable costs of operation;
and
``(B) a corresponding schedule of discounts to be
applied to the payment of such fees or payments, which
discounts are adjusted on the basis of the ability of
the patient to pay.
``(2) Rule of construction.--Nothing in this section shall
be construed to require payment for navigation services or to
require payment for health care services in cases where care is
provided free of charge, including the case of services
provided through programs of the Indian Health Service.
``(d) Model.--Not later than five years after the date of the
enactment of this section, the Director of the Institute shall develop
a peer-reviewed model of systems for the services provided by this
section. The Director shall update such model as may be necessary to
ensure that the best practices are being utilized.
``(e) Duration of Grant.--The period during which payments are made
to an entity from a grant under subsection (a)(1) or (b)(1) may not
exceed five years. The provision of such payments are subject to annual
approval by the Director of the Institute of the payments and subject
to the availability of appropriations for the fiscal year involved to
make the payments. This subsection may not be construed as establishing
a limitation on the number of grants under such subsection that may be
made to an entity.
``(f) Definitions.--For purposes of this section:
``(1) The term `culturally competent', with respect to
providing health-related services, means services that, in
accordance with standards and measures of the Secretary, are
designed to effectively and efficiently respond to the cultural
and linguistic needs of patients.
``(2) the term `appropriate follow-up care' includes
palliative and end-of-life care.
``(3) the term `health disparity population' means a
population where there exists a significant disparity in the
overall rate of disease incidence, morbidity, mortality, or
survival rates in the population as compared to the health
status of the general population. Such term includes--
``(A) racial and ethnic minority groups as defined
in section 1707; and
``(B) medically underserved groups, such as rural
and low-income individuals and individuals with low
levels of literacy.
``(4)(A) the term `patient navigator' means an individual
whose functions include--
``(i) assisting and guiding patients with a symptom
or an abnormal finding or diagnosis of cancer or other
chronic disease within the health care system to
accomplish the follow-up and diagnosis of an abnormal
finding as well as the treatment and appropriate
follow-up care of cancer or other chronic disease,
including providing information about clinical trials;
and
``(ii) identifying, anticipating, and helping
patients overcome barriers within the health care
system to ensure prompt diagnostic and treatment
resolution of an abnormal finding of cancer or other
chronic disease.
``(B) Such term includes representatives of the target
health disparity population, such as nurses, social workers,
cancer survivors, and patient advocates.
``(g) Authorization of Appropriations.--
``(1) Model programs.--For the purpose of carrying out
subsection (a), there are authorized to be appropriated such
sums as may be necessary for each of the fiscal years 2004
through 2008.
``(2) Patient navigators.--For the purpose of carrying out
subsection (b), there are authorized to be appropriated such
sums as may be necessary for each of the fiscal years 2004
through 2008.
``(3) Relation to other authorizations.--Authorizations of
appropriations under paragraphs (1) and (2) are in addition to
other authorizations of appropriations that are available for
the purposes described in such paragraphs.''.

SEC. 324. IHS GRANTS FOR MODEL COMMUNITY CANCER AND CHRONIC DISEASE
CARE AND PREVENTION; IHS GRANTS FOR PATIENT NAVIGATORS.

(a) Model Community Cancer and Chronic Disease Care and
Prevention.--
(1) In general.--The Director of the Indian Health Service
may make grants to Indian Health Service Centers, tribal
governments, urban Indian organizations, tribal organizations,
and qualified nonprofit entities demonstrating the ability to
perform all of the functions outlined in this subsection and
subsections (b) and (c) that partner with providers or centers
providing health care serving Native American populations to
provide navigation services, for the development and operation
of model programs that--
(A) provide to individuals of health disparity
populations prevention, early detection, treatment, and
appropriate follow-up care services for cancer and chronic diseases;
(B) ensure that the health services are provided to
such individuals in a culturally competent manner;
(C) assign patient navigators, in accordance with
applicable criteria of the Secretary, for managing the
care of individuals of health disparity populations
to--
(i) accomplish, to the extent possible, the
follow-up and diagnosis of an abnormal finding
and the treatment and appropriate follow-up
care of cancer or other chronic disease; and
(ii) facilitate access to appropriate
health care services within the health care
system to ensure optimal patient utilization of
such services, including aid in coordinating
and scheduling appointments and referrals,
community outreach, assistance with
transportation arrangements, and assistance
with insurance issues and other barriers to
care and providing information about clinical
trials;
(D) require training for patient navigators
employed through such model programs to ensure the
ability of navigators to perform all of the duties
required in this subsection and in subsection (b),
including training to ensure that navigators are
informed about health insurance systems and are able to
aid patients in resolving access issues; and
(E) ensure that consumers have direct access to
patient navigators during regularly scheduled hours of
business operation.
(2) Outreach services.--A condition for the receipt of a
grant under paragraph (1) is that the applicant involved agree
to provide ongoing outreach activities while receiving the
grant, in a manner that is culturally competent for the health
disparity population served by the program, to inform the
public and the specific community that the program is serving
of the services of the model program under the grant. Such
activities shall include facilitating access to appropriate
health care services and patient navigators within the health
care system to ensure optimal patient utilization of these
services.
(3) Data collection and report.--In order to allow for
effective program evaluation, the grantee shall collect
specific patient data recording services provided to each
patient served by the program and shall establish and implement
procedures and protocols, consistent with applicable Federal
and State laws (including 45 C.F.R. 160 and 164) to ensure the
confidentiality of all information shared by a participant in
the program, or their personal representative and their health
care providers, group health plans, or health insurance
insurers with the program. The program may, consistent with
applicable Federal and State confidentiality laws, collect, use
or disclose aggregate information that is not individually
identifiable (as defined in 45 C.F.R. 160 and 164). With this
data, the grantee shall submit an annual report to the
Secretary that summarizes and analyzes these data, provides
information on needs for navigation services, types of access
difficulties resolved, sources of repeated resolution and flaws
in the system of access, including insurance barriers.
(4) Application for grant.--A grant may be made under
paragraph (1) only if an application for the grant is submitted
to the Secretary and the application is in such form, is made
in such manner, and contains such agreements, assurances, and
information as the Secretary determines to be necessary to
carry out this section.
(5) Evaluations.--
(A) In general.--The Secretary, acting through the
Director of the Indian Health Service, shall, directly
or through grants or contracts, provide for evaluations
to determine which outreach activities under paragraph
(2) were most effective in informing the public and the
specific community that the program is serving of the
model program services and to determine the extent to
which such programs were effective in providing
culturally competent services to the health disparity
population served by the programs.
(B) Dissemination of findings.--The Secretary shall
as appropriate disseminate to public and private
entities the findings made in evaluations under
subparagraph (A).
(6) Coordination with other programs.--The Secretary shall
coordinate the program under this subsection with the program
under subsection (b), with the program under section 417D, and
to the extent practicable, with programs for prevention centers
that are carried out by the Director of the Centers for Disease
Control and Prevention.
(b) Program for Patient Navigators.--
(1) In general.--The Secretary, acting through the Director
of the Indian Health Service, may make grants to Indian Health
Service Centers, tribal governments, urban Indian
organizations, tribal organizations, and qualified nonprofit
entities demonstrating the ability to perform all of the
functions outlined in this subsection and subsections (a) and
(c) that partner with providers or centers providing health
care serving Native American populations to provide navigation
services, for the development and operation of model programs
to pay the costs of such organizations in--
(A) assigning patient navigators, in accordance
with applicable criteria of the Secretary, for
individuals of health disparity populations for the
duration of receiving health services from the health
centers, including aid in coordinating and scheduling
appointments and referrals, community outreach,
assistance with transportation arrangements, and
assistance with insurance issues and other barriers to
care and providing information about clinical trials;
(B) ensuring that the services provided by the
patient navigators to such individuals include case
management and psychosocial assessment and care or
information and referral to such services;
(C) ensuring that patient navigators with direct
knowledge of the communities they serve provide
services to such individuals in a culturally competent
manner;
(D) developing model practices for patient
navigators, including with respect to--
(i) coordination of health services,
including psychosocial assessment and care;
(ii) appropriate follow-up care, including
psychosocial assessment and care;
(iii) determining coverage under health
insurance and health plans for all services;
(iv) ensuring the initiation, continuation
and/or sustained access to care prescribed by
the patients' health care providers; and
(v) aiding patients with health insurance
coverage issues;
(E) requiring training for patient navigators to
ensure the ability of navigators to perform all of the
duties required in this subsection and in subsection
(a), including training to ensure that navigators are
informed about health insurance systems and are able to
aid patients in resolving access issues; and
(F) ensuring that consumers have direct access to
patient navigators during regularly scheduled hours of
business operation.
(2) Outreach services.--A condition for the receipt of a
grant under paragraph (1) is that the applicant involved agree
to provide ongoing outreach activities while receiving the
grant, in a manner that is culturally competent for the health
disparity population served by the program, to inform the
public and the specific community that the patient navigator is
serving of the services of the model program under the grant.
(3) Data collection and report.--In order to allow for
effective patient navigator program evaluation, the grantee
shall collect specific patient data recording navigation
services provided to each patient served by the program and
shall establish and implement procedures and protocols,
consistent with applicable Federal and State laws (including 45
C.F.R. 160 and 164) to ensure the confidentiality of all
information shared by a participant in the program, or their
personal representative and their health care providers, group
health plans, or health insurance insurers with the program.
The patient navigator program may, consistent with applicable
Federal and State confidentiality laws, collect, use or
disclose aggregate information that is not individually
identifiable (as defined in 45 C.F.R. 160 and 164). With this
data, the grantee shall submit an annual report to the
Secretary that summarizes and analyzes these data, provides
information on needs for navigation services, types of access
difficulties resolved, sources of repeated resolution and flaws
in the system of access, including insurance barriers.
(4) Application for grant.--A grant may be made under
paragraph (1) only if an application for the grant is submitted
to the Secretary and the application is in such form, is made
in such manner, and contains such agreements, assurances,
and information as the Secretary determines to be necessary to carry
out this section.
(5) Evaluations.--
(A) In general.--The Secretary, acting through the
Director of the Indian Health Service, shall, directly
or through grants or contracts, provide for evaluations
to determine the effects of the services of patient
navigators on the individuals of health disparity
populations for whom the services were provided, taking
into account the matters referred to in paragraph
(1)(C).
(B) Dissemination of findings.--The Secretary shall
as appropriate disseminate to public and private
entities the findings made in evaluations under
subparagraph (A).
(6) Coordination with other programs.--The Secretary shall
coordinate the program under this subsection with the program
under subsection (a) and with the program under section 417D.
(c) Requirements Regarding Fees.--
(1) In general.--A condition for the receipt of a grant
under subsection (a)(1) or (b)(1) is that the program for which
the grant is made have in effect--
(A) a schedule of fees or payments for the
provision of its health care services related to the
prevention and treatment of disease that is consistent
with locally prevailing rates or charges and is
designed to cover its reasonable costs of operation;
and
(B) a corresponding schedule of discounts to be
applied to the payment of such fees or payments, which
discounts are adjusted on the basis of the ability of the patient to
pay.
(2) Rule of construction.--Nothing in this section shall be
construed to require payment for navigation services or to
require payment for health care services in cases, such as with
the Indian Health Service, where care is provided free of
charge.
(d) Model.--Not later than five years after the date of the
enactment of this section, the Secretary shall develop a peer-reviewed
model of systems for the services provided by this section. The
Secretary shall update such model as may be necessary to ensure that
the best practices are being utilized.
(e) Duration of Grant.--The period during which payments are made
to an entity from a grant under subsection (a)(1) or (b)(1) may not
exceed five years. The provision of such payments are subject to annual
approval by the Secretary of the payments and subject to the
availability of appropriations for the fiscal year involved to make the
payments. This subsection may not be construed as establishing a
limitation on the number of grants under such subsection that may be
made to an entity.
(f) Definitions.--For purposes of this section:
(1) The term ``culturally competent'', with respect to
providing health-related services, means services that, in
accordance with standards and measures of the Secretary, are
designed to effectively and efficiently respond to the cultural
and linguistic needs of patients.
(2) The term ``appropriate follow-up care'' includes
palliative and end-of-life care.
(3) The term ``health disparity population'' means a
population where there exists a significant disparity in the
overall rate of disease incidence, morbidity, mortality, or
survival rates in the population as compared to the health
status of the general population. Such term includes--
(A) racial and ethnic minority groups as defined in
section 1707; and
(B) medically underserved groups, such as rural and
low-income individuals and individuals with low levels
of literacy.
(4)(A) The term ``patient navigator'' means an individual
whose functions include--
(i) assisting and guiding patients with a symptom
or an abnormal finding or diagnosis of cancer or other
chronic disease within the health care system to
accomplish the follow-up and diagnosis of an abnormal
finding as well as the treatment and appropriate
follow-up care of cancer or other chronic disease,
including providing information about clinical trials;
and
(ii) identifying, anticipating, and helping
patients overcome barriers within the health care
system to ensure prompt diagnostic and treatment
resolution of an abnormal finding of cancer or other
chronic disease.
(B) Such term includes representatives of the target health
disparity population, such as nurses, social workers, cancer
survivors, and patient advocates.
(g) Authorization of Appropriations.--
(1) In general.--
(A) Model programs.--For the purpose of carrying
out subsection (a) (other than the purpose described in
paragraph (2)(A)), there are authorized to be
appropriated such sums as may be necessary for each of
the fiscal years 2004 through 2008.
(B) Patient navigators.--For the purpose of
carrying out subsection (b) (other than the purpose
described in paragraph (2)(B)), there are authorized to
be appropriated such sums as may be necessary for each
of the fiscal years 2004 through 2008.
(C) Bureau of primary health 13 care.--Amounts
appropriated under subparagraph (A) or (B) shall be
administered through the Bureau of Primary Health Care.
(2) Programs in rural areas.--
(A) Model programs.--For the purpose of carrying
out subsection (a) by making grants under such
subsection for model programs in rural areas, there are
authorized to be appropriated such sums as may be
necessary for each of the fiscal years 2004 through
2008.
(B) Patient navigators.--For the purpose of
carrying out subsection (b) by making grants under such
subsection for programs in rural areas, there are authorized to be
appropriated such sums as may be necessary for each of the fiscal years
2004 through 2008.
(C) Office of rural health policy.--Amounts
appropriated under subparagraph (A) or (B) shall be
administered through the Office of Rural Health Policy.
(3) Relation to other authorizations.--Authorizations of
appropriations under paragraphs (1) and (2) are in addition to
other authorizations of appropriations that are available for
the purposes described in such paragraphs.

TITLE IV--STRENGTHENING OUR HEALTH CARE WORKFORCE

Subtitle A--Hispanic-Serving Health Professions Schools

SEC. 401. HISPANIC-SERVING HEALTH PROFESSIONS SCHOOLS.

(a) In General.--The Secretary, acting through the Administrator of
the Health Resources and Services Administration, shall make grants to
Hispanic-serving health professions schools for the purpose of carrying
out programs to recruit Hispanic individuals to enroll in and graduate
from the schools, which may include providing scholarships and other
financial assistance as appropriate.
(b) Eligibility.--For purposes of subsection (a), an entity is a
Hispanic-serving health professions school if the entity--
(1) is a school or program under section 799B of the Public
Health Service Act (42 U.S.C. 295p);
(2) has an enrollment of full-time equivalent students that
is 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; and
(5) has a significant number of graduates who are providing
health services to medically underserved populations or to
individuals in health professional shortage areas.
(c) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated $80,000,000
for each of fiscal years 2004 through 2008.

Subtitle B--Health Career Opportunity Program and Centers of Excellence

SEC. 411. EDUCATIONAL ASSISTANCE REGARDING UNDERGRADUATES.

(a) In General.--Subpart 2 of part E of title VII of the Public
Health Service Act (42 U.S.C. 295 et seq) is amended by adding at the
end the following:

``SEC. 771. HEALTH CAREERS OPPORTUNITY PROGRAM.

``(a) In General.--Subject to the provisions of this section, the
Secretary may make grants and enter into cooperative agreements and
contracts for any of the following purposes:
``(1) Identifying and recruiting individuals who--
``(A) are students of elementary schools, or
students or graduates of secondary schools or of
institutions of higher education;
``(B) are from disadvantaged backgrounds; and
``(C) are interested in a career in the health
professions.
``(2) Facilitating the entry of such individuals into a
health professions school.
``(3) Providing counseling or other services designed to
assist such individuals in successfully completing their
education at such a school.
``(4) 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.
``(5) Paying such stipends as the Secretary may approve for
such individuals for any period of education in student-
enhancement programs (other than regular courses) at a health
professions schools, except that such a stipend may not be
provided to an individual for more than 12 months, and such a
stipend may not exceed $25 per day (notwithstanding any other
provision of law regarding the amount of stipends).
``(6) Carrying out programs under which such individuals
both--
``(A) gain experience regarding a career in a field
of primary health care through working at facilities of
nonprofit private community-based providers of primary
health services; and
``(B) receive academic instruction to assist in
preparing the individuals to enter health professions
schools in such fields.
``(b) Receipt of Award.--
``(1) Eligible entities; requirement of consortium.--The
Secretary may make an award under subsection (a) only if the
following conditions are met:
``(A) The applicant for the award is a public or
nonprofit private entity, and the applicant has
established a consortium consisting of nonprofit
private community-based organizations and health
professions schools.
``(B) The health professions schools of the
consortium are schools of medicine or osteopathic
medicine, public health, dentistry, veterinary
medicine, optometry, pharmacy, allied health,
chiropractic, or podiatric medicine, or graduate
programs in mental health practice (including such
programs in clinical psychology).
``(C) Except as provided in subparagraph (D), the
membership of the consortium includes not less than one
nonprofit private community-based organization and not
less than three health professions schools.
``(D) In the case of an applicant whose exclusive
activity under the award will be carrying out one or
more programs described in subsection (a)(6), the
membership of the consortium includes not less than one
nonprofit private community-based organization and not
less than one health professions schools.
``(E) 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 only on a competitive basis.
``(c) Financial Requirements.--
``(1) Assurances regarding capacity.--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--
``(A) 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
``(B) 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.
``(2) Matching funds.--
``(A) In general.--With respect to the costs of the
activities to be carried out under subsection (a) by an
applicant, the Secretary may make an award under such
subsection only if the applicant agrees to make
available in cash (directly or through donations from
public or private entities) non-Federal contributions
toward such costs in an amount that, for any fourth or
subsequent fiscal year for which the applicant receives
such an award, is not less than 50 percent of such
costs.
``(B) Federal amounts.--Amounts provided by the
Federal Government may not be included in determining
the amount of non-Federal contributions required in
subparagraph (A).
``(C) Limitation.--The Secretary may not require
non-Federal contributions for the first three fiscal
years for which an applicant receives a grant under
subsection (a).
``(d) Preference in Making Awards.--
``(1) In general.--
``(A) Requirement.--In making awards under
subsection (a), the Secretary shall, subject to
paragraph (3), give preference to any applicant that,
for the purpose described in subparagraph (B), has made an arrangement
with not less than one entity from each of the following categories of
entities: Community-based organizations, elementary schools, secondary
schools, institutions of higher education, and health professions
schools.
``(B) Purpose.--The purpose of arrangements under
subparagraph (A) is to establish a program for
individuals identified under subsection (a) under
which--
``(i) the activities described in such
subsection are carried out on behalf of the
individuals; and
``(ii) health professions schools make a
commitment to admit as students of the schools
such individuals who participate in the
program, subject to the individuals meeting
reasonable academic standards for admission to
the schools.
``(2) Additional preferences.--Of the applicants under
subsection (a) that are receiving preference for purposes of
paragraph (1), the Secretary shall, subject to paragraph (3),
give additional preference to applicants whose consortium under
subsection (b) includes as members one or more health
professions schools that have not previously received any award
under this section (including this section as in effect prior
to fiscal year 1997).
``(3) Limitation.--An applicant may not receive preference
for purposes of paragraph (1) or (2) unless the consortium
under subsection (b) includes not less than one health
professions school that has demonstrated success in enrolling
students from disadvantaged backgrounds.
``(e) Objectives Under Awards.--
``(1) Establishment of objectives.--Before making a first
award to an applicant 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.
``(2) Precondition for subsequent awards.--In the case of
an applicant seeking an award under subsection (a) pursuant to
a competitive process of review, the Secretary may make the
award only if the applicant demonstrates to the satisfaction of
the Secretary that the applicant has met the objectives that
were applicable under paragraph (1) to the preceding awards
under such subsection.
``(f) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated $40,000,000
for fiscal year 2004, $45,000,000 for fiscal year 2005, and such sums
as may be necessary for each subsequent fiscal year.''.
(b) Technical Amendment.--Section 770(a) of the Public Health
Service Act (42 U.S.C. 295e(a)) is amended by inserting ``(other than
section 771)'' after ``this subpart''.

SEC. 412. CENTERS OF EXCELLENCE.

For the purpose of establishing and operating health careers
centers of excellence, there are authorized to be appropriated
$80,000,000 for fiscal year 2004 and each subsequent fiscal year.

Subtitle C--Bilingual Health Professionals

SEC. 421. TRAINING OF BILINGUAL HEALTH PROFESSIONALS WITH RESPECT TO
MINORITY HEALTH CONDITIONS.

(a) In General.--The Secretary, acting through the Administrator of
the Health Resources and Services Administration, shall (directly or
through awards of grants or contracts to public or nonprofit private
entities) carry out a program--
(1) to identify health professionals who speak both English
and a language used by racial or ethnic minority groups in the
United States; and
(2) to train such health professionals with respect to the
treatment of health conditions known to disproportionately
affect racial/ethnic minorities, such as diabetes, asthma,
obesity, injuries, under-immunization, oral health, HIV
infection, substance abuse, and conditions regarding mental
health.
(b) Authorization of Appropriations.--For the purpose of carrying
out subsection (a), there are authorized to be appropriated such sums
as may be necessary for each of the fiscal years 2004 through 2008.

Subtitle D--Cultural Competence

SEC. 431. DEFINITION.

(a) In General.--In this Act, 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 subsection (a) may
be modified as needed at the discretion of the Secretary after
providing a 30-day notice to Congress.

SEC. 432. ACTIVITIES OF OFFICE OF MINORITY HEALTH; CENTER FOR
LINGUISTIC AND CULTURAL COMPETENCE IN HEALTH CARE.

(a) Educational Materials; Technical Assistance.--
(1) In general.--The Secretary, acting through the Office
of Minority Health under section 1707 of the Public Health
Service Act (42 U.S.C. 300u-6), shall--
(A) provide for the development of educational
materials on providing health services in a culturally
competent manner;
(B) provide technical assistance in carrying out
programs that use such materials; and
(C) provide technical assistance on other matters
regarding the provision of health services in a
culturally competent manner.
(2) Authorization of appropriations.--For the purpose of
carrying out paragraph (1), there are authorized to be
appropriated $5,000,000 for fiscal year 2004, and such sums as
may be necessary for each of the fiscal years 2005 through
2008.
(b) Center for Linguistic and Cultural Competence in Health Care.--
(1) In general.--The Secretary, acting through the Office
of Minority Health under section 1707 of the Public Health
Service Act (42 U.S.C. 300u-6), shall provide for a Center for
Linguistic and Cultural Competence in Health Care to carry out
programs to promote and facilitate the provision of health-
related services, education, and training in a culturally
competent manner.
(2) Authorization of appropriations.--For the purpose of
carrying out paragraph (1), there are authorized to be
appropriated $5,000,000 for fiscal year 2004, and such sums as
may be necessary for each of the fiscal years 2005 through
2008.

SEC. 433. CULTURAL COMPETENCE DEMONSTRATION PROJECTS.

(a) In General.--The Secretary, acting through the Administrator of
the Centers for Medicare & Medicaid Services, shall conduct a cultural
competence demonstration project under which grants are made to two
hospitals with a history in medicare, medicaid, and the uninsured to
enable them to implement standards for the culturally competent
provision of services to address the specific needs of any population
that constitutes at least 5 percent of the population served by the
hospital involved.
(b) Number and Type.--Of the hospitals provided grants under this
section, one shall be located in an urban and the other in a rural area
(as defined in section 1886(d)(2)(D) of the Social Security Act (42
U.S.C. 1395ww(d)(2)(d)). The urban hospital shall serve a significant
limited English proficient population and be within 175 miles of the
border with Mexico. In selecting such hospitals, the Secretary shall
give preference to hospitals that serve large immigrant populations.
(c) Amount and Duration of Grant.--A grant under this section for a
hospital shall be in the amount of $5,000,000 and shall be for a period
of 5 years.
(d) Evaluation and Report.--
(1) Evaluation.--The Secretary shall also provide for a
grant to an appropriate qualified entity in an amount not to
exceed $1,000,000 to evaluate the demonstration projects
conducted under this section.
(2) Report.--The Secretary shall submit to Congress a
report on the projects conducted under this section. The
Secretary shall include in such report the results of the
evaluation conducted under paragraph (1) and recommendations on
whether on going medicare funding should be provided for
implementation of standards for cultural competency in
hospitals.
(e) Authorization of Appropriations.--There are authorized to be
appropriated from the Federal Hospital Insurance Trust Fund (under
section 1817 of the Social Security Act (42 U.S.C. 1395i) to carry out
this section, $11,000,000, which shall remain available until expended.

TITLE V--ADDITIONAL PROGRAMS

Subtitle A--Data Regarding Race and Ethnicity

SEC. 501. COLLECTION OF DATA.

Part A of title III of the Public Health Service Act (42 U.S.C. 241
et seq.) is amended by inserting after section 306 the following:

``SEC. 306A. DATA ON RACE AND ETHNICITY.

``(a) In General.--The Secretary shall by regulation provide for
the following:
``(1) Health data collected under programs carried out by
the Secretary (whether collected directly or pursuant to
grants, cooperative agreements, or contracts) shall include
data on race, ethnicity, and spoken and written language and
shall, at a minimum, use the categories for race and ethnicity
described in OMB Directive 15.
``(2) Data collected by the Secretary pursuant to title VI
of the Civil Rights Act of 1964 shall include data on race and
ethnicity and shall, at a minimum, use such categories.
``(3) Data on race and ethnicity that is collected under
paragraph (1) or (2) shall use the procedures described in such
Directive for collecting data from an individual, and shall be
maintained and presented (including for reporting purposes) in
accordance with such Directive.
``(4) For health encounters that require the presence of a
legal parent or guardian who does not speak English or who is
limited English proficient, health data collected by the
Secretary pursuant to this section shall also include data on
the accompanying adult or guardian.
``(5) Such other data as the Secretary may designate
(including administrative records) shall be collected,
maintained, and presented in accordance with such Directive, to
the extent that such data are collected by the Secretary and
relate to health-related programs that are carried out by the
Secretary.
``(6) The Secretary is directed to include Puerto Rico in
the collection of data provider under this section.
``(b) Definition.--In this section, the term `OMB Directive 15'
means Statistical Policy Directive No. 15, Race and Ethnic Standards
for Federal Statistics and Administrative Reporting, as established by
the Director of the Office of Management and Budget through the notice
issued October 30, 1997 (62 FR 58782). Such term includes any
subsequent revisions to such Directive.''.

SEC. 502. DEVELOPMENT OF STANDARDS; STUDY TO MEASURE PATIENT OUTCOMES
UNDER MEDICARE AND MEDICAID PROGRAMS.

(a) Development of Standards.--Not later than 1 year after the date
of the enactment of this Act, the Secretary, acting through the
Administrator of the Health Care Financing Administration, shall
develop outcome measures to evaluate, by race and ethnicity, the
performance of health care programs and projects that provide health
care to individuals under the medicare and medicaid programs (under
titles XVIII and XIX, respectively, of the Social Security Act (42
U.S.C. 1395 et seq.; 1396 et seq.).
(b) Study.--After the Secretary develops the outcome measures under
subsection (a), the Secretary shall conduct a study that evaluates, by
race and ethnicity, the performance of health care programs and
projects referred to in subsection (a).
(c) Report to Congress.--Not later that 2 years after the date of
the enactment of this Act, the Secretary shall submit to Congress a
report describing the outcome measures developed under subsection (a),
and the results of the study conducted pursuant to subsection (b).

Subtitle B--National Assessment of Status of Latino Health

SEC. 511. NATIONAL ASSESSMENT OF STATUS OF LATINO HEALTH.

(a) In General.--The Secretary of Health and Human Services shall
establish a national assessment of the status of Latino health to be
known as the ``Hispanic Health and Nutrition Examination Survey'' or
``HHANES II''.
(b) Goal.--The goal of the national assessment, including Puerto
Rico, under subsection (a) shall be to produce estimates of health and
nutritional status for Mexican Americans, Puerto Ricans, Cuban
Americans, and other Hispanic subpopulations.
(c) Authorization of Appropriations.--There is authorized to be
appropriated such sums as may be necessary in each of fiscal years 2004
through 2006 to carry out this section.

Subtitle C--Office of Minority Health

SEC. 521. REVISION AND EXTENSION OF PROGRAMS OF OFFICE OF MINORITY
HEALTH.

Section 1707 of the Public Health Service Act (42 U.S.C. 300u-6) is
amended by striking subsection (b) and all that follows and inserting
the following:
``(b) Duties.--With respect to improving the health of racial and
ethnic minority groups, the Secretary, acting through the Deputy
Assistant Secretary for Minority Health (in this section referred to as
the `Deputy Assistant Secretary'), shall carry out the following:
``(1) Establish short-range and long-range goals and
objectives and coordinate all other activities within the
Public Health Service that relate to disease prevention, health
promotion, service delivery, and research concerning such
individuals. The heads of each of the agencies of the Service
shall consult with the Deputy Assistant Secretary to ensure the
coordination of such activities.
``(2) Carry out the following types of activities by
entering into interagency agreements with other agencies of the
Public Health Service:
``(A) Support research, demonstrations and
evaluations to test new and innovative models.
``(B) Increase knowledge and understanding of
health risk factors.
``(C) Develop mechanisms that support better
information dissemination, education, prevention, and
service delivery to individuals from disadvantaged
backgrounds, including individuals who are members of
racial or ethnic minority groups.
``(D) Ensure that the National Center for Health
Statistics collects data on the health status of each
minority group.
``(E) 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 the individuals to such
services by developing and carrying out programs to
provide bilingual or interpretive services.
``(3) Support a national minority health resource center to
carry out the following:
``(A) Facilitate the exchange of information
regarding matters relating to health information and
health promotion, preventive health services, and
education in the appropriate use of health care.
``(B) Facilitate access to such information.
``(C) Assist in the analysis of issues and problems
relating to such matters.
``(D) Provide technical assistance with respect to
the exchange of such information (including
facilitating the development of materials for such
technical assistance).
``(4) Carry out programs to improve access to health care
services for individuals with limited proficiency in speaking
the English language by facilitating the removal of impediments
to the receipt of health care that result from such limitation.
Activities under the preceding sentence shall include
conducting research and developing and evaluating model
projects.
``(5) Not later than June 8 of each year, the Deputy
Assistant Secretary shall submit to the Secretary a report
summarizing the activities of each of the minority health
offices under section 1707A.
``(c) Advisory Committee.--
``(1) In general.--The Secretary shall establish an
advisory committee to be known as the Advisory Committee on
Minority Health (in this subsection referred to as the
`Committee'). The Deputy Assistant Secretary shall consult with
the Committee in carrying out this section.
``(2) Duties.--The Committee shall provide advice to the
Secretary, including advice on the development of goals and
specific program activities under paragraphs (1) and (2) of
subsection (b) for each racial and ethnic minority group.
``(3) Chairperson.--The Deputy Assistant Secretary shall
serve as the chairperson of the Committee.
``(4) Composition.--
``(A) In general.--The Committee shall be composed
of 12 voting members appointed in accordance with
subparagraph (B), and nonvoting, ex officio members
designated under subparagraph (C).
``(B) Voting members.--The voting members of the
Committee shall be appointed by the Secretary from
among individuals who are now officers or employees of
the Federal Government and who have expertise regarding
issues of minority health. The racial and ethnic
minority groups shall be equally represented among such
members.
``(C) Nonvoting members.--The nonvoting, ex officio
members of the Committee shall be the directors of each
of the minority health offices established under
section 707A, and such additional officials of the
Department of Health and Human Services as the
Secretary determines to be appropriate.
``(5) Terms.--Each member of the Committee shall serve for
a term of 4 years, except that the Secretary shall initially
appoint a portion of the members to terms of 1 year, 2 years,
and 3 years.
``(6) Vacancies.--If a vacancy occurs on the Committee, a
new member shall be appointed by the Secretary within 90 days
from the date on which the vacancy occurs, and shall serve for
the remainder of the term for which the predecessor of such
member was appointed. A vacancy shall not affect the power of
the remaining members to execute the duties of the Committee.
``(7) Compensation.--Members of the Committee who are
officers or employees of the United States shall serve without
compensation. Members of the Committee who are not officers or
employees of the United States shall receive, for each day
(including travel time) they are engaged in the performance of
the functions of the Committee compensation in an amount that
is not in excess of the daily equivalent of the annual maximum
rate of basic pay payable under the General Schedule (under
title 5, United States Code) for positions above GS-15.
``(d) Certain Requirements Regarding Duties.--
``(1) Recommendations regarding language as impediment to
health care.--The directors of the offices of minority health
within the Department of Health and Human Services, the
Director of the Office of Civil Rights, and the Director of the
Office of Refugee Health shall seek input from the State
minority health offices and make recommendations to the
Secretary regarding activities under subsection (b)(4).
``(2) Equitable allocation regarding activities.--
``(A) In making awards of grants, cooperative
agreements, or contracts under this section or section
338A, 338B, 724, 736, 737, 738, or 740, the Secretary,
acting as appropriate through the Deputy Assistant
Secretary or the Administrator of the Health Resources
and Services Administration, shall ensure that such
awards are equitably allocated with respect to the
various racial and minority populations.
``(B) With respect to grants, cooperative
agreements, and contracts that are available under the
sections specified in subparagraph (A), the Secretary
shall--
``(i) carry out activities to inform
entities, as appropriate, that the entities may
be eligible for awards of such assistance;
``(ii) provide technical assistance to such
entities in the process of preparing and
submitting applications for the awards in
accordance with the policies of the Secretary
regarding such application; and
``(iii) inform populations, as appropriate,
that members of the populations may be eligible
to receive services or otherwise participate in
the activities carried out with such awards.
``(3) Cultural competency of services.--The Secretary shall
ensure that information and services provided pursuant to
subsection (b) are provided in the language and cultural
context that is most appropriate for the individuals for whom
the information and services are intended.
``(e) Grants and Contracts Regarding Duties.--
``(1) In general.--In carrying out subsection (b), the
Deputy Assistant Secretary may make awards of grants,
cooperative agreements, and contracts to public and nonprofit
private entities.
``(2) Process for making awards.--The Deputy Assistant
Secretary shall ensure that awards under paragraph (1) are made
to the extent practicable on a competitive basis, and that an
award is made for a proposal only if the proposal has been
recommended for such an award through a process of peer review.
``(3) Evaluation and dissemination.--The Deputy Assistant
Secretary, directly or through contracts with public and
private entities, shall provide for evaluations of projects
carried out with awards made under paragraph (1) during the
preceding 2 fiscal years. The report shall be included in the
report required under subsection (f) for the fiscal year
involved.
``(f) Biennial Reports.--Not later than February 1 of fiscal year
1998 and of each second year thereafter, the Deputy Assistant Secretary
shall submit to the Committee on Energy and Commerce of the House of
Representatives, and to the Committee on Labor and Human Resources of
the Senate, a report describing the activities carried out under this
section during the preceding 2 fiscal years and evaluating the extent
to which such activities have been effective in improving the health of
racial and ethnic minority groups. Each such report shall include the
biennial reports submitted to the Deputy Assistant Secretary under
section 1707A(e) for such years by the heads of the minority health
offices.
``(g) Definition.--For purposes of this section:
``(1) Racial and ethnic minority group.--The term `racial
and ethnic minority group' means American Indians (including
Alaskan Natives, Eskimos, and Aleuts); Asian Americans and
Pacific Islanders; Blacks; and Hispanics/Latinos.
``(2) Hispanic/latinos.--The term `Hispanic/Latinos' means
individuals whose origin is Mexican, Puerto Rican, Cuban,
Central or South American, or any other Spanish-speaking
country.
``(h) Funding.--
``(1) Authorization of appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated $150,000,000 for each of fiscal years 2004 through
2006.
``(2) Allocation of funds by secretary.--Of the amounts
appropriated under paragraph (1) for a fiscal year in excess of
$50,000,000, the Secretary shall make available not less than
$3,000,000 for carrying out subsection (b)(2)(E).''.

SEC. 522. ESTABLISHMENT OF INDIVIDUAL OFFICES OF MINORITY HEALTH WITHIN
AGENCIES OF PUBLIC HEALTH SERVICE.

Title XVII of the Public Health Service Act (42 U.S.C. 300u et
seq.) is amended by inserting after section 1707 the following section:

``SEC. 1707A. INDIVIDUAL OFFICES OF MINORITY HEALTH WITHIN PUBLIC
HEALTH SERVICE.

``(a) In General.--The head of each agency specified in subsection
(b)(1) shall establish within the agency an office to be known as the
Office of Minority Health. Each such Office shall be headed by a
director, who shall be appointed by the head of the agency within which
the Office is established, and who shall report directly to the head of
the agency. The head of such agency shall carry out this section (as
this section relates to the agency) acting through such Director.
``(b) Specified Agencies.--
``(1) In general.--The agencies referred to in subsection
(a) are the following:
``(A) The Centers for Disease Control and
Prevention.
``(B) The Agency for Healthcare Research and
Quality.
``(C) The Health Resources and Services
Administration.
``(D) The Substance Abuse and Mental Health
Services Administration.
``(E) The Centers for Medicare & Medicaid Services.
``(F) The Agency for Toxic Substances and Disease
Registry.
``(2) National institutes of health.--For purposes of
subsection (c) and the subsequent provisions of this section,
the term `minority health office' includes the National Center
on Minority Health and Health Disparities established within
the National Institutes of Health. The Director of the National
Institutes of Health shall carry out this section (as this
section relates to the agency) acting through the Director of
such Office.
``(c) Composition.--The head of each specified agency shall ensure
that the officers and employees of the minority health office of the
agency are, collectively, experienced in carrying out community-based
health programs for each of the various racial and ethnic minority
groups that are present in significant numbers in the United States.
The head of such agency shall ensure that, of such officers and
employees who are members of racial and ethnic minority groups, no one
group is disproportionately represented in the overall office
composition.
``(d) Duties.--Each Director of a minority health office shall
monitor the programs of the specified agency of such office in order to
carry out the following:
``(1) Determine the extent to which the purposes of the
programs are being carried out with respect to racial and
ethnic minority groups.
``(2) Determine the extent to which members of such groups
are represented among the Federal officers and employees who
administer the programs.
``(3) Make recommendations to the head of such agency on
carrying out the programs with respect to such groups. In the
case of programs that provide services, such recommendations
shall include recommendations toward ensuring that--
``(A) the services are equitably delivered with
respect to racial and ethnic minority groups;
``(B) the programs provide the services in the
language and cultural context that is most appropriate
for the individuals for whom the services are intended;
and
``(C) the programs utilize racial and ethnic
minority community-based organizations to deliver the
services.
``(e) Biennial Reports to Secretary.--The head of each specified
agency shall submit to the Secretary for inclusion in each biennial
report under section 1707(g) (without change) a biennial report
describing--
``(1) the extent to which the minority health office of the
agency employs individuals who are members of racial and ethnic
minority groups, including a specification by minority group of
the number, series, and grade levels of such individuals
employed by such office;
``(2) the manner in which the agency is complying with
Public Law 94-311 (relating to collecting and reporting data on
Americans of Spanish origin or descent); and
``(3) the manner in which the agency is complying with
services for Limited English Proficient persons.
``(f) Definitions.--For purposes of this section:
``(1) Minority health office.--The term `minority health
office' means an office established under subsection (a),
subject to subsection (b)(2).
``(2) Racial and ethnic minority group.--The term `racial
and ethnic minority group' has the meaning given such term in
section 1707(g).
``(3) Specified agency.--The term `specified agency'
means--
``(A) an agency specified in subsection (b)(1); and
``(B) the National Institutes of Health.
``(g) Funding.--
``(1) Allocations.--Of the amounts appropriated for a
specified agency for a fiscal year, the Secretary may reserve
not more than 0.5 percent for the purpose of carrying out
activities under this section through the minority health
office of the agency. In reserving an amount under the
preceding sentence for a minority health office for a fiscal
year, the Secretary shall reduce, by substantially the same
percentage, the amount that otherwise would be available for
each of the programs of the designated agency involved.
``(2) Availability of funds for staffing.--The purposes for
which amounts made available under paragraph (1) may be
expended by a minority health office include the costs of
employing staff for such office.''.

SEC. 523. ASSISTANT SECRETARY OF HEALTH AND HUMAN SERVICES FOR CIVIL
RIGHTS.

(a) In General.--Part A of title II of the Public Health Service
Act (42 U.S.C. 202 et seq.) is amended by adding at the end the
following:

``SEC. 229. ASSISTANT SECRETARY FOR CIVIL RIGHTS.

``(a) Establishment of Position.--There shall be in the Department
of Health and Human Services an Assistant Secretary for Civil Rights,
who shall be appointed by the President, by and with the advice and
consent of the Senate.
``(b) Responsibilities.--The Assistant Secretary shall perform such
functions relating to civil rights as the Secretary may assign.''.
(b) Conforming Amendment.--Section 5315 of title 5, United States
Code, is amended, in the item relating to Assistant Secretaries of
Health and Human Services, by striking ``(6)'' and inserting ``(7)''.
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