July 22, 2026
Mr. Padilla (for himself, Mr. Booker, Ms. Hirono, and Mr. Warnock) introduced the following bill; which was read twice and referred to the Committee on Finance
To improve the health of minority individuals, and for other purposes.
Section 1. Short title
This Act may be cited as the Health Equity and Accountability Act of 2026
.
Sec. 2. Table of contents
The table of contents for this Act is as follows:
Title I Data collection and reporting
Sec. 1001. Strengthening data collection, improving data analysis, and expanding data reporting
(a) Amendments to the Public Health Service Act
(1) Purposes
The purposes of the amendments made by this subsection are to—
(A)
promote culturally and linguistically appropriate data collection, analysis, and reporting by race, ethnicity, sex, primary language, sexual orientation, disability status, gender identity, age, and socioeconomic status in federally supported health programs; and
(B)
ensure that data with respect to race and ethnicity is collected in accordance with the Revisions to OMB’s Statistical Policy Directive No. 15: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity (89 Fed. Reg. 22182; March 29, 2024).
(2) AHRQ general authorities
Section 902(a) of the Public Health Service Act (42 U.S.C. 299a(a)) is amended—
(A)
in paragraph (8), by striking and
at the end;
(B)
in paragraph (9), by striking the period at the end and inserting ; and
; and
(C)
by adding at the end the following:
(10)
cultural and linguistic competence of health care services and of data collection activities described under section 3101.
(3) Definition of racial and ethnic minority group
(A) In general
Section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 300u–6(g)(1)) is amended to read as follows:
(1)
(A)
The term racial and ethnic minority group means a group of individuals who are any of the following:
(i)
American Indian or Alaska Native.
(ii)
Asian.
(iii)
Black or African American, including individuals of African ancestry.
(iv)
Hispanic or Latino.
(v)
Middle Eastern or North African.
(vi)
Native Hawaiian or Pacific Islander.
(B)
The terms listed in clauses (i) through (vi) of subparagraph (A) shall have the meanings given such terms for purposes of the Revisions to OMB's Statistical Policy Directive No. 15: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity (89 Fed. Reg. 22182; March 29, 2024).
(B) References
Except as otherwise specified, any reference to the term racial and ethnic minority group in any Federal regulation, guidance, order, or document for establishment or implementation of any federally conducted or supported health care or public health program, activity, or survey shall be treated as having the definition given to such term in section 1707(g) of the Public Health Service Act (42 U.S.C. 300u–6(g)).
(C) Similar terminology
Not later than 2 years after the date of enactment of this Act, the Secretary of Health and Human Services shall—
(i)
identify all regulations, guidance, orders, and documents of the Department of Health and Human Services for establishment or implementation of a health care or public health program, activity, or survey that use, without a definition, terminology that is similar to the term racial and ethnic minority group; and
(ii)
take such actions as may be necessary to clarify whether the definition of the term racial and ethnic minority group in section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 300u–6(g)(1)), as amended by subparagraph (A), applies to such terminology.
(4) Office of Minority Health duties
Section 1707(b)(6) of the Public Health Service Act (42 U.S.C. 300u–6(b)(6)) is amended by inserting , and subgroups of racial and ethnic minority groups, and collects and reports such data consistent with the Revisions to OMB's Statistical Policy Directive No. 15: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity (89 Fed. Reg. 22182; March 29, 2024) and the standards developed under section 3101(a)(2)(B)
after the health status of each minority group
.
(5) Office of the National Coordinator for Health Information Technology
Section 3001 of the Public Health Service Act (42 U.S.C. 300jj–11) is amended—
(A)
in subsection (b)—
(i)
in paragraph (10), by striking and
at the end;
(ii)
in paragraph (11), by striking the period at the end and inserting ; and
; and
(iii)
by adding at the end the following:
(12)
ensures the interoperability of health information systems among federally conducted or supported health care or public health programs, State health agencies, and social service agencies.; and
(B)
by amending clause (vii) in subsection (c)(3)(A) to read as follows:
(vii)
Strategies to enhance the use of health information technology in improving the quality of health care; reducing medical errors; reducing health disparities and ensuring the provision of equitable health services; improving public health; increasing prevention and coordination with community resources; ensuring interoperability among federally conducted or supported health care or public health programs, State health agencies, and social service agencies; and improving the continuity of care among health care settings.
(6) Data collection, analysis, and quality
Section 3101(a) of the Public Health Service Act (42 U.S.C. 300kk(a)) is amended—
(A)
in paragraphs (1)(A), (1)(C), (2)(B) and (2)(E), by striking and disability status
and inserting sexual orientation, gender identity, age, disability status, and socioeconomic status
;
(B)
in paragraph (1)—
(i)
in subparagraph (C), by striking ; and
and inserting a semicolon; and
(ii)
by striking subparagraph (D) and inserting the following:
(D)
data for additional population groups if such groups can be aggregated into the data collection standards described under paragraph (2); and
(E)
data that is disaggregated by population groups, except in cases in which such disaggregation is statistically unreliable and the head of the program, activity, or survey documents such unreliability;;
(C)
in paragraph (2)—
(i)
by amending subparagraph (A) to read as follows:
(A)
with respect to data on race and ethnicity, use the standards provided in the Revisions to OMB's Statistical Policy Directive No. 15: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity (89 Fed. Reg. 22182; March 29, 2024);;
(ii)
in subparagraph (B), as amended by subparagraph (A), by adding before the semicolon that are equivalent, as practicable, to the standards described in subparagraph (A)
; and
(iii)
in subparagraph (C)—
(I)
in clause (i), by striking and
at the end;
(II)
in clause (ii), striking is a minor or legally incapacitated
and inserting is a minor, requires assistance with communication in speech or writing, or is legally incapacitated
; and
(III)
by adding at the end the following:
(iii)
collects data in a manner that is culturally and linguistically appropriate and does not include questions unrelated to, or that could potentially deter, care, such as questions related to immigration status; and
(iv)
prohibits assignment of an individual to a population group by a provider or institution;;
(D)
in paragraph (3), by amending subparagraph (B) to read as follows:
(B)
develop interoperability and security systems for data management among federally conducted or supported health care or public health programs, State health agencies, and social service agencies.; and
(E)
by adding at the end the following:
(4) Responses
In collecting data under this subsection, the Secretary shall—
(A)
allow respondents to select multiple race or ethnicities and provide detailed write-in responses, consistent with the Revisions to OMB's Statistical Policy Directive No. 15: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity (89 Fed. Reg. 22182; March 29, 2024); and
(B)
ensure that any responses selecting multiple race or ethnicities, and write-in responses described in subparagraph (A), are retained by the Secretary and coded for analysis.
(b) Corollary provisions
(1) Recommendations by the Data Council
The Data Council of the Department of Health and Human Services, in consultation with the Director of the National Center for Health Statistics, the Deputy Assistant Secretary for Minority Health, the Deputy Assistant Secretary for Women’s Health, the Administrator of the Centers for Medicare & Medicaid Services, the National Coordinator for Health Information Technology, and other appropriate public and private entities and officials, shall make recommendations to the Secretary of Health and Human Services concerning how to—
(A)
implement the amendments made by this section, while minimizing the cost and administrative burdens of data collection and reporting on all parties, including patients and providers, without reducing data granularity or deviating from the standards provided in the Revisions to OMB's Statistical Policy Directive No. 15: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity (89 Fed. Reg. 22182; March 29, 2024);
(B)
require Federal agencies administering programs, activities, or surveys described in section 3101(a) of the Public Health Service Act (42 U.S.C. 300kk(a)) to monitor and report rates of missing or incomplete data required under such section and improve the completeness of such data;
(C)
expand awareness among Federal agencies, States, territories, Indian Tribes, counties, municipalities, health providers, health plans, and the general public that data collection, analysis, and reporting by race, ethnicity, sex, primary language, sexual orientation, gender identity, age, socioeconomic status, and disability status is legal and necessary to ensure equity and nondiscrimination in the quality of health care services;
(D)
ensure that future patient record systems—
(i)
follow Federal standards promulgated under the HITECH Act (42 U.S.C. 201 note) for the collection and meaningful use of electronic health data on race, ethnicity, sex, primary language, sexual orientation, gender identity, age, socioeconomic status, and disability status; and
(ii)
are consistent with the United States Core Data for Interoperability data classes and use of structured, coded data elements and standardized value sets for race, ethnicity, sex, primary language, sexual orientation, gender identity, age, socioeconomic status, and disability status that support interoperability;
(E)
improve health and health care data collection and analysis for more population groups if such groups can be aggregated into minimum race and ethnicity categories, including exploring the feasibility of enhancing collection efforts in States, counties, and municipalities for racial and ethnic groups that comprise a significant proportion of the population of the State, county, or municipality;
(F)
subject to all applicable privacy and confidentiality requirements, including HIPAA privacy and security law as defined in section 3009(a) of the Public Health Service Act (42 U.S.C. 300jj–19(a)), provide researchers with greater access to racial, ethnic, primary language, sex, sexual orientation, gender identity, age, socioeconomic status, and disability status data, including de-identified, disaggregated datasets for research and public reporting, including for analysis of intersectional disparities across demographics;
(G)
ensure the cultural and linguistic competence of entities that receive Federal support to collect and report data pursuant to the amendments made by subsection (a); and
(H)
safeguard and prevent the misuse of data collected under section 3101 of the Public Health Service Act (42 U.S.C. 300kk), as amended by subsection (a)(6), without limiting the lawful collection, reporting, and use of disaggregated demographic data.
(2) Rules of construction
Nothing in this section shall be construed to—
(A)
permit the use of information collected under this section or any provision amended by this section in a manner that would adversely affect any individual providing any such information, including adverse effects to the relatives of the individual and to the community or communities of the individual; or
(B)
diminish any requirements on health care providers to collect data, including such requirements in effect on or after the date of enactment of this Act.
(3) Technical assistance for the analysis of health disparity data
The Secretary of Health and Human Services, acting through the Director of the Agency for Healthcare Research and Quality, and in coordination with the Assistant Secretary for Planning and Evaluation, the Administrator of the Centers for Medicare & Medicaid Services, the Director of the National Center for Health Statistics, the Director of the National Institutes of Health, and the National Coordinator for Health Information Technology, shall provide technical assistance to agencies of the Department of Health and Human Services in meeting Federal standards for health disparity data collection and for analysis of racial, ethnic, nationality, sex, gender, sexual orientation, gender identity, geographical, age, primary language, disability status, socioeconomic, and other disparities in health and health care in programs conducted or supported by such agencies by—
(A)
identifying appropriate quality assurance mechanisms to monitor for health disparities;
(B)
specifying the clinical, diagnostic, or therapeutic measures which should be monitored;
(C)
developing new quality measures relating to racial and ethnic disparities and their overlap with other disparity factors in health and health care;
(D)
identifying the level at which data analysis should be conducted;
(E)
sharing data with external organizations for research and quality improvement purposes; and
(F)
identifying and addressing issues relating to the interoperability of Federal- and State-level health information systems which undermine the ability of health-related programs collecting data under this section to achieve the purposes described in subsection (a)(1).
(4) Authorization of appropriations
To carry out this subsection, subsection (a), and the amendments made by subsection (a), there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2027 through 2031.
(c) Additional amendments to the Public Health Service Act
Title XXXIV of the Public Health Service Act, as added by titles II and III of this Act, is further amended by inserting after subtitle B the following:
C Strengthening data collection, improving data analysis, and expanding data reporting
3431. Establishing grants for data collection improvement activities
(a) In general
The Secretary, acting through the Director of the Agency for Healthcare Research and Quality and in consultation with the Deputy Assistant Secretary for Minority Health, the Director of the National Institutes of Health, the Assistant Secretary for Planning and Evaluation, the National Coordinator for Health Information Technology, and the Director of the National Center for Health Statistics, shall establish a technical assistance program under which the Secretary provides grants to eligible entities to assist such entities in complying with section 3101.
(b) Types of assistance
A grant provided under this section may be used to—
(1)
enhance or upgrade computer technology that will facilitate collection, analysis, and reporting of racial, ethnic, primary language, sexual orientation, sex, gender identity, age, socioeconomic status, and disability status data;
(2)
improve methods for health data collection and analysis, including additional population groups if such groups can be aggregated into the race and ethnicity categories outlined by standards developed under section 3101;
(3)
develop mechanisms for submitting collected data subject to any applicable privacy and confidentiality regulations;
(4)
develop educational programs to inform health plans, health providers, health-related agencies, and the general public that data collection and reporting by race, ethnicity, primary language, sexual orientation, sex, gender identity, age, disability status, and socioeconomic status are legal and essential for eliminating health and health care disparities; and
(5)
develop educational programs to train health providers, health care organizations, health plans, health-related agencies, and frontline health care workers on how to collect and report disaggregated data in a culturally and linguistically appropriate manner, including the privacy and confidentiality interests of individuals from whom the data is collected.
(c) Eligible entity
To be eligible for grants under this section, an entity shall—
(1)
be a State, territory, Indian Tribe, municipality, county, health provider, health care organization, or health plan making a demonstrated effort to bring data collections into compliance with section 3101;
(2)
be in compliance with the standards provided in the Revisions to OMB's Statistical Policy Directive No. 15: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity (89 Fed. Reg. 22182; March 29, 2024); and
(3)
agree to require training for personnel implementing the requirements of section 3101 on culturally appropriate, standardized data collection.
(d) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
3432. Oversampling of underrepresented groups in Federal health surveys
(a) National requirement
(1) In general
The Secretary, acting through the Director of the National Center for Health Statistics, and other officials within the Department of Health and Human Services as the Secretary determines appropriate, shall develop and implement a sustainable national requirement applicable to all Federal health surveys and program data collections for the oversampling of underrepresented populations within the categories of race, ethnicity, sex, primary language, sexual orientation, disability status, gender identity, age, and socioeconomic status as determined appropriate by the Secretary. Such national requirement shall include—
(A)
minimum sample thresholds for the oversampling of underrepresented populations; and
(B)
a requirement for oversampling of Middle Easterners and North Africans, Asian Americans, American Indians, Alaska Natives, Native Hawaiians, and Pacific Islanders.
(2) Consultation
In developing and implementing a national requirement, as described in paragraph (1), not later than 180 days after the date of the enactment of this section, the Secretary shall—
(A)
consult with representatives of community groups, nonprofit organizations, nongovernmental organizations, and government agencies working with underrepresented populations;
(B)
solicit the participation of representatives from other Federal departments and agencies, including subagencies of the Department of Health and Human Services; and
(C)
consult on, and use as models, the 2014 National Health Interview Survey oversample of Native Hawaiian and Pacific Islander populations, the 2016 Behavioral Risk Factor Survey of Health Risk Behaviors Among Arab Adults Within the State of Michigan, and the 2017 Behavioral Risk Factor Surveillance System oversample of American Indian and Alaska Native communities.
(b) Progress report
Not later than 2 years after the date of enactment of this section, the Secretary shall submit to the Congress a progress report, which shall include the national requirement under subsection (a)(1).
(c) Authorization of appropriations
To carry out this section, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2027 through 2031.
(d) Report to Congress
Not later than 2 years after the date of enactment of this Act, the Secretary of Health and Human Services shall submit a report to Congress on the implementation of this section, including the amendments made by this section.
Sec. 1002. Elimination of prerequisite of direct appropriations for data collection and analysis
Section 3101 of the Public Health Service Act (42 U.S.C. 300kk), as amended by section 1001(a), is further amended—
(1)
by striking subsection (h); and
(2)
by redesignating subsection (i) as subsection (h).
Sec. 1003. Collection of data for the Medicare program
Part A of title XI of the Social Security Act (42 U.S.C. 1301 et seq.) is amended by adding at the end the following:
1150D. Collection of data for the Medicare program
(a) Requirement
(1) In general
The Commissioner of Social Security (in this section referred to as the Commissioner), in consultation with the Administrator of the Centers for Medicare & Medicaid Services (in this section referred to as the Administrator), shall collect data on the race, ethnicity, sex, primary language, sexual orientation, gender identity, socioeconomic status, age, and disability status of all applicants for social security benefits under title II or Medicare benefits under title XVIII.
(2) Data collection standards
(A) In general
In collecting data under paragraph (1), the Commissioner shall at least use the standards for data collection developed under section 3101 of the Public Health Service Act (42 U.S.C. 300kk) or the standards developed by the Office of Management and Budget, as the baseline standard, consistent with the Office of Management and Budget Statistical Policy Directive No. 15: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity, or any successor Office of Management and Budget directive.
(B) No standards available
In the event there are no standards for the demographic groups listed under paragraph (1), the Commissioner shall consult with stakeholder groups representing the various identities as well as with the Office of Minority Health within the Centers for Medicare & Medicaid Services to develop appropriate standards.
(3) Data for additional population groups
Where practicable, the data collected by the Commissioner under paragraph (1) shall include data for additional population groups if such groups can be aggregated into the race and ethnicity categories outlined by the data collection standards described in paragraph (2)(A).
(4) Collection of data for minors and legally incapacitated individuals
With respect to the collection of the data described in paragraph (1) of applicants who are under 18 years of age or otherwise legally incapacitated, the Commissioner shall require that—
(A)
such data be collected from the parent or legal guardian of such an applicant; and
(B)
the primary language of the parent or legal guardian of such an applicant or recipient be used in collecting the data.
(5) Quality of data
The Commissioner shall periodically review the quality and completeness of the data collected under paragraph (1) and make adjustments as necessary to improve both.
(6) Transmission of data
Upon enrollment for Medicare benefits under title XVIII, the Commissioner shall transmit the demographic data of an individual as collected under paragraph (1) to the Centers for Medicare & Medicaid Services.
(7) Analysis and reporting of data
With respect to the data transmitted under paragraph (6), the Administrator, in consultation with the Commissioner, shall—
(A)
require that such data be uniformly analyzed and that such analysis be reported at least annually to Congress;
(B)
incorporate such data in other analysis and reporting on health disparities and the provision of inequitable health care services by a health care provider, as appropriate;
(C)
make such data available to researchers, under the protections outlined in paragraph (8);
(D)
provide opportunities to individuals enrolled for Medicare benefits under title XVIII to submit updated data;
(E)
ensure that the provision of assistance or benefits to an applicant, or their relatives, is not denied or otherwise adversely affected because of the failure of the applicant to provide any of the data collected under paragraph (1); and
(F)
ensure that the provision of assistance or benefit to an applicant or their relatives is not denied or otherwise adversely affected because of the content of the data provided by the applicant, except where it is required by law.
(8) Protection of data
The Commissioner shall ensure (through the promulgation of regulations or otherwise) that all data collected pursuant to paragraph (1) is protected—
(A)
under the same privacy protections as the Secretary applies to health data under the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (relating to the privacy of individually identifiable health information and other protections); and
(B)
from all inappropriate internal use by any entity that collects, stores, or receives the data, including use of such data in determinations of eligibility (or continued eligibility) in health plans, and from other inappropriate uses, as defined by the Secretary.
(b) Rule of construction
Nothing in this section shall be construed to permit the use of information collected under this section in a manner that would adversely affect any individual providing any such information.
(c) Technical assistance
The Secretary may, either directly or by grant or contract, provide technical assistance to enable any entity to comply with the requirements of this section or with regulations implementing this section.
(d) Authorization of appropriations
There are authorized to be appropriated to carry out this section $500,000,000 for fiscal year 2027 and $100,000,000 for each fiscal year thereafter.
Sec. 1004. Revision of HIPAA claims standards
(a) In general
Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services shall revise the regulations promulgated under part C of title XI of the Social Security Act (42 U.S.C. 1320d et seq.) (relating to the collection of data on demographics in a health-related transaction) to require—
(1)
the use, at a minimum, of standards for data collection on race, ethnicity, sex, primary language, sexual orientation, gender identity, age, disability status, and socioeconomic status developed under section 3101 of the Public Health Service Act (42 U.S.C. 300kk), as amended by section 1001(a)(6); and
(2)
in consultation with the Office of the National Coordinator for Health Information Technology, the designation of the appropriate racial, ethnic, primary language, disability, sex, and other code sets as required for claims and enrollment data.
(b) Dissemination
The Secretary of Health and Human Services shall disseminate the new standards developed under subsection (a) to all entities that are subject to the regulations described in such subsection and provide technical assistance with respect to the collection of the data involved.
(c) Compliance
The Secretary of Health and Human Services shall require that entities comply with the new standards developed under subsection (a) not later than 2 years after the final promulgation of such standards.
Sec. 1005. National Center for Health Statistics
Section 306(n) of the Public Health Service Act (42 U.S.C. 242k(n)) is amended—
(1)
in paragraph (1), by striking 2003
and inserting 2027
;
(2)
in paragraph (2), in the first sentence, by striking 2003
and inserting 2027
; and
(3)
in paragraph (3), by striking 2002
and inserting 2027
.
Sec. 1006. Disparities data collected by the Federal Government
(a) Repository of Government data
The Secretary of Health and Human Services, in coordination with the officials referenced in subsection (b), shall establish a centralized electronic repository of Federal Government data on factors related to the health and well-being of the population of the United States.
(b) Collection; submission
Not later than 180 days after the date of enactment of this Act, and January 31 of each year thereafter, each department, agency, and office of the Federal Government that has collected data on race, ethnicity, sex, primary language, sexual orientation, gender identity, age, disability status, or socioeconomic status during the preceding calendar year shall submit such data to the repository of Federal Government data established under subsection (a).
(c) Analysis; public availability; reporting
Not later than April 30, 2027, and April 30 of each year thereafter, the Secretary of Health and Human Services, acting through the Assistant Secretary for Planning and Evaluation, the Assistant Secretary for Health, the Director of the Agency for Healthcare Research and Quality, the Director of the National Center for Health Statistics, the Administrator of the Centers for Medicare & Medicaid Services, the Director of the National Institute on Minority Health and Health Disparities, and the Deputy Assistant Secretary for Minority Health, shall—
(1)
prepare and make available datasets for public use that relate to disparities in health status, health care access, health care quality, health outcomes, public health, the provision of equitable health services, and other areas of health and well-being by factors that include race, ethnicity, sex, primary language, sexual orientation, gender identity, disability status, age, and socioeconomic status;
(2)
ensure that these datasets are publicly identified on the repository established under subsection (a) as disparities
data; and
(3)
submit a report to the Congress on the availability and use of such data by public stakeholders.
Sec. 1007. Data collection and analysis grants to minority-serving institutions
(a) Authority
The Secretary of Health and Human Services, acting through the Director of the National Institute on Minority Health and Health Disparities and the Deputy Assistant Secretary for Minority Health, shall award grants to eligible entities to access and analyze racial and ethnic data on disparities in health and health care, and where possible other data on disparities in health and health care, to monitor and report on progress to reduce and eliminate disparities in health and health care.
(b) Eligible entity
In this section, the term eligible entity means an entity that has an accredited public health, health policy, or health services research program and is any of the following:
(1)
A part B institution, as defined in section 322 of the Higher Education Act of 1965 (20 U.S.C. 1061).
(2)
A Hispanic-serving institution, as defined in section 502 of such Act (20 U.S.C. 1101a).
(3)
A Tribal College or University, as defined in section 316 of such Act (20 U.S.C. 1059c).
(4)
An Asian American and Native American Pacific Islander-serving institution, as defined in section 371(c) of such Act (20 U.S.C. 1067q(c)).
(c) Authorization of appropriations
To carry out this section, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2027 through 2031.
Sec. 1008. Safety and effectiveness of drugs with respect to racial and ethnic background
(a) In general
Chapter V of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 351 et seq.) is amended by inserting after section 505G (21 U.S.C. 355h) the following:
505H. Safety and effectiveness of drugs with respect to racial and ethnic background
(a) Preapproval studies
If there is evidence of a racial or ethnic disparity in safety or effectiveness with respect to a drug or biological product, then—
(1)
(A)
in the case of a drug, the investigations required under section 505(b)(1)(A) shall include adequate and well-controlled investigations of the disparity; or
(B)
in the case of a biological product, the evidence required under section 351(a) of the Public Health Service Act for approval of a biologics license application for the biological product shall include adequate and well-controlled investigations of the disparity; and
(2)
if the investigations described in subparagraph (A) or (B) of paragraph (1) confirm that there is such a disparity, the labeling of the drug or biological product shall include appropriate information about the disparity.
(b) Postmarket studies
(1) In general
If there is evidence of a racial or ethnic disparity in safety or effectiveness with respect to a drug for which there is an approved application under section 505 of this Act or of a biological product for which there is an approved license under section 351 of the Public Health Service Act, the Secretary may by order require the holder of the approved application or license to conduct, by a date specified by the Secretary, postmarket studies to investigate the disparity.
(2) Labeling
If the Secretary determines that the postmarket studies confirm that there is a disparity described in paragraph (1), the labeling of the drug or biological product shall include appropriate information about the disparity.
(3) Study design
The Secretary may, in an order under paragraph (1), specify all aspects of the design of the postmarket studies required under such paragraph for a drug or biological product, including the number of studies and study participants, and the other demographic characteristics of the study participants.
(4) Modifications of study design
The Secretary may, by order and as necessary, modify any aspect of the design of a postmarket study required in an order under paragraph (1) after issuing such order.
(5) Study results
The results from a study required under paragraph (1) shall be submitted to the Secretary as a supplement to the drug application or biologics license application.
(c) Applications under section 505(j)
(1) In general
A drug for which an application has been submitted or approved under section 505(j) shall not be considered ineligible for approval under that section or misbranded under section 502 on the basis that the labeling of the drug omits information relating to a disparity on the basis of racial or ethnic background as to the safety or effectiveness of the drug, whether derived from investigations or studies required under this section or derived from other sources, when the omitted information is protected by patent or by exclusivity under section 505(j)(5)(F).
(2) Labeling
Notwithstanding paragraph (1), the Secretary may require that the labeling of a drug approved under section 505(j) that omits information relating to a disparity on the basis of racial or ethnic background as to the safety or effectiveness of the drug include a statement of any appropriate contraindications, warnings, or precautions related to the disparity that the Secretary considers necessary.
(d) Definition
In this section, the term evidence of a racial or ethnic disparity in safety or effectiveness, with respect to a drug or biological product, includes—
(1)
evidence that there is a disparity on the basis of racial or ethnic background as to safety or effectiveness of a drug or biological product in the same chemical class as the drug or biological product;
(2)
evidence that there is a disparity on the basis of racial or ethnic background in the way the drug or biological product is metabolized; and
(3)
other evidence as the Secretary may determine appropriate.
(b) Enforcement
Section 502 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 352) is amended by adding at the end the following:
(hh)
If it is a drug and the holder of the approved application under section 505 or license under section 351 of the Public Health Service Act for the drug has failed to complete the investigations or studies required under section 505H, or comply with any other requirement of such section 505H.
(c) Drug fees
Section 736(a)(1)(A)(ii) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379h(a)(1)(A)(ii)) is amended by inserting after are not required
the following: , including postmarket studies required under section 505H,
.
Sec. 1009. Improving health data regarding Native Hawaiians and Pacific Islanders
Part B of title III of the Public Health Service Act (42 U.S.C. 243 et seq.) is amended by inserting after section 317V (42 U.S.C. 247b–24) the following:
317W. Native Hawaiian and Pacific Islander health data
(a) Definitions
In this section:
(1) Insular area
The term insular area means Guam, the Commonwealth of the Northern Mariana Islands, American Samoa, the United States Virgin Islands, the Federated States of Micronesia, the Republic of Palau, or the Republic of the Marshall Islands.
(2) Native Hawaiians and Pacific Islanders (NHPI)
The term Native Hawaiians and Pacific Islanders or NHPI means people having origins in any of the original peoples of American Samoa, the Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia, Guam, Hawaii, the Republic of the Marshall Islands, the Republic of Palau, or any other Pacific Island.
(3) NHPI stakeholder groups
The term NHPI stakeholder group includes each of the following:
(A) Community group
A group of NHPI who are organized at the community level, and may include a church group, social service group, national advocacy organization, or cultural group.
(B) Nonprofit, nongovernmental organization
A group of NHPI with a demonstrated history of addressing NHPI issues, including a NHPI coalition.
(C) Designated organization
An entity established to represent NHPI populations and which has statutory responsibilities to provide, or has community support for providing, health care.
(D) Government representatives of NHPI populations
Representatives from Hawaii, American Samoa, the Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia, Guam, the Republic of Palau, and the Republic of the Marshall Islands.
(b) Preliminary health survey
(1) In general
The Secretary, acting through the Director of the National Center for Health Statistics of the Centers for Disease Control and Prevention (referred to in this section as NCHS), shall conduct a preliminary health survey in order to identify the major areas and regions in the continental United States, Hawaii, American Samoa, the Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia, Guam, the Republic of Palau, and the Republic of the Marshall Islands in which NHPI people reside.
(2) Contents
The health survey described in paragraph (1) shall include health data and any other data the Secretary determines to be—
(A)
useful in determining health status and health care needs of NHPI populations; or
(B)
required for developing or implementing the national strategy under subsection (c).
(3) Methodology
Methodology for the health survey described in paragraph (1), including plans for designing questions, implementation, sampling, and analysis, shall be developed in consultation with NHPI stakeholder groups.
(4) Timeframe
The survey required under this subsection shall be completed not later than 18 months after the date of enactment of the Health Equity and Accountability Act of 2026.
(c) National strategy
(1) In general
The Secretary, acting through the Director of the NCHS and other agencies within the Department of Health and Human Services as the Secretary determines appropriate, shall develop and implement a sustainable national strategy for identifying and evaluating the health status and health care needs of NHPI populations living in the continental United States, Hawaii, American Samoa, the Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia, Guam, the Republic of Palau, and the Republic of the Marshall Islands.
(2) Consultation
In developing and implementing a national strategy, as described in paragraph (1), not later than 180 days after the date of enactment of the Health Equity and Accountability Act of 2026, the Secretary—
(A)
shall consult with representatives of NHPI stakeholder groups; and
(B)
may solicit the participation of representatives from other Federal agencies.
(d) Progress report
Not later than 2 years after the date of enactment of the Health Equity and Accountability Act of 2026, the Secretary shall submit to Congress a progress report, which shall include the national strategy described in subsection (c)(1).
(e) Study and report by the Health and Medicine Division
(1) In general
The Secretary shall seek to enter into an agreement with the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine to conduct a study, with input from stakeholders in insular areas, on each of the following:
(A)
The standards and definitions of health care applied to health care systems in insular areas and the appropriateness of such standards and definitions.
(B)
The status and performance of health care systems in insular areas, evaluated based upon standards and definitions, as the Secretary determines appropriate.
(C)
The effectiveness of donor aid in addressing health care needs and priorities in insular areas.
(D)
The progress toward implementation of recommendations of the Committee on Health Care Services in the United States—Associated Pacific Basin that are set forth in the 1998 report entitled Pacific Partnerships for Health: Charting a New Course.
(2) Report
An agreement described in paragraph (1) shall require the Health and Medicine Division to submit to the Secretary and to Congress, not later than 2 years after the date of the enactment of the Health Equity and Accountability Act of 2026, a report containing a description of the results of the study conducted under paragraph (1), including the conclusions and recommendations of the Health and Medicine Division for each of the items described in subparagraphs (A) through (D) of such paragraph.
(f) Authorization of appropriations
To carry out this section, there are authorized to be appropriated such sums as may be necessary for fiscal years 2027 through 2031.
Sec. 1010. Data collection regarding pandemic preparedness, testing, infections, and deaths
(a) Skilled nursing Facilities Quality Reporting
Section 1819 of the Social Security Act (42 U.S.C. 1395i–3) is amended by adding at the end the following new subsection:
(l) Requirements relating to reporting during public health emergencies
During a public health emergency declared by the Secretary pursuant to section 319 of the Public Health Service Act, a skilled nursing facility shall, not later than 1 year after the first day of such declaration, and monthly thereafter during the application of such declaration, submit to the Secretary the following information, with respect to such facility and the residents of such facility:
(1)
Information described in section 483.80(g)(1) of title 42, Code of Federal Regulations.
(2)
The age, race, ethnicity, sex, sexual orientation, gender identity, socioeconomic status, disability status, and preferred language of the residents of such skilled nursing facility.
(b) Transparency of demographic information in certain settings
(1) Demographic information
The Secretary of Health and Human Services shall post the following information with respect to skilled nursing facilities (as defined in section 1819(a) of the Social Security Act (42 U.S.C. 1395i–3(a))), congregate care settings (including skilled nursing facilities, assisted living facilities, prisons and jails, residential behavioral health care and psychiatric facilities, and facilities providing services for aging adults and people with disabilities), and nursing facilities (as defined in section 1919(a) of such Act (42 U.S.C. 1396r(a))) on the Nursing Home Compare website (as described in section 1819(i) of such Act (42 U.S.C. 1395i–3(i))), or a successor website, aggregated by State:
(A)
The age, race, ethnicity, sex, sexual orientation, gender identity, socioeconomic status, disability status, and preferred language of the residents of such skilled nursing facilities, congregate care settings (including skilled nursing facilities, assisted living facilities, prisons and jails, residential behavioral health care and psychiatric facilities, and facilities providing services for aging adults and people with disabilities), and nursing facilities with suspected or confirmed infections, including residents previously treated for COVID–19.
(B)
The age, race, ethnicity, sex, sexual orientation, gender identity, socioeconomic status, disability status, and preferred language relating to total deaths and public health emergency-related deaths among residents of such skilled nursing facilities, congregate settings (including skilled nursing facilities, assisted living facilities, prisons and jails, residential behavioral health care and psychiatric facilities, and facilities providing services for aging adults and people with disabilities), and nursing facilities.
(2) Confidentiality
Any information reported under this subsection that is made available to the public shall be made so available in a manner that protects the identity of residents of skilled nursing facilities, congregate care settings (including skilled nursing facilities, assisted living facilities, prisons and jails, residential behavioral health care and psychiatric facilities, and facilities providing services for aging adults and people with disabilities), and nursing facilities.
(3) Implementation
Notwithstanding any other provision of law, the Secretary of Health and Human Services may implement the provisions of this subsection by program instruction or otherwise.
(c) Equitable data collection and disclosure regarding pandemics
Part A of title XI of the Social Security Act (42 U.S.C. 1301 et seq.) as amended by section 1003, is further amended by adding at the end the following new section:
1150E. Equitable data collection and disclosure regarding pandemics
(a) In general
Not later than 60 days after the Secretary submits to Congress written notification of the determination that a disease or disorder presents a public health emergency or that a public health emergency otherwise exists, subject to subsections (b) and (c), the Secretary, acting through the Director of the Centers for Disease Control and Prevention and the Administrator of the Centers for Medicare & Medicaid Services and in consultation with the Director of the Indian Health Service, shall collect and make publicly available on the website of the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services, and update every day during a pandemic, data collected across all surveillance systems relating to a public health emergency declared under section 319 of the Public Health Service Act that is caused by a disease (as determined by the Secretary), disaggregated by race, ethnicity, sex, sexual orientation, gender identity, age, preferred language, socioeconomic status, disability status, and county. Such data shall include the following:
(1)
Data relating to all testing for the pathogen or pathogens causing the pandemic, including the number of individuals tested and the number of tests that were positive.
(2)
Data relating to treatment for the pathogen causing the pandemic, including hospitalizations and intensive care unit admissions.
(3)
Data relating to pandemic outcomes, including total fatalities and case fatality rates (expressed as the proportion of individuals who were infected with the pathogen causing the pandemic and died from the pathogen).
(4)
In the case a vaccine is developed in response to a pandemic, data relating to such vaccination, including—
(A)
the number of vaccines administered;
(B)
the number of vaccinations offered, accepted, and refused;
(C)
the most common reasons for refusal; and
(D)
the percentage of vaccine doses allocated and administered to each priority group.
(b) Application of certain standards with respect to data collection
To the extent practicable, data collected under subsection (a) shall follow standards developed by the Department of Health and Human Services Office of Minority Health and be collected, analyzed, and reported in accordance with the standards promulgated by the Assistant Secretary for Planning and Evaluation under title XXXI of the Public Health Service Act.
(c) Privacy
In publishing data pursuant to subsection (a), the Secretary shall take all necessary steps to protect the privacy of individuals whose information is included in such data, including—
(1)
complying with privacy protections provided under the regulations promulgated under section 264(c) of the Health Insurance and Accountability Act of 1996; and
(2)
protections from all inappropriate internal use by an entity that collects, stores, or receives the data, including use of such data in determinations of eligibility (or continued eligibility) in health plans, and from inappropriate uses.
(d) Report requirements following public health emergencies
(1) Publicly available summary
Not later than 60 days after the date on which the Secretary of Health and Human Services certifies that a public health emergency declared under section 319 of the Public Health Service Act has ended, the Secretary shall make publicly available on the website of the Department of Health and Human Services a summary of the final statistics related to such emergency.
(2) Report to Congress
Not later than 60 days after the date on which the Secretary of Health and Human Services certifies that a public health emergency declared under section 319 of the Public Health Service Act has ended, the Secretary shall submit to the Committee on Health, Education, Labor, and Pensions and the Committee on Finance of the Senate and the Committee on Energy and Commerce and the Committee on Ways and Means of the House of Representatives a report—
(A)
describing the testing, hospitalization, mortality rates, vaccination rates, and preferred language of patients associated with the pandemic by race and ethnicity, rural and urban areas (as defined in section 1886(d)(2)(D) of the Social Security Act (42 U.S.C. 1395ww(d)(2)(D))), and congregate care settings (including skilled nursing facilities, assisted living facilities, prisons and jails, residential behavioral health care and psychiatric facilities, and facilities providing services for aging adults and people with disabilities) and noncongregate care settings (as such terms are defined by the Secretary); and
(B)
proposing evidenced-based response strategies to safeguard the health of these communities in future pandemics.
Sec. 1011. Commission on Ensuring Data for Health Equity
(a) In general
Not later than 30 days after the date of enactment of this Act, the Secretary of Health and Human Services (referred to in this section as the Secretary
) shall establish a commission, to be known as the Commission on Ensuring Data for Health Equity
(referred to in this section as the Commission
) to provide clear and robust guidance to improve the collection, analysis, and use of demographic data in responding to future public health emergencies.
(b) Membership and Chairperson
(1) Membership
The Commission shall be composed of—
(A)
the Assistant Secretary for Preparedness and Response;
(B)
the Director of the Centers for Disease Control and Prevention;
(C)
the Director of the National Institutes of Health;
(D)
the Commissioner of Food and Drugs;
(E)
the Administrator of the Federal Emergency Management Agency;
(F)
the Director of the National Institute on Minority Health and Health Disparities;
(G)
the Director of the Indian Health Service;
(H)
the Administrator of the Centers for Medicare & Medicaid Services;
(I)
the Director of the Agency for Healthcare Research and Quality;
(J)
the Surgeon General;
(K)
the Administrator of the Health Resources and Services Administration;
(L)
the Director of the Office of Minority Health;
(M)
the Director of the Office on Women’s Health;
(N)
the Chairperson of the National Council on Disability;
(O)
at least 4 State, local, territorial, and Tribal public health officials representing departments of public health, or an Urban Indian health representative, who shall represent jurisdictions from different regions of the United States with relatively high concentrations of historically marginalized populations and rural populations, to be appointed by the Secretary;
(P)
the National Coordinator for Health Information Technology;
(Q)
at least 3 independent individuals with expertise on racially and ethnically diverse representation with knowledge or field experience with community-based participatory research on racial and ethnic disparities in public health, to be appointed by the Secretary; and
(R)
at least 4 individuals with expertise on health equity and demographic data disparities with knowledge of, or field experience in, language, disability status, sex, sexual orientation, gender identity, or socioeconomic status.
(2) Chairperson
The Assistant Secretary for Preparedness and Response shall serve as the Chairperson of the Commission.
(c) Duties
The Commission shall—
(1)
examine barriers to collecting, analyzing, and using demographic data in public health;
(2)
determine how to best use such data to promote health equity across the United States and reduce racial, Tribal, and other demographic disparities in health outcomes;
(3)
(A)
gather available data related to treatment of individuals with disabilities during the COVID–19 pandemic and other public health emergencies, including access to vaccinations, denial of treatment for preexisting conditions, removal or denial of disability related equipment (including ventilators and continuous positive airway pressure (commonly referred to as CPAP
) machines), and data on completion of do-not-resuscitate orders; and
(B)
identify barriers to obtaining accurate and timely data related to treatment of such individuals;
(4)
solicit input from public health officials, community-connected organizations, health care providers, State and local agency officials, Tribal officials, and other experts on barriers to, and best practices for, collecting demographic data; and
(5)
recommend policy changes that the data indicates are necessary to reduce demographic disparities in health outcomes.
(d) Report
Not later than 1 year after the date of the enactment of this Act, the Commission shall submit to Congress, and publish on the website of the Department of Health and Human Services, a report containing—
(1)
the findings of the Commission pursuant to subsection (c);
(2)
to the extent possible, an analysis of—
(A)
racial and other demographic disparities in COVID–19 mortality, including an analysis of comorbidities and case fatality rates;
(B)
sex, sexual orientation, and gender identity disparities in COVID–19 treatment and mortality; and
(C)
Federal Government policies that disparately exacerbate the COVID–19 impact, and recommendations to improve racial and other demographic disparities in health outcomes;
(3)
an analysis of COVID–19 treatment of individuals with disabilities, including equity of access to treatment and equipment and intersections of disability status with other demographic factors, including race;
(4)
an analysis of what demographic data is currently being collected, the accuracy of that data and any gaps, how this data is currently being used to inform efforts to combat COVID–19, and what resources are needed to supplement existing public health data collection; and
(5)
the Commission’s recommendations with respect to—
(A)
how to enhance State, local, territorial, and Tribal capacity to conduct public health research on COVID–19 and in future public health emergencies, with a focus on expanded capacity to analyze data on disparities correlated with race, ethnicity, income, sex, sexual orientation, gender identity, age, disability status, specific geographic areas, and other relevant demographic characteristics;
(B)
how to collect, process, and disclose to the public the data described in subparagraph (A) in a way that maintains individual privacy while helping direct the State, local, and Tribal response to public health emergencies;
(C)
how to improve demographic data collection related to COVID–19 and other public health emergencies in the short-term and long-term, including how to continue to grow and value the Tribal sovereignty of data and information concerning urban and rural Tribal communities;
(D)
how to improve transparency and equity of treatment for individuals with disabilities during the COVID–19 public health emergency and future public health emergencies; and
(E)
how to support State, local, and Tribal capacity to eliminate barriers to vaccinations, testing, and treatment during the COVID–19 public health emergency and future public health emergencies.
(e) Staff of commission
(1) Additional staff
The Chairperson of the Commission may appoint and fix the pay of additional staff to the Commission as the Chairperson considers appropriate.
(2) Applicability of certain civil service laws
The staff of the Commission may be appointed without regard to the provisions of title 5, United States Code, governing appointments in the competitive service, and may be paid without regard to the provisions of chapter 51 and subchapter III of chapter 53 of that title relating to classification and General Schedule pay rates.
(3) Detailees
Any Federal Government employee may be detailed to the Commission without reimbursement from the Commission, and the detailee shall retain the rights, status, and privileges of his or her regular employment without interruption.
(f) Coordination with other efforts
The Secretary shall, in establishing the Commission under this section, take such steps as may be necessary to ensure that the work of the Commission does not overlap with, or otherwise duplicate, other Federal Government efforts with respect to ensuring health equity in data collection in public health emergencies.
(g) Authorization of appropriations
There are authorized to be appropriated such sums as may be necessary to carry out this section.
Sec. 1012. Task Force on Preventing Bias in AI and Algorithms
(a) In general
Not later than 30 days after the date of enactment of this Act, the Secretary of Health and Human Services (referred to in this section as the Secretary
) shall establish a Task Force to be known as the Task Force on Preventing AI and Algorithmic Bias in Health Care
(referred to in this section as the Task Force
) to provide clear and robust guidance on how to ensure that the development and integration of artificial intelligence and algorithmic technologies within the health care service delivery process does not exacerbate health disparities and inequities, expands access to health care services, and improves health care delivery.
(b) Membership and Chairperson
(1) Membership
The Task Force shall be composed of—
(A)
the Chief Information Officer of the Department of Health and Human Services;
(B)
the Director of the Centers for Disease Control and Prevention;
(C)
the Director of the National Institutes of Health;
(D)
the Commissioner of Food and Drugs;
(E)
the Administrator of the Federal Emergency Management Agency;
(F)
the Director of the National Institute on Minority Health and Health Disparities;
(G)
the Director of the Indian Health Service;
(H)
the Administrator of the Centers for Medicare & Medicaid Services;
(I)
the Director of the Agency for Healthcare Research and Quality;
(J)
the Surgeon General;
(K)
the Administrator of the Health Resources and Services Administration;
(L)
the Director of the Office of Minority Health;
(M)
the Director of the Office on Women’s Health;
(N)
the Chairperson of the National Council on Disability;
(O)
the National Coordinator for Health Information Technology;
(P)
at least 4 State, local, territorial, and Tribal public health officials representing departments of public health, or an Urban Indian health representative, who shall represent jurisdictions from different regions of the United States with relatively high concentrations of historically marginalized populations, to be appointed by the Secretary;
(Q)
at least 3 independent individuals with expertise on racially and ethnically diverse representation with knowledge or field experience with community-based participatory research on racial and ethnic disparities in public health, to be appointed by the Secretary; and
(R)
at least 4 individuals with expertise on health equity and demographic data disparities with knowledge of, or field experience in, language, disability status, sex, sexual orientation, gender identity, or socioeconomic status.
(2) Chairperson
The Chief Information Officer of the Department of Health and Human Services (or the Chief Information Officer’s designee) shall serve as the Chairperson of the Task Force.
(c) Duties
The Task Force shall—
(1)
examine artificial intelligence and algorithms in the health care service sector, including the health care delivery process relative to the use of autonomous human decision makers;
(2)
identify the risks of health care system utilization of artificial intelligence and algorithms in terms of civil rights, civil liberties, and discriminatory bias in health care access, quality, and outcomes; and
(3)
prepare and submit the report under subsection (d).
(d) Report
Not later than 1 year after the date of enactment of this Act, the Task Force shall—
(1)
submit a written report of the findings of the examination under subsection (c)(1) and recommendations to Congress with respect to implementation of artificial intelligence and algorithms in health care delivery and mitigation of the risks associated with that implementation; and
(2)
publish such report on the website of the Department of Health and Human Services.
(e) Public comment
Not later than 60 days after the date of the enactment of this Act, the Task Force shall publish in the Federal Register a notice providing for a public comment period on the duties and activities of the Task Force of not less than 90 days, beginning on the date of that publication.
(f) Staff of commission
(1) Additional staff
The Chairperson of the Task Force may appoint and fix the pay of additional staff to the Task Force as the Chairperson considers appropriate.
(2) Applicability of certain civil service laws
The staff of the Task Force may be appointed without regard to the provisions of title 5, United States Code, governing appointments in the competitive service, and may be paid without regard to the provisions of chapter 51 and subchapter III of chapter 53 of that title relating to classification and General Schedule pay rates.
(3) Detailees
Any Federal Government employee may be detailed to the Task Force without reimbursement from the Task Force, and the detailee shall retain the rights, status, and privileges of his or her regular employment without interruption.
Sec. 1013. Report on health of Middle Eastern and North African populations
(a) Study required
The Secretary of Health and Human Services (referred to in this section as the Secretary
) shall conduct or support a comprehensive study regarding the unique health patterns and outcomes of MENA populations.
(b) Requirements for study
The comprehensive study under subsection (a) shall include an enumeration of MENA populations across the United States, disaggregated by subpopulation, and with respect to each such population and subpopulation—
(1)
the rates of—
(A)
health risk factors, including—
(i)
behaviors, such as tobacco use, excessive alcohol consumption, physical inactivity, and unhealthy diet;
(ii)
physiological factors, such as obesity, diabetes, high blood pressure, high blood sugar, and high cholesterol;
(iii)
environmental factors, such as exposure to toxic chemicals, air and water pollution, and unsafe working conditions, including prevalence of work-related injuries;
(iv)
genetic factors, such as family history of chronic diseases, presence of specific gene mutations, and racial and ethnic predisposition to certain conditions;
(v)
demographic characteristics, such as age, geographic location, and English language proficiency; and
(vi)
social determinants of health, such as household income, health insurance coverage, socioeconomic status, education level, housing instability, educational and employment opportunities, and access to culturally and linguistically appropriate service providers;
(B)
prevalence of chronic disease or illness, including—
(i)
cancers, such as breast, lung, cervical, prostate, colorectal, liver, stomach, and oral cancer;
(ii)
cardiovascular conditions, such as heart disease, atrial fibrillation, and stroke;
(iii)
respiratory conditions, such as asthma, chronic obstructive pulmonary disease, and lung disease;
(iv)
musculoskeletal conditions, such as osteoporosis and carpal tunnel syndrome;
(v)
neurological conditions, such as Parkinson’s disease, Alzheimer’s and other related dementias, epilepsy, and cerebral palsy;
(vi)
infectious diseases, such as HIV/AIDS, hepatitis B and C, and tuberculosis; and
(vii)
autoimmune diseases, such as lupus, multiple sclerosis, ulcerative colitis, and rheumatoid arthritis;
(C)
prevalence of disability and disorder, including—
(i)
vision impairments, such as blindness and low vision;
(ii)
hearing conditions, such as deafness and varying degrees of hearing loss;
(iii)
physical impairments, such as musculoskeletal conditions, amputation, paralysis, repetitive strain injuries, and other conditions that affect movement or require assistive devices;
(iv)
intellectual or developmental conditions, such as Down syndrome, Prader-Willi syndrome, Angelman syndrome, autism, and attention-deficit/hyperactive disorder (ADHD), as well as other conditions that affect cognitive abilities, learning, and adaptive behaviors;
(v)
mental or behavioral conditions, such as depression, anxiety, insomnia, sleep apnea, bipolar disorder, schizophrenia, and traumatic brain injury;
(vi)
substance use disorders, such as disorders in use of alcohol, opioids, stimulants, and cannabis, and risk factors stemming from such disorders, such as liver damage and gastrointestinal issues;
(vii)
genetic or blood disorders, such as sickle cell anemia, G6PD deficiency, hypertension, and thalassemia; and
(viii)
endocrine disorders, such as diabetes, polycystic ovary syndrome (PCOS), and hypothyroidism;
(D)
maternal and reproductive health outcomes, including maternal morbidity and mortality, infertility, and postpartum depression;
(E)
nutritional health outcomes, including malnutrition and vitamin D and iron deficiencies, among other vitamin deficiencies;
(F)
child and adolescent health outcomes, such as pediatric developmental delays, childhood obesity, and early-onset chronic conditions;
(G)
dental and oral health outcomes, including tooth loss, gum disease, and tooth decay;
(H)
domestic violence, dating violence, sexual assault, sexual harassment, and stalking; and
(I)
morbidity and mortality, including the rates of morbidity and mortality associated with the rates referenced in subparagraphs (A) through (H);
(2)
analysis of—
(A)
the factors and conditions that contribute most to—
(i)
the rates described in paragraph (1); and
(ii)
the rates by which MENA subpopulations reported the outcomes referenced in subparagraphs (B) and (C) as a disease, illness, disorder, or disability;
(B)
the leading causes of morbidity and mortality and pregnancy-associated morbidity and mortality;
(C)
the extent to which access to health care facilities contributes to the associated outcomes of care, including the rates described in paragraph (1); and
(D)
the disparities between MENA subpopulations and between the aggregate MENA population and other racial and ethnic populations in the rates described in paragraph (1);
(3)
analysis, enumeration, or quantification of any other health or health-related parameters the Secretary determines necessary; and
(4)
analysis of the extent to which any or all of the design, implementation, and evaluation of Federal health programs contribute to the health factors, outcomes, and conditions described in paragraphs (1) through (3).
(c) Consultation
The Secretary shall—
(1)
carry out this section in consultation, as appropriate, with the Director of the Census Bureau, the Director of the Centers for Disease Control and Prevention, the Director of the National Institutes of Health, the Assistant Secretary for Mental Health and Substance Use, and other stakeholders (including community-based organizations); and
(2)
determine through such consultation the subpopulations to be used for purposes of disaggregation of data pursuant to subsection (b).
(d) Online portal
Upon conclusion of the comprehensive study under this section, the Secretary shall establish a public online portal to catalogue the results of the study, its underlying data, and information in the report submitted pursuant to subsection (e)(2).
(e) Reporting
(1) Interim report
Not later than 2 years after the date of enactment of this Act, the Secretary shall submit to Congress a report outlining the challenges associated with, and progress toward implementing, health data collection for MENA populations as a distinct category and the plan for completing a comprehensive study regarding the unique health patterns and outcomes of MENA populations.
(2) Final report
Not later than 30 days after the conclusion of the comprehensive study under this section, and not later than 2 years after the date of submission of the interim report under paragraph (1), the Secretary shall submit to Congress a report describing—
(A)
the results of the study conducted under this section; and
(B)
the rulemakings and other actions the agencies described in subsection (c)(1) can undertake to more equitably include MENA individuals in their programs, including whether and to what extent additional resources are needed to increase rates of response among MENA populations to Federal health surveys.
(f) Privacy
(1) In general
In carrying out the comprehensive study under this section, the Secretary shall implement robust privacy protections to safeguard the personal data of the individuals involved.
(2) Minimum protections
The privacy protections referred to in paragraph (1) include the following:
(A)
Personally identifiable information, such as names or addresses, shall not be collected when unnecessary for the purposes of the study.
(B)
Any personally identifiable information that is collected shall be securely destroyed upon completion of the intended use of such information.
(C)
All privacy protections and data handling procedures shall be clearly communicated to any individuals who may be subjects of the study, including through informed consent if applicable.
(3) Prohibition on inclusion of PII in online portal or reports
The Secretary shall not include any personally identifiable information on the online portal under subsection (d) or in the reports under subsection (e).
(g) Violations
Any person who, by virtue of an official position or affiliation with the Secretary—
(1)
has possession of, or access to, any record containing individually identifiable information the disclosure of which is prohibited by or under this section; and
(2)
knowingly discloses such a record to any person or agency not entitled to receive the record,
shall be guilty of a misdemeanor and fined not more than $25,000.
(h) Definitions
In this section:
(1) MENA
The term MENA, with respect to individuals or populations, includes individuals or populations who identify with or belong to one or more nationalities or ethnic groups originating in a country (or portion thereof) in the Middle Eastern and North African region (such as Lebanese, Iranians, Egyptians, Moroccans, Yemenis, Chaldeans, Imazighen, Kurds, Palestinians, and Yazidis).
(2) Personally identifiable information defined
The term personally identifiable information means individually identifying information for or about an individual, including information likely to disclose the location or specific identity of a participating individual, regardless of whether the information is encoded, encrypted, hashed, or otherwise protected, including—
(A)
a first and last name;
(B)
a home or other physical address;
(C)
contact information (including a postal, email or internet protocol address, or telephone or facsimile number);
(D)
a social security number, driver license number, passport number, or student identification number; and
(E)
any other information, including date of birth, racial or ethnic background, or religious affiliation, that would serve to identify any individual.
(i) Authorization of appropriations
There are authorized to be appropriated such sums as may be necessary to carry out this section.
Sec. 1014. Inclusion of Puerto Rico in National Survey on Drug Use and Health
Section 505(d) of the Public Health Service Act (42 U.S.C. 290aa–4(d)) is amended by adding at the end the following:
(3) Inclusion of Puerto Rico
Beginning with fiscal year 2027, annual surveys carried out under this section shall include Puerto Rico.
Title II Culturally and linguistically appropriate health and health care
Sec. 2001. Definitions
In this title, the definitions in section 3400 of the Public Health Service Act, as added by section 2004, shall apply.
Sec. 2002. Improving access to services for individuals with limited english proficiency
(a) Purpose
It is the purpose of this section—
(1)
to improve Federal agency performance regarding access to federally conducted and federally assisted programs and activities for individuals with limited English proficiency;
(2)
to require each Federal agency to examine the services it provides and develop and implement a system by which individuals with limited English proficiency can obtain culturally competent services and meaningful access to those services consistent with, and without substantially burdening, the fundamental mission of the agency;
(3)
to require each Federal agency to translate any English language written material prepared for the general public into the top 15 non-English languages in the United States (according to the most recent data from the American Community Survey or its replacement) within established timelines described in subsection (b)(2)(C)(v);
(4)
to require each Federal agency to ensure that recipients of Federal financial assistance provide meaningful access to applicants and beneficiaries who are individuals with limited English proficiency and culturally competent services to all individuals;
(5)
to ensure that recipients of Federal financial assistance take reasonable steps, consistent with the guidelines set forth in the Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons
(67 Fed. Reg. 41455 (June 18, 2002)), to ensure culturally and linguistically appropriate access to their programs and activities by individuals with limited English proficiency; and
(6)
to ensure compliance with title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) and section 1557 of the Patient Protection and Affordable Care Act (42 U.S.C. 18116) (prohibiting health care providers and organizations from discriminating in the provision of services).
(b) Federally conducted programs and activities
(1) In general
Not later than 120 days after the date of enactment of this Act, each Federal agency providing financial assistance to, or administering, a health program or activity described in section 2003(a) shall prepare a plan or update a plan to improve culturally and linguistically appropriate access to such program or activity with respect to individuals with limited English proficiency. Not later than 1 year after the date of enactment of this Act, each such Federal agency shall ensure that such plan is fully implemented.
(2) Plan requirement
Each plan under paragraph (1) shall include—
(A)
the steps the agency will take to ensure that individuals with limited English proficiency have access to each health program or activity supported or administered by the agency;
(B)
the policies and procedures for identifying, assessing, and meeting the culturally and linguistically appropriate language needs of its beneficiaries, including those who are individuals with limited English proficiency, served by such a program or activity;
(C)
the steps the agency will take for such program or activity to be culturally and linguistically appropriate by—
(i)
providing a range of language assistance options;
(ii)
giving notice to individuals with limited English proficiency of the right to competent language services;
(iii)
training staff (at least annually);
(iv)
monitoring and assessing the quality of the language services (at least annually); and
(v)
translating any English language written material prepared for the general public into the top 15 non-English languages in the United States (according to the most recent data from the American Community Survey or its replacement) within established timelines that ensure that high-quality, culturally competent translated material is provided promptly within not more than 15 calendar days in general and within not more than 7 calendar days in the case of any national emergency or State disaster declaration;
(D)
the steps the agency will take for such program or activity to provide reasonable accommodations necessary for all individuals, including individuals with limited English proficiency and other groups, to understand communications from the agency;
(E)
the steps the agency will take to ensure that applications, forms, and other significant documents for such program or activity are competently translated into the primary language of a client that is an individual with limited English proficiency where such materials are needed to improve access of such client to such program or activity;
(F)
the resources the agency will provide to improve cultural and linguistic appropriateness to assist recipients of Federal funds to improve access to health care-related programs and activities for individuals with limited English proficiency;
(G)
the resources the agency will provide to ensure that competent language assistance is provided to patients that are individuals with limited English proficiency by interpreters or trained bilingual staff;
(H)
the resources the agency will provide to ensure that family, particularly minor children, and friends are not used to provide interpretation services, except as permitted under section 1557 of the Patient Protection and Affordable Care Act (42 U.S.C. 18116); and
(I)
the steps the agency will take and resources the agency will provide to ensure that individuals know their rights, including the ability to and procedures to file a complaint.
(3) Submission of plan to DOJ
Each agency that is required to prepare a plan under paragraph (1) shall—
(A)
consult with populations who are directly impacted by policies in the plan and their representatives in the development of the plan; and
(B)
when the plan is finalized, send a copy of the plan, and any subsequent material updates to such plan, to the Attorney General, who shall serve as the central repository of all such plans.
Sec. 2003. Ensuring standards for culturally and linguistically appropriate services in health care
(a) Applicability
This section shall apply to any health program or activity—
(1)
of which any part is receiving Federal financial assistance, including credits, subsidies, or contracts of insurance; or
(2)
that is carried out (including indirectly through contracts, subcontracts, or other support) by an executive agency or any entity established under title I of the Patient Protection and Affordable Care Act (42 U.S.C. 18001 et seq.) (or amendments made thereby).
(b) Standards
Each program or activity described in subsection (a)—
(1)
shall implement strategies to recruit, retain, and promote individuals at all levels to maintain a diverse staff and leadership that can provide culturally and linguistically appropriate health care to patient populations of the service area of the program or activity;
(2)
shall educate and train governance, leadership, and workforce at all levels and across all disciplines of the program or activity in culturally and linguistically appropriate policies, and practices, and legal requirements on an ongoing basis at least yearly;
(3)
shall offer and promptly provide language assistance, including trained and competent bilingual staff and interpreter services, to individuals with limited English proficiency or who have other communication needs, at no cost to the individual at all points of contact, and during all hours of operation, to facilitate timely access to health care services and health care-related services;
(4)
shall for each language group consisting of individuals with limited English proficiency that constitutes 5 percent or 500 individuals, whichever is less, of the population of persons eligible to be served or likely to be affected or encountered in the service area of the program or activity, make available at a fifth grade reading level or at the reading level most appropriate for the individuals belonging to the relevant language group—
(A)
easily understood patient-related materials, including print and multimedia materials, in the language of such language group;
(B)
information or notices about termination of benefits in such language;
(C)
signage; and
(D)
any other documents or types of documents designated by the Secretary;
(5)
shall develop and implement clear goals, policies, operational plans, and management, accountability, and oversight mechanisms in collaboration with the relevant communities served to provide culturally and linguistically appropriate services and infuse them throughout the planning and operations of the program or activity;
(6)
shall conduct initial and ongoing, at least annually, organizational assessments of culturally and linguistically appropriate services-related activities and integrate valid linguistic, competence-related National Standards for Culturally and Linguistically Appropriate Services (CLAS) measures into the internal audits, performance improvement programs, patient satisfaction assessments, continuous quality improvement activities, and outcomes-based evaluations of the program or activity and develop ways to standardize assessments;
(7)
shall ensure that, consistent with the privacy protections provided for under the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1320d–2 note; Public Law 104–191), data on an individual required to be collected pursuant to section 3101 of the Public Health Service Act (42 U.S.C. 300kk), including the individual’s alternative format preferences and policy modification needs, are—
(A)
collected in health records;
(B)
integrated into the management information systems of the program or activity;
(C)
reported in such a way as to be interoperable with health information systems at the Federal and State levels; and
(D)
periodically updated;
(8)
shall maintain a current demographic, cultural, and epidemiological profile of the community, conduct regular assessments of community health assets and needs, and use the results of such assessments to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service area of the program or activity;
(9)
shall develop participatory, collaborative partnerships with community-based organizations and utilize a variety of formal and informal mechanisms to facilitate community and patient involvement in designing, implementing, and evaluating policies and practices to ensure culturally and linguistically appropriate service-related activities;
(10)
shall ensure that conflict and grievance resolution processes are culturally and linguistically appropriate and capable of identifying, preventing, and resolving cross-cultural conflicts or complaints by patients;
(11)
shall annually—
(A)
make available to the public—
(i)
information about the progress and successful innovations of the program or activity in implementing the standards under this section; and
(ii)
translated materials of such information that is culturally and linguistically appropriate to the communities served under this section; and
(B)
provide public notice in such communities about the availability of such information; and
(12)
shall, if requested, regularly make available to the head of each Federal entity from which Federal funds are provided, information about the progress and successful innovations of the program or activity in implementing the standards under this section as required by the head of such entity.
(c) Comments accepted through notice and comment rulemaking
An executive agency carrying out a program or activity described in subsection (a)—
(1)
shall ensure that comments with respect to such program or activity that are accepted through notice and comment rulemaking are accepted in all languages;
(2)
may not require such comments to be submitted only in English; and
(3)
shall ensure that any such comments that are not submitted in English are considered, during the agency’s review of such comments, equally as such comments that are submitted in English.
Sec. 2004. Culturally and linguistically appropriate health care in the public health service act
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by adding at the end the following:
XXXIV Culturally and linguistically appropriate health care
3400. Definitions
(a) In general
In this title:
(1) Bilingual
The term bilingual, with respect to an individual, means an individual who has a sufficient degree of proficiency in 2 languages.
(2) Community health worker
The term community health worker means a frontline health worker who is a trusted member of the community in which the worker serves or who has an unusually close understanding of the community served that enables the worker to build trusted relationships, serve as a liaison between health and social services and the community, facilitate access to services, and improve the quality and cultural competence of service delivery.
(3) Cultural
The term cultural means relating to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, age, and institutions of racial, ethnic, religious, or social groups, including lesbian, gay, bisexual, transgender, queer, and questioning individuals, and individuals with physical and mental disabilities.
(4) Culturally and linguistically appropriate
The term culturally and linguistically appropriate means being respectful of and responsive to the cultural and linguistic needs of all individuals.
(5) Effective communication
The term effective communication means an exchange of information between the provider of health care or health care-related services and the recipient of such services who is limited in English proficiency, or has a communication impairment such as a hearing, vision, speaking, or cognitive disability, that enables access to, understanding of, and benefit from, with consideration for the recipient’s health literacy, health care or health care-related services, and full participation in the development of the treatment plan of the recipient.
(6) Grievance resolution process
The term grievance resolution process means all aspects of dispute resolution including filing complaints, grievance and appeal procedures, and court action.
(7) Health care group
The term health care group means a group of physicians organized, at least in part, for the purposes of providing physician services under the Medicaid program under title XIX of the Social Security Act, the State Children’s Health Insurance Program under title XXI of such Act, or the Medicare program under title XVIII of such Act, including a provider of services under part B of such title XVIII, and may include a hospital, a hospice provider, a palliative care provider, and any other individual or entity furnishing services covered under any such program that is affiliated with the health care group.
(8) Health care
The term health care includes all health care needed throughout the life cycle and the end of life.
(9) Health care services
The term health care services means services that address physical and mental health conditions, as well as conditions impacted by social determinants of health, in all care settings throughout the life cycle and the end of life.
(10) Health care-related services
The term health care-related services means human or social services programs or activities that provide access, referrals, or links to health care services.
(11) Health educator
The term health educator includes a professional with a baccalaureate degree who is responsible for designing, implementing, and evaluating individual and population health promotion, health education (including education on end-of-life care options), end-of-life care, or chronic disease prevention programs.
(12) Indian; indian tribe
The terms
IndianandIndian Tribehave the meanings given such terms in section 4 of the Indian Self-Determination and Education Assistance Act.(13) Individual with a disability
The term individual with a disability means any individual who has a disability as defined for the purpose of section 504 of the Rehabilitation Act of 1973.
(14) Individual with limited english proficiency
The term individual with limited English proficiency means an individual who self-identifies on the Census as speaking English less than
very well.(15) Integrated health care delivery system
The term integrated health care delivery system means an interdisciplinary system that brings together providers from the primary health, mental health, substance use disorder, hospice and palliative care, and related disciplines to improve the health outcomes of an individual and the community. Such providers may include hospitals, health, mental health, or substance use prevention and treatment clinics and providers, home health agencies, home- and community-based services providers, congregate settings (including any skilled nursing facilities, assisted living facilities, prisons and jails, residential behavioral health care and psychiatric facilities, shelters, and facilities providing services for older adults and individuals with disabilities), ambulatory surgery centers, rehabilitation centers, employed, independent, or contracted physicians, and oral health care providers.
(16) Interpreting; interpretation
The terms
interpretingandinterpretationmean the transmission of a spoken, written, or signed message from one language or format into another, faithfully, accurately, and objectively.(17) Language access
The term language access means the provision of language services to an individual with limited English proficiency or an individual with communication disabilities designed to enhance that individual’s access to, understanding of, or benefit from health care services or health care-related services.
(18) Language assistance services
The term language assistance services includes—
(A)
oral language assistance, including interpretation in non-English languages provided in person or remotely by a qualified interpreter for an individual with limited English proficiency, and the use of qualified bilingual or multilingual staff to communicate directly with individuals with limited English proficiency;
(B)
written translation, performed by a qualified translator, of written content in paper or electronic form into languages other than English; and
(C)
taglines.
(19) Minority populations
The term minority populations means individuals of racial and ethnic minority groups, individuals of sexual and gender minority groups, and individuals with a disability.
(20) Onsite interpretation
The term onsite interpretation means a method of interpreting or interpretation for which the interpreter is in the physical presence of the provider of health care services or health care-related services and the recipient of such services who is limited in English proficiency or has a communication impairment such as an impairment in hearing, vision, or learning.
(21) Qualified individual with a disability
The term qualified individual with a disability means, with respect to a health program or activity, an individual with a disability who, with or without reasonable modifications to policies, practices, or procedures, the removal of architectural, communication, or transportation barriers, or the provision of auxiliary aids and services, meets the essential eligibility requirements for the receipt of aids, benefits, or services offered or provided by the health program or activity.
(22) Qualified interpreter for an individual with a disability
The term qualified interpreter for an individual with a disability, with respect to an individual with a disability—
(A)
means an interpreter for such individual who by means of a remote interpreting service or an onsite appearance—
(i)
adheres to generally accepted interpreter ethics principles, including client confidentiality; and
(ii)
is able to interpret effectively, accurately, and impartially, both receptively and expressively, using any necessary specialized vocabulary, terminology, and phraseology; and
(B)
may include—
(i)
sign language interpreters;
(ii)
oral transliterators, which are individuals who represent or spell in the characters of another alphabet; and
(iii)
cued language transliterators, which are individuals who represent or spell by using a small number of handshapes.
(23) Qualified interpreter for an individual with limited english proficiency
The term qualified interpreter for an individual with limited English proficiency means an interpreter who by means of a remote interpreting service or an onsite appearance—
(A)
adheres to generally accepted interpreter ethics principles, including client confidentiality;
(B)
has demonstrated proficiency in speaking and understanding both spoken English and one or more other spoken languages; and
(C)
is able to interpret effectively, accurately, and impartially, both receptively and expressly, to and from such languages and English, using any necessary specialized vocabulary, terminology, and phraseology.
(24) Qualified translator
The term qualified translator means a translator who—
(A)
adheres to generally accepted translator ethics principles, including client confidentiality;
(B)
has demonstrated proficiency in writing and understanding both written English and one or more other written non-English languages; and
(C)
is able to translate effectively, accurately, and impartially to and from such languages and English, using any necessary specialized vocabulary, terminology, and phraseology.
(25) Racial and ethnic minority group
The term racial and ethnic minority group has the meaning given such term in section 1707(g).
(26) Secretary
The term Secretary means the Secretary of Health and Human Services, acting through the Director of the Agency for Healthcare Research and Quality.
(27) Sexual and gender minority group
The term sexual and gender minority group includes lesbian, gay, bisexual, and transgender populations, as well as those whose sexual orientation, gender identity and expression, or reproductive development varies from traditional, societal, cultural, or physiological norms.
(28) Sight translation
The term sight translation means the transmission of a written message in one language into a spoken or signed message in another language, or an alternative format in English or another language.
(29) State
Notwithstanding section 2, the term State means each of the several States, the District of Columbia, the Commonwealth of Puerto Rico, the United States Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands.
(30) Telephonic interpretation
The term telephonic interpretation (also known as
over the phone interpretationorOPI) means, with respect to interpretation for an individual with limited English proficiency, a method of interpretation in which the interpreter is not in the physical presence of the provider of health care services or health care-related services and such individual receiving such services, but the interpreter is connected via telephone.(31) Translation
The term translation means the transmission of a written message in one language into a written or signed message in another language, and includes translation into another language or alternative format, such as large print font, Braille, audio recording, or CD.
(32) Underserved communities
The term underserved communities means populations sharing particular characteristics, or geographic communities, who have been systematically denied a full opportunity to participate in aspects of economic, social, and civic life, such as—
(A)
Black, Latino, Indigenous, and Native American persons, Asian Americans, Native Hawaiians and Pacific Islanders, Middle Easterners and North Africans, and other persons of color;
(B)
members of religious minorities;
(C)
lesbian, gay, bisexual, transgender, and queer persons;
(D)
individuals with a disability;
(E)
persons who live in rural areas;
(F)
older adults; and
(G)
persons otherwise adversely affected by persistent poverty or inequality.
(33) Video remote interpreting services
The term video remote interpreting services means the provision, in health care services or health care-related services, through a qualified interpreter for an individual with limited English proficiency, of video remote interpreting services that are—
(A)
in real-time, full-motion video, and audio over a dedicated high-speed, wide-bandwidth video connection or wireless connection that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication; and
(B)
in a sharply delineated image that is large enough to display.
(34) Vital document
The term vital document includes applications for government programs that provide health care services, medical or financial consent forms, financial assistance documents, letters containing important information regarding patient instructions (such as prescriptions, referrals to other providers, and discharge plans) and participation in a program (such as a Medicaid managed care program), notices pertaining to the reduction, denial, or termination of services or benefits, notices of the right to appeal such actions, and notices advising individuals with limited English proficiency with communication disabilities of the availability of free language services, alternative formats, and other outreach materials.
(b) Reference
In any reference in this title to a regulatory provision applicable to a
handicapped individual, the term handicapped individual in such provision shall have the same meaning as the term individual with a disability as defined in subsection (a).A Resources and innovation for culturally and linguistically appropriate health care
3401. Robert T. Matsui Center for culturally and linguistically appropriate health care
(a) Establishment
The Secretary shall establish and support a center to be known as the
Robert T. Matsui Center for Culturally and Linguistically Appropriate Health Care(referred to in this section as theCenter) to carry out each of the following activities:(1) Interpretation services
(A) In general
The Center shall provide resources via the internet to identify and link health care providers to competent and qualified interpreter and translation services.
(B) Training
For purposes of providing the services described in subparagraph (A), the Center shall adopt a language access plan that includes training requirements for Center staff to provide such services.
(2) Translation of written material
(A) Vital documents
The Center shall provide, directly or through contract, to providers of health care services and health care-related services, at no cost to such providers and in a timely and reasonable manner, vital documents—
(i)
which may be submitted by an entity described in subparagraph (C) for translation into non-English languages, or alternative formats, at a fifth-grade reading level; and
(ii)
from competent translation services, the quality of which shall be monitored and reported publicly.
(B) Forms
For each form developed or revised by the Secretary that will be used by individuals with limited English proficiency in health care or health care-related settings, the Center shall, not later than 45 calendar days of the Secretary receiving final approval of the form from the Office of Management and Budget—
(i)
translate the form, at a minimum, into the top 15 non-English languages in the United States according to the most recent data from the American Community Survey or its replacement; and
(ii)
post all translated forms on the Center’s website.
(C) Entities
(i) In general
An entity described in this subparagraph is—
(I)
an entity that operates a health program or activity, any part of which receives Federal financial assistance;
(II)
an entity established under title I of the Patient Protection and Affordable Care Act that administers a health program or activity; or
(III)
the Department of Health and Human Services.
(ii) Health program or activity
For purposes of clause (i), the term health program or activity has the meaning given such term in section 92.4 of title 45, Code of Federal Regulations, as in effect on July 5, 2024.
(3) Toll-free customer service telephone number
The Center shall provide, through a toll-free number, a customer service line for individuals with limited English proficiency that is linked to the toll-free telephone number 1–800–MEDICARE and a toll-free telephone hotline provided for pursuant to section 1311(d)(4)(B) of the Patient Protection and Affordable Care Act by an Exchange established under title I of such Act—
(A)
to obtain information about federally conducted or funded health programs, including the Medicare program under title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, and the State Children’s Health Insurance Program under title XXI of such Act, and coverage available through an Exchange established under title I of the Patient Protection and Affordable Care Act, and other sources of free or reduced care including federally qualified health centers, entities receiving assistance under title X, and public health departments;
(B)
to obtain assistance with applying for or accessing these programs and understanding Federal notices written in English; and
(C)
to learn how to access language services.
(4) Health information clearinghouse
(A) In general
The Center shall develop and maintain, and make available on the internet and in print, an information clearinghouse that includes the information described in subparagraphs (B) through (G)—
(i)
to facilitate the provision of language services by providers of health care services and health care-related services to reduce medical errors;
(ii)
to improve health outcomes, to improve cultural competence, and to reduce health care costs caused by miscommunication with individuals with limited English proficiency; and
(iii)
to reduce or eliminate the duplication of efforts to translate materials.
(B) Document templates
The Center shall collect and evaluate for accuracy, develop, and make available templates for standard documents that are necessary for patients and consumers to access and make educated decisions about their health care, including templates for each of the following:
(i)
Administrative and legal documents, including—
(I)
intake forms;
(II)
forms related to the Medicare program under title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, and the State Children’s Health Insurance Program under title XXI of such Act, including eligibility information for such programs;
(III)
forms informing patients of the compliance and consent requirements pursuant to the regulations under section 264(c) of the Health Insurance Portability and Accountability Act of 1996; and
(IV)
documents concerning informed consent, advanced directives, and waivers of rights.
(ii)
Clinical information, such as how to take medications, how to prevent transmission of a contagious disease, and other prevention and treatment instructions.
(iii)
Public health, patient education, and outreach materials, such as immunization notices, health warnings, or screening notices.
(iv)
Additional health or health care-related materials as determined appropriate by the Director of the Center.
(C) Structure of forms
In operating the clearinghouse, the Center shall—
(i)
ensure that the documents posted in English and non-English languages are culturally and linguistically appropriate;
(ii)
allow public review of the documents before dissemination in order to ensure that the documents are understandable and culturally and linguistically appropriate for the target populations;
(iii)
allow health care providers to customize the documents for their use;
(iv)
facilitate access to such documents;
(v)
provide technical assistance with respect to the access and use of such information; and
(vi)
carry out any other activities the Secretary determines to be useful to fulfill the purposes of the clearinghouse.
(D) Language assistance programs
The Center shall provide for the collection and dissemination of information on current examples of language assistance programs and strategies to improve language services for individuals with limited English proficiency, including case studies using de-identified patient information, program summaries, and program evaluations.
(E) Culturally and linguistically appropriate materials
The Center shall provide, at no cost, to all health care providers and all providers of health care-related services, information relating to culturally and linguistically appropriate health care for minority populations residing in the United States, including—
(i)
tenets of culturally and linguistically appropriate care;
(ii)
culturally and linguistically appropriate self-assessment tools;
(iii)
culturally and linguistically appropriate training tools;
(iv)
strategic plans to increase cultural and linguistic appropriateness in different types of providers of health care services and health care-related services, including regional collaborations among health care organizations for health care services and health care-related services; and
(v)
culturally and linguistically appropriate information for educators, practitioners, students, and researchers.
(F) Translation glossaries
The Center shall—
(i)
develop and publish on its website translation glossaries that provide standardized translations of commonly used terms and phrases utilized in documents translated by the Center; and
(ii)
make such glossaries available—
(I)
free of charge;
(II)
in each language in which the Center translates forms under paragraph (2)(B);
(III)
in alternative formats in accordance with the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.); and
(IV)
in paper format upon request.
(G) Information about progress
The Center shall—
(i)
regularly collect and make publicly available information about the progress of entities receiving grants under section 3402 regarding successful innovations in implementing the requirements of this subsection; and
(ii)
provide public notice in the entities’ communities about the availability of such information.
(b) Director
The Center shall be headed by a Director who shall be appointed by, and who shall report to, the Director of the Agency for Healthcare Research and Quality.
(c) Availability of language access
The Director of the Center shall collaborate with the Deputy Assistant Secretary for Minority Health, the Administrator of the Centers for Medicare & Medicaid Services, and the Administrator of the Health Resources and Services Administration to notify health care providers and health care organizations about the availability of language access services by the Center.
(d) Education
The Secretary, directly or through contract, shall undertake a national education campaign to inform providers, individuals with limited English proficiency, individuals with hearing or vision impairments, health professionals, graduate schools, community health centers, social service providers, and community-based organizations about—
(1)
Federal and State laws and guidelines governing access to language services;
(2)
the value of using trained and competent interpreters and the risks associated with using family members, friends, minors, and untrained bilingual staff;
(3)
funding sources for developing and implementing language services; and
(4)
promising practices to effectively provide language services.
(e) Authorization of appropriations
There are authorized to be appropriated to carry out this section $5,000,000 for each of fiscal years 2027 through 2031.
3402. Innovations in culturally and linguistically appropriate health care grants
(a) In general
(1) Grants
The Secretary shall award grants to eligible entities to enable such entities to design, implement, and evaluate innovative, cost-effective programs to improve culturally and linguistically appropriate access to health care services for individuals with limited English proficiency and communication disabilities.
(2) Coordination
In making grants under this section, and in the design and implementation of the program established under this section, the Secretary shall coordinate with, and ensure the participation of, other agencies including the Health Resources and Services Administration, the National Institute on Minority Health and Health Disparities, the Tribal Affairs component of the Office of Intergovernmental and External Affairs of the Department of Health and Human Services, and the Office of Minority Health.
(b) Eligibility
To be eligible to receive a grant under subsection (a), an entity shall be—
(1)
a city, county, Indian Tribe, State, or subdivision thereof;
(2)
an organization described in section 501(c)(3) of the Internal Revenue Code of 1986 and exempt from tax under section 501(a) of such Code;
(3)
a community health, mental health, or substance use disorder center or clinic;
(4)
a solo or group physician practice;
(5)
an integrated health care delivery system;
(6)
a public hospital;
(7)
a health care group, university, or college; or
(8)
any other entity designated by the Secretary.
(c) Application
An eligible entity seeking a grant under this section shall prepare and submit to the Secretary an application, at such time, in such manner, and containing such additional information as the Secretary may reasonably require.
(d) Use of funds
An entity shall use funds received through a grant under this section to—
(1)
develop, implement, and evaluate models of providing competent interpretation services through onsite interpretation, telephonic interpretation, or video remote interpreting services;
(2)
implement strategies to recruit, retain, and promote individuals at all levels of the organization to maintain a diverse staff and leadership that can promote and provide language services to patient populations of the service area of the entity;
(3)
develop and maintain a needs assessment that identifies the current demographic, cultural, and epidemiological profile of the community to accurately plan for and implement language services needed in the service area of the entity;
(4)
develop a strategic plan to implement language services;
(5)
develop participatory, collaborative partnerships with communities encompassing the patient populations of individuals with limited English proficiency served by the grant to gain input in designing and implementing language services;
(6)
develop and implement grievance resolution processes that are culturally and linguistically appropriate and capable of identifying, preventing, and resolving complaints by individuals with limited English proficiency;
(7)
develop short-term medical and mental health interpretation training courses and incentives for bilingual health care staff who are asked to provide interpretation services in the workplace;
(8)
develop formal training programs, including continued professional development and education programs as well as supervision, for individuals interested in becoming dedicated health care interpreters and culturally and linguistically appropriate providers;
(9)
provide staff language training instruction, which shall include information on the practical limitations of such instruction for nonnative speakers;
(10)
develop policies that address compensation in salary for staff who receive training to become either a staff interpreter or bilingual provider;
(11)
develop other language assistance services as determined appropriate by the Secretary;
(12)
develop, implement, and evaluate models of improving cultural competence, including cultural competence programs for community health workers;
(13)
ensure that, consistent with the privacy protections provided for under the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 and any applicable State privacy laws, data on the individual patient or recipient’s race, ethnicity, and primary language are collected (and periodically updated) in health records and integrated into the organization’s information management systems or any similar system used to store and retrieve data; and
(14)
ensure that culturally competent care and language assistance are available to individuals with limited English proficiency.
(e) Priority
In awarding grants under this section, the Secretary shall give priority to entities that primarily engage in providing direct care and that have developed partnerships with community organizations or with agencies with experience in improving language access.
(f) Evaluation
(1) By grantees
An entity that receives a grant under this section shall submit to the Secretary an evaluation that describes, in the manner and to the extent required by the Secretary, the activities carried out with funds received under the grant, and how such activities improved access to health care services and health care-related services and the quality of health care for individuals with limited English proficiency. Such evaluation shall be collected and disseminated through the Robert T. Matsui Center for Culturally and Linguistically Appropriate Health Care established under section 3401. The Director of the Agency for Healthcare Research and Quality shall notify grantees of the availability of technical assistance for the evaluation and provide such assistance upon request.
(2) By secretary
The Director of the Agency for Healthcare Research and Quality shall evaluate or arrange with other individuals or organizations to evaluate projects funded under this section.
(g) Authorization of appropriations
There is authorized to be appropriated to carry out this section $5,000,000 for each of fiscal years 2027 through 2031.
3403. Research on cultural and language competence
(a) In general
The Secretary shall expand research concerning language access in the provision of health care services.
(b) Eligibility
The Secretary may conduct the research described in subsection (a) or enter into contracts with other individuals or organizations to conduct such research.
(c) Use of funds
Research conducted under this section shall be designed to do one or more of the following:
(1)
To identify the barriers to mental and behavioral services that are faced by individuals with limited English proficiency.
(2)
To identify health care providers’ and health administrators’ knowledge and awareness of the barriers to quality health care services that are faced by individuals with limited English proficiency and communication disabilities.
(3)
To identify optimal approaches for delivering language access.
(4)
To identify best practices for data collection, including—
(A)
the collection by providers of health care services and health care-related services of data on the race, ethnicity, age, disability, and primary language of recipients of such services, taking into account existing research conducted by the Government or private sector;
(B)
the development and implementation of data collection and reporting systems; and
(C)
effective privacy safeguards for collected data.
(5)
To develop a minimum data collection set for primary language.
(6)
To evaluate the most effective ways in which the Secretary can create or coordinate, and subsidize or otherwise fund, telephonic interpretation services for health care providers, taking into consideration, among other factors, the flexibility necessary for such a system to accommodate variations in—
(A)
provider type;
(B)
languages needed and their frequency of use;
(C)
type of encounter;
(D)
time of encounter, including whether the encounter occurs during regular business hours and after hours; and
(E)
location of encounter.
(d) Authorization of appropriations
There are authorized to be appropriated to carry out this section $5,000,000 for each of fiscal years 2027 through 2031.
Sec. 2005. Pilot program for improvement and development of state medical interpreting services
(a) Grants authorized
The Secretary of Health and Human Services (referred to in this section as the Secretary
) shall award 1 grant in accordance with this section to each of 3 States (to be selected by the Secretary) to assist each such State in designing, implementing, and evaluating a statewide program to provide onsite interpreter services under the State Medicaid plan.
(b) Grant period
A grant awarded under this section is authorized for the period of 3 fiscal years beginning on October 1, 2026, and ending on September 30, 2029.
(c) Preference
In awarding a grant under this section, the Secretary shall give preference to a State—
(1)
that has a high proportion of qualified LEP enrollees, as determined by the Secretary;
(2)
that has a large number of qualified LEP enrollees, as determined by the Secretary;
(3)
that has a high growth rate of the population of individuals with limited English proficiency, as determined by the Secretary; and
(4)
that has a population of qualified LEP enrollees that is linguistically diverse, requiring interpreter services in at least 200 non-English languages.
(d) Use of funds
A State receiving a grant under this section shall use the grant funds to—
(1)
ensure that all health care providers in the State participating in the State Medicaid plan have access to onsite interpreter services, for the purpose of enabling effective communication between such providers and qualified LEP enrollees during the furnishing of items and services and administrative interactions;
(2)
establish, expand, procure, or contract for—
(A)
a statewide health care information technology system that is designed to achieve efficiencies and economies of scale with respect to onsite interpreter services provided to health care providers in the State participating in the State Medicaid plan; and
(B)
an entity to administer such system, the duties of which shall include—
(i)
procuring and scheduling interpreter services for qualified LEP enrollees;
(ii)
procuring and scheduling interpreter services for individuals with limited English proficiency seeking to enroll in the State Medicaid plan;
(iii)
ensuring that interpreters receive payment for interpreter services rendered under the system; and
(iv)
consulting regularly with organizations representing LEP consumers, interpreters, and health care providers; and
(3)
develop mechanisms to establish, improve, and strengthen the competency of the medical interpretation workforce that serves qualified LEP enrollees in the State, including a national certification process that is valid, credible, and vendor-neutral.
(e) Application
To receive a grant under this section, a State shall submit an application at such time and containing such information as the Secretary may require, which shall include the following:
(1)
A description of the language access needs of individuals in the State enrolled in the State Medicaid plan.
(2)
A description of the extent to which the program will—
(A)
use the grant funds for the purposes described in subsection (d);
(B)
meet the health care needs of rural populations of the State; and
(C)
collect information that accurately tracks the language services requested by consumers as compared to the language services provided by health care providers in the State participating in the State Medicaid plan.
(3)
A description of how the program will be evaluated, including a proposal for collaboration with organizations representing interpreters, consumers, and individuals with limited English proficiency.
(f) Definitions
In this section:
(1) Qualified lep enrollee
The term qualified LEP enrollee means an individual—
(A)
who is limited English proficient; and
(B)
who is enrolled in a State Medicaid plan.
(2) State
The term State has the meaning given the term in section 1101(a)(1) of the Social Security Act (42 U.S.C. 1301(a)(1)), for purposes of title XIX of such Act (42 U.S.C. 1396 et seq.).
(3) State medicaid plan
The term State Medicaid plan means a State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) or a waiver of such a plan.
(4) United states
The term United States has the meaning given the term in section 1101(a)(2) of the Social Security Act (42 U.S.C. 1301(a)(2)), for purposes of title XIX of such Act (42 U.S.C. 1396 et seq.).
(g) Continuation past demonstration
Any State receiving a grant under this section must agree to directly pay for language services in Medicaid for all Medicaid providers by the end of the grant period.
(h) Funding
(1) Authorization of appropriations
There is authorized to be appropriated $5,000,000 to carry out this section.
(2) Availability of funds
Amounts appropriated pursuant to the authorization in paragraph (1) are authorized to remain available without fiscal year limitation.
(3) Increased federal financial participation
Section 1903(a)(2)(E) of the Social Security Act (42 U.S.C. 1396b(a)(2)(E)) is amended by inserting (or, in the case of a State that was awarded a grant under section 2005 of the Health Equity and Accountability Act of 2026, 100 percent for each quarter occurring during the grant period specified in subsection (b) of such section)
after 75 percent
.
(i) Limitation
No Federal funds awarded under this section may be used to provide interpreter services from a location outside the United States.
Sec. 2006. Training tomorrow’s doctors for culturally and linguistically appropriate care: graduate medical education
(a) Direct graduate medical education
Section 1886(h)(4) of the Social Security Act (42 U.S.C. 1395ww(h)(4)) is amended by adding at the end the following new subparagraph:
(L) Treatment of culturally and linguistically appropriate training
In determining a hospital’s number of full-time equivalent residents for purposes of this subsection, all the time that is spent by an intern or resident in an approved medical residency training program for education and training in culturally and linguistically appropriate service delivery, which shall include all medically underserved populations (as defined in section 330(b)(3) of the Public Health Service Act), shall be counted toward the determination of full-time equivalency.
(b) Indirect medical education
Section 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended by adding at the end the following new clause:
(xiv)
The provisions of subparagraph (L) of subsection (h)(4) shall apply under this subparagraph in the same manner as they apply under such subsection.
(c) Effective date
The amendments made by subsections (a) and (b) shall apply with respect to payments made to hospitals on or after the date that is 1 year after the date of the enactment of this Act.
Sec. 2007. Federal reimbursement for culturally and linguistically appropriate services under the Medicare, Medicaid, and State Children’s Health Insurance programs
(a) Language access grants for Medicare providers
(1) Establishment
(A) In general
Not later than 6 months after the date of the enactment of this Act, the Secretary of Health and Human Services (in this subsection referred to as the Secretary
), acting through the Centers for Medicare & Medicaid Services and in consultation with the Center for Medicare and Medicaid Innovation (as referred to in section 1115A of the Social Security Act (42 U.S.C. 1315a)), shall establish a demonstration program under which the Secretary shall award grants to eligible Medicare service providers to provide culturally and linguistically appropriate services to Medicare beneficiaries who are limited English proficient, including beneficiaries who live in ethnically, racially, geographically, socioeconomically diverse and underserved communities.
(B) Application of innovation rules
The demonstration project under subparagraph (A) shall be conducted in a manner that is consistent with the applicable provisions of subsections (b), (c), and (d) of section 1115A of the Social Security Act (42 U.S.C. 1315a).
(C) Number of grants
To the extent practicable, the Secretary shall award not less than 24 grants under this subsection.
(D) Grant period
Except as provided in paragraph (2)(D), each grant awarded under this subsection shall be for a 3-year period.
(2) Eligibility requirements
To be eligible for a grant under this subsection, an entity must meet the following requirements:
(A) Medicare provider
The entity must be—
(i)
a provider of services under part A of title XVIII of the Social Security Act (42 U.S.C. 1395c et seq.);
(ii)
a provider of services under part B of such title (42 U.S.C. 1395j et seq.);
(iii)
a Medicare Advantage organization offering a Medicare Advantage plan under part C of such title (42 U.S.C. 1395w–21 et seq.); or
(iv)
a PDP sponsor offering a prescription drug plan under part D of such title (42 U.S.C. 1395w–101 et seq.).
(B) Underserved communities
The entity must serve a community that, with respect to necessary language services for improving access and utilization of health care among individuals who are limited English proficient, is disproportionally underserved.
(C) Application
The entity must prepare and submit to the Secretary an application, at such time, in such manner, and accompanied by such additional information as the Secretary may require.
(D) Reporting
In the case of a grantee that received a grant under this subsection in a previous year, such grantee is only eligible for continued payments under a grant under this subsection if the grantee met the reporting requirements under paragraph (9) for such year. If a grantee fails to meet the requirements of such paragraph for the first year of a grant, the Secretary may terminate the grant and solicit applications from new grantees to participate in the demonstration program.
(3) Distribution
To the extent feasible, the Secretary shall award—
(A)
at least 10 grants to providers of services described in paragraph (2)(A)(i);
(B)
at least 10 grants to service providers described in paragraph (2)(A)(ii);
(C)
at least 10 grants to organizations described in paragraph (2)(A)(iii); and
(D)
at least 10 grants to sponsors described in paragraph (2)(A)(iv).
(4) Considerations in awarding grants
(A) Variation among grantees
In awarding grants under this subsection, the Secretary shall select grantees to ensure the following:
(i)
The grantees provide many different types of language services.
(ii)
The grantees serve Medicare beneficiaries who speak different languages, and who, as a population, have differing needs for language services.
(iii)
The grantees serve Medicare beneficiaries in both urban and rural settings.
(iv)
The grantees represent each Centers for Medicare & Medicaid Services region, as defined by the Secretary.
(v)
The grantees serve Medicare beneficiaries in at least 2 large metropolitan statistical areas with diverse populations, including diversity in race, ethnicity, sexual orientation, gender identity, disability status, and socioeconomic status.
(B) Priority for partnerships with community organizations and agencies
In awarding grants under this subsection, the Secretary shall give priority to eligible entities that have a partnership with 1 or more of the following entities that have experience in providing language services:
(i)
A community organization.
(ii)
A consortium of community organizations, State agencies, and local agencies.
(5) Use of funds for competent language services
(A) In general
Subject to subparagraph (E), a grantee may only use grant funds received under this subsection to pay for the provision of competent language services to Medicare beneficiaries who are individuals who are limited English proficient to supplement existing Medicare requirements.
(B) Competent language services defined
For purposes of this subsection, the term competent language services means—
(i)
interpreter and translation services that—
(I)
subject to the exceptions under subparagraph (C)—
(aa)
if the grantee operates in a State that has statewide health care interpreter standards, meet the State standards currently in effect; or
(bb)
if the grantee operates in a State that does not have statewide health care interpreter standards, utilize competent interpreters who follow the National Council on Interpreting in Health Care’s Code of Ethics and Standards of Practice and comply with the requirements of section 1557 of the Patient Protection and Affordable Care Act (42 U.S.C. 18116) as published in the Federal Register on May 18, 2016, 81 Fed. Reg. 31375; and
(II)
in the case of interpreter services, are provided through—
(aa)
onsite interpretation;
(bb)
telephonic interpretation; or
(cc)
video interpretation; and
(ii)
the direct provision of health care or health care-related services by a competent bilingual health care provider.
(C) Exceptions
(i) In general
The requirements of subparagraph (B)(i)(I) do not apply, with respect to interpreter and translation services and a grantee—
(I)
in the case of a Medicare beneficiary who is limited English proficient, if—
(aa)
such beneficiary has been informed, in the beneficiary’s primary language, of the availability of free interpreter and translation services and the beneficiary instead requests that a family member, friend, or other person provide such services; and
(bb)
the grantee documents such request in the beneficiary’s medical record; or
(II)
subject to clause (ii), in the case of a medical emergency where the delay directly associated with obtaining a competent interpreter or translation services would jeopardize the health of the patient.
(ii) Clarification
Clause (i)(II) shall not be construed to exempt emergency rooms or similar entities that regularly provide health care services in medical emergencies to patients who are individuals who are limited English proficient from any applicable legal or regulatory requirements related to providing competent interpreter and translation services without undue delay.
(D) Medicare advantage organizations and pdp sponsors
A grantee that is a Medicare Advantage organization or a prescription drug plan sponsor must provide at least 50 percent of the grant funds that the grantee receives under this subsection directly to the entity’s network providers (including all health providers and pharmacists) for the purpose of providing support for such providers to provide competent language services to Medicare beneficiaries who are individuals who are limited English proficient.
(E) Administrative and reporting costs
A grantee may use up to 10 percent of the grant funds to pay for administrative costs associated with the provision of competent language services and for reporting required under paragraph (9).
(6) Determination of amount of grant payments
(A) In general
Payments to grantees under this subsection shall be calculated based on the estimated numbers of Medicare beneficiaries who are limited English proficient in a grantee’s service area utilizing—
(i)
data on the numbers of English learners who speak English less than very well
from the most recently available data from the Bureau of the Census or other State-based study the Secretary determines is likely to yield accurate data regarding the number of such individuals in such service area; or
(ii)
data provided by the grantee, if the grantee routinely collects data on the primary language of the Medicare beneficiaries that the grantee serves and the Secretary determines that the data is accurate and shows a greater number of individuals who are limited English proficient than would be estimated using the data under clause (i).
(B) Discretion of secretary
Subject to subparagraph (C), the amount of payment made to a grantee under this subsection may be modified annually at the discretion of the Secretary, based on changes in the data under subparagraph (A) with respect to the service area of a grantee for the year.
(C) Limitation on amount
The amount of a grant made under this subsection to a grantee may not exceed $500,000 for the period under paragraph (1)(D).
(7) Assurances
Grantees under this subsection shall, as a condition of receiving a grant under this subsection—
(A)
ensure that clinical and support staff receive appropriate ongoing education and training in linguistically appropriate service delivery;
(B)
ensure the linguistic competence of bilingual providers;
(C)
offer and provide appropriate language services at no additional charge to each patient who is limited English proficient for all points of contact between the patient and the grantee, in a timely manner during all hours of operation;
(D)
not less frequently that annually, notify Medicare beneficiaries of their right to receive language services in their primary language without charge;
(E)
post signage in the primary languages commonly used by the patient population in the service area of the organization; and
(F)
ensure that—
(i)
primary language data are collected for recipients of language services and such data are consistent with standards developed under title XXXIV of the Public Health Service Act, as added by section 2002 of this Act, to the extent such standards are available upon the initiation of the demonstration program; and
(ii)
consistent with the privacy protections provided under the regulations promulgated pursuant to section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1320d–2 note), if the recipient of language services is a minor or is incapacitated, primary language data must also be collected on the parent or legal guardian of such recipient.
(8) No cost sharing
Medicare beneficiaries who are limited English proficient shall not have to pay cost sharing or co-payments for competent language services provided under this demonstration program.
(9) Reporting requirements for grantees
Not later than the end of each calendar year, a grantee that receives funds under this subsection in such year shall submit to the Secretary a report that includes the following information:
(A)
The number of Medicare beneficiaries to whom competent language services are provided, disaggregated by age and entitlement basis (on the basis of age, disability, or determination of end stage renal disease).
(B)
The primary languages of those Medicare beneficiaries.
(C)
The types of language services provided to such beneficiaries.
(D)
Whether such language services were provided by employees of the grantee or through a contract with external contractors or agencies.
(E)
The types of interpretation services provided to such beneficiaries, and the approximate length of time such service is provided to such beneficiaries.
(F)
The costs of providing competent language services.
(G)
An account of the training or accreditation of bilingual staff, interpreters, and translators providing services funded by the grant under this subsection.
(10) Evaluation and report to congress
Not later than 1 year after the completion of a 3-year grant under this subsection, the Secretary shall conduct an evaluation of the demonstration program under this subsection and shall submit to the Congress a report that includes the following:
(A)
An analysis of the patient outcomes and the costs of furnishing care to the Medicare beneficiaries who are individuals who are limited English proficient participating in the project as compared to such outcomes and costs for such Medicare beneficiaries not participating, based on the data provided under paragraph (9) and any other information available to the Secretary.
(B)
The effect of delivering language services on—
(i)
Medicare beneficiary access to care and utilization of services;
(ii)
the efficiency and cost-effectiveness of health care delivery;
(iii)
patient satisfaction with respect to both health service delivery and language assistance;
(iv)
health outcomes; and
(v)
the provision of culturally appropriate services provided to such beneficiaries.
(C)
The extent to which bilingual staff, interpreters, and translators providing services under such demonstration were trained or accredited and the nature of accreditation or training needed by type of provider, service, or other category as determined by the Secretary to ensure the provision of high-quality interpretation, translation, or other language services to Medicare beneficiaries if such services are expanded pursuant to section 1115A(c) of the Social Security Act (42 U.S.C. 1315a(c)).
(D)
Recommendations, if any, regarding the extension of such project to the entire Medicare Program, subject to the provisions of such section 1115A(c).
(11) Appropriations
There is appropriated to carry out this subsection, in equal parts from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t), $16,000,000 for each fiscal year of the demonstration program.
(12) Limited english proficient defined
In this subsection, the term limited English proficient means individuals who self-identify on the Census as speaking English less than very well
.
(b) Language assistance services under the Medicare program
(1) Inclusion as rural health clinic services
Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended—
(A)
in subsection (aa)(1)—
(i)
in subparagraph (C), by striking and
at the end;
(ii)
in subparagraph (D), by inserting and
after the comma at the end; and
(iii)
by inserting after subparagraph (D) the following new subparagraph:
(E)
language assistance services as defined in subsection (ooo),; and
(B)
by adding at the end the following new subsection:
(ooo) Language assistance services and related terms
The term language assistance services means language access or language assistance services (as those terms are defined in section 3400 of the Public Health Service Act) furnished by a qualified interpreter for an individual with limited English proficiency or a qualified translator (as those terms are defined in such section 3400) to an individual with limited English proficiency (as defined in such section 3400).
(2) Coverage
Section 1832(a)(2) of the Social Security Act (42 U.S.C. 1395k(a)(2)) is amended—
(A)
in subparagraph (I), by striking and
at the end;
(B)
in subparagraph (J), by striking the period at the end and inserting ; and
; and
(C)
by adding at the end the following new subparagraph:
(K)
language assistance services (as defined in section 1861(ooo)).
(3) Payment
Section 1833(a) of the Social Security Act (42 U.S.C. 1395l(a)) is amended—
(A)
in paragraph (9), by striking and
at the end;
(B)
in paragraph (10), by striking the period at the end and inserting ; and
; and
(C)
by inserting after paragraph (10) the following new paragraph:
(11)
in the case of language assistance services (as defined in section 1861(ooo)), 100 percent of the reasonable charges for such services, as determined in consultation with the Medicare Payment Advisory Commission.
(4) Waiver of budget neutrality
For the 3-year period beginning on the date of enactment of this section, the budget neutrality provision of section 1848(c)(2)(B)(ii) of the Social Security Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not apply with respect to language assistance services (as defined in section 1861(ooo) of such Act).
(c) Medicare parts C and D; Medicare Advantage plans and prescription drug plans reporting requirement
Section 1857(e) of the Social Security Act (42 U.S.C. 1395w–27(e)) is amended by adding at the end the following new paragraph:
(6) Reporting requirements relating to effective language services
A contract under this part shall require a Medicare Advantage organization (and, through application of section 1860D–12(b)(3)(D), a contract under section 1860D–12 shall require a PDP sponsor) to annually submit (for each year of the contract) a report that contains information on the internal policies and procedures of the organization (or sponsor) related to recruitment and retention efforts directed to workforce diversity and linguistically and culturally appropriate provision of services in each of the following contexts:
(A)
The collection of data in a manner that meets the requirements of title I of the Health Equity and Accountability Act of 2026, regarding the enrollee population.
(B)
Education of staff and contractors who have routine contact with enrollees regarding the various needs of the diverse enrollee population.
(C)
Evaluation of the language services programs and services offered by the organization (or sponsor) with respect to the enrollee population, such as through analysis of complaints or satisfaction survey results.
(D)
Methods by which the plan provides to the Secretary information regarding the ethnic diversity of the enrollee population.
(E)
The periodic provision of educational information to plan enrollees on the language services and programs offered by the organization (or sponsor).
(d) Improving language services in Medicaid and CHIP
(1) Payments to states
Section 1903(a)(2)(E) of the Social Security Act (42 U.S.C. 1396b(a)(2)(E)), as amended by section 2005(h)(3), is further amended by—
(A)
striking 75
and inserting 95
;
(B)
striking translation or interpretation services
and inserting language assistance services
; and
(C)
striking children of families
and inserting individuals
.
(2) State plan requirements
Section 1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended by striking and (30)
and inserting (30), and (32)
.
(3) Definition of medical assistance
Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended—
(A)
in paragraph (31), by striking and
at the end;
(B)
by redesignating paragraph (32) as paragraph (33); and
(C)
by inserting after paragraph (31) the following new paragraph:
(32)
language assistance services, as such term is defined in section 1861(nnn), provided in a timely manner to individuals with limited English proficiency as defined in section 3400 of the Public Health Service Act; and
(4) Use of deductions and cost sharing
Subsections (a)(2) and (b)(2) of section 1916 of the Social Security Act (42 U.S.C. 1396o) are each amended—
(A)
in subparagraph (I), by striking or
at the end;
(B)
in subparagraph (J), by striking ; and
and inserting , or
; and
(C)
by adding at the end the following new subparagraph:
(K)
language assistance services described in section 1905(a)(32); and
(5) CHIP coverage requirements
Section 2103 of the Social Security Act (42 U.S.C. 1397cc) is amended—
(A)
in subsection (a), in the matter before paragraph (1), by striking (5), (6), (7) and (8)
and inserting (5) through (13)
;
(B)
in subsection (c), by adding at the end the following new paragraph:
(13) Language assistance services
The child health assistance provided to a targeted low-income child shall include coverage of language assistance services, as such term is defined in section 1861(nnn), provided in a timely manner to individuals with limited English proficiency (as defined in section 3400 of the Public Health Service Act).; and
(C)
in subsection (e)(2)—
(i)
in the heading, by striking PREVENTIVE
and inserting CERTAIN
; and
(ii)
by inserting language assistance services described in subsection (c)(13),
before or for pregnancy-related assistance
.
(6) Definition of child health assistance
Section 2110(a)(27) of the Social Security Act (42 U.S.C. 1397jj(a)(27)) is amended by striking transportation, translation, and outreach services
and inserting transportation services, language assistance services as described in section 2103(c)(13), and outreach services
.
(7) State data collection
Pursuant to the reporting requirement described in section 2107(b)(1) of the Social Security Act (42 U.S.C. 1397gg(b)(1)), the Secretary of Health and Human Services shall require that States collect data on—
(A)
the primary language of individuals receiving child health assistance under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.); and
(B)
in the case of such individuals who are minors or incapacitated, the primary language of the individual’s parent or guardian.
(8) CHIP payments to states
Section 2105 of the Social Security Act (42 U.S.C. 1397ee) is amended—
(A)
in subsection (a)(1)—
(i)
in the matter preceding subparagraph (A), by striking 75
and inserting 95
; and
(ii)
in subparagraph (D)(iv), by striking translation or interpretation services
and inserting language assistance services
; and
(B)
in subsection (c)(2)(A), by inserting before the period at the end the following: , except that expenditures pursuant to clause (iv) of subparagraph (D) of such paragraph shall not count towards this total
.
(e) Funding language assistance services furnished by providers of health care and health care-Related services that serve high rates of uninsured LEP individuals
(1) Payment of costs
(A) In general
Subject to subparagraph (B), the Secretary shall make payments (on a quarterly basis) directly to eligible entities to support the provision of language assistance services to individuals with limited English proficiency in an amount equal to an eligible entity’s eligible costs for providing such services for the quarter.
(B) Funding
Out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary such sums as may be necessary for each of fiscal years 2027 through 2031.
(C) Relation to medicaid dsh
Payments under this subsection shall not offset or reduce payments under section 1923 of the Social Security Act (42 U.S.C. 1396r–4), nor shall payments under such section be considered when determining uncompensated costs associated with the provision of language assistance services for the purposes of this subsection.
(2) Methodology for payment of claims
(A) In general
The Secretary shall establish a methodology to determine the average per person cost of language assistance services.
(B) Different entities
In establishing such methodology, the Secretary may establish different methodologies for different types of eligible entities.
(C) No individual claims
The Secretary may not require eligible entities to submit individual claims for language assistance services for individual patients as a requirement for payment under this subsection.
(3) Data collection instrument
For purposes of this subsection, the Secretary shall create a standard data collection instrument that is consistent with any existing reporting requirements by the Secretary or relevant accrediting organizations regarding the number of individuals to whom language access is provided.
(4) Guidelines
Not later than 6 months after the date of enactment of this Act, the Secretary shall establish and distribute guidelines concerning the implementation of this subsection.
(5) Reporting requirements
(A) Report to secretary
Entities receiving payment under this subsection shall provide the Secretary with a quarterly report on how the entity used such funds. Such report shall contain aggregate (and may not contain individualized) data collected using the instrument under paragraph (3) and shall otherwise be in a form and manner determined by the Secretary.
(B) Report to congress
Not later than 2 years after the date of enactment of this Act, and every 2 years thereafter, the Secretary shall submit a report to Congress concerning the implementation of this subsection.
(6) Definitions
In this subsection:
(A) Eligible costs
The term eligible costs means, with respect to an eligible entity that provides language assistance services to limited English proficient individuals, the product of—
(i)
the average per person cost of language assistance services, determined according to the methodology devised under paragraph (2); and
(ii)
the number of individuals with limited English proficiency who are provided language assistance services by the entity and for whom no reimbursement is available for such services under the amendments made by subsection (a), (b), (c), or (d), or by private health insurance.
(B) Eligible entity
The term eligible entity means an entity that—
(i)
is a Medicaid provider that is—
(I)
a physician;
(II)
a hospital with a low-income utilization rate (as defined in section 1923(b)(3) of the Social Security Act (42 U.S.C. 1396r–4(b)(3))) of greater than 25 percent;
(III)
a Federally qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 1396d(l)(2)(B)));
(IV)
provider of long-term services and supports;
(V)
a hospice provider; or
(VI)
a palliative care provider;
(ii)
not later than 6 months after the date of the enactment of this Act, provides language assistance services to not less than 8 percent of the entity’s total number of patients; and
(iii)
prepares and submits an application to the Secretary, at such time, in such manner, and accompanied by such information as the Secretary may require, to ascertain the entity’s eligibility for funding under this subsection.
(C) Language assistance services
The term language assistance services has the meaning given such term in section 1861(nnn) of the Social Security Act, as added by subsection (b).
(f) Application of civil rights act of 1964, section 1557 of the affordable care act, and other laws
Nothing in this section shall be construed to limit otherwise existing obligations of recipients of Federal financial assistance under title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), section 1557 of the Affordable Care Act (42 U.S.C. 18116), or other laws that protect the civil rights of individuals.
(g) Effective date
(1) In general
Except as otherwise provided and subject to paragraph (2), the amendments made by this section shall take effect on January 1, 2027.
(2) Exception if state legislation required
In the case of a State plan for medical assistance under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) or a State plan for child health assistance under title XXI of such Act (42 U.S.C. 1397aa et seq.) which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirement imposed by the amendments made by this section, such State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.
Sec. 2008. Increasing understanding of and improving health literacy
(a) In general
The Secretary, in consultation with the Director of the National Institute on Minority Health and Health Disparities and the Deputy Assistant Secretary for Minority Health, shall award grants to eligible entities to improve health care for patient populations that have low health literacy.
(b) Eligibility
To be eligible to receive a grant under subsection (a), an entity shall—
(1)
be a hospital, health center or clinic, health plan, or other health entity (including a nonprofit minority health organization or association); and
(2)
prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may reasonably require.
(c) Use of funds
(1) Agency for healthcare research and quality
A grant under subsection (a) that is awarded through the Director of the Agency for Healthcare Research and Quality shall be used—
(A)
to define and increase the understanding of health literacy across all areas of health care, including end of life care;
(B)
to investigate the correlation between low health literacy and health and health care;
(C)
to clarify which aspects of health literacy have an effect on health outcomes; and
(D)
for any other activity determined appropriate by the Director.
(2) Health resources and services administration
A grant under subsection (a) that is awarded through the Administrator of the Health Resources and Services Administration shall be used to conduct demonstration projects for interventions for patients with low health literacy that may include—
(A)
the development of new disease management and end of life care programs for patients with low health literacy;
(B)
the tailoring of disease management programs and end of life care addressing mental, physical, oral, and behavioral health conditions for patients with low health literacy;
(C)
the translation of written health materials for patients with low health literacy;
(D)
the identification, implementation, and testing of low health literacy screening tools;
(E)
the conduct of educational campaigns for patients and providers about low health literacy;
(F)
the conduct of educational campaigns concerning health directed specifically at patients with mental disabilities, including those with cognitive and intellectual disabilities, designed to reduce the incidence of low health literacy among these populations, which shall have instructional materials in the plain language standards promulgated under the Plain Writing Act of 2010 (5 U.S.C. 301 note) for Federal agencies; and
(G)
other activities determined appropriate by the Administrator.
(d) Definitions
In this section:
(1) Low health literacy
The term low health literacy means the inability of an individual to obtain, process, and understand basic health information and services needed to make appropriate health decisions, and engage with and self-advocate within health care systems, including through completing documents and exercising patient rights.
(2) Secretary
The term Secretary means the Secretary of Health and Human Services—
(A)
acting through the Director of the Agency for Healthcare Research and Quality, with respect to grants under subsection (c)(1); and
(B)
acting through the Administrator of the Health Resources and Services Administration with respect to grants under subsection (c)(2).
(e) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
Sec. 2009. Requirements for health programs or activities receiving federal funds
(a) Covered entity; health program or activity
In this section:
(1) Covered entity
The term covered entity means an entity described in clause (i) of section 3401(a)(2)(C) of the Public Health Service Act, as added by section 2004.
(2) Health program or activity
The term health program or activity has the meaning given such term in clause (ii) of such section 3401(a)(2)(C).
(b) Requirements
A covered entity, in order to ensure the right of individuals with limited English proficiency to receive access to high-quality health care through the health program or activity, shall—
(1)
ensure that appropriate clinical and support staff receive ongoing education and training in culturally and linguistically appropriate service delivery at least annually;
(2)
offer and provide appropriate language assistance services at no additional charge to each patient that is an individual with limited English proficiency at all points of contact, in a timely manner during all hours of operation;
(3)
notify patients of their right to receive language services in their primary language; and
(4)
utilize only qualified interpreters for an individual with limited English proficiency or qualified translators, except as provided in subsection (c).
(c) Exemptions
The requirements of subsection (b)(4) shall not apply as follows:
(1)
When a patient requests the use of family, friends, or other persons untrained in interpretation or translation if each of the following conditions are met:
(A)
The interpreter requested by the patient is over the age of 18.
(B)
The covered entity informs the patient in the primary language of the patient that he or she has the option of having the entity provide to the patient an interpreter and translation services without charge.
(C)
The covered entity informs the patient that the entity may not require an individual with a limited English proficiency to use a family member or friend as an interpreter.
(D)
The covered entity evaluates whether the person the patient wishes to use as an interpreter is competent. If the covered entity has reason to believe that such person is not competent as an interpreter, the entity provides its own interpreter to protect the covered entity from liability if the patient’s interpreter is later found not competent.
(E)
If the covered entity has reason to believe that there is a conflict of interest between the interpreter and patient, the covered entity may not use the patient’s interpreter.
(F)
The covered entity has the patient sign a waiver, witnessed by at least 1 individual not related to the patient, that includes the information stated in subparagraphs (A) through (E) and is translated into the patient’s primary language.
(2)
When a medical emergency exists and the delay directly associated with obtaining competent interpreter or translation services would jeopardize the health of the patient, but only until a competent interpreter or translation service is available.
(d) Rule of construction
Subsection (c)(2) shall not be construed to mean that emergency rooms or similar entities that regularly provide health care services in medical emergencies are exempt from legal or regulatory requirements related to competent interpreter services.
Sec. 2010. Report on federal efforts to provide culturally and linguistically appropriate health care services
(a) Report
Not later than 1 year after the date of enactment of this Act, and annually thereafter, the Secretary of Health and Human Services shall seek to enter into a contract with the National Academy of Medicine for the preparation and publication of a report that describes Federal efforts to ensure that all individuals with limited English proficiency have meaningful access to health care services and health care-related services that are culturally and linguistically appropriate. Such report shall include—
(1)
a description and evaluation of the activities carried out under this Act;
(2)
a description and analysis of best practices, model programs, guidelines, and other effective strategies for providing access to culturally and linguistically appropriate health care services;
(3)
recommendations on the development and implementation of policies and practices by providers of health care services and health care-related services for individuals with limited English proficiency, including people with cognitive, hearing, vision, or print impairments;
(4)
recommend guidelines or standards for health literacy and plain language, informed consent, discharge instructions, and written communications, and for improvement of health care access;
(5)
a description of the effect of providing language services on quality of health care and access to care; and
(6)
a description of the costs associated with or savings related to the provision of language services.
(b) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
Sec. 2011. English instruction for individuals with limited english proficiency
(a) Grants authorized
The Secretary of Education is authorized to provide grants to eligible entities for the provision of English as a second language (in this section referred to as ESL
) instruction to individuals with limited English proficiency, including health care-related English instruction, and shall determine, after consultation with appropriate stakeholders, the mechanism for administering and distributing such grants.
(b) Eligible entity
In this section, the term eligible entity means—
(1)
a State; or
(2)
a community-based organization that predominantly employs and serves racial and ethnic minority groups (as defined in section 1707(g) of the Public Health Service Act (42 U.S.C. 300u–6(g))).
(c) Application
An eligible entity that desires to receive a grant under this section shall apply by submitting to the Secretary of Education an application at such time, in such manner, and containing such information as the Secretary may require.
(d) Use of grant
An eligible entity shall use grant funds provided under this section to—
(1)
develop and implement a plan for assuring the availability of ESL instruction, free of charge, to the community served by the eligible entity, that effectively integrates information about the nature of the United States health care system, how to access care, and any special language skills that may be required for individuals with limited English proficiency to access and regularly negotiate the health care system effectively;
(2)
develop a plan for making ESL instruction available free to charge to individuals with limited English proficiency in the community served by the eligible entity who are seeking instruction, including, where appropriate, through the use of public-private partnerships; and
(3)
provide ESL instruction to individuals with limited English proficiency in the community served by the eligible entity.
(e) Supplement, not supplant
An eligible entity awarded a grant under this section shall use funds made available under this section to supplement, and not supplant, other Federal, State, and local funds that would otherwise be expended to carry out activities under this section.
(f) Duties of the secretary
The Secretary of Education shall—
(1)
collect and make publicly available annual data on how much Federal, State, and local governments spend annually on ESL instruction;
(2)
collect data from eligible entities awarded a grant under this section to identify the unmet needs of individuals with limited English proficiency for appropriate ESL instruction, including—
(A)
the preferred written and spoken language of such individuals;
(B)
the availability of enrollment in ESL instruction programs in the communities served by each eligible entity awarded a grant under this section, including the extent of waiting lists for ESL instruction, how many programs maintain waiting lists, and, for programs that do not have waiting lists, the reasons why such a list is unnecessary or otherwise not maintained;
(C)
the availability of programs to geographically isolated communities;
(D)
the impact of course enrollment policies, including open enrollment, on the availability of ESL instruction;
(E)
the number of individuals with limited English proficiency and the number of individuals enrolled in ESL instruction programs in the communities served by each eligible entity awarded a grant under this section;
(F)
the effectiveness of the ESL instruction provided through grants awarded under this section in meeting the needs of individuals receiving such instruction; and
(G)
an assessment of the need for programs that integrate job training and ESL instruction, to assist individuals with limited English proficiency in obtaining better jobs;
(3)
determine the cost and most appropriate methods of making ESL instruction available to all individuals with limited English proficiency in the United States who are seeking instruction; and
(4)
not later than 1 year after the date of enactment of this Act, issue a report to Congress that—
(A)
assesses the information collected in paragraphs (1), (2), and (3) and makes recommendations on steps that should be taken to realize the goal of making ESL instruction available to all individuals with limited English proficiency in the United States who are seeking instruction; and
(B)
evaluates the impact of the grant program authorized under this section on the accessibility of, and ability to effectively negotiate, the health care system for individuals with limited English proficiency who have received ESL instruction funded by a grant under this section.
(g) Authorization of appropriations
There are authorized to be appropriated to the Secretary of Education $250,000,000 for each of fiscal years 2027 through 2031 to carry out this section.
Sec. 2012. Implementation
(a) General provisions
(1) Immunity
A person injured by a violation of this title (including an amendment made by this title) by a State may bring a civil action in the appropriate Federal court for such injury in accordance with this section.
(2) Remedies
In a civil action under this section for a violation of this title, such remedies shall be available as would be available in a civil action for such violation against any party other than a State.
(b) Rule of construction
Nothing in this title may be construed to limit otherwise existing obligations of recipients of Federal financial assistance under title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) or any other Federal statute.
Sec. 2013. Language access services
(a) Essential benefits
Section 1302(b)(1) of the Patient Protection and Affordable Care Act (42 U.S.C. 18022(b)(1)) is amended by adding at the end the following:
(K)
Language access services, including oral interpretation and written translations.
(b) Employer-Sponsored minimum essential coverage
(1) In general
Section 36B(c)(2)(C) of the Internal Revenue Code of 1986 is amended by redesignating clauses (iii) and (iv) as clauses (iv) and (v), respectively, and by inserting after clause (ii) the following new clause:
(iii) Coverage must include language access and services
Except as provided in clause (iv), an employee shall not be treated as eligible for minimum essential coverage if such coverage consists of an eligible employer-sponsored plan (as defined in section 5000A(f)(2)) and the plan does not provide coverage for language access services, including oral interpretation and written translations.
(2) Conforming amendments
(A)
Section 36B(c)(2)(C) of such Code is amended by striking clause (iii)
each place it appears in clauses (i) and (ii) and inserting clause (iv)
.
(B)
Section 36B(c)(2)(C)(iv) of such Code, as redesignated by this subsection, is amended by striking (i) and (ii)
and inserting (i), (ii), and (iii)
.
(c) Quality reporting
Section 2717(a)(1) of the Public Health Service Act (42 U.S.C. 300gg–17(a)(1)) is amended—
(1)
by striking and
at the end of subparagraph (C);
(2)
by striking the period at the end of subparagraph (D) and inserting ; and
; and
(3)
by adding at the end the following new subparagraph:
(E)
reduce health disparities through the provision of language access services, including oral interpretation and written translations.
(d) Regulations regarding internal claims and appeals and external review processes for health plans and health insurance issuers
The Secretary of the Treasury, the Secretary of Labor, and the Secretary of Health and Human Services shall amend the regulations in section 54.9815–2719(e) of title 26, Code of Federal Regulations (or successor regulations), section 2590.715–2719(e) of title 29, Code of Federal Regulations (or successor regulations), and section 147.136(e) of title 45, Code of Federal Regulations (or successor regulations), respectively, to require group health plans and health insurance issuers offering group or individual health insurance coverage to which such sections apply—
(1)
to provide oral interpretation services without any threshold requirements;
(2)
to provide in the English versions of all notices a statement prominently displayed in not less than 15 non-English languages clearly indicating how to access the language services provided by the plan or issuer; and
(3)
with respect to the requirements for providing relevant notices in a culturally and linguistically appropriate manner in the applicable non-English languages, to apply a threshold that 5 percent of the population, or not less than 500 individuals, in the county is literate only in the same non-English language in order for the language to be considered an applicable non-English language.
(e) Data collection and reporting
The Secretary of Health and Human Services shall—
(1)
amend the single streamlined application form developed pursuant to section 1413 of the Patient Protection and Affordable Care Act (42 U.S.C. 18083) to collect the preferred spoken and written language for each household member applying for coverage under a qualified health plan through an Exchange under title I of such Act (42 U.S.C. 18001 et seq.);
(2)
require navigators, certified application counselors, and other individuals assisting with enrollment to collect and report requests for language assistance; and
(3)
require the toll-free telephone hotlines established pursuant to section 1311(d)(4)(B) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(d)(4)(B)) to submit an annual report documenting the number of language assistance requests, the types of languages requested, the range and average wait time for a consumer to speak with an interpreter, the number of complaints and any steps the hotline, and any entity contracting with the Secretary to provide language services, have taken to actively address some of the consumer complaints.
(f) Effective date
The amendments made by this section shall not apply to plans beginning prior to the date of the enactment of this Act.
Sec. 2014. Medically underserved populations
Section 330(b)(3) of the Public Health Service Act (42 U.S.C. 254b(b)(3)) is amended to read as follows:
(3) Medically underserved population
The term medically underserved population means—
(A)
the population of an urban or rural area designated by the Secretary as—
(i)
an area with a shortage of personal health services; or
(ii)
a population group having a shortage of such services; or
(B)
a population of individuals, not confined to a particular urban or rural area, who are designated by the Secretary as having a shortage of personal health services due to a specific demographic trait.
Sec. 2015. Improving access to Federal services by individuals with limited English proficiency
(a) Ensuring meaningful access
(1) In general
Not later than 1 year after the date of the enactment of this Act, the head of each agency shall ensure that individuals with LEP can meaningfully access the federally conducted programs and activities of the agency, including by—
(A)
consistent with any applicable Language Access Technical Standards established by the agency under subsection (c)—
(i)
translating each vital document or content created for the public into—
(I)
any languages the agency frequently encounters; and
(II)
the dominant languages spoken in the United States based on current U.S. Census data; and
(ii)
adding multilingual functionality to agency digital and information technology systems to identify and track the spoken and written language needs of people who engage with the agency and to provide documents and content in other languages;
(B)
providing oral interpretation, sight translation, and telephonic or remote interpretation services to such individuals;
(C)
recognizing, as an alternative to using qualified interpreters or translators, the use of demonstrably bilingual staff of the agency that have been assessed and are qualified to deliver accurate and effective communication as an appropriate method of providing language assistance;
(D)
acknowledging that, when qualified, such staff may offer service that is faster, more effective, and more cost-efficient than the use of qualified interpreters or translators;
(E)
notifying the public of the availability of language assistance, including interpreters, translated documents and digital content, and bilingual staff, through the use of multilingual notices, taglines, signage or demonstrably equivalent alternatives included on documents and digital content the agency creates for the public and in agency buildings and offices; and
(F)
training employees of the agency who interact with the public on any policy or procedure established by the agency to implement the language access plan established by the agency under subsection (b).
(2) Public complaint and tracking system
(A) Complaints
The Attorney General shall establish and maintain a publicly accessible system for individuals to submit complaints to the Attorney General regarding barriers to receiving meaningful access, as described under paragraph (1), from an agency.
(B) Response
The head of the agency with respect to which the complaint was made shall respond to each complaint that was made not later than 60 days after receipt of the complaint from the Attorney General.
(C) Reports
The Attorney General shall publish on the website of the Department of Justice an annual report summarizing the complaints made under subparagraph (A), disaggregated by the agency that is the subject of the complaint, the language with respect to which the agency failed to provide access, and the program or activity to which the person is guaranteed meaningful access under paragraph (1).
(b) Language access plan
(1) Establishment
Not later than 1 year after the date of the enactment of this Act, the head of each agency shall establish a language access plan to implement subsection (a) that—
(A)
is practical and effective, readily implemented, and responsive to the particular circumstances and mission of the agency;
(B)
is consistent with the Language Access Technical Standards issued under subsection (c);
(C)
is consistent with the standards set forth—
(i)
in the initial LEP Guidance of the agency;
(ii)
in the policy guidance document entitled Enforcement of Title VI of the Civil Rights Act of 1964—National Origin Discrimination Against Persons With Limited English Proficiency
65 Fed. Reg. 50, 123 (Aug. 16, 2000); and
(iii)
in the Attorney General’s memorandum to the heads of Department components issued on November 21, 2022, entitled Strengthening the Federal Government’s Commitment to Language Access
;
(D)
identifies which populations containing individuals with LEP are likely to seek access to the services and programs of the agency, including language populations that are emerging, have been historically isolated, are of lesser diffusion, and do not have a commonly used written format;
(E)
describes how multilingual communications will be meaningfully provided to the populations identified pursuant under subparagraph (D), including whether such communications will be provided through oral, visual, or community-based modes of communication as appropriate;
(F)
in the case that the agency provides assistance during emergency response situations (such as disasters, public health crises, and other urgent circumstances) specifies how multilingual communications will be meaningfully provided to such populations during such situations regardless of whether an official state of emergency has been declared; and
(G)
sets procedures for the agency with respect to monitoring, evaluating, and improving the performance of the agency in implementing the plan, including—
(i)
regular assessments of the language access needs of the agency and the effectiveness of the language access provided by the agency;
(ii)
measurable performance indicators addressing timeliness, accuracy, and quality of language assistance services;
(iii)
mechanisms for collecting and reviewing data on service usage, complaints, and identified barriers;
(iv)
periodic internal reviews conducted by the civil rights office of the agency; and
(v)
processes for corrective action and continuous improvement when deficiencies or gaps in meaningful access are identified.
(2) Notice and comment
The head of each agency shall publish a proposal for the plan required to be established under paragraph (1) in the Federal Register for a 60-day public comment period to ensure that stakeholders, including individuals with LEP and organizations representing such individuals, have an adequate opportunity to provide input on how the head of such agency carries out the provisions of this section.
(3) Federal Register
After considering any comments received during the period described under paragraph (2) with respect to plan published under such paragraph, the head of an agency shall—
(A)
update such plan on the basis of such comments as the head of the agency determines appropriate; and
(B)
publish a finalized version of the plan in the Federal Register.
(4) Submission to the Attorney General and to congress
Not later than 30 days after the head of an agency establishes the language access plan required by paragraph (1), the head of such agency shall submit such plan to—
(A)
the Attorney General; and
(B)
the Chair and Ranking Minority Member of—
(i)
the Committee on the Judiciary of the House of Representatives;
(ii)
the Committee on the Judiciary of the Senate;
(iii)
the Committee on Oversight and Government Reform of the House of Representatives; and
(iv)
the Committee on Homeland Security and Governmental Affairs of the Senate.
(5) Central repository
The Department of Justice shall establish and maintain a publicly available website with the domain name LEP.gov
to serve as the central repository for each plan submitted to the Attorney General under paragraph (4)(A).
(c) Language access technical standards
(1) Establishment of standard
Not later than 1 year after the date of the enactment of this Act, the head of each agency, in consultation with the Attorney General, the National Institute of Standards and Technology, and stakeholders and advocates from non-English-speaking communities, shall establish standards to be known as Language Access Technical Standards to—
(A)
ensure meaningful access to federally conducted programs and activities under subsection (a); and
(B)
be used as a measure of progress to evaluate the effectiveness and accuracy of language access for federally conducted programs and activities carried out by each agency.
(2) General accessibility requirements
The Language Access Technical Standards shall at a minimum, with respect to the systems and services of the agency—
(A)
allow individuals with LEP to access any written content provided by the agency in the language of their choice among the agency’s supported languages;
(B)
ensure the functionality, quality, and timeliness of the system and services for all languages;
(C)
implement user-friendly interfaces that account for varying literacy and digital skills; and
(D)
be culturally determined.
(3) Undue burden exception
(A) Written request
In the case that the head of an agency determines that compliance with a specific requirement included in the Language Access Technical Standards established under this subsection would impose an undue burden on the agency, the head of the agency shall submit to the Attorney General a written request to waive such requirement for the agency that identifies—
(i)
the specific requirement that would impose such undue burden;
(ii)
the nature of the burden; and
(iii)
any alternative to fulfilling the requirement and why each such alternative is not feasible.
(B) Attorney General review
(i) In general
Not later than 30 days after receiving a request under subparagraph (A), the Attorney General shall grant or deny the request.
(ii) Determination criteria
In determining whether to grant or deny a request under paragraph (2), the Attorney General an agency shall consider whether—
(I)
individuals with limited English proficiency are likely to interact with the agency; and
(II)
a failure to provide meaningful language access is likely to result in significant harm, denial of benefits, or diminished civil rights protections.
(C) Expiration
A grant of a waiver under this subsection shall expire two years after such grant.
(D) Record
The Attorney General shall maintain a publicly accessible record of all written requests received under subparagraph (A) in the central repository established under subsection (b)(5).
(4) Public participation and comment
Before establishing Language Access Technical Standards, or updating any such standards, the head of an agency shall provide opportunity for public comment and engage communities representing individuals with LEP, including community and cultural organizations that work with individuals with LEP, and providers of professional language services.
(5) Updates
The Language Access Technical Standards shall be reviewed at least once every 3 years, and updated as necessary following such review.
(6) Adoption
The head of each agency shall certify compliance with the Language Access Technical Standards annually to the Attorney General.
(7) Scope
The Language Access Technical Standards shall apply to all agency programs, activities, and communications, including—
(A)
in-person, telephonic, and virtual interactions;
(B)
paper and digital content and documents;
(C)
websites, portals, and mobile applications; and
(D)
artificial intelligence-assisted and machine translation language assistance services, including automated translation, transcription, and interpretation technologies.
(d) AI and automated language assistance services
(1) Limitation
The head of an agency—
(A)
may not fully replace any qualified language assistance services of the agency with artificial intelligence or machine translation services; and
(B)
shall require a qualified human translator or interpreter to verify any use of such service or machine translation by the agency.
(2) Requirements
The head of each agency shall ensure that any artificial intelligence-assisted language assistance services used by the agency—
(A)
do not replace any qualified translators and interpreters;
(B)
publicly disclose on an annual basis on www.LEP.gov data sources, limitations, confidence levels, and error rates of the service;
(C)
comply with section 552a of title 5, United States Code (commonly referred to as the Privacy Act of 1974), the Federal Information Security Modernization Act of 2014, and the E–Government Act of 2002, and protect personal and sensitive information from disclosure;
(D)
are tested to prevent discrimination based on language, culture, ethnicity, or other protected characteristics, with mitigation strategies documented;
(E)
are reviewed and validated by qualified translators and interpreters to ensure proper cultural context, idiomatic accuracy, and clarity of the translation or interpretation; and
(F)
are continuously monitored by the agency for performance, with errors reported and corrective actions for user-reported inaccuracies in translation and interpretation implemented.
(3) Best practices
Not later than 1 year after the date of the enactment of this Act, the Attorney General shall issue guidance on best practices for the use of artificial intelligence in language assistance services, including validation, monitoring, and accountability measures for such artificial intelligence.
(4) Audit requirement
(A) In general
The Inspector General of each agency shall conduct, at least once every two years after the date of the enactment of this Act, an audit of all artificial intelligence-assisted language systems to assess accuracy, fairness, cultural relevance, and compliance with the Language Access Technical Standards established under subsection (c).
(B) Report
An Inspector General shall submit to the Attorney General a report on an audit conducted under subparagraph (A), not later than 90 days after such audit is completed.
(C) Public transparency
The Attorney General shall make publicly available a summary of the report submitted under subparagraph (B).
(5) NIST
The National Institute of Standards and Technology shall provide technical expertise, validation protocols, and standardization tools for artificial intelligence-assisted language assistance services.
(e) Interagency coordination
(1) Interagency Language Access Standard Council
The Administrator of General Services shall convene an Interagency Language Access Standards Council to coordinate updates, best practices, and research on emerging technologies.
(2) Language Access Working Group
(A) In general
There is established an Language Access Working Group to—
(i)
serve as a central resource for providing support and technical assistance to agencies in implementing the language access plan of the agency; and
(ii)
directly engage with community groups, individuals with LEP, and other stakeholders to ensure adherence with this section.
(B) Membership
The members of the Group shall be comprised of one Language Access Coordinator from each agency and the Attorney General.
(C) Head of group
The Attorney General shall serve as the head of the Group.
(f) Establishment of Language Access Coordinator position
(1) Position
There is established in each agency a position to be known as the Language Access Coordinator.
(2) Designation
The head of each agency shall designate an officer or employee of the agency to serve as the Language Access Coordinator for the agency.
(3) Duties
The Language Access Coordinator shall—
(A)
serve as point of contact for each language access effort of the agency;
(B)
shall ensure that each agency component that frequently interacts with individuals with LEP provides, if feasible, mandatory annual training to managers, personnel who frequently communicate with individuals with LEP, and personnel who arrange for language support, on this section, the language access plan of the agency, and agency procedures for identifying language access needs, providing language assistance services, working with interpreters and translators, requesting document translations, and tracking the use of language access services;
(C)
determine annually whether additional federally conducted programs and activities should be made accessible for individuals with LEP and notify agency components of their responsibility to provide such access; and
(D)
beginning on the date that is 3 years after the date of the enactment of this Act, evaluate the language access plan of the agency, including a review of the costs of language assistance services, and propose changes to agency components, as appropriate, to refine such plan.
(g) Noncompliance
Noncompliance with the requirements of this section—
(1)
shall be treated as discrimination under title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), thereby granting the Department of Justice enforcement authority, including the authority to conduct an investigation, commence an administrative action, and seek civil remedies; and
(2)
may trigger administrative, civil, or injunctive remedies by aggrieved parties or the Attorney General.
(h) Definitions
In this section:
(1) Agency
The term agency has the meaning given that term in section 551 of title 5, United States Code.
(2) Individual with LEP
The term individual with LEP means an individual for whom English is not a primary language and who has a limited ability to read, speak, write, or understand the English language (including an individual who is able to speak or understand the English language, but has a limited ability to read or write the English language).
(3) Language assistance services
The term language assistance services means oral and written language assistance services used to provide individuals with LEP meaningful access to, and an equal opportunity to participate fully in, the services, activities, and other programs administered by the Federal Government.
(4) Meaningful access
The term meaningful access means access that—
(A)
results in accurate, timely, and effective communication at no cost to the individual with LEP; and
(B)
is comparable to the access provided to individuals who are proficient in English.
(5) Primary language
The term primary language means the language in which an individual most effectively communicates.
(6) Program or activity
The term program or activity means all the operations of an agency that involve contact with the public, the administration of Federal benefits, or communication with members of the public or program participants.
(7) Qualified interpreter or translator
The term qualified interpreter or translator means—
(A)
an individual who—
(i)
is capable of effective, accurate, and impartial rendition of spoken or signed communication from one language to another between people who speak, sign, read, or write in a different language, both receptively and expressively, using any necessary specialized vocabulary and with appropriate cultural relevance, either simultaneously or consecutively;
(ii)
demonstrates to the Language Access Coordinator of the agency proficiency in and ability to listen to a spoken language, seeing or feeling a signed or manual language, or reading something written in one language and expressing what is being conveyed by that language accurately and with appropriate cultural relevance into another language, either simultaneously or consecutively, including with respect to any specialized term, concept, or any particularized vocabulary or phraseology particular to the program or service concerned that is being conveyed; and
(iii)
understands and adheres to the roles of interpreters or translators, including any confidentiality, ethics, and impartiality rules.
(8) Vital document
The term vital document means any written material containing information critical for—
(A)
accessing or understanding a Federal program or activity or required by law; or
(B)
obtaining any aid, benefit, service, or training, such as—
(i)
an application for a benefit or service;
(ii)
a consent or complaint form;
(iii)
a notice of rights and responsibilities; or
(iv)
a letter or notice that requires a response from a beneficiary, applicant, participant, or employee.
Sec. 2016. Stop Mental Health Stigma Act
(a) Definitions
In this section:
(1) AANHPI
The term AANHPI means Asian American, Native Hawaiian, and Pacific Islander.
(2) Secretary
Except as otherwise specified, the term Secretary means the Secretary of Health and Human Services.
(b) Findings
Congress finds the following:
(1)
The AANHPI community is among the fastest growing population groups in the United States. It is a diverse population representing more than 70 distinct ethnicities, and speaking more than 100 languages and dialects.
(2)
There is a growing mental health crisis in the United States, particularly for AANHPI individuals. AANHPI individuals with mental health challenges have the lowest rates of mental health service utilization compared to other racial or ethnic populations. In 2023, only 35 percent of Asian adults with a mental health challenge received treatment in the past year. Although suicide is the eleventh leading cause of death, it is the leading cause of death for AANHPI youth. From 2018 to 2023, AANHPI youth between the ages of 10 to 24 years were the only racial or ethnic population in this age category where suicide was the leading cause of death.
(3)
Such mental health disparities within the AANHPI community may be attributed to systemic barriers to accessing mental health services, including stigma attached to mental health, limited availability of and access to culturally and linguistically appropriate services, and insufficient research.
(4)
Insufficient research on AANHPI communities often leads to an inaccurate representation of their experiences and needs. It is imperative to disaggregate AANHPI population data to better understand the range of mental health issues for each subpopulation so that specific culturally and linguistically appropriate solutions can be developed.
(5)
Critical investments are necessary to reduce stigma and improve mental health within AANHPI communities, including increasing culturally and linguistically appropriate outreach education and mental health services, improving representation of AANHPI individuals among the behavioral health workforce, and strengthening disaggregated data collection in research.
(c) National AANHPI behavioral health outreach and education strategy
Part D of title V of the Public Health Service Act (42 U.S.C. 290dd et seq.) is amended by adding at the end the following new section:
554. National AANHPI behavioral health outreach and education strategy
(a) In general
The Secretary, acting through the Assistant Secretary, shall, in coordination with the Director of the Office of Minority Health, the Director of the National Institutes of Health, and the Director of the Centers for Disease Control and Prevention, and in consultation with advocacy and behavioral health organizations serving populations of Asian American, Native Hawaiian, and Pacific Islander individuals or communities, develop and implement a national outreach and education strategy to promote behavioral health and reduce stigma associated with mental health and substance use disorders within the Asian American, Native Hawaiian, and Pacific Islander population. Such strategy shall—
(1)
be designed to meet the diverse cultural and language needs and preferences of the various Asian American, Native Hawaiian, and Pacific Islander populations;
(2)
be developmentally and age appropriate;
(3)
increase awareness of symptoms of mental illnesses common within subgroups of such population, taking into account differences within subgroups, such as gender, gender identity, age, sexual orientation, culture, or ethnicity;
(4)
provide information, in a publicly accessible manner, on evidence-based, culturally and linguistically appropriate, and adapted interventions and treatments;
(5)
ensure full participation of, and engage, both consumers and community members in the development and implementation of materials; and
(6)
seek to broaden the perspective among both individuals in Asian American, Native Hawaiian, and Pacific Islander communities and stakeholders serving such communities to use a comprehensive public health approach to promoting behavioral health that addresses a holistic view of health by focusing on the intersection between behavioral and physical health.
(b) Reports
Beginning not later than 1 year after the date of the enactment of the Health Equity and Accountability Act of 2026 and annually thereafter, the Secretary, acting through the Assistant Secretary, shall submit to Congress, and make publicly available, a report on the extent to which the strategy developed and implemented under subsection (a) increased awareness among the Asian American, Native Hawaiian, and Pacific Islander population of mental health and substance use disorders.
(c) Authorization of appropriations
There is authorized to be appropriated to carry out this section $3,000,000 for each of fiscal years 2026 through 2030.
(d) Systematic review of and report on the AANHPI youth behavioral health crisis
(1) Systematic review
(A) In general
The Secretary, acting through the Assistant Secretary for Mental Health and Substance Use, in coordination with the Director of the National Institutes of Health, the Director of the Centers for Disease Control and Prevention, and the Director of the Office of Minority Health, shall conduct a systematic review of behavioral health among AANHPI youth.
(B) Elements
Such systematic review required under subparagraph (A) shall include an assessment of—
(i)
the prevalence, risk factors, and root causes of mental health challenges, substance misuse, and mental health and substance use disorders among AANHPI youth;
(ii)
the prevalence and methods of attempted suicide, nonfatal substance use overdose, and death by suicide or substance use overdose among AANHPI youth; and
(iii)
AANHPI youth that received treatment for mental health and substance use disorders.
(2) Report
Not later than one year after the date of the enactment of this Act, the Secretary shall 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, and make publicly available, a report on the findings of the systematic review conducted under paragraph (1), including—
(A)
identification of the barriers to accessing behavioral health prevention, treatment, and recovery services for AANHPI youth;
(B)
identification of root causes of mental health challenges and substance misuse among AANHPI youth;
(C)
recommendations for evidence-based actions to be taken by the Secretary to improve behavioral health among AANHPI youth;
(D)
recommendations for legislative or administrative action to improve the behavioral health of AANHPI youth experiencing depression, suicide, and overdose, and to reduce the prevalence of depression, suicide, overdose, and other behavioral health conditions among AANHPI youth; and
(E)
such other recommendations as the Secretary determines appropriate.
(3) Data
Any data included in the systematic review or report under this section shall be disaggregated by race, ethnicity, age, sex, gender identity, sexual orientation, geographic region, disability status, and other relevant factors, in a manner that protects personal privacy and that is consistent with applicable Federal and State privacy law.
(4) Authorization of appropriations
For purposes of carrying out this subsection, there is authorized to be appropriated $1,500,000 for fiscal year 2027.
(e) Systematic review of and report on strategies on the AANHPI behavioral health workforce shortage
(1) Systematic review
(A) In general
The Secretary, acting through the Assistant Secretary for Mental Health and Substance Use, in coordination with the Administrator of the Health Resources and Services Administration, the Secretary of Labor, and the Director of the Office of Minority Health, shall conduct a systematic review of strategies for increasing the behavioral health workforce that identify as AANHPI.
(B) Elements
Such systematic review required under subparagraph (A) shall include an assessment of—
(i)
the total number of behavioral health workers in the United States who identify as AANHPI;
(ii)
with respect to each such worker, information regarding the current type of license, geographic area of practice, and type of employer (such as hospital, Federally qualified health center, school, or private practice);
(iii)
information regarding the cultural and linguistic capabilities of such workers, including languages spoken proficiently;
(iv)
the relevant barriers to enrollment in behavioral health professional education programs and entering the behavioral health workforce for AANHPI individuals; and
(v)
the total number of behavioral health workers who identify as AANHPI and who participate in Federal programs that seek to increase, train, and support the behavioral health workforce.
(2) Report
Not later than one year after the date of the enactment of this Act, the Secretary shall 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, and make publicly available, a report on the findings of the systematic review conducted under paragraph (1), including—
(A)
identification of AANHPI behavioral health workers’ knowledge and awareness of the barriers to quality behavioral health care services faced by AANHPI individuals, including stigma, limited English proficiency, and lack of health insurance coverage;
(B)
recommendations for actions to be taken by the Secretary to increase the number of AANHPI behavioral health workers;
(C)
recommendations for legislative or administrative action to improve the enrollment of AANHPI individuals in behavioral health workforce education and training programs; and
(D)
such other recommendations as the Secretary determines appropriate.
(3) Data
Any data included in the systematic review or report under this section shall be disaggregated by race, ethnicity, age, sex, gender identity, sexual orientation, geographic region, disability status, and other relevant factors, in a manner that protects personal privacy and that is consistent with applicable Federal and State privacy law.
(4) Definition
In this section the term behavioral health worker means any individual licensed or certified to provide mental health or substance use disorder services, including in the professions of social work, psychology, psychiatry, marriage and family therapy, mental health counseling, peer support, and substance use disorder counseling.
(5) Authorization of appropriations
For purposes of carrying out this subsection, there is authorized to be appropriated $1,500,000 for fiscal year 2027.
Title III Health workforce diversity
Subtitle A Diversifying the health care workplace
Sec. 3001. Amendment to the Public Health Service Act
Title XXXIV of the Public Health Service Act, as added by section 2004, is amended by adding at the end the following:
B Diversifying the health care workplace
3411. National Working Group on Workforce Diversity
(a) In general
The Secretary, acting through the Bureau of Health Workforce of the Health Resources and Services Administration, shall award a grant to an entity determined appropriate by the Secretary for the establishment of a national working group on workforce diversity.
(b) Representation
In establishing the national working group under subsection (a):
(1)
The grantee shall ensure that the group has representatives of each of the following:
(A)
The Health Resources and Services Administration.
(B)
The Department of Health and Human Services Data Council.
(C)
The Office of Minority Health of the Department of Health and Human Services.
(D)
The Substance Abuse and Mental Health Services Administration.
(E)
The Bureau of Labor Statistics of the Department of Labor.
(F)
The National Institute on Minority Health and Health Disparities.
(G)
The Agency for Healthcare Research and Quality.
(H)
The National Academy of Medicine.
(I)
The Indian Health Service.
(J)
The Centers for Medicare & Medicaid Services.
(K)
The Department of Education.
(L)
Institutions described in section 371(a) of the Higher Education Act of 1965.
(M)
Consumer organizations.
(N)
Health professional associations, including those that represent underrepresented minority populations.
(O)
Researchers in the area of health workforce.
(P)
Health workforce accreditation entities.
(Q)
Private (including nonprofit) foundations that have sponsored workforce diversity initiatives.
(R)
Local and State health departments.
(S)
Representatives of community members to be included on admissions committees for health profession schools pursuant to subsection (c)(9).
(T)
National community-based organizations that serve as a national intermediary to their rural or urban affiliate members and have demonstrated capacity to train health care professionals.
(U)
The Veterans Health Administration.
(V)
Other entities determined appropriate by the Secretary.
(2)
The grantee shall ensure that, in addition to the representatives under paragraph (1), the working group has not less than 5 health professions students representing various health profession fields and levels of training.
(c) Activities
The working group established under subsection (a) shall convene at least twice each year to complete the following activities:
(1)
Review public and private health workforce diversity initiatives.
(2)
Identify successful health workforce diversity programs and practices.
(3)
Examine challenges relating to the development and implementation of health workforce diversity initiatives.
(4)
Draft a national strategic work plan for health workforce diversity, including recommendations for public and private sector initiatives.
(5)
Develop a framework and methods for the evaluation of current and future health workforce diversity initiatives.
(6)
Develop recommended standards for workforce diversity that could be applicable to all health professions programs and programs funded under this Act.
(7)
Develop guidelines to train health professionals to care for a diverse population.
(8)
Develop a workforce data collection or tracking system to identify where health professionals of racial and ethnic minority groups practice.
(9)
Develop a strategy for the inclusion of community members on admissions committees for health profession schools.
(10)
Help with monitoring of standards for diversity, equity, and inclusion.
(11)
Other activities determined appropriate by the Secretary.
(d) Annual report
Not later than 1 year after the establishment of the working group under subsection (a), and annually thereafter, the working group shall prepare and make available to the general public for comment, an annual report on the activities of the working group. Such report shall include the recommendations of the working group for improving health workforce diversity.
(e) Coordination with other efforts
In providing for the establishment of the working group under subsection (a), the Secretary shall take such steps as may be necessary to ensure that the work of the working group does not overlap with, or otherwise duplicate, other Federal Government efforts with respect to ensuring health equity in data collection in public health emergencies.
(f) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
3412. Technical clearinghouse for health workforce diversity
(a) In general
The Secretary, acting through the Deputy Assistant Secretary for Minority Health, and in collaboration with the Bureau of Health Workforce within the Health Resources and Services Administration and the National Institute on Minority Health and Health Disparities, shall establish a technical clearinghouse on health workforce diversity within the Office of Minority Health and coordinate current and future clearinghouses related to health workforce diversity.
(b) Information and services
The clearinghouse established under subsection (a) shall offer the following information and services:
(1)
Information on the importance of health workforce diversity.
(2)
Statistical information relating to representation of underrepresented minority populations in health and allied health professions and occupations.
(3)
Model health workforce diversity practices and programs, including integrated models of care.
(4)
Admissions policies that promote health workforce diversity and are in compliance with Federal and State laws.
(5)
Retainment policies that promote completion of health profession degrees for underserved populations.
(6)
Lists of scholarship, loan repayment, and loan cancellation grants as well as fellowship information for underserved populations for health professions schools.
(7)
Foundation and other large organizational initiatives relating to health workforce diversity.
(c) Consultation
In carrying out this section, the Secretary shall consult with non-Federal entities which may include health professional associations representing minority populations and sections of major health professional associations representing minority populations to ensure the adequacy and accuracy of information.
(d) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
3413. Support for institutions committed to workforce diversity, equity, and inclusion
(a) In general
The Secretary, acting through the Administrator of the Health Resources and Services Administration and the Director of the Centers for Disease Control and Prevention, shall award grants to eligible entities that demonstrate a commitment to health workforce diversity.
(b) Eligibility
To be eligible to receive a grant under subsection (a), an entity shall—
(1)
be an educational institution or entity that historically produces or trains meaningful numbers of underrepresented health professionals of minority populations, including—
(A)
part B institutions, as defined in section 322 of the Higher Education Act of 1965;
(B)
historically Black professional or graduate institutions eligible for grants under section 326 of such Act;
(C)
Hispanic-serving health professions schools;
(D)
Hispanic-serving institutions, as defined in section 502 of such Act;
(E)
Tribal Colleges or Universities, as defined in section 316 of such Act;
(F)
Asian American and Native American Pacific Islander-serving institutions, as defined in section 371(c) of such Act;
(G)
institutions that have programs to recruit and retain underrepresented health professionals of minority populations, in which a significant number of the enrolled participants are from minority populations;
(H)
health professional associations, which may include health professional associations representing underrepresented minority populations; and
(I)
institutions, including national and regional community-based organizations with demonstrated commitment to a diversified workforce—
(i)
located in communities with predominantly underrepresented minority populations;
(ii)
with whom partnerships have been formed for the purpose of increasing workforce diversity; and
(iii)
in which at least 20 percent of the enrolled participants are from underrepresented minority populations; and
(2)
submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(c) Use of funds
Amounts received under a grant under subsection (a) shall be used to expand existing workforce diversity programs, implement new workforce diversity programs, or evaluate existing or new workforce diversity programs, including with respect to mental health care professions. Such programs shall enhance diversity by considering status as a member of a minority population as part of an individualized consideration of qualifications. Possible activities may include—
(1)
educational outreach programs relating to opportunities in the health professions;
(2)
scholarship, fellowship, grant, loan repayment, and loan cancellation programs;
(3)
postbaccalaureate programs;
(4)
academic enrichment programs, particularly targeting those who would not be competitive for health professions schools;
(5)
supporting workforce diversity in kindergarten through 12th grade and other health pipeline programs;
(6)
mentoring programs;
(7)
internship or rotation programs involving hospitals, health systems, health plans, and other health entities;
(8)
community partnership development for purposes relating to workforce diversity; or
(9)
leadership training.
(d) Reports
Not later than 1 year after receiving a grant under this section, and annually for the term of the grant, a grantee shall submit to the Secretary a report that summarizes and evaluates all activities conducted under the grant.
(e) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
3414. Career development for scientists and researchers
(a) In general
The Secretary, acting through the Director of the National Institutes of Health, the Director of the Centers for Disease Control and Prevention, the Commissioner of Food and Drugs, the Director of the Agency for Healthcare Research and Quality, and the Administrator of the Health Resources and Services Administration, shall award grants that expand existing opportunities for scientists and researchers and promote the inclusion of underrepresented minority populations in the health professions.
(b) Research funding
The head of each agency listed in subsection (a) shall establish or expand existing programs to provide research funding to scientists and researchers in training. Under such programs, the head of each such entity shall give priority in allocating research funding to support health research in traditionally underserved communities, including underrepresented minority populations, and research classified as community or participatory.
(c) Data collection
The head of each agency listed in subsection (a) shall collect data on the number (expressed as an absolute number and a percentage) of underrepresented applicants from minority populations, and applicants from populations that are not minority populations, who receive and are denied agency funding at every stage of review. Such data shall be reported annually to the Secretary and the appropriate committees of Congress.
(d) Student loan reimbursement
The Secretary shall establish a student loan reimbursement program to provide student loan reimbursement assistance to researchers who focus on racial and ethnic disparities in health. The Secretary shall promulgate regulations to define the scope and procedures for the program under this subsection.
(e) Student loan cancellation
The Secretary shall establish a student loan cancellation program to provide student loan cancellation assistance to researchers who focus on racial and ethnic disparities in health. Students participating in the program shall make a minimum 5-year commitment to work at an accredited health professions school. The Secretary shall promulgate additional regulations to define the scope and procedures for the program under this subsection.
(f) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
3415. Career support for nonresearch health professionals
(a) In general
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, the Assistant Secretary for Mental Health and Substance Use, the Administrator of the Health Resources and Services Administration, and the Administrator of the Centers for Medicare & Medicaid Services, shall establish a program to award grants to universities and other institutions to enter into agreements with eligible individuals under which—
(1)
the university or institution supports the eligible individual’s career in a nonresearch-related health and wellness profession; and
(2)
the eligible individual commits to performing a period of obligated service in such a career to serve, or to work on health issues affecting, underserved communities, such as communities of racial and ethnic minority groups.
(b) Eligible individuals
To be an eligible individual for purposes of subsection (a), an individual shall be a student in a health professions school, a graduate of such a school who is working in a health profession, an individual working in a health or wellness profession (including mental and behavioral health), or a faculty member of such a school.
(c) Application
To seek a grant under this section, a university or other institution shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(d) Use of funds
A university or other institution receiving a grant under this section shall use the grant for agreements described in subsection (a). Such agreements may—
(1)
support an eligible individual’s health activities or projects that involve underserved communities, including communities of racial and ethnic minority groups;
(2)
support an eligible individual’s health-related career advancement activities;
(3)
pay, or reimburse for payment of, student loans or training or credentialing costs for eligible individuals who are health professionals and are focused on health issues affecting underserved communities, including communities of racial and ethnic minority groups; and
(4)
establish and promote leadership training programs for eligible individuals to decrease health disparities and to increase cultural competence with the goal of increasing diversity in leadership positions.
(e) Definition
In this section, the term career in a nonresearch-related health and wellness profession means employment or intended employment in the field of public health, health policy, health management, health administration, medicine, nursing, pharmacy, psychology, social work, psychiatry, other mental and behavioral health, allied health, community health, social work, or other fields determined appropriate by the Secretary, other than in a position that involves research.
(f) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
3416. Research on the effect of workforce diversity on quality
(a) In general
The Director of the Agency for Healthcare Research and Quality (in this section referred to as the
Director), in collaboration with the Deputy Assistant Secretary for Minority Health and the Director of the National Institute on Minority Health and Health Disparities, shall award grants to eligible entities to expand research on the link between health workforce diversity and quality health care.(b) Eligibility
To be eligible to receive a grant under subsection (a), an entity shall—
(1)
be a clinical, public health, or health services research entity or other entity determined appropriate by the Director; and
(2)
submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(c) Use of funds
Amounts received under a grant awarded under subsection (a) shall be used to support research that investigates the effect of health workforce diversity on—
(1)
language access;
(2)
cultural competence;
(3)
patient satisfaction;
(4)
timeliness of care;
(5)
safety of care;
(6)
effectiveness of care;
(7)
efficiency of care;
(8)
patient outcomes;
(9)
community engagement;
(10)
resource allocation;
(11)
organizational structure;
(12)
compliance of care; or
(13)
other topics determined appropriate by the Director.
(d) Priority
In awarding grants under subsection (a), the Director shall give individualized consideration to all relevant aspects of the applicant’s background. Consideration of prior research experience involving the health of underserved communities shall be such a relevant aspect.
(e) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
3417. Health disparities education program
(a) Establishment
The Secretary, acting through the Office of Minority Health, in collaboration with the National Institute on Minority Health and Health Disparities, the Office for Civil Rights, the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, the Health Resources and Services Administration, and other appropriate public and private entities, shall establish and coordinate a health and health care disparities education program to support, develop, and implement educational initiatives and outreach strategies that inform health care professionals and the public about the existence of and methods to reduce racial and ethnic disparities in health and health care.
(b) Activities
The Secretary, through the education program established under subsection (a), shall, through the use of public awareness and outreach campaigns targeting the general public and the medical community at large—
(1)
disseminate scientific evidence for the existence and extent of racial and ethnic disparities in health care, including disparities that are not otherwise attributable to known factors such as access to care, patient preferences, or appropriateness of intervention, as described in the 2002 report of the National Academy of Medicine (formerly the
Institute of Medicine) entitled Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, as well as the impact of disparities related to age, disability status, socioeconomic status, sex, gender identity, and sexual orientation on racial and ethnic minority groups;(2)
disseminate new research findings to health care providers and patients to assist them in understanding, reducing, and eliminating health and health care disparities;
(3)
disseminate information about the impact of linguistic and cultural barriers on health care quality and the obligation of health providers who receive Federal financial assistance to ensure that individuals with limited English proficiency have access to language access services;
(4)
disseminate information about the importance and legality of racial, ethnic, disability status, socioeconomic status, sex, gender identity, and sexual orientation, and primary language data collection, analysis, and reporting;
(5)
design and implement specific educational initiatives to health care providers relating to health and health care disparities;
(6)
assess the impact of the programs established under this section in raising awareness of health and health care disparities and providing information on available resources; and
(7)
design and implement specific educational initiatives to educate the health care workforce relating to unconscious bias.
(c) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
Sec. 3002. Hispanic-serving institutions, historically Black colleges and universities, historically Black professional or graduate institutions, Asian American and Native American Pacific Islander-serving institutions, Tribal Colleges, regional community-based organizations, and national minority medical associations
Part B of title VII of the Public Health Service Act (42 U.S.C. 293 et seq.) is amended by adding at the end the following:
742. Hispanic-serving institutions, historically Black colleges and universities, historically Black professional or graduate institutions, Asian American and Native American Pacific Islander-serving institutions, and Tribal Colleges
(a) In general
The Secretary, acting through the Administrator of the Health Resources and Services Administration and in consultation with the Secretary of Education, shall award grants to Hispanic-serving institutions, historically Black colleges and universities, historically Black professional or graduate institutions eligible for grants under section 326 of the Higher Education Act of 1965, Asian American and Native American Pacific Islander-serving institutions, Tribal Colleges or Universities, regional community-based organizations, and national minority medical associations, for counseling, mentoring, and providing information on financial assistance to prepare underrepresented minority individuals to enroll in and graduate from health professional schools and to increase services for underrepresented minority students including—
(1)
mentoring with underrepresented health professionals;
(2)
providing financial assistance information for continued education and applications to health professional schools; and
(3)
retaining existing enrolled underrepresented minority students in a health professions school.
(b) Definitions
In this section:
(1) Asian American and Native American Pacific Islander-serving institution
The term Asian American and Native American Pacific Islander-serving institution has the meaning given such term in section 320(b) of the Higher Education Act of 1965.
(2) Hispanic-serving institution
The term Hispanic-serving institution means an entity that—
(A)
is a school or program for which there is a definition under section 799B;
(B)
has an enrollment of full-time equivalent students that is made up of at least 9 percent Hispanic students;
(C)
has been effective in carrying out programs to recruit Hispanic individuals to enroll in and graduate from the school;
(D)
has been effective in recruiting and retaining Hispanic faculty members;
(E)
has a significant number of graduates who are providing health services to medically underserved populations or to individuals in health professional shortage areas; and
(F)
is a Hispanic Center of Excellence in Health Professions Education designated under section 736(d)(2).
(3) Historically Black college and university
The term historically Black college and university has the meaning given the term part B institution as defined in section 322 of the Higher Education Act of 1965.
(4) Tribal college or university
The term Tribal College or University has the meaning given such term in section 316(b) of the Higher Education Act of 1965.
(c) Certain loan repayment programs
In carrying out the National Health Service Corps Loan Repayment Program established under subpart III of part D of title III and the loan repayment program under section 317F, the Secretary shall ensure, notwithstanding such subpart or section, that loan repayments of not less than $50,000 per year per person are awarded for repayment of loans incurred for enrollment or participation of underrepresented minority individuals in health professional schools and other health programs described in this section.
(d) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
Sec. 3003. Loan repayment program of Centers for Disease Control and Prevention
Section 317F(c)(1) of the Public Health Service Act (42 U.S.C. 247b–7(c)(1)) is amended by striking $500,000 for fiscal year 1994, and such sums as may be necessary for each of the fiscal years 1995 through 2002
and inserting such sums as may be necessary for each of fiscal years 2027 through 2031
.
Sec. 3004. Cooperative agreements for online degree programs at schools of public health and schools of allied health
Part D of title VII of the Public Health Service Act (42 U.S.C. 294 et seq.) is amended by inserting after section 755 of such Act (42 U.S.C. 294e) the following:
755A. Cooperative agreements for online degree programs
(a) Cooperative agreements
The Secretary, acting through the Administrator of the Health Resources and Services Administration, in consultation with the Director of the Centers for Disease Control and Prevention, the Director of the Agency for Healthcare Research and Quality, and the Deputy Assistant Secretary for Minority Health, shall enter into cooperative agreements with schools of public health and schools of allied health to design and implement online degree programs.
(b) Priority
In entering into cooperative agreements under this section, the Secretary shall give priority to any school of public health or school of allied health that has an established track record of serving medically underserved communities.
(c) Requirements
As a condition of entering into a cooperative agreement with the Secretary under this section, a school of public health or school of allied health shall agree to design and implement an online degree program that meets the following restrictions:
(1)
Enrollment of individuals who have obtained a secondary school diploma or its recognized equivalent.
(2)
Maintaining a significant enrollment of underrepresented minority or disadvantaged students.
(3)
Achieving a high completion rate of enrolled underrepresented minority or disadvantaged students.
(d) Period of cooperative agreements
The period during which payments are made through a cooperative agreement entered into under this section may not exceed 3 years.
(e) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
Sec. 3005. National Health Care Workforce Commission
(a) Sense of Congress
It is the sense of Congress that the National Health Care Workforce Commission established by section 5101 of the Patient Protection and Affordable Care Act (42 U.S.C. 294q) should, in carrying out its assigned duties under that section, give attention to the needs of racial and ethnic minority groups, individuals with lower socioeconomic status, individuals with mental, developmental, and physical disabilities, lesbian, gay, bisexual, transgender, queer, and questioning populations, and individuals who are members of multiple minority or special population groups.
(b) Reauthorization
Section 5101(h)(2) of the Patient Protection and Affordable Care Act (42 U.S.C. 294q(h)(2)) is amended by striking such sums as may be necessary
and inserting $3,000,000 for each of fiscal years 2027 through 2029
.
Sec. 3006. Scholarship and fellowship programs
Subtitle B of title XXXIV of the Public Health Service Act, as added by section 3001, is further amended by inserting after section 3417 the following:
3418. David Satcher Public Health and Health Services Corps
(a) In general
The Director of the Centers for Disease Control and Prevention, in collaboration with the Administrator of the Health Resources and Services Administration and the Deputy Assistant Secretary for Minority Health, shall award grants to eligible entities to increase awareness among secondary and postsecondary students of career opportunities in the health professions.
(b) Eligibility
To be eligible to receive a grant under subsection (a), an entity shall—
(1)
be a clinical, public health, or health services organization, community-based or nonprofit entity, or other entity determined appropriate by the Director of the Centers for Disease Control and Prevention;
(2)
serve a health professional shortage area, as determined by the Secretary;
(3)
work with students, including those from racial and ethnic minority groups, that have expressed an interest in the health professions; and
(4)
submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(c) Use of funds
Grant awards under subsection (a) shall be used to support internships that will increase awareness among students of non-research-based, career opportunities in the following health professions:
(1)
Medicine.
(2)
Nursing.
(3)
Public health.
(4)
Pharmacy.
(5)
Health administration and management.
(6)
Health policy.
(7)
Psychology.
(8)
Dentistry.
(9)
International health.
(10)
Social work.
(11)
Allied health.
(12)
Psychiatry.
(13)
Hospice care.
(14)
Community health, patient navigation, and peer support.
(15)
Other professions determined appropriate by the Director of the Centers for Disease Control and Prevention.
(d) Priority
In awarding grants under subsection (a), the Director of the Centers for Disease Control and Prevention shall give priority to those entities that—
(1)
serve a high proportion of individuals from disadvantaged backgrounds;
(2)
have experience in health disparity elimination programs;
(3)
facilitate the entry of disadvantaged individuals into institutions of higher education; and
(4)
provide counseling or other services designed to assist disadvantaged individuals in successfully completing their education at the postsecondary level.
(e) Stipends
(1) In general
Subject to paragraph (2), an entity receiving a grant under this section may use the funds made available through such grant to award stipends for educational and living expenses to students participating in the internship supported by the grant.
(2) Limitations
A stipend awarded under paragraph (1) to an individual—
(A)
may not be provided for a period that exceeds 6 months; and
(B)
may not exceed $50 per day for an individual (notwithstanding any other provision of law regarding the amount of a stipend).
(f) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
3419. Louis Stokes Public Health Scholars Program
(a) In general
The Director of the Centers for Disease Control and Prevention, in collaboration with the Deputy Assistant Secretary for Minority Health, shall award scholarships to eligible individuals under subsection (b) who seek a career in public health.
(b) Eligibility
To be eligible to receive a scholarship under subsection (a), an individual shall—
(1)
have interest, knowledge, or skill in public health research or public health practice, or other health professions as determined appropriate by the Director of the Centers for Disease Control and Prevention;
(2)
reside in a health professional shortage area as determined by the Secretary;
(3)
demonstrate promise for becoming a leader in public health;
(4)
secure admission to a 4-year institution of higher education; and
(5)
submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(c) Use of funds
Amounts received under an award under subsection (a) shall be used to support opportunities for students to become public health professionals.
(d) Priority
In awarding grants under subsection (a), the Director shall give priority to those students that—
(1)
are from disadvantaged backgrounds;
(2)
have secured admissions to an institution described in section 371(a) of the Higher Education Act of 1965; and
(3)
have identified a health professional as a mentor at their institution described in subsection (b)(4) and an academic advisor to assist in the completion of their baccalaureate degree.
(e) Scholarships
The Secretary may approve payment of scholarships under this section for such individuals for any period of education in student undergraduate tenure, except that such a scholarship may not be provided to an individual for more than 4 years, and such a scholarship may not exceed $20,000 per academic year for an individual (notwithstanding any other provision of law regarding the amount of a scholarship).
(f) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
3420. Patsy Mink Health and Gender Research Fellowship Program
(a) In general
The Director of the Centers for Disease Control and Prevention, in collaboration with the Deputy Assistant Secretary for Minority Health, the Assistant Secretary for Mental Health and Substance Use, and the Director of the Indian Health Service, shall award research fellowships to eligible individuals under subsection (b) to conduct research that will examine gender and health disparities and to pursue a career in the health professions.
(b) Eligibility
To be eligible to receive a fellowship under subsection (a), an individual shall—
(1)
have experience in health research or public health practice;
(2)
reside in a health professional shortage area designated by the Secretary under section 332;
(3)
have expressed an interest in the health professions;
(4)
demonstrate promise for becoming a leader in the field of women’s sexual and reproductive health, including family planning;
(5)
secure admission to a health professions school or graduate program with an emphasis in gender studies; and
(6)
submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(c) Use of funds
A fellowship awarded under subsection (a) to an eligible individual under subsection (b) shall be used to support an opportunity for the individual to become a researcher and advance the research base on the intersection between gender and health.
(d) Priority
In awarding fellowships under subsection (a), the Director of the Centers for Disease Control and Prevention shall give priority to those applicants that—
(1)
are from disadvantaged backgrounds; and
(2)
have identified a mentor and academic advisor who will assist in the completion of their graduate or professional degree and have secured a research assistant position with a researcher working in the area of gender and health.
(e) Fellowships
The Director of the Centers for Disease Control and Prevention may approve fellowships for individuals under this section for any period of education in the student’s graduate or health profession tenure, except that such a fellowship may not be provided to an individual for more than 3 years, and such a fellowship may not exceed $25,000 per academic year for an individual (notwithstanding any other provision of law regarding the amount of a fellowship).
(f) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
3421. Paul David Wellstone International Health Fellowship Program
(a) In general
The Director of the Agency for Healthcare Research and Quality, in collaboration with the Deputy Assistant Secretary for Minority Health, shall award research fellowships to eligible individuals under subsection (b) to advance their understanding of international health.
(b) Eligibility
To be eligible to receive a fellowship under subsection (a), an individual shall—
(1)
have educational experience in the field of international health;
(2)
reside in a health professional shortage area as determined by the Secretary;
(3)
demonstrate promise for becoming a leader in the field of international health;
(4)
be in the fourth year of a 4-year institution of higher education or a recent graduate of a 4-year institution of higher education; and
(5)
submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(c) Use of funds
A fellowship awarded under subsection (a) to an eligible individual under subsection (b) shall be used to support an opportunity for the individual to become a health professional and to advance the knowledge of the individual about international issues relating to health care access and quality.
(d) Priority
In awarding fellowships under subsection (a), the Director of the Agency for Healthcare Research and Quality shall give priority to eligible individuals under subsection (b) that—
(1)
are from a disadvantaged background; and
(2)
have identified a mentor at a health professions school or institution, an academic advisor to assist in the completion of their graduate or professional degree, and an advisor from an international health non-governmental organization, private volunteer organization, or other international institution or program that focuses on increasing health care access and quality for residents in developing countries.
(e) Fellowships
A fellowship awarded under this section may not—
(1)
be provided to an eligible individual for more than a period of 6 months;
(2)
be awarded to a graduate of a 4-year institution of higher education that has not been enrolled in such institution for more than 1 year; or
(3)
exceed $8,000 per academic year (notwithstanding any other provision of law regarding the amount of a fellowship).
(f) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
3422. Edward R. Roybal Health Scholar Program
(a) In general
The Director of the Agency for Healthcare Research and Quality, the Administrator of the Centers for Medicare & Medicaid Services, and the Administrator of the Health Resources and Services Administration, in collaboration with the Deputy Assistant Secretary for Minority Health, shall award grants to eligible entities under subsection (b) to expose entering graduate students to the health professions.
(b) Eligibility
To be eligible to receive a grant under subsection (a), an entity shall—
(1)
be a clinical, public health, or health services organization, community-based, academic, or nonprofit entity, or other entity determined appropriate by the Director of the Agency for Healthcare Research and Quality;
(2)
serve in a health professional shortage area designated by the Secretary under section 332;
(3)
work with students obtaining a degree in the health professions; and
(4)
submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(c) Use of funds
Amounts received under a grant awarded under subsection (a) shall be used to support opportunities that expose students to non-research-based health professions, including—
(1)
public health policy;
(2)
health care and pharmaceutical policy;
(3)
health care administration and management;
(4)
health economics; and
(5)
other professions determined appropriate by the Director of the Agency for Healthcare Research and Quality, the Administrator of the Centers for Medicare & Medicaid Services, or the Administrator of the Health Resources and Services Administration.
(d) Priority
In awarding grants under subsection (a), the Director of the Agency for Healthcare Research and Quality, the Administrator of the Centers for Medicare & Medicaid Services, and the Administrator of the Health Resources and Services Administration, in collaboration with the Deputy Assistant Secretary for Minority Health, shall give priority to entities that—
(1)
have experience with health disparity elimination programs;
(2)
facilitate training in the fields described in subsection (c); and
(3)
provide counseling or other services designed to assist students in successfully completing their education at the postsecondary level.
(e) Stipends
(1) In general
Subject to paragraph (2), an entity receiving a grant under this section may use the funds made available through such grant to award stipends for educational and living expenses to students participating in the opportunities supported by the grant.
(2) Limitations
A stipend awarded under paragraph (1) to an individual—
(A)
may not be provided for a period that exceeds 2 months; and
(B)
may not exceed $100 per day (notwithstanding any other provision of law regarding the amount of a stipend).
(f) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
3423. Leadership fellowship programs
(a) In general
The Secretary shall award grants to national minority medical or health professional associations to develop leadership fellowship programs for underrepresented health professionals in order to—
(1)
assist such professionals in becoming future leaders in public health and health care delivery institutions; and
(2)
increase diversity in decision-making positions that can improve the health of underserved communities.
(b) Use of funds
A leadership fellowship program supported under this section shall—
(1)
focus on training mid-career physicians and health care executives who have documented leadership experience and a commitment to public health services in underserved communities; and
(2)
support Federal public health policy and budget programs, and priorities that impact health equity, through activities such as didactic lectures and leader site visits.
(c) Period of grants
The period during which payments are made under a grant awarded under subsection (a) may not exceed 3 years.
(d) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
Sec. 3007. McNair Postbaccalaureate Achievement Program
Section 402E of the Higher Education Act of 1965 (20 U.S.C. 1070a–15) is amended by striking subsection (g) and inserting the following:
(g) Collaboration in health profession diversity training programs
The Secretary shall coordinate with the Secretary of Health and Human Services to ensure that there is collaboration between the goals of the program under this section and programs of the Health Resources and Services Administration that promote health workforce diversity. The Secretary of Education shall take such measures as may be necessary to encourage students participating in projects assisted under this section to consider health profession careers.
(h) Funding
From amounts appropriated pursuant to the authority of section 402A(g), the Secretary shall, to the extent practicable, allocate funds for projects authorized by this section in an amount that is not less than $31,000,000 for each of the fiscal years 2027 through 2031.
Sec. 3008. Rules for determination of full-time equivalent residents for cost-reporting periods
(a) DGME determinations
Section 1886(h)(4) of the Social Security Act (42 U.S.C. 1395ww(h)(4)), as amended by section 2006(a), is amended—
(1)
in subparagraph (E), by striking Subject to subparagraphs (J) and (K), such rules
and inserting Subject to subparagraphs (J), (K), and (M), such rules
;
(2)
in subparagraph (J), by striking Such rules
and inserting Subject to subparagraph (M), such rules
;
(3)
in subparagraph (K), by striking In determining
and inserting Subject to subparagraph (M), in determining
; and
(4)
by adding at the end the following new subparagraph:
(M) Treatment of certain residents and interns
For purposes of cost-reporting periods beginning on or after October 1, 2027, in determining the hospital’s number of full-time equivalent residents for purposes of this paragraph, all time spent by an intern or resident in an approved medical residency training program shall be counted toward the determination of full-time equivalency if the hospital—
(i)
is recognized as a subsection (d) hospital;
(ii)
is recognized as a subsection (d) Puerto Rico hospital;
(iii)
is reimbursed under a reimbursement system authorized under section 1814(b)(3); or
(iv)
is a provider-based hospital outpatient department.
(b) IME determinations
Section 1886(d)(5)(B)(xi) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)(xi)) is amended—
(1)
in subclause (II), by striking In determining
and inserting Subject to subclause (IV), in determining
;
(2)
in subclause (III), by striking In determining
and inserting Subject to subclause (IV), in determining
; and
(3)
by inserting after subclause (III) the following new subclause:
(IV)
For purposes of cost-reporting periods beginning on or after October 1, 2027, the provisions of subparagraph (M) of subsection (h)(4) shall apply under this subparagraph in the same manner as they apply under such subsection.
Sec. 3009. Developing and implementing strategies for local health equity
(a) Grants
The Secretary of Health and Human Services, acting jointly with the Secretary of Education and the Secretary of Labor, shall make grants to eligible institutions of higher educations for the purposes of—
(1)
in accordance with subsection (b), developing capacity—
(A)
to build an evidence base for successful strategies for increasing local health equity; and
(B)
to serve as national models of driving local health equity; and
(2)
in accordance with subsection (c), developing a strategic partnership with the community in which the institution is located.
(b) Developing capacity for increasing local health equity
As a condition of receipt of a grant under subsection (a), an institution of higher education shall agree to use such grant to build an evidence base for successful strategies for increasing local health equity, and to serve as a national model of driving local health equity, by supporting—
(1)
resources to strengthen institutional metrics and capacity to execute institution-wide health workforce goals that can serve as models for increasing health equity in communities across the United States;
(2)
collaborations among a cohort of institutions in implementing systemic change, partnership development, and programmatic efforts supportive of health equity goals across disciplines and populations; and
(3)
enhanced or newly developed data systems and research infrastructure capable of informing current and future workforce efforts and building a foundation for a broader research agenda targeting urban health disparities.
(c) Strategic partnerships
As a condition of receipt of a grant under subsection (a), an institution of higher education shall agree to use the grant to develop a strategic partnership with the community in which such institution is located for the purposes of—
(1)
strengthening connections between such institution and the community—
(A)
to improve evaluation of, and address, the health and health workforce needs of such community; and
(B)
to engage such community in health workforce development;
(2)
developing, enhancing, or accelerating innovative undergraduate and graduate programs in the biomedical sciences and health professions; and
(3)
strengthening pipeline programs in the biomedical sciences and health professions, including by developing partnerships between institutions of higher education and elementary schools and secondary schools to recruit the next generation of health professionals earlier in the pipeline to a health care career.
(d) Definition of eligible institution of higher education
For purposes of this section, the term eligible institution of higher education includes—
(1)
a program authorized under section 317(a) of the Higher Education Act of 1965 (20 U.S.C. 1059d(a)); and
(2)
a professional or graduate institution described in section 326 of such Act (20 U.S.C. 1063b).
(e) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
Sec. 3010. Health Professions Workforce Fund
(a) Establishment
There is established in the Health Resources and Services Administration of the Department of Health and Human Services a Health Professions Workforce Fund to provide for expanded and sustained national investment in the health professions and nursing workforce development programs under titles VII and title VIII of the Public Health Service Act (42 U.S.C. 292 et seq.; 42 U.S.C. 296 et seq.).
(b) Funding
(1) In general
There is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, to the Health Professions Workforce Fund—
(A)
$392,000,000 for fiscal year 2027;
(B)
$412,000,000 for fiscal year 2028;
(C)
$432,000,000 for fiscal year 2029;
(D)
$454,000,000 for fiscal year 2030;
(E)
$476,000,000 for fiscal year 2031;
(F)
$500,000,000 for fiscal year 2032;
(G)
$525,000,000 for fiscal year 2033; and
(H)
$552,000,000 for fiscal year 2034.
(2) Health professions education programs
For the purpose of carrying out health professions education programs authorized under title VII of the Public Health Service Act (42 U.S.C. 292 et seq.), in addition to any other amounts authorized to be appropriated for such purpose, there is authorized to be appropriated out of any monies in the Health Professions Workforce Fund, the following:
(A)
$265,000,000 for fiscal year 2027.
(B)
$278,000,000 for fiscal year 2028.
(C)
$292,000,000 for fiscal year 2029.
(D)
$307,000,000 for fiscal year 2030.
(E)
$322,000,000 for fiscal year 2031.
(F)
$338,000,000 for fiscal year 2032.
(G)
$355,000,000 for fiscal year 2033.
(H)
$373,000,000 for fiscal year 2034.
(3) Nursing workforce development programs
For the purpose of carrying out nursing workforce development programs authorized under title VIII of the Public Health Service Act (42 U.S.C. 296 et seq.), in addition to any other amounts authorized to be appropriated for such purpose, there is authorized to be appropriated out of any monies in the Health Professions Workforce Fund, the following:
(A)
$127,000,000 for fiscal year 2027.
(B)
$134,000,000 for fiscal year 2028.
(C)
$140,000,000 for fiscal year 2029.
(D)
$147,000,000 for fiscal year 2030.
(E)
$154,000,000 for fiscal year 2031.
(F)
$162,000,000 for fiscal year 2032.
(G)
$170,000,000 for fiscal year 2033.
(H)
$179,000,000 for fiscal year 2034.
Sec. 3011. Future advancement of academic nursing
(a) Support for nursing education and the future nursing workforce
Part D of title VIII of the Public Health Service Act (42 U.S.C. 296p et seq.) is amended by adding at the end the following:
832. Nursing education enhancement and modernization grants in underserved areas
(a) In general
The Secretary, acting through the Administrator of the Health Resources and Services Administration, may award grants to schools of nursing for—
(1)
increasing the number of faculty and students at such schools in order to enhance the preparedness of the United States for, and the ability of the United States to address and quickly respond to, public health emergencies declared under section 319 and pandemics; or
(2)
the enhancement and modernization of nursing education programs.
(b) Priority
In selecting grant recipients under this section, the Secretary shall give priority to schools of nursing that—
(1)
are located in a medically underserved community;
(2)
are located in a health professional shortage area as defined under section 332(a); or
(3)
are institutions of higher education listed under section 371(a) of the Higher Education Act of 1965.
(c) Consideration
In awarding grants under this section, the Secretary, to the extent practicable, may ensure equitable distribution of awards among the geographic regions of the United States.
(d) Use of funds
A school of nursing that receives a grant under this section may use the funds awarded through such grant for activities that include—
(1)
enhancing enrollment and retention of students at such school, with a priority for students from disadvantaged backgrounds (including racial or ethnic groups underrepresented in the nursing workforce), individuals from rural and underserved areas, low-income individuals, and first generation college students (as defined in section 402A(h)(3) of the Higher Education Act of 1965);
(2)
creating, supporting, or modernizing educational programs and curriculum at such school;
(3)
retaining current faculty, and hiring new faculty, with an emphasis on faculty from racial or ethnic groups who are underrepresented in the nursing workforce;
(4)
modernizing infrastructure at such school, including audiovisual or other equipment, personal protective equipment, simulation and augmented reality resources, telehealth technologies, and virtual and physical laboratories;
(5)
partnering with a health care facility, nurse-managed health clinic, community health center, or other facility that provides health care in order to provide educational opportunities for the purpose of establishing or expanding clinical education;
(6)
enhancing and expanding nursing programs that prepare nurse researchers and scientists;
(7)
establishing nurse-led intradisciplinary and interprofessional educational partnerships; and
(8)
other activities that the Secretary determines further the development, improvement, and expansion of schools of nursing.
(e) Reports from entities
Each school of nursing awarded a grant under this section shall submit an annual report to the Secretary on the activities conducted under such grant.
(f) Report to Congress
Not later than 5 years after the date of the enactment of this section, the Secretary shall 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 that provides a summary of the activities and outcomes associated with grants made under this section. Such report shall include—
(1)
a list of schools of nursing receiving grants under this section, including the primary geographic location of any school of nursing that was improved or expanded through such a grant;
(2)
the total number of students who are enrolled at or who have graduated from any school of nursing that was improved or expanded through a grant under this section;
(3)
to the extent such information is available, the effects of the grants awarded under this section on retaining and hiring of faculty, including any increase in diverse faculty, the number of clinical education partnerships, the modernization of nursing education infrastructure, and other ways this section helps address and quickly respond to public health emergencies and pandemics;
(4)
recommendations for improving the grants awarded under this section; and
(5)
any other considerations as the Secretary determines appropriate.
(g) Authorization of appropriations
To carry out this section, there is authorized to be appropriated $1,000,000,000, to remain available until expended.
(b) Strengthening nurse education
The heading of part D of title VIII of the Public Health Service Act (42 U.S.C. 296p et seq.) is amended by striking Basic
.
Sec. 3012. Sense of Congress relating to graduate medical education
It is the sense of Congress that eliminating the limit of the number of residency positions that receive some level of Medicare support under section 1886(h) of the Social Security Act (42 U.S.C. 1395ww(h)), also referred to as the Medical graduate medical education cap, is critical to—
(1)
ensuring an appropriate supply of physicians to meet the health care needs in the United States;
(2)
facilitating equitable access for all who seek health care;
(3)
increasing the racial and ethnic diversity of physicians in the United States; and
(4)
mitigating disparities in health and health care.
Sec. 3013. Career support for skilled, internationally educated health professionals
(a) Grants to eligible entities
(1) Authority to provide grants
The Secretary of Health and Human Services (in this section referred to as the Secretary
), acting through the Bureau of Health Workforce within the Health Resources and Services Administration, the National Institute on Minority Health and Health Disparities, or the Office of Minority Health, may award grants to eligible entities under paragraph (2) to carry out activities described in subsection (b).
(2) Eligibility
To be eligible to receive a grant under this section, an entity shall—
(A)
be a clinical, public health, or health services organization, a community-based or nonprofit entity, an academic institution, a faith-based organization, a State, county, or local government, an area health education center, or another entity determined appropriate by the Secretary; and
(B)
submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(b) Authorized activities
A grant awarded under this section shall be used—
(1)
to provide services to assist unemployed and underemployed skilled immigrants, residing in the United States, who have legal, permanent work authorization and who are internationally educated health professionals, enter into the health workforce of the United States with employment matching their health professional skills and education, and advance in employment to positions that better match their health professional education and expertise;
(2)
to provide training opportunities to reduce barriers to entry and advancement in the health workforce for skilled, internationally educated immigrants;
(3)
to educate employers regarding the abilities and capacities of internationally educated health professionals;
(4)
to assist in the evaluation of foreign credentials;
(5)
to support preceptorships for international medical graduates in primary care training; and
(6)
to facilitate access to contextualized and accelerated courses on English as a second language.
Sec. 3014. Study and report on strategies for increasing diversity
(a) Study
The Comptroller General of the United States shall conduct a study on strategies for increasing the diversity of the health professional workforce. Such study shall include an analysis of strategies for increasing the number of health professionals from rural, lower income, and underrepresented minority communities, including which strategies are most effective for achieving such goal.
(b) Report
Not later than 2 years after the date of enactment of this Act, the Comptroller General shall submit to Congress a report on the study conducted under subsection (a), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.
Sec. 3015. Conrad State 30 program; physician retention
(a) Conrad State 30 program extension
(1) In general
Section 220(c) of the Immigration and Nationality Technical Corrections Act of 1994 (Public Law 103–416; 8 U.S.C. 1182 note) is amended by striking September 30, 2015
and inserting the date that is 3 years after the date of the enactment of the Health Equity and Accountability Act of 2026
.
(2) Effective date
The amendment made by paragraph (1) shall take effect as if enacted on September 30, 2018.
(b) Retaining physicians who have practiced in medically underserved communities
Section 201(b)(1) of the Immigration and Nationality Act (8 U.S.C. 1151(b)(1)) is amended by adding at the end the following:
(F)
(i)
Alien physicians who have completed service requirements of a waiver requested under section 203(b)(2)(B)(ii), including—
(I)
alien physicians who completed such service before the date of the enactment of the Health Equity and Accountability Act of 2026; and
(II)
the spouse or children of an alien physician described in subclause (I).
(ii)
Nothing in this subparagraph may be construed—
(I)
to prevent the filing of a petition with the Secretary of Homeland Security for classification under section 204(a) or the filing of an application for adjustment of status under section 245 by an alien physician described in clause (i)(I) before the date on which such alien physician completed the service described in section 214(l) or worked full-time as a physician for an aggregate of 5 years at the location identified in the section 214(l) waiver or in an area or areas designated by the Secretary of Health and Human Services as having a shortage of health care professionals; or
(II)
to permit the Secretary of Homeland Security to grant a petition or application described in subclause (I) until the alien has satisfied all of the requirements of the waiver received under section 214(l).
(c) Employment protections for physicians
(1) Exceptions to 2-year foreign residency requirement
Section 214(l)(1) of the Immigration and Nationality Act (8 U.S.C. 1184(l)(1)) is amended—
(A)
in the matter preceding subparagraph (A), by striking Attorney General
and inserting Secretary of Homeland Security
;
(B)
in subparagraph (A), by striking Director of the United States Information Agency
and inserting Secretary of State
;
(C)
in subparagraph (B), by inserting , except as provided in paragraphs (7) and (8)
before the semicolon at the end;
(D)
in subparagraph (C), by amending clauses (i) and (ii) to read as follows:
(i)
the alien demonstrates a bona fide offer of full-time employment at a health facility or health care organization, which employment has been determined by the Secretary of Homeland Security to be in the public interest; and
(ii)
the alien—
(I)
has accepted employment with the health facility or health care organization in a geographic area or areas which are designated by the Secretary of Health and Human Services as having a shortage of health care professionals;
(II)
begins employment by the later of the date that is—
(aa)
120 days after receiving such waiver;
(bb)
120 days after completing graduate medical education or training under a program approved pursuant to section 212(j)(1); or
(cc)
120 days after receiving nonimmigrant status or employment authorization, if the alien or the alien’s employer petitions for such nonimmigrant status or employment authorization not later than 120 days after the date on which the alien completes his or her graduate medical education or training under a program approved pursuant to section 212(j)(1); and
(III)
agrees to continue to work for a total of not less than 3 years in the status authorized for such employment under this subsection, except as provided in paragraph (8); and; and
(E)
in subparagraph (D), in the matter preceding clause (i), by inserting except as provided in paragraph (8),
before in the case
.
(2) Allowable visa status for physicians fulfilling waiver requirements in medically underserved areas
Section 214(l)(2)(A) of such Act (8 U.S.C. 1184(l)(2)(A)) is amended to read as follows:
(A)
Upon the request of an interested Federal agency or an interested State agency for recommendation of a waiver under this section by a physician who is maintaining valid nonimmigrant status under section 101(a)(15)(J) and received a favorable recommendation by the Secretary of State, the Secretary of Homeland Security may adjust the status of such physician to any status authorized for employment under this Act. The numerical limitations set forth in subsection (g)(1)(A) shall not apply to any alien whose status is adjusted pursuant to this subparagraph.
(3) Violation of agreements
Section 214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is amended by inserting substantial requirement of an
before agreement entered into
.
(4) Physician employment in underserved areas
Section 214(l) of such Act, as amended by this subsection, is further amended by adding at the end the following:
(4)
(A)
If an interested State agency denies an application for a waiver under paragraph (1)(B) from a physician pursuing graduate medical education or training pursuant to section 101(a)(15)(J) because the State has requested the maximum number of waivers permitted for that fiscal year, the physician’s nonimmigrant status shall be extended for up to 6 months if the physician agrees to seek a waiver under this subsection (except for paragraph (1)(D)(ii)) to work for an employer described in paragraph (1)(C) in a State that has not yet requested the maximum number of waivers.
(B)
Such physician shall be authorized to work only for the employer referred to in subparagraph (A) during the period beginning on the date on which a new waiver application is filed with such State and ending on the earlier of—
(i)
the date on which the Secretary of Homeland Security denies such waiver; or
(ii)
the date on which the Secretary approves an application for adjustment of status under paragraph (2)(A) pursuant to the approval of such waiver.
(5) Contract requirements
Section 214(l) of such Act, as amended by this subsection, is further amended by adding at the end the following:
(5)
An alien granted a waiver under paragraph (1)(C) shall enter into an employment agreement with the contracting health facility or health care organization that—
(A)
specifies—
(i)
the maximum number of on-call hours per week (which may be a monthly average) that the alien will be expected to be available; and
(ii)
the compensation the alien will receive for on-call time;
(B)
specifies—
(i)
whether the contracting facility or organization—
(I)
has secured medical malpractice liability protection for the alien under section 224(g) of the Public Health Service Act (42 U.S.C. 233(g)); or
(II)
will pay the alien's malpractice insurance premiums; and
(ii)
the amount of such liability protection that will be provided;
(C)
describes all of the work locations that the alien will work and includes a statement that the contracting facility or organization will not add additional work locations without the approval of the Federal agency or State agency that requested the waiver; and
(D)
does not include a non-compete provision.
(6)
An alien granted a waiver under this subsection whose employment relationship with a health facility or health care organization terminates under paragraph (1)(C)(ii) during the 3-year service period required under paragraph (1) shall be considered to be maintaining lawful status in an authorized period of stay during the 120-day period referred to in items (aa) and (bb) of subclause (III) of paragraph (1)(C)(ii) or the 45-day period referred to in subclause (III)(cc) of such paragraph.
(6) Recapturing waiver slots lost to other States
Section 214(l) of such Act, as amended by this subsection, is further amended by adding at the end the following:
(7)
If a recipient of a waiver under this subsection terminates the recipient’s employment with a health facility or health care organization pursuant to paragraph (1)(C)(ii), including termination of employment because of circumstances described in paragraph (1)(C)(ii)(III), and accepts new employment with such a facility or organization in a different State, the State from which the alien is departing may be granted an additional waiver by the Secretary of State for use in the fiscal year in which the alien’s employment was terminated.
(7) Exception To 3-year work requirement
Section 214(l) of such Act, as amended by this subsection, is further amended by adding at the end the following:
(8)
The 3-year work requirement set forth in subparagraphs (C) and (D) of paragraph (1) shall not apply if—
(A)
(i)
the Secretary of Homeland Security determines the existence of extenuating circumstances, including violations by the employer of the employment agreement with the alien or of labor and employment laws, which justify a lesser period of employment at such facility or organization; and
(ii)
the alien demonstrates, not later than 120 days after the employment termination date (unless the Secretary determines that extenuating circumstances would justify an extension), another bona fide offer of employment at a health facility or health care organization in a geographic area or areas designated by the Secretary of Health and Human Services as having a shortage of health care professionals, for the remainder of such 3-year period;
(B)
(i)
the interested State agency that requested the waiver attests to the existence of extenuating circumstances, including violations by the employer of the employment agreement with the alien or of labor and employment laws, which justify a lesser period of employment at such facility or organization; and
(ii)
the alien demonstrates, not later than 120 days after the employment termination date (unless the Secretary determines that extenuating circumstances would justify an extension), another bona fide offer of employment at a health facility or health care organization in a geographic area or areas designated by the Secretary of Health and Human Services as having a shortage of health care professionals, for the remainder of such 3-year period; or
(C)
the alien—
(i)
elects not to pursue a determination of extenuating circumstances pursuant to subparagraph (A) or (B);
(ii)
terminates the alien’s employment relationship with the health facility or health care organization at which the alien was employed;
(iii)
demonstrates, not later than 45 days after the employment termination date, another bona fide offer of employment at a health facility or health care organization in a geographic area or areas, in the State that requested the alien’s waiver, which are designated by the Secretary of Health and Human Services as having a shortage of health care professionals; and
(iv)
agrees to be employed for the remainder of such 3-year period, and 1 additional year for each termination under clause (ii).
(d) Allotment of Conrad State 30 waivers
(1) In general
Section 214(l) of the Immigration and Nationality Act (8 U.S.C. 1184(l)), as amended by subsection (c), is further amended by adding at the end the following:
(9)
(A)
(i)
All States shall be allotted a total of 35 waivers under paragraph (1)(B) for a fiscal year if 90 percent of the waivers available to the States receiving at least 5 waivers were used in the previous fiscal year.
(ii)
When an allotment occurs under clause (i), all States shall be allotted an additional 5 waivers under paragraph (1)(B) for each subsequent fiscal year if 90 percent of the waivers available to the States receiving at least 5 waivers were used in the previous fiscal year. If the States are allotted 45 or more waivers for a fiscal year, the States will only receive an additional increase of 5 waivers the following fiscal year if 95 percent of the waivers available to the States receiving at least 1 waiver were used in the previous fiscal year.
(B)
Any increase in allotments under subparagraph (A) shall be maintained indefinitely, unless in a fiscal year the total number of such waivers granted is 5 percent lower than in the last year in which there was an increase in the number of waivers allotted pursuant to this paragraph, in which case—
(i)
the number of waivers allotted shall be decreased by 5 for all States beginning in the next fiscal year; and
(ii)
each additional 5 percent decrease in such waivers granted from the last year in which there was an increase in the allotment, shall result in an additional decrease of 5 waivers allotted for all States, provided that the number of waivers allotted for all States shall not drop below 30.
(2) Academic medical centers
Section 214(l)(1)(D) of such Act, as amended by subsection (c)(1)(E), is further amended—
(A)
in clause (ii), by striking and
at the end;
(B)
in clause (iii), by striking the period at the end and inserting ; and
; and
(C)
by adding at the end the following:
(iv)
in the case of a request by an interested State agency—
(I)
the head of such agency determines that the alien is to practice medicine in, or be on the faculty of a residency program at, an academic medical center (as defined in section 411.355(e)(2) of title 42, Code of Federal Regulations, or a similar successor regulation), without regard to whether such facility is located within an area designated by the Secretary of Health and Human Services as having a shortage of health care professionals; and
(II)
the head of such agency determines that—
(aa)
the alien physician’s work is in the public interest; and
(bb)
the grant of such waiver would not cause the number of the waivers granted on behalf of aliens for such State for a fiscal year to exceed 3 (within the limitation in subparagraph (B) and subject to paragraph (6)), in accordance with the conditions of this clause.
(e) Amendments to the procedures, definitions, and other provisions related to physician immigration
(1) Dual intent for physicians seeking graduate medical training
Section 214(b) of the Immigration and Nationality Act (8 U.S.C. 1184(b)) is amended by striking and other than a nonimmigrant described in any provision of section 101(a)(15)(H)(i) except subclause (b1) of such section)
and inserting a nonimmigrant described in any provision of section 101(a)(15)(H)(i) (except subclause (b1) of such section), and an alien coming to the United States to receive graduate medical education or training as described in section 212(j) or to take examinations required to receive graduate medical education or training as described in section 212(j))
.
(2) Physician national interest waiver clarifications
(A) Practice and geographic area
Section 203(b)(2)(B)(ii)(I) of the Immigration and Nationality Act (8 U.S.C. 1153(b)(2)(B)(ii)(I)) is amended by striking items (aa) and (bb) and inserting the following:
(aa)
the alien physician agrees to work on a full-time basis practicing primary care, specialty medicine, or a combination thereof, in an area or areas designated by the Secretary of Health and Human Services as having a shortage of health care professionals, or at a health care facility under the jurisdiction of the Secretary of Veterans Affairs; or
(bb)
the alien physician is pursuing such waiver based upon service at a facility or facilities that serve patients who reside in a geographic area or areas designated by the Secretary of Health and Human Services as having a shortage of health care professionals (without regard to whether such facility or facilities are located within such an area) and a Federal agency, or a local, county, regional, or State department of public health determines the alien physician’s work was or will be in the public interest.
(B) Five-year service requirement
Section 203(b)(2)(B)(ii) of such Act, as amended by subparagraph (A), is further amended—
(i)
by moving subclauses (II), (III), and (IV) 4 ems to the left; and
(ii)
in subclause (II)—
(I)
by inserting (aa)
after (II)
; and
(II)
by adding at the end the following:
(bb)
The 5-year service requirement described in item (aa) shall begin on the date on which the alien physician begins work in the shortage area in any legal status and not on the date on which an immigrant visa petition is filed or approved. Such service shall be aggregated without regard to when such service began and without regard to whether such service began during or in conjunction with a course of graduate medical education.
(cc)
An alien physician shall not be required to submit an employment contract with a term exceeding the balance of the 5-year commitment yet to be served or an employment contract dated within a minimum time period before filing a visa petition under this subsection.
(dd)
An alien physician shall not be required to file additional immigrant visa petitions upon a change of work location from the location approved in the original national interest immigrant petition.
(3) Technical clarification regarding advanced degree for physicians
Section 203(b)(2)(A) of such Act is amended by adding at the end the following: An alien physician holding a foreign medical degree that has been deemed sufficient for acceptance by an accredited United States medical residency or fellowship program is a member of the professions holding an advanced degree or its equivalent.
.
(4) Short-Term work authorization for physicians completing their residencies
(A) In general
A physician completing graduate medical education or training described in section 212(j) of the Immigration and Nationality Act (8 U.S.C. 1182(j)) as a nonimmigrant described in section 101(a)(15)(H)(i) of such Act (8 U.S.C. 1101(a)(15)(H)(i))—
(i)
shall have such nonimmigrant status automatically extended until October 1 of the fiscal year for which a petition for a continuation of such nonimmigrant status has been submitted in a timely manner and the employment start date for the beneficiary of such petition is October 1 of that fiscal year; and
(ii)
shall be authorized to be employed incident to status during the period between the filing of such petition and October 1 of such fiscal year.
(B) Termination
The physician's status and employment authorization shall terminate on the date that is 30 days after the date on which a petition described in clause (i)(I) is rejected, denied, or revoked.
(C) Automatic extension
A physician's status and employment authorization will automatically extend to October 1 of the next fiscal year if all of the visas described in section 101(a)(15)(H)(i) of the Immigration and Nationality Act (8 U.S.C. 1101(a)(15)(H)(i)) that were authorized to be issued for the fiscal year have been issued.
(5) Applicability of section 212(e) to spouses and children of J–1 exchange visitors
A spouse or child of an exchange visitor described in section 101(a)(15)(J) of the Immigration and Nationality Act (8 U.S.C. 1101(a)(15)(J)) shall not be subject to the requirements under section 212(e) of such Act (8 U.S.C. 1182(e)).
(f) Annual Conrad State 30 J–1 Visa Waiver Program statistical report
The Director of U.S. Citizenship and Immigration Service shall submit an annual report to Congress and to the Secretary of Health and Human Services that identifies the number of aliens admitted during the most recently concluded fiscal year as a result of the Conrad State 30 J–1 Visa Waiver Program established under sections 212(e) and 214(l) of the Immigration and Nationality Act (8 U.S.C. 1182(e) and 1184(l)), broken down by State.
Sec. 3016. Grants for schools of medicine and schools of osteopathic medicine in underserved areas
Subpart II of part C of title VII of the Public Health Service Act (42 U.S.C. 293m et seq.) is amended by adding at the end the following:
749C. Grants for schools of medicine and schools of osteopathic medicine in underserved areas
(a) In general
The Secretary may award grants to institutions of higher education (including consortiums of such institutions) for the establishment, improvement, or expansion of a school of medicine or osteopathic medicine, or a branch campus of a school of medicine or osteopathic medicine.
(b) Priority
In selecting grant recipients under this section, the Secretary shall give priority to any institution of higher education (or consortium of such institutions) that—
(1)
proposes to use the grant for the establishment of a school of medicine or osteopathic medicine, or a branch campus of a school of medicine or osteopathic medicine, in an area—
(A)
in which—
(i)
no other such school is based; or
(ii)
in the case in which the school of medicine or osteopathic medicine proposed to be established would be a minority-serving institution, no other minority-serving institution that includes a school of medicine or osteopathic medicine is based; and
(B)
that is a medically underserved community or a health professional shortage area; or
(2)
is a minority-serving institution described in section 371(a) of the Higher Education Act of 1965 or an institution or program described in section 326(e) of such Act.
(c) Considerations
In awarding grants under this section, the Secretary, to the extent practicable, may ensure equitable distribution of awards among the geographical regions of the United States.
(d) Use of funds
An institution of higher education (or a consortium of such institutions)—
(1)
shall use grant amounts received under this section to—
(A)
recruit, enroll, and retain medical students who are pursuing a degree of doctor of medicine or doctor of osteopathy, including individuals who are from disadvantaged backgrounds (including racial and ethnic groups underrepresented among medical students and health professions), individuals from rural and underserved areas, low-income individuals, and first generation college students, at a school of medicine or osteopathic medicine or a branch campus of a school of medicine or osteopathic medicine; and
(B)
develop, implement, and expand curriculum that emphasizes care for rural and underserved populations, including accessible and culturally and linguistically appropriate care and services, at such school or branch campus; and
(2)
may use grant amounts received under this section to—
(A)
plan and construct—
(i)
a school of medicine or osteopathic medicine, or a branch campus of a school of medicine or osteopathic medicine, in an area in which no other such school is based; or
(ii)
a school of medicine or osteopathic medicine, or a branch campus of a school of medicine or osteopathic medicine, that will be a minority-serving institution, in an area in which no other such school that is a minority-serving institution is based;
(B)
plan, develop, and meet criteria for accreditation for a school of medicine or osteopathic medicine or a branch campus of a school of medicine or osteopathic medicine;
(C)
hire faculty, including faculty from racial and ethnic groups who are underrepresented among the medical and other health professions, and other staff to serve at such a school or branch campus;
(D)
support educational programs at such a school or branch campus;
(E)
modernize and expand infrastructure at such a school or branch campus; and
(F)
support other activities that the Secretary determines further the establishment, improvement, or expansion of a school of medicine or osteopathic medicine or a branch campus of a school of medicine or osteopathic medicine.
(e) Application
To be eligible to receive a grant under subsection (a), an institution of higher education (or a consortium of such institutions), shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require, including a description of the institution’s or consortium's planned activities described in subsection (d).
(f) Reporting
(1) Reports from entities
Each institution of higher education, or consortium of such institutions, awarded a grant under this section shall submit an annual report to the Secretary on the activities conducted under such grant.
(2) Report to Congress
Not later than 5 years after the date of enactment of this section and every 5 years thereafter, the Secretary shall 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 that provides a summary of the activities and outcomes associated with grants made under this section. Such reports shall include a list of awardees, including their primary geographic location, and location of any school of medicine or osteopathic medicine, or a branch campus of a school of medicine or osteopathic medicine that was established, improved, or expanded under this program.
(g) Definitions
In this section:
(1) Branch campus
(A) In general
The term branch campus, with respect to a school of medicine or osteopathic medicine, means an additional location of such school that is geographically apart and independent of the main campus, at which the school offers at least 50 percent of the program leading to a degree of doctor of medicine or doctor of osteopathy that is offered at the main campus.
(B) Independence from main campus
For purposes of subparagraph (A), the location of a school described in such subparagraph shall be considered to be independent of the main campus described in such subparagraph if the location—
(i)
is permanent in nature;
(ii)
offers courses in educational programs leading to a degree, certificate, or other recognized educational credential;
(iii)
has its own faculty and administrative or supervisory organization; and
(iv)
has its own budgetary and hiring authority.
(2) First generation college student
The term first generation college student has the meaning given such term in section 402A(h)(3) of the Higher Education Act of 1965.
(3) Health professional shortage area
The term health professional shortage area has the meaning given such term in section 332(a).
(4) Institution of higher education
The term institution of higher education has the meaning given such term in section 101 of the Higher Education Act of 1965.
(5) Medically underserved community
The term medically underserved community has the meaning given such term in section 799B(6).
(h) Authorization of appropriations
There is authorized to be appropriated such sums as may be necessary to carry out this section.
Subtitle B Substance Use Disorder Treatment and Behavioral and Mental Health Workforce
Sec. 3021. Short title
This subtitle may be cited as the STAR Plus Scholarship Act
.
Sec. 3022. Substance Use Disorder Treatment and Behavioral and Mental Health Workforce Scholarship Program
(a) In general
Part F of title VII of the Public Health Service Act (42 U.S.C. 295h) is amended by adding at the end the following:
782. Substance Use Disorder Treatment and Behavioral and Mental Health Workforce Scholarship Program
(a) Establishment
The Secretary, acting through the Administrator of the Health Resources and Services Administration (in this section referred to as the
Secretary) shall establish the Substance Use Disorder Treatment and Behavioral and Mental Health Workforce Scholarship Program (in this section referred to as theScholarship Program) to award scholarships to assure an adequate supply of individuals in covered employment.(b) Eligibility; application; written contract
To be eligible to participate in the Scholarship Program, an individual must—
(1)
be accepted for enrollment, or be enrolled, as a full-time student—
(A)
in an accredited (as determined by the Secretary) educational institution in a State; and
(B)
in a course of study or program, offered by such institution and approved by the Secretary, leading to covered employment;
(2)
submit an application to participate in the Scholarship Program; and
(3)
sign and submit to the Secretary, at the time of submittal of such application, a written contract (described in subsection (f)) to accept payment of a scholarship and to serve (in accordance with this section) for the applicable period of obligated service in a mental health professional shortage area.
(c) Review and evaluation of information and forms by prospective applicant
(1) Contents of application and contract forms
In disseminating application forms and contract forms to individuals desiring to participate in the Scholarship Program, the Secretary shall include with such forms—
(A)
a fair summary of the rights and liabilities of an individual whose application is approved (and whose contract is accepted) by the Secretary, including in the summary a clear explanation of the damages to which the United States is entitled under subsection (j) in the case of the individual’s breach of the contract; and
(B)
such other information as may be necessary for the individual to understand the individual’s prospective participation in the Scholarship Program, including a statement of all factors considered in approving applications for participation in the Scholarship Program and in approving specific positions and employers that are eligible for the Scholarship Program.
(2) Clarity; availability
The application form, contract form, and all other information furnished by the Secretary under this section shall be written in a manner calculated to be understood by the average individual applying to participate in the Scholarship Program. The Secretary shall make such application forms, contract forms, and other information available to individuals desiring to participate in the Scholarship Program on a date sufficiently early to ensure that such individuals have adequate time to carefully review and evaluate such forms and information.
(3) Education and assistance
(A) Distribution of informational materials
The Secretary shall distribute to health professions schools materials providing information on the Scholarship Program and shall encourage the schools to disseminate the materials to the students of the schools.
(B) End of obligated service
(i) Encouragement to continue service
In the case of any health professional whose period of obligated service under the Scholarship Program is nearing completion, the Secretary shall encourage the individual to remain in a mental health professional shortage area and to continue in covered employment.
(ii) Assistance in transition
During the period in which a health professional is planning and making the transition from obligated service under the Scholarship Program, the Secretary may provide assistance to the professional regarding such transition if the professional is remaining in a mental health professional shortage area and is continuing in covered employment.
(d) Factors considered in providing contracts; priorities
(1) Factors considered in providing contracts
In providing contracts under the Scholarship Program—
(A)
the Secretary shall consider the extent of the demonstrated interest of the applicants for the contracts in providing substance use disorder treatment and behavioral and mental health services; and
(B)
may consider such other factors regarding the applicants as the Secretary determines to be relevant to selecting qualified individuals to participate in such Program.
(2) Priorities
In providing contracts under the Scholarship Program, the Secretary shall give priority—
(A)
to any application for such a contract submitted by an individual who has characteristics that increase the probability that the individual will continue to serve in a mental health professional shortage area after the period of obligated service pursuant to subsection (f) is completed; and
(B)
to any application for such a contract submitted by an individual who is from a group or population that is underrepresented in the substance use disorder treatment and behavioral and mental health workforce.
(e) Commencement of participation in Scholarship Program; notice
(1) Commencement of participation
An individual becomes a participant in the Scholarship Program only upon the Secretary’s approval of the individual’s application submitted under subsection (b)(2) and the Secretary’s acceptance of the contract submitted by the individual under subsection (b)(3).
(2) Notice
The Secretary shall provide written notice to an individual promptly upon the Secretary’s approving, under paragraph (1), of the individual’s participation in the Scholarship Program.
(f) Written contract; contents
The written contract (referred to in this section) between the Secretary and an individual shall contain—
(1)
an agreement that—
(A)
subject to paragraph (2), the Secretary agrees to provide the individual with a scholarship (described in subsection (g)) for a period of one or more school years during which the individual is pursuing a course of study described in subsection (b)(1)(B); and
(B)
subject to paragraph (2), the individual agrees—
(i)
to accept provision of such a scholarship to the individual;
(ii)
to maintain enrollment in a course of study described in subsection (b)(1)(B) until the individual completes the course of study;
(iii)
while enrolled in such course of study, to maintain an acceptable level of academic standing (as determined under regulations of the Secretary by the educational institution offering such course of study); and
(iv)
to serve for a time period (in this section referred to as the
period of obligated service) equal to one year for each school year for which the individual was provided a scholarship under the Scholarship Program, in covered employment in a mental health professional shortage area (designated under section 332);(2)
a provision that any financial obligation of the United States arising out of a contract entered into under this section and any obligation of the individual which is conditioned thereon, is contingent upon funds being appropriated for scholarships under this section;
(3)
a statement of the damages to which the United States is entitled, under subsection (j), for the individual’s breach of the contract; and
(4)
such other statements of the rights and liabilities of the Secretary and of the individual, not inconsistent with the provisions of this section.
(g) Scholarship provisions; contract with educational institution; increase in monthly stipend
(1) Scholarship provisions
A scholarship provided to a student for a school year under a written contract under the Scholarship Program shall consist of payment to, or (in accordance with paragraph (2)) on behalf of, the student of the amount (except as provided in section 711) of—
(A)
the tuition of the student in such school year; and
(B)
all other reasonable educational expenses, including fees, books, and laboratory expenses, incurred by the student in such school year.
(2) Contract with educational institution
The Secretary may contract with an educational institution, in which a participant in the Scholarship Program is enrolled, for the payment to the educational institution of the amounts of tuition and other reasonable educational expenses described in paragraph (1). Payment to such an educational institution may be made without regard to section 3324 of title 31, United States Code.
(h) Employment ceiling of Department unaffected
Notwithstanding any other provision of law, individuals who have entered into written contracts with the Secretary under this section, while undergoing academic training, shall not be counted against any employment ceiling affecting the Department.
(i) Obligated service
Any individual receiving payments under the Scholarship Program as required by an agreement under this section shall agree to an annual commitment to work full-time in covered employment, with no more than 1 year passing between any 2 years of covered employment, in the United States in—
(1)
a mental health professional shortage area, as designated under section 332;
(2)
a county (or a municipality, if not contained within any county) where the mean drug overdose death rate per 100,000 people over the past 3 years for which official data is available from the State, is higher than the most recent available national average overdose death rate per 100,000 people, as reported by the Centers for Disease Control and Prevention; or
(3)
any facility, program, center, or clinic as determined appropriate by the Secretary for purposes of this section because of a shortage of mental health professionals, including private practices and other medical facilities designated under section 332(a) as having such a shortage.
(j) Breach
(1) Liquidated damages formula
The Secretary may establish a liquidated damages formula to be used in the event of a breach of an agreement entered into under this section.
(2) Limitation
The failure by an individual to complete the full period of service obligated pursuant to such an agreement, taken alone, shall not constitute a breach of the agreement, so long as the individual completed in good faith the years of service for which payments were made to the individual under this section.
(k) Fund regarding use of amounts recovered for contract breach To replace services lost as result of breach
(1) Establishment of Fund
There is established in the Treasury of the United States a fund to be known as the Substance Use Disorder Treatment and Behavioral and Mental Health Workforce Scholarship Program Replacement Fund (in this subsection referred to as the
Fund). The Fund shall consist of such amounts as may be appropriated under paragraph (2) to the Fund. Amounts appropriated for the Fund shall remain available until expended.(2) Authorization of Appropriations to Fund
For each fiscal year, there is authorized to be appropriated to the Fund an amount equal to the sum of—
(A)
the amount collected during the preceding fiscal year by the Federal Government pursuant to the liability of individuals under subsection (j) for the breach of contracts entered into under this section; and
(B)
the aggregate of the amount of interest accruing during the preceding fiscal year on obligations held in the Fund pursuant to paragraph (4) and the amount of proceeds from the sale or redemption of such obligations during such fiscal year.
(3) Use of Fund
(A) Payments to certain health facilities
Amounts in the Fund and available pursuant to appropriations Acts may, subject to subparagraph (B), be expended by the Secretary to make payments to any entity that has a need for a health professional to provide substance use disorder treatment and behavioral and mental health services as a result of the breach by an individual of a contract entered into under this section.
(B) Purpose of payments
An entity receiving payments pursuant to subparagraph (A) may expend the payments to recruit and employ a health professional to provide substance use disorder treatment and behavioral and mental health services to patients of the entity, or to enter into a contract with such a professional to provide the services to the patients.
(4) Investment
(A) In general
The Secretary of the Treasury shall invest such amounts of the Fund as such Secretary determines are not required to meet current withdrawals from the Fund. Such investments may be made only in interest-bearing obligations of the United States. For such purpose, such obligations may be acquired on original issue at the issue price, or by purchase of outstanding obligations at the market price.
(B) Sale of obligations
Any obligation acquired by the Fund may be sold by the Secretary of the Treasury at the market price.
(l) Covered employment defined
In this section, the term covered employment means—
(1)
full-time employment (including a fellowship) where the primary intent and function of the position is the direct treatment or recovery support of patients with or in recovery from a substance use, behavioral health, or mental health disorder; and
(2)
may include employment as a physician (with a degree of doctor of medicine or doctor of osteopathy), a psychiatric nurse, a social worker, a marriage and family therapist, a mental health counselor, an addiction counselor, an occupational therapist, a psychologist, a psychiatrist, a child and adolescent psychiatrist, or a neurologist.
(m) Authorization of appropriations
There is authorized to be appropriated to carry out this section $75,000,000 for each of fiscal years 2027 through 2031.
(b) Exclusion of scholarship from gross income of the recipient
(1) In general
Section 117(c)(2) of the Internal Revenue Code of 1986 is amended—
(A)
by striking or
at the end of subparagraph (B);
(B)
by striking the period at the end of subparagraph (C) and inserting , or
; and
(C)
by adding at the end the following new subparagraph:
(D)
section 782 of the Public Health Service Act.
(2) Effective date
The amendments made by this section shall apply to taxable years ending after the date of the enactment of this Act.
Subtitle C ACCESS in Mental Health Act
Sec. 3031. Short title
This subtitle may be cited as the Advancing Culturally Competent and Equitable Supportive Services in Mental Health Act
or the ACCESS in Mental Health Act
.
Sec. 3032. Purpose
The purpose of this subtitle is to increase the number, size, and quality of accredited graduate training programs for mental and behavioral health professions at minority-serving institutions to address shortages in the mental and behavioral health professional workforce and diversify such workforce.
Sec. 3033. Grants to support graduate programs in mental and behavioral health professions at historically black colleges and universities, tribal colleges and universities, and other minority-serving institutions
Part A of title VII of the Higher Education Act of 1965 (20 U.S.C. 1070) is amended—
(1)
by redesignating subpart 5 as subpart 6;
(2)
in section 731—
(A)
in the section heading, by striking subparts 1 through 4
and inserting subparts 1 through 5
;
(B)
in subsection (a), by striking subparts 1 through 4
and inserting subparts 1 through 5
;
(C)
in subsection (b), by striking subparts 1 through 4
and inserting subparts 1 through 5
; and
(D)
in subsection (d), by striking subpart 1, 2, 3, or 4
and inserting subpart 1, 2, 3, 4, or 5
; and
(3)
by inserting after subpart 4 the following:
5 Grants To Support Graduate Programs in Mental and Behavioral Health Professions at Historically Black Colleges and Universities, Tribal Colleges and Universities, and other Minority-Serving Institutions
727. Definitions
In this subpart:
(1) Cost of attendance
The term cost of attendance has the meaning given that term in section 472.
(2) Culturally responsive care
The term culturally responsive care means care that is conducted or provided in a manner that is responsive to the beliefs, backgrounds, customs, interpersonal styles, lived experiences, language, and behaviors of individuals who are receiving the care, and in a manner that has the greatest likelihood of ensuring maximum benefit and participation in the treatment provided.
(3) Eligible institution
The term eligible institution means—
(A)
an institution of higher education that is—
(i)
a part B institution (as defined in section 322);
(ii)
a Hispanic-serving institution (as defined in section 502);
(iii)
a Tribal College or University (as defined in section 316);
(iv)
an Alaska Native-serving institution (as defined in section 317(b));
(v)
a Native Hawaiian-serving institution (as defined in section 317(b));
(vi)
a Predominantly Black Institution (as defined in section 318);
(vii)
an Asian American and Native American Pacific Islander-serving institution (as defined in section 320(b)); or
(viii)
a Native American-serving, nontribal institution (as defined in section 319);
(B)
a consortium of institutions described in subparagraph (A); or
(C)
an institution described in subparagraph (A), or a consortium described in subparagraph (B), in partnership with any other institution of higher education, but only if the program supported with a grant under this subpart is carried out at an institution described in subparagraph (A).
(4) Health professional shortage area
The term health professional shortage area means an area designated as a health professional shortage area by the Administrator of the Health Resources and Services Administration of the Department of Health and Human Services.
(5) Mental or behavioral health professional
The term mental or behavioral health professional means an individual with a graduate degree from an institution of higher education with an accredited program that prepares students for State licensing or certification in fields such as psychiatry, psychology, school psychology, behavioral pediatrics, psychiatric nursing, social work, school social work, substance use disorder prevention and treatment, marriage and family counseling, school counseling, professional counseling, child and adolescent psychiatry, or any other provider that is a State licensed or certified mental health professional qualified under State law to provide mental health services.
(6) School-based mental health services provider
The term school-based mental health services provider has the meaning given the term in section 4102 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7112).
(7) Trauma-informed care
The term trauma-informed care means care received by individuals who have experienced or witnessed trauma that is healing-centered and culturally responsive in accordance with professional standards of practice and accounting for patients’ experiences and that recognizes the emotional, behavioral, and developmental challenges that can accompany trauma exposure in order to eliminate or mitigate triggers that may cause re-traumatization of the patient.
728. Grants to institutions for graduate training programs in mental or behavioral health professions
(a) Program authorized
From amounts made available to carry out this section for each fiscal year and not reserved under subsection (b), the Secretary is authorized to award grants, on a competitive basis, to eligible institutions—
(1)
to establish, expand, or improve graduate programs in mental and behavioral health professions, including programs that train school-based mental services providers; or
(2)
to engage in planning activities necessary for the establishment of new graduate programs in mental and behavioral health professions, including programs that train school-based mental health services providers.
(b) Reservation
The Secretary may reserve not more than 2 percent of the funds made available to carry out this section for a fiscal year to provide technical assistance to eligible institutions on matters relating to the grant program under this section and the implementation of programs supported by such grants.
(c) Use of funds
(1) Required use of funds
An eligible institution that receives a grant under subsection (a)(1) shall use not less than 5 percent of grant funds to award scholarships or stipends, based on financial need, to cover all or part of a student’s cost of attendance for the mental or behavioral health graduate program. Scholarships and stipends awarded under this subsection shall prioritize students who are from health professional shortage areas.
(2) Allowable use of funds
After fulfilling the requirement in paragraph (1), an eligible institution that receives a grant under subsection (a)(1) shall use any remaining grant funds to carry out one or more of the following activities:
(A)
Establish new accredited graduate programs that prepare students for State licensing and certification to serve as mental or behavioral health professionals or school-based mental health services providers, including through hiring and compensating faculty, purchasing or developing culturally responsive course materials, or other activities necessary to establish such programs.
(B)
Ensure that graduate programs in mental or behavioral health professions offered by the institution are preparing professionals who are highly qualified, are able to provide culturally responsive care and trauma-informed care, and are equipped to serve in health professional shortage areas or other high-need areas or schools, which may include—
(i)
recruiting, training, retraining, or retaining faculty for such programs;
(ii)
designing or redesigning such programs—
(I)
to prepare mental or behavioral health professionals to serve in health professional shortage areas or other high-need areas or schools, provide culturally responsive care and trauma-informed care to diverse patients, and meet the needs of the whole child or person;
(II)
to incorporate rigorous academic content and scientifically valid research; and
(III)
to adequately prepare students to meet State licensure and certification standards; and
(iii)
developing or implementing high quality course materials, which may include purchasing necessary educational materials or other academic resources, to support the design or redesign of the program as described in clause (ii).
(C)
Provide students with sustained and high-quality preservice and clinical experience that is aligned with graduate education standards for their respective fields, which may include—
(i)
arranging for exemplary mental or behavioral health professionals in relevant fields or work settings to mentor students who are prospective mental or behavioral health professionals; or
(ii)
substantially increasing the level of interaction between faculty at institutions of higher education and new and experienced mental or behavioral health professionals, and providing support, including preparation time, for such interactions.
(D)
Establish partnerships with other institutions of higher education with accredited programs that prepare students for State licensing or certification in mental or behavioral health fields to allow cross registration or other forms of program collaboration determined eligible by the Secretary for the purposes of expanding access to classes, certificate programs, or degree programs in mental or behavioral health fields for students from racial or ethnic minority communities.
(E)
Develop and implement supportive services for former students of the institution who work as mental or behavioral health professionals or partnerships with school districts, State or local agencies, or other places of employment for former students to promote retention in those professions, including services such as—
(i)
mental or behavioral health professional mentoring from exemplary mental or behavioral health professionals in relevant fields or work settings, including those working in schools or home-based care settings;
(ii)
materials, resources, and support for mental or behavioral health professionals during their first 3 years of employment in such profession; or
(iii)
services to prevent or mitigate secondary trauma or burnout associated with working in mental health professional shortage areas or other high-need areas or schools.
(F)
Disseminate information on effective practices for the preparation of mental or behavioral health professionals, including practices for obtaining any certifications or licenses needed to practice as a mental or behavioral health professional or a school-based mental health services provider in a State.
(G)
Develop strategies to increase awareness, interest, and experiential learning opportunities in mental and behavioral health careers, especially among racial and ethnic minority communities, including through partnerships with State educational agencies, local educational agencies, or other institutions of higher education to increase awareness of and interest in such careers among elementary school students, secondary school students, or undergraduate students.
(3) Planning grants
An eligible institution that receives a grant under subsection (a)(2) shall use the grant to engage in planning activities necessary for the establishment of at least 1 new graduate program in mental or behavioral health professions.
(d) Application
To be eligible to receive a grant under this section, an eligible institution shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require. An eligible institution applying for a grant under subsection (a)(2) shall include in the institution’s application for such grant information demonstrating evidence of—
(1)
an institutional commitment to opening and sustaining a graduate program that prepares students to work as a mental or behavioral health professional; and
(2)
a relationship with the relevant professional organization, accreditation agency or association, or regulatory body to ensure that planning aligns with professional standards and State credentialing requirements.
(e) Grant amount
(1) In general
The minimum amount of each grant under subsection (a)(1) shall be $500,000.
(2) Planning grants
The amount of each grant under subsection (a)(2) shall be an amount determined by the Secretary.
(f) Limitation on administrative expenses
An eligible institution that receives a grant under this section may use not more than 3 percent of funds provided to administer the grant, not including salary and benefits for faculty and staff.
(g) Regulations
The Secretary shall prescribe such regulations as may be necessary to carry out this section.
(h) Report
Not later than 2 years after the date of enactment of this section, and not less frequently than once every 2 years thereafter, the Secretary shall submit to the authorizing committees a report on the grant program under this section. Each report shall include—
(1)
descriptions of the programs supported with grants under this section;
(2)
demographic information about the students served by such programs; and
(3)
such other information as the Secretary determines appropriate.
(i) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each fiscal year.
729. Grants to students for graduate study in mental or behavioral health professions
(a) In general
The Secretary is authorized to carry out a program under which the Secretary shall pay to an eligible institution such sums as may be necessary to enable the institution to provide each eligible student with a grant in the amount of $10,000 for each year during which the student attends an eligible graduate program at the institution.
(b) Application
To be eligible to receive a grant under this section, a student shall submit to the institution an application at such time, in such manner, and containing such information as the Secretary, in consultation with the institution, may require.
(c) Distribution to students
Subject to subsection (d), grants to students under this section shall be made in accordance with a process determined by the Secretary for such purpose, in such manner as will best accomplish the purpose of this section.
(d) Limitation on secretarial and institutional authority
In carrying out the grant program under this section, the Secretary and any institution participating in the program may not—
(1)
convert a grant into a loan or otherwise require a student to repay any portion of the grant amount; or
(2)
require a student to complete a service obligation as a condition of receiving such a grant.
(e) Report
Not later than 2 years after the date of enactment of this section, and not less frequently than once every 2 years thereafter, the Secretary shall submit to the authorizing committees a report on the grant program under this section. Each report shall include information on the following:
(1)
The number and demographic information of students who received grants under this section.
(2)
The degrees obtained by such recipients.
(3)
Such other information as the Secretary determines appropriate.
(f) Definitions
In this section:
(1) Eligible graduate program
The term eligible graduate program means a graduate degree program in a mental or behavioral health profession, including school-based mental health services, offered by an eligible institution.
(2) Eligible student
The term eligible student means a student who—
(A)
is enrolled in an eligible graduate program at a eligible institution participating in the program under this section;
(B)
is in good academic standing, as determined by the institution; and
(C)
has submitted an application to the institution in accordance with subsection (b).
(g) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each fiscal year.
Subtitle D Developing the Community Health Workforce Act
Sec. 3041. Improving recruitment and retention of Federal qualified health center staff
(a) Priority to FQHCs and rural health clinics
Section 333(a) of the Public Health Service Act (42 U.S.C. 254f(a)) is amended by adding at the end the following:
(4)
In approving applications for assignment of members of the Corps, the Secretary shall, notwithstanding paragraph (3), give priority to applications with respect to health professional shortage areas that are Federally qualified health centers and rural health clinics, as defined in section 1861(aa) of the Social Security Act.
(b) Loan repayment program
(1) In general
The Secretary of Health and Human Services shall award grants to Federally qualified health centers (as defined in section 1861(aa) of the Social Security Act (42 U.S.C. 1395x(aa))) for the purpose of addressing health professional workforce shortages by making loan repayments on behalf of health care professionals serving at such centers.
(2) Applications
To seek a grant under paragraph (1), a Federally qualified health center shall submit an application to the Secretary of Health and Human Services at such time, in such manner, and containing such information as the Secretary may require. At a minimum, such an application shall include—
(A)
a description of the center’s capacity to address specific regional workforce shortages, supported by data;
(B)
a plan for making loan repayments as described in paragraph (1); and
(C)
a description of the center’s use of an interdisciplinary approach to care (such as through the use of teams to provide care that include physicians, nurses, social workers, community health workers, pharmacists, and other health care professionals).
Sec. 3042. Community Health Center Workforce Pipeline Program
(a) Grants To recruit, train, and retain a community-Based health center workforce
(1) In general
Section 330 of the Public Health Service Act (42 U.S.C. 254b) is amended—
(A)
by redesignating subsection (r) as subsection (u); and
(B)
by inserting after subsection (q) the following new subsection:
(r) Recruiting, training, and retaining a community-Based workforce
The Secretary may award grants to health centers for the purpose of assisting such centers in—
(1)
recruiting and hiring staff with the skills and experience necessary to effectively serve health center patient populations in rural and underserved areas; and
(2)
supporting career advancement and workforce development opportunities for such staff.
(b) FQHCs deemed eligible To register as apprenticeship program
Not later than 180 days after the date of the enactment of this Act, the Secretary of Labor shall revise the regulations under part 29 of title 29, Code of Federal Regulations, as in effect on the date of the enactment of this Act, so that Federally qualified health centers (as defined in section 1861(aa) of the Social Security Act (42 U.S.C. 1395x(aa))) are eligible to register as apprenticeship programs under such part.
(c) Health centers career opportunities
Section 330 of the Public Health Service Act (42 U.S.C. 254b), as amended by subsection (a), is further amended by inserting after subsection (r) the following:
(s) Health centers career opportunities
(1) In general
The Secretary may award grants to institutions of higher education, including community colleges and minority-serving institutions, to establish partnerships with one or more health centers funded under this section for training students in health professions.
(2) Use of funds
(A) Costs
An institution of higher education receiving a grant under this subsection may use the grant to pay the costs of training, including the salary of the clinicians or other educators who provide the training.
(B) Training supported
The training supported pursuant to a grant under this subsection may include formal training and mentorships.
(C) Types of training
The types of training supported pursuant to a grant under this subsection may include clinical, information technology, operations, finance, or other training for students of health professions, as determined by the institution of higher education receiving the grant in partnership with the health center involved.
(3) Definitions
In this subsection:
(A)
The term institution of higher education means an institution of higher education described in subsection (a) or (b) of section 101 of the Higher Education Act of 1965.
(B)
The term minority-serving institution means an institution of higher education described in section 371(a) of the Higher Education Act of 1965.
(d) Behavioral health specialists
Section 330 of the Public Health Service Act (42 U.S.C. 254b), as amended by subsection (c), is further amended by inserting after subsection (s) the following:
(t) Behavioral health specialists
(1) In general
The Secretary may award grants to health centers to establish, operate, or expand training programs for behavioral health specialists.
(2) Use of funds
The training programs for behavioral health specialists supported pursuant to a grant under this subsection may include—
(A)
stipends for personnel to operate the training programs;
(B)
apprenticeship programs; and
(C)
other recruitment and retention activities for behavioral health specialists.
Sec. 3043. Expanding hospital and FQHC partnerships for graduate medical education
(a) Payments to teaching health centers
(1) In general
Section 340H of the Public Health Service Act (42 U.S.C. 256h) is amended—
(A)
in subsection (a)(1), in the matter preceding subparagraph (A), by inserting , or that have in effect a covered agreement with a sponsoring institution so listed,
after relevant accrediting body
; and
(B)
in subsection (j), by adding at the end the following new paragraph:
(5) Covered agreement
The term covered agreement means a written contract, memorandum of understanding, or other written agreement entered into for a period of not less than 2 years for the purpose of conducting an approved graduate medical residency training program.
(2) Effective date
The amendments made by paragraph (1) shall apply with respect to expenses incurred on or after October 1, 2027.
(b) Medicare GME cap
Section 1886(h) of the Social Security Act (42 U.S.C. 1395ww(h)) is amended—
(1)
in paragraph (4)(F)(i), by striking and (10)
and inserting (10), and (11)
; and
(2)
by adding at the end the following new paragraph:
(11) Training programs at Federally qualified health centers
(A) In general
For cost reporting periods beginning on or after October 1, 2027, in the case of a hospital that has an approved medical residency training program where a significant portion of such program occurs at a Federally qualified health center (as determined by the Secretary), the Secretary shall increase the otherwise applicable resident limit for such hospital by 3 full-time equivalent residency positions.
(B) Definitions
In this paragraph:
(i) Otherwise applicable resident limit
The term
otherwise applicable resident limitmeans, with respect to a hospital, the limit otherwise applicable under subparagraphs (F)(i) and (H) of paragraph (4) on the resident level for the hospital determined without regard to this paragraph but taking into account subparagraphs (A) and (B) of paragraph (7), subparagraphs (A) and (B) of paragraph (8), and paragraphs (9)(A) and (10)(A).(ii) Resident level
The term
resident levelhas the meaning given such term in paragraph (7)(C)(i).
Sec. 3044. Expanding FQHC services
(a) Behavioral health professional and case manager services
(1) Medicare
Section 1861(aa) of the Social Security Act (42 U.S.C. 1395x(aa)) is amended—
(A)
in paragraph (1)—
(i)
in subparagraph (B), by inserting such services furnished on or after October 1, 2026, by a behavioral health consultant, peer support specialist, or other behavioral health professional (as such terms are defined by the Secretary),
before and such services
;
(ii)
in subparagraph (C), by striking and
at the end;
(iii)
in subparagraph (D), by striking the comma at the end and inserting , and
; and
(iv)
by inserting after subparagraph (D) the following new subparagraph:
(E)
case management services furnished on or after October 1, 2026, by a case manager (as defined by the Secretary),; and
(B)
in paragraph (3)(A), by striking (D)
and inserting (E)
.
(2) Medicaid
Section 1905(l)(2)(A) of the Social Security Act (42 U.S.C. 1396d(l)(2)(A)) is amended by inserting and (E)
before of section
.
(b) Guidance on State Medicaid payments to FQHCs
Section 1902(bb) of the Social Security Act (42 U.S.C. 1396a(bb)) is amended by adding at the end the following new paragraph:
(7) Study and guidance on payment adjustments
Not later than October 1, 2027, and not less frequently than annually thereafter, the Secretary shall—
(A)
conduct a study on any differences in the methods by which State plans adjust the payment amount under paragraph (3) for services furnished during a fiscal year; and
(B)
based on the results of the study conducted under subparagraph (A), issue guidance to State plans on best practices for adjusting the payment amount under paragraph (3) for services furnished during a fiscal year.
Title IV Improving Health Care Access and Quality
Sec. 4000. Definition
In this title and the amendments made by this title, the term health care includes all health care needed throughout the life cycle and the end of life.
Subtitle A Reducing Barriers to Accessing Care
Sec. 4001. The Protecting Sensitive Locations Act
(a) In general
Section 287 of the Immigration and Nationality Act (8 U.S.C. 1357) is amended by adding at the end the following:
(i)
(1)
In order to ensure individuals' access to sensitive locations, this subsection shall apply to any enforcement action by—
(A)
officers or agents of the Department of Homeland Security, including officers and agents of U.S. Immigration and Customs Enforcement and U.S. Customs and Border Protection; and
(B)
any individual designated to perform immigration enforcement functions pursuant to a written agreement described in subsection (g).
(2)
(A)
Except as provided in subparagraphs (C) and (D) of paragraph (3), an enforcement action may not take place, be focused on a location, or occur, within 1,000 feet of a sensitive location, except under exigent circumstances.
(B)
If an immigration enforcement action is taking place under exigent circumstances, and the exigent circumstances permitting the enforcement action cease, the enforcement action shall be discontinued until such exigent circumstances reemerge.
(C)
If an individual referred to in subparagraph (A) or (B) of paragraph (1) is not certain that exigent circumstances exist, the individual—
(i)
shall cease the enforcement action immediately;
(ii)
shall consult with his or her supervisor in real time regarding the existence of exigent circumstances; and
(iii)
may not continue the enforcement action until the individual's supervisor affirmatively confirms the existence of exigent circumstances.
(3)
(A)
When proceeding with an enforcement action at or near a sensitive location, individuals referred to in subparagraph (A) or (B) of paragraph (1) shall make every effort—
(i)
to conduct themselves as discreetly as possible, consistent with officer and public safety;
(ii)
to limit the time spent at the sensitive location; and
(iii)
to limit the enforcement action to the person or persons for whom prior approval was obtained.
(B)
If, in the course of an enforcement action that is not initiated at, or focused on, a sensitive location, individuals referred to in subparagraph (A) or (B) of paragraph (1) are led to or near a sensitive location, and no clear exigent circumstance with respect to the sensitive location exists, such individuals shall—
(i)
cease taking any further enforcement action;
(ii)
conduct themselves in a discreet manner;
(iii)
maintain surveillance; and
(iv)
in the event that uncertainty exists about the existence of exigent circumstances, immediately consult their supervisor in order to determine whether such enforcement action should be discontinued pursuant to paragraph (2)(C).
(C)
This subsection shall not apply to the transportation of an individual apprehended at or near a land or sea border to a hospital or health care provider for the purpose of providing such individual medical care.
(D)
This subsection shall not apply to a rare premeditated arrest operation, undertaken with the prior written approval of an appropriate authorizing official, involving the targeted arrest of a terrorist suspect, an individual who poses a clear threat to national security, or an individual who poses an extraordinary danger to public safety.
(4)
If an enforcement action is carried out in violation of this subsection—
(A)
no information resulting from the enforcement action may be entered into the record or received into evidence in a removal proceeding resulting from the enforcement action; and
(B)
the alien who is the subject of such removal proceeding may file a motion for the immediate termination of the removal proceeding.
(5)
(A)
Each official specified in subparagraph (B) shall ensure the employees under the supervision of such official receive annual training in compliance with the requirements of this subsection, section 239, and section 384 of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (8 U.S.C. 1367).
(B)
The officials specified in this subparagraph are the following:
(i)
The Chief Counsel of U.S. Immigration and Customs Enforcement.
(ii)
The Field Office Directors of U.S. Immigration and Customs Enforcement.
(iii)
Each Special Agent in Charge of U.S. Immigration and Customs Enforcement.
(iv)
Each Chief Patrol Agent of U.S. Customs and Border Protection.
(v)
The Director of Field Operations of U.S. Customs and Border Protection.
(vi)
The Director of Air and Marine Operations of U.S. Customs and Border Protection.
(vii)
The Internal Affairs Special Agent in Charge of U.S. Customs and Border Protection.
(6)
(A)
Not later than 30 days after any enforcement action is taken at a sensitive location by any individual referred to in subparagraph (A) or (B) of paragraph (1), the Secretary of Homeland Security shall provide a report to the Office of the Inspector General of the Department of Homeland Security and the Office for Civil Rights and Civil Liberties of the Department of Homeland Security with respect to each such enforcement action, which shall contain—
(i)
the date, State, and local political subdivision (such as city, town, or county) in which each enforcement action occurred;
(ii)
the specific sensitive location site where the enforcement action occurred;
(iii)
the type of enforcement action that occurred;
(iv)
the specific department, agency, and officers responsible for the enforcement action;
(v)
a thorough description of the circumstances which purportedly justified the enforcement action, including—
(I)
a clear description of the exigent circumstances involved; or
(II)
a certified copy of the written approval for the immigration arrest that was signed by an appropriate authorizing officer, along with a clear description of the specific and rare threat which justified the premeditated arrest at such sensitive location;
(vi)
a description of the intended target of the enforcement action;
(vii)
the number of individuals, if any, arrested or taken into custody through the enforcement action;
(viii)
the number of collateral arrests, if any, from the enforcement action and the reasons for each such arrest; and
(ix)
a certification of whether a supervisor was contacted before, during, or after each such enforcement action.
(B)
An appropriate committee of Congress may, at any time, request and successfully receive a confidential or redacted copy of any of the individual reports described in subparagraph (A).
(7)
(A)
The Director of U.S. Immigration and Customs Enforcement and the Commissioner for U.S. Customs and Border Protection shall each submit an annual report to the appropriate committees of Congress that describes the enforcement actions covered by this subsection that were undertaken by U.S. Immigration and Customs Enforcement or U.S. Customs and Border Protection, as applicable, during the preceding fiscal year.
(B)
Each report submitted pursuant to subparagraph (A) shall include—
(i)
the number of enforcement actions at or focused on a sensitive location;
(ii)
the number of enforcement actions where officers or agents were subsequently led to or near a sensitive location;
(iii)
the date, site, State, and local political subdivision (such as city, town, or county) in which each enforcement action covered by clause (i) or (ii) occurred;
(iv)
the component of the agency responsible for each such enforcement action;
(v)
a description of the intended target of each such enforcement action;
(vi)
the number of individuals, if any, arrested or taken into custody through each such enforcement action;
(vii)
the number of collateral arrests, if any, from each such enforcement action and the reasons for each such arrest; and
(viii)
a certification of whether the location administrator was contacted prior to, during, or after each such enforcement action.
(8)
(A)
The Office of Inspector General of the Department of Homeland Security shall submit an annual report to the appropriate committees of Congress regarding the complaints of enforcement actions covered by this subsection that were taken in sensitive locations by U.S. Immigration and Customs Enforcement and U.S. Customs and Border Protection during the preceding year.
(B)
Each report submitted pursuant to subparagraph (A) shall include—
(i)
the number of complaints of enforcement actions reported at, or focused on, a sensitive location;
(ii)
the reported date, site, State, and local political subdivision (such as city, town, or county) in which each enforcement action referred to in clause (i) occurred;
(iii)
the reported agency responsible for each such enforcement action;
(iv)
a description of the intended target of each such enforcement action;
(v)
the reported number of individuals, if any, arrested or taken into custody through each such enforcement action;
(vi)
the reported number of collateral arrests, if any, from each such enforcement action, and the reasons for each such arrest; and
(vii)
if available, a certification of whether the location administrator was contacted prior to, during, or after each such enforcement action.
(9)
In this subsection:
(A)
The term appropriate authorizing official means—
(i)
in the case of officers and agents of U.S. Immigration and Customs Enforcement—
(I)
in the case of officers and agents of U.S. Immigration and Customs Enforcement—
(II)
the Executive Associate Director of Homeland Security Investigations;
(III)
the Assistant Director for Field Operations, Enforcement, and Removal Operations;
(IV)
the Executive Associate Director for Field Operations, Enforcement, and Removal Operations; or
(V)
any other individual who is determined to be an appropriate authorizing official by the Secretary of Homeland Security; and
(ii)
in the case of officers and agents of U.S. Customs and Border Protection—
(I)
a Chief Patrol Agent;
(II)
the Director of Field Operations;
(III)
the Director of Air and Marine Operations;
(IV)
the Internal Affairs Special Agent in Charge; or
(V)
any other individual who is determined to be an appropriate authorizing official by the Secretary of Homeland Security; and
(iii)
in the case of all other individuals referred to in subparagraph (A) or (B) of paragraph (1), an official determined under rules promulgated by the Secretary of Homeland Security not later than 90 days after the date of the enactment of the Protecting Sensitive Locations Act.
(B)
The term appropriate committees of Congress means—
(i)
the Committee on Homeland Security and Governmental Affairs of the Senate;
(ii)
the Committee on the Judiciary of the Senate;
(iii)
the Committee on Appropriations of the Senate;
(iv)
the Committee on Homeland Security of the House of Representatives;
(v)
the Committee on the Judiciary of the House of Representatives; and
(vi)
the Committee on Appropriations of the House of Representatives.
(C)
The term early childhood education program has the meaning given such term in section 103(8) of the Higher Education Act of 1965 (20 U.S.C. 1003(8)).
(D)
The term enforcement action—
(i)
means an apprehension, arrest, interview, request for identification, search, or surveillance for the purposes of immigration enforcement; and
(ii)
includes an enforcement action at, or focused on, a sensitive location that is part of a joint case led by another law enforcement agency.
(E)
The term exigent circumstances means a situation involving—
(i)
the imminent risk of death, violence, or physical harm to any person, including a situation implicating terrorism or the national security of the United States in some other manner;
(ii)
the immediate arrest or hot pursuit of an individual presenting an imminent danger to public safety, including the imminent risk of death, violence, or physical harm to a person;
(iii)
a rare, premeditated arrest operation described in paragraph (3)(D), undertaken with the prior written approval of an appropriate authorizing official, involving the targeted arrest of a terrorist suspect, an individual who poses a clear threat to national security, or an individual who poses an extraordinary danger to public safety;
(iv)
a direct threat to national security; or
(v)
the imminent risk of destruction of evidence that is material to an ongoing criminal case.
(F)
The term sensitive location includes all of the physical space located within 1,000 feet of—
(i)
any medical or mental healthcare facility, including any hospital, health care practitioner's office, accredited health clinic, vaccination or testing site, or emergent or urgent care facility, or community health center;
(ii)
any public or private school (including preschools, primary schools, secondary schools, and postsecondary schools (including colleges and ), any site of an early childhood education program, any other institution of learning, such as vocational or trade schools, and any other site where individuals who are unemployed or underemployed may apply for or receive workforce training;
(iii)
any scholastic or education-related activity or event, including field trips and interscholastic events;
(iv)
any school bus or school bus stop during periods when school children are present on the bus or at the stop;
(v)
any recreational facility for children, such as playgrounds and formal recreational facilities;
(vi)
any child care focused facility, including child care centers, before or after school care centers, foster care facilities, and group homes for children;
(vii)
any location where disaster or emergency response and relief is being provided by Federal, State, or local entities, such as the distribution of emergency supplies, food, and water; any place of temporary shelter; any place along an evacuation route; and any site where registration for disaster-related assistance or family reunification is taking place;
(viii)
any location of any organization that—
(I)
assists children, pregnant women, victims of crime or abuse, or individuals with significant mental or physical disabilities, including domestic violence shelters, child advocacy centers, facilities that serve disabled persons, drug or alcohol counseling and treatment facilities, rape crisis centers, supervised visitation centers, family justice centers, victims' services providers, and community-based organizations providing social services; or
(II)
provides disaster or emergency social services and assistance, or services for individuals experiencing homelessness, including food banks, pantries, or other establishments distributing food, and shelters;
(ix)
any church, synagogue, mosque, or other place of worship or religious study, such as buildings rented for the purpose of religious services, or a temporary facility or location where such activities are taking place;
(x)
any sites of a funeral, graveside ceremony, wedding, or any site where other religious or civil ceremonies or observances are occurring;
(xi)
any site during the occurrence of a public demonstration, such as a march, rally, or parade;
(xii)
any Federal, State, or local courthouse, including the office of an individual's legal counsel or representative, and a probation office;
(xiii)
any congressional district office;
(xiv)
any Social Security office;
(xv)
any public assistance offices, including locations where individuals may apply for or receive unemployment compensation or report violations of labor and employment laws;
(xvi)
the indoor or outdoor premises of a department of motor vehicles;
(xvii)
a polling place, including any building or infrastructure where voting takes place during an election;
(xviii)
a labor union hall or any other union- operated building or office where registered applicants are referred in rotation to jobs;
(xix)
any public library; or
(xx)
any other location specified by the Secretary of Homeland Security for purposes of this subsection.
(G)
The term supervisor means an official determined under rules promulgated by the Secretary of Homeland Security pursuant to section 2(c) of the Protecting Sensitive Locations Act.
(b) Effective date
The amendment made by subsection (a) shall take effect on the date that is 90 days after the date of the enactment of this Act.
(c) Rulemaking
Not later than 90 days after the date of the enactment of this Act, the Secretary of Homeland Security shall promulgate regulations to carry out the amendment made by subsection (a).
Sec. 4002. Repeal of requirement for documentation evidencing citizenship or nationality under the Medicaid program
(a) Repeal
Subsections (i)(22) and (x) of section 1903 of the Social Security Act (42 U.S.C. 1396b) are each repealed.
(b) Conforming amendments
(1) State payments for medical assistance
Section 1902 of the Social Security Act (42 U.S.C. 1396a) is amended—
(A)
by amending paragraph (46) of subsection (a) to read as follows:
(46)
provide that information is requested and exchanged for purposes of income and eligibility verification in accordance with a State system which meets the requirements of section 1137 of this Act;;
(B)
in subsection (e)(13)(A)(i)—
(i)
in the matter preceding subclause (I), by striking sections 1902(a)(46)(B) and 1137(d)
and inserting section 1137(d)
; and
(ii)
by striking subclause (IV) and redesignating subclause (V) as subclause (IV); and
(C)
by striking subsection (ee).
(2) Repeal
Subsection (c) of section 6036 of the Deficit Reduction Act of 2005 (42 U.S.C. 1396b note) is repealed.
(3) CHIP repeal
Section 2105(c)(9) of the Social Security Act (42 U.S.C. 1397ee(c)(9)) is repealed.
(c) Effective date
The amendments made by this section shall take effect on the date of enactment of this Act.
Sec. 4003. Removing barriers to health care and nutrition assistance for children, pregnant persons, and lawfully present individuals
(a) Medicaid
Section 1903(v) of the Social Security Act (42 U.S.C. 1396b(v)) is amended by striking paragraphs (4) and (5) and inserting the following new paragraph:
(4)
(A)
Notwithstanding sections 401(a), 402(b), 403, and 421 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 and paragraph (1), payment shall be made to a State under this section for medical assistance furnished to an alien under this title (including an alien described in such paragraph) who meets any of the following conditions:
(i)
The alien is otherwise eligible for such assistance under the State plan approved under this title (other than the requirement of the receipt of aid or assistance under title IV, supplemental security income benefits under title XVI, or a State supplementary payment) within either or both of the following eligibility categories:
(I)
Children under 21 years of age, including any optional targeted low-income child (as such term is defined in section 1905(u)(2)(B)).
(II)
Pregnant persons during pregnancy and during the 12-month period beginning on the last day of the pregnancy.
(ii)
The alien is lawfully present in the United States.
(B)
No debt shall accrue under an affidavit of support against any sponsor of an alien who meets the conditions specified in subparagraph (A) on the basis of the provision of medical assistance to such alien under this paragraph and the cost of such assistance shall not be considered as an unreimbursed cost.
(b) CHIP
Subparagraph (Q) of section 2107(e)(1) of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended to read as follows:
(Q)
Paragraph (4) of section 1903(v) (relating to coverage of categories of children, pregnant persons, and other lawfully present individuals).
(c) Supplemental nutrition assistance program benefits
(1) Personal Responsibility and Work Opportunity Reconciliation Act of 1996
(A) Federal public benefits
Section 401(b) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1611(b)) is amended by adding at the end the following:
(6)
Subsection (a) shall not apply to benefits under the supplemental nutrition assistance program established under the Food and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.) for an individual who is lawfully present in the United States, regardless of—
(A)
the immigration status of the individual; or
(B)
the date of entry by the individual into the United States.
(B) Other specified Federal programs
Section 402(a) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1612(a)) is amended—
(i)
in paragraph (2)—
(I)
in subparagraph (D)(ii)—
(aa)
in the clause heading, by striking Food stamps
and inserting Supplemental nutrition assistance program
; and
(bb)
in subclause (I), in the first sentence, by striking Food Stamp Act of 1977
and inserting Food and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.)
;
(II)
in subparagraph (F)(ii), by striking (within
and all that follows through the end of the clause and inserting (within the meaning of section 3(j) of the Food and Nutrition Act of 2008 (7 U.S.C. 2012(j))).
;
(III)
in subparagraph (G)(ii), by striking section 4(e) of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b(e)))
and inserting section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304))
;
(IV)
in subparagraph (I), in the subparagraph heading, by striking Food stamp
and inserting Supplemental nutrition assistance program
;
(V)
in subparagraph (J), in the subparagraph heading, by striking Food stamp
and inserting Supplemental nutrition assistance program
;
(VI)
in subparagraph (K)—
(aa)
in the subparagraph heading, by striking Food stamp
and inserting Supplemental nutrition assistance program
; and
(bb)
in clause (i), by striking subclause (I) and inserting the following:
(I)
is lawfully present in the United States, regardless of the immigration status of the individual or the date of entry by the individual into the United States; and; and
(VII)
by striking subparagraph (L) and inserting the following:
(L) Supplemental nutrition assistance program benefits generally
With respect to eligibility for benefits for the specified Federal program described in paragraph (3)(B), paragraph (1) shall not apply to any individual who is lawfully present in the United States, regardless of—
(i)
the immigration status of the individual; or
(ii)
the date of entry by the individual into the United States.; and
(ii)
in paragraph (3)—
(I)
in the matter preceding subparagraph (A), by striking For purposes of
and inserting In
; and
(II)
by striking subparagraph (B) and inserting the following:
(B) SNAP
The supplemental nutrition assistance program established under the Food and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.).
(C) Certain limited eligibility
Section 403 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1613) is amended—
(i)
in subsection (b)—
(I)
in the matter preceding paragraph (1), by striking aliens
;
(II)
in paragraph (2)(C), by striking an individual described in clause (i) or (ii)
and inserting such an individual
; and
(III)
by adding at the end the following:
(4) Supplemental nutrition assistance program benefits
Benefits under the supplemental nutrition assistance program established under the Food and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.) for an individual who is lawfully present in the United States, regardless of—
(A)
the immigration status of the individual; or
(B)
the date of entry by the individual into the United States.; and
(ii)
in subsection (c)(2)(L), by striking the Food Stamp Act of 1977 (7 U.S.C. 2011 et seq.)
and inserting the supplemental nutrition assistance program established under the Food and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.)
.
(2) Food and Nutrition Act of 2008
(A) In general
Section 6(f) of the Food and Nutrition Act of 2008 (7 U.S.C. 2015(f)) is amended—
(i)
in paragraph (2)—
(I)
by redesignating subparagraphs (B), (C), and (D) as clauses (ii), (iii), and (iv), respectively;
(II)
by striking the paragraph designation and all that follows through a citizen
in subparagraph (A) and inserting the following:
(B)
(i)
a citizen; and
(III)
in the undesignated matter following clause (iv) of subparagraph (B) (as so redesignated)—
(aa)
by striking the individual
and inserting an individual
; and
(bb)
by striking The income
and inserting the following:
(2) Factor for consideration
The income;
(ii)
by redesignating paragraph (1) as subparagraph (A) and indenting the subparagraph appropriately;
(iii)
by striking (f) No individual
and inserting the following:
(f) Aliens
(1) In general
Subject to paragraph (3), no individual; and
(iv)
by adding at the end the following:
(3) Clarification of applicability
Notwithstanding paragraph (1), an individual who is lawfully present in the United States shall not be considered to be ineligible for benefits under that paragraph on the basis of—
(A)
the immigration status of the individual; or
(B)
the date of entry by the individual into the United States.
(B) Conforming amendment
Section 5(i)(1) of the Food and Nutrition Act of 2008 (7 U.S.C. 2014(i)(1)) is amended, in the first sentence, by striking section 6(f)(2)(B) of this Act
and inserting section 6(f)(1)(B)(ii)
.
(d) Eligibility for families with children
Section 421(d) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1631(d)) is amended by striking paragraph (3) and inserting the following:
(3) Supplemental nutrition assistance program
This section shall not apply to benefits under the supplemental nutrition assistance program established under the Food and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.), to the extent that a child is a member of a household under that program.
(e) Ensuring proper screening
Section 11(e)(2)(B) of the Food and Nutrition Act of 2008 (7 U.S.C. 2020(e)(2)(B)) is amended—
(1)
by redesignating clauses (vi) and (vii) as clauses (vii) and (viii), respectively; and
(2)
by inserting after clause (v) the following:
(vi)
shall provide a method for implementing section 421 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1631) that does not require any unnecessary information from an individual who may be exempt from that provision;
Sec. 4004. Improve affordability and reduce premium costs of health insurance for consumers
(a) In general
Section 36B(b)(3)(A) of the Internal Revenue Code of 1986 is amended to read as follows:
(A) Applicable percentage
The applicable percentage for any taxable year shall be the percentage such that the applicable percentage for any taxpayer whose household income is within an income tier specified in the following table shall increase, on a sliding scale in a linear manner, from the initial premium percentage to the final premium percentage specified in such table for such income tier:
In the case of household income (expressed as a percent of poverty line) within the following income tier: The initial premium percentage is— The final premium percentage is— Up to 150 percent 0.0 0.0 150 percent up to 200 percent 0.0 3.0 200 percent up to 250 percent 3.0 4.0 250 percent up to 300 percent 4.0 6.0 300 percent up to 400 percent 6.0 8.5 400 percent and higher 8.5 8.5.
(b) Conforming amendments
Section 36B(c)(1) of the Internal Revenue Code of 1986 is amended—
(1)
by striking but does not exceed 400 percent
in subparagraph (A), and
(2)
by striking subparagraph (E).
(c) Effective date
The amendments made by this section shall apply to taxable years beginning after December 31, 2026.
Sec. 4005. Removing citizenship and immigration barriers to access to affordable health care under the ACA
(a) In general
(1) Premium tax credits
Section 36B of the Internal Revenue Code of 1986 is amended—
(A)
in subsection (c)(1), by inserting after subparagraph (A) the following:
(B) Special rule for certain individuals ineligible for Medicaid due to status
If—
(i)
a taxpayer has a household income which is not greater than 100 percent of an amount equal to the poverty line for a family of the size involved,
(ii)
the taxpayer is a noncitizen who is not eligible for the Medicaid program under title XIX of the Social Security Act by reason of the individual’s immigration status,
(iii)
the taxpayer is ineligible for minimum essential coverage under section 5000A(f)(1)(A)(ii), and
(iv)
under the Medicaid eligibility criteria for noncitizens in effect on December 26, 2020, the taxpayer would be ineligible for such minimum essential coverage by reason of the taxpayer’s immigration status,
the taxpayer shall, for purposes of the credit under this section, be treated as an applicable taxpayer with a household income which is equal to 100 percent of the poverty line for a family of the size involved., and
(B)
by striking subsection (e).
(2) Cost-sharing reductions
Section 1402 of the Patient Protection and Affordable Care Act (42 U.S.C. 18071) is amended—
(A)
by striking subsection (e); and
(B)
by redesignating subsections (f) and (g) as subsections (e) and (f), respectively.
(3) Basic health program eligibility
Section 1331(e)(1)(B) of the Patient Protection and Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is amended by striking lawfully present in the United States,
.
(4) Restrictions on Federal payments
Section 1412 of the Patient Protection and Affordable Care Act (42 U.S.C. 18082) is amended—
(A)
by striking subsection (d); and
(B)
by redesignating subsection (e) as subsection (d).
(5) Requirement to maintain minimum essential coverage
Section 5000A(d) of the Internal Revenue Code of 1986 is amended—
(A)
by striking paragraph (3); and
(B)
by redesignating paragraph (4) as paragraph (3).
(b) Conforming amendments
(1) Establishment of program
Section 1411(a) of the Patient Protection and Affordable Care Act (42 U.S.C. 18081(a)) is amended—
(A)
by striking paragraph (1); and
(B)
by redesignating paragraphs (2), (3), and (4) as paragraphs (1), (2), and (3), respectively.
(2) Qualified individuals
Section 1312(f) of the Patient Protection and Affordable Care Act (42 U.S.C. 18032(f)) is amended—
(A)
in the heading, by striking ; access limited to citizens and lawful residents
; and
(B)
by striking paragraph (3).
(c) Effective date
The amendments made by this section shall apply to years, plan years, and taxable years, as applicable, beginning after December 31, 2026.
Sec. 4006. HEAL for Immigrant Families Act
(a) Consistency in health insurance coverage for individuals with federally authorized presence, including deferred action
(1) In general
For purposes of eligibility under any of the provisions described in paragraph (2), all individuals granted federally authorized presence in the United States shall be considered to be lawfully present in the United States.
(2) Provisions described
The provisions described in this paragraph are the following:
(A) Exchange eligibility
Section 1411 of the Patient Protection and Affordable Care Act (42 U.S.C. 18031).
(B) Reduced cost-sharing eligibility
Section 1402 of the Patient Protection and Affordable Care Act (42 U.S.C. 18071).
(C) Premium subsidy eligibility
Section 36B of the Internal Revenue Code of 1986 (26 U.S.C. 36B).
(D) Medicaid and chip eligibility
Titles XIX and XXI of the Social Security Act, including under section 1903(v) of such Act (42 U.S.C. 1396b(v)).
(3) Effective date
(A) In general
Paragraph (1) shall take effect on the date of enactment of this Act.
(B) Transition through special enrollment period
In the case of an individual described in paragraph (1) who, before the first day of the first annual open enrollment period under subparagraph (B) of section 1311(c)(6) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(6)) beginning after the date of enactment of this Act, is granted federally authorized presence in the United States and who, as a result of such subsection, qualifies for a subsidy under a provision described in subparagraph (B) or (C) of paragraph (2), the Secretary of Health and Human Services shall establish a special enrollment period under subparagraph (C) of such section 1311(c)(6) during which such individual may enroll in qualified health plans through Exchanges under title I of the Patient Protection and Affordable Care Act and qualify for such a subsidy. For such an individual who has been granted federally authorized presence in the United States as of the date of enactment of this Act, such special enrollment period shall begin not later than 90 days after such date of enactment. Nothing in this paragraph shall be construed as affecting the authority of the Secretary to establish additional special enrollment periods under such subparagraph (C).
(b) State option To expand Medicaid and CHIP to individuals without lawful presence
(1) Medicaid
(A) In general
Section 1902(a)(10)(A)(ii) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended—
(i)
in subclause (XXII), by striking or
at the end;
(ii)
in subclause (XXIII), by striking the semicolon and inserting ; or
; and
(iii)
by adding at the end the following new subclause:
(XXIV)
who would be eligible under the State plan (or waiver of such plan) under this title if they were citizens of the United States;
(B) Conforming amendment
Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended, in the matter preceding paragraph (1)—
(i)
in the matter designated as clause (xvii), by striking or
at the end;
(ii)
in the matter designated as clause (xviii), by adding or
at the end; and
(iii)
by inserting after the matter designated as clause (xviii) the following:
(xix)
individuals described in section 1902(a)(10)(A)(ii)(XXIV),
(2) CHIP
Title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.) is amended by inserting after section 2112 the following new section:
2112A. State option to provide coverage for individuals without lawful presence
A State may elect through an amendment to its State child health plan under section 2102 to treat an individual as a targeted low-income child or a targeted low-income pregnant woman for purposes of this title if such individual would otherwise be included as such a child or such a pregnant woman (as applicable) under such plan if the individual were a citizen of the United States.
(3) Nonapplication of eligibility prohibition
Section 401(a) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (42 U.S.C. 1611(a)) is amended by adding at the end the following new sentence: The preceding sentence shall not apply with respect to a noncitizen’s eligibility under a State plan (or waiver of such plan) under title XIX of the Social Security Act or under a State child health plan (or waiver of such plan) under title XXI of such Act to the extent that such State has elected to make such individual so eligible pursuant to section 1902(a)(10)(A)(ii)(XXIV) or 2112A of such Act, respectively.
.
(c) Preserving access to coverage
(1) In general
Nothing in this section, including the amendments made by this section, shall prevent lawfully present noncitizens who are ineligible for full benefits under the Medicaid program under title XIX of the Social Security Act from securing a credit for which such lawfully present noncitizens would be eligible under section 36B(c)(1)(B) of the Internal Revenue Code of 1986 and under the Medicaid provisions for lawfully present noncitizens, as in effect on the date prior to the date of enactment of this Act.
(2) Definition
For purposes of paragraph (1), the term full benefits means, with respect to an individual and State, medical assistance for all services covered under the State plan under title XIX of the Social Security Act that is not less in amount, duration, or scope, or is determined by the Secretary of Health and Human Services to be substantially equivalent to the medical assistance available for an individual described in section 1902(a)(10)(A)(i) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)(i)).
Sec. 4007. Study on the uninsured
(a) In general
The Secretary of Health and Human Services (in this section referred to as the Secretary
) shall—
(1)
conduct a study, in accordance with the standards under section 3101 of the Public Health Service Act (42 U.S.C. 300kk), on the demographic characteristics of the population of individuals who do not have health insurance or oral health coverage; and
(2)
predict, based on such study, the demographic characteristics of the population of individuals who would remain without health insurance after the end of any annual open enrollment or any special enrollment period or upon enactment and implementation of any legislative changes to the Patient Protection and Affordable Care Act (Public Law 111–148) that affect the number of persons eligible for health insurance.
(b) Reporting requirements
(1) In general
Not later than 12 months after the date of the enactment of this Act, the Secretary shall submit to the Congress the results of the study under subsection (a)(1) and the prediction made under subsection (a)(2).
(2) Reporting of demographic characteristics
The Secretary shall—
(A)
report the demographic characteristics under paragraphs (1) and (2) of subsection (a) on the basis of racial and ethnic minority group (as defined in section 1707(g)(1) of the Public Health Service Act), and stratify the reporting on each racial and ethnic minority group by other demographic characteristics that can impact access to health insurance, such as sexual orientation, gender identity, primary language, disability status, sex, socioeconomic status, age group, citizenship, and immigration status, in a manner consistent with title I of this Act, including the amendments made by such title; and
(B)
not use such report, or any information gathered in preparing such report—
(i)
to share information on any individual with the Department of Homeland Security or any other agency that engages in immigration enforcement actions; or
(ii)
for the exploitation of, or discrimination against, communities of color or the LGBTQ+ population.
Sec. 4008. Medicaid fallback coverage program for low-income adults in non-expansion States
(a) In general
As soon as possible after the date of enactment of this Act the Secretary of Health and Human Services (in this section referred to as the Secretary) shall—
(1)
directly or by contract, establish a program that offers eligible individuals the opportunity to enroll in health benefits coverage that meets the requirements described in subsection (c) and any requirements applicable to such coverage pursuant to subsection (d); and
(2)
ensure that such program is administered consistent with the requirements of section 431.10(c)(2) of title 42, Code of Federal Regulations.
(b) Definition of eligible individual
In this section, the term eligible individual means an individual who—
(1)
is described in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII));
(2)
resides in a State that—
(A)
does not expend amounts for medical assistance under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) for all individuals described in such section; and
(B)
did not expend amounts for medical assistance under such title for all such individuals as of the date of enactment of this Act; and
(3)
would not be eligible for medical assistance under such State's plan for medical assistance under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), or a waiver of such plan, as such plan or waiver was in effect on such date.
(c) Health benefits coverage requirements
The requirements described in this subsection with respect to health benefits coverage are the following:
(1) Essential health benefits
At a minimum, the coverage meets the minimum standards required under paragraph (5) of section 1937(b) of the Social Security Act (42 U.S.C. 1396u–7(b)) for benchmark coverage described in paragraph (1) of such section or benchmark equivalent coverage described in paragraph (2) of such section.
(2) Premiums and cost-sharing
No premiums are imposed for the coverage, and deductibles, cost-sharing, or similar charges may only be imposed in accordance with the requirements imposed on State Medicaid plans under section 1916 of the Social Security Act (42 U.S.C. 1396o).
(d) Application of requirements and provisions of title XIX of the Social Security Act
The Secretary shall specify that—
(1)
any requirement applicable to the furnishing of medical assistance under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) by States that have elected to make medical assistance available to individuals described in section 1902(a)(10)(A)(i)(VIII) of such title (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)) that does not conflict with the requirements specified in subsection (c) applies to the program established under this section; and
(2)
other provisions of such title apply to such program.
(e) No State mandate
Nothing in this section shall be construed as requiring a State to make expenditures related to the program established under this section and the Secretary shall not impose any such requirement.
(f) Funding
There are appropriated to the Secretary for each fiscal year beginning with fiscal year 2027 from any funds in the Treasury not otherwise appropriated, such sums as are necessary to carry out this section.
Sec. 4009. Increase and extension of temporary enhanced FMAP for States which begin to expend amounts for certain mandatory individuals
(a) In general
Section 1905(ii)(1) of the Social Security Act (42 U.S.C. 1396d(ii)(1)) is amended—
(1)
by striking 8-quarter period
and inserting 40-quarter period
; and
(2)
by striking 5 percentage points
and inserting 10 percentage points
.
(b) Effective date
The amendments made by this section shall take effect as if included in the enactment of section 9814 of the American Rescue Plan Act of 2021 (Public Law 117–2).
Subtitle B Improvement of Coverage
Sec. 4101. Medicaid in the territories
(a) Elimination of general Medicaid funding limitations (CAP
) for territories
(1) In general
Section 1108 of the Social Security Act (42 U.S.C. 1308) is amended—
(A)
in subsection (f), in the matter preceding paragraph (1), by striking subsections (g) and (h)
and inserting subsections (g), (h), and (j)
;
(B)
in subsection (g)(2), in the matter preceding subparagraph (A), by inserting subsection (j) and
after subject to
;
(C)
in subsection (i)—
(i)
by striking paragraph (4); and
(ii)
by redesignating paragraph (5) as paragraph (4); and
(D)
by adding at the end the following new subsection:
(j) Sunset of medicaid funding limitations for puerto rico, the virgin islands, guam, the northern mariana islands, and american samoa
Subsections (f) and (g) shall not apply to Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa beginning with fiscal year 2027.
(2) Conforming amendments
(A)
Section 1902(j) of the Social Security Act (42 U.S.C. 1396a(j)) is amended by striking , the limitation in section 1108(f),,
.
(B)
Section 1903(u) of the Social Security Act (42 U.S.C. 1396b(u)) is amended by striking paragraph (4).
(3) Effective date
The amendments made by this subsection shall apply beginning with fiscal year 2027.
(b) Elimination of specific Federal medical assistance percentage (FMAP) limitation for Puerto Rico
Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended—
(1)
in subsection (b), in the first sentence, by inserting for fiscal years before fiscal year 2027
after American Samoa
; and
(2)
in subsection (ff)(2), by striking 2027
and inserting 2026
.
(c) Permitting medicaid DSH allotments for territories
Section 1923(f) of the Social Security Act (42 U.S.C. 1396r–4(f)) is amended—
(1)
in paragraph (6), by adding at the end the following new subparagraph:
(C) Territories
(i) Fiscal year 2027
For fiscal year 2027, the DSH allotment for Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa shall bear the same ratio to $300,000,000 as the ratio of the number of individuals who are low-income or uninsured and residing in such respective territory (as estimated from time to time by the Secretary) bears to the sums of the number of such individuals residing in all of the territories.
(ii) Subsequent fiscal year
For each subsequent fiscal year, the DSH allotment for each such territory is subject to an increase in accordance with paragraph (3).; and
(2)
in paragraph (9), by inserting before the period at the end the following: , and includes, beginning with fiscal year 2027, Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa
.
Sec. 4102. Extension of the Supplemental Security Income Program to Puerto Rico, the United States Virgin Islands, Guam, and American Samoa
(a) In general
Section 303 of the Social Security Amendments of 1972 (86 Stat. 1484) is amended by striking subsection (b).
(b) Conforming amendments
(1) Definition of state
Section 1101(a)(1) of the Social Security Act (42 U.S.C. 1301(a)(1)) is amended by striking the 5th sentence and inserting the following: Such term when used in title XVI includes Puerto Rico, the United States Virgin Islands, Guam, and American Samoa.
.
(2) Elimination of limit on total payments to the territories
Section 1108 of such Act (42 U.S.C. 1308) is amended—
(A)
in the section heading, by striking ; limitation on total payments
;
(B)
by striking subsection (a); and
(C)
in subsection (c), by striking paragraphs (2) and (4) and redesignating paragraphs (3) and (5) as paragraphs (2) and (4), respectively.
(3) United States nationals treated the same as citizens
Section 1614(a)(1)(B) of such Act (42 U.S.C. 1382c(a)(1)(B)) is amended—
(A)
in clause (i)(I), by inserting or national,
after citizen
;
(B)
in clause (i)(II), by adding ; or
at the end; and
(C)
in clause (ii), by inserting or national
after citizen
.
(4) Territories included in geographic meaning of United States
Section 1614(e) of such Act (42 U.S.C. 1382c(e)) is amended by striking and the District of Columbia
and inserting , the District of Columbia, Puerto Rico, the United States Virgin Islands, Guam, and American Samoa
.
(c) Waiver authority
The Commissioner of Social Security may waive or modify any statutory requirement relating to the provision of benefits under the Supplemental Security Income Program under title XVI of the Social Security Act in Puerto Rico, the United States Virgin Islands, Guam, or American Samoa, to the extent that the Commissioner deems it necessary in order to adapt the program to the needs of the territory involved.
(d) Effective date
This section and the amendments made by this section shall take effect on the 1st day of the 1st Federal fiscal year that begins 1 year or more after the date of the enactment of this Act.
Sec. 4103. Extension of Medicare secondary payer
(a) In general
Section 1862(b)(1)(C) of the Social Security Act (42 U.S.C. 1395y(b)(1)(C)) is amended—
(1)
in the last sentence, by inserting , and before January 1, 2027
after prior to such date)
; and
(2)
by adding at the end the following new sentence: Effective for items and services furnished on or after January 1, 2027 (with respect to periods beginning on or after the date that is 42 months prior to such date), clauses (i) and (ii) shall be applied by substituting
.42-month
for 12-month
each place it appears.
(b) Effective date
The amendments made by this section shall take effect on the date of enactment of this Act. For purposes of determining an individual’s status under section 1862(b)(1)(C) of the Social Security Act (42 U.S.C. 1395y(b)(1)(C)), as amended by subsection (a), an individual who is within the coordinating period as of the date of enactment of this Act shall have that period extended to the full 42 months described in the last sentence of such section, as added by the amendment made by subsection (a)(2).
Sec. 4104. Indian defined in title I of the Patient Protection and Affordable Care Act
(a) Definition of Indian
Section 1304 of the Patient Protection and Affordable Care Act (42 U.S.C. 18024) is amended by adding at the end the following:
(f) Indian
In this title:
(1) In general
The term Indian means—
(A)
an Indian, a California Indian, or an Urban Indian (as those terms are defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)); or
(B)
an individual who is of Indian descent and a member of an Indian community served by a local facility or program of the Indian Health Service.
(2) Inclusions
The term Indian includes the following individuals:
(A)
A member of a federally recognized Indian Tribe.
(B)
A resident of an urban center who meets 1 or more of the following criteria:
(i)
A member of a Tribe, band, or other organized group of Indians, including those Tribes, bands, or groups terminated since 1940 and those recognized as of the date of enactment of the Health Equity and Accountability Act of 2026 or later by the State in which they reside, or being a descendant, in the first or second degree, of any such member.
(ii)
An Eskimo or Aleut or other Alaska Native.
(iii)
An individual who is determined to be an Indian under regulations promulgated by the Secretary.
(C)
An individual who is considered by the Secretary of the Interior to be an Indian for any purpose.
(D)
An individual who is considered by the Secretary to be an Indian for purposes of eligibility for services provided by the Indian Health Service, including as a California Indian, Eskimo, Aleut, or other Alaska Native.
(b) Conforming amendments
(1) Affordable choices of health benefit plans
Section 1311(c)(6)(D) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(6)(D)) is amended by striking (as defined in section 4 of the Indian Health Care Improvement Act)
.
(2) Reduced cost-sharing for individuals enrolling in qualified health plans
Section 1402(d) of the Patient Protection and Affordable Care Act (42 U.S.C. 18071(d)) is amended—
(A)
in paragraph (1), in the matter preceding subparagraph (A), by striking (as defined in section 4(d) of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b(d)))
; and
(B)
in paragraph (2), in the matter preceding subparagraph (A), by striking (as so defined)
.
(3) Exemption from penalty for not maintaining minimum essential coverage
Section 5000A(e) of the Internal Revenue Code of 1986 is amended by striking paragraph (3) and inserting the following:
(3) Indians
Any applicable individual who is an Indian (as defined in section 1304(f) of the Patient Protection and Affordable Care Act).
(c) Effective date of IRC amendment
The amendment made by subsection (b)(3) shall apply to taxable years beginning after the date of the enactment of this Act.
Sec. 4105. Removing Medicare barrier to health care
(a) Part A
Section 1818(a)(3)(B) of the Social Security Act (42 U.S.C. 1395i–2(a)(3)(B)) is amended by striking an alien
and all that follows through under this section
and inserting an individual who is lawfully present in the United States
.
(b) Part B
Section 1836(a)(2)(B) of the Social Security Act (42 U.S.C. 1395o(a)(2)(B)) is amended by striking an alien
and all that follows through under this part
and inserting an individual who is lawfully present in the United States
.
Sec. 4106. Lowering Medicare premiums and prescription drug costs
(a) Medicare Cost Assistance Program
(1) In general
Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by adding at the end the following new section:
1899D. Medicare Cost Assistance Program
(a) In general
Effective beginning January 1, 2027, in the case of a Medicare Cost Assistance Program eligible individual (as defined in subsection (b)(1)), the Secretary shall provide Medicare cost assistance for the following costs incurred with respect to the individual:
(1)
Premiums under section 1818.
(2)
Premiums under section 1839.
(3)
Coinsurance under this title (including coinsurance described in section 1813).
(4)
Deductibles established under this title (including those described in section 1813 and section 1833(b)).
(5)
The difference between the amount that is paid under section 1833(a) and the amount that would be paid under such section if any reference to a percent less than 100 percent therein were deemed a reference to
100 percent.(b) Determination of eligibility
(1) Medicare Cost Assistance Program eligible individual defined
The term Medicare Cost Assistance Program eligible individual means an individual who—
(A)
is eligible for, and is receiving, medical assistance for the payment of medicare cost-sharing under a State Medicaid program pursuant to clause (i), (iii), or (iv) of section 1902(a)(10)(E) as of December 31, 2026; or
(B)
(i)
is entitled to hospital insurance benefits under part A (including an individual entitled to such benefits pursuant to an enrollment under section 1818); and
(ii)
has income at or below 200 percent of the poverty line applicable to a family of the size involved.
(2) Joint determination by Commissioner of Social Security for LIS and Medicare cost assistance
(A) In general
The determination of whether an individual is a Medicare Cost Assistance Program eligible individual shall be determined by the Commissioner of Social Security (referred to in this section as the
Commissioner) jointly with the determination of whether an individual is a subsidy eligible individual described in section 1860D–14(a)(3). Such determination shall be made with respect to eligibility for Medicare cost assistance under this section and premium and cost-sharing subsidies under section 1860D–14 upon application of an individual for a determination with respect to eligibility for either such assistance or such subsidies. There are authorized to be appropriated to the Social Security Administration such sums as may be necessary for the determination of eligibility under this paragraph.(B) Effective period
Determinations under this paragraph with respect to eligibility for each of such assistance or such subsidies shall be effective beginning with the month in which the individual applies for a determination described in subparagraph (A) and shall remain in effect until such time as the Secretary determines the individual is no longer eligible as determined under subparagraph (C)(ii).
(C) Redeterminations
With respect to eligibility determinations under this paragraph—
(i)
redeterminations shall be made at the same time with respect to eligibility for Medicare cost assistance under this section and cost-sharing subsidies under section 1860D–14, but not more frequently than once every 12 months;
(ii)
a redetermination shall automatically determine that an individual remains eligible for such assistance or subsidies unless—
(I)
the Commissioner has information indicating that the individual's circumstances have changed such that the individual is no longer eligible for such assistance or subsidies;
(II)
the Commissioner sends notice to the individual regarding such information that requests a response either confirming or correcting such information; and
(III)
the individual either confirms such information or fails to provide documentation indicating that such circumstances have not changed within 60 days of receiving the notice described in subclause (II);
(iii)
the Commissioner shall establish procedures for appeals of such determinations that are similar to the procedures described in the third sentence of section 1631(c)(1)(A); and
(iv)
judicial review of the final decision of the Commissioner made after a hearing shall be available to the same extent, and with the same limitations, as provided in subsections (g) and (h) of section 205.
(D) Treatment of medicaid beneficiaries
The Secretary shall provide that individuals who are full-benefit dual eligible individuals (as defined in section 1935(c)(6)) or who are recipients of supplemental security income benefits under title XVI shall be treated as a Medicare Cost Assistance Program eligible individual and, in the case of such individual who is a part D eligible individual, a subsidy eligible individual described in section 1860D–14(a)(3).
(E) Simplified application form
(i) In general
The Secretary shall develop and distribute a simplified application form for use by individuals in applying for Medicare cost assistance under this section and premium and cost-sharing subsidies under section 1860D–14. Such form shall be easily readable based on culturally fluid language for all demographics beyond just the various languages offered. An audio version, digital version, and photo-voice option should also be provided for all learners. The Secretary shall provide for the translation of such application form into at least the 10 languages (other than English) that are most often used by individuals applying for hospital insurance benefits under section 226 or 226A and shall make the translated forms available to the Commissioner of Social Security.
(ii) Consultation
In developing the form under clause (i), the Secretary shall consult with beneficiary groups.
(3) Income determinations
For purposes of applying this section—
(A)
in the case of an individual who is not treated as a Medicare Cost Assistance Program eligible individual or a subsidy eligible individual under paragraph (2)(D), income shall be determined in the manner described under section 1612 for purposes of the supplemental security income program, except that support and maintenance furnished in kind shall not be counted as income; and
(B)
the term poverty line has the meaning given such term in section 673(2) of the Community Services Block Grant Act (42 U.S.C. 9902(2)), including any revision required by such section.
(c) Beneficiary protections
(1) In general
In the case in which the payment for Medicare cost assistance for a Medicare Cost Assistance Program eligible individual with respect to an item or service is reduced or eliminated, the individual shall not have any legal liability to make payment to a provider of services (as defined in section 1861(u)), a supplier (as defined in section 1861(d)), or to an organization described in section 1903(m)(1)(A) for the service, and any lawful sanction that may be imposed upon a provider of services, a supplier, or such an organization for excess charges under this title or title XIX shall apply to the imposition of any charge imposed upon the individual in such case.
(2) Clarification
This paragraph shall not be construed as preventing payment of any medicare cost assistance by a medicare supplemental policy or an employer retiree health plan on behalf of an individual.
(d) Administration
(1) In general
The Secretary shall establish procedures for the administration of the program under this section.
(2) Funding
For purposes of carrying out this section, the Secretary shall make payments from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841, in such proportion as the Secretary determines appropriate, of such amounts as the Secretary determines necessary to provide Medicare cost assistance under this section.
(e) References to medicare cost-Sharing
Effective beginning January 1, 2027, any reference to medicare cost-sharing described in section 1905(p) shall be deemed a reference to Medicare cost assistance under this section.
(f) Outreach efforts
For provisions relating to outreach efforts to increase awareness of the availability of Medicare cost assistance, see section 1144.
(2) Special enrollment period
(A) No premium penalty
Section 1839(b) of the Social Security Act (42 U.S.C. 1395r(b)) is amended, in the last sentence, by inserting the following before the period: or, effective beginning January 1, 2027, for individuals who are Medicare Cost Assistance Program eligible individuals (as defined in section 1899D(b)(1)).
.
(B) Special enrollment period
Section 1837 of the Social Security Act (42 U.S.C. 1395p) is amended by adding at the end the following new subsection:
(p) Special enrollment period for Medicare Cost Assistance Program eligible individual
(1) In general
Effective beginning January 1, 2027, the Secretary shall establish special enrollment periods for Medicare Cost Assistance Program eligible individuals (as defined in section 1899D(b)(1)).
(2) Coverage period
In the case of an individual who enrolls during the special enrollment period provided under paragraph (1), the coverage period under this part shall—
(A)
begin on the first day of the first month in which the individual applies for a determination under section 1899D(b)(2)(A); and
(B)
remain in effect until such time as the Secretary determines the individual is no longer eligible as determined under section 1899D(b)(2)(C)(ii).
(C) Conforming sunset of State agreements relating to enrollment of qualified medicare beneficiaries
(i) Part A
Section 1818(g) of the Social Security Act (42 U.S.C. 1395i–2(g)) is amended by adding at the end the following new paragraph:
(3) Sunset
This subsection shall not apply on or after January 1, 2027.
(ii) Part B
Section 1843(h) of the Social Security Act (42 U.S.C. 1395v(h)) is amended by adding at the end the following new paragraph:
(4) Sunset with respect to qualified medicare beneficiaries
This subsection shall not apply with respect to qualified medicare beneficiaries on or after January 1, 2027.
(3) Public awareness campaign
Section 1144 of the Social Security Act (42 U.S.C. 1320b–14) is amended by adding at the end the following new subsection:
(d) Public awareness campaign
(1) In general
The Commissioner shall conduct a public awareness campaign to educate Medicare beneficiaries on the availability of Medicare cost assistance for low-income individuals under section 1899D.
(2) Coordination
In carrying out the public awareness campaign under paragraph (1), the Commissioner shall coordinate with State health insurance assistance programs described in subsection (a)(1)(A) of section 119 of the Medicare Improvements for Patients and Providers Act of 2008 (42 U.S.C. 1395b–3 note), the Administrator of the Administration for Community Living, and the Administrator of the Centers for Medicare & Medicaid Services.
(3) Funding
There is appropriated to the Commissioner, out of any funds in the Treasury not otherwise appropriated, $10,000,000 for each of fiscal years 2027 through 2031, to provide grants to State health insurance assistance programs to carry out outreach and education activities under the public awareness campaign pursuant to this subsection.
(b) Moving Medicare cost-Sharing benefits from Medicaid to Medicare
(1) Ending most Medicare cost-sharing benefits under Medicaid
Section 1902(a)(10) of the Social Security Act (42 U.S.C. 1396a(a)(10)) is amended—
(A)
by inserting for calendar quarters beginning before January 1, 2027,
before for making
each place it appears in clauses (i), (iii), and (iv) of subparagraph (E); and
(B)
in the matter following subparagraph (G)—
(i)
by inserting furnished during calendar quarters beginning before January 1, 2027
after (described in section 1905(p)(3))
;
(ii)
by striking (XV)
and inserting , (XV)
;
(iii)
by striking and (XVIII)
and inserting (XVIII)
;
(iv)
by striking and (XIX)
and inserting (XIX)
; and
(v)
by inserting , and (XX) no medical assistance for medicare cost-sharing, other than medical assistance for medicare cost-sharing for qualified disabled and working individuals described in section 1905(s), shall be made available after January 1, 2027
before the semicolon at the end.
(2) Conforming amendments
(A) Title XIX
(i)
Section 1903(i) of such Act (42 U.S.C. 1396b(i)), as amended by section 4002, is further amended—
(I)
in paragraph (26), by striking or
at the end;
(II)
in paragraph (27), by striking the period at the end and inserting ; or
; and
(III)
by inserting after paragraph (27) the following new paragraph:
(28)
with respect to any amount expended for medical assistance for medicare cost-sharing (other than medical assistance for medicare cost-sharing for qualified disabled and working individuals described in section 1905(s)) furnished during calendar quarters beginning on or after January 1, 2027.
(ii)
Section 1905(a) of such Act (42 U.S.C. 1396d(a)) is amended, in the first sentence, by inserting furnished during calendar quarters beginning before January 1, 2027
after medicare cost-sharing
.
(iii)
Section 1933(g) of such Act (42 U.S.C. 1396u–3(g)) is amended—
(I)
in paragraph (2)(Q), by striking paragraph (4), for each subsequent year
and inserting paragraphs (4) and (5), for each subsequent year before 2027
; and
(II)
by adding at the end the following:
(5) Sunset
No individual shall be selected to be a qualifying individual for any calendar year or period under this section beginning on or after January 1, 2027, and no State allocation shall be made for any fiscal year or period under this section beginning on or after January 1, 2027.
(iv)
Section 1935(a) of such Act (42 U.S.C. 1396u–5(a)) is amended—
(I)
in paragraph (2)(A), by striking make determinations
and inserting prior to January 1, 2027, make determinations
; and
(II)
in paragraph (3), by inserting prior to January 1, 2027,
before the State shall
.
(B) Title XI
Section 1144 of the Social Security Act (42 U.S.C. 1320b–14) is amended—
(i)
in subsection (a)—
(I)
in paragraph (1)(A)—
(aa)
by striking sections 1902(a)(10)(E) and 1933
and inserting section 1902(a)(10)(E) and (prior to January 1, 2027) section 1933
;
(bb)
by striking for the transitional assistance under section 1860D–31(f), or
and inserting a comma; and
(cc)
by inserting , or for Medicare premium and cost-sharing assistance under section 1899D (in the case of months beginning on or after January 1, 2027)
before the semicolon; and
(II)
by striking paragraph (2) and inserting the following:
(2) Content of notice
Any notice furnished under paragraph (1) shall state that eligibility for such medical assistance, subsidies, or program is conditioned upon meeting the applicable eligibility criteria.;
(ii)
in subsection (b)(1)(A)—
(I)
by striking sections 1902(a)(10)(E) and 1933
and inserting section 1902(a)(10)(E) and (prior to January 1, 2027) section 1933
;
(II)
by striking for transitional assistance under section 1860D–31(f), or
; and
(III)
by inserting , or for Medicare premium and cost-sharing assistance under section 1899D
before the semicolon; and
(iii)
in subsection (c)—
(I)
in paragraph (1)(B), by inserting , and (beginning January 1, 2027) provide an application for enrollment under the Medicare Savings Program
before the period;
(II)
in paragraph (2), in the paragraph header, by inserting medicare savings program application and
before lis application
; and
(III)
in paragraph (7), by striking means the program of medical assistance
and all that follows through the period and inserting “means—
(A)
prior to January 1, 2027, the program of medical assistance for payment of the cost of medicare cost-sharing under the Medicaid program pursuant to sections 1902(a)(10)(E) and 1933; and
(B)
beginning January 1, 2027, the program for medical assistance for payment of the cost of medicare cost-sharing for qualified disabled and working individuals described in section 1905(s) pursuant to section 1902(a)(10)(E)(ii) and medicare premium and cost-sharing assistance provided under section 1899D.
(3) Ensuring that Medicare cost-Sharing beneficiaries under Medicaid receive Medicare cost assistance
Not later than January 1, 2027, the Secretary of Health and Human Services and the Commissioner of Social Security shall jointly develop and implement a transition plan to ensure that all individuals who are eligible for and are receiving medical assistance for the payment of medicare cost-sharing under a State Medicaid program pursuant to clauses (i), (iii), and (iv) of section 1902(a)(10)(E) of the Social Security Act (42 U.S.C. 1396a(a)(10)(E)) as of December 31, 2022, receive Medicare cost assistance under section 1899D of such Act, as added by subsection (a), as of January 1, 2027.
(c) Enhancing prescription drug affordability by expanding access to assistance with out-of-Pocket costs under Medicare part D for low-Income seniors and individuals with disabilities
(1) Expanding access
Section 1860D–14 of the Social Security Act (42 U.S.C. 1395w–114) is amended—
(A)
in subsection (a)—
(i)
in paragraph (1), in the matter preceding subparagraph (A)—
(I)
by striking 150 percent
and inserting 200 percent
; and
(II)
by striking and who meets the resources requirement described in paragraph (3)(D) (or, with respect to a plan year beginning on or after January 1, 2024, paragraph (3)(E)) or who is covered under this paragraph under paragraph (3)(B)(i)
;
(ii)
by striking paragraph (2);
(iii)
in paragraph (3)—
(I)
in subparagraph (A)—
(aa)
in clause (i), by adding and
at the end;
(bb)
in clause (ii)—
(AA)
by striking 150 percent
and inserting 200 percent
; and
(BB)
by striking ; and
at the end and inserting a period; and
(cc)
by striking clause (iii);
(II)
by striking subparagraphs (B) and (C) and inserting the following:
(B) Determinations
For provisions relating to joint determinations with respect to eligibility for Medicare cost assistance under section 1899D and premium and cost-sharing subsidies under this section, see section 1899D(b)(2).
(C) Income determinations
For purposes of applying this section—
(i)
in the case of an individual who is not treated as a Medicare cost-sharing assistance eligible individual and a subsidy eligible individual under section 1899D(b)(2)(D), income shall be determined in the manner described under section 1612 for purposes of the supplemental security income program, except that support and maintenance furnished in kind shall not be counted as income; and
(ii)
the term poverty line has the meaning given such term in section 673(2) of the Community Services Block Grant Act (42 U.S.C. 9902(2)), including any revision required by such section. ; and
(III)
by striking subparagraphs (D), (E), and (G); and
(iv)
in paragraph (4)—
(I)
in subparagraph (A)—
(aa)
by striking (A) Copayment for lowest income dual eligible individuals.—
;
(bb)
by redesignating clauses (i) and (ii) as subparagraphs (A) and (B), respectively and indenting appropriately; and
(cc)
by moving the flush text at the end 2 ems to the left; and
(II)
by striking subparagraph (B); and
(B)
in subsection (c)(1), in the second sentence, by striking subsections (a)(1)(D) and (a)(2)(E)
and inserting subsection (a)(1)(D)
.
(2) Treatment of reduction of cost-sharing for individuals receiving home and community-based services
Section 1860D–14(a)(1)(D)(i) of the Social Security Act (42 U.S.C. 1395w–114(a)(1)(D)(i)) is amended—
(A)
by striking who would be such an institutionalized individual or couple, if the full-benefit dual eligible individual were not
; and
(B)
by striking or subsection (c) or (d) of section 1915 or under a State plan amendment under subsection (i) of such section
and inserting , section 1115A, section 1915, or under a State plan amendment
.
(3) Effective date
The amendments made by this subsection shall apply to plan year 2027 and subsequent plan years.
Sec. 4107. Reducing cost-sharing, aligning income and resource eligibility tests, simplifying enrollment, and other program improvements for low-income beneficiaries
(a) Increase in income eligibility to 135 percent of FPL for qualified Medicare beneficiaries
(1) In general
Section 1905(p)(2)(A) of the Social Security Act (42 U.S.C. 1396d(p)(2)(A)) is amended by striking shall be at least the percent provided under subparagraph (B) (but not more than 100 percent) of the official poverty line
and all that follows through the period at the end and inserting the following:
shall be—
(i)
before January 1, 2027, at least the percent provided under subparagraph (B) (but not more than 100 percent) of the official poverty line (as defined by the Office of Management and Budget, and revised annually in accordance with section 673(2) of the Community Services Block Grant Act (42 U.S.C. 9902(2))) applicable to a family of the size involved; and
(ii)
on or after January 1, 2027, equal to 135 percent of the official poverty line (as so defined and revised) applicable to a family of the size involved.
(2) Not counting in-kind support and maintenance as income
Section 1905(p)(2)(D) of the Social Security Act (42 U.S.C. 1396d(p)(2)(D)) is amended by adding at the end the following new clause:
(iii)
In determining income under this subsection, support and maintenance furnished in kind shall not be counted as income.
(b) Increase in income eligibility to 200 percent of FPL for specified low-Income Medicare beneficiaries
(1) Eligibility of individuals with incomes below 150 percent of FPL
Section 1902(a)(10)(E) of the Social Security Act (42 U.S.C. 1396a(a)(10)(E)) is amended—
(A)
by adding and
at the end of clause (ii);
(B)
in clause (iii)—
(i)
by striking and 120 percent in 1995 and years thereafter
and inserting 120 percent in 1995 and years thereafter before 2027, and 200 percent in 2027 and years thereafter
; and
(ii)
by striking and
at the end; and
(C)
by striking clause (iv).
(2) References
Section 1905(p)(1) of the Social Security Act (42 U.S.C. 1396d(p)(1)) is amended by adding at and below subparagraph (C) the following flush sentence:
The term specified low-income medicare beneficiary means an individual described in section 1902(a)(10)(E)(iii).
(3) Conforming amendments
(A)
The first sentence of section 1905(b) of such Act (42 U.S.C. 1396d(b)) is amended by striking “and section 1933(d)”.
(B)
Section 1933 of such Act (42 U.S.C. 1396u–3) is repealed.
(c) 100 percent FMAP
Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended—
(1)
in subsection (b), by striking and (ii)
and inserting (ii), and (ll)
; and
(2)
amended by adding at the end the following new subsection:
(ll) Increased FMAP for expanded medicare cost-Sharing populations
(1) In general
Notwithstanding subsection (b), with respect to expenditures described in paragraph (2) the Federal medical assistance percentage shall be equal to 100 percent.
(2) Expenditures described
The expenditures described in this paragraph are expenditures made on or after January 1, 2027, for medical assistance for medicare cost-sharing provided to any individual under clause (i), (ii), or (iii) of section 1902(a)(10)(E) who would not have been eligible for medicare cost-sharing under any such clause under the income or resource eligibility standards in effect on October 1, 2018.
(d) Consolidation of low-Income subsidy resource eligibility tests
(1) In general
Section 1860D–14(a)(3) of the Social Security Act (42 U.S.C. 1395w–114(a)(3)) is amended—
(A)
by striking subparagraph (D);
(B)
by redesignating subparagraphs (E) through (G) as subparagraphs (D) through (F), respectively; and
(C)
in the heading of subparagraph (D), as so redesignated, by striking Alternative resource
and inserting Resource
.
(2) Clarification of certain rules relating to income and resource determinations
Section 1860D–14(a)(3) of the Social Security Act (42 U.S.C. 1395w–114(a)(3)), as amended by paragraph (1), is amended by striking subparagraph (F) and inserting the following new subparagraphs:
(F) Resource exclusions
In determining the resources of an individual (and the eligible spouse of the individual, if any) under section 1613 for purposes of subparagraph (D)—
(i)
no part of the value of any life insurance policy shall be taken into account;
(ii)
no part of the value of any vehicle shall be taken into account;
(iii)
there shall be excluded an amount equal to $1,500 each with respect to any individual or eligible spouse of an individual who attests that some of the resources of such individual or spouse will be used to meet the burial and related expenses of such individual or spouse; and
(iv)
no balance in, or benefits received under, an employee pension benefit plan (as defined in section 3 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1002)) shall be taken into account.
(G) Family size
In determining the size of the family of an individual for purposes of determining the income eligibility of such individual under this section, an individual's family shall consist of—
(i)
the individual;
(ii)
the individual's spouse who lives in the same household as the individual (if any); and
(iii)
any other individuals who—
(I)
are related to the individual whose income eligibility is in question or such individual's spouse who lives in the same household;
(II)
are living in the same household as such individual; and
(III)
are dependent on such individual or such individual's spouse who is living in the same household for at least one-half of their financial support.
(3) Conforming amendments
Section 1860D–14(a) of the Social Security Act (42 U.S.C. 1395w–114(a)) is amended—
(A)
in paragraph (1), in the matter preceding subparagraph (A), by inserting (as determined under paragraph (3)(G))
after family of the size involved
; and
(B)
in paragraph (3), as amended by paragraphs (1) and (2)—
(i)
in subparagraph (A), in the matter preceding clause (i), by striking subparagraph (F)
and inserting subparagraph (E)
;
(ii)
in subparagraph (A)(ii), by inserting (as determined under subparagraph (G))
after family of the size involved
;
(iii)
in subparagraph (A)(iii), by striking or (E)
;
(iv)
in subparagraph (B)(v), in the matter preceding subclause (I), by striking subparagraph (F)
and inserting subparagraph (E)
; and
(v)
in subparagraph (D)(i), in the matter preceding subclause (I), by striking subject to the life insurance policy exclusion provided under subparagraph (G)
and inserting subject to the resource exclusions provided under subparagraph (F)
.
(e) Alignment of low-Income subsidy and medicare savings program income and resource eligibility tests
(1) Application of Medicaid spousal impoverishment resource allowance to MSP and LIS resource eligibility
Section 1905(p)(1)(C) of the Social Security Act (42 U.S.C. 1396d(p)(1)(C)) is amended to read as follows:
(C)
whose resources (as determined under section 1613 for purposes of the supplemental security income program subject to the resource exclusions under subparagraph (F) of section 1860D–14(a)(3)) do not exceed—
(i)
in the case of an individual with a spouse, an amount equal to the sum of the first amount specified in subsection (f)(2)(A)(i) of section 1924 (as adjusted under subsection (g) of such section) and the amount specified in subsection (f)(2)(A)(ii)(II) of such section (as so adjusted); or
(ii)
in the case of an individual who does not have a spouse, an amount equal to ½ of the amount described in clause (i).
(2) Application to QDWIs
Section 1905(s)(3) of the Social Security Act (42 U.S.C. 1396d(s)(3)) is amended to read as follows:
(3)
whose resources (as determined under section 1613 for purposes of the supplemental security income program subject to the resource exclusions under subparagraph (F) of section 1860D–14(a)(3)) do not exceed—
(A)
in the case of an individual with a spouse, the amount in effect for the year under clause (i) of subsection (p)(1)(C); and
(B)
in the case of an individual who does not have a spouse, the amount in effect for the year under clause (ii) of subsection (p)(1)(C); and
(3) Application to LIS
Clause (i) of section 1860D–14(a)(3)(D) of the Social Security Act (42 U.S.C. 1395w–114(a)(3)(D)), as redesignated and amended by subsection (d), is amended to read as follows:
(i) In general
The resources requirement of this subparagraph is that an individual's resources (as determined under section 1613 for purposes of the supplemental security income program subject to the resource exclusions provided under subparagraph (F)) do not exceed the amount in effect for the year under section 1905(p)(1)(C)(ii).
(f) Enrollment simplifications
(1) Application of 3-month retroactive eligibility to QMBs
(A) In general
Section 1902(e)(8) of the Social Security Act (42 U.S.C. 1396a(e)(8)) is amended by striking after the end of the month in which the determination first occurs
and inserting in or after the third month before the month in which the individual makes application for assistance
.
(B) Process for submitting claims during retroactive eligibility period
Section 1902(e)(8) of the Social Security Act (42 U.S.C. 1396a(e)(8)) is further amended by adding at the end the following: The Secretary shall provide for a process under which claims for medical assistance under the State plan may be submitted for services furnished to such an individual during such 3-month period before the month in which the individual made application for assistance.
.
(C) Conforming amendment
Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended, in the matter preceding paragraph (1), by striking or, in the case of medicare cost-sharing with respect to a qualified medicare beneficiary described in subsection (p)(1), if provided after the month in which the individual becomes such a beneficiary
.
(2) State option for 12-month continuous eligibility for SLMBs and QWDIs
Section 1902(e)(12) of the Social Security Act (42 U.S.C. 1396a(e)(12)) is amended—
(A)
by redesignating subparagraphs (A), (B), and (C) as clauses (i), (ii), and (iii) respectively;
(B)
by inserting (A)
after (12)
; and
(C)
by adding at the end the following:
(B)
At the option of the State, the plan may provide that an individual who is determined to be eligible for benefits under a State plan approved under this title under any of the following eligibility categories, or who is redetermined to be eligible for such benefits under any of such categories, shall be considered to meet the eligibility requirements met on the date of application and shall remain eligible for those benefits until the end of the 12-month period following the date of the determination or redetermination of eligibility, except that a State may provide for such determinations more frequently, but not more frequently than once every 6 months for an individual:
(i)
A specified low-income medicare beneficiary described in subsection (a)(10)(E)(iii) of this section who is determined eligible for medicare cost-sharing described in section 1905(p)(3)(A)(ii).
(ii)
A qualified disabled and working individual described in section 1905(s) who is determined eligible for medicare cost-sharing described in section 1905(p)(3)(A)(i).
(3) State option to use Express Lane eligibility for the Medicare Savings Program
Section 1902(e)(13)(A) of the Social Security Act (42 U.S.C. 1396a(e)(13)(A)) is amended by adding at the end the following new clause:
(iii) State option to extend express lane eligibility to other populations
(I) In general
At the option of the State, the State may apply the provisions of this paragraph with respect to determining eligibility under this title for an eligible individual (as defined in subclause (II)). In applying this paragraph in the case of a State making such an option, any reference in this paragraph to a child with respect to this title (other than a reference to child health assistance) shall be deemed to be a reference to an eligible individual.
(II) Eligible individual defined
In this clause, the term eligible individual means any of the following:
(aa)
A qualified medicare beneficiary described in section 1905(p)(1) for purposes of determining eligibility for medicare cost-sharing (as defined in section 1905(p)(3)).
(bb)
A specified low-income medicare beneficiary described in subsection (a)(10)(E)(iii) of this section for purposes of determining eligibility for medicare cost-sharing described in section 1905(p)(3)(A)(ii).
(cc)
A qualified disabled and working individual described in section 1905(s) for purposes of determining eligibility for medicare cost-sharing described in section 1905(p)(3)(A)(i).
(g) Medicaid treatment of certain Medicare providers
Section 1902(n) of the Social Security Act (42 U.S.C. 1396a(n)) is amended by inserting after paragraph (3)(C) the following new paragraph:
(4)
A State plan shall not deny a claim from a provider or supplier with respect to medicare cost-sharing described in subparagraph (B), (C), or (D) of section 1905(p)(3) for an item or service which is eligible for payment under title XVIII on the basis that the provider or supplier does not have a provider agreement in effect under this title or does not otherwise serve all individuals entitled to medical assistance under this title. The State shall create a mechanism through which providers or suppliers that do not otherwise have provider agreements with the State can bill the State for medicare cost-sharing for qualified medicare beneficiaries.
(h) Eligibility for other programs
Section 1905(p) of the Social Security Act (42 U.S.C. 1396d(p)) is amended by adding at the end the following new paragraph:
(7)
Notwithstanding any other provision of law, any medical assistance for some or all medicare cost-sharing under this title shall not be considered income or resources in determining eligibility for, or the amount of assistance or benefits provided under, any other public benefit provided under Federal law or the law of any State or political subdivision thereof.
(i) Treatment of qualified Medicare beneficiaries, specified low-Income Medicare beneficiaries, and other dual eligibles as medicare beneficiaries
Section 1862 of the Social Security Act (42 U.S.C. 1395y) is amended by adding at the end the following new subsection:
(p) Treatment of Qualified Medicare Beneficiaries (QMBs), Specified Low-Income Medicare Beneficiaries (SLMBs), and Other Dual Eligibles
Nothing in this title shall be construed as authorizing a provider of services or supplier to discriminate (through a private contractual arrangement or otherwise) against an individual who is otherwise entitled to services under this title on the basis that the individual is a qualified medicare beneficiary (as defined in section 1905(p)(1)), a specified low-income medicare beneficiary, or is otherwise eligible for medical assistance for medicare cost-sharing or other benefits under title XIX.
(j) Additional Funding for State Health Insurance Assistance Programs
(1) Grants
(A) In general
The Secretary of Health and Human Services (in this subsection referred to as the Secretary
) shall use amounts made available under subparagraph (B) to make grants to States for State health insurance assistance programs receiving assistance under section 4360 of the Omnibus Budget Reconciliation Act of 1990 (42 U.S.C. 1395b–4).
(B) Funding
For purposes of making grants under this subsection, the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t), in the same proportion as the Secretary determines under section 1853(f) of such Act (42 U.S.C. 1395w–23(f)), of $50,000,000 to the Centers for Medicare & Medicaid Services Program Management Account for each of the fiscal years 2027 through 2031, to remain available until expended.
(2) Amount of grants
The amount of a grant to a State under this subsection from the total amount made available under paragraph (1) shall be equal to the sum of the amount allocated to the State under paragraph (3)(A) and the amount allocated to the State under subparagraph (3)(B).
(3) Allocation to States
(A) Allocation based on percentage of low-income beneficiaries
The amount allocated to a State under this subparagraph from 2/3 of the total amount made available under paragraph (1) shall be based on the number of individuals who meet the requirement under subsection (a)(3)(A)(ii) of section 1860D–14 of the Social Security Act (42 U.S.C. 1395w–114) but who have not enrolled to receive a subsidy under such section 1860D–14 relative to the total number of individuals who meet the requirement under such subsection (a)(3)(A)(ii) in each State, as estimated by the Secretary.
(B) Allocation based on percentage of rural beneficiaries
The amount allocated to a State under this subparagraph from 1/3 of the total amount made available under paragraph (1) shall be based on the number of part D eligible individuals (as defined in section 1860D–1(a)(3)(A) of such Act (42 U.S.C. 1395w–101(a)(3)(A))) residing in a rural area relative to the total number of such individuals in each State, as estimated by the Secretary.
(4) Portion of grant based on percentage of low-income beneficiaries to be used to provide outreach to individuals who may be subsidy eligible individuals or eligible for the Medicare Savings Program
Each grant awarded under this subsection with respect to amounts allocated under paragraph (3)(A) shall be used to provide outreach to individuals who may be subsidy eligible individuals (as defined in section 1860D–14(a)(3)(A) of the Social Security Act (42 U.S.C. 1395w–114(a)(3)(A))) or eligible for the program of medical assistance for payment of the cost of medicare cost-sharing under the Medicaid program pursuant to section 1902(a)(10)(E) of such Act (42 U.S.C. 1396a(a)(10)(E), 1396u–3).
(k) Effective date
(1) In general
Except as provided in paragraph (2), the amendments and repeal made by this section take effect on January 1, 2027, and, with respect to title XIX of the Social Security Act, apply to calendar quarters beginning on or after January 1, 2027.
(2) Exception for State legislation
In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendments and repeal made by this section, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.
Sec. 4108. 100 percent FMAP for medical assistance provided by urban Indian organizations
(a) In general
The third sentence of section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) is amended by striking for the 8 fiscal year quarters beginning with the first fiscal year quarter beginning after the date of the enactment of the American Rescue Plan Act of 2021,
and inserting and
.
(b) Effective date
The amendment made by this section shall apply to medical assistance provided on or after the date of enactment of this Act.
Sec. 4109. 100 percent FMAP for medical assistance provided to a Native Hawaiian through a federally qualified health center or a Native Hawaiian health care system under the Medicaid program
(a) In general
The third sentence of section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) is amended by striking , for such 8 fiscal year quarters
.
(b) Effective date
The amendment made by this section shall apply to medical assistance provided on or after the date of enactment of this Act.
Sec. 4110. Repeal of requirement for estate recovery under the Medicaid program
Section 1917 of the Social Security Act (42 U.S.C. 1396p) is amended—
(1)
in subsection (a)—
(A)
by amending paragraph (1) to read as follows:
(1)
No lien may be imposed against the property of any individual prior to his death on account of medical assistance paid or to be paid on his behalf under the State plan, except pursuant to the judgment of a court on account of benefits incorrectly paid on behalf of such individual.;
(B)
by striking paragraph (2);
(C)
in paragraph (3), by striking (1)(B)
and inserting (1)
; and
(D)
by redesignating paragraph (3) as paragraph (2); and
(2)
by amending subsection (b) to read as follows:
(b) Adjustment or recovery of medical assistance correctly paid under a State plan
No adjustment or recovery of any medical assistance correctly paid on behalf of an individual under the State plan may be made.
Sec. 4111. Allow for suspension of Medicare benefits and premium liability for individuals who are incarcerated and provide a special enrollment period around the date of release
(a) Special enrollment period for individuals incarcerated at time of Medicare eligibility
Section 1837(i) of the Social Security Act (42 U.S.C. 1395p(i)) is amended by adding at the end the following new paragraph:
(5)
(A)
In the case of an individual who—
(i)
at the time the individual first satisfies paragraph (1) or (2) of section 1836(a), is incarcerated; or
(ii)
has elected not to enroll (or to be deemed enrolled) under this section during the individual’s initial enrollment period;
there shall be a special enrollment period described in subparagraph (B).
(B)
The special enrollment period referred to in subparagraph (A) is the 6-month period beginning on the first day after which the individual is no longer incarcerated.
(b) Premium amount
Section 1839(a) of the Social Security Act (42 U.S.C. 1395r(a)) is amended—
(1)
in paragraph (1), in the second sentence, by striking and (7),
and inserting (7), and (8),
; and
(2)
by adding at the end the following new paragraph:
(8)
In the case of an individual whose coverage period includes months in which by reason of custody under penal authority coverage is excluded pursuant to section 1862(a)(3), the premium amount for such months such individual is in custody under penal authority shall be 0.
(c) Conforming amendment
Section 1818(d)(5) of the Social Security Act (42 U.S.C. 1395i–2(d)(5)) is amended by adding at the end the following:
(D)
In the case of an individual who is a person who is excluded from coverage pursuant to section 1862(a)(3) by reason of custody under penal authority, the amount of the monthly premium for such individual shall be 0 for any month in which such individual is in custody under penal authority.
Sec. 4112. Federal employee health benefits plans
(a) Coverage of pregnancy
The Director of the Office of Personnel Management shall issue such regulations as are necessary to ensure that pregnancy is considered a change in family status and a qualifying life event for an individual who is eligible to enroll, but is not enrolled, in a health benefits plan under chapter 89 of title 5, United States Code.
(b) Effective date
The requirement in paragraph (1) shall apply with respect to any contract entered into under section 8902 of title 5, United States Code, on or after the date that is 1 year after the date of enactment of this Act.
Sec. 4113. Continuation of Medicaid income eligibility standard for pregnant individuals and infants
Section 1902(l)(2)(A) of the Social Security Act (42 U.S.C. 1396a(l)(2)(A)) is amended—
(1)
in clause (i), by striking and not more than 185 percent
;
(2)
in clause (ii)—
(A)
in subclause (I), by striking and
after the comma;
(B)
in subclause (II), by striking the period at the end and inserting , and
; and
(C)
by adding at the end the following:
(III)
January 1, 2027, is the percentage provided under clause (v).; and
(3)
by adding at the end the following new clause:
(v)
The percentage provided under clause (ii) for medical assistance provided on or after January 1, 2027, with respect to individuals described in subparagraph (A) or (B) of paragraph (1) shall not be less than—
(I)
the percentage specified for such individuals by the State in an amendment to its State plan (whether approved or not) as of January 1, 2014; or
(II)
if no such percentage is specified as of January 1, 2014, the percentage established for such individuals under the State’s authorizing legislation or provided for under the State’s appropriations as of that date.
Subtitle C Expansion of Access
Part 1 General Provisions
Sec. 4201. Amendment to the Public Health Service Act
Title XXXIV of the Public Health Service Act, as amended by titles I, II, and III of this Act, is further amended by inserting after subtitle C the following:
D Reconstruction and Improvement Grants for Public Health Care Facilities Serving Pacific Islanders and the Insular Areas
3441. Grant support for quality improvement initiatives
(a) In general
The Secretary, in collaboration with the Administrator of the Health Resources and Services Administration, the Director of the Agency for Healthcare Research and Quality, and the Administrator of the Centers for Medicare & Medicaid Services, shall award grants to eligible entities for the conduct of demonstration projects to improve the quality of and access to health care.
(b) Eligibility
To be eligible to receive a grant under subsection (a), an entity shall—
(1)
be a health center, hospital, health plan, health system, community clinic, hospice or palliative care provider, or other health entity determined appropriate by the Secretary—
(A)
that, by legal mandate or explicitly adopted mission, provides patients with access to services regardless of their ability to pay;
(B)
that provides care or treatment for a substantial number of patients who are uninsured, are receiving assistance under a State plan under title XIX of the Social Security Act (or under a waiver of such plan), or are members of vulnerable populations, as determined by the Secretary; and
(C)
(i)
with respect to which, not less than 50 percent of the entity’s patient population is made up of racial and ethnic minority groups; or
(ii)
that—
(I)
serves a disproportionate percentage of local patients who are from a racial and ethnic minority group, or has a patient population at least 50 percent of which is composed of individuals with limited English proficiency; and
(II)
provides an assurance that amounts received under the grant will be used only to support quality improvement activities in the racial and ethnic minority group served; and
(2)
prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(c) Priority
In awarding grants under subsection (a), the Secretary shall give priority to eligible entities that—
(1)
demonstrate an intent to operate as part of a health care partnership, network, collaborative, coalition, or alliance where each member entity contributes to the design, implementation, and evaluation of the proposed intervention; or
(2)
intend to use funds to carry out systemwide changes with respect to health care quality improvement, including—
(A)
improved systems for data collection and reporting;
(B)
innovative collaborative or similar processes;
(C)
group programs with behavioral or self-management interventions;
(D)
case management services;
(E)
physician or patient reminder systems;
(F)
educational interventions;
(G)
comprehensive and patient-centric health care;
(H)
creation and distribution of education materials on available health care options; or
(I)
other activities determined appropriate by the Secretary.
(d) Use of funds
An entity shall use amounts received under a grant under subsection (a) to support the implementation and evaluation of health care quality improvement activities or minority health and health care disparity reduction activities that include—
(1)
with respect to health care systems, activities relating to improving—
(A)
patient safety;
(B)
timeliness of care;
(C)
effectiveness of care;
(D)
efficiency of care;
(E)
patient centeredness;
(F)
health information technology;
(G)
accessibility and availability of information on health care;
(H)
comprehensiveness of health care; and
(I)
patient involvement and choice in health care; and
(2)
with respect to patients, activities relating to—
(A)
staying healthy;
(B)
getting well, mentally and physically;
(C)
living effectively with illness or disability;
(D)
preparing for end of life and ensuring that end-of-life care is accessible and available, as well as coping with end-of-life issues; and
(E)
shared decision making.
(e) Common data systems
The Secretary shall provide financial and other technical assistance to grantees under this section for the development of common data systems.
(f) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2034.
3442. Centers of excellence
(a) In general
The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall designate centers of excellence at public hospitals, and other health systems serving large numbers of patients from minority populations, that—
(1)
meet the requirements of section 3441(b)(1);
(2)
demonstrate excellence in providing care to minority populations; and
(3)
demonstrate excellence in reducing disparities in health and health care.
(b) Requirements
A hospital or health system that serves as a center of excellence under subsection (a) shall—
(1)
design, implement, and evaluate programs and policies relating to the delivery of care in racially, ethnically, and linguistically diverse populations;
(2)
provide training and technical assistance to other hospitals and health systems relating to the provision of high-quality health care to minority populations; and
(3)
develop activities for graduate or continuing medical education that institutionalize a focus on cultural competence training for health care providers.
(c) Authorization of appropriations
There are authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2027 through 2034.
3443. Reconstruction and improvement grants for public health care facilities serving pacific islanders and the insular areas
(a) In general
The Secretary shall provide direct financial assistance to designated health care providers and community health centers in American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the United States Virgin Islands, Puerto Rico, and Hawaii for the purposes of reconstructing and improving health care facilities and services in a culturally competent and sustainable manner.
(b) Eligibility
To be eligible to receive direct financial assistance under subsection (a), an entity shall be a public health facility or community health center located in American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the United States Virgin Islands, Puerto Rico, or Hawaii that—
(1)
is owned or operated by—
(A)
the Government of American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the United States Virgin Islands, Puerto Rico, or Hawaii or a unit of local government; or
(B)
a nonprofit organization; and
(2)
(A)
provides care or treatment for a substantial number of patients who are uninsured, are receiving assistance under title XVIII of the Social Security Act or under a State plan under title XIX of such Act (or under a waiver of such plan), or are members of a vulnerable population, as determined by the Secretary; or
(B)
serves a disproportionate percentage of local patients that are from a racial and ethnic minority group.
(c) Report
Not later than 180 days after the date of enactment of this title and annually thereafter, the Secretary shall submit to the Congress and the President a report that includes an assessment of health resources and facilities serving populations in American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the United States Virgin Islands, Puerto Rico, and Hawaii. In preparing such report, the Secretary shall—
(1)
consult with and obtain information on all health care facilities needs from the entities receiving direct financial assistance under subsection (a);
(2)
include all amounts of Federal assistance received by each such entity in the preceding fiscal year;
(3)
review the total unmet needs of health care facilities serving American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the United States Virgin Islands, Puerto Rico, and Hawaii, including needs for renovation and expansion of existing facilities;
(4)
include a strategic plan for addressing the needs of each such population identified in the report; and
(5)
evaluate the effectiveness of the care provided by measuring patient outcomes and cost measures.
(d) Authorization of appropriations
There are authorized to be appropriated such sums as necessary to carry out this section.
Sec. 4202. Border health grants
(a) Definitions
In this section:
(1) Border area
The term border area means the United States-Mexico Border Area, as defined in section 8 of the United States-Mexico Border Health Commission Act (22 U.S.C. 290n–6).
(2) Eligible entity
The term eligible entity means an entity that is located in the border area and is any of the following:
(A)
A State, local government, or Tribal government.
(B)
A public institution of higher education.
(C)
A nonprofit health organization.
(D)
A community health center.
(E)
A community clinic that is a health center receiving assistance under section 330 of the Public Health Service Act (42 U.S.C. 254b).
(F)
A nonprofit organization serving immigrants.
(b) Authorization
From funds appropriated pursuant to subsection (f), the Secretary of Health and Human Services (in this section referred to as the Secretary
), in consultation with 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 and demonstrating the entity’s capacity to provide culturally and linguistically appropriate services to border area residents.
(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)
musculoskeletal health and obesity;
(E)
health education and promotion;
(F)
oral health;
(G)
mental and behavioral health;
(H)
substance use disorders;
(I)
health conditions that have a high prevalence in the border area;
(J)
medical and health services research;
(K)
workforce training and development;
(L)
community health workers, patient navigators, and promotores;
(M)
health care infrastructure problems in the border area (including planning and construction grants);
(N)
health disparities in the border area;
(O)
environmental health;
(P)
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 et seq.; 42 U.S.C. 1397aa et seq.));
(Q)
end-of-life care; and
(R)
addressing social determinants of health; and
(2)
other programs determined appropriate by the Secretary.
(e) Supplement, not supplant
Amounts provided to an eligible entity awarded a grant under subsection (b) shall be used to supplement and not supplant other funds available to the eligible entity to carry out the activities described in subsection (d).
(f) Authorization of appropriations
There are authorized to be appropriated to carry out this section, $200,000,000 for fiscal year 2027, and such sums as may be necessary for each succeeding fiscal year.
Sec. 4203. Critical access hospital improvements
(a) Elimination of isolation test for cost-Based ambulance reimbursement
(1) In general
Section 1834(l)(8) of the Social Security Act (42 U.S.C. 1395m(l)(8)) is amended—
(A)
in subparagraph (B)—
(i)
by striking owned and
; and
(ii)
by inserting (including when such services are provided by the entity under an arrangement with the hospital)
after hospital
; and
(B)
by striking the comma at the end of subparagraph (B) and all that follows and inserting a period.
(2) Effective date
The amendments made by this subsection shall apply to services furnished on or after January 1, 2027.
(b) Provision of a more flexible alternative to the CAH designation 25 inpatient bed limit requirement
(1) In general
Section 1820(c)(2) of the Social Security Act (42 U.S.C. 1395i–4(c)(2)) is amended—
(A)
in subparagraph (B)(iii), by striking provides not more than
and inserting subject to subparagraph (F), provides not more than
; and
(B)
by adding at the end the following new subparagraph:
(F) Alternative to 25 inpatient bed limit requirement
(i) In general
A State may elect to treat a facility, with respect to the designation of the facility for a cost reporting period, as satisfying the requirement of subparagraph (B)(iii) relating to a maximum number of acute care inpatient beds if the facility elects, in accordance with a method specified by the Secretary and before the beginning of the cost reporting period, to meet the requirement under clause (ii).
(ii) Alternate requirement
The requirement under this clause, with respect to a facility and a cost reporting period, is that the total number of inpatient bed days described in subparagraph (B)(iii) during such period will not exceed 7,300. For purposes of this subparagraph, an individual who is an inpatient in a bed in the facility for a single day shall be counted as one inpatient bed day.
(iii) Withdrawal of election
The option described in clause (i) shall not apply to a facility for a cost reporting period if the facility (for any two consecutive cost reporting periods during the previous 5 cost-reporting periods) was treated under such option and had a total number of inpatient bed days for each of such two cost reporting periods that exceeded the number specified in such clause.
(2) Effective date
The amendments made by paragraph (1) shall apply to cost reporting periods beginning on or after the date of the enactment of this Act.
Sec. 4204. Medicare remote monitoring pilot projects
(a) Pilot projects
(1) In general
Not later than 9 months after the date of enactment of this Act, the Secretary of Health and Human Services (in this section referred to as the Secretary) shall conduct pilot projects under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) for the purpose of providing incentives to home health agencies to utilize home monitoring and communications technologies that—
(A)
enhance health and health care outcomes for Medicare beneficiaries; and
(B)
reduce expenditures under such title.
(2) Site requirements
(A) Urban and Rural
The Secretary shall conduct the pilot projects under this section in both urban and rural areas.
(B) Site in a small State
The Secretary shall conduct at least 3 of the pilot projects in a State with a population of less than 1,000,000.
(3) Definition of home health agency
In this section, the term home health agency has the meaning given that term in section 1861(o) of the Social Security Act (42 U.S.C. 1395x(o)).
(b) Medicare beneficiaries within the scope of projects
The Secretary shall specify the criteria for identifying those Medicare beneficiaries who shall be considered within the scope of the pilot projects under this section for purposes of the application of subsection (c) and for the assessment of the effectiveness of the home health agency in achieving the objectives of this section. Such criteria may provide for the inclusion in the projects of Medicare beneficiaries who begin receiving home health services under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) after the date of the implementation of the projects.
(c) Incentives
(1) Performance targets
The Secretary shall establish for each home health agency participating in a pilot project under this section a performance target using one of the following methodologies, as determined appropriate by the Secretary:
(A) Adjusted historical performance target
The Secretary shall establish for the agency—
(i)
a base expenditure amount equal to the average total payments made to the agency under parts A and B of title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) for Medicare beneficiaries determined to be within the scope of the pilot project in a base period determined by the Secretary; and
(ii)
an annual per capita expenditure target for such beneficiaries, reflecting the base expenditure amount adjusted for risk and adjusted growth rates.
(B) Comparative performance target
The Secretary shall establish for the agency a comparative performance target equal to the average total payments under such parts A and B during the pilot project for comparable individuals in the same geographic area that are not determined to be within the scope of the pilot project.
(2) Incentive
Subject to paragraph (3), the Secretary shall pay to each participating home care agency an incentive payment for each year under the pilot project equal to a portion of the Medicare savings realized for such year relative to the performance target under paragraph (1).
(3) Limitation on expenditures
The Secretary shall limit incentive payments under this section in order to ensure that the aggregate expenditures under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) (including incentive payments under this subsection) do not exceed the amount that the Secretary estimates would have been expended if the pilot projects under this section had not been implemented.
(d) Waiver authority
The Secretary may waive such provisions of titles XI and XVIII of the Social Security Act (42 U.S.C. 1301 et seq.; 42 U.S.C. 1395 et seq.) as the Secretary determines to be appropriate for the conduct of the pilot projects under this section.
(e) Report to Congress
Not later than 5 years after the date that the first pilot project under this section is implemented, the Secretary shall submit to Congress a report on the pilot projects. Such report shall contain a detailed description of issues related to the expansion of the projects under subsection (f) and recommendations for such legislation and administrative actions as the Secretary considers appropriate.
(f) Expansion
If the Secretary determines that any of the pilot projects under this section enhance health outcomes for Medicare beneficiaries and reduce expenditures under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), the Secretary may initiate comparable projects in additional areas.
(g) Incentive payments have no effect on other Medicare payments to agencies
An incentive payment under this section—
(1)
shall be in addition to the payments that a home health agency would otherwise receive under title XVIII of the Social Security Act for the provision of home health services; and
(2)
shall have no effect on the amount of such payments.
Sec. 4205. Community health center collaborative access expansion
Section 330(r)(4) of the Public Health Service Act (42 U.S.C. 254b(r)(4)) is amended—
(1)
in subparagraph (A), by striking primary health care services
each place it appears and inserting primary health care and other mental, dental, and physical health services
; and
(2)
in subparagraph (B)—
(A)
in clause (i), by striking and
at the end;
(B)
in clause (ii), by striking the period at the end and inserting ; and
; and
(C)
by adding at the end the following:
(iii)
in the case of a rural health clinic described in such subparagraph—
(I)
that such clinic provides, to the extent possible, enabling services, such as transportation and language assistance (including translation and interpretation); and
(II)
that the primary health care and other services described in such subparagraph are subject to full reimbursement according to the prospective payment system for Federally qualified health center services under section 1834(o) of the Social Security Act.
Sec. 4206. Facilitating the provision of telehealth services across State lines
(a) In general
For purposes of expediting the provision of telehealth services, for which payment is made under the Medicare Program established under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.). across State lines, the Secretary of Health and Human Services shall, in consultation with representatives of States, physicians, health care practitioners, and patient advocates, encourage and facilitate the adoption of provisions allowing for multistate practitioner practice across State lines.
(b) Definitions
In subsection (a):
(1) Telehealth service
The term telehealth service has the meaning given that term in subparagraph (F) of section 1834(m)(4) of the Social Security Act (42 U.S.C. 1395m(m)(4)).
(2) Physician, practitioner
The terms physician and practitioner have the meaning given those terms in subparagraphs (D) and (E), respectively, of section 1834(m)(4) of the Social Security Act (42 U.S.C. 1395m(m)(4)).
(3) Medicare program
The term Medicare Program means the program of health insurance administered by the Secretary of Health and Human Services under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
Sec. 4207. Scoring of preventive health savings
Section 202 of the Congressional Budget and Impoundment Control Act of 1974 (2 U.S.C. 602) is amended by adding at the end the following:
(h) Scoring of preventive health savings
(1) Determination by the Director
Upon a request by the chairman or ranking minority member of the Committee on the Budget of the Senate, or by the chairman or ranking minority member of the Committee on the Budget of the House of Representatives, the Director shall determine if a proposed measure would result in reductions in budget outlays in budgetary outyears through the use of preventive health and preventive health services.
(2) Projections
If the Director determines that a measure would result in substantial reductions in budget outlays as described in paragraph (1), the Director—
(A)
shall include, in any projection prepared by the Director, a description and estimate of the reductions in budget outlays in the budgetary outyears and a description of the basis for such conclusions; and
(B)
may prepare a budget projection that includes some or all of the budgetary outyears, notwithstanding the time periods for projections described in subsection (e) and sections 308, 402, and 424.
(3) Definitions
As used in this subsection—
(A)
the term budgetary outyears means the 2 consecutive 10-fiscal-year periods beginning with the first fiscal year that is 10 years after the budget year provided for in the most recently agreed to concurrent resolution on the budget; and
(B)
the term preventive health means an action that focuses on the health of the public, individuals, and defined populations in order to protect, promote, and maintain health, wellness, and functional ability, and prevent disease, disability, and premature death that is demonstrated by credible and publicly available epidemiological projection models, incorporating clinical trials or observational studies in humans, to avoid future health care costs.
Sec. 4208. Sense of Congress on maintenance of effort provisions regarding children’s health
It is the sense of the Congress that—
(1)
the maintenance of effort provisions added to sections 1902 and 2105(d) of the Social Security Act (42 U.S.C. 1396a; 42 U.S.C. 1397ee(d)) by sections 2001(b) and 2101(b) of the Patient Protection and Affordable Care Act were intended to maintain the eligibility standards for the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) and Children’s Health Insurance Program under title XXI of such Act (42 U.S.C. 1397aa et seq.) to protect vulnerable and disabled adults, children, and senior citizens, many of whom are also members of communities of color;
(2)
the maintenance of effort provisions for children’s coverage have been extended by the Congress through September 30, 2029;
(3)
the maintenance of effort provisions ensure the continued success of the Medicaid program and Children’s Health Insurance Program and were intended to specifically protect vulnerable and disabled children, many of whom are also members of communities of color; and
(4)
the maintenance of effort provisions must be strictly enforced and proposals to weaken or waive the maintenance of effort provisions must not be considered.
Sec. 4209. Protection of the HHS Offices of Minority Health
(a) In general
Pursuant to section 1707A of the Public Health Service Act (42 U.S.C. 300u–6a), the Offices of Minority Health established within the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration, the Agency for Healthcare Research and Quality, the Food and Drug Administration, and the Centers for Medicare & Medicaid Services, are offices that, regardless of change in the structure of the Department of Health and Human Services, shall report to the Secretary of Health and Human Services.
(b) Sense of Congress
It is the sense of the Congress that the Offices of Minority Health referred to in subsection (a) play a critical role in addressing health disparities and should be adequately funded and given a prominent role in evaluating and establishing health policies and programs.
Sec. 4210. Office of Minority Health in Veterans Health Administration of Department of Veterans Affairs
(a) Establishment and functions
Subchapter I of chapter 73 of title 38, United States Code, is amended by inserting after section 7308 the following new section:
7308A. Office of Minority Health
(a) Establishment
There is established in the Department within the Office of the Under Secretary for Health an office to be known as the
Office of Minority Health(in this section referred to as the Office).(b) Head
(1) In general
The Director of the Office of Minority Health shall be the head of the Office.
(2) Appointment
The Director of the Office of Minority Health shall be appointed by the Under Secretary for Health from among individuals qualified to perform the duties of the position.
(c) Functions
The functions of the Office are as follows:
(1)
To establish short-range and long-range goals and objectives and coordinate all other activities within the Veterans Health Administration that relate to disease prevention, health promotion, health care services delivery, health and health care education, health care quality, and health care research concerning veterans who are members of a racial or ethnic minority group.
(2)
To support research, demonstrations, and evaluations to test new and innovative models for the discharge of activities described in paragraph (1).
(3)
To increase knowledge and understanding of health risk factors for veterans who are members of a racial or ethnic minority group.
(4)
To develop mechanisms that support better health care information dissemination, education, prevention, and services delivery to veterans from disadvantaged backgrounds, including veterans who are members of a racial or ethnic minority group.
(5)
To enter into contracts or agreements with appropriate public and nonprofit private entities to develop and carry out programs to provide bilingual or interpretive services to assist veterans who are members of a racial or ethnic minority group and who lack proficiency in speaking the English language in accessing and receiving health care services through the Veterans Health Administration.
(6)
To carry out programs to improve access to health care services through the Veterans Health Administration for veterans with limited proficiency in speaking the English language, including the development and evaluation of demonstration and pilot projects for that purpose.
(7)
To advise the Under Secretary for Health on matters relating to the development, implementation, and evaluation of health professions education in decreasing disparities in health care outcomes between veterans who are members of a racial or ethnic minority group and other veterans, including cultural competency as a method of eliminating such health disparities.
(8)
To perform such other functions and duties as the Secretary or the Under Secretary for Health considers appropriate.
(d) Definitions
In this section:
(1)
The term racial or ethnic minority group means any of the following:
(A)
American Indians (including Alaska Natives, Eskimos, and Aleuts).
(B)
Asian Americans.
(C)
Native Hawaiians and Pacific Islanders.
(D)
Blacks.
(E)
Hispanics.
(2)
The term Hispanic means individuals whose origin is from Mexico, Puerto Rico, Cuba, Central or South America, or any other Spanish-speaking country.
(b) Clerical amendment
The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 7308 the following new item:
Sec. 4211. Study of DSH payments to ensure hospital access for low-income patients
(a) In general
Not later than January 1, 2027, the Comptroller General of the United States shall conduct a study on how amendments made by the Patient Protection and Affordable Care Act (Public Law 111–148) and the Health Care and Education Reconciliation Act of 2010 (Public Law 111–152) to titles XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et seq.; 42 U.S.C. 1396 et seq.) relating to disproportionate share hospital adjustment payments under Medicare and Medicaid (and subsequent amendments made with respect to such payments) affect the timely access to health care services for low-income patients. Such study shall—
(1)
evaluate and examine whether States electing to make medical assistance available under section 1902(a)(10)(A)(i)(VIII) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)) (including States making such an election through a waiver of the State plan) to individuals described in such section mitigate the need for payments to disproportionate share hospitals under section 1886(d)(5)(F) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(F)) and section 1923 of such Act (42 U.S.C. 1396r–4), including the impact of such States electing to make medical assistance available to such individuals on—
(A)
the number of individuals in the United States who are without health insurance and the distribution of such individuals in relation to areas primarily served by disproportionate share hospitals; and
(B)
the low-income utilization rate of such hospitals and the resulting fiscal sustainability of such hospitals;
(2)
evaluate the appropriate level and distribution of such payments among such disproportionate share hospitals for purposes of—
(A)
sufficiently accounting for the level of uncompensated care provided by such hospitals to low-income patients; and
(B)
providing timely access to health care services for individuals in medically underserved areas; and
(3)
assess, with respect to such disproportionate share hospitals—
(A)
the role played by such hospitals in providing critical access to emergency, inpatient, and outpatient health services, including end-of-life services, as well as the location of such hospitals in relation to medically underserved areas; and
(B)
the extent to which such hospitals satisfy the requirements established for charitable hospital organizations under section 501(r) of the Internal Revenue Code of 1986 with respect to community health needs assessments, financial assistance policy requirements, limitations on charges, and billing and collection requirements.
(b) Reports
(1) Report to Congress
Not later than 180 days after the date on which the study under subsection (a) is completed, the Comptroller General of the United States shall submit to the Committee on Finance of the Senate and the Committee on Energy and Commerce of the House of Representatives a report that contains—
(A)
the results of such study; and
(B)
recommendations to Congress for any legislative changes to the payments to disproportionate share hospitals under section 1886(d)(5)(F) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(F)) and section 1923 of such Act (42 U.S.C. 1396r–4) that are needed to ensure access to health services for low-income patients that—
(i)
are based on the number of individuals without health insurance, the amount of uncompensated care provided by such hospitals, and the impact of reduced payment levels on low-income communities; and
(ii)
takes into account any reports submitted by the Secretary of the Treasury, in consultation with the Secretary of Health and Human Services, to congressional committees regarding the costs incurred by charitable hospital organizations for charity care, bad debt, nonreimbursed expenses for services provided to individuals under the Medicare program under title XVIII of the Social Security Act and the Medicaid program under title XIX of such Act (42 U.S.C. 1395 et seq.; 42 U.S.C. 1396 et seq.), and any community benefit activities provided by such organizations.
(2) Report to the Secretary of Health and Human Services
Not later than 180 days after the date on which the study under subsection (a) is completed, the Comptroller General of the United States shall submit to the Secretary of Health and Human Services a report that contains—
(A)
the results of such study; and
(B)
any recommendations for purposes of assisting in the development of the methodology for the adjustment of payments to disproportionate share hospitals, as required under section 1886(r) of the Social Security Act (42 U.S.C. 1395ww(r)) and the reduction of such payments under section 1923(f)(7) of such Act (42 U.S.C. 1396r–4(f)(7)), taking into account the reports referred to in paragraph (1)(B)(ii).
Sec. 4212. Reauthorization of programs under the Native Hawaiian Health Care Improvement Act
(a) Native Hawaiian health care systems
Section 6(h)(1) of the Native Hawaiian Health Care Improvement Act (42 U.S.C. 11705(h)(1)) is amended by striking may be necessary for fiscal years 1993 through 2019
and inserting are necessary
.
(b) Administrative grant for Papa Ola Lokahi
Section 7(b) of the Native Hawaiian Health Care Improvement Act (42 U.S.C. 11706(b)) is amended by striking may be necessary for fiscal years 1993 through 2019
and inserting are necessary
.
(c) Native Hawaiian health scholarships
Section 10(c) of the Native Hawaiian Health Care Improvement Act (42 U.S.C. 11709(c)) is amended by striking may be necessary for fiscal years 1993 through 2019
and inserting are necessary
.
Part 2 Rural
Sec. 4221. Establishment of Rural Community Hospital (RCH) Program
(a) In general
Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by section 2007(b)(1), is amended by adding at the end of the following new subsection:
(ppp) Rural Community Hospital; Rural Community Hospital Services
(1)
The term rural community hospital means a hospital (as defined in subsection (e)) that—
(A)
is located in a rural area (as defined in section 1886(d)(2)(D)) or treated as being so located pursuant to section 1886(d)(8)(E);
(B)
subject to paragraph (2), has less than 51 acute care inpatient beds, as reported in its most recent cost report;
(C)
makes available 24-hour emergency care services;
(D)
subject to paragraph (3), has a provider agreement in effect with the Secretary and is open to the public as of January 1, 2010; and
(E)
applies to the Secretary for such designation.
(2)
For purposes of paragraph (1)(B), beds in a psychiatric or rehabilitation unit of the hospital which is a distinct part of the hospital shall not be counted.
(3)
Paragraph (1)(D) shall not be construed to prohibit any of the following from qualifying as a rural community hospital:
(A)
A replacement facility (as defined by the Secretary in regulations in effect on January 1, 2012) with the same service area (as defined by the Secretary in regulations in effect on such date).
(B)
A facility obtaining a new provider number pursuant to a change of ownership.
(C)
A facility which has a binding written agreement with an outside, unrelated party for the construction, reconstruction, lease, rental, or financing of a building as of January 1, 2012.
(4)
Nothing in this subsection shall be construed as prohibiting a critical access hospital from qualifying as a rural community hospital if the critical access hospital meets the conditions otherwise applicable to hospitals under subsection (e) and section 1866.
(5)
Nothing in this subsection shall be construed as prohibiting a rural community hospital participating in the demonstration program under section 410A of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (42 U.S.C. 1395ww note; Public Law 108–173) from qualifying as a rural community hospital if the rural community hospital meets the conditions otherwise applicable to hospitals under subsection (e) and section 1866.
(b) Payment
(1) Inpatient hospital services
Section 1814 of the Social Security Act (42 U.S.C. 1395f) is amended by adding at the end the following new subsection:
(m) Payment for Inpatient Services Furnished in Rural Community Hospitals
The amount of payment under this part for inpatient hospital services furnished in a rural community hospital, other than such services furnished in a psychiatric or rehabilitation unit of the hospital which is a distinct part, is, at the election of the hospital in the application referred to in section 1861(ppp)(1)(E)—
(1)
101 percent of the reasonable costs of providing such services, without regard to the amount of the customary or other charge, or
(2)
the amount of payment provided for under the prospective payment system for inpatient hospital services under section 1886(d).
(2) Outpatient services
Section 1834 of the Social Security Act (42 U.S.C. 1395m) is amended by adding at the end the following new subsection:
(bb) Payment for outpatient services furnished in rural community hospitals
The amount of payment under this part for outpatient services furnished in a rural community hospital is, at the election of the hospital in the application referred to in section 1861(ppp)(1)(E)—
(1)
101 percent of the reasonable costs of providing such services, without regard to the amount of the customary or other charge and any limitation under section 1861(v)(1)(U), or
(2)
the amount of payment provided for under the prospective payment system for covered OPD services under section 1833(t).
(3) Exemption from 30-percent reduction in reimbursement for bad debt
Section 1861(v)(1)(T) of the Social Security Act (42 U.S.C. 1395x(v)(1)(T)) is amended in the matter preceding clause (i) by inserting (other than for a rural community hospital)
after In determining such reasonable costs for hospitals
.
(c) Beneficiary cost-Sharing for outpatient services
Section 1834(bb) of the Social Security Act (as added by subsection (b)(2)) is amended—
(1)
by redesignating paragraphs (1) and (2) as subparagraphs (A) and (B), respectively;
(2)
by inserting (1)
after (bb)
; and
(3)
by adding at the end the following:
(2)
The amounts of beneficiary cost-sharing for outpatient services furnished in a rural community hospital under this part shall be as follows:
(A)
For items and services that would have been paid under section 1833(t) if furnished by a hospital, the amount of cost-sharing determined under paragraph (8) of such section.
(B)
For items and services that would have been paid under section 1833(h) if furnished by a provider of services or supplier, no cost-sharing shall apply.
(C)
For all other items and services, the amount of cost-sharing that would apply to the item or service under the methodology that would be used to determine payment for such item or service if provided by a physician, provider of services, or supplier, as the case may be.
(d) Conforming amendments
(1) Part A payment
Section 1814(b) of the Social Security Act (42 U.S.C. 1395f(b)) is amended in the matter preceding paragraph (1) by inserting other than inpatient hospital services furnished by a rural community hospital,
after critical access hospital services,
.
(2) Part B payment
Section 1833(a) of the Social Security Act (42 U.S.C. 1395l(a)), as amended by section 2207(b)(3), is amended—
(A)
by striking and
at the end of paragraph (10);
(B)
by striking the period at the end of paragraph (11) and inserting ; and
; and
(C)
by adding at the end the following:
(12)
in the case of outpatient services furnished by a rural community hospital, the amounts described in section 1834(bb).
(3) Technical amendments
(A) Consultation with State agencies
Section 1863 of the Social Security Act (42 U.S.C. 1395z) is amended by striking and (dd)(2)
and inserting (dd)(2), and (ppp)(1)
.
(B) Provider agreements
Section 1866(a)(2)(A) of the Social Security Act (42 U.S.C. 1395cc(a)(2)(A)) is amended by inserting section 1834(bb)(2),
after section 1833(b),
.
(e) Effective Date
The amendments made by this section shall apply to items and services furnished on or after the date that is 30 days after the date of the enactment of this Act.
Sec. 4222. Rural Health Quality Advisory Commission and demonstration projects
(a) Rural Health Quality Advisory Commission
(1) Establishment
Not later than 6 months after the date of the enactment of this section, the Secretary of Health and Human Services (in this section referred to as the Secretary) shall establish a commission to be known as the Rural Health Quality Advisory Commission
(in this section referred to as the Commission).
(2) Duties of commission
(A) National plan
The Commission shall develop, coordinate, and facilitate implementation of a national plan for rural health quality improvement. The national plan shall—
(i)
identify objectives for rural health quality improvement;
(ii)
identify strategies to eliminate known gaps in rural health system capacity and improve rural health quality; and
(iii)
provide recommendations for Federal programs to identify opportunities for strengthening and aligning policies and programs to improve rural health quality.
(B) Demonstration projects
The Commission shall design demonstration projects to recommend to the Secretary to test alternative models for rural health quality improvement, including with respect to both personal and population health.
(C) Monitoring
The Commission shall monitor progress toward the objectives identified pursuant to subparagraph (A)(i).
(3) Membership
(A) Number
The Commission shall be composed of 11 members appointed by the Secretary.
(B) Selection
The Secretary shall select the members of the Commission from among individuals with significant rural health care and health care quality expertise, including expertise in clinical health care, health care quality research, end-of-life care, population or public health, or purchaser organizations.
(4) Contracting authority
Subject to the availability of funds, the Commission may enter into contracts and make other arrangements, as may be necessary to carry out the duties described in paragraph (2).
(5) Staff
Upon the request of the Commission, the Secretary may detail, on a reimbursable basis, any of the personnel of the Office of Rural Health Policy of the Health Resources and Services Administration, the Agency for Healthcare Research and Quality, or the Centers for Medicare & Medicaid Services to the Commission to assist in carrying out this subsection.
(6) Reports to congress
Not later than 1 year after the establishment of the Commission, and annually thereafter, the Commission shall submit a report to the Congress on rural health quality. Each such report shall include the following:
(A)
An inventory of relevant programs and recommendations for improved coordination and integration of policy and programs.
(B)
An assessment of achievement of the objectives identified in the national plan developed under paragraph (2) and recommendations for realizing such objectives.
(C)
Recommendations on Federal legislation, regulations, or administrative policies to enhance rural health quality and outcomes.
(b) Rural Health Quality Demonstration Projects
(1) In general
Not later than 270 days after the date of the enactment of this section, the Secretary, in consultation with the Rural Health Quality Advisory Commission, the Office of Rural Health Policy of the Health Resources and Services Administration, the Agency for Healthcare Research and Quality, and the Centers for Medicare & Medicaid Services, shall make grants to eligible entities for a total of 5 demonstration projects to implement and evaluate methods for improving the quality of health care in rural communities. Each such demonstration project shall include—
(A)
alternative community models that—
(i)
will achieve greater integration of personal and population health services; and
(ii)
address safety, effectiveness, patient- or community-centeredness, timeliness, efficiency, and equity (the 6 aims identified by the National Academy of Medicine (formerly known as the Institute of Medicine
) in its report entitled Crossing the Quality Chasm: A New Health System for the 21st Century released on March 1, 2001);
(B)
innovative approaches to the financing and delivery of health care services to achieve rural health quality and accessibility goals for patients; and
(C)
development of quality improvement support structures to assist rural health systems and professionals in the provision of health care (such as workforce support structures, quality monitoring and reporting, clinical care protocols, and information technology applications).
(2) Eligible entities
In this subsection, the term eligible entity means a consortium that—
(A)
shall include—
(i)
at least one health care provider or health care delivery system located in a rural area; and
(ii)
at least one organization representing multiple community stakeholders; and
(B)
may include other partners such as rural research centers.
(3) Consultation
In developing the program for awarding grants under this subsection, the Secretary shall consult with the Administrator of the Agency for Healthcare Research and Quality, rural health care providers, rural health care researchers, and private and nonprofit groups (including national associations) which are undertaking similar efforts.
(4) Expedited waivers
The Secretary shall expedite the processing of any waiver that—
(A)
is authorized under title XVIII or XIX of the Social Security Act (42 U.S.C. 1395 et seq.; 42 U.S.C. 1396 et seq.); and
(B)
is necessary to carry out a demonstration project under this subsection.
(5) Demonstration project sites
The Secretary shall ensure that the 5 demonstration projects funded under this subsection are conducted at a variety of sites representing the diversity of rural communities in the United States.
(6) Duration
Each demonstration project under this subsection shall be for a period of 4 years.
(7) Independent evaluation
The Secretary shall enter into an arrangement with an entity that has experience working directly with rural health systems for the conduct of an independent evaluation of the program carried out under this subsection.
(8) Report
Not later than 1 year after the conclusion of all of the demonstration projects funded under this subsection, the Secretary shall submit a report to the Congress on the results of such projects. The report shall include—
(A)
an evaluation of patient access to care, patient outcomes, and an analysis of the cost-effectiveness of each such project; and
(B)
recommendations on Federal legislation, regulations, or administrative policies to enhance rural health quality and outcomes.
(c) Appropriations
(1) In general
Out of funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary to carry out this section $30,000,000 for the period of fiscal years 2027 through 2031.
(2) Availability
(A) In general
Except as provided in subparagraph (B), funds appropriated under paragraph (1) shall remain available for expenditure through fiscal year 2030.
(B) Report
For purposes of carrying out subsection (b)(8), funds appropriated under paragraph (1) shall remain available for expenditure through fiscal year 2031.
(3) Reservation
Of the amount appropriated under paragraph (1), the Secretary shall reserve—
(A)
$5,000,000 to carry out subsection (a); and
(B)
$25,000,000 to carry out subsection (b), of which—
(i)
2 percent shall be for the provision of technical assistance to grant recipients; and
(ii)
5 percent shall be for the independent evaluation under subsection (b)(7).
Sec. 4223. Rural health care services
Section 330A of the Public Health Service Act (42 U.S.C. 254c) is amended to read as follows:
330A. Rural health care services outreach, rural health network development, Delta rural disparities and health systems development, and small rural health care provider quality improvement grant programs
(a) Purpose
The purpose of this section is to provide for grants—
(1)
under subsection (b), to promote rural health care services outreach;
(2)
under subsection (c), to provide for the planning and implementation of integrated health care networks in rural areas;
(3)
under subsection (d), to assist rural communities in the Delta Region to reduce health disparities and to promote and enhance health system development; and
(4)
under subsection (e), to provide for the planning and implementation of small rural health care provider quality improvement activities.
(b) Rural health care services outreach grants
(1) Grants
The Director of the Office of Rural Health Policy of the Health Resources and Services Administration (referred to in this section as the
Director) may award grants to eligible entities to promote rural health care services outreach by expanding the delivery of health care services to include new and enhanced services in rural areas. The Director may award the grants for periods of not more than 3 years.(2) Eligibility
To be eligible to receive a grant under this subsection for a project, an entity—
(A)
shall be a rural public or rural nonprofit private entity, a facility that qualifies as a rural health clinic under title XVIII of the Social Security Act, a public or nonprofit entity existing exclusively to provide services to migrant and seasonal farm workers in rural areas, or a Tribal government whose grant-funded activities will be conducted within federally recognized Tribal areas;
(B)
shall represent a consortium composed of members—
(i)
that include 3 or more independently owned health care entities; and
(ii)
that may be nonprofit or for-profit entities; and
(C)
shall not previously have received a grant under this subsection for the same or a similar project, unless the entity is proposing to expand the scope of the project or the area that will be served through the project.
(3) Applications
To be eligible to receive a grant under this subsection, an eligible entity shall prepare and submit to the Director an application at such time, in such manner, and containing such information as the Director may require, including—
(A)
a description of the project that the eligible entity will carry out using the funds provided under the grant;
(B)
a description of the manner in which the project funded under the grant will meet the health care needs of rural populations in the local community or region to be served;
(C)
a plan for quantifying how health care needs will be met through identification of the target population and benchmarks of service delivery or health status, such as—
(i)
quantifiable measurements of health and health care status improvement for projects focusing on health promotion; or
(ii)
benchmarks of increased access to primary and end-of-life care, including tracking factors such as the number and type of primary and end-of-life care visits, identification of a medical home, or other general measures of such access;
(D)
a description of how the local community or region to be served will be involved in the development and ongoing operations of the project;
(E)
a plan for sustaining the project after Federal support for the project has ended;
(F)
a description of how the project will be evaluated;
(G)
the administrative capacity to submit annual performance data electronically as specified by the Director; and
(H)
other such information as the Director determines to be appropriate.
(c) Rural health network development grants
(1) Grants
(A) In general
The Director may award rural health network development grants to eligible entities to promote, through planning and implementation, the development of integrated health care networks that have combined the functions of the entities participating in the networks in order to—
(i)
achieve efficiencies and economies of scale;
(ii)
expand access to, coordinate, and improve the quality of the health care delivery system through development of organizational efficiencies;
(iii)
implement health information technology to achieve efficiencies, reduce medical errors, and improve quality;
(iv)
coordinate care and manage chronic and terminal illness; and
(v)
strengthen the rural health care system as a whole and across all facets of the health care delivery system, including end-of-life care, in such a manner as to show a quantifiable return on investment to the participants in the network.
(B) Grant periods
The Director may award such a rural health network development grant—
(i)
for a period of 3 years for implementation activities; or
(ii)
for a period of 1 year for planning activities to assist in the initial development of an integrated health care network, if the proposed participants in the network do not have a history of collaborative efforts and a 3-year grant would be inappropriate.
(2) Eligibility
To be eligible to receive a grant under this subsection, an entity—
(A)
shall be a rural public or rural nonprofit private entity, a facility that qualifies as a rural health clinic under title XVIII of the Social Security Act, a public or nonprofit entity existing exclusively to provide services to migrant and seasonal farm workers in rural areas, or a Tribal government whose grant-funded activities will be conducted within federally recognized Tribal areas;
(B)
shall represent a network composed of participants—
(i)
that include 3 or more independently owned health care entities; and
(ii)
that may be nonprofit or for-profit entities; and
(C)
shall not previously have received a grant under this subsection (other than a 1-year grant for planning activities) for the same or a similar project.
(3) Applications
To be eligible to receive a grant under this subsection, an eligible entity, in consultation with the appropriate State office of rural health or another appropriate State entity, shall prepare and submit to the Director an application at such time, in such manner, and containing such information as the Director may require, including—
(A)
a description of the project that the eligible entity will carry out using the funds provided under the grant;
(B)
an explanation of the reasons why Federal assistance is required to carry out the project;
(C)
a description of—
(i)
the history of collaborative activities carried out by the participants in the network;
(ii)
the degree to which the participants are ready to integrate their functions; and
(iii)
how the local community or region to be served will benefit from and be involved in the activities carried out by the network;
(D)
a description of how the local community or region to be served will experience increased access to quality health care services across the continuum of care as a result of the integration activities carried out by the network, including a description of—
(i)
return on investment for the community and the network members; and
(ii)
other quantifiable performance measures that show the benefit of the network activities;
(E)
a plan for sustaining the project after Federal support for the project has ended;
(F)
a description of how the project will be evaluated;
(G)
the administrative capacity to submit annual performance data electronically as specified by the Director; and
(H)
other such information as the Director determines to be appropriate.
(d) Delta rural disparities and health systems development grants
(1) Grants
The Director may award grants to eligible entities to support reduction of health disparities, improve access to health care, and enhance rural health system development in the Delta Region.
(2) Eligibility
To be eligible to receive a grant under this subsection, an entity shall be a rural public or rural nonprofit private entity, a facility that qualifies as a rural health clinic under title XVIII of the Social Security Act, a public or nonprofit entity existing exclusively to provide services to migrant and seasonal farm workers in rural areas, or a Tribal government whose grant-funded activities will be conducted within federally recognized Tribal areas.
(3) Applications
To be eligible to receive a grant under this subsection, an eligible entity shall prepare and submit to the Director an application at such time, in such manner, and containing such information as the Director may require, including—
(A)
a description of the project that the eligible entity will carry out using the funds provided under the grant;
(B)
an explanation of the reasons why Federal assistance is required to carry out the project;
(C)
a description of the manner in which the project funded under the grant will meet the health care needs of the Delta Region;
(D)
a description of how the local community or region to be served will experience increased access to quality health care services as a result of the activities carried out by the entity;
(E)
a description of how health disparities will be reduced or the health system will be improved;
(F)
a plan for sustaining the project after Federal support for the project has ended;
(G)
a description of how the project will be evaluated including process and outcome measures related to the quality of care provided or how the health care system improves its performance;
(H)
a description of how the grantee will develop an advisory group made up of representatives of the communities to be served to provide guidance to the grantee to best meet community need; and
(I)
other such information as the Director determines to be appropriate.
(e) Small rural health care provider quality improvement grants
(1) Grants
The Director may award grants to provide for the planning and implementation of small rural health care provider quality improvement activities. The Director may award the grants for periods of 1 to 3 years.
(2) Eligibility
To be eligible for a grant under this subsection, an entity—
(A)
shall be—
(i)
a rural public or rural nonprofit private health care provider or provider of health care services, such as a rural health clinic; or
(ii)
another rural provider or network of small rural providers identified by the Director as a key source of local care; and
(B)
shall not previously have received a grant under this subsection for the same or a similar project.
(3) Preference
In awarding grants under this subsection, the Director shall give preference to facilities that qualify as rural health clinics under title XVIII of the Social Security Act.
(4) Applications
To be eligible to receive a grant under this subsection, an eligible entity shall prepare and submit to the Director an application at such time, in such manner, and containing such information as the Director may require, including—
(A)
a description of the project that the eligible entity will carry out using the funds provided under the grant;
(B)
an explanation of the reasons why Federal assistance is required to carry out the project;
(C)
a description of the manner in which the project funded under the grant will assure continuous quality improvement in the provision of services by the entity;
(D)
a description of how the local community or region to be served will experience increased access to quality health care services as a result of the activities carried out by the entity;
(E)
a plan for sustaining the project after Federal support for the project has ended;
(F)
a description of how the project will be evaluated including process and outcome measures related to the quality of care provided; and
(G)
other such information as the Director determines to be appropriate.
(f) General requirements
(1) Prohibited uses of funds
An entity that receives a grant under this section may not use funds provided through the grant—
(A)
to build or acquire real property; or
(B)
for construction.
(2) Coordination with other agencies
The Director shall coordinate activities carried out under grant programs described in this section, to the extent practicable, with Federal and State agencies and nonprofit organizations that are operating similar grant programs, to maximize the effect of public dollars in funding meritorious proposals.
(g) Report
Not later than September 30, 2027, the Secretary shall prepare and submit to the appropriate committees of Congress a report on the progress and accomplishments of the grant programs described in subsections (b), (c), (d), and (e).
(h) Definition of Delta Region
In this section, the term Delta Region has the meaning given to the term region in section 382A of the Consolidated Farm and Rural Development Act (7 U.S.C. 2009aa).
(i) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2030.
Part 3 Indian Communities
Sec. 4231. Assistant Secretary of the Indian Health Service
(a) References
Any reference in a law, regulation, document, paper, or other record of the United States to the Director of the Indian Health Service shall be deemed to be a reference to the Assistant Secretary of the Indian Health Service.
(b) Executive Schedule
Section 5315 of title 5, United States Code, is amended, in the matter relating to the Assistant Secretaries of Health and Human Services, by striking (6)
and inserting (7), one of whom shall be the Assistant Secretary of the Indian Health Service
.
(c) Conforming amendment
Section 5316 of title 5, United States Code, is amended by striking Director, Indian Health Service, Department of Health and Human Services.
.
Sec. 4232. Extension of full Federal medical assistance percentage to Indian health care providers
Section 1905(a)(9) of the Social Security Act (42 U.S.C. 1396d(a)(9)) is amended to read as follows:
(9)
clinic services furnished by or under the direction of a physician, without regard to whether the clinic itself is administered by a physician, including—
(A)
such services furnished outside the clinic by clinic personnel to an eligible individual who does not reside in a permanent dwelling or does not have a fixed home or mailing address; and
(B)
such services furnished outside the clinic by any Indian Health Service facility, a health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act (Public Law 93–638), or an urban Indian organization receiving funds under title V of the Indian Health Care Improvement Act;
Sec. 4233. Conferring with urban Indian organizations
Section 514 of the Indian Health Care Improvement Act (25 U.S.C. 1660d) is amended by striking subsection (b) and inserting the following:
(b) Requirement
The Secretary and the Secretary of Veterans Affairs shall ensure that the Service, other agencies and offices of the Department, and the Department of Veterans Affairs confer, to the maximum extent practicable, with urban Indian organizations in carrying out—
(1)
this Act; and
(2)
other provisions of law relating to Indian health care.
Part 4 Providers
Sec. 4241. Availability of non-English language speaking providers
(a) In general
Section 1311(c)(1)(B) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(1)(B)) is amended by inserting before the semicolon the following: and the ability of such provider to provide care in a language other than English either through the provider speaking such language or by the provider having a qualified interpreter for an individual with limited English proficiency (as defined in section 3400 of such Act) who speaks such language available during office hours
.
(b) Effective date
The amendment made by subsection (a) shall not apply to any plan beginning on or prior to the date that is 1 year after the date of the enactment of this Act.
Sec. 4242. Access to essential community providers
(a) Essential community providers
Section 1311(c)(1)(C) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(1)(C)) is amended—
(1)
by inserting (i)
after (C)
; and
(2)
by adding at the end the following new clauses:
(ii)
not later than January 1, 2027, increase the percentage of essential community providers as described in clause (i) included in its network by 10 percent annually (based on the level in the plan for 2023) until 90 percent of all federally qualified health centers and 75 percent of all other such essential community providers in the contract service area are in-network; and
(iii)
include at least one essential community provider in each of the essential community provider categories described in section 156.235(a)(2)(ii)(B) of title 45, Code of Federal Regulations (as in effect on the date of enactment of the Health Equity and Accountability Act of 2026), in each county in the service area, where available;
(b) Reporting requirements
Section 1311(e)(3) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(e)(3)) is amended by adding at the end the following new subparagraph:
(E) Data on essential community providers
The Secretary shall require qualified health plans to submit annually to the Secretary data on the percentage of essential community providers as described in clause (ii) of subsection (c)(1)(C), by county, that contract with each qualified health plan offered in that county and the percentage of such essential community providers, by category as described in clause (iii) of such subsection, that contract with each qualified health plan offered in that county. Such data shall be made available to the general public.
(c) Essential Community Provider provisions applied under Medicare and Medicaid
(1) Medicare
Section 1852(d)(1) of the Social Security Act (42 U.S.C. 1395w–22(d)(1)) is amended—
(A)
by striking and
at the end of subparagraph (D);
(B)
by striking the period at the end of subparagraph (E) and inserting ; and
; and
(C)
by adding at the end the following new subparagraph:
(F)
the plan meets the requirements of clauses (ii) and (iii) of section 1311(c)(1)(C) of the Patient Protection and Affordable Care Act (relating to inclusion in networks of essential community providers).
(2) Medicaid
Section 1932(b)(5) of the Social Security Act (42 U.S.C. 1396u–2(b)(5)) is amended—
(A)
by striking , and
at the end of subparagraph (A) and inserting a semicolon;
(B)
by striking the period at the end of subparagraph (B) and inserting ; and
; and
(C)
by adding at the end the following new subparagraph:
(C)
meets the requirements of clauses (ii) and (iii) of section 1311(c)(1)(C) of the Patient Protection and Affordable Care Act (relating to inclusion in networks of essential community providers) with respect to services offered in the service area involved.
Sec. 4243. Provider network adequacy in communities of color
(a) In general
Section 1311(c)(1)(B) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(1)(B)), as amended by section 4241(a), is further amended—
(1)
by inserting (i)
after (B)
; and
(2)
by adding at the end the following new clauses:
(ii)
meet such network adequacy standards as the Secretary may establish with regard to—
(I)
appointment wait time;
(II)
travel time and distance to health care provider facilities and providers by public and private transit;
(III)
hours of operation to accommodate individuals who cannot come to provider appointments during standard business hours;
(IV)
availability of health care options for patients; and
(V)
other network adequacy standards to ensure that care through these plans is accessible to diverse communities, including individuals with limited English proficiency as defined in section 3400 of such Act; and
(iii)
provide coverage for services for enrollees through out-of-network providers at no additional cost to the enrollees in cases where in-network providers are unable to comply with the standards established under subclause (III) or (IV) of clause (ii) for such services and the out-of-network providers can deliver such services in compliance with such standards;
(b) Effective date
The amendments made by subsection (a) shall not apply to plans beginning on or prior to the date that is 1 year after the date of the enactment of the Health Equity and Accountability Act of 2026.
Part 5 Dental
Sec. 4251. Improving access to dental care
(a) Reports to Congress
(1) GAO reports
Not later than 1 year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress—
(A)
a report on the Alaska Dental Health Aide Therapists program and the Dental Therapist and Advanced Dental Therapist programs in Minnesota, to assess the effectiveness of dental therapists in—
(i)
improving access to timely dental care among communities of color;
(ii)
providing high-quality care;
(iii)
providing culturally competent care; and
(iv)
providing accessible care to people with disabilities;
(B)
a report on State variations in the use of dental hygienists and the effectiveness of expanding the scope of practice for dental hygienists in—
(i)
improving access to timely dental care among communities of color;
(ii)
providing high-quality care;
(iii)
providing culturally competent care; and
(iv)
providing accessible care to people with disabilities; and
(C)
a report on the use of telehealth services to enhance services provided by dental hygienists and therapists, including recommendations for any modifications to the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) and the Medicaid program under title XIX of such Act (42 U.S.C. 1396 et seq.) to better provide for telehealth consultations in conjunction with therapists’ and hygienists’ care.
(2) HRSA report on dental shortage areas
Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration, shall submit to Congress a report which details geographic dental access shortages and the preparedness of dental providers to offer culturally and linguistically appropriate, affordable, accessible, and timely services.
(b) Expansion of dental health aid therapists in Tribal and urban Indian communities
Section 119 of the Indian Health Care Improvement Act (25 U.S.C. 1616l) is amended—
(1)
in subsection (d)—
(A)
by striking paragraph (2) and inserting the following:
(2) Requirements; exclusion
Subject to paragraphs (3) and (4), in establishing a national program under paragraph (1), the Secretary—
(A)
shall not reduce the amounts provided for the Community Health Aide Program described in subsections (a) and (b);
(B)
shall exclude dental health aide therapist services from services covered under that Program; and
(C)
shall include urban Indian organizations.; and
(B)
in paragraph (3)—
(i)
in the paragraph heading, by striking or tribal organization
and inserting , tribal organization, or urban Indian organization
; and
(ii)
in each of subparagraphs (A) and (B), by striking or tribal organization
and inserting , tribal organization, or urban Indian organization
; and
(2)
in subsection (e), by striking or a tribal organization
and inserting a tribal organization, or an urban Indian organization
.
(c) Coverage of dental services under the Medicare program
(1) Coverage
Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is amended—
(A)
in subparagraph (JJ), by striking and
at the end;
(B)
in subparagraph (KK), by inserting and
at the end; and
(C)
by adding at the end the following new subparagraph:
(LL)
dental and oral health services (as defined in subsection (qqq));
(2) Dental and oral health services defined
Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by sections 2007(b) and 4221(a), is amended by adding at the end the following new subsection:
(qqq) Dental and oral health services
(1)
The term dental and oral health services means services (as defined by the Secretary) that are necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions, including—
(A)
routine diagnostic and preventive care such as dental cleanings, exams, and x-rays;
(B)
basic dental services such as fillings and extractions;
(C)
major dental services such as root canals, crowns, and dentures;
(D)
emergency dental care; and
(E)
other necessary services related to dental and oral health (as defined by the Secretary).
(2)
For purposes of paragraph (1), such term shall include mobile and portable oral health services (as defined by the Secretary) that—
(A)
are provided for the purpose of overcoming mobility, transportation, and access barriers for individuals; and
(B)
satisfy the standards and certification requirements established under section 1902(a)(82) for the State in which the services are provided.
(3) Payment and coinsurance
Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended—
(A)
by striking and
before (HH)
; and
(B)
by inserting before the semicolon at the end the following: and (II) with respect to dental and oral health services (as defined in section 1861(qqq)), the amount paid shall be (i) in the case of such services that are preventive, 100 percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section 1848, and (ii) in the case of all other such services, 80 percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section 1848
.
(4) Payment under physician fee schedule
Section 1848(j)(3) of the Social Security Act (42 U.S.C. 1395w–4(j)(3)) is amended by inserting , (2)(LL),
after (including administration of the health risk assessment)
.
(5) Dentures
Section 1861(s)(8) of the Social Security Act (42 U.S.C. 1395x(s)(8)) is amended—
(A)
by striking (other than dental)
and inserting (including dentures)
; and
(B)
by striking internal body
.
(6) Repeal of ground for exclusion
Section 1862(a) of the Social Security Act (42 U.S.C. 1395y) is amended by striking paragraph (12).
(7) Effective date
The amendments made by this section shall apply to services furnished on or after January 1, 2028.
(d) Requiring Medicaid coverage of dental and oral health services for adults
(1) In general
(A) Mandatory coverage
(i) In general
(I) Requirement
Section 1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended by inserting (10),
before (13)(B),
.
(II) Medically needy
(aa) In general
Section 1902(a)(10)(C)(iv) of such Act (42 U.S.C. 1396a(a)(10)(C)(iv)) is amended by inserting (10),
before (13)(B)
.
(bb) Rule of construction
Nothing in this section or the amendments made by this section shall be construed to limit the access of an individual residing in an institutional setting to dental and oral health services (as such term is defined in section 1905(mm) of the Social Security Act, as added by paragraph (2)(B)).
(III) Effective date
The amendments made by subclauses (I) and (II) shall apply with respect to expenditures for medical assistance in calendar quarters beginning on or after January 1, 2028.
(ii) Benchmark coverage
Section 1937(b)(5) of the Social Security Act (42 U.S.C. 1396u–7(b)(5)) is amended by striking the period at the end and inserting , and beginning January 1, 2028, coverage of dental and oral health services (as such term is defined in section 1905(mm)).
.
(iii) Optional application to territories
Section 1902(j) of the Social Security Act (42 U.S.C. 1396a(j)) is amended—
(I)
by striking this title, the Secretary
and inserting “this title—
(1)
in the case of a State other than the 50 States and the District of Columbia, the requirement under subsection (a)(10)(A) to provide the care and services listed in paragraph (10) of section 1905(a) shall be optional; and
(2)
the Secretary; and
(II)
by striking the second comma after section 1108(f)
.
(B) Definition of dental and oral health services
Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by section 4107(c), is further amended—
(i)
in subsection (a)(10), by inserting and dental and oral health services (as defined in subsection (mm))
after dental services
; and
(ii)
by adding at the end the following new subsection:
(mm) Dental and oral health services
For purposes of subsection (a)(10), the term dental and oral health services means dentures and denture services, implants and implant services, and services necessary to prevent oral disease and promote oral health, restore oral structures to health and function, reduce oral pain, and treat emergency oral conditions, that are furnished by a provider who is legally authorized to furnish such items and services under State law (or the State regulatory mechanism provided by State law).
(C) Conforming amendment
(i) In general
Section 1905(a)(10) of the Social Security Act (42 U.S.C. 1396d(a)(10)), as amended by paragraph (2), is further amended by striking dental services and
.
(ii) Effective date
The amendment made by clause (i) shall take effect on January 1, 2028.
(2) State option for additional dental and oral health benefits
Section 1905(a)(13) of the Social Security Act (42 U.S.C. 1396d(a)(13)) is amended—
(A)
in subparagraph (B), by striking ; and
and inserting a semicolon;
(B)
in subparagraph (C), by striking the semicolon at the end and inserting ; and
; and
(C)
by inserting after subparagraph (C) the following new subparagraph:
(D)
at State option, such items and services related to dental and oral health services (as defined in subsection (mm)) that are in addition to those identified in such subsection (mm) as the State may specify;
(3) Increased FMAP
(A) Medicaid
Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by paragraphs (1) and (2), is further amended—
(i)
in subsection (b), by striking and (ll)
and inserting (ll), and (nn)
;
(ii)
in subsection (ff), by striking and (ii)
and inserting , (ii), and (nn)
; and
(iii)
by adding at the end the following new subsection:
(nn) Increased FMAP for expenditures related to dental and oral health services
(1) In general
(A) 50 States and DC
Notwithstanding subsection (b), in the case of a State that is 1 of the 50 States or the District of Columbia, during the 12-quarter period that begins on January 1, 2028, the Federal medical assistance percentage shall be equal to 100 percent with respect to amounts expended by the State for medical assistance for dental and oral health services authorized under paragraph (10) of subsection (a). In no case may the application of this subparagraph result in the Federal medical assistance percentage determined for a State with respect to expenditures described in this subparagraph exceeding 100 percent.
(B) Territories
(i) In general
Notwithstanding subsection (b), in the case of a State that is Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa, during a period described in clause (ii), the Federal medical assistance percentage shall be equal to 100 percent with respect to amounts expended by the State for medical assistance for any item or service that is included in dental and oral health services authorized under paragraph (10) of subsection (a). In no case may the application of this clause result in the Federal medical assistance percentage determined for a State with respect to expenditures described in this clause exceeding 100 percent.
(ii) Period described
A period described in this clause is, with respect to an item or service described in clause (i) and a State described in such clause, the 12-quarter period that begins with the first quarter beginning on or after January 1, 2028, in which such item or service is first covered under the State plan or under a waiver of such plan.
(2) Exclusions
The Federal medical assistance percentage specified in paragraph (1) shall not apply to amounts expended for medical assistance during any period for—
(A)
additional items and services authorized under paragraph (13)(D) of subsection (a); or
(B)
items and services furnished to an individual if, as of the date of enactment of this subsection, medical assistance was available to such individual for such items and services or medicare cost-sharing under the State plan or a waiver of such plan.
(B) Exclusion of amounts attributable to increased FMAP from territorial caps
Section 1108 of the Social Security Act (42 U.S.C. 1308), as amended by section 4101, is amended—
(i)
in subsection (f), in the matter preceding paragraph (1), by striking (h), and (j)
and inserting (h), (j), and (k)
; and
(ii)
by adding at the end the following:
(k) Exclusion from caps of amounts attributable to increased FMAP for coverage of dental and oral health services
Any additional amount paid to Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa for expenditures for medical assistance that is attributable to an increase in the Federal medical assistance percentage applicable to such expenditures under section 1905(nn) shall not be taken into account for purposes of applying payment limits under subsections (f) and (g).
(e) Oral health services as an essential health benefit
Section 1302(b) of the Patient Protection and Affordable Care Act (42 U.S.C. 18022(b)), as amended by section 2013(a), is further amended—
(1)
in paragraph (1)—
(A)
in subparagraph (J), by striking oral and
; and
(B)
by adding at the end the following:
(L)
Oral health services for children and adults.; and
(2)
by adding at the end the following:
(6) Oral health services
For purposes of paragraph (1)(L), the term oral health services means services (as defined by the Secretary) that are necessary to prevent any oral disease and promote oral health, restore oral structures to health and function, and treat emergency oral conditions.
(f) Demonstration program on training and employment of alternative dental health care providers for dental health care services for veterans in rural and other underserved communities
(1) Demonstration program authorized
The Secretary of Veterans Affairs may carry out a demonstration program to establish programs to train and employ alternative dental health care providers in order to increase access to dental health care services for veterans who are entitled to such services from the Department of Veterans Affairs and reside in rural and other underserved communities.
(2) Telehealth
For purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care, dental services provided under the demonstration program under this subsection may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible.
(3) Alternative dental health care providers defined
In this subsection, the term alternative dental health care providers has the meaning given that term in section 340G–1(a)(2) of the Public Health Service Act (42 U.S.C. 256g–1(a)(2)).
(4) Authorization of appropriations
There are authorized to be appropriated such sums as are necessary to carry out the demonstration program under this subsection.
(g) Demonstration program on training and employment of alternative dental health care providers for dental health care services for members of the Armed Forces and dependents lacking ready access to such services
(1) Demonstration program authorized
The Secretary of Defense may carry out a demonstration program to establish programs to train and employ alternative dental health care providers in order to increase access to dental health care services for members of the Armed Forces and their dependents who lack ready access to such services, including the following individuals:
(A)
Members and dependents who reside in rural areas or areas otherwise underserved by dental health care providers.
(B)
Members of a reserve component of the Armed Forces in active status who are potentially deployable.
(2) Telehealth
For purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care, dental services provided under the demonstration program under this subsection may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible.
(3) Definitions
In this subsection:
(A) Active status
The term active status has the meaning given that term in section 101(d) of title 10, United States Code.
(B) Alternative dental health care providers
The term alternative dental health care providers has the meaning given that term in section 340G–1(a)(2) of the Public Health Service Act (42 U.S.C. 256g–1(a)(2)).
(4) Authorization of appropriations
There are authorized to be appropriated such sums as are necessary to carry out the demonstration program under this subsection.
(h) Demonstration program on training and employment of alternative dental health care providers for dental health care services for prisoners within the custody of the bureau of prisons
(1) Demonstration program authorized
The Attorney General, acting through the Director of the Bureau of Prisons, may carry out a demonstration program to establish programs to train and employ alternative dental health care providers in order to increase access to dental health services for prisoners within the custody of the Bureau of Prisons.
(2) Telehealth
For purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care, dental services provided under the demonstration program under this subsection may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible.
(3) Alternative dental health care providers defined
In this subsection, the term alternative dental health care providers has the meaning given that term in section 340G–1(a)(2) of the Public Health Service Act (42 U.S.C. 256g–1(a)(2)).
(4) Authorization of appropriations
There are authorized to be appropriated such sums as are necessary to carry out the demonstration program under this subsection.
(i) Demonstration program on training and employment of alternative dental health care providers for dental health care services under the Indian Health Service
(1) Definitions
In this subsection:
(A) Alternative dental health care providers defined
The term alternative dental health care providers has the meaning given the term in section 340G–1(a)(2) of the Public Health Service Act (42 U.S.C. 256g–1(a)(2)).
(B) Indian Health Care Improvement Act terms
The terms Indian tribe, tribal organization, and Urban Indian organization have the meaning given those terms in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603).
(2) Demonstration program authorized
The Secretary of Health and Human Services, acting through the Indian Health Service, may carry out a demonstration program to establish programs to train and employ alternative dental health care providers in order to help eliminate oral health disparities and increase access to dental services through health programs operated by the Indian Health Service, Indian tribes, tribal organizations, and Urban Indian organizations.
(3) Telehealth
For purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care, dental services provided under the demonstration program under this subsection may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible.
(4) Authorization of appropriations
There are authorized to be appropriated such sums as are necessary to carry out the demonstration program under this subsection.
Sec. 4252. Oral health literacy and awareness campaign
The Public Health Service Act is amended by inserting after section 340G–1 of such Act (42 U.S.C. 256g–1) the following:
340G–2. Oral health literacy and awareness
(a) Campaign
The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall establish a public education campaign (referred to in this subsection as the
campaign) across all relevant programs of the Health Resources and Services Administration (including the health center program, oral health workforce programs, maternal and child health programs, the Ryan White HIV/AIDS Program, and rural health programs) to increase oral health literacy and awareness.(b) Strategies
In carrying out the campaign, the Secretary shall identify oral health literacy and awareness strategies that are evidence based and focused on oral health care education, including education on prevention of oral disease such as early childhood and other caries, periodontal disease, and oral cancer.
(c) Focus
The Secretary shall design the campaign to communicate directly with specific populations, including children, pregnant women, parents, the elderly, individuals with disabilities, and ethnic and racial minority populations, including Indians, Alaska Natives, and Native Hawaiians, in a culturally and linguistically appropriate manner.
(d) Outcomes
In carrying out the campaign, the Secretary shall include a process for measuring outcomes and effectiveness.
(e) Report to Congress
Not later than 3 years after the date of enactment of this section, the Secretary shall submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report on the outcomes and effectiveness of the campaign.
(f) Authorization of appropriations
To carry out this section, there is authorized to be appropriated $750,000 for each of fiscal years 2027 through 2031.
Sec. 4253. Ensuring Kids Have Access to Medically Necessary Dental Care Act
(a) Prohibition of lifetime or annual limits on dental benefits under the Children's Health Insurance Program
(1) In general
Section 2103(c)(6) of the Social Security Act (42 U.S.C. 1397cc(c)(6)) is amended—
(A)
in subparagraph (A), by inserting , subject to subparagraph (D),
after shall include
;
(B)
in subparagraph (B), by striking A State
and inserting Subject to subparagraph (D), a State
; and
(C)
by adding at the end the following new subparagraph:
(D) No lifetime or annual limits on dental benefits
A State shall not establish lifetime or annual limits on the dollar value of benefits for dental services provided under the State child health plan to a targeted low-income child, and, in the case that the State elects to provide pregnancy-related assistance pursuant to section 2112, to a targeted low-income pregnant woman (as defined in section 2112(d)), including benefits for such services that are provided through dental coverage that is otherwise equivalent to a benchmark dental package described in subparagraph (C).
(2) Effective date
The amendments made by this subsection shall take effect on the date that is 6 months after the date of enactment of this Act.
(b) Requiring wraparound coverage of dental services for certain children under CHIP
(1) In general
Section 2110(b)(5) of the Social Security Act (42 U.S.C. 1397jj(b)(5)) is amended—
(A)
in the paragraph header, by striking Option
and inserting Requirement
;
(B)
in subparagraph (A), by striking may waive
and inserting shall waive
; and
(C)
in subparagraph (C), to read as follows:
(C) Requirement
A State child health plan may not provide more favorable dental coverage or cost-sharing protection for dental coverage to children provided dental-only supplemental coverage under this paragraph than the dental coverage and cost-sharing protection for dental coverage provided to targeted low-income children who are eligible for the full range of child health assistance provided under the State child health plan.
(2) Effective date
The amendments made by this subsection shall take effect on the date that is 6 months after the date of enactment of this Act.
Subtitle D Advancing Health Equity Through Payment and Delivery Reform
Sec. 4301. Centers for Medicare & Medicaid Services reporting and value-based programs
(a) Advancing Health Equity in Reporting and Value-Based Payment Programs
(1) In general
The Administrator of the Centers for Medicare & Medicaid Services (in this section referred to as the Administrator
) shall require that a clinician or other professional participating in any pay-for-reporting or value-based payment program stratify clinical quality measures by disparity variables, including race, ethnicity, sex, primary language, disability status, sexual orientation, gender identity, and socioeconomic status.
(2) Use of existing demographic data collection fields
A clinician or other professional described in paragraph (1) may use existing demographic data collection fields in certified EHR technology (as defined in section 1848(o)(4) of the Social Security Act (42 U.S.C. 1395w–4(o)(4))) to carry out such data stratification under such paragraph. Such stratified data will assist clinicians and other professionals in the identification of disparities obscured in aggregated data and assist with the provision of interventions that target reducing those disparities.
(3) Clinician
In assessing performance in any value-based payment program, the Administrator shall incorporate a clinician or other professional’s performance in reducing disparities across race, ethnicity, sex, primary language, disability status, sexual orientation, gender identity, and socioeconomic status. Linking performance payments to the reduction of health care disparities across such variables will assist in holding clinicians and other professionals accountable for providing quality care that can lead to decreased health inequities.
(4) Requirement of adoption of cert
All entities, clinicians, or other professionals participating in the Quality Payment Program of the Centers for Medicare & Medicaid Services shall be required to adopt certified EHR technology (as so defined) as a condition of participating in such program.
(b) Quality improvement activities
The Administrator, upon yearly review of the Quality Payment Program, shall add quality improvement activities that implement the Culturally and Linguistically Accessible Standards (CLAS) as Improvement Activities under the Quality Payment Program.
Sec. 4302. Development and testing of disparity reducing delivery and payment models
(a) In general
The Center for Medicare and Medicaid Innovation established under section 1115A of the Social Security Act (42 U.S.C. 1315a) (in this section referred to as the CMI
) shall establish a dedicated fund to identify, test, evaluate, and scale delivery and payment models under the applicable titles (as defined in subsection (a)(4)(B) of such section) that target health disparities among racial and ethnic minorities, including models that support high-value nonmedical services that address socially determined barriers to health in all stages of the life cycle through end-of-life, including English proficiency status, low health and health care literacy, lack of access to health care planning, including end-of-life care planning, case management, transportation, enrollment assistance needs, stable and affordable housing, utility assistance, employment and career development, and nutrition and food security which will help to reduce disparities and impact the overall cost of care.
(b) Amendment to Social Security Act
The second sentence of section 1115A(a)(1) of the Social Security Act (42 U.S.C. 1315a(a)(1)) is amended by inserting and improve health equity
after expenditures
.
(c) Pilot programs
The CMI shall prioritize the testing of models under such section 1115A that include partnerships with entities, including community-based organizations or other nonprofit entities, to help address socially determined barriers to health and health care.
(d) Alternatives
Any model tested by the CMI under such 1115A shall include measures to assess and track the impact of the model on health disparities, using existing measures such as the Healthcare Disparities and Cultural Competency Measures endorsed by the entity with a contract under section 1890(a) of the Social Security Act (42 U.S.C. 1395aaa(a)), and stratified by race, ethnicity, English proficiency, gender identity, sexual orientation, and disability status.
Sec. 4303. Diversity in Centers for Medicare and Medicaid consultation
(a) In general
In carrying out the duties under this subtitle, the Center for Medicare and Medicaid Innovation established under section 1115A of the Social Security Act (42 U.S.C. 1315a) (in this section referred to as the CMI
) shall consult clinical and analytical experts with expertise in medicine and health care management, specifically such experts with expertise in—
(1)
the health care needs of minority, rural, and underserved populations; and
(2)
the financial needs of safety net, community-based, rural, and critical access providers, including federally qualified health centers.
(b) Open door forums
The CMI shall use open door forums or other mechanisms to seek external feedback from interested parties and incorporate that feedback into the development of models.
Sec. 4304. Supporting safety net and community-based providers to compete in value-based payment systems
(a) In general
Any pay-for-performance or alternative payment model that is developed and tested by the Center for Medicare and Medicaid Innovation established under section 1115A of the Social Security Act (42 U.S.C. 1315a), or any other agency of the Department of Health and Human Services with respect to the programs under titles XVIII, XIX, or XXI of such Act, shall be assessed for potential impact on safety net, community-based, and critical access providers, including Federally qualified health centers.
(b) New models
The rollout of any such models shall include training and additional up front resources for community-based and safety net providers to enable those providers to participate in the model.
Sec. 4305. Improving access to care for Medicare and Medicaid beneficiaries
Section 1115A of the Social Security Act (42 U.S.C. 1315a) is amended—
(1)
in subsection (a)—
(A)
in the last sentence of paragraph (1), by inserting advance health equity and
before improve the coordination
; and
(B)
in the first sentence of paragraph (3)—
(i)
by inserting (including the Office of Minority Health of the Centers for Medicare & Medicaid Services, the Office of Rural Health Policy of the Health Resources and Services Administration, and the Office on Women’s Health of the Department of Health and Human Services)
after relevant Federal agencies
; and
(ii)
by striking experts with expertise in medicine
and inserting experts with expertise in medicine, the causes of health disparities and the social determinants of health, and
;
(2)
in subsection (b)—
(A)
in paragraph (2)—
(i)
in subparagraph (A)—
(I)
by inserting the following after the first sentence: Prior to selecting a model under this paragraph, the Secretary shall consult with the Office of Minority Health of the Centers for Medicare & Medicaid Services, the Office of Rural Health Policy of the Health Resources and Services Administration, and the Office on Women’s Health of the Department of Health and Human Services to ensure that models under consideration address health disparities and social determinants of health as appropriate for populations to be cared for under the model.
;
(II)
by inserting and, for models for which testing begins on or after January 1, 2027, address health equity as well as improving access to care received by individuals receiving benefits under such title
after applicable title
; and
(III)
by adding at the end the following: The models selected under this subparagraph shall include the social determinants of health payment model described in subsection (h), the testing of which shall begin not later than December 31, 2027.
; and
(ii)
in subparagraph (C), by adding at the end the following new clauses:
(ix)
Whether the model will affect access to care from providers and suppliers caring for high risk patients or operating in underserved areas.
(x)
Whether the model has the potential to reduce health disparities, including minority and rural health disparities.;
(B)
in paragraph (3)(B)—
(i)
in clause (i), by inserting or health equity
after quality of care
;
(ii)
in clause (ii), by inserting or increasing health inequities
after quality of care
; and
(iii)
in clause (iii), by inserting or health equity
after quality of care
; and
(C)
in paragraph (4)(A)—
(i)
in clause (i), by striking ; and
and inserting a semicolon;
(ii)
in clause (ii), by striking the period and inserting ; and
; and
(iii)
by adding at the end the following new clause:
(iii)
for models for which testing begins on or after January 1, 2027, the extent to which the model improves health equity.;
(3)
in subsection (c)—
(A)
in paragraph (1)—
(i)
in subparagraph (A), by inserting or, beginning on or after January 1, 2027, increasing health inequities
before the semicolon; and
(ii)
in subparagraph (B), by inserting or, beginning on or after January 1, 2027, health equity
after patient care
; and
(B)
in paragraph (3), by inserting or increase health disparities experienced by beneficiaries, including low-income, minority, or rural beneficiaries, or that such expansion would improve health equity
before the period;
(4)
in subsection (g), by adding at the end the following:
For reports submitted after the date of enactment of the Health Equity and Accountability Act of 2026, each such report shall include information on the following:
(1)
The interventions that address social determinants of health, health disparities, or health equity in payment models selected by the CMI for testing under this section.
(2)
Estimated Federal savings achieved through reducing disparities, including rural and minority health disparities, improving health equity, or addressing social determinants of health.
(3)
The effectiveness of interventions in mitigating negative health outcomes and higher costs associated with social determinants of health within models selected by the Center for Medicare and Medicaid Innovation for testing.
(4)
Other areas determined appropriate by the Secretary.; and
(5)
by adding at the end the following new subsection:
(h) Social determinants of health payment model
(1) In general
The social determinants of health payment model described in this subsection is a payment model that tests each of the payment and service delivery innovations described in paragraph (2) in a region determined appropriate by the Secretary.
(2) Payment and service delivery innovations described
For purposes of paragraph (1), the payment and service delivery innovations described in this clause are the following:
(A)
Payment and service delivery innovations for behavioral health services, focusing on gathering actionable data to address the higher costs associated with beneficiaries with diagnosed behavioral conditions.
(B)
Payment and service delivery innovations targeting conditions or comorbidities of individuals entitled or enrolled under the Medicare program under title XVIII and enrolled under a State plan under the Medicaid program under title XIX to increase capacity in underserved areas.
(C)
Payment and service delivery innovations targeting conditions or comorbidities of applicable individuals to increase capacity in underserved areas.
(D)
Payment and service delivery innovations targeted on Medicaid eligible pregnant and postpartum women, up to 1 year after delivery.
Subtitle E Health Empowerment Zones
Sec. 4401. Designation of health empowerment zones
(a) In general
The Secretary may, at the request of an eligible community partnership described in subsection (b)(1), designate an eligible area described in subsection (b)(2) as a health empowerment zone for the purpose of eligibility for a grant under section 4402.
(b) Eligibility criteria
(1) Eligible community partnership
A community partnership is eligible to submit a request under this section if the partnership—
(A)
demonstrates widespread public support from key individuals and entities in the eligible area, including members of the target community, State and local governments, nonprofit organizations including national and regional intermediaries with demonstrated capacity to serve low-income urban communities, and community and industry leaders, for designation of the eligible area as a health empowerment zone; and
(B)
includes representatives of—
(i)
a broad cross-section of stakeholders and residents from communities in the eligible area experiencing disproportionate disparities in health status and health care; and
(ii)
organizations, facilities, and institutions that have a history of working within and serving such communities.
(2) Eligible area
An area is eligible to be designated as a health empowerment zone under this section if one or more communities in the area experience disproportionate disparities in health status and health care. In determining whether a community experiences such disparities, the Secretary shall consider data collected by the Department of Health and Human Services focusing on the following areas:
(A)
Access to affordable, high-quality health care services.
(B)
The prevalence of disproportionate rates of certain illnesses or diseases including the following:
(i)
Arthritis, osteoporosis, chronic back conditions, and other musculoskeletal diseases.
(ii)
Cancer.
(iii)
Chronic kidney disease.
(iv)
Diabetes.
(v)
Injury (intentional and unintentional).
(vi)
Violence (intimate and nonintimate).
(vii)
Maternal and paternal illnesses and diseases.
(viii)
Infant mortality.
(ix)
Mental illness and other disabilities.
(x)
Substance use disorder treatment and prevention, including underage drinking.
(xi)
Nutrition, obesity, and overweight conditions.
(xii)
Heart disease.
(xiii)
Hypertension.
(xiv)
Cerebrovascular disease or stroke.
(xv)
Tuberculosis.
(xvi)
HIV/AIDS and other sexually transmitted infections.
(xvii)
Viral hepatitis.
(xviii)
Asthma.
(xix)
Tooth decay and other oral health issues.
(C)
Within the community, the historical and persistent presence of conditions that have been found to contribute to health disparities including any such conditions respecting any of the following:
(i)
Poverty.
(ii)
Educational status and the quality of community schools.
(iii)
Income.
(iv)
Access to high-quality affordable health care.
(v)
Work and work environment.
(vi)
Environmental conditions in the community, including with respect to clean water, clean air, and the presence or absence of pollutants.
(vii)
Language and English proficiency.
(viii)
Access to affordable healthy food.
(ix)
Access to ethnically and culturally diverse health and human service providers and practitioners.
(x)
Access to culturally and linguistically competent health and human services and health and human service providers.
(xi)
Health-supporting infrastructure.
(xii)
Health insurance that is adequate and affordable.
(xiii)
Race, racism, and bigotry (conscious and unconscious).
(xiv)
Sexual orientation.
(xv)
Health and health care literacy.
(xvi)
Place of residence (such as urban areas, rural areas, and reservations of Indian Tribes).
(xvii)
Stress.
(c) Procedure
(1) Request
A request under subsection (a) shall—
(A)
describe the bounds of the area to be designated as a health empowerment zone and the process used to select those bounds;
(B)
demonstrate that the partnership submitting the request is an eligible community partnership described in subsection (b)(1);
(C)
demonstrate that the area is an eligible area described in subsection (b)(2);
(D)
include a comprehensive assessment of disparities in health status and health care experience by one or more communities in the area;
(E)
set forth—
(i)
a vision and a set of values for the area; and
(ii)
a comprehensive and holistic set of goals to be achieved in the area through designation as a health empowerment zone; and
(F)
include a strategic plan and an action plan for achieving the goals described in subparagraph (E)(ii).
(2) Approval
Not later than 60 days after the receipt of a request for designation of an area as a health empowerment zone under this section, the Secretary shall approve or disapprove the request.
(d) Minimum number
The Secretary—
(1)
shall designate not more than 110 health empowerment zones under this section; and
(2)
of such zones designated under paragraph (1), shall designate at least one health empowerment zone in each of the several States, the District of Columbia, and each territory or possession of the United States.
Sec. 4402. Assistance to those seeking designation
At the request of any organization or entity seeking to submit a request under section 4401(a), the Secretary shall provide technical assistance, and may award a grant, to assist such organization or entity—
(1)
to form an eligible community partnership described in section 4401(b)(1);
(2)
to complete a health assessment, including an assessment of health disparities under section 4401(c)(1)(D); or
(3)
to prepare and submit a request, including a strategic plan, in accordance with section 4401.
Sec. 4403. Benefits of designation
(a) Priority
In awarding a grant under subsection (b), the Secretary shall give priority to any applicant that—
(1)
meets the eligibility criteria for the grant;
(2)
proposes to use the grant for activities in a health empowerment zone; and
(3)
demonstrates that such activities will directly and significantly further the goals of the strategic plan approved for such zone under section 4401.
(b) Grants for initial implementation of strategic plan
(1) In general
Upon designating an eligible area as a health empowerment zone at the request of an eligible community partnership, the Secretary shall, subject to the availability of appropriations, make a grant to the community partnership for implementation of the strategic plan for such zone.
(2) Grant period
A grant under paragraph (1) for a health empowerment zone shall be for a period of 2 years and may be renewed, except that the total period of grants under paragraph (1) for such zone may not exceed 10 years.
(3) Limitation
In awarding grants under this subsection, the Secretary shall not give less priority to an applicant or reduce the amount of a grant because the Secretary rendered technical assistance or made a grant to the same applicant under section 4401.
(4) Reporting
The Secretary shall establish metrics for measuring the progress of grantees under this subsection and, based on such metrics, require each such grantee to report to the Secretary not less than every 6 months on the progress in implementing the strategic plan for the health empowerment zone.
Sec. 4404. Definition of Secretary
In this subtitle, the term Secretary means the Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration and the Deputy Assistant Secretary for Minority Health, and in cooperation with the Director of the Office of Community Services and the Director of the National Institute on Minority Health and Health Disparities.
Sec. 4405. Authorization of appropriations
To carry out this subtitle, there is authorized to be appropriated $100,000,000 for fiscal year 2027.
Subtitle F Equitable Health Care for All
Sec. 4501. Data collection and reporting
(a) Required reporting
(1) In general
The Secretary of Health and Human Services, in consultation with the Director for Civil Rights and Health Equity, the Director of the National Institutes of Health, the Administrator of the Centers for Medicare & Medicaid Services, the Director of the Agency for Healthcare Research and Quality, the Deputy Assistant Secretary for Minority Health, and the Director of the Centers for Disease Control and Prevention, shall by regulation require all health care providers and facilities that are required under other provisions of law to report data on specific health outcomes to the Department of Health and Human Services in aggregate form, to disaggregate such data by demographic characteristics, including by race, national origin, sex (including sexual orientation and gender identity), disability, and age, as well as any other factor that the Secretary of Health and Human Services determines would be useful for determining a pattern of provision of inequitable health care.
(2) Proposed regulations
Not later than 90 days after the date of enactment of this Act, the Secretary of Health and Human Services shall issue proposed regulations to carry out paragraph (1).
(b) Repository
The Secretary of Health and Human Services shall—
(1)
not later than 1 year after the date of enactment of this Act, establish a repository of the disaggregated data reported pursuant to subsection (a);
(2)
subject to paragraph (3), make the data in such repository publicly available; and
(3)
ensure that such repository does not contain any data that is individually identifiable.
Sec. 4502. Requiring equitable health care in the hospital value-based purchasing program
(a) Equitable health care as value measurement
Section 1886(b)(3)(B)(viii) of the Social Security Act (42 U.S.C. 1395ww(b)(3)(B)(viii)) is amended by adding at the end the following new subclause:
(XIII)
(aa)
Effective for payments beginning with fiscal year 2027, in expanding the number of measures under subclause (III), the Secretary shall adopt measures that relate to equitable health care furnished by hospitals in inpatient settings.
(bb)
In carrying out this subclause, the Secretary shall solicit input and recommendations from individuals and groups representing communities of color and other protected classes and ensure measures adopted pursuant to this subclause account for social determinants of health, as defined in section 4505(e)(10) of the Health Equity and Accountability Act of 2026.
(cc)
For purposes of this subclause, the term equitable health care refers to the principle that high-quality care should be provided to all individuals and health care treatment and services should not vary on account of the real or perceived race, national origin, sex (including sexual orientation and gender identity), disability, or age of an individual, as well as any other factor that the Secretary determines would be useful for determining a pattern of provision of inequitable health care.
(b) Inclusion of equitable health care measures
Section 1886(o)(2)(B) of the Social Security Act (42 U.S.C. 1395ww(o)(2)(B)) is amended by adding at the end the following new clause:
(iv) Inclusion of equitable health care measures
Beginning in fiscal year 2027, measures selected under subparagraph (A) shall include the equitable health care measures described in subsection (b)(3)(B)(viii)(XIII).
Sec. 4503. Provision of inequitable health care as a basis for permissive exclusion from Medicare and State health care programs
Section 1128(b) of the Social Security Act (42 U.S.C. 1320a–7(b)) is amended by adding at the end the following new paragraph:
(18) Provision of inequitable health care
(A) In general
Subject to subparagraph (B), any health care provider that the Secretary determines has engaged in a pattern of providing inequitable health care (as defined in section 4505(e)(7) of the Health Equity and Accountability Act of 2026) on the basis of race, national origin, sex (including sexual orientation and gender identity), disability, or age of an individual.
(B) Exception
For purposes of carrying out subparagraph (A), the Secretary shall not exclude any health care provider from participation in the Medicare program under title XVIII or the Medicaid program under title XIX if the exclusion of such health care provider would result in increased difficulty in access to health care services for underserved or low-income communities.
Sec. 4504. Office for Civil Rights and Health Equity of the Department of Health and Human Services
(a) Name of office
Beginning on the date of enactment of this Act, the Office for Civil Rights of the Department of Health and Human Services shall be known as the Office for Civil Rights and Health Equity
of the Department of Health and Human Services. Any reference to the Office for Civil Rights of the Department of Health and Human Services in any law, regulation, map, document, record, or other paper of the United States shall be deemed to be a reference to the Office for Civil Rights and Health Equity.
(b) Head of office
The head of the Office for Civil Rights and Health Equity shall be the Director for Civil Rights and Health Equity, to be appointed by the President, by and with the advice and consent of the Senate. Any reference to the Director of the Office for Civil Rights of the Department of Health and Human Services in any law, regulation, map, document, record, or other paper of the United States shall be deemed to be a reference to the Director for Civil Rights and Health Equity.
Sec. 4505. Prohibiting discrimination in health care
(a) Prohibiting discrimination
(1) In general
No health care provider, in or affecting commerce, may on the basis, in whole or in part, of race, sex (including sexual orientation and gender identity), disability, age, or religion, subject an individual to the provision of inequitable health care.
(2) Notice of patient rights
The Secretary shall provide to each patient a notice of a patient’s rights under this section.
(b) Administrative complaint and conciliation process
(1) Complaints and answers
(A) In general
An aggrieved person may, not later than 1 year after an alleged violation of subsection (a) has occurred or concluded, file a complaint with the Director alleging provision of inequitable health care by a provider described in subsection (a).
(B) Complaint
A complaint submitted pursuant to subparagraph (A) shall be in writing and shall contain such information and be in such form as the Director requires.
(C) Oath or affirmation
The complaint and any answer made under this subsection shall be made under oath or affirmation, and may be reasonably and fairly modified at any time.
(2) Response to complaints
(A) In general
Upon the filing of a complaint under this subsection, the following procedures shall apply:
(i) Complainant notice
The Director shall serve notice upon the complainant acknowledging receipt of such filing and advising the complainant of the time limits and procedures provided under this section.
(ii) Respondent notice
The Director shall, not later than 30 days after receipt of such filing—
(I)
serve on the respondent a notice of the complaint, together with a copy of the original complaint; and
(II)
advise the respondent of the procedural rights and obligations of respondents under this section.
(iii) Answer
The respondent may file, not later than 60 days after receipt of the notice from the Director, an answer to such complaint.
(iv) Investigative duties
The Director shall—
(I)
make an investigation of the alleged provision of inequitable health care; and
(II)
complete such investigation within 180 days (unless it is impracticable to complete such investigation within 180 days) after the filing of the complaint.
(B) Investigations
(i) Pattern or practice
In the course of investigating the complaint, the Director may seek records of care provided to patients other than the complainant if necessary to demonstrate or disprove an allegation of provision of inequitable health care or to determine whether there is a pattern or practice of such care.
(ii) Accounting for social determinants of health
In investigating the complaint and reaching a determination on the validity of the complaint, the Director shall account for social determinants of health and the effect of such social determinants on health care outcomes.
(iii) Inability to complete investigation
If the Director is unable to complete (or finds it is impracticable to complete) the investigation within 180 days after the filing of the complaint (or, if the Director makes a certification under paragraph (6)(B) with respect to a complaint, within 180 days after the commencement of such further action), the Director shall notify the complainant and respondent in writing of the reasons involved.
(iv) Report to State licensing authorities
On completing each investigation under this subparagraph, the Director shall provide to the appropriate State licensing authorities information specifying the results of the investigation.
(C) Report
(i) Final report
On completing each investigation under this paragraph, the Director shall prepare a final investigative report.
(ii) Modification of report
A final report under this subparagraph may be modified if additional evidence is later discovered.
(3) Conciliation
(A) In general
During the period beginning on the date on which a complaint is filed under this subsection and ending on the date of final disposition of such complaint (including during an investigation under paragraph (2)(B)), the Director shall, to the extent feasible, engage in conciliation with respect to such complaint.
(B) Conciliation agreement
A conciliation agreement arising out of such conciliation shall be an agreement between the respondent and the complainant, and shall be subject to approval by the Director.
(C) Rights protected
The Director shall approve a conciliation agreement only if the agreement protects the rights of the complainant and other persons similarly situated.
(D) Publicly available agreement
(i) In general
Subject to clause (ii), the Secretary shall make available to the public a copy of a conciliation agreement entered into pursuant to this subsection unless the complainant and respondent otherwise agree, and the Secretary determines, that disclosure is not required to further the purposes of this subsection.
(ii) Limitation
A conciliation agreement that is made available to the public pursuant to clause (i) may not disclose individually identifiable health information.
(4) Failure to comply with conciliation agreement
Whenever the Director has reasonable cause to believe that a respondent has breached a conciliation agreement, the Director shall refer the matter to the Attorney General to consider filing a civil action to enforce such agreement.
(5) Written consent for disclosure of information
Nothing said or done in the course of conciliation under this subsection may be made public, or used as evidence in a subsequent proceeding under this subsection, without the written consent of the parties to the conciliation.
(6) Prompt judicial action
(A) In general
If the Director determines at any time following the filing of a complaint under this subsection that prompt judicial action is necessary to carry out the purposes of this subsection, the Director may recommend that the Attorney General promptly commence a civil action under subsection (d).
(B) Immediate suit
If the Director determines at any time following the filing of a complaint under this subsection that the public interest would be served by allowing the complainant to bring a civil action under subsection (c) in a State or Federal court immediately, the Director shall certify that the administrative process has concluded and that the complainant may file such an action immediately.
(7) Annual report
Not later than 1 year after the date of enactment of this Act, and annually thereafter, the Director shall make publicly available a report detailing the activities of the Office for Civil Rights and Health Equity under this subsection, including—
(A)
the number of complaints filed and the basis on which the complaints were filed;
(B)
the number of investigations undertaken as a result of such complaints; and
(C)
the disposition of all such investigations.
(c) Enforcement by private persons
(1) In general
(A) Civil action
(i) In suit
A complainant under subsection (b) may commence a civil action to obtain appropriate relief with respect to an alleged violation of subsection (a), or for breach of a conciliation agreement under subsection (b), in an appropriate district court of the United States or State court—
(I)
not sooner than the earliest of—
(aa)
the date a conciliation agreement is reached under subsection (b);
(bb)
the date on which the Director makes a certification under subsection (b)(6)(B); or
(cc)
180 days after the first day of the alleged violation; and
(II)
not later than 2 years after the final day of the alleged violation.
(ii) Statute of limitations
The computation of such 2-year period shall not include any time during which an administrative proceeding (including investigation or conciliation) under subsection (b) was pending with respect to a complaint under such subsection.
(B) Barring suit
If the Director has obtained a conciliation agreement under subsection (b) regarding an alleged violation of subsection (a), no action may be commenced under this paragraph by the complainant involved with respect to the alleged violation except for the purpose of enforcing the terms of such an agreement.
(2) Relief which may be granted
(A) In general
In a civil action under paragraph (1), if the court finds that a violation of subsection (a) or breach of a conciliation agreement has occurred, the court may award to the plaintiff actual and punitive damages, and may grant as relief, as the court determines to be appropriate, any permanent or temporary injunction, temporary restraining order, or other order (including an order enjoining the defendant from engaging in a practice violating subsection (a) or ordering such affirmative action as may be appropriate).
(B) Fees and costs
In a civil action under paragraph (1), the court, in its discretion, may allow the prevailing party, other than the United States, a reasonable attorney’s fee and costs. The United States shall be liable for such fees and costs to the same extent as a private person.
(3) Intervention by Attorney General
Upon timely application, the Attorney General may intervene in a civil action under paragraph (1), if the Attorney General certifies that the case involves a pattern or practice or an issue described in subsection (d)(1)(A).
(d) Enforcement by the Attorney General
(1) Commencement of actions
(A) Pattern or practice cases
The Attorney General may commence a civil action in any appropriate district court of the United States if the Attorney General has reasonable cause to believe that any health care provider covered by subsection (a)—
(i)
is engaged in a pattern or practice that violates such subsection; or
(ii)
is engaged in a violation of such subsection that raises an issue of significant public importance.
(B) Cases by referral
The Director may determine, based on a pattern of complaints, a pattern of violations, a review of data reported by a health care provider covered by subsection (a), or any other means, that there is reasonable cause to believe a health care provider is engaged in a pattern or practice that violates subsection (a). The Director may determine, based on a review of data reported by a health care provider covered by subsection (a), or any other means, that there is reasonable cause to believe that a health care provider is engaged in a violation of subsection (a) described in subparagraph (A)(ii). If the Director makes a determination under this subparagraph, the Director shall refer the related findings to the Attorney General. If the Attorney General finds that corresponding reasonable cause exists, the Attorney General may commence a civil action in any appropriate district court of the United States.
(2) Enforcement of subpoenas
The Attorney General, on behalf of the Director, or another party at whose request a subpoena is issued under this subsection, may enforce such subpoena in appropriate proceedings in the district court of the United States for the district in which the person to whom the subpoena was addressed resides, was served, or transacts business.
(3) Relief which may be granted in civil actions
(A) In general
In a civil action under paragraph (1), the court—
(i)
may award such preventive relief, including a permanent or temporary injunction, temporary restraining order, or other order against the person responsible for a violation of subsection (a) as is necessary to assure the full enjoyment of the rights granted by this subsection;
(ii)
may award such other relief as the court determines to be appropriate, including monetary damages, to aggrieved persons; and
(iii)
may, to vindicate the public interest, assess punitive damages against the respondent—
(I)
in an amount not exceeding $500,000, for a first violation; and
(II)
in an amount not exceeding $1,000,000, for any subsequent violation.
(B) Fees and costs
In a civil action under this subsection, the court, in its discretion, may allow the prevailing party, other than the United States, a reasonable attorney’s fee and costs. The United States shall be liable for such fees and costs to the extent provided by section 2412 of title 28, United States Code.
(4) Intervention in civil actions
Upon timely application, any person may intervene in a civil action commenced by the Attorney General under paragraphs (1) and (2) if the action involves an alleged violation of subsection (a) with respect to which such person is an aggrieved person (including a person who is a complainant under subsection (b)) or a conciliation agreement to which such person is a party.
(e) Definitions
In this section:
(1) Aggrieved person
The term aggrieved person means—
(A)
a person who believes that the person was or will be injured in violation of subsection (a); or
(B)
the personal representative or estate of a deceased person who was injured in violation of subsection (a).
(2) Director
The term Director means the Director for Civil Rights and Health Equity of the Department of Health and Human Services.
(3) Disability
The term disability has the meaning given such term in section 3 of the Americans with Disabilities Act of 1990 (42 U.S.C. 12102).
(4) Conciliation
The term conciliation means the attempted resolution of issues raised by a complaint, or by the investigation of such complaint, through informal negotiations involving the complainant, the respondent, and the Secretary.
(5) Conciliation agreement
The term conciliation agreement means a written agreement setting forth the resolution of the issues in conciliation.
(6) Individually identifiable health information
The term individually identifiable health information means any information, including demographic information collected from an individual—
(A)
that is created or received by a health care provider covered by subsection (a), health plan, employer, or health care clearinghouse;
(B)
that relates to the past, present, or future physical or mental health or condition of, the provision of health care to, or the past, present, or future payment for the provision of health care to, the individual; and
(C)
(i)
that identifies the individual; or
(ii)
with respect to which there is a reasonable basis to believe that the information can be used to identify the individual.
(7) Provision of inequitable health care
The term provision of inequitable health care means the provision of any health care service, by a health care provider covered by subsection (a) in a manner that—
(A)
fails to meet a high-quality care standard, meaning the health care provider fails to—
(i)
avoid harm to patients as a result of the health services that are intended to help the patient;
(ii)
refrain from providing services to patients not likely to benefit;
(iii)
provide care that is responsive to patient preferences, needs, and values; and
(iv)
avoids waits or delays in care; and
(B)
is discriminatory in intent or effect based at least in part on a basis specified in subsection (a).
(8) Respondent
The term respondent means the person or other entity accused in a complaint of a violation of subsection (a).
(9) Secretary
The term Secretary means the Secretary of Health and Human Services.
(10) Social determinants of health
The term social determinants of health means conditions in the environments in which individuals live, work, attend school, and worship, that affect a wide range of health, functioning, and quality-of-life outcomes and risks.
(f) Rule of construction
Nothing in this section shall be construed as repealing or limiting the effect of title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), section 1557 of the Patient Protection and Affordable Care Act (42 U.S.C. 18116), section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), title II or III of the Americans with Disabilities Act of 1990 (42 U.S.C. 12131 et seq, 12181 et seq.), or the Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.).
Sec. 4506. Federal Health Equity Commission
(a) Establishment of Commission
(1) In general
There is established the Federal Health Equity Commission (in this section referred to as the Commission
).
(2) Membership
(A) In general
The Commission shall be composed of—
(i)
8 voting members appointed under subparagraph (B); and
(ii)
the nonvoting, ex officio members listed in subparagraph (C).
(B) Voting members
Not more than 4 of the members described in subparagraph (A)(i) shall at any one time be of the same political party. Such members shall have recognized expertise in and personal experience with racial and ethnic health inequities, health care needs of vulnerable and marginalized populations, and health equity as a vehicle for improving health status and health outcomes. Such members shall be appointed to the Commission as follows:
(i)
4 members of the Commission shall be appointed by the President.
(ii)
2 members of the Commission shall be appointed by the President pro tempore of the Senate, upon the recommendations of the majority leader and the minority leader of the Senate. Each member appointed to the Commission under this clause shall be appointed from a different political party.
(iii)
2 members of the Commission shall be appointed by the Speaker of the House of Representatives upon the recommendations of the majority leader and the minority leader of the House of Representatives. Each member appointed to the Commission under this clause shall be appointed from a different political party.
(C) Ex officio member
The Commission shall have the following nonvoting, ex officio members:
(i)
The Director for Civil Rights and Health Equity of the Department of Health and Human Services.
(ii)
The Deputy Assistant Secretary for Minority Health of the Department of Health and Human Services.
(iii)
The Director of the National Institute on Minority Health and Health Disparities.
(iv)
The Chairperson of the Advisory Committee on Minority Health established under section 1707(c) of the Public Health Service Act (42 U.S.C. 300u–6(c)).
(3) Terms
The term of office of each member appointed under paragraph (2)(B) of the Commission shall be 6 years.
(4) Chairperson; Vice Chairperson
(A) Chairperson
The President shall, with the concurrence of a majority of the members of the Commission appointed under paragraph (2)(B), designate a Chairperson from among the members of the Commission appointed under such paragraph.
(B) Vice Chairperson
(i) Designation
The Speaker of the House of Representatives shall, in consultation with the majority leaders and the minority leaders of the Senate and the House of Representatives and with the concurrence of a majority of the members of the Commission appointed under paragraph (2)(B), designate a Vice Chairperson from among the members of the Commission appointed under such paragraph. The Vice Chairperson may not be a member of the same political party as the Chairperson.
(ii) Duty
The Vice Chairperson shall act in place of the Chairperson in the absence of the Chairperson.
(5) Removal of members
The President may remove a member of the Commission only for neglect of duty or malfeasance in office.
(6) Quorum
A majority of members of the Commission appointed under paragraph (2)(B) shall constitute a quorum of the Commission, but a lesser number of members may hold hearings.
(b) Duties of the Commission
(1) In general
The Commission shall—
(A)
monitor and report on the implementation of this Act; and
(B)
investigate, monitor, and report on progress towards health equity and the elimination of health disparities.
(2) Annual report
The Commission shall—
(A)
submit to the President and Congress at least one report annually on health equity and health disparities; and
(B)
include in such report—
(i)
a description of actions taken by the Department of Health and Human Services and any other Federal agency related to health equity or health disparities; and
(ii)
recommendations on ensuring equitable health care and eliminating health disparities.
(c) Powers
(1) Hearings
(A) In general
The Commission or, at the direction of the Commission, any subcommittee or member of the Commission, may, for the purpose of carrying out this section, as the Commission or the subcommittee or member considers advisable—
(i)
hold such hearings, meet and act at such times and places, take such testimony, receive such evidence, and administer such oaths; and
(ii)
require, by subpoena or otherwise, the attendance and testimony of such witnesses and the production of such books, records, correspondence, memoranda, papers, documents, tapes, and materials.
(B) Limitation on hearings
The Commission may hold a hearing under subparagraph (A)(i) only if the hearing is approved—
(i)
by a majority of the members of the Commission appointed under subsection (a)(2)(B); or
(ii)
by a majority of such members present at a meeting when a quorum is present.
(2) Issuance and enforcement of subpoenas
(A) Issuance
A subpoena issued under paragraph (1) shall—
(i)
bear the signature of the Chairperson of the Commission; and
(ii)
be served by any person or class of persons designated by the Chairperson for that purpose.
(B) Enforcement
In the case of contumacy or failure to obey a subpoena issued under paragraph (1), the United States district court for the district in which the subpoenaed person resides, is served, or may be found may issue an order requiring the person to appear at any designated place to testify or to produce documentary or other evidence.
(C) Noncompliance
Any failure to obey the order of the court may be punished by the court as a contempt of court.
(3) Witness allowances and fees
(A) In general
Section 1821 of title 28, United States Code, shall apply to a witness requested or subpoenaed to appear at a hearing of the Commission.
(B) Expenses
The per diem and mileage allowances for a witness shall be paid from funds available to pay the expenses of the Commission.
(4) Postal services
The Commission may use the United States mails in the same manner and under the same conditions as other agencies of the Federal Government.
(5) Gifts
The Commission may accept, use, and dispose of gifts or donations of services or property.
(d) Administrative Provisions
(1) Staff
(A) Director
There shall be a full-time staff director for the Commission who shall—
(i)
serve as the administrative head of the Commission; and
(ii)
be appointed by the Chairperson with the concurrence of the Vice Chairperson.
(B) Other personnel
The Commission may—
(i)
appoint such other personnel as it considers advisable, subject to the provisions of title 5, United States Code, governing appointments in the competitive service, and the provisions of chapter 51 and subchapter III of chapter 53 of that title relating to classification and General Schedule pay rates; and
(ii)
may procure temporary and intermittent services under section 3109(b) of title 5, United States Code, at rates for individuals not in excess of the daily equivalent paid for positions at the maximum rate for GS–15 of the General Schedule under section 5332 of title 5, United States Code.
(2) Compensation of members
(A) Non-Federal employees
Each member of the Commission who is not an officer or employee of the Federal Government shall be compensated at a rate equal to the daily equivalent of the annual rate of basic pay prescribed for level IV of the Executive Schedule under section 5315 of title 5, United States Code, for each day (including travel time) during which the member is engaged in the performance of the duties of the Commission.
(B) Federal employees
Each member of the Commission who is an officer or employee of the Federal Government shall serve without compensation in addition to the compensation received for the services of the member as an officer or employee of the Federal Government.
(C) Travel expenses
A member of the Commission shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for an employee of an agency under subchapter I of chapter 57 of title 5, United States Code, while away from the home or regular place of business of the member in the performance of the duties of the Commission.
(3) Cooperation
The Commission may secure directly from any Federal department or agency such information as the Commission considers necessary to carry out this Act. Upon request of the Chairman of the Commission, the head of such department or agency shall furnish such information to the Commission.
(e) Permanent Commission
Section 1013 of title 5, United States Code, shall not apply to the Commission.
(f) Authorization of appropriations
There are authorized to be appropriated for fiscal year 2027 and each fiscal year thereafter such sums as may be necessary to carry out the duties of the Commission.
Sec. 4507. Grants for hospitals to promote equitable health care and outcomes
(a) In general
Not later than 180 days after the date of the enactment of this Act, the Secretary of Health and Human Services (in this section referred to as the Secretary
) shall award grants to hospitals to promote equitable health care treatment and services, and reduce disparities in care and outcomes.
(b) Consultation
In establishing the criteria for grants under this section and evaluating applications for such grants, the Secretary shall consult with the Director for Civil Rights and Health Equity of the Department of Health and Human Services.
(c) Use of funds
A hospital shall use funds received from a grant under this section to establish or expand programs to provide equitable health care to all patients and to ensure equitable health care outcomes. Such uses may include—
(1)
providing explicit and implicit bias training to medical providers and staff;
(2)
providing translation or interpretation services for patients;
(3)
recruiting and training a diverse workforce;
(4)
tracking data related to care and outcomes; and
(5)
training on cultural sensitivity.
(d) Priority
In awarding grants under this section, the Secretary shall give priority to hospitals that have received disproportionate share hospital payments under section 1886(r) of the Social Security Act (42 U.S.C. 1395ww(r)) or section 1923 of such Act (42 U.S.C. 1396r–4) with respect to fiscal year 2026.
(e) Supplement, not supplant
Grants awarded under this section shall be used to supplement, not supplant, any nongovernment efforts, or other Federal, State, or local funds provided to a recipient.
(f) Equitable health care defined
The term equitable health care has the meaning given such term in section 1886(b)(3)(B)(viii)(XIII)(cc) of the Social Security Act (42 U.S.C. 1395ww(b)(3)(B)(viii)(XIII)(cc)), as added by section 4502(a).
(g) Authorization of appropriations
To carry out this section, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2027 through 2031.
Subtitle G Investing in Equity
Sec. 4601. Definitions
In this subtitle:
(1) Advisory Council
The term Advisory Council means the Pay for Equity Advisory Council convened under section 4603.
(2) Secretary
The term Secretary means the Secretary of Health and Human Services.
(3) Strategy
The term Strategy means the Pay for Equity Strategy set forth under section 4602.
Sec. 4602. Strategy to incentivize health equity
(a) In general
The Secretary, in consultation with the heads of other appropriate Federal agencies, shall develop jointly with the Advisory Council and submit to the Committee on Finance of the Senate and the Committee on Energy and Commerce and the Committee on Ways and Means of the House of Representatives, and make publicly available on the internet website of the Department of Health and Human Services, a Pay for Equity Strategy.
(b) Contents
The Strategy shall establish goals for Federal programs, including those authorized under titles XVIII and XIX of the Social Security Act, to incentivize health equity, which may include at least—
(1)
incorporating measures of equity into all payment models by 2028;
(2)
tying a percentage of reimbursement in value-based payment models to equity measure performance by 2031; and
(3)
increasing the number of safety net providers participating in value-based payment by a set percentage by 2033.
(c) Duties of the Secretary
The Secretary, in carrying out subsection (a), shall oversee the following:
(1)
Collecting and making publicly available information submitted by the Advisory Council.
(2)
Coordinating and assessing existing Federal Government programs and activities to assess capacity to meet equity goals.
(3)
Providing technical assistance, as appropriate, such as disseminating identified best practices and information sharing based on reports developed as a result of this subtitle.
(d) Initial strategy; updates
The Secretary shall—
(1)
not later than 18 months after the date of enactment of this Act, develop, publish, and submit to the Committee on Finance of the Senate and the Committee on Energy and Commerce and the Committee on Ways and Means of the House of Representatives the strategy outlined in subsection (a); and
(2)
biennially update, publish, and submit to Congress an updated strategy to—
(A)
reflect new developments, challenges, opportunities, and solutions; and
(B)
review progress and, based on the results of such review, recommend priority actions for improving the implementation of such recommendations, as appropriate.
(e) Process for public input
The Secretary shall establish a process for public input to inform the development of, and updates to, the Strategy, including a process for the public to submit recommendations to the Advisory Council and an opportunity for public comment on the proposed Strategy.
Sec. 4603. Pay for Equity Advisory Council
(a) Convening
The Secretary shall convene a Pay for Equity Advisory Council to advise and provide recommendations, including identified best practices, to the Secretary on the Pay for Equity Strategy.
(b) Membership
(1) In general
The members of the Advisory Council shall consist of—
(A)
the appointed members under paragraph (2); and
(B)
the Federal members under paragraph (3).
(2) Appointed members
In addition to the Federal members under paragraph (3), the Secretary shall appoint not more than 15 voting members of the Advisory Council who are not representatives of Federal departments or agencies and who shall include at least 1 representative of each of the following:
(A)
Beneficiaries of Medicare and Medicaid.
(B)
Safety net health care providers.
(C)
Value-based payment experts.
(D)
Other members with expertise and lived experience the Secretary deems appropriate.
(3) Federal members
The Federal members of the Advisory Council, who shall be nonvoting members, shall consist of the following:
(A)
The Administrator of the Centers for Medicare & Medicaid Services (or the Administrator’s designee).
(B)
The Administrator of the Health Resources and Services Administration.
(4) Diverse representation
The Secretary shall ensure that the membership of the Advisory Council reflects the diversity of individuals impacted by Federal health payment programs.
(c) Meetings
The Advisory Council shall meet quarterly during the 1-year period beginning on the date of enactment of this Act and at least 3 times during each year thereafter. Meetings of the Advisory Council shall be open to the public.
Subtitle H Miscellaneous
Sec. 4701. Coverage for acupuncturist services under the Medicare program
(a) In general
Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by section 2007(b), is amended—
(1)
in subsection (s)(2)—
(A)
in subparagraph (JJ), by striking and
at the end;
(B)
in subparagraph (KK), by inserting and
after the semicolon; and
(C)
by adding at the end the following new subparagraph:
(LL)
qualified acupuncturist services (as defined in subsection (ppp)(1));; and
(2)
by adding at the end the following new subsection:
(ppp) Qualified acupuncturist services
(1) In general
The term qualified acupuncturist services means such services furnished by a qualified acupuncturist (as defined in paragraph (2)), and such services and supplies furnished as an incident to services furnished by the qualified acupuncturist, as the qualified acupuncturist is legally authorized to perform under State law.
(2) Qualified acupuncturist defined
For purposes of this subsection, the term qualified acupuncturist means—
(A)
an individual who is licensed as an acupuncturist by a State or, in the case of an individual in a State that does not provide for such licensure, meets such criteria (such as certification through an appropriate nationally recognized certification authority for acupuncturists) as the Secretary may specify; or
(B)
a physician who is legally authorized to perform acupuncture as part of the practice of medicine and surgery by the State in which the physician performs such function or action.
In specifying requirements under subparagraph (A), the Secretary may use the same requirements as those established by a certification authority described in such subparagraph.
(b) Payment rules
(1) Payment under physician fee schedule
Section 1848(j)(3) of the Social Security Act (42 U.S.C. 1395w–4(j)(3)) is amended by inserting (2)(LL),
before (3),
.
(2) Separate payment for services of institutional providers
Section 1833(a)(2)(B) of the Social Security Act (42 U.S.C. 1395l(a)(2)(B)) is amended—
(A)
in clause (i), by inserting and in the case of qualified acupuncturist services,
after 1999,
;
(B)
in clause (ii), by inserting or in the case of qualified acupuncturist services,
after 1999,
; and
(C)
in clause (iii), by inserting (other than qualified acupuncturist services)
after such services
.
(3) Qualified acupuncturist treatment as a practitioner
Section 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)) is amended by adding at the end the following new clause:
(ix)
A qualified acupuncturist (as defined in section 1861(ppp)(2)).
(4) Separate billing for acupuncturist services furnished in an inpatient hospital setting
Section 1861(b)(4) of the Social Security Act (42 U.S.C. 1395x(b)(4)) is amended by inserting qualified acupuncturist services,
after qualified psychologist services,
.
(c) Effective date
The amendments made by this section apply with respect to services furnished on or after the date that is 270 days after the date of enactment of this Act.
Sec. 4702. Repeal of denial of benefits
Section 115 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (21 U.S.C. 862a) is amended—
(1)
in the section heading, by striking and benefits
;
(2)
in subsection (a)—
(A)
in paragraph (1), by striking , or
and all that follows through that Act
in paragraph (2) and inserting (42 U.S.C. 601 et seq.)
; and
(B)
in the matter preceding paragraph (1), by striking for—
and all that follows through assistance
in paragraph (1) and inserting for assistance
;
(3)
in subsection (b)—
(A)
in the subsection heading, by striking and benefits
;
(B)
by striking paragraph (2); and
(C)
in paragraph (1), by striking the paragraph designation and heading and all that follows through The amount
and inserting The amount
;
(4)
in subsection (c), by striking or benefits
; and
(5)
in subsection (e)—
(A)
in the subsection heading, by striking Definitions
and inserting Definition
;
(B)
in paragraph (1), by striking , and
and all that follows through that Act
in paragraph (2) and inserting (42 U.S.C. 601 et seq.)
; and
(C)
in the matter preceding paragraph (1), by striking it—
and all that follows through in section 419(5)
and inserting the term in section 419(5)
.
Sec. 4703. Addressing disparities in Medicare Advantage benchmark levels based on penetration
(a) In general
Section 1853(n) of the Social Security Act (42 U.S.C. 1395w–23(n)) is amended—
(1)
in paragraph (1)(B), by striking subsequent year
and inserting subsequent year, subject to paragraph (6),
; and
(2)
by adding at the end the following new paragraph:
(6) Average geographic adjustment floor
For 2027 and subsequent years, when calculating the adjusted average per capita cost under section 1876(a)(4) for the purposes of establishing the base payment amount specified in paragraph (2)(E), the average geographic adjustment shall not be less than 0.70 for any area. For the purposes of the previous sentence, the Secretary may define the term
average geographic adjustmentunder subparagraph (A) by program instruction or otherwise.
(b) Ensuring plan payments flow to providers and patients
Section 1854(a)(6) of the Social Security Act (42 U.S.C. 1395w–24(a)(6)) is amended by adding at the end the following new subparagraph:
(C) Ensuring increased payments support care
With respect to the increase in blended benchmark amount attributable to the application of section 1853(n)(6), no less than 50 percent shall be directed toward payment for basic benefits as defined in section 1852(a)(1)(B).
Sec. 4704. Women Expansion of Learning and Labor Safety (WELLS) Act
(a) Requiring hospitals participating in Medicare To develop discharge plans for pregnant individuals
Section 1866 of the Social Security Act (42 U.S.C. 1395cc) is amended—
(1)
in subsection (a)(1)—
(A)
in subparagraph (X), by striking and
at the end;
(B)
in subparagraph (Y), by striking the period at the end and inserting , and
; and
(C)
by inserting after subparagraph (Y) the following new subparagraph:
(Z)
beginning January 1, 2027, in the case of a hospital, critical access hospital, or rural emergency hospital, to comply with the requirements described in subsection (l)(1).; and
(2)
by adding at the end the following new subsection:
(l) Discharge plan requirements for pregnant individuals
(1) In general
For purposes of subsection (a)(1)(Z), the requirements described in this paragraph are, with respect to a hospital, critical access hospital, or rural emergency hospital, that the hospital—
(A)
provides for the development and implementation of a discharge plan meeting the standards under paragraph (2) with respect to any individual (whether or not eligible for benefits under this title) admitted to the hospital who—
(i)
is identified as pregnant;
(ii)
is experiencing signs or symptoms consistent with labor, which may include contractions; and
(iii)
is expected to be discharged from the hospital, critical access hospital, or rural emergency hospital prior to delivery, as determined based on the documented clinical judgment of the treating physician or practitioner at the time that such discharge is contemplated;
(B)
includes such discharge plan in the individual’s medical record; and
(C)
provides for such discharge plan to be discussed with the individual (or the individual’s representative) prior to discharge.
(2) Discharge plan standards
A discharge plan for an individual described in paragraph (1)(A) meets the standards under this paragraph if such plan includes at least the following information:
(A)
A clinical justification for the discharge.
(B)
An assessment of travel distance and time between the primary residence of the individual and the hospital, critical access hospital, or rural emergency hospital.
(C)
Verification of reliable transportation between the primary residence of the individual and the hospital, critical access hospital, or rural emergency hospital.
(D)
Identification of a back-up hospital or facility at which such individual may obtain labor and delivery services.
(E)
Confirmation that the plan was reviewed and approved by a qualified medical professional (as defined by the Secretary through regulations).
(F)
Confirmation that the individual (or the individual’s representative) has received the information described in subparagraphs (A) through (D), that such information was provided in the primary language of such individual (or representative), and that such individual (or representative) confirmed their understanding of such information.
(3) Rule of construction
Nothing in this subsection shall be construed as limiting or otherwise affecting the discharge planning requirements otherwise applicable to a hospital, critical access hospital, or rural emergency hospital under this title.
(b) Rural maternal and obstetric care training demonstration grants
Section 764 of the Public Health Service Act (42 U.S.C. 294s) is amended—
(1)
in subsection (c)(1)—
(A)
in subparagraph (A), by striking and
at the end;
(B)
by redesignating subparagraph (B) as subparagraph (C); and
(C)
by inserting after subparagraph (A) the following:
(B)
shall use the grant funds to provide racial bias training as part of such training program; and;
(2)
by redesignating subsections (d) and (e) as subsections (e) and (f), respectively;
(3)
by inserting after subsection (c) the following:
(d) Minimum performance milestones
(1) Establishment
Beginning with the grants awarded under this section for fiscal year 2027, the Secretary shall establish minimum performance milestones that grant recipients must meet during a fiscal year as a condition of remaining eligible for funding through such a grant for any subsequent fiscal year.
(2) Milestones related to percent of staff trained
The minimum performance milestones referred to in paragraph (1) shall include milestones related to the percent of all staff of the grant recipient that are trained, or that receive refresher training, with support from a grant under this section.; and
(4)
in subsection (e), as so redesignated—
(A)
in the subsection heading, by striking report
and inserting reports
;
(B)
in paragraph (1)(B), by striking the report described in paragraph (2)
and inserting the reports described in paragraphs (2) and (3)
; and
(C)
by adding at the end the following:
(3) Subsequent reports
Not later than January 1, 2027, and annually thereafter, the Secretary shall submit to Congress, and make publicly available, a report that includes—
(A)
updates to the information described in subparagraphs (A) through (C) of paragraph (2); and
(B)
additional information regarding the grants under this section, including—
(i)
a list of the entities receiving such grants;
(ii)
the number and amount of such grants;
(iii)
whether training supported by such grants was delivered in-person, virtually, asynchronously, or through some other format; and
(iv)
descriptions of the geographical coverage of such grants, the number of providers trained under such grants, and patient-level metrics linked to such training (such as changes in clinical outcomes, patient experience, and racial disparities).
(c) Multi-Center implementation science initiative for maternal health
The Secretary of Health and Human Services, in consultation with the Director of the Agency for Healthcare Research and Quality and the Director of the National Institutes of Health, shall establish a multi-center implementation science initiative for maternal health to rigorously evaluate different training models for health care professionals (including in-person, virtual, simulation, and cohort-based) and the impact of such models on provider behavior, patient outcomes, and maternal health disparities.
(d) Maternal health dashboard
The Secretary of Health and Human Services shall develop, maintain, and make publicly available on the websites of the Department of Health and Human Services an interagency maternal health dashboard, which shall include maternal health outcome metrics from agencies within the Department of Health and Human Services and the data collected as part of the initiative under subsection (c), such as data related to maternal mortality and severe maternal morbidity, the number and outcomes of discharges of pregnant individuals prior to delivery from institutions, and data on Federal investments in maternal health research.
Sec. 4705. Access to Birth Control Act
(a) Short title
This section may be cited as the Access to Birth Control Act
.
(b) Findings
Congress finds as follows:
(1)
Family planning is basic health care. Access to contraception helps people determine if and when to become pregnant. Contraception is also a cornerstone of reproductive autonomy and can help people fulfill their educational, professional, and social aspirations.
(2)
As a result of the enactment of the Patient Protection and Affordable Care Act (Public Law 111–148), approximately 151,600,000 individuals in the United States were enrolled in private health insurance plans in the United States in 2020, including 58,000,000 women between the ages of 19 and 64 who had coverage of contraceptive methods approved, cleared, or authorized by the Food and Drug Administration without cost-sharing under such plans.
(3)
The Patient Protection and Affordable Care Act saved women $1,400,000,000 on birth control pills alone in 2013.
(4)
According to the Centers for Disease Control and Prevention, nearly 2/3 of women between the ages of 15 and 49 are currently using a contraceptive method, and among sexually active women who were not seeking pregnancy, nearly 9 in 10 have used contraception.
(5)
Although the Centers for Disease Control and Prevention included family planning in its published list of the Ten Great Public Health Achievements in the 20th Century, people in the United States face a myriad of barriers in accessing birth control, including cost, geography, immigration status, language access, discrimination, and stigma. These contraceptive barriers are rooted in systemic inequities, structural racism, and other forms of oppression in our health care system and society.
(6)
In 2019, approximately 2,293,000 pregnancies, nearly 42 percent of all pregnancies, in the United States were unintended.
(7)
Systemic racism and discrimination, as well as lack of access to comprehensive sex education, exacerbates severe health inequities and creates additional barriers to accessing contraception; for example, due to high uninsured rates and barriers, Hispanic women with low-incomes experience a significantly higher rate of unintended pregnancy (58 percent) compared to their White counterparts (33 percent). In a 2023 study exploring challenges accessing contraceptive care among people who identified as Asian-American, Native Hawaiian, or Pacific Islander, Black or African-American, Indigenous, or Latina/Latinx, 45 percent of respondents reported experiencing at least one challenge accessing contraception in the past year.
(8)
In addition to preventing pregnancy, contraceptives are used for a range of medical purposes, such as treating abnormal uterine bleeding, irregular menstrual cycles, and endometriosis, as well as for people managing other chronic conditions, which are generally higher in communities of color due to systemic discrimination.
(9)
The Food and Drug Administration has approved, cleared, or authorized multiple emergency contraceptive methods as safe and effective in preventing unintended pregnancy and has approved over-the-counter access to some forms of emergency contraception for all individuals, regardless of age. If taken soon after unprotected sex or primary contraceptive failure, emergency contraception can significantly reduce a person’s chance of unintended pregnancy. Additionally, in 2023, the Food and Drug Administration approved the first over-the-counter daily birth control pill which will give people of all ages greater access to birth control options without a prescription.
(10)
Contraception is a protected fundamental right in the United States and access to contraception should not be impeded by one individual’s personal beliefs. Providers, including pharmacists, play a key role in providing contraceptive services and important information about prescription and over-the-counter birth control options to people across the country. It is critical that contraceptive care is provided to people of all ages in a supportive way that is culturally appropriate and delivered without stigma, bias, or delay.
(11)
Reports of pharmacists refusing to fill prescriptions for contraceptives, including emergency contraceptives, or provide emergency contraception over-the-counter have surfaced in States across the Nation, including Alabama, Arizona, California, the District of Columbia, Georgia, Illinois, Louisiana, Massachusetts, Michigan, Minnesota, Missouri, Montana, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, Tennessee, Texas, Washington, West Virginia, and Wisconsin.
(12)
Since the Supreme Court decision in Dobbs v. Jackson Women’s Health Organization (142 S. Ct. 2228 (2022)), there have been increased reports of people being denied birth control at pharmacies.
(13)
In 2022, the Department of Health and Human Services issued guidance clarifying that refusing to dispense birth control can be sex discrimination under section 1557 of the Patient Protection and Affordable Care Act (42 U.S.C. 18116).
(c) Duties of pharmacies To ensure provision of contraception and medication related to contraception
Part B of title II of the Public Health Service Act (42 U.S.C. 238 et seq.) is amended by adding at the end the following:
249. Duties of pharmacies to ensure provision of contraception and medication related to contraception
(a) In General
Subject to subsection (c), a pharmacy that receives drugs or devices approved, cleared, or authorized by the Food and Drug Administration in interstate commerce shall maintain compliance with the following:
(1)
If a customer requests a contraceptive or a medication related to a contraceptive that is in stock, the pharmacy shall ensure that the contraceptive or the medication related to a contraceptive is provided to the customer without delay.
(2)
If a customer requests a contraceptive or a medication related to a contraceptive that is not in stock and the pharmacy in the normal course of business stocks contraception or the medication related to contraception, the pharmacy shall immediately inform the customer that the contraceptive or the medication related to a contraceptive is not in stock and without delay offer the customer the following options:
(A)
If the customer prefers to obtain the contraceptive or the medication related to a contraceptive through a referral or transfer, the pharmacy shall—
(i)
locate a pharmacy of the customer’s choice or the closest pharmacy confirmed to have the contraceptive or the medication related to a contraceptive in stock; and
(ii)
refer the customer or transfer the prescription to that pharmacy.
(B)
If the customer prefers for the pharmacy to order the contraceptive or the medication related to a contraceptive, the pharmacy shall obtain the contraceptive or the medication related to a contraceptive under the pharmacy’s standard procedure for expedited ordering of medication and notify the customer when the contraceptive or the medication related to a contraceptive arrives.
(3)
The pharmacy shall ensure that—
(A)
it does not operate an environment in which customers are intimidated, threatened, or harassed in the delivery of services relating to a request for contraception or a medication related to contraception;
(B)
its employees do not interfere with or obstruct the delivery of services relating to a request for contraception or a medication related to contraception;
(C)
its employees do not intentionally misrepresent or deceive customers about the availability of contraception or a medication related to contraception or its mechanism of action;
(D)
its employees do not breach medical confidentiality with respect to a request for contraception or a medication related to contraception or threaten to breach such confidentiality; or
(E)
its employees do not refuse to return a valid, lawful prescription for contraception or a medication related to contraception upon customer request.
(b) Contraceptives or medication related to a contraceptive not ordinarily stocked
Nothing in subsection (a)(2) shall be construed to require any pharmacy to comply with such subsection if the pharmacy does not ordinarily stock contraceptives or medication related to a contraceptive in the normal course of business.
(c) Refusals Pursuant to Standard Pharmacy Practice
This section does not prohibit a pharmacy from refusing to provide a contraceptive or a medication related to a contraceptive to a customer in accordance with any of the following:
(1)
If it is unlawful to dispense the contraceptive or the medication related to a contraceptive to the customer without a valid, lawful prescription and no such prescription is presented.
(2)
If the customer is unable to pay for the contraceptive or the medication related to a contraceptive.
(3)
If the employee of the pharmacy refuses to provide the contraceptive or the medication related to a contraceptive on the basis of a professional clinical judgment.
(d) Relation to other laws
(1) Rule of construction
Nothing in this section shall be construed to invalidate or limit rights, remedies, procedures, or legal standards under title VII of the Civil Rights Act of 1964.
(2) Certain claims
The Religious Freedom Restoration Act of 1993 shall not provide a claim concerning, or a defense to a claim under, this section, or provide a basis for challenging the application or enforcement of this section.
(e) Preemption
This section does not preempt any provision of State law or any professional obligation made applicable by a State board or other entity responsible for licensing or discipline of pharmacies or pharmacists, to the extent that such State law or professional obligation provides protections for customers that are greater than the protections provided by this section.
(f) Enforcement
(1) Civil penalty
A pharmacy that violates a requirement of subsection (a) is liable to the United States for a civil penalty in an amount not exceeding $1,000 per day of violation, not to exceed $100,000 for all violations adjudicated in a single proceeding.
(2) Private cause of action
Any person aggrieved as a result of a violation of a requirement of subsection (a) may, in any court of competent jurisdiction, commence a civil action against the pharmacy involved to obtain appropriate relief, including actual and punitive damages, injunctive relief, and a reasonable attorney’s fee and cost.
(3) Limitations
A civil action under paragraph (1) or (2) may not be commenced against a pharmacy after the expiration of the 5-year period beginning on the date on which the pharmacy allegedly engaged in the violation involved.
(g) Definitions
In this section:
(1)
The term contraception or contraceptive means any drug or device approved, cleared, or authorized by the Food and Drug Administration to prevent pregnancy.
(2)
The term employee means a person hired, by contract or any other form of an agreement, by a pharmacy.
(3)
The term medication related to contraception or medication related to a contraceptive means any drug or device approved, cleared, or authorized by the Food and Drug Administration that a medical professional determines necessary to use before or in conjunction with contraception or a contraceptive.
(4)
The term pharmacy means an entity that—
(A)
is authorized by a State to engage in the business of selling prescription drugs at retail; and
(B)
employs one or more employees.
(5)
The term product means a drug or device approved, cleared, or authorized by the Food and Drug Administration.
(6)
The term professional clinical judgment means the use of professional knowledge and skills to form a clinical judgment, in accordance with prevailing medical standards.
(7)
The term without delay, with respect to a pharmacy providing, providing a referral for, or ordering contraception or a medication related to contraception, or transferring the prescription for contraception or a medication related to contraception, means within the usual and customary timeframe at the pharmacy for providing, providing a referral for, or ordering other products, or transferring the prescription for other products, respectively.
(h) Effective Date
This section shall take effect 31 days after the date of enactment of this section, without regard to whether the Secretary has issued any guidance or final rule regarding this section.
Sec. 4706. Enabling State Medicaid programs to provide care through health homes to individuals with sickle cell disease
Section 1945 of the Social Security Act (42 U.S.C. 1396w–4) is amended—
(1)
in subsection (a), by inserting (and, beginning January 1, 2027, to eligible individuals with sickle cell disease (as defined in subsection (c)(5)))
after chronic conditions
;
(2)
in subsection (c)—
(A)
in paragraph (1), by inserting and each eligible individual with sickle cell disease
after chronic conditions
; and
(B)
by adding at the end the following new paragraph:
(5) Special rule relating to sickle cell disease health homes
(A) In general
Beginning January 1, 2027, the Secretary may approve a State plan amendment under this section that is designed to provide health home services primarily to eligible individuals with sickle cell disease (in this section referred to as a sickle cell disease-focused State plan amendment).
(B) Requirement to provide dental and vision services
In the case of a sickle cell disease-focused State plan amendment approved by the Secretary on or after January 1, 2027, a State shall ensure the provision of dental and vision services to eligible individuals with sickle cell disease who are enrolled in such health home. Such requirement shall apply irrespective of existing requirements related to comparability or whether or not the State provides dental or vision services to other Medicaid beneficiaries.
(C) Report requirements
(i) In general
In the case of a State with a sickle cell disease-focused State plan amendment, such State shall, at the end of the first 8 fiscal year quarters that such State plan amendment is in effect, submit to the Secretary a report on the following, with respect to eligible individuals with sickle cell disease provided health home services under such State plan amendment:
(I)
The quality of health care provided to such individuals, with a focus on outcomes relevant to the recovery of each such individual.
(II)
The access of such individuals to health care.
(III)
The total expenditures of such individuals for health care.
(ii) Applicable measures
For purposes of the report required under this subparagraph, the Secretary shall specify all applicable measures for determining quality of health care provided to eligible individuals with sickle cell disease, access to health care by such individuals, and expenditures on health care by such individuals.
(D) Best practices
Not later than June 30, 2027, the Secretary shall make publicly available on the website of the Centers for Medicare & Medicaid Services best practices for designing and implementing a sickle cell disease-focused State plan amendment, based on clinical practice guidelines for sickle cell disease developed by medical specialty societies and in consultation with sickle cell disease providers and patient advocacy organizations.
(E) Definitions
For purposes of this section:
(i) Eligible individual with sickle cell disease
The term eligible individual with sickle cell disease means, with respect to a State, an individual who satisfies all of the following:
(I)
The individual is eligible for medical assistance under the State plan or under a waiver of such plan.
(II)
The individual has sickle cell disease.
(III)
The individual may or may not have previously received health home services under any other State plan amendment approved for the State under this section by the Secretary.
(ii) Sickle cell disease
The term sickle cell disease means an inherited blood disorder affecting red blood cells that occurs when an individual has inherited a sickle cell gene from each parent, as identified by a newborn screening or other genetic test.; and
(3)
in subsection (h)—
(A)
in paragraph (3), by inserting or an eligible individual with sickle cell disease
after chronic conditions
; and
(B)
in paragraph (5), by inserting or a health home for eligible individuals with sickle cell disease
after chronic conditions
.
Sec. 4707. Grant program for community schools and health equity
(a) In general
The Secretary of Education, in coordination with the Secretary of Health and Human Services, shall carry out a program under which the Secretary of Education makes grants to eligible entities, on a competitive basis, to support the implementation or expansion of school-based health services in community schools.
(b) Applications
To be eligible to receive a grant under this section, an eligible entity shall submit to the Secretary of Education an application at such time, in such manner, and containing such information as the Secretary may require.
(c) Use of funds
An eligible entity that receives a grant under this section shall use the grant funds to carry out one or more of the following activities:
(1)
Expanding or establishing school-based health services, including partnerships with Federally qualified health centers.
(2)
Hiring and training personnel, including school nurses, mental health professionals, social workers, and community school coordinators.
(3)
Providing wraparound services, including nutrition assistance, housing support referrals, family engagement, and legal services.
(4)
Supporting programs that address social determinants of health affecting students and families.
(5)
Providing culturally and linguistically appropriate services for English learners and immigrant families.
(6)
Supporting trauma-informed practices and crisis response services.
(7)
Building partnerships with institutions of higher education to develop health career pathways for students.
(d) Priority
In awarding grants under this section, the Secretary of Education shall give priority to eligible entities that—
(1)
serve high concentrations of low-income students;
(2)
serve a significant number of English learners or students from immigrant families;
(3)
demonstrate unmet health or mental health needs among students;
(4)
are located in medically underserved areas or health professional shortage areas; or
(5)
propose to partner with Federally qualified health centers or public health agencies to carry out activities supported with the grant.
(e) Interagency coordination
The Secretary of Education and the Secretary of Health and Human Services shall enter into a memorandum of understanding for purposes of coordinating the implementation of the grant program under this section. At a minimum, such memorandum shall provide for coordination between the Secretaries on—
(1)
reducing the administrative burdens of implementing the program; and
(2)
providing technical assistance to eligible entities.
(f) Reporting and oversight
(1) Grantee reports
On an annual basis for each year an eligible entity receives a grant under this section, the entity shall submit to the Secretary of Education a report on the activities carried out with the grant. Each report shall include, with respect to the year covered by the report—
(A)
identification of the number of students served by activities supported with the grant;
(B)
a description of student outcomes related to health, attendance, and academic performance; and
(C)
to the extent practicable, the information described in subparagraphs (A) and (B) and other relevant student data disaggregated by income, race, ethnicity, and English learner status.
(2) Reports to Congress
Not later than 3 years after the date of enactment of this Act, and not less frequently than once every 3 years thereafter, the Secretary of Education shall submit to Congress a report on the grant program under this section. Each report shall include, with respect to the period covered by the report—
(A)
an evaluation of the effectiveness of the program; and
(B)
based on the results of the program, identification of any best practices or recommendations for improving coordination between the education and the health systems.
(g) Rule of construction
Nothing in this section shall be construed to alter or supersede any Federal privacy protections, including those provided under section 444 of the General Education Provisions Act (20 U.S.C. 1232g; commonly known as the Family Educational Rights and Privacy Act of 1974
) and the amendments made by the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. 201 et seq.).
(h) Definitions
In this section:
(1) Community school
The term community school means a full-service community school (as defined in section 4622 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7272)).
(2) Eligible entity
The term eligible entity means—
(A)
a local educational agency;
(B)
a consortium of local educational agencies; or
(C)
a partnership between a local educational agency and one or more—
(i)
community-based organizations;
(ii)
Federally qualified health centers (as defined in section 1861(aa) of the Social Security Act (42 U.S.C. 1395x));
(iii)
public health agencies; or
(iv)
institutions of higher education.
(3) Local educational agency
The term local educational agency has the meaning given the term in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).
(4) School-based health services
The term school-based health services means comprehensive health services provided to students in a school setting, including primary care, mental health services, preventative services, and medical referrals.
Subtitle I Territories Health Equity
Part 1 Medicare
Subpart A Part A
Sec. 4801. Calculation of medicare DSH payments for IPPS hospitals in Puerto Rico
Section 1886(d)(9)(D)(iii) of the Social Security Act (42 U.S.C. 1395ww(d)(9)(D)(iii)) is amended to read as follows:
(iii)
Subparagraph (F) (relating to disproportionate share payments), including application of subsection (r), except that for this purpose—
(I)
the sum described in clause (ii) of this subparagraph shall be substituted for the sum referred to in paragraph (5)(F)(ii)(I); and
(II)
for discharges occurring on or after October 1, 2026, subclause (I) of paragraph (5)(F)(vi) shall be applied by substituting for the numerator described in such subclause the number of subsection (d) Puerto Rico hospital’s patient days for the cost reporting period involved which were made up of patients who (for such days) were entitled to benefits under part A of this title and were—
(aa)
entitled to supplementary security income benefits (excluding any State supplementation) under title XVI;
(bb)
eligible for medical assistance under a State plan under title XIX; or
(cc)
receiving aid or assistance under any plan of the State approved under title I, X, XIV, or XVI.
Sec. 4802. Rebasing target amount for hospitals in territories
Section 1886(b)(3) of the Social Security Act (42 U.S.C. 1395ww(b)(3)) is amended by adding at the end the following new subparagraph:
(M)
(i)
For each cost reporting period beginning on or after October 1, 2026, in the case of a hospital located in a territory of the United States, there shall be substituted for the target amount otherwise determined under subparagraph (A) the rebased target amount (as defined in clause (ii)), if such substitution results in an amount of payment under this section to the hospital for such period that is greater than the amount of payment that would be made under this section to the hospital for such period if this subparagraph were not to apply.
(ii)
For purposes of this subparagraph, the term rebased target amount has the meaning given the term target amount in subparagraph (A), except that—
(I)
for a cost reporting period beginning on or after October 1, 2026, and before September 30, 2031, there shall be substituted for the preceding 12-month cost reporting period the 12-month cost reporting period beginning during fiscal year 2017;
(II)
for a cost reporting period beginning on or after October 1, 2031, there shall be substituted for the preceding 12-month cost reporting period the cost reporting period for which the target amount determined under subparagraph (A) is the highest among the 5 cost reporting periods for which the Secretary has the most recent settled cost reports;
(III)
any reference in subparagraph (A)(i) to the
first such cost reporting periodis deemed a reference to the first cost reporting period following the 12-month cost reporting period beginning during fiscal year 2017; and(IV)
the applicable percentage increase shall only be applied under subparagraph (B)(ii) for cost reporting periods beginning on or after October 1, 2026.
Sec. 4803. Medicare DSH target adjustment for hospitals in territories
Section 1886(b)(3) of the Social Security Act (42 U.S.C. 1395ww(b)(3)), as amended by section 4802, is further amended by adding at the end the following new subparagraph:
(N)
(i)
For each cost reporting period beginning on or after October 1, 2026, in the case of a hospital that is located in a territory of the United States other than Puerto Rico and that would be a subsection (d) hospital if it were located in one of the 50 States, the target amount shall be increased by—
(I)
in the case that such hospital has a disproportionate patient percentage of not less than 15 percent and not greater than 40 percent, 10 percent; and
(II)
in the case that such hospital has a disproportionate patient percentage of greater than 40 percent, 10 percent plus 60 percent of the number of percentage points by which such hospital’s disproportionate patient percentage exceeds 40 percent.
(ii)
For purposes of this subparagraph, the term disproportionate patient percentage has the meaning given such term in subsection (d)(5)(F)(vi), except that in applying such meaning any reference under such subsection to individuals entitled to supplementary security income under title XVI shall be deemed for purposes of this subparagraph to include individuals—
(I)
eligible for medical assistance under a State plan under title XIX; or
(II)
receiving aid or assistance under any plan of the territory approved under title I, X, XIV, or XVI.
Subpart B Part B
Sec. 4811. Eliminating late enrollment penalties under Part B of the medicare program for certain individuals residing in Puerto Rico
(a) In general
Section 1839(b) of the Social Security Act (42 U.S.C. 1395r(b)) is amended in the second sentence by inserting or months occurring in the 5-year period beginning on the date on which the individual becomes entitled to benefits under part A if such individual was residing in Puerto Rico as of such date and such date is after the date that is 4 years before the date of the enactment of the Health Equity and Accountability Act of 2026
before the period at the end of such sentence.
(b) Application
The amendment made by subsection (a) shall apply with respect to premiums paid for months beginning on or after the date of the enactment of this Act.
Subpart C Medicare Advantage (Part C)
Sec. 4821. Adjustment in benchmark for low-base payment counties in Puerto Rico
Section 1853(n) of the Social Security Act (42 U.S.C. 1395w–23(n)) is amended—
(1)
in paragraph (1), by striking and (5)
and inserting (5), and (6)
;
(2)
in paragraph (4), by striking In no case
and inserting Subject to paragraph (6), in no case
; and
(3)
by adding at the end the following new paragraph:
(6) Special rules for blended benchmark amount for territories
(A) In general
Subject to paragraph (2), the blended benchmark amount for an area in a territory for a year (beginning with 2027) shall not be less than 80 percent of the national average of the base payment amounts specified in subparagraph (2)(E) for such year for areas within the 50 States and the District of Columbia.
(B) Limitation
In no case shall the blended benchmark amount for an area in a territory for a year under subparagraph (A) exceed the lowest blended benchmark amount for any area within the 50 States and the District of Columbia for such year.
Subpart D Part D
Sec. 4831. Automatic eligibility of certain low-income territorial residents for premium and cost-sharing subsidies under the medicare program; sunset of enhanced allotment program
(a) Automatic eligibility of certain low-Income territorial residents for premium and cost-Sharing subsidies under the medicare program
(1) In general
Section 1860D–14(a)(3) of the Social Security Act (42 U.S.C. 1395w–114(a)(3)) is amended—
(A)
in subparagraph (B)(v)—
(i)
in subclause (I), by striking and
at the end;
(ii)
in subclause (II), by striking the period and inserting ; and
; and
(iii)
by inserting after subclause (II) the following new subclause:
(III)
with respect to plan years beginning on or after January 1, 2027, shall provide that any part D eligible individual who is enrolled for medical assistance under the State Medicaid plan of a territory (as defined in section 1935(f)) under title XIX (or a waiver of such a plan) shall be treated as a subsidy eligible individual described in paragraph (1).; and
(B)
in subparagraph (F), by adding at the end the following new sentence: The previous sentence shall not apply with respect to eligibility determinations for premium and cost-sharing subsidies under this section made on or after January 1, 2027.
.
(2) Conforming amendment
Section 1860D–31(j)(2)(D) of the Social Security Act (42 U.S.C. 1395w–141(j)(2)(D)) is amended by adding at the end the following new sentence: The previous sentence shall not apply with respect to amounts made available to a State under this paragraph on or after January 1, 2026.
.
(b) Sunset of enhanced allotment program
(1) In general
Section 1935(e) of the Social Security Act (42 U.S.C. 1396u–5(e)) is amended—
(A)
in paragraph (1)(A), by inserting after such State
the following: before January 1, 2027
; and
(B)
in paragraph (3)—
(i)
in subparagraph (A), in the matter preceding clause (i), by inserting after a year
the following: (before 2027)
; and
(ii)
in subparagraph (B)(iii), by striking a subsequent year
and inserting each of fiscal years 2010 through 2026
.
(2) Territory defined
Section 1935 of the Social Security Act (42 U.S.C. 1396u–5) is amended by adding at the end the following new subsection:
(f) Territory defined
In this section, the term territory means Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa.
Part 2 Miscellaneous
Sec. 4841. Medicaid and CHIP territory transparency and information
(a) Publication of information on federal expenditures under medicaid and CHIP in the territories
Not later than 180 days after the date of the enactment of this section, the Secretary of Health and Human Services shall publish, and periodically update, on the internet site of the Centers for Medicare & Medicaid Services information on Medicaid and CHIP carried out in the territories of the United States. Such information shall include, with respect to each such territory—
(1)
the income levels established by the territory for purposes of eligibility of an individual to receive medical assistance under Medicaid or child health assistance under CHIP;
(2)
the number of individuals enrolled in Medicaid and CHIP in such territory;
(3)
any State plan amendments in effect to carry out Medicaid or CHIP in such territory;
(4)
any waiver of the requirements of title XIX or title XXI issued by the Secretary to carry out Medicaid or CHIP in the territory, including a waiver under section 1115 of the Social Security Act (42 U.S.C. 1315), any application for such a waiver, and any documentation related to such application (including correspondence);
(5)
the amount of the Federal and non-Federal share of expenditures under Medicaid and CHIP in such territory;
(6)
the systems in place for the furnishing of health care items and services under Medicaid and CHIP in such territory;
(7)
the design of CHIP in such territory; and
(8)
other information regarding the carrying out of Medicaid and CHIP in the territory that is published on such internet site with respect to carrying out Medicaid and CHIP in each State and the District of Columbia.
(b) Definitions
In this section:
(1) CHIP
The term CHIP means the State Children’s Health Insurance Program under title XXI of the Social Security Act.
(2) Medicaid
The term Medicaid means the Medicaid program under title XIX of the Social Security Act.
(3) Territory
The term territory of the United States includes Puerto Rico, the Virgin Islands of the United States, Guam, the Northern Mariana Islands, and American Samoa.
Sec. 4842. Report on exclusion of territories from exchanges
(a) In general
Not later than February 1, 2028, the Secretary of Health and Human Services shall submit to Congress a report that details the adverse impacts in each territory from the practical exclusion of the territories from the provisions of part 2 of subtitle D of title I of the Patient Protection and Affordable Care Act (42 U.S.C. 18031 et seq.) insofar as such provisions provide for the establishment of an American Health Benefit Exchange or the administration of a federally facilitated Exchange in each State and in the District of Columbia for the purpose of making health insurance more affordable and accessible for individuals and small businesses.
(b) Information in report
The report shall include information on the following:
(1)
An estimate of the total number of uninsured and underinsured individuals residing in each territory.
(2)
The number of health insurance issuers in each territory and a description of the health insurance plans such issuers offer.
(3)
An estimate of the number of individuals residing in each territory who are denied premium or cost-sharing assistance under section 36B of the Internal Revenue Code of 1986 or section 1402 of the Patient Protection and Affordable Care Act (42 U.S.C. 18071) that would otherwise be available to them for obtaining health insurance coverage through an Exchange if they resided in one of the 50 States or in the District of Columbia.
(4)
An estimate of the amount of Federal assistance described in paragraph (3) that is not being made available to residents of each territory.
(5)
An estimate of the number of small employers in each territory that would be eligible to purchase health insurance coverage through a Small Business Health Options Program (SHOP) Marketplace that would operate as part of an Exchange if the employers were in one of the 50 States or in the District of Columbia.
Sec. 4843. Access to coverage for individuals in certain areas without any available exchange plans
Part 2 of subtitle D of title I of the Patient Protection and Affordable Care Act (42 U.S.C. 18031 et seq.) is amended by adding at the end the following:
1314. Access to coverage for individuals in certain areas without any available exchange plans
(a) In general
(1) Coverage through dc exchange
Not later than 3 months after the date of enactment of this section, the Secretary, in consultation with the Secretary of the Treasury and the Director of the Office of Personnel Management, shall establish a mechanism to ensure that, for any plan year beginning on or after the date described in subsection (c), any individual described in paragraph (2) has access to health insurance coverage which is at least as broad as the coverage available to Members of Congress and congressional staff (as defined in section 1312(d)(3)(D)) through the Exchange operating in the District of Columbia. Such individuals shall be eligible for any premium tax credit under section 36B of the Internal Revenue Code of 1986, reduced cost sharing under section 1402, and advance determination and payment of such credits or such reductions under section 1412 to be administered by the Secretary, in consultation with the Secretary of the Treasury and the Director of the Office of Personnel Management. The District of Columbia, its residents, and small businesses shall be held harmless from any increased costs resulting from the enactment of this section.
(2) Individual described
An individual described in this paragraph is any individual who—
(A)
is not eligible to enroll in an employer-sponsored health plan (excluding such a plan that would not be considered minimum essential coverage due to the application of subparagraph (C) of section 36B(c)(2) of the Internal Revenue Code of 1986 if such subparagraph applied to such plan); and
(B)
is a bona fide resident of any possession of the United States (as determined under section 937(a) of such Code) in which the Secretary certifies that no qualified health plan is offered through an Exchange established under this title.
(3) Possession of the united states
For purposes of this section, the term possession of the United States shall include such possessions as are specified in section 937(a)(1) of the Internal Revenue Code of 1986.
(b) Treatment of possessions
(1) Payments to possessions
(A) Mirror code possession
The Secretary of the Treasury shall periodically (but not less frequently than annually) pay to each possession of the United States with a mirror code tax system amounts equal to the loss to that possession by reason of the application of this section (determined without regard to paragraph (2)) with respect to taxable years beginning after the date described in subsection (c). Such amounts shall be determined by the Secretary of the Treasury based on information provided by the government of the respective possession.
(B) Other possessions
The Secretary of the Treasury shall periodically (but not less frequently than annually) pay to each possession of the United States which does not have a mirror code tax system amounts estimated by the Secretary of the Treasury as being equal to the aggregate benefits that would have been provided to residents of such possession by reason of the application of this section for any taxable years beginning after the date described in subsection (c) if a mirror code tax system had been in effect in such possession. The preceding sentence shall not apply with respect to any possession of the United States unless such possession has a plan, which has been approved by the Secretary of the Treasury, under which such possession will promptly distribute such payments to the residents of such possession.
(2) Coordination with credit allowed against united states income taxes
No credit shall be allowed against United States income taxes for any taxable year under section 36B of the Internal Revenue Code of 1986 to any person—
(A)
to whom a credit is allowed against taxes imposed by the possession by reason of this section (determined without regard to this paragraph) for such taxable year, or
(B)
who is eligible for a payment under a plan described in paragraph (1)(B) with respect to such taxable year.
(3) Mirror code tax system
For purposes of this subsection, the term mirror code tax system means, with respect to any possession of the United States, the income tax system of such possession if the income tax liability of the residents of such possession under such system is determined by reference to the income tax laws of the United States as if such possession were the United States.
(4) Treatment of payments
For purposes of section 1324(b)(2) of title 31, United States Code, or any similar rule of law, the payments under this subsection shall be treated in the same manner as a refund due from the credit allowed under section 36B of the Internal Revenue Code of 1986.
(c) Date described
The date described in this subsection is the date on which the Secretary establishes the mechanism described in subsection (a)(1).
Sec. 4844. Prohibition on disclosing Medicaid data
Notwithstanding section 552a of title 5, United States Code, the Secretary of Health and Human Services and the Administrator of the Centers for Medicare & Medicaid Services shall not disclose the individually identifiable health information (as defined in section 1171(6) of the Social Security Act (42 U.S.C. 1320d(6))) of an individual that is obtained in relation to such individual’s enrollment under a State plan (or waiver of such plan) under title XIX of such Act (42 U.S.C. 1396 et seq.) to any person, including U.S. Immigration and Customs Enforcement, for the purpose of enforcing the immigration laws (as such term is defined in section 101 of the Immigration and Nationality Act (8 U.S.C. 1101)).
Title V Improving health outcomes for women, gender-diverse people, children, and families
Subtitle A Underserved communities
Sec. 5001. Grants to promote health for underserved communities
Part Q of title III of the Public Health Service Act (42 U.S.C. 280h et seq.) is amended by adding at the end the following:
399Z–3. Grants to promote health for underserved communities
(a) Grants Authorized
The Secretary, in collaboration with the Administrator of the Health Resources and Services Administration and other Federal officials determined appropriate by the Secretary, may award grants to eligible entities—
(1)
to promote health for medically underserved communities, such as racial and ethnic minority women, racial and ethnic minority children, adolescents, and lesbian, gay, bisexual, transgender, queer, nonbinary, gender-nonconforming, or questioning communities; and
(2)
to strengthen health outreach initiatives in medically underserved communities, including linguistically isolated populations.
(b) Use of Funds
Grants awarded pursuant to subsection (a) may be used to support the activities of community health workers, including such activities—
(1)
to provide education and outreach regarding enrollment in health insurance including the State Children’s Health Insurance Program under title XXI of the Social Security Act, Medicare under title XVIII of such Act, and Medicaid under title XIX of such Act;
(2)
to provide education and outreach in a community setting regarding health problems prevalent among medically underserved communities, and especially among racial and ethnic minority women, racial and ethnic minority children, adolescents, and lesbian, gay, bisexual, transgender, queer, nonbinary, gender-nonconforming, or questioning communities;
(3)
to provide education and experiential learning opportunities and target risk factors and healthy behaviors that impede or contribute to achieving positive health outcomes, including—
(A)
healthy nutrition;
(B)
physical activity;
(C)
overweight or obesity;
(D)
tobacco use, including the use of e-cigarettes and vaping;
(E)
alcohol and substance use;
(F)
injury and violence;
(G)
sexual health;
(H)
mental health;
(I)
musculoskeletal health and arthritis;
(J)
prenatal and postnatal care;
(K)
dental and oral health;
(L)
understanding informed consent;
(M)
stigma; and
(N)
environmental hazards;
(4)
to promote community wellness and awareness; and
(5)
to provide education and refer target populations to appropriate health care agencies and community-based programs and organizations in order to increase access to quality health care services, including preventive health services.
(c) Application
(1) In general
Each eligible entity that desires to receive a grant under subsection (a) shall submit an application to the Secretary at such time, in such manner, and accompanied by such additional information as the Secretary may require.
(2) Contents
Each application submitted pursuant to paragraph (1) shall—
(A)
describe the activities for which assistance under this section is sought;
(B)
contain an assurance that, with respect to each community health worker program receiving funds under the grant awarded, such program provides in-language training and supervision to community health workers to enable such workers to provide authorized program activities in (at least) the most commonly used languages within a particular geographic region;
(C)
contain an assurance that the applicant will evaluate the effectiveness of community health worker programs receiving funds under the grant;
(D)
contain an assurance that each community health worker program receiving funds under the grant will provide culturally competent services in the linguistic context most appropriate for the individuals served by the program;
(E)
contain a plan to document and disseminate project descriptions and results to other States and organizations as identified by the Secretary; and
(F)
describe plans to enhance the capacity of individuals to utilize health services and health-related social services under Federal, State, and local programs by—
(i)
assisting individuals in establishing eligibility under the programs and in receiving the services or other benefits of the programs; and
(ii)
providing other services, as the Secretary determines to be appropriate, which may include transportation and translation services.
(d) Priority
In awarding grants under subsection (a), the Secretary shall give priority to those applicants—
(1)
who propose to target geographic areas that—
(A)
(i)
have a high percentage of residents who are uninsured or underinsured (if the targeted geographic area is located in a State that has elected to make medical assistance available under section 1902(a)(10)(A)(i)(VIII) of the Social Security Act to individuals described in such section);
(ii)
have a high percentage of underinsured residents in a particular geographic area (if the targeted geographic area is located in a State that has not so elected); or
(iii)
have a high number of households experiencing extreme poverty; and
(B)
have a high percentage of families for whom English is not their primary language or including smaller limited English-proficient communities within the region that are not otherwise reached by linguistically appropriate health services;
(2)
with experience in providing health or health-related social services to individuals who are underserved with respect to such services; and
(3)
with documented community activity and experience with community health workers.
(e) Collaboration with academic institutions
The Secretary shall encourage community health worker programs receiving funds under this section to collaborate with academic institutions, including minority-serving institutions. Nothing in this section shall be construed to require such collaboration.
(f) Quality assurance and cost-Effectiveness
The Secretary shall establish guidelines for ensuring the quality of the training and supervision of community health workers under the programs funded under this section and for ensuring the cost-effectiveness of such programs.
(g) Monitoring
The Secretary shall monitor community health worker programs identified in approved applications and shall determine whether such programs are in compliance with the guidelines established under subsection (f).
(h) Technical assistance
The Secretary may provide technical assistance to community health worker programs identified in approved applications with respect to planning, developing, and operating programs under the grant.
(i) Report to Congress
(1) In general
Not later than 4 years after the date on which the Secretary first awards grants under subsection (a), the Secretary shall submit to Congress a report regarding the grant project.
(2) Contents
The report required under paragraph (1) shall include the following:
(A)
A description of the programs for which grant funds were used.
(B)
The number of individuals served.
(C)
An evaluation of—
(i)
the effectiveness of these programs;
(ii)
the cost of these programs; and
(iii)
the impact of these programs on the health outcomes of the community residents.
(D)
Recommendations for sustaining the community health worker programs developed or assisted under this section.
(E)
Recommendations regarding training to enhance career opportunities for community health workers.
(j) Definitions
In this section:
(1) Community health worker
The term community health worker means an individual who promotes health or nutrition within the community in which the individual resides—
(A)
by serving as a liaison between communities and health care agencies;
(B)
by providing guidance and social assistance to community residents;
(C)
by enhancing community residents’ ability to effectively communicate with health care providers;
(D)
by providing culturally and linguistically appropriate health or nutrition education;
(E)
by advocating for individual and community health, including dental, oral, mental, and environmental health, or nutrition needs;
(F)
by taking into consideration the needs of the communities served, including the prevalence rates of risk factors that impede achieving positive healthy outcomes among pregnant, birthing, and postpartum people and children, especially among racial and ethnic minority pregnant, birthing, and postpartum people and children; or
(G)
by providing referral and followup services.
(2) Community setting
The term community setting means a home or a community organization that serves a population.
(3) Eligible entity
The term eligible entity means—
(A)
a unit of State, territorial, local, or Tribal government (including a federally recognized Tribe or Alaska Native village); or
(B)
a community-based organization.
(4) Medically underserved community
The term medically underserved community means a community—
(A)
that has a substantial number of individuals who are members of a medically underserved population, as defined by section 330(b)(3);
(B)
a significant portion of which is a health professional shortage area as designated under section 332; and
(C)
that includes populations that are linguistically isolated, such as geographic areas with a shortage of health professionals able to provide linguistically appropriate services.
(5) Support
The term support means the provision of training, supervision, and materials needed to effectively deliver the services described in subsection (b), reimbursement for services, and other benefits.
(k) Authorization of Appropriations
There are authorized to be appropriated to carry out this section $15,000,000 for each of fiscal years 2027 through 2031.
Subtitle B Pregnancy screening
Sec. 5101. Pregnancy intention screening initiative demonstration program
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:
399V–8. Pregnancy intention screening initiative demonstration program
(a) Program establishment
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall establish a demonstration program to facilitate the clinical adoption of pregnancy intention screening initiatives by health care and social services providers.
(b) Grants
The Secretary may carry out the demonstration program through awarding grants to eligible entities to implement pregnancy intention screening initiatives, collect data, and evaluate such initiatives.
(c) Eligible entities
To be eligible for a grant under this section, an entity shall—
(1)
provide non-directive, comprehensive, medically accurate information; and
(2)
be a community-based organization, voluntary health organization, public health department, community health center, or other interested public or private primary, behavioral, or other health care or social service provider or organization.
(d) Pregnancy intention screening initiative
For purposes of this section, the term pregnancy intention screening initiative means any initiative by an eligible entity to routinely screen people with respect to their pregnancy intentions and goals to either prevent unintended pregnancies or improve the likelihood of healthy pregnancies, in order to better provide health care that meets the contraceptive or pre-pregnancy needs and goals of such people.
(e) Evaluation
(1) In general
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall, by grant or contract, and after consultation as described in paragraph (2), conduct an evaluation of the demonstration program, with respect to pregnancy intention screening initiatives, conducted under this section. Such evaluation shall include:
(A)
Assessment of the implementation of pregnancy intention screening protocols among a diverse group of patients and providers, including collecting data on the experiences and outcomes for diverse patient populations in a variety of clinical settings.
(B)
Analysis of outcome measures that will facilitate effective and widespread adoption of such protocols by health care providers for inquiring about and responding to pregnancy goals of people with both contraceptive and pre-pregnancy care.
(C)
Consideration of health inequities among the population served.
(D)
Assessment of the equitable and voluntary application of such initiatives to minority and medically underserved communities.
(E)
Assessment of the training, capacity, and ongoing technical assistance needed for providers to effectively implement such pregnancy intention screening protocols.
(F)
Assessment of whether referral systems for selected protocols follow evidence-based standards that ensure access to comprehensive health services and appropriate follow-up care.
(G)
Measuring through rigorous methods the effect of such initiatives on key health outcomes.
(2) Consultation with independent, expert advisory panel
In conducting the evaluation under paragraph (1), the Director of the Centers for Disease Control and Prevention shall consult with physicians, physician assistants, advanced practice registered nurses, nurse midwives, and other health care providers who specialize in women’s health, and other experts in public health, clinical practice, program evaluation, and research.
(3) Report
Not later than one year after the last day of the demonstration program under this section, the Director of the Centers for Disease Control and Prevention shall—
(A)
submit to Congress a report on the results of the evaluation conducted under paragraph (1); and
(B)
make the report publicly available.
(f) Funding
(1) Authorization of appropriations
To carry out this section, there is authorized to be appropriated $10,000,000 for each of fiscal years 2027 through 2031.
(2) Limitation
Not more than 20 percent of funds appropriated to carry out this section pursuant to paragraph (1) for a fiscal year may be used for purposes of the evaluation under subsection (e).
Sec. 5102. Birth defects prevention, risk reduction, and awareness
(a) In general
The Secretary shall establish and implement a birth defects prevention and public awareness program, consisting of the activities described in subsections (b) and (c).
(b) Nationwide media campaign
In carrying out subsection (a), the Secretary shall conduct or support a nationwide media campaign to increase awareness among health care providers and at-risk populations about pregnancy and breastfeeding information services.
(c) Grants for pregnancy and breastfeeding information services
(1) In general
In carrying out subsection (a), the Secretary shall award grants to State or regional agencies or organizations for any of the following:
(A) Information services
The provision of, or campaigns to increase awareness about, pregnancy and breastfeeding information services.
(B) Surveillance and research
The conduct or support of—
(i)
surveillance of or research on—
(I)
maternal exposures and maternal health conditions that may influence the risk of birth defects, prematurity, or other adverse pregnancy outcomes; and
(II)
maternal exposures that may influence health risks to a breastfed infant; or
(ii)
networking to facilitate surveillance or research described in this subparagraph.
(2) Preference for certain States
The Secretary, in making any grant under this subsection, shall give preference to States, otherwise equally qualified, that have pregnancy and breastfeeding information services in place.
(3) Matching funds
The Secretary may only award a grant under this subsection to a State or regional agency or organization that agrees, with respect to the costs to be incurred in carrying out the grant activities, to make available (directly or through donations from public or private entities) non-Federal funds toward such costs in an amount equal to not less than 25 percent of the amount of the grant.
(4) Coordination
The Secretary shall ensure that activities funded through a grant under this subsection are coordinated, to the maximum extent practicable, with other birth defects prevention and environmental health activities of the Federal Government, including with respect to pediatric environmental health specialty units and children’s environmental health centers.
(d) Evaluation
The Secretary shall provide for an evaluation of pregnancy and breastfeeding information services carried out by States to identify efficient and effective models of—
(1)
providing information;
(2)
raising awareness and increasing knowledge about birth defects prevention measures and targeting education to at-risk groups;
(3)
modifying risk behaviors; or
(4)
other outcome measures as determined appropriate by the Secretary.
(e) Definitions
In this section:
(1) Maternal
The term maternal refers to people who are pregnant or breastfeeding.
(2) Pregnancy and breastfeeding information services
The term pregnancy and breastfeeding information services includes only—
(A)
information services to provide accurate, evidence-based, clinical information regarding maternal exposures during pregnancy or breastfeeding that may be associated with birth defects, health risks to a breastfed infant, or other health risks, such as exposures to medications, chemicals, infections, foodborne pathogens, illnesses, nutrition, lifestyle, or climate- and weather-related factors;
(B)
the provision of accurate, evidence-based information weighing risks of exposures during breastfeeding against the benefits of breastfeeding; and
(C)
the provision of information described in subparagraph (A) or (B) through counselors, websites, fact sheets, telephonic or electronic communication, community outreach efforts, or other appropriate means.
(3) Secretary
The term Secretary means the Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention.
(f) Authorization of appropriations
To carry out this section, there are authorized to be appropriated—
(1)
$5,000,000 for fiscal year 2027;
(2)
$6,000,000 for fiscal year 2028;
(3)
$7,000,000 for fiscal year 2029;
(4)
$8,000,000 for fiscal year 2030; and
(5)
$9,000,000 for fiscal year 2031.
Subtitle C Pregnancy-Related care
Sec. 5201. Community access, resources, and empowerment for moms
(a) Short title
This section may be cited as the Community Access, Resources, and Empowerment for Moms Act
or the CARE for Moms Act
.
(b) Improving Federal efforts with respect to prevention of maternal mortality
(1) Funding for State-based perinatal quality collaboratives development and sustainability
(A) In general
Not later than one year after the date of enactment of this Act, the Secretary of Health and Human Services, acting through the Division of Reproductive Health of the Centers for Disease Control and Prevention (referred to in this paragraph as the Secretary
), shall establish a grant program to be known as the State-Based Perinatal Quality Collaborative Grant Program
, under which the Secretary shall award grants to eligible entities for the purpose of development and sustainability of State-based perinatal quality collaboratives in every State, the District of Columbia, and eligible territories, in order to measurably improve perinatal care and perinatal health outcomes for pregnant and postpartum women and their infants.
(B) Grant amounts
Grants awarded under this paragraph shall be in amounts not to exceed $250,000 per year, for the duration of the grant period.
(C) State-based perinatal quality collaborative defined
For purposes of this paragraph, the term State-based perinatal quality collaborative means a network of teams that—
(i)
is multidisciplinary in nature and includes the full range of perinatal and maternity care providers;
(ii)
works to improve measurable outcomes for maternal and infant health by advancing evidence-informed clinical practices using quality improvement principles;
(iii)
works with hospital-based or outpatient facility-based clinical teams, experts, and stakeholders, including patients and families, to spread best practices and optimize resources to improve perinatal care and outcomes;
(iv)
employs strategies that include the use of the collaborative learning model to provide opportunities for hospitals and clinical teams to collaborate on improvement strategies, rapid-response data to provide timely feedback to hospital and other clinical teams to track progress, and quality improvement science to provide support and coaching to hospital and clinical teams;
(v)
has the goal of improving population-level outcomes in maternal and infant health; and
(vi)
has the goal of improving outcomes of all birthing people, through the coordination, integration, and collaboration across birth settings.
(D) Authorization of appropriations
For purposes of carrying out this paragraph, there is authorized to be appropriated $35,000,000 for each of fiscal years 2027 through 2031.
(2) Expansion of Medicaid and CHIP coverage for pregnant and postpartum women
(A) Requiring coverage of oral health services for pregnant and postpartum women
(i) Medicaid
Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by section 4251(d)(3)(A), is amended—
(I)
in subsection (a)(4)—
(aa)
by striking ; and (D)
and inserting ; (D)
;
(bb)
by striking ; and (E)
and inserting ; (E)
;
(cc)
by striking ; and (F)
and inserting ; (F)
; and
(dd)
by striking the semicolon at the end and inserting ; and (G) oral health services for pregnant and postpartum women (as defined in subsection (nn));
; and
(II)
by adding at the end the following new subsection:
(nn) Oral health services for pregnant and postpartum women
(1) In general
For purposes of this title, the term oral health services for pregnant and postpartum women means dental services necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions that are furnished to a woman during pregnancy (or during the 1-year period beginning on the last day of the pregnancy).
(2) Coverage requirements
To satisfy the requirement to provide oral health services for pregnant and postpartum women, a State shall, at a minimum, provide coverage for preventive, diagnostic, periodontal, and restorative care consistent with recommendations for perinatal oral health care and dental care during pregnancy from the American Academy of Pediatric Dentistry and the American College of Obstetricians and Gynecologists.
(ii) CHIP
Section 2103(c)(6) of the Social Security Act (42 U.S.C. 1397cc(c)(6)) is amended—
(I)
in subparagraph (A)—
(aa)
by inserting or a targeted low-income pregnant woman
after targeted low-income child
; and
(bb)
by inserting , and, in the case of a targeted low-income child who is pregnant or a targeted low-income pregnant woman, satisfy the coverage requirements specified in section 1905(nn)
after emergency conditions
; and
(II)
in subparagraph (B), by inserting (but only if, in the case of a targeted low-income child who is pregnant or a targeted low-income pregnant woman, the benchmark dental benefit package satisfies the coverage requirements specified in section 1905(nn))
after subparagraph (C)
.
(B) Requiring 12-month continuous coverage of full benefits for pregnant and postpartum individuals under Medicaid and CHIP
(i) Medicaid
Section 1902 of the Social Security Act (42 U.S.C. 1396a) is amended—
(I)
in subsection (a)—
(aa)
in paragraph (89), by striking and
at the end;
(bb)
in paragraph (90)(C), by striking the period at the end and inserting ; and
; and
(cc)
by inserting after paragraph (90)(C) the following new paragraph:
(91)
provide that the State plan is in compliance with subsection (e)(16).; and
(II)
in subsection (e)(16)—
(aa)
in subparagraph (A), by striking At the option of the State, the State plan (or waiver of such State plan) may provide
and inserting A State plan (or waiver of such State plan) shall provide
;
(bb)
in subparagraph (B), in the matter preceding clause (i), by striking by a State making an election under this paragraph
and inserting under a State plan (or a waiver of such State plan)
; and
(cc)
by striking subparagraph (C).
(ii) CHIP
(I) In general
Section 2107(e)(1)(K) of the Social Security Act (42 U.S.C. 1397gg(e)(1)(J)) is amended to read as follows:
(K)
Paragraphs (5) and (16) of section 1902(e) (relating to the requirement to provide medical assistance under the State plan or waiver consisting of full benefits during pregnancy and throughout the 12-month postpartum period under title XIX).
(II) Conforming
Section 2112(d)(2)(A) of the Social Security Act (42 U.S.C. 1397ll(d)(2)(A)) is amended by striking the month in which the 60-day period
and all that follows through pursuant to section 2107(e)(1),
.
(C) Maintenance of effort
(i) Medicaid
Section 1902(l) of the Social Security Act (42 U.S.C. 1396a(l)) is amended by adding at the end the following new paragraph:
(5)
During the period that begins on the date of enactment of this paragraph and ends on the date that is 5 years after such date of enactment, as a condition for receiving any Federal payments under section 1903(a) for calendar quarters occurring during such period, a State shall not have in effect, with respect to women who are eligible for medical assistance under the State plan or under a waiver of such plan on the basis of being pregnant or having been pregnant, eligibility standards, methodologies, or procedures under the State plan or waiver that are more restrictive than the eligibility standards, methodologies, or procedures, respectively, under such plan or waiver that are in effect on the date of enactment of this paragraph.
(ii) CHIP
Section 2105(d) of the Social Security Act (42 U.S.C. 1397ee(d)) is amended by adding at the end the following new paragraph:
(4) In eligibility standards for targeted low-income pregnant women
During the period that begins on the date of enactment of this paragraph and ends on the date that is 5 years after such date of enactment, as a condition of receiving payments under subsection (a) and section 1903(a), a State that elects to provide assistance to women on the basis of being pregnant (including pregnancy-related assistance provided to targeted low-income pregnant women (as defined in section 2112(d)), pregnancy-related assistance provided to women who are eligible for such assistance through application of section 1903(v)(4)(A)(i) under section 2107(e)(1), or any other assistance under the State child health plan (or a waiver of such plan) which is provided to women on the basis of being pregnant) shall not have in effect, with respect to such women, eligibility standards, methodologies, or procedures under such plan (or waiver) that are more restrictive than the eligibility standards, methodologies, or procedures, respectively, under such plan (or waiver) that are in effect on the date of enactment of this paragraph.
(D) Information on benefits
The Secretary of Health and Human Services shall make publicly available on the internet website of the Department of Health and Human Services, information regarding benefits available to pregnant and postpartum women and under the Medicaid program and the Children's Health Insurance Program, including information on—
(i)
benefits that States are required to provide to pregnant and postpartum women under such programs;
(ii)
optional benefits that States may provide to pregnant and postpartum women under such programs; and
(iii)
the availability of different kinds of benefits for pregnant and postpartum women, including oral health and mental health benefits and breastfeeding services and supplies, under such programs.
(E) Federal funding for cost of extended Medicaid and CHIP coverage for postpartum women
(i) Medicaid
Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by title IV and subparagraph (A)(i)(II), is further amended—
(I)
in subsection (b), by striking and (mm)
and inserting (mm), and (oo)
; and
(II)
by adding at the end the following:
(oo) Increased FMAP for extended medical assistance for postpartum individuals
(1) In general
Notwithstanding subsection (b), the Federal medical assistance percentage for a State, with respect to amounts expended by such State for medical assistance for an individual who is eligible for such assistance on the basis of being pregnant or having been pregnant that is provided during the 305-day period that begins on the 60th day after the last day of the individual's pregnancy (including any such assistance provided during the month in which such period ends), shall be equal to—
(A)
during the first 20-quarter period for which this subsection is in effect with respect to a State, 100 percent; and
(B)
with respect to a State, during each quarter thereafter, 90 percent.
(2) Exclusion from territorial caps
Any payment made to a territory for expenditures for medical assistance for an individual described in paragraph (1) that is subject to the Federal medical assistance percentage specified under paragraph (1) shall not be taken into account for purposes of applying payment limits under subsections (f) and (g) of section 1108.
(ii) CHIP
Section 2105(c) of the Social Security Act (42 U.S.C. 1397ee(c)) is amended by adding at the end the following new paragraph:
(13) Enhanced payment for extended assistance provided to pregnant women
Notwithstanding subsection (b), the enhanced FMAP, with respect to payments under subsection (a) for expenditures under the State child health plan (or a waiver of such plan) for assistance provided under the plan (or waiver) to a woman who is eligible for such assistance on the basis of being pregnant (including pregnancy-related assistance provided to a targeted low-income pregnant woman (as defined in section 2112(d)), pregnancy-related assistance provided to a woman who is eligible for such assistance through application of section 1903(v)(4)(A)(i) under section 2107(e)(1), or any other assistance under the plan (or waiver) provided to a woman who is eligible for such assistance on the basis of being pregnant) during the 305-day period that begins on the 60th day after the last day of her pregnancy (including any such assistance provided during the month in which such period ends), shall be equal to—
(A)
during the first 20-quarter period for which this subsection is in effect with respect to a State, 100 percent; and
(B)
with respect to a State, during each quarter thereafter, 90 percent.
(F) Guidance on State options for Medicaid coverage of doula services
Not later than 1 year after the date of the enactment of this section, the Secretary of Health and Human Services shall issue guidance for the States concerning options for Medicaid coverage and payment for support services provided by doulas.
(G) Enhanced FMAP for rural obstetric and gynecological services
Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by title IV and subparagraphs (A) and (E), is further amended—
(i)
in subsection (b), by striking and (oo)
and inserting (oo), and (pp)
; and
(ii)
by adding at the end the following new subsection:
(pp) Increased FMAP for medical assistance for obstetric and gynecological services furnished at rural hospitals
(1) In general
Notwithstanding subsection (b), the Federal medical assistance percentage for a State, with respect to amounts expended by such State for medical assistance for obstetric or gynecological services that are furnished in a hospital that is located in a rural area (as defined for purposes of section 1886) shall be equal to 90 percent for each calendar quarter beginning with the first calendar quarter during which this subsection is in effect.
(2) Exclusion from territorial caps
Any payment made to a territory for expenditures for medical assistance described in paragraph (1) that is subject to the Federal medical assistance percentage specified under paragraph (1) shall not be taken into account for purposes of applying payment limits under subsections (f) and (g) of section 1108.
(H) Effective dates
(i) In general
Subject to clauses (ii) and (iii)—
(I)
the amendments made by subparagraphs (A), (B), and (E) shall take effect on the first day of the first calendar quarter that begins on or after the date that is 1 year after the date of enactment of this section;
(II)
the amendments made by subparagraph (C) shall take effect on the date of enactment of this section; and
(III)
the amendments made by subparagraph (G) shall take effect on the first day of the first calendar quarter that begins on or after the date of enactment of this section.
(ii) Exception for State legislation
In the case of a State plan under title XIX of the Social Security Act or a State child health plan under title XXI of such Act that the Secretary of Health and Human Services determines requires State legislation in order for the respective plan to meet any requirement imposed by amendments made by this paragraph, the respective plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this section. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session shall be considered to be a separate regular session of the State legislature.
(iii) State option for earlier effective date
A State may elect to have subsection (e)(16) of section 1902 of the Social Security Act (42 U.S.C. 1396a) and subparagraph (K) of section 2107(e)(1) of the Social Security Act (42 U.S.C. 1397gg(e)(1)), as amended by subparagraph (B), and subsection (oo) of section 1905 of the Social Security Act (42 U.S.C. 1396d) and paragraph (13) of section 2105(c) of the Social Security Act (42 U.S.C. 1397ee(c)), as added by subparagraph (E), take effect with respect to the State on the first day of any fiscal quarter that begins before the date described in clause (i) and apply to amounts payable to the State for expenditures for medical assistance, child health assistance, or pregnancy-related assistance to pregnant or postpartum individuals furnished on or after such day.
(3) Regional centers of excellence
Part P of title III of the Public Health Service Act (42 U.S.C. 280g et seq.) (as amended by section 5101) is amended by adding at the end the following:
399V–9. Regional centers of excellence addressing implicit bias and cultural competency in patient-provider interactions education
(a) In general
Not later than one year after the date of enactment of this section, the Secretary, in consultation with such other agency heads as the Secretary determines appropriate, shall award cooperative agreements for the establishment or support of regional centers of excellence addressing implicit bias, cultural competency, and respectful care practices in patient-provider interactions education for the purpose of enhancing and improving how health care professionals are educated in implicit bias and delivering culturally competent health care.
(b) Eligibility
To be eligible to receive a cooperative agreement under subsection (a), an entity shall—
(1)
be a public or other nonprofit entity specified by the Secretary that provides educational and training opportunities for students and health care professionals, which may be a health system, teaching hospital, community health center, medical school, school of public health, school of nursing, dental school, social work school, school of professional psychology, or any other health professional school or program at an institution of higher education (as defined in section 101 of the Higher Education Act of 1965) focused on the prevention, treatment, or recovery of health conditions that contribute to maternal mortality and the prevention of maternal mortality and severe maternal morbidity;
(2)
demonstrate community engagement and participation, such as through partnerships with home visiting and case management programs and community-based organizations serving minority populations;
(3)
demonstrate engagement with groups engaged in the implementation of health care professional training in implicit bias and delivering culturally competent care, such as departments of public health, perinatal quality collaboratives, hospital systems, and health care professional groups, in order to obtain input on resources needed for effective implementation strategies; and
(4)
provide to the Secretary such information, at such time and in such manner, as the Secretary may require.
(c) Diversity
In awarding a cooperative agreement under subsection (a), the Secretary shall take into account any regional differences among eligible entities and make an effort to ensure geographic diversity among award recipients.
(d) Dissemination of information
(1) Public availability
The Secretary shall make publicly available on the internet website of the Department of Health and Human Services information submitted to the Secretary under subsection (b)(4).
(2) Evaluation
The Secretary shall evaluate each regional center of excellence established or supported pursuant to subsection (a) and disseminate the findings resulting from each such evaluation to the appropriate public and private entities.
(3) Distribution
The Secretary shall share evaluations and overall findings with State departments of health and other relevant State level offices to inform State and local best practices.
(e) Maternal mortality defined
In this section, the term maternal mortality means death of a woman that occurs during pregnancy or within the one-year period following the end of such pregnancy.
(f) Authorization of appropriations
For purposes of carrying out this section, there is authorized to be appropriated $5,000,000 for each of fiscal years 2027 through 2031.
(4) Special supplemental nutrition program for women, infants, and children
Section 17(d)(3)(A)(ii) of the Child Nutrition Act of 1966 (42 U.S.C. 1786(d)(3)(A)(ii)) is amended—
(A)
by striking the clause designation and heading and all that follows through A State
and inserting the following:
(ii) Women
(I) Breastfeeding women
A State;
(B)
in subclause (I) (as so designated), by striking 1 year
and all that follows through earlier
and inserting 2 years postpartum
; and
(C)
by adding at the end the following:
(II) Postpartum women
A State may elect to certify a postpartum woman for a period of 2 years.
(c) Full spectrum doula workforce
(1) In general
The Secretary of Health and Human Services shall establish and implement a program to award grants or contracts to health professions schools, schools of public health, academic health centers, State or local governments, territories, Indian Tribes and Tribal organizations, Urban Indian organizations, Native Hawaiian organizations, or other appropriate public or private nonprofit entities or community-based organizations (or consortia of any such entities, including entities promoting multidisciplinary approaches), to establish or expand programs to grow and diversify the doula workforce, including through improving the capacity and supply of health care providers.
(2) Use of funds
Amounts made available by paragraph (1) shall be used for the following activities:
(A)
Establishing programs that provide education and training to individuals seeking appropriate training or certification as full spectrum doulas.
(B)
Expanding the capacity of existing programs described in subparagraph (A), for the purpose of increasing the number of students enrolled in such programs, including by awarding scholarships for students who agree to work in underserved communities after receiving such education and training.
(C)
Developing and implementing strategies to recruit and retain students from underserved communities, particularly from demographic groups experiencing high rates of maternal mortality and severe maternal morbidity, including racial and ethnic minority groups, into programs described in subparagraphs (A) and (B).
(3) Funding
In addition to amounts otherwise available, there is appropriated to the Secretary of Health and Human Services for fiscal year 2027, out of any money in the Treasury not otherwise appropriated, $50,000,000, to remain available until expended, for carrying out this subsection.
(d) Grants for rural obstetric mobile health units
Part B of title III of the Public Health Service Act (42 U.S.C. 243 et seq.) is amended by adding at the end the following:
320C. Grants for rural obstetric mobile health units
(a) In general
The Secretary, acting through the Administrator of the Health Resources and Services Administration (referred to in this section as the
Secretary), shall establish a pilot program under which the Secretary shall make grants to States—(1)
to purchase and equip rural mobile health units for the purpose of providing pre-conception, pregnancy, postpartum, and obstetric emergency services in rural and underserved communities;
(2)
to train providers including obstetrician-gynecologists, certified nurse-midwives, nurse practitioners, nurses, and midwives to operate and provide obstetric services, including training and planning for obstetric emergencies, in such mobile health units; and
(3)
to address access issues, including social determinants of health and wrap-around clinical and community services including nutrition, housing, lactation services, and transportation support and referrals.
(b) No sharing of data with law enforcement
As a condition of receiving a grant under this section, a State shall submit to the Secretary an assurance that the State will not make available to Federal or State law enforcement any personally identifiable information regarding any pregnant or postpartum individual collected pursuant to such grant.
(c) Grant duration
The period of a grant under this section shall not exceed 5 years.
(d) Implementing and reporting
(1) In general
States that receive pilot grants under this section shall—
(A)
implement the program funded by the pilot grants; and
(B)
not later than 3 years after the date of enactment of this section, and not later than 6 years after such date of enactment, submit to the Secretary a report that describes the results of such program, including—
(i)
relevant information and relevant quantitative indicators of the programs’ success in improving the standard of care and maternal health outcomes for individuals in rural and underserved communities seen for pre-conception, pregnancy, or postpartum visits in the rural mobile health units, stratified by the categories of data specified in paragraph (2);
(ii)
relevant qualitative evaluations from individuals receiving pre-conception, pregnant, or postpartum care from rural mobile health units, including measures of patient-reported experience of care and measures of patient-reported issues with access to care without the rural mobile health unit pilot; and
(iii)
strategies to sustain such programs beyond the duration of the grant and expand such programs to other rural and underserved communities.
(2) Categories of data
The categories of data specified in this paragraph are the following:
(A)
Race, ethnicity, sex, gender, gender identity, primary language, age, geography, insurance status, disability status.
(B)
Number of visits provided for preconception, prenatal, or postpartum care.
(C)
Number of repeat visits provided for preconception, prenatal, or postpartum care.
(D)
Number of screenings or tests provided for smoking, substance use, hypertension, sexually-transmitted diseases, diabetes, HIV, depression, intimate partner violence, pap smears, and pregnancy.
(3) Data privacy protection
The reports referred to in paragraph (1)(B) shall not contain any personally identifiable information regarding any pregnant or postpartum individual.
(e) Evaluation
The Secretary shall conduct an evaluation of the pilot program under this section to determine the impact of the pilot program with respect to—
(1)
the effectiveness of the grants awarded under this section to improve maternal health outcomes in rural and underserved communities, with data stratified by race, ethnicity, primary language, socioeconomic status, geography, insurance type, and other factors as the Secretary determines appropriate;
(2)
spending on maternity care by States participating in the pilot program;
(3)
to the extent practicable, qualitative and quantitative measures of patient experience; and
(4)
any other areas of assessment that the Secretary determines relevant.
(f) Report
Not later than one year after the completion of the pilot program under this section, the Secretary shall submit to Congress, and make publicly available, a report that describes—
(1)
the results of the evaluation conducted under subsection (e); and
(2)
a recommendation regarding whether the pilot program should be continued after fiscal year 2031 and expanded on a national basis.
(g) Authorization of appropriations
There is authorized to be appropriated to the Secretary to carry out this section $10,000,000 for each of fiscal years 2027 through 2031.
(e) Requiring notification of impending hospital obstetric unit closure
Section 1866(a)(1) of the Social Security Act (42 U.S.C. 1395cc(a)(1)) is amended—
(1)
in subparagraph (X), by striking and
at the end;
(2)
in subparagraph (Y)(ii)(V), by striking the period and inserting , and
; and
(3)
by inserting after subparagraph (Y) the following new subparagraph:
(Z)
beginning 180 days after the date of the enactment of this subparagraph, in the case of a hospital, not less than 90 days prior to the closure of any obstetric unit of the hospital, to submit to the Secretary a notification which shall include—
(i)
a report analyzing the impact the closure will have on the community;
(ii)
steps the hospital will take to identify other health care providers that can alleviate any service gaps as a result of the closure; and
(iii)
any additional information as may be required by the Secretary.
(f) Evaluation and report on maternal health needs
(1) In general
Not later than 2 years after the date of enactment of this Act, the Secretary of Health and Human Services shall conduct, and submit to Congress a report that describes the results of, an evaluation of—
(A)
where the maternal health needs are greatest in the United States; and
(B)
the Federal expenditures made to address such needs.
(2) Period covered
The evaluation under paragraph (1) shall cover the period of calendar years 2000 through 2026.
(3) Analysis
The evaluation under paragraph (1) shall include analysis of the following:
(A)
How Federal funds provided to States for maternal health were distributed across regions, States, and localities or counties.
(B)
Barriers to applying for and receiving Federal funds for maternal health, including, with respect to initial applications—
(i)
requirements for submission in partnership with other entities; and
(ii)
stringent network requirements.
(C)
Why applicants did not receive funding, including limited availability of funds, the strength of the respective applications, and failure to adhere to requirements.
(4) Disaggregation of data
The report under paragraph (1) shall disaggregate data on mothers served by race, ethnicity, insurance status, and language spoken.
(g) Increasing excise taxes on cigarettes and establishing excise tax equity among all tobacco product tax rates
(1) Tax parity for Roll-Your-Own tobacco
Section 5701(g) of the Internal Revenue Code of 1986 is amended by striking $24.78
and inserting $49.56
.
(2) Tax parity for pipe tobacco
Section 5701(f) of the Internal Revenue Code of 1986 is amended by striking $2.8311 cents
and inserting $49.56
.
(3) Tax parity for smokeless tobacco
(A)
Section 5701(e) of the Internal Revenue Code of 1986 is amended—
(i)
in paragraph (1), by striking $1.51
and inserting $26.84
;
(ii)
in paragraph (2), by striking 50.33 cents
and inserting $10.74
; and
(iii)
by adding at the end the following:
(3) Smokeless tobacco sold in discrete single-use units
On discrete single-use units, $100.66 per thousand.
(B)
Section 5702(m) of such Code is amended—
(i)
in paragraph (1), by striking or chewing tobacco
and inserting , chewing tobacco, or discrete single-use unit
;
(ii)
in paragraphs (2) and (3), by inserting and which is not a discrete single-use unit
before the period in each such paragraph; and
(iii)
by adding at the end the following:
(4) Discrete single-use unit
The term discrete single-use unit means any product containing, made from, or derived from tobacco or nicotine that—
(A)
is not intended to be smoked; and
(B)
is in the form of a lozenge, tablet, pill, pouch, dissolvable strip, or other discrete single-use or single-dose unit.
(4) Tax parity for small cigars
Paragraph (1) of section 5701(a) of the Internal Revenue Code of 1986 is amended by striking $50.33
and inserting $100.66
.
(5) Tax parity for large cigars
(A) In general
Paragraph (2) of section 5701(a) of the Internal Revenue Code of 1986 is amended by striking 52.75 percent
and all that follows through the period and inserting the following: $49.56 per pound and a proportionate tax at the like rate on all fractional parts of a pound but not less than 10.066 cents per cigar.
.
(B) Guidance
The Secretary of the Treasury, or the Secretary's delegate, may issue guidance regarding the appropriate method for determining the weight of large cigars for purposes of calculating the applicable tax under section 5701(a)(2) of the Internal Revenue Code of 1986.
(C) Conforming amendment
Section 5702 of such Code is amended by striking subsection (l).
(6) Tax parity for Roll-Your-Own tobacco and certain processed tobacco
Subsection (o) of section 5702 of the Internal Revenue Code of 1986 is amended by adding at the end the following: Such term includes processed tobacco that is removed for delivery or delivered to a person other than a person with a permit provided under section 5713, but does not include removals of processed tobacco for exportation.
.
(7) Clarifying tax rate for other tobacco products
(A) In general
Section 5701 of the Internal Revenue Code of 1986 is amended by adding at the end the following new subsection:
(i) Other tobacco products
Any product not otherwise described under this section that has been determined to be a tobacco product by the Food and Drug Administration through its authorities under the Family Smoking Prevention and Tobacco Control Act shall be taxed at a level of tax equivalent to the tax rate for cigarettes on an estimated per use basis as determined by the Secretary.
(B) Establishing per use basis
For purposes of section 5701(i) of the Internal Revenue Code of 1986, not later than 12 months after the later of the date of the enactment of this Act or the date that a product has been determined to be a tobacco product by the Food and Drug Administration, the Secretary of the Treasury (or the Secretary of the Treasury's delegate) shall issue final regulations establishing the level of tax for such product that is equivalent to the tax rate for cigarettes on an estimated per use basis.
(8) Clarifying definition of tobacco products
(A) In general
Subsection (c) of section 5702 of the Internal Revenue Code of 1986 is amended to read as follows:
(c) Tobacco products
The term tobacco products means—
(1)
cigars, cigarettes, smokeless tobacco, pipe tobacco, and roll-your-own tobacco, and
(2)
any other product subject to tax pursuant to section 5701(i).
(B) Conforming amendments
Subsection (d) of section 5702 of such Code is amended by striking cigars, cigarettes, smokeless tobacco, pipe tobacco, or roll-your-own tobacco
each place it appears and inserting tobacco products
.
(9) Increasing tax on cigarettes
(A) Small cigarettes
Section 5701(b)(1) of such Code is amended by striking $50.33
and inserting $100.66
.
(B) Large cigarettes
Section 5701(b)(2) of such Code is amended by striking $105.69
and inserting $211.38
.
(10) Tax rates adjusted for inflation
Section 5701 of such Code, as amended by paragraph (7), is amended by adding at the end the following new subsection:
(j) Inflation adjustment
(1) In general
In the case of any calendar year beginning after 2026, the dollar amounts provided under this chapter shall each be increased by an amount equal to—
(A)
such dollar amount, multiplied by
(B)
the cost-of-living adjustment determined under section 1(f)(3) for the calendar year, determined by substituting ‘calendar year 2025’ for ‘calendar year 2016’ in subparagraph (A)(ii) thereof.
(2) Rounding
If any amount as adjusted under paragraph (1) is not a multiple of $0.01, such amount shall be rounded to the next highest multiple of $0.01.
(11) Floor Stocks Taxes
(A) Imposition of tax
On tobacco products manufactured in or imported into the United States which are removed before any tax increase date and held on such date for sale by any person, there is hereby imposed a tax in an amount equal to the excess of—
(i)
the tax which would be imposed under section 5701 of the Internal Revenue Code of 1986 on the article if the article had been removed on such date, over
(ii)
the prior tax (if any) imposed under section 5701 of such Code on such article.
(B) Credit against tax
Each person shall be allowed as a credit against the taxes imposed by subparagraph (A) an amount equal to the lesser of $1,000 or the amount of such taxes. For purposes of the preceding sentence, all persons treated as a single employer under subsection (b), (c), (m), or (o) of section 414 of the Internal Revenue Code of 1986 shall be treated as 1 person for purposes of this subparagraph.
(C) Liability for tax and method of payment
(i) Liability for tax
A person holding tobacco products on any tax increase date to which any tax imposed by subparagraph (A) applies shall be liable for such tax.
(ii) Method of payment
The tax imposed by subparagraph (A) shall be paid in such manner as the Secretary shall prescribe by regulations.
(iii) Time for payment
The tax imposed by subparagraph (A) shall be paid on or before the date that is 120 days after the effective date of the tax rate increase.
(D) Articles in foreign trade zones
Notwithstanding the Act of June 18, 1934 (commonly known as the Foreign Trade Zone Act, 48 Stat. 998, 19 U.S.C. 81a et seq.), or any other provision of law, any article which is located in a foreign trade zone on any tax increase date shall be subject to the tax imposed by subparagraph (A) if—
(i)
internal revenue taxes have been determined, or customs duties liquidated, with respect to such article before such date pursuant to a request made under the first proviso of section 3(a) of such Act, or
(ii)
such article is held on such date under the supervision of an officer of the United States Customs and Border Protection of the Department of Homeland Security pursuant to the second proviso of such section 3(a).
(E) Definitions
For purposes of this paragraph—
(i) In general
Any term used in this paragraph which is also used in section 5702 of such Code shall have the same meaning as such term has in such section.
(ii) Tax increase date
The term tax increase date means the effective date of any increase in any tobacco product excise tax rate pursuant to the amendments made by this subsection (other than paragraph (10) thereof).
(iii) Secretary
The term Secretary means the Secretary of the Treasury or the Secretary’s delegate.
(F) Controlled groups
Rules similar to the rules of section 5061(e)(3) of such Code shall apply for purposes of this paragraph.
(G) Other laws applicable
All provisions of law, including penalties, applicable with respect to the taxes imposed by section 5701 of such Code shall, insofar as applicable and not inconsistent with the provisions of this paragraph, apply to the floor stocks taxes imposed by subparagraph (A), to the same extent as if such taxes were imposed by such section 5701. The Secretary may treat any person who bore the ultimate burden of the tax imposed by subparagraph (A) as the person to whom a credit or refund under such provisions may be allowed or made.
(12) Effective dates
(A) In general
Except as provided in subparagraphs (B) and (C), the amendments made by this subsection shall apply to articles removed (as defined in section 5702(j) of the Internal Revenue Code of 1986) after the last day of the month which includes the date of the enactment of this Act.
(B) Discrete single-use units, large cigars, and processed tobacco
The amendments made by paragraphs (3)(A)(iii), (3)(B), (5), and (6) shall apply to articles removed (as defined in section 5702(j) of the Internal Revenue Code of 1986) after the date that is 6 months after the date of the enactment of this Act.
(C) Other tobacco products
The amendments made by paragraph (7)(A) shall apply to products removed after the last day of the month which includes the date that the Secretary of the Treasury (or the Secretary of the Treasury's delegate) issues final regulations establishing the level of tax for such product.
Sec. 5202. MOMMIES
(a) GAO study and report
(1) In general
Not later than 1 year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the gaps in coverage with respect to—
(A)
pregnant individuals enrolled under a State plan (or waiver of such plan) under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) and the Children's Health Insurance Program under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.); and
(B)
postpartum individuals enrolled under a State plan (or waiver of such plan) under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) and the Children's Health Insurance Program under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.) who received assistance under either such program during their pregnancy.
(2) Content of report
The report required under this subsection shall include the following:
(A)
Information about the abilities and successes of State Medicaid agencies in determining whether pregnant and postpartum individuals are eligible under another insurance affordability program, and in transitioning any such individuals who are so eligible to coverage under such a program at the end of their period of eligibility for medical assistance, pursuant to section 435.1200 of the title 42, Code of Federal Regulations (as in effect on September 1, 2018).
(B)
Information on factors contributing to gaps in coverage that disproportionately impact underserved populations, including low-income individuals, Black, Indigenous, and other individuals of color, individuals who reside in a health professional shortage area (as defined in section 332(a)(1)(A) of the Public Health Service Act (42 U.S.C. 254e(a)(1)(A))) or individuals who are members of a medically underserved population (as defined by section 330(b)(3) of such Act (42 U.S.C. 254b(b)(3)(A))).
(C)
Recommendations for addressing and reducing such gaps in coverage.
(D)
Such other information as the Comptroller General deems necessary.
(3) Data disaggregation
To the greatest extent possible, the Comptroller General shall disaggregate data presented in the report, including by age, gender identity, race, ethnicity, income level, and other demographic factors.
(b) Maternity care home demonstration project
Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is amended by inserting the following new section after section 1948:
1949. Maternity Care Home Demonstration Project
(a) In general
Not later than 1 year after the date of the enactment of this section, the Secretary shall establish a demonstration project (in this section referred to as the demonstration project) under which the Secretary shall provide grants to States to enter into arrangements with eligible entities to implement or expand a maternity care home model for eligible individuals.
(b) Goals of demonstration project
The goals of the demonstration project are the following:
(1)
To improve—
(A)
maternity and infant care outcomes;
(B)
birth equity;
(C)
health equity for—
(i)
Black, Indigenous, and other people of color;
(ii)
lesbian, gay, bisexual, transgender, queer, non-binary, and gender nonconforming individuals;
(iii)
individuals with disabilities; and
(iv)
other underserved populations;
(D)
communication by maternity, infant care, oral health services, and social services providers;
(E)
integration of perinatal support services, including community health workers, doulas, social workers, public health nurses, peer lactation counselors, lactation consultants, childbirth educators, peer mental health workers, and others, into health care entities and organizations;
(F)
care coordination between maternity, infant care, oral health services, and social services providers within the community;
(G)
the quality and safety of maternity and infant care;
(H)
the experience of individuals receiving maternity care, including by increasing the ability of an individual to develop and follow their own birthing plans; and
(I)
access to adequate prenatal and postpartum care, including—
(i)
prenatal care that is initiated in a timely manner;
(ii)
not fewer than 5 post-pregnancy visits to a maternity care provider; and
(iii)
interpregnancy care.
(2)
To provide coordinated, evidence-based, respectful, culturally and linguistically appropriate, and person-centered maternity care management.
(3)
To decrease—
(A)
severe and preventable maternal morbidity and maternal mortality;
(B)
overall health care spending;
(C)
unnecessary emergency department visits;
(D)
inequities in maternal and infant care outcomes, including racial, economic, disability, gender-based, and geographical inequities;
(E)
racial, gender, economic, and other discrimination among health care professionals;
(F)
racism, discrimination, disrespect, and abuse in maternity care settings;
(G)
the rate of cesarean deliveries for low-risk pregnancies;
(H)
the rate of pre-term births and infants born with low birth weight; and
(I)
the rate of avoidable maternal and newborn hospitalizations and admissions to intensive care units.
(c) Consultation
In designing and implementing the demonstration project the Secretary shall consult with stakeholders, including—
(1)
States;
(2)
organizations representing relevant health care professionals, including oral health services professionals;
(3)
organizations (including reproductive justice and birth justice organizations led by people of color) that represent consumers of maternal health care, including consumers of maternal health care who are disproportionately impacted by poor maternal health outcomes;
(4)
representatives with experience implementing other maternity care home models, including representatives from the Center for Medicare and Medicaid Innovation;
(5)
community-based health care professionals, including doulas, lactation consultants, and other stakeholders;
(6)
experts in promoting health equity and combating racial bias in health care settings; and
(7)
Black, Indigenous, and other maternal health care consumers of color who have experienced severe maternal morbidity.
(d) Application and selection of States
(1) In general
A State seeking to participate in the demonstration project shall submit an application to the Secretary at such time and in such manner as the Secretary shall require.
(2) Selection of States
(A) In general
The Secretary shall select at least 10 States to participate in the demonstration project.
(B) Selection requirements
In selecting States to participate in the demonstration project, the Secretary shall—
(i)
ensure that there is geographic and regional diversity in the areas in which activities will be carried out under the project;
(ii)
ensure that States with significant inequities in maternal and infant health outcomes, including severe maternal morbidity, and other inequities based on race, income, or access to maternity care, are included; and
(iii)
ensure that at least 1 territory is included.
(e) Grants
(1) In general
Subject to the availability of appropriations, the Secretary shall award 1 grant for each year of the demonstration project to each State that is selected to participate in the demonstration project.
(2) Use of grant funds
A State may use funds received under this section to—
(A)
award grants or make payments to eligible entities as part of an arrangement described in subsection (f)(2);
(B)
provide financial incentives to health care professionals, including community-based health care workers and community-based doulas, who participate in the State's maternity care home model;
(C)
provide adequate training for health care professionals, including community-based health care workers, doulas, and care coordinators, who participate in the State's maternity care home model, which may include training for cultural humility and antiracism, racial bias, health equity, reproductive and birth justice, trauma-informed care, home visiting skills, and respectful communication and listening skills, particularly in regards to maternal health;
(D)
pay for personnel and administrative expenses associated with designing, implementing, and operating the State's maternity care home model;
(E)
pay for items and services that are furnished under the State's maternity care home model and for which payment is otherwise unavailable under this title;
(F)
pay for services and materials to ensure culturally and linguistically appropriate communication, including—
(i)
language services such as interpreters and translation of written materials; and
(ii)
development of culturally and linguistically appropriate materials, as well as auxiliary aids and services; and
(G)
pay for other costs related to the State's maternity care home model, as determined by the Secretary.
(3) Grant for national independent evaluator
(A) In general
From the amounts appropriated under subsection (l), prior to awarding any grants under paragraph (1), the Secretary shall enter into a contract with a national external entity to create a single, uniform process to—
(i)
ensure that States that receive grants under paragraph (1) comply with the requirements of this section; and
(ii)
evaluate the outcomes of the demonstration project in each participating State.
(B) Annual report
The contract described in subparagraph (A) shall require the national external entity to submit to the Secretary—
(i)
a yearly evaluation report for each year of the demonstration project; and
(ii)
a final impact report after the demonstration project has concluded.
(C) Secretary's authority
Nothing in this paragraph shall prevent the Secretary from making a determination that a State is not in compliance with the requirements of this section without the national external entity making such a determination.
(f) Partnership with eligible entities
(1) In general
As a condition of receiving a grant under this section, a State shall enter into an arrangement with 1 or more eligible entities that meet the requirements of paragraph (2).
(2) Arrangements with eligible entities
Under an arrangement between a State and an eligible entity under this subsection, the eligible entity shall perform the following functions, with respect to eligible individuals enrolled with the entity under the State's maternity care home model:
(A)
Provide culturally and linguistically appropriate congruent care, which may include prenatal care, family planning services, medical care, mental and behavioral care, postpartum care, and oral health services to such eligible individuals through a team of health care professionals, which may include obstetrician-gynecologists, maternal-fetal medicine specialists, family physicians, primary care providers, oral health providers, physician assistants, advanced practice registered nurses (such as nurse practitioners and certified nurse midwives), certified midwives, certified professional midwives, physical therapists, social workers, traditional and community-based doulas, lactation consultants, childbirth educators, community health workers, peer mental health supporters, and other health care professionals.
(B)
Conduct a risk assessment of each such eligible individual to determine if their pregnancy is high or low risk, and, based on the results of such risk assessment, establish for each such eligible individual a tailored pregnancy care plan, which—
(i)
takes into consideration the individual's own preferences, pregnancy care, and birthing plans; and
(ii)
determines the appropriate support services to reduce the individual's medical, social, and environmental risk factors.
(C)
Assign each such eligible individual to a culturally and linguistically appropriate care coordinator, which may be a nurse, social worker, traditional or community-based doula, community health worker, midwife, or other health care provider, who is responsible for ensuring that such eligible individual receives the necessary medical care and connections to essential support services.
(D)
Provide, or arrange for the provision of, essential support services, such as services that address—
(i)
food access, nutrition, and exercise;
(ii)
smoking cessation;
(iii)
substance use disorder and addiction treatment;
(iv)
anxiety, depression, trauma, and other mental and behavioral health issues;
(v)
breastfeeding, chestfeeding, or other infant feeding options supports, initiation, continuation, and duration;
(vi)
stable, affordable, safe, and healthy housing;
(vii)
transportation;
(viii)
intimate partner violence;
(ix)
community and police violence;
(x)
home visiting services;
(xi)
childbirth and newborn care education;
(xii)
oral health education;
(xiii)
continuous labor support;
(xiv)
group prenatal care;
(xv)
family planning and contraceptive care and supplies; and
(xvi)
affordable child care.
(E)
As appropriate, facilitate connections to a usual primary care provider, which may be a reproductive health care provider.
(F)
Refer to guidelines and opinions of medical associations when determining whether an elective delivery should be performed on an eligible individual before 39 weeks of gestation.
(G)
Provide such eligible individual with evidence-based and culturally and linguistically appropriate education and resources to identify potential warning signs of pregnancy and postpartum complications, including information regarding when and how to obtain medical attention.
(H)
Provide, or arrange for the provision of, culturally and linguistically appropriate pregnancy and postpartum health services, including family planning counseling and services, to eligible individuals.
(I)
Track and report postpartum health and birth outcomes of such eligible individuals and their children.
(J)
Ensure that care is person-centered, culturally and linguistically appropriate, and patient-led, including by engaging eligible individuals in their own care, including through communication and education.
(K)
Ensure adequate training for appropriately serving the population of individuals who are eligible for medical assistance under the State plan (or waiver of such plan), including through reproductive justice, birth justice, birth equity, and anti-racist frameworks, home visiting skills, and knowledge of social services.
(g) Term of demonstration project
The Secretary shall conduct the demonstration project for a period of 5 years.
(h) Report
Not later than 18 months after the date of the enactment of this section and annually thereafter for each year of the demonstration project term, the Secretary shall submit a report to Congress on the results of the demonstration project, including—
(1)
the results of the final report of the national external entity required under subsection (e)(3)(B)(ii); and
(2)
recommendations on whether the model studied in the demonstration project should be continued or more widely adopted, including by private health plans.
(i) Waiver authority
To the extent that the Secretary determines necessary in order to carry out the demonstration project, the Secretary may waive section 1902(a)(1) (relating to statewideness) and section 1902(a)(10)(B) (relating to comparability).
(j) Technical assistance
The Secretary shall establish a process to provide technical assistance to States that are awarded grants under this section and to eligible entities and other providers participating in a State maternity care home model funded by such a grant.
(k) Definitions
In this section:
(1) Eligible entity
The term eligible entity means an entity or organization that provides medically accurate, comprehensive maternity services to individuals who are eligible for medical assistance under a State plan under this title or a waiver of such a plan, and may include:
(A)
A freestanding birth center.
(B)
An entity or organization receiving assistance under section 330 of the Public Health Service Act.
(C)
A federally qualified health center.
(D)
A rural health clinic.
(E)
A health facility operated by an Indian tribe or tribal organization (as those terms are defined in section 4 of the Indian Health Care Improvement Act).
(2) Eligible individual
The term eligible individual means a pregnant individual or a formerly pregnant individual during the 1-year period beginning on the last day of the pregnancy, or during such longer period beginning on the last day of the pregnancy as a State may elect, who is—
(A)
enrolled in a State plan under this title, a waiver of such a plan, or a State child health plan under title XXI; and
(B)
a patient of an eligible entity which has entered into an arrangement with a State under subsection (f).
(l) Authorization of appropriations
There are authorized to be appropriated to the Secretary, for each of fiscal years 2027 through 2034, such sums as may be necessary to carry out this section.
(c) Reapplication of Medicare payment rate floor to primary care services furnished under Medicaid and inclusion of additional providers
(1) Reapplication of payment floor; additional providers
(A) In general
Section 1902(a)(13) of the Social Security Act (42 U.S.C. 1396a(a)(13)) is amended—
(i)
in subparagraph (B), by striking ; and
and inserting a semicolon;
(ii)
in subparagraph (C), by striking the semicolon and inserting ; and
; and
(iii)
by adding at the end the following new subparagraph:
(D)
payment for primary care services (as defined in subsection (jj)(1)) furnished in the period that begins on the first day of the first month that begins after the date of enactment of this subparagraph by a provider described in subsection (jj)(2)—
(i)
at a rate that is not less than 100 percent of the payment rate that applies to such services and the provider of such services under part B of title XVIII;
(ii)
in the case of items and services that are not items and services provided under such part, at a rate to be established by the Secretary; and
(iii)
in the case of items and services that are furnished in rural areas (as defined in section 1886(d)(2)(D)), health professional shortage areas (as defined in section 332(a)(1)(A) of the Public Health Service Act (42 U.S.C. 254e(a)(1)(A))), or medically underserved areas (according to a designation under section 330(b)(3)(A) of the Public Health Service Act (42 U.S.C. 254b(b)(3)(A))), at the rate otherwise applicable to such items or services under clause (i) or (ii) increased, at the Secretary's discretion, by not more than 25 percent;
(B) Conforming amendments
(i)
Section 1902(a)(13)(C) of the Social Security Act (42 U.S.C. 1396a(a)(13)(C)) is amended by striking subsection (jj)
and inserting subsection (jj)(1)
.
(ii)
Section 1905(dd) of the Social Security Act (42 U.S.C. 1396d(dd)) is amended—
(I)
by striking Notwithstanding
and inserting the following:
(1) In general
Notwithstanding;
(II)
by striking section 1902(a)(13)(C)
and inserting subparagraph (C) of section 1902(a)(13)
;
(III)
by inserting or for services described in subparagraph (D) of section 1902(a)(13) furnished during an additional period specified in paragraph (2),
after 2015,
;
(IV)
by striking under such section
and inserting under subparagraph (C) or (D) of section 1902(a)(13), as applicable
; and
(V)
by adding at the end the following:
(2) Additional periods
For purposes of paragraph (1), an additional period includes the period that begins on the first day of the first month that begins after the date of enactment of this paragraph.
(2) Improved targeting of primary care
Section 1902(jj) of the Social Security Act (42 U.S.C. 1396a(jj)) is amended—
(A)
by redesignating paragraphs (1) and (2) as clauses (i) and (ii), respectively, and realigning the left margins accordingly;
(B)
by striking For purposes of subsection (a)(13)(C)
and inserting the following:
(1) In general
(A) Definition
For purposes of subparagraphs (C) and (D) of subsection (a)(13); and
(C)
by inserting after clause (ii) (as so redesignated) the following:
(B) Exclusions
Such term does not include any services described in subparagraph (A) if such services are provided in an emergency department of a hospital.
(2) Additional providers
For purposes of subparagraph (D) of subsection (a)(13), a provider described in this paragraph is any of the following:
(A)
A physician with a primary specialty designation of family medicine, general internal medicine, pediatric medicine, or obstetrics and gynecology.
(B)
An advanced practice clinician, as defined by the Secretary, that works under the supervision of—
(i)
a physician that satisfies the criteria specified in subparagraph (A);
(ii)
a nurse practitioner or a physician assistant (as such terms are defined in section 1861(aa)(5)(A)) who is working in accordance with State law; or
(iii)
or a certified nurse-midwife (as defined in section 1861(gg)) or a certified professional midwife who is working in accordance with State law.
(C)
A rural health clinic, federally qualified health center, health center that receives funding under title X of the Public Health Service Act, or other health clinic that receives reimbursement on a fee schedule applicable to a physician.
(D)
An advanced practice clinician supervised by a physician described in subparagraph (A), another advanced practice clinician, or a certified nurse-midwife.
(E)
A midwife who is working in accordance with State law.
(3) Ensuring payment by managed care entities
(A) In general
Section 1903(m)(2)(A) of the Social Security Act (42 U.S.C. 1396b(m)(2)(A)) is amended—
(i)
in clause (xii), by striking and
after the semicolon;
(ii)
by realigning the left margin of clause (xiii) so as to align with the left margin of clause (xii) and by striking the period at the end of clause (xiii) and inserting ; and
; and
(iii)
by inserting after clause (xiii) the following:
(xiv)
such contract provides that (I) payments to providers specified in section 1902(a)(13)(D) for primary care services (as defined in section 1902(jj)(1)) that are furnished during a year or period (as specified in section 1902(a)(13)(D) and section 1905(dd)) are at least equal to the amounts set forth and required by the Secretary by regulation; (II) the entity shall, upon request, provide documentation to the State, sufficient to enable the State and the Secretary to ensure compliance with subclause (I); and (III) the Secretary shall approve payments described in subclause (I) that are furnished through an agreed upon capitation, partial capitation, or other value-based payment arrangement if the capitation, partial capitation, or other value-based payment arrangement is based on a reasonable methodology and the entity provides documentation to the State sufficient to enable the State and the Secretary to ensure compliance with subclause (I).
(B) Conforming amendment
Section 1932(f) of the Social Security Act (42 U.S.C. 1396u–2(f)) is amended—
(i)
by striking section 1902(a)(13)(C)
and inserting subsections (C) and (D) of section 1902(a)(13)
; and
(ii)
by inserting , and clause (xiv) of section 1903(m)(2)(A)
before the period.
(d) MACPAC report and CMS guidance on increasing access to doula services for Medicaid beneficiaries
(1) MACPAC Report
(A) In general
Not later than 1 year after the date of the enactment of this Act, the Medicaid and CHIP Payment and Access Commission (referred to in this subsection as MACPAC) shall publish a report on the coverage of doula services under State Medicaid programs, which shall at a minimum include the following:
(i)
Information about coverage for doula services under State Medicaid programs that, as of the date of enactment of this Act, provide coverage for such care, including the type of doula services offered (such as prenatal, labor and delivery, postpartum support, as well as community-based and traditional doula services).
(ii)
An analysis of barriers to covering doula services under State Medicaid programs.
(iii)
An identification of effective strategies to increase the use of doula services in order to provide better care and achieve better maternal and infant health outcomes, including strategies that States may use to recruit, train, and certify a diverse doula workforce, particularly from underserved communities, communities of color, and communities facing linguistic or cultural barriers.
(iv)
Recommendations for legislative and administrative actions to increase access to doula services in State Medicaid programs, including actions that ensure doulas may earn a living wage that accounts for their time and costs associated with providing care, and to provide for the administration and operation of community-based doula programs.
(B) Stakeholder consultation
In developing the report required under subparagraph (A), MACPAC shall consult with relevant stakeholders, including—
(i)
States;
(ii)
organizations (especially reproductive justice and birth justice organizations led by people of color) representing consumers of maternal health care, including those that are disproportionately impacted by poor maternal health outcomes;
(iii)
organizations and individuals representing doulas, including community-based doula programs and those who serve underserved communities (including communities of color, and communities facing linguistic or cultural barriers);
(iv)
organizations representing health care providers; and
(v)
Black, Indigenous, and other maternal health care consumers of color who have experienced severe maternal morbidity.
(2) CMS guidance
(A) In general
Not later than 1 year after the date that MACPAC publishes the report required under paragraph (1)(A), the Administrator of the Centers for Medicare & Medicaid Services shall issue guidance to States on increasing access to doula services under Medicaid. Such guidance shall, at a minimum, include—
(i)
options for States to provide medical assistance for doula services under State Medicaid programs;
(ii)
best practices for ensuring that doulas, including community-based doulas, receive reimbursement for doula services provided under a State Medicaid program at a level that allows doulas to earn a living wage that accounts for their time and costs associated with providing care and community-based doula program administration; and
(iii)
best practices for increasing access to doula services, including services provided by community-based doulas, under State Medicaid programs.
(B) Stakeholder consultation
In developing the guidance required under subparagraph (A), the Administrator of the Centers for Medicare & Medicaid Services shall consult with MACPAC and other relevant stakeholders, including—
(i)
State Medicaid officials;
(ii)
organizations representing consumers of maternal health care, including those that are disproportionately impacted by poor maternal health outcomes;
(iii)
organizations representing doulas, including community-based doulas and those who serve underserved communities, such as communities of color and communities facing linguistic or cultural barriers; and
(iv)
organizations representing medical professionals.
(e) GAO report on State Medicaid programs’ use of telehealth to increase access to maternity care
Not later than 1 year after the date of the enactment of this Act, the Comptroller General of the United States shall submit a report to Congress on State Medicaid programs’ use of telehealth to increase access to maternity care. Such report shall include the following:
(1)
The number of State Medicaid programs that utilize telehealth that increases access to maternity care.
(2)
With respect to State Medicaid programs that utilize telehealth that increases access to maternity care, information about—
(A)
common characteristics of such programs' approaches to utilizing telehealth that increases access to maternity care;
(B)
differences in States’ approaches to utilizing telehealth to improve access to maternity care, and the resulting differences in State maternal health outcomes, as determined by factors described in subsection (C); and
(C)
when compared to patients who receive maternity care in person, what is known about—
(i)
the demographic characteristics, such as race, ethnicity, sex, sexual orientation, gender identity, disability status, age, and preferred language of the individuals enrolled in such programs who use telehealth to access maternity care;
(ii)
health outcomes for such individuals, including frequency of mortality and severe morbidity, as compared to individuals with similar characteristics who did not use telehealth to access maternity care;
(iii)
the services provided to individuals through telehealth, including family planning services, mental health care services, and oral health services;
(iv)
the devices and equipment provided to individuals for remote patient monitoring and telehealth, including blood pressure monitors and blood glucose monitors;
(v)
the quality of maternity care provided through telehealth, including whether maternity care provided through telehealth is culturally and linguistically appropriate;
(vi)
the level of patient satisfaction with maternity care provided through telehealth to individuals enrolled in State Medicaid programs;
(vii)
the impact of utilizing telehealth to increase access to maternity care on spending, cost savings, access to care, and utilization of care under State Medicaid programs; and
(viii)
the accessibility and effectiveness of telehealth for maternity care during the COVID–19 pandemic.
(3)
An identification and analysis of the barriers to using telehealth to increase access to maternity care under State Medicaid programs.
(4)
Recommendations for such legislative and administrative actions related to increasing access to telehealth maternity services under Medicaid as the Comptroller General deems appropriate.
Sec. 5203. Social determinants for moms
(a) Task force To develop a strategy To address social determinants of maternal health
(1) In general
The Secretary of Health and Human Services shall convene a task force (in this subsection referred to as the Task Force
) to develop a strategy to coordinate efforts between Federal agencies to address social determinants of maternal health with respect to pregnant and postpartum individuals.
(2) Ex officio members
The ex officio members of the Task Force shall consist of the following:
(A)
The Secretary of Health and Human Services (or a designee thereof).
(B)
The Secretary of Housing and Urban Development (or a designee thereof).
(C)
The Secretary of Transportation (or a designee thereof).
(D)
The Secretary of Agriculture (or a designee thereof).
(E)
The Secretary of Labor (or a designee thereof).
(F)
The Administrator of the Environmental Protection Agency (or a designee thereof).
(G)
The Assistant Secretary for the Administration for Children and Families (or a designee thereof).
(H)
The Administrator of the Centers for Medicare & Medicaid Services (or a designee thereof).
(I)
The Director of the Indian Health Service (or a designee thereof).
(J)
The Director of the National Institutes of Health (or a designee thereof).
(K)
The Administrator of the Health Resources and Services Administration (or a designee thereof).
(L)
The Deputy Assistant Secretary for Minority Health of the Department of Health and Human Services (or a designee thereof).
(M)
The Deputy Assistant Secretary for Women’s Health of the Department of Health and Human Services (or a designee thereof).
(N)
The Director of the Centers for Disease Control and Prevention (or a designee thereof).
(O)
The Director of the Office on Violence Against Women of the Department of Justice (or a designee thereof).
(3) Appointed members
In addition to the ex officio members of the Task Force, the Secretary of Health and Human Services shall appoint the following members of the Task Force:
(A)
At least two representatives of patients, to include—
(i)
a representative of patients who have suffered from severe maternal morbidity; or
(ii)
a representative of patients who is a family member of an individual who suffered a pregnancy-related death.
(B)
At least two leaders of community-based organizations that address maternal mortality and severe maternal morbidity with a specific focus on racial and ethnic inequities. In appointing such leaders under this subparagraph, the Secretary of Health and Human Services shall give priority to individuals who are leaders of organizations led by individuals from racial and ethnic minority groups.
(C)
At least two perinatal health workers.
(D)
A professionally diverse panel of maternity care providers.
(4) Chair
The Secretary of Health and Human Services shall select the chair of the Task Force from among the members of the Task Force.
(5) Report
Not later than 2 years after the date of enactment of this Act, the Task Force shall submit to Congress a report on—
(A)
the strategy developed under paragraph (1);
(B)
recommendations on funding amounts with respect to implementing such strategy; and
(C)
recommendations for how to expand coverage of social services to address social determinants of maternal health under Medicaid managed care organizations and State Medicaid programs.
(6) Termination
Section 1013 of title 5, United States Code, shall not apply to the Task Force with respect to termination.
(b) Housing for Moms grant program
(1) Definitions
In this subsection:
(A) Eligible entity
The term eligible entity means—
(i)
a community-based organization;
(ii)
a State or local governmental entity, including a State or local public health department;
(iii)
an Indian tribe or Tribal organization (as such terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304)); or
(iv)
an Urban Indian organization (as such term is defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)).
(B) Secretary
The term Secretary means the Secretary of Housing and Urban Development.
(2) Establishment
The Secretary shall establish a Housing for Moms grant program to make grants to eligible entities to increase access to safe, stable, affordable, and adequate housing for pregnant and postpartum individuals and their families.
(3) Application
To be eligible to receive a grant under this subsection, an eligible entity shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may provide.
(4) Priority
In awarding grants under this subsection, the Secretary shall give priority to an eligible entity that—
(A)
is a community-based organization or will partner with a community-based organization to implement initiatives to increase access to safe, stable, affordable, and adequate housing for pregnant and postpartum individuals and their families;
(B)
is operating in an area with high rates of adverse maternal health outcomes or significant racial or ethnic inequities in maternal health outcomes, to the extent such data are available; and
(C)
is operating in an area with a high poverty rate or a significant number of individuals who lack consistent access to safe, stable, affordable, and adequate housing.
(5) Use of funds
An eligible entity that receives a grant under this subsection shall use funds from the grant for the purposes of—
(A)
identifying and conducting outreach to pregnant and postpartum individuals who are low-income and lack consistent access to safe, stable, affordable, and adequate housing;
(B)
providing safe, stable, affordable, and adequate housing options to such individuals;
(C)
connecting such individuals with local organizations offering safe, stable, affordable, and adequate housing options;
(D)
providing application assistance to such individuals seeking to enroll in programs offering safe, stable, affordable, and adequate housing options;
(E)
providing direct financial assistance to such individuals for the purposes of maintaining safe, stable, and adequate housing for the duration of the individual’s pregnancy and postpartum periods; and
(F)
working with relevant stakeholders to ensure that local housing and homeless shelter infrastructure is supportive to pregnant and postpartum individuals, including through—
(i)
health-promoting housing codes;
(ii)
enforcement of housing codes;
(iii)
proactive rental inspection programs;
(iv)
code enforcement officer training; and
(v)
partnerships between regional offices of the Department of Housing and Urban Development and community-based organizations to ensure housing laws are understood and violations are discovered.
(6) Reporting
(A) Eligible entities
The Secretary shall require each eligible entity receiving a grant under this subsection to annually submit to the Secretary and make publicly available a report on the status of activities conducted using the grant.
(B) Secretary
Not later than the end of each fiscal year in which grants are made under this subsection, the Secretary shall submit to Congress and make publicly available a report that—
(i)
summarizes the reports received under subparagraph (A);
(ii)
evaluates the effectiveness of grants awarded under this subsection in increasing access to safe, stable, affordable, and adequate housing for pregnant and postpartum individuals and their families; and
(iii)
makes recommendations with respect to ensuring activities described in paragraph (5) continue after grant amounts made available under this subsection are expended.
(7) Authorization of appropriations
There is authorized to be appropriated to carry out this subsection $10,000,000 for fiscal year 2027, which shall remain available until expended.
(c) Department of Transportation
(1) Report
Not later than 1 year after the date of enactment of this Act, the Secretary of Transportation shall submit to Congress and make publicly available a report containing—
(A)
an assessment of transportation barriers preventing individuals from attending prenatal and postpartum appointments, accessing maternal health care services, or accessing services and resources related to social determinants of maternal health;
(B)
recommendations on how to overcome the barriers assessed under subparagraph (A); and
(C)
an assessment of transportation safety risks for pregnant individuals and recommendations on how to mitigate those risks.
(2) Considerations
In carrying out paragraph (1), the Secretary of Transportation shall give special consideration to solutions for—
(A)
pregnant and postpartum individuals living in a health professional shortage area designated under section 332 of the Public Health Service Act (42 U.S.C. 254e);
(B)
pregnant and postpartum individuals living in areas with high maternal mortality or severe morbidity rates or significant racial or ethnic inequities in maternal health outcomes; and
(C)
pregnant and postpartum individuals with a disability that impacts mobility.
(d) Department of Agriculture
(1) Special supplemental nutrition program for women, infants, and children
(A) Extension of postpartum period
Section 17(b)(10) of the Child Nutrition Act of 1966 (42 U.S.C. 1786(b)(10)) is amended by striking six
and inserting 24
.
(B) Report
Not later than 2 years after the date of enactment of this Act, the Secretary shall submit to Congress a report that evaluates the effect of the amendment made by subparagraph (A) on—
(i)
maternal and infant health outcomes, including racial and ethnic inequities with respect to those outcomes;
(ii)
breastfeeding rates among postpartum individuals;
(iii)
qualitative evaluations of family experiences under the special supplemental nutrition program for women, infants, and children established under section 17 of the Child Nutrition Act of 1966 (42 U.S.C. 1786); and
(iv)
other relevant information as determined by the Secretary.
(2) Grant program for healthy food and clean water for pregnant and postpartum individuals
(A) In general
The Secretary shall establish a program (referred to in this paragraph as the program
) to award grants, on a competitive basis, to eligible entities to carry out the activities described in subparagraph (D).
(B) Application
To be eligible for a grant under the program, an eligible entity shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary determines appropriate.
(C) Priority
In awarding grants under the program, the Secretary shall give priority to an eligible entity that—
(i)
is, or will partner with, an eligible entity described in paragraph (3)(A)(i); and
(ii)
is operating in an area with a high rate of—
(I)
adverse maternal health outcomes; or
(II)
significant racial or ethnic inequities in maternal health outcomes.
(D) Use of funds
An eligible entity shall use a grant awarded under the program to deliver healthy food, infant formula, clean water, or diapers to pregnant and postpartum individuals located in areas that are food deserts, as determined by the Secretary using data from the Food Access Research Atlas of the Department of Agriculture.
(E) Reports
(i) Eligible entities
Not later than 1 year after the date on which an eligible entity receives a grant under the program, and annually thereafter, the eligible entity shall submit to the Secretary a report on the status of activities conducted using the grant, which shall contain such information as the Secretary may require.
(ii) Secretary
(I) In general
Not later than 2 years after the date on which the first grant is awarded under the program, the Secretary shall submit to Congress a report that includes—
(aa)
a summary of the reports submitted by eligible entities under clause (i);
(bb)
an assessment of the extent to which food distributed using grants awarded under the program was purchased from local and regional food systems;
(cc)
an evaluation of the effect of the program on maternal and infant health outcomes, including racial and ethnic inequities with respect to those outcomes; and
(dd)
recommendations with respect to ensuring the activities described in subparagraph (D) continue after the grant period funding those activities expires.
(II) Publication
The Secretary shall make the report submitted under subclause (I) publicly available on the website of the Department of Agriculture.
(F) Authorization of appropriations
There is authorized to be appropriated to carry out the program $5,000,000 for the period of fiscal years 2027 through 2031.
(3) Definitions
In this subsection:
(A) Eligible entity
The term eligible entity means—
(i)
a community-based organization;
(ii)
a State or local governmental entity, including a State or local public health department;
(iii)
an Indian Tribe or Tribal organization (as those terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304)); and
(iv)
an Urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)).
(B) Secretary
The term Secretary means the Secretary of Agriculture.
(e) Environmental study through National Academies
(1) In general
Not later than 60 days after the date of enactment of this Act, the Administrator of the Environmental Protection Agency shall seek to enter into an agreement with the National Academies of Sciences, Engineering, and Medicine (referred to in this subsection as the National Academies
) under which the National Academies agree to conduct a study on the impacts of, with respect to maternal and infant health incomes, water and air quality, exposure to extreme temperatures, environmental chemicals, environmental risks in the workplace and the home, and pollution levels.
(2) Study requirements
The agreement under paragraph (1) shall direct the National Academies to make recommendations for—
(A)
improving environmental conditions to improve maternal and infant health outcomes; and
(B)
reducing or eliminating racial and ethnic inequities in those outcomes.
(3) Report
The agreement under paragraph (1) shall direct the National Academies to complete the study under this subsection, and submit to Congress and make publicly available a report on the results of the study, not later than 1 year after the date of enactment of this Act.
(f) Child care access
(1) Grant program
The Secretary of Health and Human Services (in this subsection referred to as the Secretary
) shall award grants to eligible organizations to carry out programs to provide pregnant and postpartum individuals with free and accessible drop-in child care services during prenatal and postpartum appointments.
(2) Application
To be eligible to receive a grant under this subsection, an eligible entity shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(3) Eligible organizations
(A) Eligibility
To be eligible to receive a grant under this subsection, an organization shall be an organization that—
(i)
provides child care services; and
(ii)
can carry out a program providing pregnant and postpartum individuals with free and accessible drop-in child care services during prenatal and postpartum appointments.
(B) Prioritization
In selecting grant recipients under this subsection, the Secretary shall give priority to eligible organizations that operate in an area that has, to the extent data with respect to such an area are available—
(i)
high rates of adverse maternal health outcomes; or
(ii)
significant racial or ethnic inequities in maternal health outcomes.
(4) Timing
The Secretary shall commence the grant program under paragraph (1) not later than 1 year after the date of enactment of this Act.
(5) Reporting
(A) Grantees
Each recipient of a grant under this subsection shall annually submit to the Secretary and make publicly available a report on the status of activities conducted using the grant. Each such report shall include—
(i)
an analysis of the effect of the funded program on prenatal and postpartum appointment attendance rates;
(ii)
summaries of qualitative assessments of the funded program from—
(I)
pregnant and postpartum individuals participating in the program; and
(II)
the families of such individuals; and
(iii)
such additional information as the Secretary may require.
(B) Secretary
Not later than the end of fiscal year 2027, the Secretary shall submit to the Congress, and make publicly available, a report containing each of the following:
(i)
A summary of the reports received under subparagraph (A).
(ii)
An assessment of the effects, if any, of the funded programs on maternal health outcomes, with a specific focus on racial and ethnic inequities in such outcomes.
(iii)
A description of actions the Secretary can take to ensure that pregnant and postpartum individuals eligible for medical assistance under a State plan under title XIX of the Social Security Act (42 U.S.C. 1936 et seq.) have access to free and accessible drop-in child care services during prenatal and postpartum appointments, including identification of the funding necessary to carry out such actions.
(6) Drop-In child care services defined
In this subsection, the term drop-in child care services means child care (including early childhood education) services that are—
(A)
delivered at a facility that meets the requirements of all applicable laws and regulations of the State or local government in which it is located, including the requirements for licensing of the facility as a child care facility; and
(B)
provided in single encounters without requiring full-time enrollment of a person in a child care program.
(7) Authorization of appropriations
To carry out this subsection, there is authorized to be appropriated $5,000,000 for the period of fiscal years 2027 through 2029.
(g) Grants to local entities addressing social determinants of maternal health
(1) In general
The Secretary of Health and Human Services (in this subsection referred to as the Secretary
) shall award grants to eligible entities to—
(A)
address social determinants of maternal health for pregnant and postpartum individuals; and
(B)
eliminate racial and ethnic inequities in maternal health outcomes.
(2) Application
To be eligible to receive a grant under this subsection an eligible entity shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may provide.
(3) Prioritization
In awarding grants under paragraph (1), the Secretary shall give priority to an eligible entity that—
(A)
is a community-based organization, or will partner with a community-based organization to carry out the activities under paragraph (4);
(B)
is operating in an area with high rates of adverse maternal health outcomes or significant racial or ethnic inequities in maternal health outcomes; and
(C)
is operating in an area with a high poverty rate.
(4) Activities
An eligible entity that receives a grant under this subsection may use funds received through the grant to—
(A)
hire and retain staff;
(B)
develop and distribute a list of available resources with respect to social service programs in a community;
(C)
establish a resource center that provides multiple social service programs in a single location;
(D)
offer programs and resources in the communities in which the respective eligible entities are located to address social determinants of health for pregnant and postpartum individuals; and
(E)
consult with such pregnant and postpartum individuals to conduct an assessment of the activities under this paragraph.
(5) Technical assistance
The Secretary shall provide to grant recipients under this subsection technical assistance to plan for sustaining programs to address social determinants of maternal health among pregnant and postpartum individuals after the period of the grant.
(6) Reporting
(A) Grantees
Not later than 1 year after the date on which an eligible entity first receives a grant under this subsection, and annually thereafter, an eligible entity shall submit to the Secretary, and make publicly available, a report on the status of activities conducted using the grant. Each such report shall include data on the effects of such activities, disaggregated by race, ethnicity, gender, and other relevant factors.
(B) Secretary
Not later than the end of fiscal year 2031, the Secretary shall submit to Congress a report that includes—
(i)
a summary of the reports received under subparagraph (A); and
(ii)
recommendations for—
(I)
improving maternal health outcomes; and
(II)
reducing or eliminating racial and ethnic inequities in maternal health outcomes.
(7) Authorization of appropriations
There is authorized to be appropriated to carry out this subsection $15,000,000 for each of fiscal years 2027 through 2031.
(h) Definitions
In this section:
(1) Culturally congruent
The term culturally congruent, with respect to care or maternity care provided to a health care consumer, means care that is in agreement with the preferred cultural values, beliefs, worldview, language, and practices of the health care consumer and other relevant stakeholders.
(2) Maternity care provider
The term maternity care provider means a health care provider who—
(A)
is a physician, physician assistant, midwife who meets at a minimum the international definition of the midwife and global standards for midwifery education as established by the International Confederation of Midwives, nurse practitioner, or clinical nurse specialist; and
(B)
has a focus on maternal or perinatal health.
(3) Maternal mortality
The term maternal mortality means a death occurring during or within a one-year period after pregnancy, caused by pregnancy-related or childbirth complications, including a suicide, overdose, or other death resulting from a mental health or substance use disorder attributed to or aggravated by pregnancy-related or childbirth complications.
(4) Perinatal health worker
The term perinatal health worker means a doula, community health worker, peer supporter, breastfeeding and lactation educator or counselor, nutritionist or dietitian, childbirth educator, social worker, home visitor, language interpreter, or navigator.
(5) Postpartum and postpartum period
The terms postpartum and postpartum period refer to the 1-year period beginning on the last day of the pregnancy of an individual.
(6) Racial and ethnic minority group
The term racial and ethnic minority group has the meaning given such term in section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 300u–6(g)(1)).
(7) Severe maternal morbidity
The term severe maternal morbidity means a health condition, including mental health conditions and substance use disorders, attributed to or aggravated by pregnancy or childbirth that results in significant short-term or long-term consequences to the health of the individual who was pregnant.
(8) Social determinants of maternal health defined
The term social determinants of maternal health means non-clinical factors that impact maternal health outcomes, including—
(A)
economic factors, which may include poverty, employment, food security, support for and access to lactation and other infant feeding options, housing stability, and related factors;
(B)
neighborhood factors, which may include quality of housing, access to transportation, access to child care, availability of healthy foods and nutrition counseling, availability of clean water, air and water quality, ambient temperatures, neighborhood crime and violence, access to broadband, and related factors;
(C)
social and community factors, which may include systemic racism, gender discrimination or discrimination based on other protected classes, workplace conditions, incarceration, and related factors;
(D)
household factors, which may include ability to conduct lead testing and abatement, car seat installation, indoor air temperatures, and related factors;
(E)
education access and quality factors, which may include educational attainment, language and literacy, and related factors; and
(F)
health care access factors, including health insurance coverage, access to culturally congruent health care services, providers, and non-clinical support, access to home visiting services, access to wellness and stress management programs, health literacy, access to telehealth and items required to receive telehealth services, and related factors.
Sec. 5204. Kira Johnson Act
(a) Investments in community-Based organizations To improve Black maternal health outcomes
(1) Awards
Following the 1-year period described in paragraph (3), the Secretary of Health and Human Services (in this subsection referred to as the Secretary
) shall award grants to eligible entities to establish or expand programs to prevent maternal mortality and severe maternal morbidity among Black pregnant and postpartum individuals.
(2) Eligibility
To be eligible to seek a grant under this subsection, an entity shall be a community-based organization offering programs and resources aligned with evidence-based practices for improving maternal health outcomes for Black pregnant and postpartum individuals.
(3) Outreach and technical assistance period
During the 1-year period beginning on the date of enactment of this Act, the Secretary shall—
(A)
conduct outreach to encourage eligible entities to apply for grants under this subsection; and
(B)
provide technical assistance to eligible entities on best practices for applying for grants under this subsection.
(4) Special consideration
(A) Outreach
In conducting outreach under paragraph (3), the Secretary shall give special consideration to eligible entities that—
(i)
are based in, and provide support for, communities with high rates of adverse maternal health outcomes or significant racial and ethnic inequities in maternal health outcomes, to the extent such data are available;
(ii)
are led by Black people; and
(iii)
offer programs and resources that are aligned with evidence-based practices for improving maternal health outcomes for Black pregnant and postpartum individuals.
(B) Awards
In awarding grants under this subsection, the Secretary shall give special consideration to eligible entities that—
(i)
are described in clauses (i), (ii), and (iii) of subparagraph (A);
(ii)
offer programs and resources designed in consultation with and intended for Black pregnant and postpartum individuals; and
(iii)
offer programs and resources in the communities in which the respective eligible entities are located that—
(I)
promote maternal mental health and maternal substance use disorder treatments and supports that are aligned with evidence-based practices for improving maternal mental and behavioral health outcomes for Black pregnant and postpartum individuals;
(II)
address social determinants of maternal health for pregnant and postpartum individuals;
(III)
promote evidence-based health literacy and pregnancy, childbirth, and parenting education for pregnant and postpartum individuals;
(IV)
provide support from perinatal health workers to pregnant and postpartum individuals;
(V)
provide culturally congruent training to perinatal health workers;
(VI)
conduct or support research on maternal health issues disproportionately impacting Black pregnant and postpartum individuals;
(VII)
provide support to family members of individuals who suffered a pregnancy-associated death or pregnancy-related death;
(VIII)
operate midwifery practices that provide culturally congruent maternal health care and support, including for the purposes of—
(aa)
supporting additional education, training, and certification programs, including support for distance learning;
(bb)
providing financial support to current and future midwives to address education costs, debts, and other needs;
(cc)
clinical site investments;
(dd)
supporting preceptor development trainings;
(ee)
expanding the midwifery practice; or
(ff)
related needs identified by the midwifery practice and described in the practice’s application; or
(IX)
have developed other programs and resources that address community-specific needs for pregnant and postpartum individuals and are aligned with evidence-based practices for improving maternal health outcomes for Black pregnant and postpartum individuals.
(5) Technical assistance
The Secretary shall provide to grant recipients under this subsection technical assistance on—
(A)
capacity building to establish or expand programs to prevent adverse maternal health outcomes among Black pregnant and postpartum individuals;
(B)
best practices in data collection, measurement, evaluation, and reporting; and
(C)
planning for sustaining programs to prevent maternal mortality and severe maternal morbidity among Black pregnant and postpartum individuals after the period of the grant.
(6) Evaluation
Not later than the end of fiscal year 2031, the Secretary shall submit to the Congress an evaluation of the grant program under this subsection that—
(A)
assesses the effectiveness of outreach efforts during the application process in diversifying the pool of grant recipients;
(B)
makes recommendations for future outreach efforts to diversify the pool of grant recipients for Department of Health and Human Services grant programs and funding opportunities related to maternal health;
(C)
assesses the effectiveness of programs funded by grants under this subsection in improving maternal health outcomes for Black pregnant and postpartum individuals, to the extent practicable; and
(D)
makes recommendations for future Department of Health and Human Services grant programs and funding opportunities that deliver funding to community-based organizations that provide programs and resources that are aligned with evidence-based practices for improving maternal health outcomes for Black pregnant and postpartum individuals.
(7) Authorization of appropriations
To carry out this subsection, there is authorized to be appropriated $10,000,000 for each of fiscal years 2027 through 2031.
(b) Investments in community-Based organizations To improve maternal health outcomes in underserved communities
(1) Awards
Following the 1-year period described in paragraph (3), the Secretary of Health and Human Services (in this subsection referred to as the Secretary
) shall award grants to eligible entities to establish or expand programs to prevent maternal mortality and severe maternal morbidity among underserved groups.
(2) Eligibility
To be eligible to seek a grant under this subsection, an entity shall be a community-based organization offering programs and resources aligned with evidence-based practices for improving maternal health outcomes for pregnant and postpartum individuals.
(3) Outreach and technical assistance period
During the 1-year period beginning on the date of enactment of this Act, the Secretary shall—
(A)
conduct outreach to encourage eligible entities to apply for grants under this subsection; and
(B)
provide technical assistance to eligible entities on best practices for applying for grants under this subsection.
(4) Special consideration
(A) Outreach
In conducting outreach under paragraph (3), the Secretary shall give special consideration to eligible entities that—
(i)
are based in, and provide support for, communities with high rates of adverse maternal health outcomes or significant racial and ethnic inequities in maternal health outcomes, to the extent such data are available;
(ii)
are led by individuals from racially, ethnically, and geographically diverse backgrounds; and
(iii)
offer programs and resources that are aligned with evidence-based practices for improving maternal health outcomes for pregnant and postpartum individuals.
(B) Awards
In awarding grants under this subsection, the Secretary shall give special consideration to eligible entities that—
(i)
are described in clauses (i), (ii), and (iii) of subparagraph (A);
(ii)
offer programs and resources designed in consultation with and intended for pregnant and postpartum individuals from underserved groups;
(iii)
offer programs and resources in the communities in which the respective eligible entities are located that—
(I)
promote maternal mental health and maternal substance use disorder treatments and support that are aligned with evidence-based practices for improving maternal mental and behavioral health outcomes for pregnant and postpartum individuals;
(II)
address social determinants of maternal health for pregnant and postpartum individuals;
(III)
promote evidence-based health literacy and pregnancy, childbirth, and parenting education for pregnant and postpartum individuals;
(IV)
provide support from perinatal health workers to pregnant and postpartum individuals;
(V)
provide culturally congruent training to perinatal health workers;
(VI)
conduct or support research on maternal health outcomes and inequities;
(VII)
provide support to family members of individuals who suffered a pregnancy-associated death or pregnancy-related death; or
(VIII)
operate midwifery practices that provide culturally congruent maternal health care and support, including for the purposes of—
(aa)
supporting additional education, training, and certification programs, including support for distance learning;
(bb)
providing financial support to current and future midwives to address education costs, debts, and other needs;
(cc)
clinical site investments;
(dd)
supporting preceptor development trainings;
(ee)
expanding the midwifery practice; or
(ff)
related needs identified by the midwifery practice and described in the practice’s application; or
(iv)
have developed other programs and resources that address community-specific needs for pregnant and postpartum individuals and are aligned with evidence-based practices for improving maternal health outcomes for pregnant and postpartum individuals.
(5) Technical assistance
The Secretary shall provide to grant recipients under this subsection technical assistance on—
(A)
capacity building to establish or expand programs to prevent adverse maternal health outcomes among pregnant and postpartum individuals from underserved groups;
(B)
best practices in data collection, measurement, evaluation, and reporting; and
(C)
planning for sustaining programs to prevent maternal mortality and severe maternal morbidity among pregnant and postpartum individuals from underserved groups after the period of the grant.
(6) Evaluation
Not later than the end of fiscal year 2031, the Secretary shall submit to the Congress an evaluation of the grant program under this subsection that—
(A)
assesses the effectiveness of outreach efforts during the application process in diversifying the pool of grant recipients;
(B)
makes recommendations for future outreach efforts to diversify the pool of grant recipients for Department of Health and Human Services grant programs and funding opportunities related to maternal health;
(C)
assesses the effectiveness of programs funded by grants under this subsection in improving maternal health outcomes for pregnant and postpartum individuals from underserved groups, to the extent practicable; and
(D)
makes recommendations for future Department of Health and Human Services grant programs and funding opportunities that deliver funding to community-based organizations that provide programs and resources that are aligned with evidence-based practices for improving maternal health outcomes for pregnant and postpartum individuals.
(7) Definition
In this subsection, the term underserved groups refers to pregnant and postpartum individuals—
(A)
from racial and ethnic minority groups;
(B)
whose household income is equal to or less than 150 percent of the Federal poverty line;
(C)
who live in health professional shortage areas (as such term is defined in section 332 of the Public Health Service Act (42 U.S.C. 254e));
(D)
who live in counties with no hospital offering obstetric care, no birth center, and no obstetric provider; or
(E)
who live in counties with a level of vulnerability of moderate-to-high or higher, according to the Social Vulnerability Index of the Centers for Disease Control and Prevention.
(8) Authorization of appropriations
To carry out this subsection, there is authorized to be appropriated $10,000,000 for each of fiscal years 2027 through 2031.
(c) Respectful maternity care training for all employees in maternity care settings
Part B of title VII of the Public Health Service Act (42 U.S.C. 293 et seq.) (as amended by section 3002), is amended by adding at the end the following:
743. Respectful maternity care training for all employees in maternity care settings
(a) Grants
The Secretary shall award grants for programs to reduce and prevent bias, racism, and discrimination in maternity care settings and to advance respectful, culturally congruent, trauma-informed care.
(b) Special consideration
In awarding grants under subsection (a), the Secretary shall give special consideration to applications for programs that would—
(1)
apply to all maternity care providers and any employees who interact with pregnant and postpartum individuals in the provider setting, including front desk employees, sonographers, schedulers, health care professionals, hospital or health system administrators, security staff, and other employees;
(2)
emphasize periodic, as opposed to one-time, trainings for all birthing professionals and employees described in paragraph (1);
(3)
address implicit bias, racism, and cultural humility;
(4)
be delivered in ongoing education settings for providers maintaining their licenses, with a preference for trainings that provide continuing education units;
(5)
include trauma-informed care best practices and an emphasis on shared decision making between providers and patients;
(6)
include antiracism training and programs;
(7)
be delivered in undergraduate programs that funnel into health professions schools;
(8)
be delivered in settings that apply to providers of the special supplemental nutrition program for women, infants, and children under section 17 of the Child Nutrition Act of 1966;
(9)
integrate bias training in obstetric emergency simulation trainings or related trainings;
(10)
include training for emergency department employees and emergency medical technicians on recognizing warning signs for severe pregnancy-related complications;
(11)
offer training to all maternity care providers on the value of racially, ethnically, and professionally diverse maternity care teams to provide culturally congruent care; or
(12)
be based on one or more programs designed by a historically Black college or university or other minority-serving institution.
(c) Application
To seek a grant under subsection (a), an entity shall submit an application at such time, in such manner, and containing such information as the Secretary may require.
(d) Reporting to Secretary
Each recipient of a grant under this section shall annually submit to the Secretary a report on the status of activities conducted using the grant, including, as applicable, a description of the impact of training provided through the grant on patient outcomes and patient experience for pregnant and postpartum individuals from racial and ethnic minority groups and their families.
(e) Dissemination of findings
Based on the annual reports submitted pursuant to subsection (d), the Secretary—
(1)
shall produce an annual report on the findings resulting from programs funded through this section;
(2)
shall disseminate such report to all recipients of grants under this section and to the public; and
(3)
may include in such report findings on best practices for improving patient outcomes and patient experience for pregnant and postpartum individuals from racial and ethnic minority groups and their families in maternity care settings.
(f) Definitions
In this section:
(1) Culturally congruent
The term culturally congruent means in agreement with the preferred cultural values, beliefs, world view, language, and practices of the health care consumer and other stakeholders.
(2) Maternity care provider
The term maternity care provider means a health care provider who—
(A)
is a physician, physician assistant, midwife who meets at a minimum the international definition of the midwife and global standards for midwifery education as established by the International Confederation of Midwives, nurse practitioner, or clinical nurse specialist; and
(B)
has a focus on maternal or perinatal health.
(3) Postpartum
The term postpartum means the one-year period beginning on the last day of an individual’s pregnancy.
(4) Racial and ethnic minority group
The term racial and ethnic minority group has the meaning given such term in section 1707(g)(1).
(g) Authorization of appropriations
To carry out this section, there is authorized to be appropriated $5,000,000 for each of fiscal years 2027 through 2031.
(d) Study on reducing and preventing bias, racism, and discrimination in maternity care settings
(1) In general
The Secretary of Health and Human Services shall seek to enter into an agreement, not later than 90 days after the date of enactment of this Act, with the National Academies of Sciences, Engineering, and Medicine (referred to in this subsection as the National Academies
) under which the National Academies agree to—
(A)
conduct a study on the design and implementation of programs to reduce and prevent bias, racism, and discrimination in maternity care settings and to advance respectful, culturally congruent, trauma-informed care; and
(B)
not later than 2 years after the date of enactment of this Act—
(i)
complete the study; and
(ii)
transmit a report on the results of the study to the Congress.
(2) Possible topics
The agreement entered into pursuant to paragraph (1) may provide for the study of any of the following:
(A)
The development of a scorecard or other evaluation standards for programs designed to reduce and prevent bias, racism, and discrimination in maternity care settings to assess the effectiveness of such programs in improving patient outcomes and patient experience for pregnant and postpartum individuals from racial and ethnic minority groups and their families.
(B)
Determination of the types and frequency of training to reduce and prevent bias, racism, and discrimination in maternity care settings that are demonstrated to improve patient outcomes or patient experience for pregnant and postpartum individuals from racial and ethnic minority groups and their families.
(e) Respectful maternity care compliance program
(1) In general
The Secretary of Health and Human Services (referred to in this subsection as the Secretary
) shall award grants to accredited hospitals, health systems, and other maternity care settings to establish as an integral part of quality implementation initiatives within one or more hospitals or other birth settings a respectful maternity care compliance program.
(2) Program requirements
A respectful maternity care compliance program funded through a grant under this subsection shall—
(A)
institutionalize mechanisms to allow patients receiving maternity care services, the families of such patients, or perinatal health workers supporting such patients to report instances of racism or evidence of bias on the basis of race, ethnicity, or another protected class;
(B)
institutionalize response mechanisms through which representatives of the program can directly follow up with the patient, if possible, and the patient’s family in a timely manner;
(C)
prepare, and make publicly available, a hospital- or health system-wide strategy to reduce bias on the basis of race, ethnicity, or another protected class in the delivery of maternity care that includes—
(i)
information on the training programs to reduce and prevent bias, racism, and discrimination on the basis of race, ethnicity, or another protected class for all employees in maternity care settings;
(ii)
information on the number of cases reported to the compliance program; and
(iii)
the development of methods to routinely assess the extent to which bias, racism, or discrimination on the basis of race, ethnicity, or another protected class are present in the delivery of maternity care to patients from racial and ethnic minority groups;
(D)
develop mechanisms to routinely collect and publicly report hospital-level data related to patient-reported experience of care; and
(E)
provide annual reports to the Secretary with information about each case reported to the compliance program over the course of the year containing such information as the Secretary may require, such as—
(i)
de-identified demographic information on the patient in the case, such as race, ethnicity, gender identity, and primary language;
(ii)
the content of the report from the patient or the family of the patient to the compliance program;
(iii)
the response from the compliance program; and
(iv)
to the extent applicable, institutional changes made as a result of the case.
(3) Secretary requirements
(A) Processes
Not later than 180 days after the date of enactment of this Act, the Secretary shall establish processes for—
(i)
disseminating best practices for establishing and implementing a respectful maternity care compliance program within a hospital or other birth setting;
(ii)
promoting coordination and collaboration between hospitals, health systems, and other maternity care delivery settings on the establishment and implementation of respectful maternity care compliance programs; and
(iii)
evaluating the effectiveness of respectful maternity care compliance programs on maternal health outcomes and patient and family experiences, especially for patients from racial and ethnic minority groups and their families.
(B) Study
(i) In general
Not later than 2 years after the date of enactment of this Act, the Secretary shall, through a contract with an independent research organization, conduct a study on strategies to address—
(I)
racism or bias on the basis of race, ethnicity, or another protected class in the delivery of maternity care services; and
(II)
successful implementation of respectful care initiatives.
(ii) Components of study
The study shall include the following:
(I)
An assessment of the reports submitted to the Secretary from the respectful maternity care compliance programs pursuant to paragraph (2)(E).
(II)
Based on such assessment, recommendations for potential accountability mechanisms related to cases of racism or bias on the basis of race, ethnicity, or another protected class in the delivery of maternity care services at hospitals and other birth settings. Such recommendations shall take into consideration medical and non-medical factors that contribute to adverse patient experiences and maternal health outcomes.
(iii) Report
The Secretary shall submit to the Congress, and make publicly available, a report on the results of the study under this subparagraph.
(4) Authorization of appropriations
To carry out this subsection, there is authorized to be appropriated such sums as may be necessary for fiscal years 2027 through 2032.
(f) GAO report
(1) In general
Not later than 2 years after the date of enactment of this Act and annually thereafter, the Comptroller General of the United States shall submit to the Congress, and make publicly available, a report on the establishment of respectful maternity care compliance programs within hospitals, health systems, and other maternity care settings.
(2) Matters included
The report under paragraph (1) shall include the following:
(A)
Information regarding the extent to which hospitals, health systems, and other maternity care settings have elected to establish respectful maternity care compliance programs, including—
(i)
which hospitals and other birth settings elect to establish compliance programs and when such programs are established;
(ii)
to the extent practicable, impacts of the establishment of such programs on maternal health outcomes and patient and family experiences in the hospitals and other birth settings that have established such programs, especially for patients from racial and ethnic minority groups and their families;
(iii)
information on geographic areas, and types of hospitals or other birth settings, where respectful maternity care compliance programs are not being established and information on factors contributing to decisions to not establish such programs; and
(iv)
recommendations for establishing respectful maternity care compliance programs in geographic areas, and types of hospitals or other birth settings, where such programs are not being established.
(B)
Whether the funding made available to carry out this subsection has been sufficient and, if applicable, recommendations for additional appropriations to carry out this subsection.
(C)
Such other information as the Comptroller General determines appropriate.
(g) Definitions
In this section:
(1) Culturally congruent
The term culturally congruent, with respect to care or maternity care, means care that is in agreement with the preferred cultural values, beliefs, worldview, language, and practices of the health care consumer and other stakeholders.
(2) Maternity care provider
The term maternity care provider means a health care provider who—
(A)
is a physician, physician assistant, midwife who meets at a minimum the international definition of the midwife and global standards for midwifery education as established by the International Confederation of Midwives, nurse practitioner, or clinical nurse specialist; and
(B)
has a focus on maternal or perinatal health.
(3) Maternal mortality
The term maternal mortality means a death occurring during or within a one-year period after pregnancy, caused by pregnancy-related or childbirth complications, including a suicide, overdose, or other death resulting from a mental health or substance use disorder attributed to or aggravated by pregnancy-related or childbirth complications.
(4) Perinatal health worker
The term perinatal health worker means a doula, community health worker, peer supporter, breastfeeding and lactation educator or counselor, nutritionist or dietitian, childbirth educator, social worker, home visitor, language interpreter, or navigator.
(5) Postpartum and postpartum period
The terms postpartum and postpartum period mean the 1-year period beginning on the last day of the pregnancy of an individual.
(6) Pregnancy-associated death
The term pregnancy-associated death means a death of a pregnant or postpartum individual, by any cause, that occurs during, or within 1 year following, the individual’s pregnancy, regardless of the outcome, duration, or site of the pregnancy.
(7) Pregnancy-related death
The term pregnancy-related death means a death of a pregnant or postpartum individual that occurs during, or within 1 year following, the individual’s pregnancy, from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy.
(8) Racial and ethnic minority group
The term racial and ethnic minority group has the meaning given such term in section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 300u–6(g)(1)).
(9) Severe maternal morbidity
The term severe maternal morbidity means a health condition, including mental health conditions and substance use disorders, attributed to or aggravated by pregnancy or childbirth that results in significant short-term or long-term consequences to the health of the individual who was pregnant.
(10) Social determinants of maternal health defined
The term social determinants of maternal health means non-clinical factors that impact maternal health outcomes, including—
(A)
economic factors, which may include poverty, employment, food security, support for and access to lactation and other infant feeding options, housing stability, and related factors;
(B)
neighborhood factors, which may include quality of housing, access to transportation, access to child care, availability of healthy foods and nutrition counseling, availability of clean water, air and water quality, ambient temperatures, neighborhood crime and violence, access to broadband, and related factors;
(C)
social and community factors, which may include systemic racism, gender discrimination or discrimination based on other protected classes, workplace conditions, incarceration, and related factors;
(D)
household factors, which may include ability to conduct lead testing and abatement, car seat installation, indoor air temperatures, and related factors;
(E)
education access and quality factors, which may include educational attainment, language and literacy, and related factors; and
(F)
health care access factors, including health insurance coverage, access to culturally congruent health care services, providers, and non-clinical support, access to home visiting services, access to wellness and stress management programs, health literacy, access to telehealth and items required to receive telehealth services, and related factors.
Sec. 5205. Perinatal workforce
(a) HHS agency directives
(1) Guidance to States
(A) In general
Not later than 2 years after the date of enactment of this Act, the Secretary of Health and Human Services shall issue and disseminate guidance to States to educate providers, managed care entities, and other insurers about the value and process of delivering respectful maternal health care through diverse and multidisciplinary care provider models.
(B) Contents
The guidance required by subparagraph (A) shall address how States can encourage and incentivize hospitals, health systems, midwifery practices, freestanding birth centers, other maternity care provider groups, managed care entities, and other insurers—
(i)
to recruit and retain maternity care providers, mental and behavioral health care providers acting in accordance with State law, registered dietitians or nutrition professionals (as such term is defined in section 1861(vv)(2) of the Social Security Act (42 U.S.C. 1395x(vv)(2))), and lactation consultants certified by the International Board of Lactation Consultants Examiners—
(I)
from racially, ethnically, and linguistically diverse backgrounds;
(II)
with experience practicing in racially and ethnically diverse communities; and
(III)
who have undergone training on implicit bias and racism;
(ii)
to incorporate into maternity care teams—
(I)
midwives who meet, at a minimum, the international definition of the midwife and global standards for midwifery education, as established by the International Confederation of Midwives; and
(II)
perinatal health workers;
(iii)
to provide collaborative, culturally congruent care; and
(iv)
to provide opportunities for individuals enrolled in accredited midwifery education programs to participate in job shadowing with maternity care teams in hospitals, health systems, midwifery practices, and freestanding birth centers.
(2) Study on respectful and culturally congruent maternity care
(A) Study
The Secretary of Health and Human Services, acting through the Director of the National Institutes of Health (in this paragraph referred to as the Secretary
), shall conduct a study on best practices in respectful and culturally congruent maternity care.
(B) Report
Not later than 2 years after the date of enactment of this Act, the Secretary shall—
(i)
complete the study required by subparagraph (A);
(ii)
submit to the Congress, and make publicly available, a report on the results of such study; and
(iii)
include in such report—
(I)
a compendium of examples of hospitals, health systems, midwifery practices, freestanding birth centers, other maternity care provider groups, managed care entities, and other insurers that are delivering respectful and culturally congruent maternal health care;
(II)
a compendium of examples of hospitals, health systems, midwifery practices, freestanding birth centers, other maternity care provider groups, managed care entities, and other insurers that have made progress in reducing inequities in maternal health outcomes and improving birthing experiences for pregnant and postpartum individuals from racial and ethnic minority groups; and
(III)
recommendations to hospitals, health systems, midwifery practices, freestanding birth centers, other maternity care provider groups, managed care entities, and other insurers, for best practices in respectful and culturally congruent maternity care.
(b) Grants To grow and diversify the perinatal workforce
Title VII of the Public Health Service Act is amended by inserting after section 757 (42 U.S.C. 294f) the following:
758. Perinatal workforce grants
(a) In general
The Secretary shall award grants to entities to establish or expand programs described in subsection (b) to grow and diversify the perinatal workforce.
(b) Use of funds
Recipients of grants under this section shall use the grants to grow and diversify the perinatal workforce by—
(1)
establishing schools or programs that provide education and training to individuals seeking appropriate licensing or certification as—
(A)
physician assistants who will complete clinical training in the field of maternal and perinatal health; or
(B)
perinatal health workers; and
(2)
expanding the capacity of existing schools or programs described in paragraph (1), for the purposes of increasing the number of students enrolled in such schools or programs, including by awarding scholarships for students.
(c) Prioritization
In awarding grants under this section, the Secretary shall give priority to any entity that—
(1)
has demonstrated a commitment to recruiting and retaining students and faculty from racial and ethnic minority groups;
(2)
has developed a strategy to recruit and retain a diverse pool of students into the perinatal workforce program or school supported by funds received through the grant, particularly from racial and ethnic minority groups and other underserved populations;
(3)
has developed a strategy to recruit and retain students who plan to practice in a health professional shortage area designated under section 332;
(4)
has developed a strategy to recruit and retain students who plan to practice in an area with significant racial and ethnic inequities in maternal health outcomes, to the extent practicable; and
(5)
includes in the standard curriculum for all students within the perinatal workforce program or school a bias, racism, or discrimination training program that includes training on implicit bias and racism.
(d) Reporting
As a condition on receipt of a grant under this section for a perinatal workforce program or school, an entity shall agree to submit to the Secretary an annual report on the activities conducted through the grant, including—
(1)
the number and demographics of students participating in the program or school;
(2)
the extent to which students in the program or school are entering careers in—
(A)
health professional shortage areas designated under section 332; and
(B)
areas with significant racial and ethnic inequities in maternal health outcomes, to the extent such data are available; and
(3)
whether the program or school has included in the standard curriculum for all students a bias, racism, or discrimination training program that includes explicit and implicit bias, and if so the effectiveness of such training program.
(e) Period of grants
The period of a grant under this section shall not exceed 5 years.
(f) Application
To seek a grant under this section, an entity shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require, including any information necessary for prioritization under subsection (c).
(g) Technical assistance
The Secretary shall provide, directly or by contract, technical assistance to entities seeking or receiving a grant under this section on the development, use, evaluation, and post-grant period sustainability of the perinatal workforce programs or schools proposed to be, or being, established or expanded through the grant.
(h) Report by the Secretary
Not later than 4 years after the date of enactment of this section, the Secretary shall prepare and submit to the Congress, and post on the internet website of the Department of Health and Human Services, a report on the effectiveness of the grant program under this section at—
(1)
recruiting students from racial and ethnic minority groups;
(2)
increasing the number of physician assistants who will complete clinical training in the field of maternal and perinatal health, and perinatal health workers, from racial and ethnic minority groups and other underserved populations;
(3)
increasing the number of physician assistants who will complete clinical training in the field of maternal and perinatal health, and perinatal health workers, working in health professional shortage areas designated under section 332; and
(4)
increasing the number of physician assistants who will complete clinical training in the field of maternal and perinatal health, and perinatal health workers, working in areas with significant racial and ethnic inequities in maternal health outcomes, to the extent such data are available.
(i) Definition of racial and ethnic minority group
In this section, the term racial and ethnic minority group has the meaning given such term in section 1707(g).
(j) Authorization of appropriations
To carry out this section, there is authorized to be appropriated $15,000,000 for each of fiscal years 2027 through 2031.
(c) Grants To grow and diversify the nursing workforce in maternal and perinatal health
Title VIII of the Public Health Service Act is amended by inserting after section 811 (42 U.S.C. 296j) the following:
812. Perinatal nursing workforce grants
(a) In general
The Secretary shall award grants to schools of nursing to grow and diversify the perinatal nursing workforce.
(b) Use of funds
Recipients of grants under this section shall use the grants to grow and diversify the perinatal nursing workforce by providing scholarships to students seeking to become—
(1)
nurse practitioners whose education includes a focus on maternal and perinatal health; or
(2)
clinical nurse specialists whose education includes a focus on maternal and perinatal health.
(c) Prioritization
In awarding grants under this section, the Secretary shall give priority to any school of nursing that—
(1)
has developed a strategy to recruit and retain a diverse pool of students seeking to enter careers focused on maternal and perinatal health, particularly students from racial and ethnic minority groups and other underserved populations;
(2)
has developed a partnership with a practice setting in a health professional shortage area designated under section 332 for the clinical placements of the school’s students;
(3)
has developed a strategy to recruit and retain students who plan to practice in an area with significant racial and ethnic inequities in maternal health outcomes, to the extent practicable; and
(4)
includes in the standard curriculum for all students seeking to enter careers focused on maternal and perinatal health a bias, racism, or discrimination training program that includes education on implicit bias and racism.
(d) Reporting
As a condition on receipt of a grant under this section, a school of nursing shall agree to submit to the Secretary an annual report on the activities conducted through the grant, including, to the extent practicable—
(1)
the number and demographics of students in the school of nursing seeking to enter careers focused on maternal and perinatal health;
(2)
the extent to which such students are preparing to enter careers in—
(A)
health professional shortage areas designated under section 332; and
(B)
areas with significant racial and ethnic inequities in maternal health outcomes, to the extent such data are available; and
(3)
whether the standard curriculum for all students seeking to enter careers focused on maternal and perinatal health includes a bias, racism, or discrimination training program that includes education on implicit bias and racism.
(e) Period of grants
The period of a grant under this section shall be up to 5 years.
(f) Application
To seek a grant under this section, an entity shall submit to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require, including any information necessary for prioritization under subsection (c).
(g) Technical assistance
The Secretary shall provide, directly or by contract, technical assistance to schools of nursing seeking or receiving a grant under this section on the processes of awarding and evaluating scholarships through the grant.
(h) Report by the Secretary
Not later than 4 years after the date of enactment of this section, the Secretary shall prepare and submit to the Congress, and post on the internet website of the Department of Health and Human Services, a report on the effectiveness of the grant program under this section at—
(1)
recruiting students from racial and ethnic minority groups and other underserved populations;
(2)
increasing the number of nurse practitioners and clinical nurse specialists entering careers focused on maternal and perinatal health from racial and ethnic minority groups and other underserved populations;
(3)
increasing the number of nurse practitioners and clinical nurse specialists entering careers focused on maternal and perinatal health working in health professional shortage areas designated under section 332; and
(4)
increasing the number of nurse practitioners and clinical nurse specialists entering careers focused on maternal and perinatal health working in areas with significant racial and ethnic inequities in maternal health outcomes, to the extent such data are available.
(i) Authorization of appropriations
To carry out this section, there is authorized to be appropriated $15,000,000 for each of fiscal years 2027 through 2031.
(d) GAO report
(1) In general
Not later than 2 years after the date of enactment of this Act, and every 5 years thereafter, the Comptroller General of the United States shall submit to Congress a report on barriers to maternal health education and access to care in the United States. Such report shall include the information and recommendations described in paragraph (2).
(2) Content of report
The report under paragraph (1) shall include—
(A)
an assessment of current barriers to entering accredited midwifery education programs, and recommendations for addressing such barriers, particularly for low-income people and people from racial and ethnic minority groups;
(B)
an assessment of current barriers to entering and successfully completing accredited education programs for other health professional careers related to maternity care, including maternity care providers, mental and behavioral health care providers acting in accordance with State law, registered dietitians or nutrition professionals (as such term is defined in section 1861(vv)(2) of the Social Security Act (42 U.S.C. 1395x(vv)(2))), and lactation consultants certified by the International Board of Lactation Consultants Examiners, particularly for low-income people and people from racial and ethnic minority groups;
(C)
an assessment of current barriers that prevent midwives from meeting the international definition of the midwife and global standards for midwifery education as established by the International Confederation of Midwives, and recommendations for addressing such barriers, particularly for low-income people and people from racial and ethnic minority groups;
(D)
an assessment of inequities in access to maternity care providers, mental or behavioral health care providers acting in accordance with State law, registered dietitians or nutrition professionals (as such term is defined in section 1861(vv)(2) of the Social Security Act (42 U.S.C. 1395x(vv)(2))), lactation consultants certified by the International Board of Lactation Consultants Examiners, and perinatal health workers, stratified by race, ethnicity, gender identity, geographic location, and insurance type and recommendations to promote greater access equity; and
(E)
recommendations to promote greater equity in compensation for perinatal health workers under public and private insurers, particularly for such individuals from racially and ethnically diverse backgrounds.
(e) Definitions
In this section:
(1) Culturally congruent
The term culturally congruent, with respect to care or maternity care, means care that is in agreement with the preferred cultural values, beliefs, worldview, language, and practices of the health care consumer and other stakeholders.
(2) Maternity care provider
The term maternity care provider means a health care provider who—
(A)
is a physician, physician assistant, midwife who meets at a minimum the international definition of the midwife and global standards for midwifery education as established by the International Confederation of Midwives, nurse practitioner, or clinical nurse specialist; and
(B)
has a focus on maternal or perinatal health.
(3) Perinatal health worker
The term perinatal health worker means a doula, community health worker, peer supporter, breastfeeding and lactation educator or counselor, nutritionist or dietitian, childbirth educator, social worker, home visitor, language interpreter, or navigator.
(4) Postpartum
The terms postpartum means the 1-year period beginning on the last day of the pregnancy of an individual.
(5) Racial and ethnic minority group
The term racial and ethnic minority group has the meaning given such term in section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 300u–6(g)(1)).
Sec. 5206. Data to Save Moms Act
(a) Short title
This section may be cited as the Data To Save Moms Act
.
(b) Funding for maternal mortality review committees To promote representative community engagement
(1) In general
Section 317K(d) of the Public Health Service Act (42 U.S.C. 247b–12(d)) is amended by adding at the end the following:
(9) Grants to promote representative community engagement in maternal mortality review committees
(A) In general
The Secretary may, using funds made available pursuant to subparagraph (C), provide assistance to an applicable maternal mortality review committee of a State, Indian tribe, tribal organization, or Urban Indian organization (as such terms are defined in section 4 of the Indian Health Care Improvement Act)—
(i)
to select for inclusion in the membership of such a committee community members from the State, Indian tribe, tribal organization, or Urban Indian organization by—
(I)
prioritizing community members who can increase the diversity of the committee’s membership with respect to race and ethnicity, location, and professional background, including members with non-clinical experiences; and
(II)
to the extent applicable, using funds reserved under subsection (g), to address barriers to maternal mortality review committee participation for community members, including through providing required training, reducing transportation barriers, providing compensation, and providing other supports as may be necessary;
(ii)
to establish initiatives to conduct outreach and community engagement efforts within communities throughout the State or Indian tribe to seek input from community members on the work of such maternal mortality review committee, with a particular focus on outreach to people who are members of minority groups; and
(iii)
to release public reports assessing—
(I)
the pregnancy-related death and pregnancy-associated death review processes of the maternal mortality review committee, with a particular focus on the maternal mortality review committee’s sensitivity to the unique circumstances of pregnant and postpartum individuals from racial and ethnic minority groups (as such term is defined in section 1707(g)(1)) who have suffered pregnancy-related deaths; and
(II)
the impact of the use of funds made available pursuant to paragraph (C) on increasing the diversity of the maternal mortality review committee membership and promoting community engagement efforts throughout the State or Indian tribe.
(B) Technical assistance
The Secretary shall provide (either directly through the Department of Health and Human Services or by contract) technical assistance to any maternal mortality review committee receiving a grant under this paragraph on best practices for increasing the diversity of the maternal mortality review committee’s membership and for conducting effective community engagement throughout the State or Indian tribe.
(C) Authorization of appropriations
In addition to any funds made available under subsection (g), there are authorized to be appropriated to carry out this paragraph $10,000,000 for each of fiscal years 2027 through 2031.
(2) Reservation of funds
Section 317K(g) of the Public Health Service Act (42 U.S.C. 247b–12(g)) is amended—
(A)
by striking 2026 through 2030
and inserting 2027 through 2031
; and
(B)
by adding at the end the following: Of the amount made available under the preceding sentence for a fiscal year, not less than $1,500,000 shall be reserved for grants awarded under subsection (d)(9) to Indian tribes, tribal organizations, or Urban Indian organizations (as such terms are defined in section 4 of the Indian Health Care Improvement Act).
.
(c) Data collection and review
Section 317K(d)(3)(A)(i) of the Public Health Service Act (42 U.S.C. 247b–12(d)(3)(A)(i)) is amended—
(1)
by redesignating subclauses (II) and (III) as subclauses (V) and (VI), respectively; and
(2)
by inserting after subclause (I) the following:
(II)
to the extent practicable, reviewing cases of severe maternal morbidity, according to the most up-to-date indicators;
(III)
to the extent practicable, reviewing deaths during pregnancy or up to 1 year after the end of a pregnancy from suicide, overdose, or other death from a mental health condition or substance use disorder attributed to, or aggravated by, pregnancy or childbirth complications;
(IV)
to the extent practicable, consulting with local community-based organizations representing pregnant and postpartum individuals from demographic groups disproportionately impacted by poor maternal health outcomes to ensure that, in addition to clinical factors, non-clinical factors that might have contributed to a pregnancy-related death are appropriately considered;
(d) Review of maternal health data collection processes and quality measures
(1) In general
The Secretary of Health and Human Services, acting through the Administrator for the Centers for Medicare & Medicaid Services and the Director of the Agency for Healthcare Research and Quality (referred to in this subsection as the Secretary
), shall consult with relevant stakeholders—
(A)
to review existing maternal health data collection processes and quality measures; and
(B)
to make recommendations to improve such processes and measures, including topics described in paragraph (3).
(2) Collaboration
In carrying out this subsection, the Secretary shall consult with a diverse group of maternal health stakeholders, which may include—
(A)
pregnant and postpartum individuals and their family members, and nonprofit organizations representing such individuals, with a particular focus on patients from racial and ethnic minority groups;
(B)
community-based organizations that provide support for pregnant and postpartum individuals, with a particular focus on patients from racial and ethnic minority groups;
(C)
membership organizations for maternity care providers;
(D)
organizations representing perinatal health workers;
(E)
organizations that focus on maternal mental or behavioral health;
(F)
organizations that focus on intimate partner violence;
(G)
institutions of higher education, with a particular focus on minority-serving institutions;
(H)
licensed and accredited hospitals, birth centers, midwifery practices, or other medical practices that provide maternal health care services to pregnant and postpartum patients;
(I)
relevant State and local public agencies, including State maternal mortality review committees; and
(J)
the National Quality Forum, or such other standard-setting organizations specified by the Secretary.
(3) Topics
The review of maternal health data collection processes and recommendations to improve such processes and measures required under paragraph (1) shall assess all available relevant information, including information from State-level sources, and shall consider at least the following:
(A)
Current State and Tribal practices for maternal health, maternal mortality, and severe maternal morbidity data collection and dissemination, including consideration of—
(i)
the timeliness of processes for amending a death certificate when new information pertaining to the death becomes available to reflect whether the death was a pregnancy-related death;
(ii)
relevant data collected with electronic health records, including data on race, ethnicity, socioeconomic status, insurance type, and other relevant demographic information;
(iii)
maternal health data collected and publicly reported by hospitals, health systems, midwifery practices, and birth centers;
(iv)
the barriers preventing States from correlating maternal outcome data with race and ethnicity data;
(v)
processes for determining the cause of a pregnancy-associated death in States that do not have a maternal mortality review committee;
(vi)
whether maternal mortality review committees include multidisciplinary and diverse membership (as described in section 317K(d)(1)(A) of the Public Health Service Act (42 U.S.C. 247b–12(d)(1)(A)));
(vii)
whether members of maternal mortality review committees participate in trainings on bias, racism, or discrimination, and the quality of such trainings;
(viii)
the extent to which States have implemented systematic processes of listening to the stories of pregnant and postpartum individuals and their family members, with a particular focus on pregnant and postpartum individuals from racial and ethnic minority groups and their family members, to fully understand the causes of, and inform potential solutions to, the maternal mortality and severe maternal morbidity crisis within their respective States;
(ix)
the extent to which maternal mortality review committees are considering social determinants of maternal health when examining the causes of pregnancy-associated and pregnancy-related deaths;
(x)
the extent to which maternal mortality review committees are making actionable recommendations based on their reviews of adverse maternal health outcomes and the extent to which such recommendations are being implemented by appropriate stakeholders;
(xi)
the legal and administrative barriers preventing the collection, collation, and dissemination of State maternity care data;
(xii)
the effectiveness of data collection and reporting processes in separating pregnancy-associated deaths from pregnancy-related deaths; and
(xiii)
the current Federal, State, local, and Tribal funding support for the activities referred to in clauses (i) through (xii).
(B)
Whether the funding support referred to in subparagraph (A)(xiii) is adequate for States to carry out optimal data collection and dissemination processes with respect to maternal health, maternal mortality, and severe maternal morbidity.
(C)
Current quality measures for maternity care, including prenatal measures, labor and delivery measures, and postpartum measures, including topics such as—
(i)
effective quality measures for maternity care used by hospitals, health systems, midwifery practices, birth centers, health plans, and other relevant entities;
(ii)
the sufficiency of current outcome measures used to evaluate maternity care for driving improved care, experiences, and outcomes in maternity care payment and delivery system models;
(iii)
maternal health quality measures that other countries effectively use;
(iv)
validated measures that have been used for research purposes that could be tested, refined, and submitted for national endorsement;
(v)
barriers preventing maternity care providers and insurers from implementing quality measures that are aligned with best practices;
(vi)
the frequency with which maternity care quality measures are reviewed and revised;
(vii)
the strengths and weaknesses of the Prenatal and Postpartum Care measures of the Health Plan Employer Data and Information Set measures established by the National Committee for Quality Assurance;
(viii)
the strengths and weaknesses of maternity care quality measures under the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) and the Children’s Health Insurance Program under title XXI of such Act (42 U.S.C. 1397aa et seq.), including the extent to which States voluntarily report relevant measures;
(ix)
the extent to which maternity care quality measures are informed by patient experiences that include measures of patient-reported experience of care;
(x)
the current processes for collecting stratified data on the race and ethnicity of pregnant and postpartum individuals in hospitals, health systems, midwifery practices, and birth centers, and for incorporating such racially and ethnically stratified data in maternity care quality measures;
(xi)
the extent to which maternity care quality measures account for the unique experiences of pregnant and postpartum individuals from racial and ethnic minority groups; and
(xii)
the extent to which hospitals, health systems, midwifery practices, and birth centers are implementing existing maternity care quality measures.
(D)
Recommendations on authorizing additional funds and providing additional technical assistance to improve maternal mortality review committees and State and Tribal maternal health data collection and reporting processes.
(E)
Recommendations for new authorities that may be granted to maternal mortality review committees to be able to—
(i)
access records from other Federal and State agencies and departments that may be necessary to identify causes of pregnancy-associated and pregnancy-related deaths that are unique to pregnant and postpartum individuals from specific populations, such as veterans and individuals who are incarcerated; and
(ii)
work with relevant experts who are not members of the maternal mortality review committee to assist in the review of pregnancy-associated deaths of pregnant and postpartum individuals from specific populations, such as veterans and individuals who are incarcerated.
(F)
Recommendations to improve and standardize current quality measures for maternity care, with a particular focus on racial and ethnic inequities in maternal health outcomes.
(G)
Recommendations to improve the coordination by the Department of Health and Human Services of the efforts undertaken by the agencies and organizations within the Department related to maternal health data and quality measures.
(4) Report
Not later than 1 year after the date of enactment of this Act, the Secretary shall submit to Congress, and make publicly available, a report on the results of the review of maternal health data collection processes and quality measures and recommendations to improve such processes and measures required under paragraph (1).
(5) Definition of maternal mortality review committee
In this subsection, the term maternal mortality review committee means a maternal mortality review committee duly authorized by a State and receiving funding under section 317K(a)(2)(D) of the Public Health Service Act (42 U.S.C. 247b–12(a)(2)(D)).
(6) Authorization of appropriations
There are authorized to be appropriated such sums as may be necessary to carry out this subsection for each of fiscal years 2027 through 2031.
(e) Indian Health Service study on maternal mortality and severe maternal morbidity
(1) In general
The Director of the Indian Health Service (referred to in this subsection as the Director
) shall, in coordination with entities described in paragraph (2)—
(A)
not later than 90 days after the date of enactment of this Act, enter into a contract with an independent research organization or Tribal Epidemiology Center to conduct a comprehensive study on maternal mortality and severe maternal morbidity in the populations of American Indian and Alaska Native individuals; and
(B)
not later than 3 years after the date of enactment of this Act, submit to Congress a report on that study that contains recommendations for policies and practices that can be adopted to improve maternal health outcomes for pregnant and postpartum American Indian and Alaska Native individuals.
(2) Participating entities
(A) In general
The entities referred to in paragraph (1) shall consist of 12 members, selected by the Director from among individuals nominated by Indian Tribes and Tribal organizations (as those terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304)) and Urban Indian organizations (as defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)).
(B) Requirement
In selecting members under subparagraph (A), the Director shall ensure that each of the 12 service areas of the Indian Health Service are represented.
(3) Contents of study
The study conducted pursuant to paragraph (1)(A) shall—
(A)
examine the causes of maternal mortality and severe maternal morbidity that are unique to American Indian and Alaska Native individuals;
(B)
include a systematic process of listening to the stories of American Indian and Alaska Native pregnant and postpartum individuals to fully understand the causes of, and inform potential solutions to, the maternal mortality and severe maternal morbidity crisis within the communities of those individuals;
(C)
distinguish between the causes of, landscape of maternity care at, and recommendations to improve maternal health outcomes within the different settings in which American Indian and Alaska Native pregnant and postpartum individuals receive maternity care, including—
(i)
facilities operated by the Indian Health Service;
(ii)
an Indian health program operated by an Indian Tribe or a Tribal organization (as those terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304)) pursuant to a contract, grant, cooperative agreement, or compact with the Indian Health Service pursuant to the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5301 et seq.); and
(iii)
an Urban Indian health program operated by an Urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)) pursuant to a grant or contract with the Indian Health Service pursuant to title V of the Indian Health Care Improvement Act (25 U.S.C. 1651 et seq.);
(D)
review processes for coordinating programs of the Indian Health Service with social services provided through other programs administered by the Secretary of Health and Human Services (other than the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), the Medicaid program under title XIX of that Act (42 U.S.C. 1396 et seq.), and the State Children’s Health Insurance Program under title XXI of that Act (42 U.S.C. 1397aa et seq.));
(E)
review current data collection and quality measurement processes and practices;
(F)
assess causes and frequency of maternal mental health conditions and substance use disorders;
(G)
consider social determinants of health, including poverty, lack of health insurance, unemployment, sexual violence, and environmental conditions in Tribal areas;
(H)
consider the role that historical mistreatment of American Indian and Alaska Native people has played in causing currently high rates of maternal mortality and severe maternal morbidity;
(I)
consider how current funding of the Indian Health Service affects the ability of the Indian Health Service to deliver quality maternity care;
(J)
consider the extent to which the delivery of maternity care services is culturally appropriate for American Indian and Alaska Native pregnant and postpartum individuals;
(K)
make recommendations to reduce misclassification of American Indian and Alaska Native pregnant and postpartum individuals, including consideration of best practices in training for maternal mortality review committee members to be able to correctly classify American Indian and Alaska Native individuals; and
(L)
make recommendations informed by the stories shared by American Indian and Alaska Native pregnant and postpartum individuals pursuant to subparagraph (B) to improve maternal health outcomes for those individuals.
(4) Report
The agreement entered into under paragraph (1)(A) with an independent research organization or Tribal Epidemiology Center shall require that the independent research organization or Tribal Epidemiology Center, as applicable, submit to Congress a report on the results of the study conducted pursuant to that agreement not later than 36 months after the date of enactment of this Act.
(5) Authorization of appropriations
There is authorized to be appropriated to carry out this subsection $2,000,000 for each of fiscal years 2027 through 2029.
(f) Grants to minority-Serving institutions To study maternal mortality, severe maternal morbidity, and other adverse maternal health outcomes
(1) In general
The Secretary of Health and Human Services (referred to in this subsection as the Secretary
) shall establish a program under which the Secretary shall award grants to research centers, health professions schools and programs, and other entities at minority-serving institutions to study specific aspects of the maternal health crisis among pregnant and postpartum individuals from racial and ethnic minority groups. Such research may—
(A)
include the development and implementation of systematic processes of listening to the stories of pregnant and postpartum individuals from racial and ethnic minority groups, and perinatal health workers supporting such individuals, to fully understand the causes of, and inform potential solutions to, the maternal mortality and severe maternal morbidity crisis within their respective communities;
(B)
assess the potential causes of relatively low rates of maternal mortality among Hispanic individuals, including potential racial misclassification and other data collection and reporting issues that might be misrepresenting maternal mortality rates among Hispanic individuals in the United States; and
(C)
assess differences in rates of adverse maternal health outcomes among subgroups identifying as Hispanic.
(2) Application
To be eligible to receive a grant under paragraph (1), an entity described in such paragraph shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(3) Technical assistance
The Secretary may use not more than 10 percent of the funds made available under paragraph (7)—
(A)
to conduct outreach to minority-serving institutions to raise awareness of the availability of grants under paragraph (1);
(B)
to provide technical assistance in the application process for such a grant; and
(C)
to promote capacity building, as needed to enable entities described in such paragraph to submit such an application.
(4) Reporting requirement
Each entity awarded a grant under this subsection shall periodically submit to the Secretary a report on the status of activities conducted using the grant.
(5) Evaluation
Beginning one year after the date on which the first grant is awarded under this subsection, the Secretary shall submit to Congress an annual report summarizing the findings of research conducted using funds made available under this subsection.
(6) Minority-Serving institutions defined
In this subsection, the term minority-serving institution means an eligible institution described in section 371(a) of the Higher Education Act of 1965 (20 U.S.C. 1067q(a)).
(7) Authorization of appropriations
There are authorized to be appropriated to carry out this subsection $10,000,000 for each of fiscal years 2027 through 2031.
(g) Definitions
In this section:
(1) Culturally congruent
The term culturally congruent, with respect to care or maternity care, means care that is in agreement with the preferred cultural values, beliefs, worldview, language, and practices of the health care consumer and other stakeholders.
(2) Maternity care provider
The term maternity care provider means a health care provider who—
(A)
is a physician, physician assistant, midwife who meets at a minimum the international definition of the midwife and global standards for midwifery education as established by the International Confederation of Midwives, nurse practitioner, or clinical nurse specialist; and
(B)
has a focus on maternal or perinatal health.
(3) Maternal mortality
The term maternal mortality means a death occurring during or within a one-year period after pregnancy, caused by pregnancy-related or childbirth complications, including a suicide, overdose, or other death resulting from a mental health or substance use disorder attributed to or aggravated by pregnancy-related or childbirth complications.
(4) Perinatal health worker
The term perinatal health worker means a doula, community health worker, peer supporter, breastfeeding and lactation educator or counselor, nutritionist or dietitian, childbirth educator, social worker, home visitor, language interpreter, or navigator.
(5) Postpartum and postpartum period
The terms postpartum and postpartum period mean the 1-year period beginning on the last day of the pregnancy of an individual.
(6) Pregnancy-associated
The term pregnancy-associated, with respect to a death, means a death of a pregnant or postpartum individual, by any cause, that occurs during, or within 1 year following, the individual’s pregnancy, regardless of the outcome, duration, or site of the pregnancy.
(7) Pregnancy-related
The term pregnancy-related, with respect to a death, means a death of a pregnant or postpartum individual that occurs during, or within 1 year following, the individual’s pregnancy, from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy.
(8) Racial and ethnic minority group
The term racial and ethnic minority group has the meaning given such term in section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 300u–6(g)(1)).
(9) Severe maternal morbidity
The term severe maternal morbidity means a health condition, including mental health conditions and substance use disorders, attributed to or aggravated by pregnancy or childbirth that results in significant short-term or long-term consequences to the health of the individual who was pregnant.
(10) Social determinants of maternal health
The term social determinants of maternal health means non-clinical factors that impact maternal health outcomes, including—
(A)
economic factors, which may include poverty, employment, food security, support for and access to lactation and other infant feeding options, housing stability, and related factors;
(B)
neighborhood factors, which may include quality of housing, access to transportation, access to child care, availability of healthy foods and nutrition counseling, availability of clean water, air and water quality, ambient temperatures, neighborhood crime and violence, access to broadband, and related factors;
(C)
social and community factors, which may include systemic racism, gender discrimination or discrimination based on other protected classes, workplace conditions, incarceration, and related factors;
(D)
household factors, which may include ability to conduct lead testing and abatement, car seat installation, indoor air temperatures, and related factors;
(E)
education access and quality factors, which may include educational attainment, language and literacy, and related factors; and
(F)
health care access factors, including health insurance coverage, access to culturally congruent health care services, providers, and non-clinical support, access to home visiting services, access to wellness and stress management programs, health literacy, access to telehealth and items required to receive telehealth services, and related factors.
Sec. 5207. Moms matter
(a) Maternal mental health equity grant program
(1) In general
The Secretary shall establish a program to award grants to eligible entities to address maternal mental health conditions and substance use disorders with respect to pregnant and postpartum individuals, with a focus on racial and ethnic minority groups.
(2) Application
To be eligible to receive a grant under this subsection, an eligible entity shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may provide, including how such entity will use funds for activities described in paragraph (4) that are culturally congruent.
(3) Priority
In awarding grants under this subsection, the Secretary shall give priority to an eligible entity that—
(A)
is, or will partner with, a community-based organization to address maternal mental health conditions and substance use disorders described in paragraph (1);
(B)
is operating in an area with high rates of—
(i)
adverse maternal health outcomes; or
(ii)
significant racial or ethnic inequities in maternal health outcomes; and
(C)
is operating in a health professional shortage area designated under section 332 of the Public Health Service Act (42 U.S.C. 254e).
(4) Use of funds
An eligible entity that receives a grant under this subsection shall use funds for the following:
(A)
Establishing or expanding maternity care programs to improve the integration of maternal health and behavioral health care services into primary care settings where pregnant individuals regularly receive health care services.
(B)
Establishing or expanding group prenatal care programs or postpartum care programs.
(C)
Expanding existing programs that improve maternal mental and behavioral health during the prenatal and postpartum periods, with a focus on individuals from racial and ethnic minority groups.
(D)
Providing services and support for pregnant and postpartum individuals with maternal mental health conditions and substance use disorders, including referrals to addiction treatment centers that offer evidence-based treatment options.
(E)
Addressing stigma associated with maternal mental health conditions and substance use disorders, with a focus on racial and ethnic minority groups.
(F)
Raising awareness of warning signs of maternal mental health conditions and substance use disorders, with a focus on pregnant and postpartum individuals from racial and ethnic minority groups.
(G)
Establishing or expanding programs to prevent suicide or self-harm among pregnant and postpartum individuals.
(H)
Offering evidence-aligned programs at freestanding birth centers that provide maternal mental and behavioral health care education, treatments, and services, and other services for individuals throughout the prenatal and postpartum period.
(I)
Establishing or expanding programs to provide education and training to maternity care providers with respect to—
(i)
identifying potential warning signs for maternal mental health conditions or substance use disorders in pregnant and postpartum individuals, with a focus on individuals from racial and ethnic minority groups; and
(ii)
in the case where such providers identify such warning signs, offering referrals to mental and behavioral health care professionals.
(J)
Developing a website, or other source, that includes information on health care providers who treat maternal mental health conditions and substance use disorders.
(K)
Establishing or expanding programs in communities to improve coordination between maternity care providers and mental and behavioral health care providers who treat maternal mental health conditions and substance use disorders, including through the use of toll-free hotlines.
(L)
Carrying out other programs aligned with evidence-based practices for addressing maternal mental health conditions and substance use disorders for pregnant and postpartum individuals from racial and ethnic minority groups.
(5) Reporting
(A) Eligible entities
An eligible entity that receives a grant under paragraph (1) shall submit annually to the Secretary, and make publicly available, a report on the activities conducted using funds received through a grant under this subsection. Such reports shall include quantitative and qualitative evaluations of such activities, including the experience of individuals who received health care through such grant.
(B) Secretary
Not later than the end of fiscal year 2028, the Secretary shall submit to Congress a report that includes—
(i)
a summary of the reports received under subparagraph (A);
(ii)
an evaluation of the effectiveness of grants awarded under this subsection;
(iii)
recommendations with respect to expanding coverage of evidence-based screenings and treatments for maternal mental health conditions and substance use disorders; and
(iv)
recommendations with respect to ensuring activities described under paragraph (4) continue after the end of a grant period.
(6) Definitions
In this subsection:
(A) Culturally congruent
The term culturally congruent, with respect to care or maternity care, means care that is in agreement with the preferred cultural values, beliefs, worldview, language, and practices of the health care consumer and other stakeholders.
(B) Eligible entity
The term eligible entity means—
(i)
a community-based organization serving pregnant and postpartum individuals, including such organizations serving individuals from racial and ethnic minority groups and other underserved populations;
(ii)
a nonprofit or patient advocacy organization with expertise in maternal mental and behavioral health;
(iii)
a maternity care provider;
(iv)
a mental or behavioral health care provider who treats maternal mental health conditions or substance use disorders;
(v)
a State or local governmental entity, including a State or local public health department;
(vi)
an Indian Tribe or Tribal organization (as such terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304)); and
(vii)
an Urban Indian organization (as such term is defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)).
(C) Freestanding birth center
The term freestanding birth center has the meaning given that term under section 1905(l) of the Social Security Act (42 U.S.C. 1396d(1)).
(D) Maternity care provider
The term maternity care provider means a health care provider who—
(i)
is a physician, physician assistant, midwife who meets at a minimum the international definition of the midwife and global standards for midwifery education as established by the International Confederation of Midwives, nurse practitioner, or clinical nurse specialist; and
(ii)
has a focus on maternal or perinatal health.
(E) Secretary
The term Secretary means the Secretary of Health and Human Services, acting through the Assistant Secretary for Mental Health and Substance Use.
(7) Authorization of appropriations
To carry out this subsection, there is authorized to be appropriated $25,000,000 for each of fiscal years 2027 through 2030.
(b) Grants To grow and diversify the maternal mental and behavioral health care workforce
Title VII of the Public Health Service Act is amended by inserting after section 758 (as added by section 5205(b)) the following:
758A. Maternal mental and behavioral health care workforce grants
(a) In general
The Secretary may award grants to entities to establish or expand programs described in subsection (b) to grow and diversify the maternal mental and behavioral health care workforce.
(b) Use of funds
Recipients of grants under this section shall use the grants to grow and diversify the maternal mental and behavioral health care workforce by—
(1)
establishing schools or programs that provide education and training to individuals seeking appropriate licensing or certification as mental or behavioral health care providers who will specialize in maternal mental health conditions or substance use disorders; or
(2)
expanding the capacity of existing schools or programs described in paragraph (1), for the purposes of increasing the number of students enrolled in such schools or programs, including by awarding scholarships for students.
(c) Prioritization
In awarding grants under this section, the Secretary shall give priority to any entity that—
(1)
has demonstrated a commitment to recruiting and retaining students and faculty from racial and ethnic minority groups;
(2)
has developed a strategy to recruit and retain a diverse pool of students into the maternal mental or behavioral health care workforce program or school supported by funds received through the grant, particularly from racial and ethnic minority groups and other underserved populations;
(3)
has developed a strategy to recruit and retain students who plan to practice in a health professional shortage area designated under section 332;
(4)
has developed a strategy to recruit and retain students who plan to practice in an area with significant racial and ethnic inequities in maternal health outcomes, to the extent practicable; and
(5)
includes in the standard curriculum for all students within the maternal mental or behavioral health care workforce program or school a bias, racism, or discrimination training program that includes training on implicit bias and racism.
(d) Reporting
As a condition on receipt of a grant under this section for a maternal mental or behavioral health care workforce program or school, an entity shall agree to submit to the Secretary an annual report on the activities conducted through the grant, including—
(1)
the number and demographics of students participating in the program or school;
(2)
the extent to which students in the program or school are entering careers in—
(A)
health professional shortage areas designated under section 332; and
(B)
areas with significant racial and ethnic inequities in maternal health outcomes, to the extent such data are available; and
(3)
whether the program or school has included in the standard curriculum for all students a bias, racism, or discrimination training program that includes training on implicit bias and racism, and if so the effectiveness of such training program.
(e) Period of grants
The period of a grant under this section shall be up to 5 years.
(f) Application
To seek a grant under this section, an entity shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require, including any information necessary for prioritization under subsection (c).
(g) Technical assistance
The Secretary shall provide, directly or by contract, technical assistance to entities seeking or receiving a grant under this section on the development, use, evaluation, and post-grant period sustainability of the maternal mental or behavioral health care workforce programs or schools proposed to be, or being, established or expanded through the grant.
(h) Report by the Secretary
Not later than 4 years after the date of enactment of this section, the Secretary shall prepare and submit to the Congress, and post on the internet website of the Department of Health and Human Services, a report on the effectiveness of the grant program under this section at—
(1)
recruiting students from racial and ethnic minority groups and other underserved populations;
(2)
increasing the number of mental or behavioral health care providers specializing in maternal mental health conditions or substance use disorders from racial and ethnic minority groups and other underserved populations;
(3)
increasing the number of mental or behavioral health care providers specializing in maternal mental health conditions or substance use disorders working in health professional shortage areas designated under section 332; and
(4)
increasing the number of mental or behavioral health care providers specializing in maternal mental health conditions or substance use disorders working in areas with significant racial and ethnic inequities in maternal health outcomes, to the extent such data are available.
(i) Definitions
In this section:
(1) Racial and ethnic minority group
The term racial and ethnic minority group has the meaning given such term in section 1707(g)(1).
(2) Mental or behavioral health care provider
The term mental or behavioral health care provider refers to a health care provider in the field of mental and behavioral health, including substance use disorders, acting in accordance with State law.
(j) Authorization of appropriations
To carry out this section, there is authorized to be appropriated $15,000,000 for each of fiscal years 2027 through 2031.
Sec. 5208. Justice for Incarcerated Moms
(a) Ending the shackling of pregnant individuals
(1) In general
Beginning on the date that is 6 months after the date of enactment of this Act, and annually thereafter, in each State that receives a grant under subpart 1 of part E of title I of the Omnibus Crime Control and Safe Streets Act of 1968 (34 U.S.C. 10151 et seq.) (commonly referred to as the Edward Byrne Memorial Justice Assistance Grant Program
) and that does not have in effect throughout the State for such fiscal year laws restricting the use of restraints on pregnant individuals in prison that are substantially similar to the rights, procedures, requirements, effects, and penalties set forth in section 4322 of title 18, United States Code, the amount of such grant that would otherwise be allocated to such State under such subpart for the fiscal year shall be decreased by 25 percent.
(2) Reallocation
Amounts not allocated to a State for failure to comply with paragraph (1) shall be reallocated in accordance with subpart 1 of part E of title I of the Omnibus Crime Control and Safe Streets Act of 1968 (34 U.S.C. 10151 et seq.) to States that have complied with such paragraph.
(b) Creating model programs for the care of incarcerated individuals in the prenatal and postpartum periods
(1) In general
Not later than 1 year after the date of enactment of this Act, the Attorney General, acting through the Director of the Bureau of Prisons, shall establish, in not fewer than 6 Bureau of Prisons facilities, programs to optimize maternal health outcomes for pregnant and postpartum individuals incarcerated in such facilities. The Attorney General shall establish such programs in consultation with stakeholders such as—
(A)
relevant community-based organizations, particularly organizations that represent incarcerated and formerly incarcerated individuals and organizations that seek to improve maternal health outcomes for pregnant and postpartum individuals from demographic groups with elevated rates of maternal mortality, severe maternal morbidity, maternal health disparities, or other adverse perinatal or childbirth outcomes;
(B)
relevant organizations representing patients, with a particular focus on patients from demographic groups with elevated rates of maternal mortality, severe maternal morbidity, maternal health disparities, or other adverse perinatal or childbirth outcomes;
(C)
organizations representing maternity care providers and maternal health care education programs;
(D)
perinatal health workers; and
(E)
researchers and policy experts in fields related to maternal health care for incarcerated individuals.
(2) Start date
Each selected facility shall begin facility programs not later than 18 months after the date of enactment of this Act.
(3) Facility priority
In carrying out paragraph (1), the Director shall give priority to a facility based on—
(A)
the number of pregnant and postpartum individuals incarcerated in such facility and, among such individuals, the number of pregnant and postpartum individuals from demographic groups with elevated rates of maternal mortality, severe maternal morbidity, maternal health disparities, or other adverse perinatal or childbirth outcomes; and
(B)
the extent to which the leaders of such facility have demonstrated a commitment to developing exemplary programs for pregnant and postpartum individuals incarcerated in such facility.
(4) Program duration
The programs established under this subsection shall be for a 5-year period.
(5) Programs
Bureau of Prisons facilities selected by the Director shall establish programs for pregnant and postpartum incarcerated individuals, and such programs may—
(A)
provide access to perinatal health workers from pregnancy through the postpartum period;
(B)
provide access to healthy foods and counseling on nutrition, recommended activity levels, and safety measures throughout pregnancy;
(C)
train correctional officers to ensure that pregnant incarcerated individuals receive safe and respectful treatment;
(D)
train medical personnel to ensure that pregnant incarcerated individuals receive trauma-informed, culturally and linguistically congruent care that promotes the health and safety of the pregnant individuals;
(E)
provide counseling and treatment for individuals who have suffered from—
(i)
diagnosed mental or behavioral health conditions, including trauma and substance use disorders;
(ii)
trauma or violence, including domestic violence;
(iii)
human immunodeficiency virus;
(iv)
sexual abuse;
(v)
pregnancy or infant loss; or
(vi)
chronic conditions;
(F)
provide evidence-based pregnancy and childbirth education, parenting support, and other relevant forms of health literacy;
(G)
provide clinical education opportunities to maternity care providers in training to expand pathways into maternal health care careers serving incarcerated individuals;
(H)
offer opportunities for postpartum individuals to maintain contact with the individual’s newborn child to promote bonding, including enhanced visitation policies, access to prison nursery programs, or breastfeeding support;
(I)
provide reentry assistance, particularly to—
(i)
ensure access to health insurance coverage and transfer of health records to community providers if an incarcerated individual exits the criminal justice system during such individual’s pregnancy or in the postpartum period; and
(ii)
connect individuals exiting the criminal justice system during pregnancy or in the postpartum period to community-based resources, such as referrals to health care providers, substance use disorder treatments, and social services that address social determinants of maternal health; or
(J)
establish partnerships with local public entities, private community entities, community-based organizations, Indian Tribes and Tribal organizations (as such terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304)), and Urban Indian organizations (as such term is defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)) to establish or expand pretrial diversion programs as an alternative to incarceration for pregnant and postpartum individuals. Such programs may include—
(i)
evidence-based childbirth education or parenting classes;
(ii)
prenatal health coordination;
(iii)
family and individual counseling;
(iv)
evidence-based screenings, education, and, as needed, treatment for mental and behavioral health conditions, including drug and alcohol treatments;
(v)
family case management services;
(vi)
domestic violence education and prevention;
(vii)
physical and sexual abuse counseling; and
(viii)
programs to address social determinants of health such as employment, housing, education, transportation, and nutrition.
(6) Implementation and reporting
A selected facility shall be responsible for—
(A)
implementing programs, which may include the programs described in paragraph (5); and
(B)
not later than 3 years after the date of enactment of this Act, and 6 years after the date of enactment of this Act, reporting results of the programs to the Director, including information describing—
(i)
relevant quantitative indicators of success in improving the standard of care and health outcomes for pregnant and postpartum incarcerated individuals in the facility, including data stratified by race, ethnicity, sex, gender, primary language, age, geography, disability status, the category of the criminal charge against such individual, rates of pregnancy-related deaths, pregnancy-associated deaths, cases of infant mortality and morbidity, rates of preterm births and low-birthweight births, cases of severe maternal morbidity, cases of violence against pregnant or postpartum individuals, diagnoses of maternal mental or behavioral health conditions, and other such information as appropriate;
(ii)
relevant qualitative and quantitative evaluations from pregnant and postpartum incarcerated individuals who participated in such programs, including measures of patient-reported experience of care; and
(iii)
strategies to sustain such programs after fiscal year 2031 and expand such programs to other facilities.
(7) Report
Not later than 6 years after the date of enactment of this Act, the Director shall submit to the Attorney General and to Congress a report describing the results of the programs funded under this subsection.
(8) Oversight
Not later than 1 year after the date of enactment of this Act, the Attorney General shall award a contract to an independent organization or independent organizations to conduct oversight of the programs described in paragraph (5).
(9) Authorization of appropriations
There is authorized to be appropriated to carry out this subsection $10,000,000 for each of fiscal years 2027 through 2031.
(c) Grant program To improve maternal health outcomes for individuals in state and local prisons and jails
(1) Establishment
Not later than 1 year after the date of enactment of this Act, the Attorney General, acting through the Director of the Bureau of Justice Assistance, shall award Justice for Incarcerated Moms grants to States to establish or expand programs in State and local prisons and jails for pregnant and postpartum incarcerated individuals. The Attorney General shall award such grants in consultation with stakeholders such as—
(A)
relevant community-based organizations, particularly organizations that represent incarcerated and formerly incarcerated individuals and organizations that seek to improve maternal health outcomes for pregnant and postpartum individuals from demographic groups with elevated rates of maternal mortality, severe maternal morbidity, maternal health disparities, or other adverse perinatal or childbirth outcomes;
(B)
relevant organizations representing patients, with a particular focus on patients from demographic groups with elevated rates of maternal mortality, severe maternal morbidity, maternal health disparities, or other adverse perinatal or childbirth outcomes;
(C)
organizations representing maternity care providers and maternal health care education programs;
(D)
perinatal health workers; and
(E)
researchers and policy experts in fields related to maternal health care for incarcerated individuals.
(2) Applications
Each applicant for a grant under this subsection shall submit to the Director of the Bureau of Justice Assistance an application at such time, in such manner, and containing such information as the Director may require.
(3) Use of funds
A State that is awarded a grant under this subsection shall use such grant to establish or expand programs for pregnant and postpartum incarcerated individuals, and such programs may—
(A)
provide access to perinatal health workers from pregnancy through the postpartum period;
(B)
provide access to healthy foods and counseling on nutrition, recommended activity levels, and safety measures throughout pregnancy;
(C)
train correctional officers to ensure that pregnant incarcerated individuals receive safe and respectful treatment;
(D)
train medical personnel to ensure that pregnant incarcerated individuals receive trauma-informed, culturally and linguistically congruent care that promotes the health and safety of the pregnant individuals;
(E)
provide counseling and treatment for individuals who have suffered from—
(i)
diagnosed mental or behavioral health conditions, including trauma and substance use disorders;
(ii)
trauma or violence, including domestic violence;
(iii)
human immunodeficiency virus;
(iv)
sexual abuse;
(v)
pregnancy or infant loss; or
(vi)
chronic conditions;
(F)
provide evidence-based pregnancy and childbirth education, parenting support, and other relevant forms of health literacy;
(G)
provide clinical education opportunities to maternity care providers in training to expand pathways into maternal health care careers serving incarcerated individuals;
(H)
offer opportunities for postpartum individuals to maintain contact with the individual’s newborn child to promote bonding, including enhanced visitation policies, access to prison nursery programs, or breastfeeding support;
(I)
provide reentry assistance, particularly to—
(i)
ensure access to health insurance coverage and transfer of health records to community providers if an incarcerated individual exits the criminal justice system during such individual’s pregnancy or in the postpartum period; and
(ii)
connect individuals exiting the criminal justice system during pregnancy or in the postpartum period to community-based resources, such as referrals to health care providers, substance use disorder treatments, and social services that address social determinants of maternal health; or
(J)
establish partnerships with local public entities, private community entities, community-based organizations, Indian Tribes and Tribal organizations (as such terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304)), and Urban Indian organizations (as such term is defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)) to establish or expand pretrial diversion programs as an alternative to incarceration for pregnant and postpartum individuals. Such programs may include—
(i)
evidence-based childbirth education or parenting classes;
(ii)
prenatal health coordination;
(iii)
family and individual counseling;
(iv)
evidence-based screenings, education, and, as needed, treatment for mental and behavioral health conditions, including drug and alcohol treatments;
(v)
family case management services;
(vi)
domestic violence education and prevention;
(vii)
physical and sexual abuse counseling; and
(viii)
programs to address social determinants of health such as employment, housing, education, transportation, and nutrition.
(4) Priority
In awarding grants under this subsection, the Director of the Bureau of Justice Assistance shall give priority to applicants based on—
(A)
the number of pregnant and postpartum individuals incarcerated in the State and, among such individuals, the number of pregnant and postpartum individuals from demographic groups with elevated rates of maternal mortality, severe maternal morbidity, maternal health disparities, or other adverse perinatal or childbirth outcomes; and
(B)
the extent to which the State has demonstrated a commitment to developing exemplary programs for pregnant and postpartum individuals incarcerated in the prisons and jails in the State.
(5) Grant duration
A grant awarded under this subsection shall be for a 5-year period.
(6) Implementing and reporting
A State that receives a grant under this subsection shall be responsible for—
(A)
implementing the program funded by the grant; and
(B)
not later than 3 years after the date of enactment of this Act, and 6 years after the date of enactment of this Act, reporting results of such program to the Attorney General, including information describing—
(i)
relevant quantitative indicators of the program’s success in improving the standard of care and health outcomes for pregnant and postpartum incarcerated individuals in the facility, including data stratified by race, ethnicity, sex, gender, primary language, age, geography, disability status, category of the criminal charge against such individual, incidence rates of pregnancy-related deaths, pregnancy-associated deaths, cases of infant mortality and morbidity, rates of preterm births and low-birthweight births, cases of severe maternal morbidity, cases of violence against pregnant or postpartum individuals, diagnoses of maternal mental or behavioral health conditions, and other such information as appropriate;
(ii)
relevant qualitative and quantitative evaluations from pregnant and postpartum incarcerated individuals who participated in such programs, including measures of patient-reported experience of care; and
(iii)
strategies to sustain such programs beyond the duration of the grant and expand such programs to other facilities.
(7) Report
Not later than 6 years after the date of enactment of this Act, the Attorney General shall submit to Congress a report describing the results of such grant programs.
(8) Oversight
Not later than 1 year after the date of enactment of this Act, the Attorney General shall award a contract to an independent organization or independent organizations to conduct oversight of the programs described in paragraph (3).
(9) Authorization of appropriations
There is authorized to be appropriated to carry out this subsection $10,000,000 for each of fiscal years 2027 through 2031.
(d) GAO report
(1) In general
Not later than 2 years after the date of enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on adverse maternal and infant health outcomes among incarcerated individuals and infants born to such individuals, with a particular focus on racial and ethnic disparities in maternal and infant health outcomes for incarcerated individuals.
(2) Contents of report
The report described in this subsection shall include—
(A)
to the extent practicable—
(i)
the number of pregnant individuals who are incarcerated in Bureau of Prisons facilities;
(ii)
the number of incarcerated individuals, including those incarcerated in Federal, State, and local correctional facilities, who have experienced a pregnancy-related death, pregnancy-associated death, or the death of an infant in the most recent 10 years of available data;
(iii)
the number of cases of severe maternal morbidity among incarcerated individuals, including those incarcerated in Federal, State, and local detention facilities, in the most recent 10 years of available data;
(iv)
the number of preterm and low-birthweight births of infants born to incarcerated individuals, including those incarcerated in Federal, State, and local correctional facilities, in the most recent 10 years of available data; and
(v)
statistics on the racial and ethnic disparities in maternal and infant health outcomes and severe maternal morbidity rates among incarcerated individuals, including those incarcerated in Federal, State, and local detention facilities;
(B)
in the case that the Comptroller General of the United States is unable determine the information required in clauses (i) through (iii) of subparagraph (A), an assessment of the barriers to determining such information and recommendations for improvements in tracking maternal health outcomes among incarcerated individuals, including those incarcerated in Federal, State, and local detention facilities;
(C)
the implications of pregnant and postpartum incarcerated individuals being ineligible for medical assistance under a State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) including information about—
(i)
the effects of such ineligibility on maternal health outcomes for pregnant and postpartum incarcerated individuals, with emphasis given to such effects for pregnant and postpartum individuals from racial and ethnic minority groups; and
(ii)
potential implications on maternal health outcomes resulting from temporarily suspending, rather than permanently terminating, such eligibility when a pregnant or postpartum individual is incarcerated;
(D)
the extent to which Federal, State, and local correctional facilities are holding pregnant and postpartum individuals who test positive for illicit drug use in detention with special conditions, such as additional bond requirements, due to the individual’s drug use, and the effect of such detention policies on maternal and infant health outcomes;
(E)
causes of adverse maternal health outcomes that are unique to incarcerated individuals, including those incarcerated in Federal, State, and local detention facilities;
(F)
causes of adverse maternal health outcomes and severe maternal morbidity that are unique to incarcerated individuals from racial and ethnic minority groups;
(G)
recommendations to reduce maternal mortality and severe maternal morbidity among incarcerated individuals and to address racial and ethnic disparities in maternal health outcomes for incarcerated individuals in Bureau of Prisons facilities and State and local prisons and jails; and
(H)
such other information as may be appropriate to reduce the occurrence of adverse maternal health outcomes among incarcerated individuals and to address racial and ethnic disparities in maternal health outcomes for such individuals.
(e) Definitions
In this section:
(1) Culturally and linguistically congruent
The term culturally and linguistically congruent, with respect to care or maternity care, means care that is in agreement with the preferred cultural values, beliefs, worldview, language, and practices of the health care consumer and other stakeholders.
(2) Maternal mortality
The term maternal mortality means a death occurring during or within a 1-year period after pregnancy, caused by pregnancy-related or childbirth complications, including a suicide, overdose, or other death resulting from a mental health or substance use disorder attributed to or aggravated by pregnancy-related or childbirth complications.
(3) Maternity care provider
The term maternity care provider means a health care provider who—
(A)
is a physician, a physician assistant, a midwife who meets, at a minimum, the international definition of a midwife and global standards for midwifery education as established by the International Confederation of Midwives, an advanced practice registered nurse, or a lactation consultant certified by the International Board of Lactation Consultant Examiners; and
(B)
has a focus on maternal or perinatal health.
(4) Perinatal health worker
The term perinatal health worker means a nonclinical health worker focused on maternal or perinatal health, such as a doula, community health worker, peer supporter, lactation educator or counselor, nutritionist or dietitian, childbirth educator, social worker, home visitor, patient navigator or coordinator, or language interpreter.
(5) Postpartum and postpartum period
The terms postpartum
and postpartum period
mean the 1-year period beginning on the last day of the pregnancy of an individual.
(6) Pregnancy-associated death
The term pregnancy-associated death means a death of a pregnant or postpartum individual, by any cause, that occurs during, or within 1 year following, the individual’s pregnancy, regardless of the outcome, duration, or site of the pregnancy.
(7) Pregnancy-related death
The term pregnancy-related death means a death of a pregnant or postpartum individual that occurs during, or within 1 year following, the individual’s pregnancy, from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy.
(8) Racial and ethnic minority group
The term racial and ethnic minority group has the meaning given such term in section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 300u–6(g)(1)).
(9) Severe maternal morbidity
The term severe maternal morbidity means a health condition, including mental health conditions and substance use disorders, attributed to or aggravated by pregnancy or childbirth that results in significant short-term or long-term consequences to the health of the individual who was pregnant.
(10) Social determinants of maternal health
The term social determinants of maternal health means nonclinical factors that impact maternal health outcomes.
Sec. 5209. Tech to save moms
(a) Definitions
In this section:
(1) Postpartum and postpartum period
The terms postpartum and postpartum period mean the 1-year period beginning on the last day of the pregnancy of an individual.
(2) Racial and ethnic minority group
The term racial and ethnic minority group has the meaning given such term in section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 300u–6(g)(1)).
(3) Severe maternal morbidity
The term severe maternal morbidity means a health condition, including mental health conditions and substance use disorders, attributed to or aggravated by pregnancy or childbirth that results in significant short-term or long-term consequences to the health of the individual who was pregnant.
(4) Social determinants of maternal health
The term social determinants of maternal health means non-clinical factors that impact maternal health outcomes, including—
(A)
economic factors, which may include poverty, employment, food security, support for and access to lactation and other infant feeding options, housing stability, and related factors;
(B)
neighborhood factors, which may include quality of housing, access to transportation, access to child care, availability of healthy foods and nutrition counseling, availability of clean water, air and water quality, ambient temperatures, neighborhood crime and violence, access to broadband, and related factors;
(C)
social and community factors, which may include systemic racism, gender discrimination or discrimination based on other protected classes, workplace conditions, incarceration, and related factors;
(D)
household factors, which may include ability to conduct lead testing and abatement, car seat installation, indoor air temperatures, and related factors;
(E)
education access and quality factors, which may include educational attainment, language and literacy, and related factors; and
(F)
health care access factors, including health insurance coverage, access to culturally congruent health care services, providers, and non-clinical support, access to home visiting services, access to wellness and stress management programs, health literacy, access to telehealth and items required to receive telehealth services, and related factors.
(b) Integrated telehealth models in maternity care services
(1) In general
Section 1115A(b)(2)(B) of the Social Security Act (42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the end the following:
(xxviii)
Focusing on title XIX, providing for the adoption of and use of telehealth tools that allow for screening, monitoring, and management of common health complications with respect to an individual receiving medical assistance during such individual’s pregnancy and for not more than a 1-year period beginning on the last day of the pregnancy.
(2) Effective date
The amendment made by paragraph (1) shall take effect 1 year after the date of the enactment of this section.
(c) Grants To expand the use of technology-Enabled collaborative learning and capacity models for pregnant and postpartum individuals
Title III of the Public Health Service Act is amended by inserting after section 330N (42 U.S.C. 254c–20) the following:
330N–1. Expanding capacity for maternal health outcomes
(a) Establishment
Beginning not later than 1 year after the date of enactment of this section, the Secretary shall award grants to eligible entities to evaluate, develop, and expand the use of technology-enabled collaborative learning and capacity building models and improve maternal health outcomes—
(1)
in health professional shortage areas;
(2)
in areas with high rates of maternal mortality and severe maternal morbidity;
(3)
in areas with significant racial and ethnic inequities in maternal health outcomes; and
(4)
for medically underserved populations and American Indians and Alaska Natives, including Indian Tribes, Tribal organizations, and Urban Indian organizations.
(b) Use of Funds
(1) Required uses
Recipients of grants under this section shall use the grants to—
(A)
train maternal health care providers, students, and other similar professionals through models that include—
(i)
methods to increase safety and health care quality;
(ii)
training to increase awareness of, and eliminate implicit bias, racism, and discrimination in, the provision of health care;
(iii)
best practices in screening for and, as needed, evaluating and treating maternal mental health conditions and substance use disorders;
(iv)
training on best practices in maternity care for pregnant and postpartum individuals during the COVID–19 public health emergency or future public health emergencies;
(v)
methods to screen for social determinants of maternal health risks in the prenatal and postpartum periods; and
(vi)
the use of remote patient monitoring tools for pregnancy-related complications described in section 1115A(b)(2)(B)(xxviii) of the Social Security Act;
(B)
evaluate and collect information on the effect of such models on—
(i)
access to, and quality of, care;
(ii)
outcomes with respect to the health of an individual; and
(iii)
the experience of individuals who receive pregnancy-related health care;
(C)
develop qualitative and quantitative measures to identify best practices for the expansion and use of such models;
(D)
study the effect of such models on patient outcomes and maternity care providers; and
(E)
conduct any other activity, as determined by the Secretary.
(2) Permissible uses
Recipients of grants under this section may use grants to support—
(A)
the use and expansion of technology-enabled collaborative learning and capacity building models, including hardware and software that—
(i)
enable distance learning and technical support; and
(ii)
support the secure exchange of electronic health information; and
(B)
maternity care providers, students, and other similar professionals in the provision of maternity care through such models.
(c) Application
(1) In general
An eligible entity seeking a grant under subsection (a) shall submit to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require.
(2) Assurance
An application under paragraph (1) shall include an assurance that such entity shall collect information on, and assess the effect of, the use of technology-enabled collaborative learning and capacity building models, including with respect to—
(A)
maternal health outcomes;
(B)
access to maternal health care services;
(C)
quality of maternal health care; and
(D)
retention of maternity care providers serving areas and populations described in subsection (a).
(d) Limitations
(1) Number
The Secretary may not award more than 1 grant under this section to an eligible entity.
(2) Duration
A grant awarded under this section shall be for a 5-year period.
(e) Access to broadband
In administering grants under this section, the Secretary may coordinate with other agencies to ensure that funding opportunities are available to support access to reliable, high-speed internet for grantees.
(f) Technical assistance
The Secretary shall provide (either directly or by contract) technical assistance to eligible entities, including recipients of grants under subsection (a), on the development, use, and sustainability of technology-enabled collaborative learning and capacity building models to expand access to maternal health care services provided by such entities, including—
(1)
in health professional shortage areas;
(2)
in areas with high rates of maternal mortality and severe maternal morbidity or significant racial and ethnic inequities in maternal health outcomes; and
(3)
for medically underserved populations or American Indians and Alaska Natives.
(g) Research and evaluation
The Secretary, in consultation with experts, shall develop a strategic plan to research and evaluate the evidence for such models.
(h) Reporting
(1) Eligible entities
An eligible entity that receives a grant under subsection (a) shall submit to the Secretary a report, at such time, in such manner, and containing such information as the Secretary may require.
(2) Secretary
Not later than 4 years after the date of enactment of this section, the Secretary shall submit to the Congress, and make available on the website of the Department of Health and Human Services, a report that includes—
(A)
a description of grants awarded under subsection (a) and the purpose and amounts of such grants;
(B)
a summary of—
(i)
the evaluations conducted under subsection (b)(1)(B);
(ii)
any technical assistance provided under subsection (f); and
(iii)
the activities conducted under subsection (a); and
(C)
a description of any significant findings with respect to—
(i)
patient outcomes; and
(ii)
best practices for expanding, using, or evaluating technology-enabled collaborative learning and capacity building models.
(i) Authorization of appropriations
There is authorized to be appropriated to carry out this section, $6,000,000 for each of fiscal years 2027 through 2031.
(j) Definitions
In this section:
(1) Eligible entity
(A) In general
The term eligible entity means an entity that provides, or supports the provision of, maternal health care services or other evidence-based services for pregnant and postpartum individuals—
(i)
in health professional shortage areas;
(ii)
in areas with high rates of adverse maternal health outcomes or significant racial and ethnic inequities in maternal health outcomes; or
(iii)
who are—
(I)
members of medically underserved populations; or
(II)
American Indians and Alaska Natives, including Indian Tribes, Tribal organizations, and Urban Indian organizations.
(B) Inclusions
An eligible entity may include entities that lead, or are capable of leading, a technology-enabled collaborative learning and capacity building model.
(2) Health professional shortage area
The term health professional shortage area means a health professional shortage area designated under section 332.
(3) Indian Tribe
The term Indian Tribe has the meaning given such term in section 4 of the Indian Self-Determination and Education Assistance Act.
(4) Maternal mortality
The term maternal mortality means a death occurring during or within the 1-year period after pregnancy caused by pregnancy-related or childbirth complications, including a suicide, overdose, or other death resulting from a mental health or substance use disorder attributed to or aggravated by pregnancy or childbirth complications.
(5) Medically underserved population
The term medically underserved population has the meaning given such term in section 330(b)(3).
(6) Postpartum
The term postpartum means the 1-year period beginning on the last date of an individual’s pregnancy.
(7) Severe maternal morbidity
The term severe maternal morbidity means a health condition, including a mental health or substance use disorder, attributed to or aggravated by pregnancy or childbirth that results in significant short-term or long-term consequences to the health of the individual who was pregnant.
(8) Technology-enabled collaborative learning and capacity building model
The term technology-enabled collaborative learning and capacity building model means a distance health education model that connects health care professionals, and other specialists, through simultaneous interactive videoconferencing for the purpose of facilitating case-based learning, disseminating best practices, and evaluating outcomes in the context of maternal health care.
(9) Tribal organization
The term Tribal organization has the meaning given such term in section 4 of the Indian Self-Determination and Education Assistance Act.
(10) Urban Indian organization
The term Urban Indian organization has the meaning given such term in section 4 of the Indian Health Care Improvement Act.
(d) Grants To promote equity in maternal health outcomes through digital tools
(1) In general
Beginning not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services (referred to in this subsection as the Secretary) shall make grants to eligible entities to reduce racial and ethnic inequities in maternal health outcomes by increasing access to digital tools related to maternal health care.
(2) Applications
To be eligible to receive a grant under this subsection, an eligible entity shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(3) Prioritization
In awarding grants under this subsection, the Secretary shall prioritize an eligible entity—
(A)
in an area with high rates of adverse maternal health outcomes or significant racial and ethnic inequities in maternal health outcomes;
(B)
in a health professional shortage area designated under section 332 of the Public Health Service Act (42 U.S.C. 254e); and
(C)
that promotes technology that addresses racial and ethnic inequities in maternal health outcomes.
(4) Limitations
(A) Number
The Secretary may award not more than 1 grant under this subsection to an eligible entity.
(B) Duration
A grant awarded under this subsection shall be for a 5-year period.
(5) Technical assistance
The Secretary shall provide technical assistance to an eligible entity on the development, use, evaluation, and post-grant sustainability of digital tools for purposes of promoting equity in maternal health outcomes.
(6) Reporting
(A) Eligible entities
An eligible entity that receives a grant under paragraph (1) shall submit to the Secretary a report, at such time, in such manner, and containing such information as the Secretary may require.
(B) Secretary
Not later than 4 years after the date of enactment of this Act, the Secretary shall submit to Congress a report that includes—
(i)
an evaluation on the effectiveness of grants awarded under this subsection to improve health outcomes for pregnant and postpartum individuals from racial and ethnic minority groups;
(ii)
recommendations on new grant programs that promote the use of technology to improve such maternal health outcomes; and
(iii)
recommendations with respect to—
(I)
technology-based privacy and security safeguards in maternal health care;
(II)
reimbursement rates for maternal telehealth services;
(III)
the use of digital tools to analyze large data sets to identify potential pregnancy-related complications;
(IV)
barriers that prevent maternity care providers from providing telehealth services across States;
(V)
the use of consumer digital tools such as mobile phone applications, patient portals, and wearable technologies to improve maternal health outcomes;
(VI)
barriers that prevent access to telehealth services, including a lack of access to reliable, high-speed internet or electronic devices;
(VII)
barriers to data sharing between the Special Supplemental Nutrition Program for Women, Infants, and Children and maternity care providers, and recommendations for addressing such barriers; and
(VIII)
lessons learned from expanded access to telehealth related to maternity care during the COVID–19 public health emergency.
(7) Authorization of appropriations
There is authorized to be appropriated to carry out this subsection $6,000,000 for each of fiscal years 2027 through 2031.
(e) Report on the use of technology in maternity care
(1) In general
Not later than 60 days after the date of enactment of this Act, the Secretary of Health and Human Services shall enter into an agreement with the National Academies of Sciences, Engineering, and Medicine (referred to in this section as the National Academies
) under which the National Academies shall conduct a study on the use of technology and patient monitoring devices in maternity care.
(2) Content
The agreement entered into pursuant to paragraph (1) shall provide for the study of the following:
(A)
The use of innovative technology (including artificial intelligence) in maternal health care, including the extent to which such technology has affected racial or ethnic biases in maternal health care.
(B)
The use of patient monitoring devices (including pulse oximeter devices) in maternal health care, including the extent to which such devices have affected racial or ethnic biases in maternal health care.
(C)
Best practices for reducing and preventing racial or ethnic biases in the use of innovative technology and patient monitoring devices in maternity care.
(D)
Best practices in the use of innovative technology and patient monitoring devices for pregnant and postpartum individuals from racial and ethnic minority groups.
(E)
Best practices with respect to privacy and security safeguards in such use.
(3) Report
Not later than 2 years after the date of enactment of this Act, the National Academies shall complete the study under this subsection, and transmit a report of the results of such study to Congress.
Sec. 5210. IMPACT To Save Moms Act
(a) Perinatal Care Alternative Payment Model Demonstration Project
(1) In general
For the period of fiscal years 2027 through 2030, the Secretary of Health and Human Services (referred to in this subsection as the Secretary
), acting through the Administrator of the Centers for Medicare & Medicaid Services, shall establish and implement, in accordance with the requirements of this subsection, a demonstration project, to be known as the Perinatal Care Alternative Payment Model Demonstration Project (referred to in this subsection as the Demonstration Project
), for purposes of allowing States to test payment models under their State plans under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) and State child health plans under title XXI of such Act (42 U.S.C. 1397aa et seq.) with respect to maternity care provided to pregnant and postpartum individuals enrolled in such State plans and State child health plans.
(2) Coordination
In establishing the Demonstration Project, the Secretary shall coordinate with stakeholders such as—
(A)
State Medicaid programs;
(B)
relevant organizations representing maternal health care providers;
(C)
relevant organizations representing patients, with a particular focus on individuals from demographic groups with disproportionate rates of adverse maternal health outcomes;
(D)
relevant community-based organizations, particularly organizations that seek to improve maternal health outcomes for individuals from demographic groups with disproportionate rates of adverse maternal health outcomes;
(E)
non-clinical perinatal health workers such as doulas, community health workers, peer supporters, certified lactation consultants, nutritionists and dieticians, social workers, home visitors, and navigators;
(F)
relevant health insurance issuers;
(G)
hospitals, health systems, freestanding birth centers (as such term is defined in paragraph (3)(B) of section 1905(l) of the Social Security Act (42 U.S.C. 1396d(l))), Federally qualified health centers (as such term is defined in paragraph (2)(B) of such section), and rural health clinics (as such term is defined in section 1861(aa) of such Act (42 U.S.C. 1395x(aa)));
(H)
researchers and policy experts in fields related to maternity care payment models; and
(I)
any other stakeholders as the Secretary determines appropriate, with a particular focus on stakeholders from demographic groups with disproportionate rates of adverse maternal health outcomes.
(3) Considerations
In establishing the Demonstration Project, the Secretary shall consider each of the following:
(A)
Findings from any evaluations of the Strong Start for Mothers and Newborns initiative carried out by the Centers for Medicare & Medicaid Services, the Health Resources and Services Administration, and the Administration on Children and Families.
(B)
Any alternative payment model that—
(i)
is designed to improve maternal health outcomes for racial and ethnic groups with disproportionate rates of adverse maternal health outcomes;
(ii)
includes methods for stratifying patients by pregnancy risk level and, as appropriate, adjusting payments under such model to take into account pregnancy risk level;
(iii)
establishes evidence-based quality metrics for such payments;
(iv)
includes consideration of non-hospital birth settings such as freestanding birth centers (as so defined);
(v)
includes consideration of social determinants of health that are relevant to maternal health outcomes such as housing, transportation, nutrition, and other non-clinical factors that influence maternal health outcomes; or
(vi)
includes diverse maternity care teams that include—
(I)
maternity care providers, including obstetrician-gynecologists, family physicians, physician assistants, midwives who meet, at a minimum, the international definition of the term midwife and global standards for midwifery education (as established by the International Confederation of Midwives), and nurse practitioners—
(aa)
from racially, ethnically, and professionally diverse backgrounds;
(bb)
with experience practicing in racially and ethnically diverse communities; or
(cc)
who have undergone trainings on racism, implicit bias, and explicit bias; and
(II)
non-clinical perinatal health workers such as doulas, community health workers, peer supporters, certified lactation consultants, nutritionists and dieticians, social workers, home visitors, and navigators.
(4) Eligibility
To be eligible to participate in the Demonstration Project, a State shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.
(5) Evaluation
The Secretary shall conduct an evaluation of the Demonstration Project to determine the impact of the Demonstration Project on—
(A)
maternal health outcomes, with data stratified by race, ethnicity, socioeconomic indicators, and any other factors as the Secretary determines appropriate;
(B)
spending on maternity care by States participating in the Demonstration Project;
(C)
to the extent practicable, subjective measures of patient experience; and
(D)
any other areas of assessment that the Secretary determines relevant.
(6) Report
Not later than 1 year after the completion or termination date of the Demonstration Project, the Secretary shall submit to the Committee on Energy and Commerce, the Committee on Ways and Means, and the Committee on Education and Workforce of the House of Representatives and the Committee on Finance and the Committee on Health, Education, Labor, and Pensions of the Senate, and make publicly available, a report containing—
(A)
the results of any evaluation conducted under paragraph (5); and
(B)
a recommendation regarding whether the Demonstration Project should be continued after fiscal year 2030 and expanded on a national basis.
(7) Authorization of appropriations
There are authorized to be appropriated such sums as are necessary to carry out this subsection.
(8) Definitions
In this subsection:
(A) Alternative payment model
The term alternative payment model has the meaning given such term in section 1833(z)(3)(C) of the Social Security Act (42 U.S.C. 1395l(z)(3)(C)).
(B) Perinatal
The term perinatal means the period beginning on the day a person becomes pregnant and ending on the last day of the 1-year period beginning on the last day of such person’s pregnancy.
(b) MACPAC report
(1) In general
Not later than 2 years after the date of the enactment of this section, the Medicaid and CHIP Payment and Access Commission shall publish a report on issues relating to the continuity of coverage under State plans under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) and State child health plans under title XXI of such Act (42 U.S.C. 1397aa et seq.) for pregnant and postpartum individuals. Such report shall, at a minimum, include the following:
(A)
An assessment of any existing policies under such State plans and such State child health plans regarding presumptive eligibility for pregnant individuals while their application for enrollment in such a State plan or such a State child health plan is being processed.
(B)
An assessment of any existing policies under such State plans and such State child health plans regarding measures to ensure continuity of coverage under such a State plan or such a State child health plan for pregnant and postpartum individuals, including such individuals who need to change their health insurance coverage during their pregnancy or the postpartum period following their pregnancy.
(C)
An assessment of any existing policies under such State plans and such State child health plans regarding measures to automatically reenroll individuals who are eligible to enroll under such a State plan or such a State child health plan as a parent.
(D)
If determined appropriate by the Commission, any recommendations for the Department of Health and Human Services, or such State plans and such State child health plans, to ensure continuity of coverage under such a State plan or such a State child health plan for pregnant and postpartum people.
(2) Postpartum defined
In this subsection, the term postpartum means the 1-year period beginning on the last day of a person’s pregnancy.
Sec. 5211. Protecting moms and babies against climate change
(a) Grant program To protect vulnerable mothers and babies from climate change risks
(1) In general
Not later than 180 days after the date of enactment of this section, the Secretary of Health and Human Services (in this section referred to as the Secretary
) shall establish a grant program (in this subsection referred to as the Program
) to protect vulnerable individuals from risks associated with climate change.
(2) Grant authority
In carrying out the Program, the Secretary may award, on a competitive basis, grants to 10 covered entities.
(3) Applications
To be eligible for a grant under the Program, a covered entity shall submit to the Secretary an application at such time, in such form, and containing such information as the Secretary may require, which shall include, at a minimum, a description of the following:
(A)
Plans for the use of grant funds awarded under the Program and how patients and stakeholder organizations were involved in the development of such plans.
(B)
How such grant funds will be targeted to geographic areas that have disproportionately high levels of risks associated with climate change for vulnerable individuals.
(C)
How such grant funds will be used to address racial and ethnic inequities in—
(i)
adverse maternal and infant health outcomes; and
(ii)
exposure to risks associated with climate change for vulnerable individuals.
(D)
Strategies to prevent an initiative assisted with such grant funds from causing—
(i)
adverse environmental impacts;
(ii)
displacement of residents and businesses;
(iii)
rent and housing price increases; or
(iv)
disproportionate adverse impacts on racial and ethnic minority groups and other underserved populations.
(4) Selection of grant recipients
(A) Timing
Not later than 270 days after the date of enactment of this Act, the Secretary shall select the recipients of grants under the Program.
(B) Consultation
In selecting covered entities for grants under the Program, the Secretary shall consult with—
(i)
representatives of stakeholder organizations;
(ii)
the Administrator of the Environmental Protection Agency;
(iii)
the Administrator of the National Oceanic and Atmospheric Administration; and
(iv)
from the Department of Health and Human Services—
(I)
the Deputy Assistant Secretary for Minority Health;
(II)
the Administrator of the Centers for Medicare & Medicaid Services;
(III)
the Administrator of the Health Resources and Services Administration;
(IV)
the Director of the National Institutes of Health; and
(V)
the Director of the Centers for Disease Control and Prevention.
(C) Priority
In selecting a covered entity to be awarded a grant under the Program, the Secretary shall give priority to covered entities that serve a county—
(i)
designated, or located in an area designated, as a nonattainment area pursuant to section 107 of the Clean Air Act (42 U.S.C. 7407) for any air pollutant for which air quality criteria have been issued under section 108(a) of such Act (42 U.S.C. 7408(a));
(ii)
with a level of vulnerability of moderate-to-high or higher, according to the Social Vulnerability Index of the Centers for Disease Control and Prevention; or
(iii)
with temperatures that pose a risk to human health, as determined by the Secretary, in consultation with the Administrator of the National Oceanic and Atmospheric Administration and the Chair of the United States Global Change Research Program, based on the best available science.
(D) Limitation
A recipient of grant funds under the Program may not use such grant funds to serve a county that is served by any other recipient of a grant under the Program.
(5) Use of funds
A covered entity awarded grant funds under the Program may only use such grant funds for the following:
(A)
Initiatives to identify risks associated with climate change for vulnerable individuals and to provide services and support to such individuals that address such risks, which may include—
(i)
training for health care providers, doulas, and other employees in hospitals, birth centers, midwifery practices, and other health care practices that provide prenatal or labor and delivery services to vulnerable individuals on the identification of, and patient counseling relating to, risks associated with climate change for vulnerable individuals;
(ii)
hiring, training, or providing resources to community health workers and perinatal health workers who can help identify risks associated with climate change for vulnerable individuals, provide patient counseling about such risks, and carry out the distribution of relevant services and support;
(iii)
enhancing the monitoring of risks associated with climate change for vulnerable individuals, including by—
(I)
collecting data on such risks in specific census tracts, neighborhoods, or other geographic areas; and
(II)
sharing such data with local health care providers, doulas, and other employees in hospitals, birth centers, midwifery practices, and other health care practices that provide prenatal or labor and delivery services to local vulnerable individuals; and
(iv)
providing vulnerable individuals—
(I)
air conditioning units, residential weatherization support, filtration systems, household appliances, or related items;
(II)
direct financial assistance; and
(III)
services and support, including housing and transportation assistance, to prepare for or recover from extreme weather events, which may include floods, hurricanes, wildfires, droughts, and related events.
(B)
Initiatives to mitigate levels of and exposure to risks associated with climate change for vulnerable individuals, which shall be based on the best available science and which may include initiatives to—
(i)
develop, maintain, or expand urban or community forestry initiatives and tree canopy coverage initiatives;
(ii)
improve infrastructure, including buildings and paved surfaces;
(iii)
develop or improve community outreach networks to provide culturally and linguistically appropriate information and notifications about risks associated with climate change for vulnerable individuals; and
(iv)
provide enhanced services to racial and ethnic minority groups and other underserved populations.
(6) Length of award
A grant under this subsection shall be disbursed over 4 fiscal years.
(7) Technical assistance
The Secretary shall provide technical assistance to a covered entity awarded a grant under the Program to support the development, implementation, and evaluation of activities funded with such grant.
(8) Reports to Secretary
(A) Annual report
For each fiscal year during which a covered entity is disbursed grant funds under the Program, such covered entity shall submit to the Secretary a report that summarizes the activities carried out by such covered entity with such grant funds during such fiscal year, which shall include a description of the following:
(i)
The involvement of stakeholder organizations in the implementation of initiatives assisted with such grant funds.
(ii)
Relevant health and environmental data, disaggregated, to the extent practicable, by race, ethnicity, gender, and pregnancy status.
(iii)
Qualitative feedback received from vulnerable individuals with respect to initiatives assisted with such grant funds.
(iv)
Criteria used in selecting the geographic areas assisted with such grant funds.
(v)
Efforts to address racial and ethnic inequities in adverse maternal and infant health outcomes and in exposure to risks associated with climate change for vulnerable individuals.
(vi)
Any negative and unintended impacts of initiatives assisted with such grant funds, including—
(I)
adverse environmental impacts;
(II)
displacement of residents and businesses;
(III)
rent and housing price increases; and
(IV)
disproportionate adverse impacts on racial and ethnic minority groups and other underserved populations.
(vii)
How the covered entity will address and prevent any impacts described in clause (vi).
(B) Publication
Not later than 30 days after the date on which a report is submitted under subparagraph (A), the Secretary shall publish such report on a public website of the Department of Health and Human Services.
(9) Report to Congress
Not later than the date that is 5 years after the date on which the Program is established, the Secretary shall submit to Congress and publish on a public website of the Department of Health and Human Services a report on the results of the Program, including the following:
(A)
Summaries of the annual reports submitted under paragraph (8).
(B)
Evaluations of the initiatives assisted with grant funds under the Program.
(C)
An assessment of the effectiveness of the Program in—
(i)
identifying risks associated with climate change for vulnerable individuals;
(ii)
providing services and support to such individuals;
(iii)
mitigating levels of and exposure to such risks; and
(iv)
addressing racial and ethnic inequities in adverse maternal and infant health outcomes and in exposure to such risks.
(D)
A description of how the Program could be expanded, including—
(i)
monitoring efforts or data collection that would be required to identify areas with high levels of risks associated with climate change for vulnerable individuals;
(ii)
how such areas could be identified using the strategy developed under subsection (d); and
(iii)
recommendations for additional funding.
(10) Covered entity defined
In this subsection, the term covered entity means a consortium of organizations serving a county that—
(A)
shall include a community-based organization; and
(B)
may include—
(i)
another stakeholder organization;
(ii)
the government of such county;
(iii)
the governments of one or more municipalities within such county;
(iv)
a State or local public health department or emergency management agency;
(v)
a local health care practice, which may include a licensed and accredited hospital, birth center, midwifery practice, or other health care practice that provides prenatal or labor and delivery services to vulnerable individuals;
(vi)
an Indian tribe or tribal organization (as such terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304));
(vii)
an Urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)); and
(viii)
an institution of higher education.
(11) Authorization of appropriations
There is authorized to be appropriated to carry out this subsection $100,000,000 for fiscal years 2027 through 2030.
(b) Grant program for education and training at health profession schools
(1) In general
Not later than 1 year after the date of enactment of this Act, the Secretary shall establish a grant program (in this subsection referred to as the Program
) to provide funds to health profession schools to support the development and integration of education and training programs for identifying and addressing risks associated with climate change for vulnerable individuals.
(2) Grant authority
In carrying out the Program, the Secretary may award, on a competitive basis, grants to health profession schools.
(3) Application
To be eligible for a grant under the Program, a health profession school shall submit to the Secretary an application at such time, in such form, and containing such information as the Secretary may require, which shall include, at a minimum, a description of the following:
(A)
How such health profession school will engage with vulnerable individuals, and stakeholder organizations representing such individuals, in developing and implementing the education and training programs supported by grant funds awarded under the Program.
(B)
How such health profession school will ensure that such education and training programs will address racial and ethnic inequities in exposure to, and the effects of, risks associated with climate change for vulnerable individuals.
(4) Use of funds
A health profession school awarded a grant under the Program shall use the grant funds to develop, and integrate into the curriculum and continuing education of such health profession school, education and training on each of the following:
(A)
Identifying risks associated with climate change for vulnerable individuals and individuals with the intent to become pregnant.
(B)
How risks associated with climate change affect vulnerable individuals and individuals with the intent to become pregnant.
(C)
Racial and ethnic inequities in exposure to, and the effects of, risks associated with climate change for vulnerable individuals and individuals with the intent to become pregnant.
(D)
Patient counseling and mitigation strategies relating to risks associated with climate change for vulnerable individuals.
(E)
Relevant services and support for vulnerable individuals relating to risks associated with climate change and strategies for ensuring vulnerable individuals have access to such services and support.
(F)
Implicit and explicit bias, racism, and discrimination.
(G)
Related topics identified by such health profession school based on the engagement of such health profession school with vulnerable individuals and stakeholder organizations representing such individuals.
(5) Partnerships
In carrying out activities with grant funds, a health profession school awarded a grant under the Program may partner with one or more of the following:
(A)
A State or local public health department.
(B)
A health care professional membership organization.
(C)
A stakeholder organization.
(D)
A health profession school.
(E)
An institution of higher education.
(6) Reports to Secretary
(A) Annual report
For each fiscal year during which a health profession school is disbursed grant funds under the Program, such health profession school shall submit to the Secretary a report that describes the activities carried out with such grant funds during such fiscal year.
(B) Final report
Not later than the date that is 1 year after the end of the last fiscal year during which a health profession school is disbursed grant funds under the Program, the health profession school shall submit to the Secretary a final report that summarizes the activities carried out with such grant funds.
(7) Report to Congress
Not later than the date that is 6 years after the date on which the Program is established, the Secretary shall submit to Congress and publish on a public website of the Department of Health and Human Services a report that includes the following:
(A)
A summary of the reports submitted under paragraph (6).
(B)
Recommendations to improve education and training programs at health profession schools with respect to identifying and addressing risks associated with climate change for vulnerable individuals.
(8) Health profession school defined
In this subsection, the term health profession school means an accredited—
(A)
medical school;
(B)
school of nursing;
(C)
midwifery program;
(D)
physician assistant education program;
(E)
teaching hospital;
(F)
residency or fellowship program; or
(G)
other school or program determined appropriate by the Secretary.
(9) Authorization of Appropriations
There is authorized to be appropriated to carry out this subsection $5,000,000 for fiscal years 2027 through 2030.
(c) NIH Consortium on Birth and Climate Change Research
(1) Establishment
Not later than 1 year after the date of enactment of this Act, the Director of the National Institutes of Health (in this subsection referred to as the Director of NIH
) shall establish the Consortium on Birth and Climate Change Research (in this subsection referred to as the Consortium
).
(2) Duties
(A) In general
The Consortium shall coordinate, across the institutes, centers, and offices of the National Institutes of Health, research on the risks associated with climate change for vulnerable individuals.
(B) Required activities
In carrying out subparagraph (A), the Consortium shall—
(i)
establish research priorities, including by prioritizing research that—
(I)
identifies the risks associated with climate change for vulnerable individuals with a particular focus on inequities in such risks among racial and ethnic minority groups and other underserved populations; and
(II)
identifies strategies to reduce levels of, and exposure to, such risks, with a particular focus on risks among racial and ethnic minority groups and other underserved populations;
(ii)
identify gaps in available data related to such risks;
(iii)
identify gaps in, and opportunities for, research collaborations;
(iv)
identify funding opportunities for community-based organizations and researchers from racially, ethnically, and geographically diverse backgrounds; and
(v)
publish annual reports on the work and findings of the Consortium on a public website of the National Institutes of Health.
(3) Membership
The Director of NIH shall appoint to the Consortium representatives of such institutes, centers, and offices of the National Institutes of Health as the Director of NIH considers appropriate, including, at a minimum, representatives of—
(A)
the National Institute of Environmental Health Sciences;
(B)
the National Institute on Minority Health and Health Disparities;
(C)
the Eunice Kennedy Shriver National Institute of Child Health and Human Development;
(D)
the National Institute of Nursing Research; and
(E)
the Office of Research on Women’s Health.
(4) Chairperson
The Chairperson of the Consortium shall be designated by the Director of NIH and selected from among the representatives appointed under paragraph (3).
(5) Consultation
In carrying out the duties described in paragraph (2), the Consortium shall consult with—
(A)
the heads of relevant Federal agencies, including—
(i)
the Environmental Protection Agency;
(ii)
the National Oceanic and Atmospheric Administration;
(iii)
the Occupational Safety and Health Administration; and
(iv)
from the Department of Health and Human Services—
(I)
the Office of Minority Health in the Office of the Secretary;
(II)
the Centers for Medicare & Medicaid Services;
(III)
the Health Resources and Services Administration;
(IV)
the Centers for Disease Control and Prevention;
(V)
the Indian Health Service; and
(VI)
the Administration for Children and Families; and
(B)
representatives of—
(i)
stakeholder organizations;
(ii)
health care providers and professional membership organizations with expertise in maternal health or environmental justice;
(iii)
State and local public health departments;
(iv)
licensed and accredited hospitals, birth centers, midwifery practices, or other health care practices that provide prenatal or labor and delivery services to vulnerable individuals; and
(v)
institutions of higher education, including such institutions that are minority-serving institutions or have expertise in maternal health or environmental justice.
(d) Strategy for identifying climate change risk zones for vulnerable mothers and babies
(1) In general
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall develop a strategy (in this subsection referred to as the Strategy
) for designating areas that the Secretary determines to have a high risk of adverse maternal and infant health outcomes among vulnerable individuals as a result of risks associated with climate change.
(2) Strategy requirements
(A) In general
In developing the Strategy, the Secretary shall establish a process to identify areas where vulnerable individuals are exposed to a high risk of adverse maternal and infant health outcomes as a result of risks associated with climate change in conjunction with other factors that can impact such health outcomes, including—
(i)
the incidence of diseases associated with air pollution, extreme heat, and other environmental factors;
(ii)
the availability and accessibility of maternal and infant health care providers;
(iii)
English-language proficiency among people of reproductive age;
(iv)
the health insurance status of people of reproductive age;
(v)
the number of people of reproductive age who are members of racial or ethnic groups with disproportionately high rates of adverse maternal and infant health outcomes;
(vi)
the socioeconomic status of people of reproductive age, including with respect to—
(I)
poverty;
(II)
unemployment;
(III)
household income; and
(IV)
educational attainment; and
(vii)
access to quality housing, transportation, and nutrition.
(B) Resources
In developing the Strategy, the Secretary shall identify, and incorporate a description of, the following:
(i)
Existing mapping tools or Federal programs that identify—
(I)
risks associated with climate change for vulnerable individuals; and
(II)
other factors that can influence maternal and infant health outcomes, including the factors described in subparagraph (A).
(ii)
Environmental, health, socioeconomic, and demographic data relevant to identifying risks associated with climate change for vulnerable individuals.
(iii)
Existing monitoring networks that collect data described in clause (ii), and any gaps in such networks.
(iv)
Federal, State, and local stakeholders involved in maintaining monitoring networks identified under clause (iii), and how such stakeholders are coordinating their monitoring efforts.
(v)
Additional monitoring networks, and enhancements to existing monitoring networks, that would be required to address gaps identified under clause (iii), including at the subcounty and census tract level.
(vi)
Funding amounts required to establish the monitoring networks identified under clause (v) and recommendations for Federal, State, and local coordination with respect to such networks.
(vii)
Potential uses for data collected and generated as a result of the Strategy, including how such data may be used in determining recipients of grants under the program established by subsection (a) or other similar programs.
(viii)
Other information the Secretary considers relevant for the development of the Strategy.
(3) Coordination and consultation
In developing the Strategy, the Secretary shall—
(A)
coordinate with the Administrator of the Environmental Protection Agency and the Administrator of the National Oceanic and Atmospheric Administration; and
(B)
consult with—
(i)
stakeholder organizations;
(ii)
health care providers and professional membership organizations with expertise in maternal health or environmental justice;
(iii)
State and local public health departments;
(iv)
licensed and accredited hospitals, birth centers, midwifery practices, or other health care providers that provide prenatal or labor and delivery services to vulnerable individuals; and
(v)
institutions of higher education, including such institutions that are minority-serving institutions or have expertise in maternal health or environmental justice.
(4) Notice and comment
At least 240 days before the date on which the Strategy is published in accordance with paragraph (5), the Secretary shall provide—
(A)
notice of the Strategy on a public website of the Department of Health and Human Services; and
(B)
an opportunity for public comment of at least 90 days.
(5) Publication
Not later than 18 months after the date of enactment of this Act, the Secretary shall publish on a public website of the Department of Health and Human Services—
(A)
the Strategy;
(B)
the public comments received under paragraph (4); and
(C)
the responses of the Secretary to such public comments.
(e) Definitions
In this section:
(1) Adverse maternal and infant health outcomes
The term adverse maternal and infant health outcomes includes the outcomes of pre-term birth, low birth weight, stillbirth, infant or maternal mortality, and severe maternal morbidity.
(2) Institution of higher education
The term institution of higher education has the meaning given such term in section 101 of the Higher Education Act of 1965 (20 U.S.C. 1001).
(3) Minority-serving institution
The term minority-serving institution means an entity specified in any of paragraphs (1) through (7) of section 371(a) of the Higher Education Act of 1965 (20 U.S.C. 1067q(a)).
(4) Racial and ethnic minority group
The term racial and ethnic minority group has the meaning given such term in section 1707(g) of the Public Health Service Act (42 U.S.C. 300u–6(g)).
(5) Risks associated with climate change
The term risks associated with climate change includes risks associated with extreme heat, air pollution, extreme weather events, and other environmental issues associated with climate change that can result in adverse maternal and infant health outcomes.
(6) Stakeholder organization
The term stakeholder organization means—
(A)
a community-based organization with expertise in providing assistance to vulnerable individuals;
(B)
a nonprofit organization with expertise in maternal or infant health or environmental justice; and
(C)
a patient advocacy organization representing vulnerable individuals.
(7) Vulnerable individual
The term vulnerable individual means—
(A)
an individual who is pregnant;
(B)
an individual who was pregnant during any portion of the preceding 1-year period; and
(C)
an individual under 3 years of age.
Sec. 5212. Protect moms from domestic violence
(a) Study by Department of Health and Human Services
(1) Study
The Secretary, in collaboration with the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration, and the Administration for Children and Families, and in consultation with the Attorney General of the United States, the Director of the Indian Health Service, and stakeholders (including community-based organizations, culturally specific organizations, and Tribal public health authorities), shall conduct a study on the extent to which individuals are more at risk of maternal mortality or severe maternal morbidity as a result of being a victim of domestic violence, dating violence, sexual assault, stalking, human trafficking, sex trafficking, child sexual abuse, or forced marriage.
(2) Reports
Not later than 2 years after the date of enactment of this Act, the Secretary shall complete the study under paragraph (1) and submit a report to the Congress on the results of such study. Such report shall include—
(A)
an analysis of the extent to which domestic violence, dating violence, sexual assault, stalking, human trafficking, sex trafficking, child sexual abuse, and forced marriage contribute to, or result in, maternal mortality;
(B)
an analysis of the impact of domestic violence, dating violence, sexual assault, stalking, human trafficking, sex trafficking, child sexual abuse, and forced marriage on access to health care (including mental health care) and substance use disorder treatment and recovery support;
(C)
a breakdown (including by race and ethnicity) of categories of individuals who are disproportionately victims of domestic violence, dating violence, sexual assault, stalking, human trafficking, sex trafficking, child sexual abuse, or forced marriage that contributes to, or results in, pregnancy-related death;
(D)
an analysis of the impact on health, mental health, and substance use resulting from domestic violence, dating violence, sexual assault, stalking, human trafficking, sex trafficking, child sexual abuse, and forced marriage among Alaskan Natives, Native Hawaiians, and American Indians during the prenatal and postpartum period;
(E)
an assessment of the factors that increase or decrease risks for maternal mortality or severe maternal morbidity among victims of domestic violence, dating violence, sexual assault, stalking, human trafficking, sex trafficking, child sexual abuse, or forced marriage;
(F)
an assessment of increased risk of maternal mortality or severe maternal morbidity stemming from suicide, substance use disorders, or drug overdose due to domestic violence, dating violence, sexual assault, stalking, human trafficking, sex trafficking, child sexual abuse, or forced marriage;
(G)
recommendations for legislative or policy changes—
(i)
to reduce maternal mortality rates; and
(ii)
to address health inequities that contribute to inequities in such rates and deaths;
(H)
best practices to reduce maternal mortality and severe maternal morbidity among victims of domestic violence, dating violence, sexual assault, stalking, human trafficking, sex trafficking, child sexual abuse, and forced marriage, including—
(i)
reducing reproductive coercion, mental health conditions, and substance use coercion; and
(ii)
routinely assessing pregnant people for domestic violence and other forms of reproductive violence; and
(I)
any other information on maternal mortality or severe maternal morbidity the Secretary determines appropriate to include in the report.
(b) Study by National Academy of medicine
(1) In general
The Secretary shall seek to enter into an arrangement with the National Academy of Medicine (or, if the Academy declines to enter into such arrangement, another appropriate entity) to study—
(A)
the impact of domestic violence, dating violence, sexual assault, stalking, human trafficking, sex trafficking, child sexual abuse, and forced marriage on an individual’s health; relative to
(B)
maternal mortality and severe maternal morbidity.
(2) Topics
The study under paragraph (1) shall—
(A)
examine—
(i)
whether domestic violence, dating violence, sexual assault, stalking, human trafficking, sex trafficking, child sexual abuse, or forced marriage, or generational intimate partner violence, trauma, and psychiatric disorders, increase the risk of suicide, substance use, and drug overdose among pregnant and postpartum persons; and
(ii)
the intersection of domestic violence, dating violence, sexual assault, stalking, human trafficking, sex trafficking, child sexual abuse, and forced marriage as a social determinant of health; and
(B)
give particular focus to impacts among African American, American Indian, Native Hawaiian, Alaskan Native, and LGBTQ birthing persons.
(c) Grants for innovative approaches
(1) In general
The Secretary, acting through the Administrator of the Health Resources and Services Administration, and in collaboration with the Administration for Children and Families, the Indian Health Service, and the Substance Abuse and Mental Health Services Administration, shall award grants to eligible entities for developing and implementing innovative approaches to improve maternal and child health outcomes of victims of domestic violence, dating violence, sexual assault, stalking, human trafficking, sex trafficking, child sexual abuse, or forced marriage.
(2) Eligible entity
To seek a grant under this subsection, an entity shall be—
(A)
a State, local, or federally recognized Tribal government;
(B)
a nonprofit organization or community-based organization that provides prevention or intervention services related to domestic violence, dating violence, sexual assault, stalking, human trafficking, sex trafficking, child sexual abuse, or forced marriage;
(C)
a tribal organization or Urban Indian organization (as such terms are defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603));
(D)
an entity, the principal purpose of which is to provide health care, such as a hospital, clinic, health department, freestanding birthing center, perinatal health worker, or maternity care provider;
(E)
an institution of higher education; or
(F)
a comprehensive substance use disorder parenting program.
(3) Priority
In awarding grants under this subsection, the Secretary shall give priority to applicants proposing to address—
(A)
mental health and substance use disorders among pregnant persons; or
(B)
pregnant and postpartum persons experiencing intimate partner violence.
(4) Freestanding birth center defined
In this subsection, the term freestanding birth center has the meaning given that term in section 1905(l) of the Social Security Act (42 U.S.C. 1396d(l)).
(5) Authorization of appropriations
To carry out this subsection, there is authorized to be appropriated $25,000,000 for the period of fiscal years 2027 through 2029.
(d) Guidance
Not later than 2 years after the date of enactment of this Act, the Secretary shall issue and disseminate guidance to States, Tribes, territories, maternity care providers, and managed care entities on—
(1)
providing universal education on healthy relationships and intimate partner violence;
(2)
developing protocols on—
(A)
routine assessment of intimate partner violence; and
(B)
health promotion and strategies for trauma-informed care plans; and
(3)
creating sustainable partnerships with community-based organizations that address domestic violence, dating violence, sexual assault, stalking, human trafficking, sex trafficking, child sexual abuse, or forced marriage.
(e) Definitions
In this section:
(1) Maternal mortality
The term maternal mortality—
(A)
means death that—
(i)
occurs during, or within the 1-year period after, pregnancy; and
(ii)
is attributed to or aggravated by pregnancy-related or childbirth complications; and
(B)
includes a suicide, drug overdose death, homicide (including a domestic violence-related homicide), or other death resulting from a mental health or substance use disorder attributed to or aggravated by pregnancy-related or childbirth complications.
(2) Maternity care provider
The term maternity care provider means a health care provider who—
(A)
is a physician, physician assistant, nurse, midwife who meets at a minimum the international definition of the midwife and global standards for midwifery education as established by the International Confederation of Midwives, nurse practitioner, or clinical nurse specialist; and
(B)
has a focus on maternal or perinatal health.
(3) Perinatal health worker
The term perinatal health worker means a worker who—
(A)
is a doula, community health worker, peer supporter, breastfeeding and lactation educator or counselor, nutritionist or dietitian, childbirth educator, social worker, home visitor, language interpreter, or navigator; and
(B)
provides assistance with perinatal health.
(4) Postpartum
The term postpartum means the 12-month period following childbirth.
(5) Secretary
The term Secretary means the Secretary of Health and Human Services.
(6) Severe maternal morbidity
The term severe maternal morbidity means a health condition, including a mental health condition or substance use disorder, that—
(A)
is attributed to or aggravated by pregnancy or childbirth; and
(B)
results in significant short-term or long-term consequences to the health of the individual who was pregnant.
Sec. 5213. Midwives schools and programs expansion
(a) Midwifery schools and programs
(1) In general
Title VII of the Public Health Service Act is amended by inserting after section 760 (42 U.S.C. 294k) the following:
760A. Midwifery schools and programs
(a) In general
The Secretary may award grants to institutions of higher education (as defined in subsections (a) and (b) of section 101 of the Higher Education Act of 1965) for the following:
(1)
Direct support of students in an accredited midwifery school or program.
(2)
Establishment or expansion of an accredited midwifery school or program.
(3)
Securing, preparing, or providing support for increasing the number of qualified preceptors for training the students of an accredited midwifery school or program.
(b) Special considerations
In awarding grants under subsection (a), the Secretary shall give special consideration to any institution of higher education that—
(1)
agrees to prioritize students who plan to practice in a health professional shortage area designated under section 332; and
(2)
demonstrates a focus on increasing racial and ethnic minority representation in midwifery education.
(c) Restriction
The Secretary shall not provide any assistance under this section to be used with respect to a midwifery school or program within a school of nursing (as defined in section 801).
(d) Authorization of appropriations
(1) In general
There is authorized to be appropriated to carry out this section $15,000,000 for the period of fiscal years 2027 through 2031.
(2) Allocation
Of the amounts made available to carry out this section for any fiscal year, the Secretary shall use—
(A)
50 percent to award grants for purposes specified in subsection (a)(1);
(B)
25 percent to award grants for purposes specified in subsection (a)(2); and
(C)
25 percent to award grants for purposes specified in subsection (a)(3).
(2) Definitions
(A) Midwifery school or program
Section 799B(1)(A) of the Public Health Service Act (42 U.S.C. 295p(1)(A)) is amended—
(i)
by inserting
before midwifery school or program
,and
;school of chiropractic
(ii)
by inserting a degree or certificate in midwifery or an equivalent degree or certificate,
before and a degree of doctor of chiropractic or an equivalent degree
; and
(iii)
by striking any such school
and inserting any such school or program
.
(B) Accredited
Section 799B(1)(E) of the Public Health Service Act (42 U.S.C. 295p(1)(E)) is amended by inserting a midwifery school or program,
before or a graduate program in health administration
.
(b) Nurse-Midwives
Title VIII of the Public Health Service Act is amended by inserting after section 812 (as added by section 5205(c)), the following:
812A. Midwifery expansion program
(a) In general
The Secretary may award grants to schools of nursing for the following:
(1)
Direct support of students in an accredited nurse-midwifery school or program.
(2)
Establishment or expansion of an accredited nurse-midwifery school or program.
(3)
Securing, preparing, or providing support for increasing the number of qualified preceptors at clinical training sites to precept students training to become certified nurse-midwives.
(b) Special considerations
In awarding grants under subsection (a), the Secretary shall give special consideration to any school of nursing that—
(1)
agrees to prioritize students who choose to pursue an advanced education degree in nurse-midwifery to practice in a health professional shortage area designated under section 332; and
(2)
demonstrates a focus on increasing racial and ethnic minority representation in nurse-midwifery education.
(c) Authorization of appropriations
(1) In general
To carry out this section, there is authorized to be appropriated $20,000,000 for the period of fiscal years 2027 through 2031.
(2) Allocation
Of the amounts made available to carry out this section for any fiscal year, the Secretary shall use—
(A)
50 percent to award grants for purposes specified in subsection (a)(1);
(B)
25 percent to award grants for purposes specified in subsection (a)(2); and
(C)
25 percent to award grants for purposes specified in subsection (a)(3).
Sec. 5214. Gestational diabetes
Part B of title III of the Public Health Service Act (42 U.S.C. 243 et seq.) is amended by adding after section 317H (42 U.S.C. 247b–9) the following:
317H–1. Gestational diabetes
(a) Understanding and monitoring gestational diabetes
(1) In general
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, in consultation with the Diabetes Mellitus Interagency Coordinating Committee established under section 429 and representatives of appropriate national health organizations, shall develop a multisite gestational diabetes research project within the diabetes program of the Centers for Disease Control and Prevention to expand and enhance surveillance data and public health research on gestational diabetes.
(2) Areas to be addressed
The research project developed under paragraph (1) shall address—
(A)
procedures to establish accurate and efficient systems for the collection of gestational diabetes data within each State and commonwealth, territory, or possession of the United States;
(B)
the progress of collaborative activities with the National Vital Statistics System, the National Center for Health Statistics, and State health departments with respect to the standard birth certificate, in order to improve surveillance of gestational diabetes;
(C)
postpartum methods of tracking individuals with gestational diabetes after delivery as well as targeted interventions proven to lower the incidence of type 2 diabetes in that population;
(D)
variations in the distribution of diagnosed and undiagnosed gestational diabetes, and of impaired fasting glucose tolerance and impaired fasting glucose, within and among groups of pregnant individuals; and
(E)
factors and culturally sensitive interventions that influence risks and reduce the incidence of gestational diabetes and related complications during childbirth, including cultural, behavioral, racial, ethnic, geographic, demographic, socioeconomic, and genetic factors.
(3) Report
Not later than 2 years after the date of enactment of this section, and annually thereafter, the Secretary shall generate a report on the findings and recommendations of the research project including prevalence of gestational diabetes in the multisite area and disseminate the report to the appropriate Federal and non-Federal agencies.
(b) Expansion of gestational diabetes research
(1) In General
The Secretary shall expand and intensify public health research regarding gestational diabetes. Such research may include—
(A)
developing and testing novel approaches for improving postpartum diabetes testing or screening and for preventing type 2 diabetes in individuals who can become pregnant with a history of gestational diabetes; and
(B)
conducting public health research to further understanding of the epidemiologic, socioenvironmental, behavioral, translation, and biomedical factors and health systems that influence the risk of gestational diabetes and the development of type 2 diabetes in individuals who can become pregnant with a history of gestational diabetes.
(2) Authorization of Appropriations
There is authorized to be appropriated to carry out this subsection $5,000,000 for each of fiscal years 2027 through 2031.
(c) Demonstration grants To lower the rate of gestational diabetes
(1) In General
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall award grants, on a competitive basis, to eligible entities for demonstration projects that implement evidence-based interventions to reduce the incidence of gestational diabetes, the recurrence of gestational diabetes in subsequent pregnancies, and the development of type 2 diabetes in individuals who can become pregnant with a history of gestational diabetes.
(2) Priority
In making grants under this subsection, the Secretary shall give priority to projects focusing on—
(A)
helping individuals who can become pregnant who have 1 or more risk factors for developing gestational diabetes;
(B)
working with individuals who can become pregnant with a history of gestational diabetes during a previous pregnancy;
(C)
providing postpartum care for individuals who can become pregnant with gestational diabetes;
(D)
tracking cases where individuals who can become pregnant with a history of gestational diabetes developed type 2 diabetes;
(E)
educating mothers with a history of gestational diabetes about the increased risk of their child developing diabetes;
(F)
working to prevent gestational diabetes and prevent or delay the development of type 2 diabetes in individuals who can become pregnant with a history of gestational diabetes; and
(G)
achieving outcomes designed to assess the efficacy and cost-effectiveness of interventions that can inform decisions on long-term sustainability, including third-party reimbursement.
(3) Application
An eligible entity desiring to receive a grant under this subsection shall submit to the Secretary—
(A)
an application at such time, in such manner, and containing such information as the Secretary may require; and
(B)
a plan to—
(i)
lower the rate of gestational diabetes during pregnancy; or
(ii)
develop methods of tracking individuals who can become pregnant with a history of gestational diabetes and develop effective interventions to lower the incidence of the recurrence of gestational diabetes in subsequent pregnancies and the development of type 2 diabetes.
(4) Uses of Funds
An eligible entity receiving a grant under this subsection shall use the grant funds to carry out demonstration projects described in paragraph (1), including—
(A)
expanding community-based health promotion education, activities, and incentives focused on the prevention of gestational diabetes and development of type 2 diabetes in individuals who can become pregnant with a history of gestational diabetes;
(B)
aiding State- and Tribal-based diabetes prevention and control programs to collect, analyze, disseminate, and report surveillance data on individuals who can become pregnant with, and at risk for, gestational diabetes, the recurrence of gestational diabetes in subsequent pregnancies, and, for individuals who can become pregnant with a history of gestational diabetes, the development of type 2 diabetes; and
(C)
training and encouraging health care providers—
(i)
to promote risk assessment, high-quality care, and self-management for gestational diabetes and the recurrence of gestational diabetes in subsequent pregnancies; and
(ii)
to prevent the development of type 2 diabetes in individuals who can become pregnant with a history of gestational diabetes, and its complications in the practice settings of the health care providers.
(5) Report
Not later than 4 years after the date of enactment of this section, the Secretary shall prepare and submit to the Congress a report concerning the results of the demonstration projects conducted through the grants awarded under this subsection.
(6) Definition of Eligible Entity
In this subsection, the term eligible entity means a nonprofit organization (such as a nonprofit academic center or community health center) or a State, Tribal, or local health agency.
(7) Authorization of Appropriations
There is authorized to be appropriated to carry out this subsection $5,000,000 for each of fiscal years 2027 through 2031.
(d) Postpartum followup regarding gestational diabetes
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall work with the State- and Tribal-based diabetes prevention and control programs assisted by the Centers to encourage postpartum followup after gestational diabetes, as medically appropriate, for the purpose of reducing the incidence of gestational diabetes, the recurrence of gestational diabetes in subsequent pregnancies, the development of type 2 diabetes in individuals with a history of gestational diabetes, and related complications.
Sec. 5215. Consumer education campaign
Section 229(b) of the Public Health Service Act (42 U.S.C. 237a(b)) is amended—
(1)
in paragraph (6), by striking and
at the end;
(2)
in paragraph (7), by striking the period at the end and inserting a semicolon; and
(3)
by adding at the end the following:
(8)
not later than 1 year after the date of enactment of this paragraph, develop and implement a 4-year culturally and linguistically appropriate multimedia consumer education campaign that is designed to promote understanding and acceptance of evidence-based maternity practices and models of care for optimal maternity outcomes among individuals of childbearing ages and families of such individuals and that—
(A)
highlights the importance of protecting, promoting, and supporting the innate capacities of childbearing individuals and their newborns for childbirth, breastfeeding, and attachment;
(B)
promotes understanding of the importance of using obstetric interventions when medically necessary and when supported by strong, high-quality evidence;
(C)
highlights the widespread overuse of maternity practices that have been shown to have benefit when used appropriately in situations of medical necessity, but which can expose pregnant individuals, infants, or both to risk of harm if used routinely and indiscriminately;
(D)
emphasizes the noninvasive maternity practices that have proven correlation or may be associated with improvement in outcomes with no detrimental side effects, and are significantly underused in the United States, including smoking cessation programs in pregnancy, group model prenatal care, continuous labor support, nonsupine positions for birth, and external version to turn breech babies at term;
(E)
educates consumers about—
(i)
the qualifications of licensed providers of maternity care, including obstetrician-gynecologists, family physicians, certified nurse-midwives, certified midwives, and certified professional midwives; and
(ii)
the best evidence about the safety, satisfaction, outcomes, and costs of such providers;
(F)
informs consumers about the best available research comparing birth center births, planned home births, and hospital births, including information about each setting’s safety, satisfaction, outcomes, and costs;
(G)
fosters participation in high-quality, evidence-based childbirth education that promotes a healthy and safe approach to pregnancy, childbirth, and early parenting; is taught by certified educators, peer counselors, and health professionals; and promotes informed decision making by childbearing individuals;
(H)
informs consumers about—
(i)
the effects of systemic, institutional, and interpersonal racism on the health, well-being, and outcomes of birthing people;
(ii)
the importance of respectful, culturally and linguistically appropriate, and culturally congruent care; and
(iii)
the value of community-based and community-led maternal care and support; and
(I)
is pilot tested for consumer comprehension, cultural sensitivity, and acceptance of the messages across geographically, racially, ethnically, and linguistically diverse populations;
Sec. 5216. Bibliographic database of systematic reviews for care of childbearing individuals and newborns
(a) In general
Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services, acting through the Director of the Agency for Healthcare Research and Quality, shall—
(1)
make publicly available an online bibliographic database identifying systematic reviews, including an explanation of the level and quality of evidence, for care of childbearing individuals and newborns; and
(2)
initiate regular updates that incorporate newly issued and updated systematic reviews.
(b) Sources
To aim for a comprehensive inventory of systematic reviews relevant to maternal and newborn care, the database shall identify reviews from diverse sources, including—
(1)
scientific peer-reviewed journals;
(2)
databases, including the Cochrane Database of Systematic Reviews; and
(3)
internet websites of agencies and organizations throughout the world that produce such systematic reviews.
(c) Features
The database shall—
(1)
provide bibliographic citations for each record within the database, and for each such citation include an explanation of the level and quality of evidence;
(2)
include abstracts, as available;
(3)
provide reference to companion documents as may exist for each review, such as evidence tables and guidelines or consumer educational materials developed from the review;
(4)
provide links to the source of the full review and to any companion documents;
(5)
provide links to the source of a previous version or update of the review;
(6)
be searchable by intervention or other topic of the review, reported outcomes, author, title, and source; and
(7)
offer to users periodic electronic notification of database updates relating to users’ topics of interest.
(d) Outreach
Not later than the first date the database is made publicly available and periodically thereafter, the Secretary of Health and Human Services shall publicize the availability, features, and uses of the database under this section to the stakeholders described in subsection (e).
(e) Consultation
For purposes of developing the database under this section and maintaining and updating such database, the Secretary of Health and Human Services shall convene and consult with an advisory committee composed of relevant stakeholders, including—
(1)
Federal Medicaid administrators and State agencies administrating State plans under title XIX of the Social Security Act pursuant to section 1902(a)(5) of such Act (42 U.S.C. 1396a(a)(5));
(2)
providers of maternity and newborn care from both academic and community-based settings, including obstetrician-gynecologists, family physicians, certified nurse midwives, certified midwives, certified professional midwives, physician assistants, perinatal nurses, pediatricians, and nurse practitioners;
(3)
maternal-fetal medicine specialists;
(4)
neonatologists;
(5)
childbearing individuals and advocates for such individuals, including childbirth educators certified by a nationally accredited program, representing communities that are diverse in terms of race, ethnicity, indigenous status, and geographic area;
(6)
employers and purchasers;
(7)
health facility and system leaders, including both hospital and birth center facilities;
(8)
journalists; and
(9)
bibliographic informatics specialists.
(f) Authorization of appropriations
There is authorized to be appropriated $2,500,000 for each of fiscal years 2027 through 2029 for the purpose of developing the database and such sums as may be necessary for each subsequent fiscal year for updating the database and providing outreach and notification to users, as described in this section.
Sec. 5217. Development of interprofessional maternity care educational models and tools
(a) In general
Not later than 180 days after the date of enactment of this Act, the Secretary of Health and Human Services, acting in conjunction with the Administrator of the Health Resources and Services Administration, shall convene, for a 1-year period, an Interprofessional Maternity Provider Education Commission (referred to in this section as the Commission
) to discuss and make recommendations for—
(1)
a consensus standard physiologic maternity care curriculum that takes into account the core competencies for basic midwifery practice such as those developed by the American College of Nurse-Midwives and the North American Registry of Midwives, and the educational objectives for physicians practicing in obstetrics and gynecology as determined by the Council on Resident Education in Obstetrics and Gynecology;
(2)
suggestions for multidisciplinary use of the consensus physiologic curriculum;
(3)
strategies to integrate and coordinate education across maternity care disciplines, including recommendations to increase medical and midwifery student exposure to out-of-hospital birth;
(4)
curriculum and strategies for continuing education of practicing perinatal professionals who have completed their undergraduate and graduate education; and
(5)
pilot demonstrations of interprofessional educational models.
(b) Participants
(1) Professions
The Commission shall include maternity care educators, curriculum developers, service leaders, certification leaders, and accreditation leaders from the various professions that provide or support maternity care in the United States. Such professions shall include obstetrician gynecologists, certified nurse midwives or certified midwives, family practice physicians, nurse practitioners, physician assistants, certified professional midwives, perinatal nurses, doulas, lactation personnel, and community health workers.
(2) Consumer advocates
The Commission shall also include representation from maternity care consumer advocates.
(c) Curriculum
The consensus standard physiologic maternity care curriculum described in subsection (a)(1) shall—
(1)
have a public health focus with a foundation in health promotion and disease prevention;
(2)
foster physiologic childbearing and person and family centered care;
(3)
reflect the extensive, growing research evidence about—
(A)
the innate abilities and processes of the birthing person and the fetus or newborn for labor, birth, postpartum transition, breastfeeding, and attachment, when promoted, supported, and protected; and
(B)
the effects of factors that disturb and disrupt these processes;
(4)
integrate strategies to reduce maternal and infant morbidity and mortality;
(5)
incorporate recommendations to ensure respectful, safe, and seamless consultation, referral, transport, and transfer of care when necessary;
(6)
include cultural sensitivity and strategies to decrease inequities in maternity outcomes; and
(7)
include implicit bias training.
(d) Report
Not later than 180 days after the final meeting of the Commission, the Secretary of Health and Human Services shall—
(1)
submit to Congress a report containing the recommendations made by the Commission under this section; and
(2)
make such report publicly available.
(e) Authorization of appropriations
There are authorized to be appropriated to carry out this section—
(1)
$1,000,000 for each of fiscal years 2027 and 2028; and
(2)
such sums as are necessary for each of fiscal years 2029 through 2031.
Sec. 5218. Dissemination of the quality family planning guidelines
(a) In general
Not later than 180 days after the date of enactment of this Act, the Secretary of Health and Human Services and the Director of the Centers for Disease Control and Prevention shall—
(1)
develop a plan for outreach to publicly funded health care providers, including federally qualified health centers (as defined in section 1861(aa)(4) of the Social Security Act (42 U.S.C. 1395x(aa)(4))) and branches of the Indian Health Service, about the quality family planning guidelines referred to in section 5304; and
(2)
award grants to eligible entities to implement such guidelines for all patients seeking family planning services.
(b) Definition
In this section, the term eligible entity means a publicly funded health care provider that serves persons of reproductive age.
Subtitle D Federal agency coordination on maternal health
Sec. 5301. Interagency Coordinating Committee on the Promotion of Optimal Maternity Outcomes
(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:
229A. Interagency Coordinating Committee on the Promotion of Optimal Maternity Outcomes
(a) In general
The Secretary, acting through the Deputy Assistant Secretary for Women’s Health under section 229 and in collaboration with the Federal officials specified in subsection (b), shall establish the Interagency Coordinating Committee on the Promotion of Optimal Maternity Outcomes (referred to in this section as the
ICCPOM).(b) Other agencies
The officials specified in this subsection are the Secretary of Labor, the Secretary of Defense, the Secretary of Veterans Affairs, the Surgeon General, the Director of the Centers for Disease Control and Prevention, the Administrator of the Health Resources and Services Administration, the Administrator of the Centers for Medicare & Medicaid Services, the Director of the Indian Health Service, the Assistant Secretary for Mental Health and Substance Use, the Director of the National Institute of Child Health and Human Development, the Director of the Agency for Healthcare Research and Quality, the Assistant Secretary for Children and Families, the Deputy Assistant Secretary for Minority Health, the Director of the Office of Personnel Management, and such other Federal officials as the Secretary of Health and Human Services determines to be appropriate.
(c) Chair
The Deputy Assistant Secretary for Women’s Health shall serve as the chair of the ICCPOM.
(d) Duties
The ICCPOM shall guide policy and program development across the Federal Government with respect to promotion of optimal maternity care. Nothing in this section shall be construed as transferring regulatory or program authority from an agency to the ICCPOM.
(e) Consultations
The ICCPOM shall actively seek the input of, and shall consult with, all appropriate and interested stakeholders, including State health departments, public health research and interest groups, foundations, childbearing individuals and their advocates, and maternity care professional associations and organizations, reflecting racially, ethnically, demographically, and geographically diverse communities.
(f) Annual report
(1) In general
The Secretary, on behalf of the ICCPOM, shall annually submit to Congress a report that summarizes—
(A)
all programs and policies of Federal agencies (including the Medicare program under title XVIII of the Social Security Act and the Medicaid program under title XIX of such Act) designed to promote optimal maternity care, focusing particularly on programs and policies that support the adoption of evidence-based maternity care, as defined by timely, scientifically sound systematic reviews;
(B)
all programs and policies of Federal agencies (including the Medicare program under title XVIII of the Social Security Act and the Medicaid program under title XIX of such Act) designed to address the problems of maternal mortality and morbidity, infant mortality, prematurity, and low birth weight, including such programs and policies designed to address racial and ethnic inequities with respect to each of such problems;
(C)
the extent of progress in reducing maternal mortality and infant mortality, low birth weight, and prematurity at State and national levels; and
(D)
such other information regarding optimal maternity care (such as quality and performance measures) as the Secretary determines to be appropriate.
(2) Reducing inequities with respect to indigenous status
The information specified in paragraph (1)(C) shall be included in each such report in a manner that disaggregates such information by race, ethnicity, and indigenous status in order to determine the extent of progress in reducing racial and ethnic inequities and inequities related to indigenous status.
(3) Certain information
Each report under paragraph (1) shall include information (disaggregated by race, ethnicity, and indigenous status, as applicable) on the following rates, trends, and costs by State:
(A)
The rate and trend of primary cesarean deliveries and repeat cesarean deliveries.
(B)
The rate and trend of vaginal births after cesarean.
(C)
The rate and trend of vaginal breech births.
(D)
The rate and trend of induction of labor.
(E)
The rate and trend of freestanding birth center births.
(F)
The rate and trend of planned and unplanned home birth.
(G)
The rate and trends of attended births by different types of maternity care providers, including by an obstetrician-gynecologist, family practice physician, obstetrician-gynecologist, physician assistant, certified nurse-midwife, certified midwife, and certified professional midwife.
(H)
The rate and trend of severe maternal morbidity.
(I)
The rates and trends of prenatal and postpartum anxiety and depression.
(J)
The rate and trend of preterm birth.
(K)
The rate and trend of low birth weight.
(L)
The cost of maternity care disaggregated by place of birth and provider of care, including—
(i)
uncomplicated vaginal birth;
(ii)
complicated vaginal birth;
(iii)
uncomplicated cesarean birth; and
(iv)
complicated cesarean birth.
(g) Authorization of appropriations
There is authorized to be appropriated, in addition to amounts authorized to be appropriated under section 229(e), to carry out this section $1,000,000 for each of the fiscal years 2027 through 2031.
(b) Conforming amendments
(1) Inclusion as duty of HHS office on women’s health
Section 229(b) of the Public Health Service Act (42 U.S.C. 237a(b)) (as amended by section 5215) is amended by adding at the end the following:
(9)
establish the Interagency Coordinating Committee on the Promotion of Optimal Maternity Outcomes in accordance with section 229A; and
(2) Treatment of biennial reports
Section 229(d) of such Act (42 U.S.C. 237a(d)) is amended by inserting (other than under subsection (b)(9))
after under this section
.
Sec. 5302. Expansion of CDC Prevention Research Centers Program to include Centers on Optimal Maternity Outcomes
(a) In general
Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services shall support the establishment of additional Prevention Research Centers under the Prevention Research Center Program administered by the Centers for Disease Control and Prevention. Such additional centers shall each be known as a Center for Excellence on Optimal Maternity Outcomes.
(b) Research
Each Center for Excellence on Optimal Maternity Outcomes shall—
(1)
conduct at least one focused program of research to improve maternity outcomes, including the reduction of cesarean birth rates, early elective inductions, prematurity rates, and low birth weight rates within an underserved population that has a disproportionately large burden of suboptimal maternity outcomes, including maternal mortality and morbidity, infant mortality, prematurity, or low birth weight, which such program shall include developing performance and quality measures for accountability;
(2)
work with partners on special interest projects, as specified by the Centers for Disease Control and Prevention and other relevant agencies within the Department of Health and Human Services, and on projects funded by other sources; and
(3)
involve a minimum of two distinct birth setting models, such as—
(A)
a hospital labor and delivery model and freestanding birth center model; or
(B)
a hospital labor and delivery model and planned home birth model.
(c) Interdisciplinary providers
Each Center for Excellence on Optimal Maternity Outcomes shall include the following interdisciplinary providers of maternity care:
(1)
Obstetrician-gynecologists.
(2)
At least two of the following providers:
(A)
Family practice physicians.
(B)
Nurse practitioners.
(C)
Physician assistants.
(D)
Certified professional midwives, certified nurse-midwives, or certified midwives.
(d) Services
Research conducted by each Center for Excellence on Optimal Maternity Outcomes shall include at least 2 (and preferably more) of the following supportive provider services:
(1)
Mental health.
(2)
Doula labor support.
(3)
Nutrition education.
(4)
Childbirth education.
(5)
Social work.
(6)
Physical therapy or occupation therapy.
(7)
Substance use disorder services.
(8)
Home visiting.
(e) Coordination
The programs of research at each of the Centers of Excellence on Optimal Maternity Outcomes shall complement and not replicate the work of the other.
(f) Authorization of appropriations
There is authorized to be appropriated to carry out this section $2,000,000 for each of fiscal years 2027 through 2031.
Sec. 5303. Expanding models to be tested by Center for Medicare and Medicaid Innovation to explicitly include maternity care and children’s health models
Section 1115A(b)(2) of the Social Security Act (42 U.S.C. 1315a(b)(2)), as amended by section 5209(b), is amended—
(1)
in subparagraph (B), by adding at the end the following:
(xxix)
Promoting evidence-based models of care that have been associated with reductions in pregnancy-related and infant health inequities, including incorporating the use of and payment for doulas, particularly community-based doulas, and promoting support for people during pregnancy and for the one-year period after the last day of such person’s pregnancy, through evidence-based models of antepartum, birth, postpartum care, and two-generation birthing person and newborn care models, and supporting the risk-appropriate use of out-of-hospital birth models, including births at home and in freestanding birth centers. Such models shall be selected and evaluated based on their impact on quality, equity, and developmental outcomes, notwithstanding any other provision of this section. ;
(2)
in subparagraph (C), by adding at the end the following:
(ix)
Whether the model includes a regular process for ensuring the provision of culturally and linguistically appropriate services.
(x)
Whether health care services and supportive services included in the model are tailored to community health and health-related social needs and provided by community-based and community-led providers.
(xi)
Whether the model is designed to mitigate harmful effects of discrimination on the basis of race, sex, disability, ethnicity, language, and age. ; and
(3)
by adding at the end the following:
(D) Mandatory health equity models to be tested
The Secretary shall select—
(i)
Medicaid payment models for culturally and linguistically appropriate antepartum, labor and delivery, and postpartum doula services, including community-based doula services, that are—
(I)
structured to provide payment to doulas as individuals, health care entity staff, or members of a doula group or collective, or through a third-party administrator;
(II)
designed to reduce racial and intersecting health inequities;
(III)
designed to provide doulas providing support with an equitable and sustainable reimbursement rate;
(IV)
designed to reduce barriers to workforce entry for culturally and linguistically competent and racially congruent doulas to provide services to Medicaid enrollees; and
(V)
designed with input from community-based doulas, maternal health advocates, reproductive justice advocates, and Medicaid beneficiaries;
(ii)
a Medicaid episode-based payment model for pregnancy-related services, including health care services and supportive services to address health-related social needs, during the prenatal, intrapartum, and postpartum periods, to improve health outcomes and reduce racial health inequities, and to be designed with input from maternity care providers, maternal health advocates, reproductive justice advocates, and Medicaid beneficiaries;
(iii)
a Medicaid alternative payment model for a pregnancy-related health home service to improve health outcomes during and for one year after pregnancy and during the newborn period, and to reduce racial health inequities, designed with input from maternity care providers, maternal health advocates, reproductive justice advocates, and Medicaid beneficiaries;
(iv)
a Medicaid perinatal health worker service delivery model for culturally and linguistically appropriate and respectful health care and supportive services that are tailored to community health and health-related social needs, designed to improve health outcomes and mitigate harmful effects of racism and other forms of discrimination, and provided by community-based and community-led providers; and
(v)
one or more models exclusively focused on early intervention and prevention for children enrolled in a State plan (or waiver of such plan) under title XIX or a State child health plan under title XXI using evidence-based interventions including parenting support programs, home-visiting services, and dyadic therapy treatment for children and adolescents at risk.
Such models shall be selected and evaluated based on their impact on quality, equity, and developmental outcomes, notwithstanding any other provision of this section.
Sec. 5304. Interagency update to the quality family planning guidelines
(a) In general
Not later than 180 days after the date of enactment of this Act, the Director of the Centers for Disease Control and Prevention and the Office of Population Affairs shall review and expand the 2014 Quality Family Planning Guidelines to address—
(1)
health inequities; and
(2)
the importance of patient-directed contraceptive decision making.
(b) Consultation
In carrying out subsection (a), the Director of the Centers for Disease Control and Prevention and the Office of Population Affairs shall convene a meeting, and solicit the views of, stakeholders including experts on health inequities, experts on reproductive coercion, representatives of provider organizations, patient advocates, reproductive justice organizations, organizations that represent racial and ethnic minority communities, organizations that represent people with disabilities, organizations that represent LGBTQ persons, and organizations that represent people with limited English proficiency.
Subtitle E Reproductive and Sexual Health
Sec. 5401. Sense of Congress on urgent issues concerning barriers to abortion access and vital solutions
It is the sense of Congress that eliminating the Hyde amendment, enacting the Equal Access to Abortion Coverage in Health Insurance Act of 2025, and enacting the Women’s Health Protection Act of 2025, are critical to—
(1)
promoting equitable abortion access, including coverage, for all who seek care;
(2)
creating enforceable rights to receive, and receive coverage for, such care;
(3)
advancing equitable access to comprehensive health coverage, which cannot be achieved without abortion coverage; and
(4)
alleviating urgent racial, gender, and other inequities in health and health care and corresponding reproductive injustices.
Sec. 5402. Emergency contraception education and information programs
(a) Emergency Contraception Public Education Program
(1) In general
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall develop and disseminate to the public medically accurate and complete information on emergency contraceptives.
(2) Dissemination
The Secretary may disseminate medically accurate and complete information under paragraph (1) directly or through arrangements with nonprofit organizations, community health workers, including patient advocates, consumer groups, institutions of higher education, clinics, the media, and Federal, State, and local agencies.
(3) Information
The information disseminated under paragraph (1) shall—
(A)
include, at a minimum, a description of emergency contraceptives and an explanation of the use, safety, efficacy, affordability, and availability, including over-the-counter access, of such contraceptives and options for access to such contraceptives without cost-sharing through insurance and other programs; and
(B)
be pilot tested for consumer comprehension, cultural and linguistic appropriateness, and acceptance of the messages across geographically, racially, ethnically, and linguistically diverse populations.
(b) Emergency Contraception Information Program for Health Care Providers
(1) In general
The Secretary, acting through the Administrator of the Health Resources and Services Administration and in consultation with major medical and public health organizations, shall develop and disseminate to health care providers, including pharmacists, information on emergency contraceptives.
(2) Information
The information disseminated under paragraph (1) shall include, at a minimum—
(A)
information describing the use, safety, efficacy, and availability of emergency contraceptives, and options for access without cost-sharing through insurance and other programs;
(B)
a recommendation regarding the use of such contraceptives; and
(C)
information explaining how to obtain copies of the information developed under subsection (a) for distribution to the patients of the providers.
(c) Definitions
In this section:
(1) Health care provider
The term health care provider means an individual who is licensed or certified under State law to provide health care services and who is operating within the scope of such license. Such term shall include a pharmacist.
(2) Institution of higher education
The term institution of higher education has the meaning given such term in section 101(a) of the Higher Education Act of 1965 (20 U.S.C. 1001(a)).
(3) Secretary
The term Secretary means the Secretary of Health and Human Services.
(d) Authorization of Appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
Sec. 5403. Duties of pharmacies to ensure provision of FDA-approved contraception
Part B of title II of the Public Health Service Act (42 U.S.C. 238 et seq.) is amended by adding at the end the following:
249. Duties of pharmacies to ensure provision of FDA-approved contraception
(a) In general
Subject to subsection (c), a pharmacy that receives Food and Drug Administration-approved drugs or devices in interstate commerce shall maintain compliance with each of the following:
(1)
If a customer requests a contraceptive or a medication related to a contraceptive, including emergency contraception, that is in stock, the pharmacy shall ensure that the requested contraceptive or medication is provided to the customer without delay.
(2)
If a customer requests a contraceptive or a medication related to a contraceptive that is not in stock and the pharmacy in the normal course of business stocks contraception, the pharmacy shall immediately inform the customer that the requested contraceptive or medication is not in stock and without delay offer the customer the following options:
(A)
If the customer prefers to obtain the requested contraceptive or medication through a referral or transfer, the pharmacy shall—
(i)
locate a pharmacy of the customer’s choice or the closest pharmacy confirmed to have the requested contraceptive or medication in stock; and
(ii)
refer the customer or transfer the prescription to that pharmacy.
(B)
If the customer prefers for the pharmacy to order the requested contraceptive or medication, the pharmacy shall obtain the contraceptive or medication under the pharmacy’s standard procedure for expedited ordering of medication and notify the customer when the contraceptive or medication arrives.
(3)
The pharmacy shall ensure that—
(A)
the pharmacy does not operate an environment in which customers are intimidated, threatened, or harassed in the delivery of services relating to a request for contraception or a medication related to a contraceptive;
(B)
the pharmacy’s employees do not interfere with or obstruct the delivery of services relating to a request for contraception or a medication related to a contraceptive;
(C)
the pharmacy’s employees do not intentionally misrepresent or deceive customers about the availability of a contraceptive or a medication related to a contraceptive, or the mechanism of action of such contraceptive or medication;
(D)
the pharmacy’s employees do not breach medical confidentiality with respect to a request for a contraceptive or a medication related to a contraceptive or threaten to breach such confidentiality; or
(E)
the pharmacy’s employees do not refuse to return a valid, lawful prescription for a contraceptive or a medication related to a contraceptive upon customer request.
(b) Contraceptives not ordinarily stocked
Nothing in subsection (a)(2) shall be construed to require any pharmacy to comply with such subsection if the pharmacy does not ordinarily stock contraceptives or medications related to contraceptives, as the case may be, in the normal course of business.
(c) Refusals pursuant to standard pharmacy practice
This section does not prohibit a pharmacy from refusing to provide a contraceptive or a medication related to a contraceptive to a customer in accordance with any of the following:
(1)
If it is unlawful to dispense the requested contraceptive or medication to the customer without a valid, lawful prescription and no such prescription is presented.
(2)
If the customer is unable to pay for the requested contraceptive or medication.
(3)
If the employee of the pharmacy refuses to provide the requested contraceptive or medication on the basis of a professional clinical judgment.
(d) Relation to other law
(1) Rule of construction
Nothing in this section shall be construed to invalidate or limit rights, remedies, procedures, or legal standards under title VII of the Civil Rights Act of 1964.
(2) Certain claims
The Religious Freedom Restoration Act of 1993 shall not provide a basis for a claim concerning, or a defense to a claim under, this section, or provide a basis for challenging the application or enforcement of this section.
(e) Preemption
This section does not preempt any provision of State law or affect any professional obligation made applicable by a State board or other entity responsible for licensing or discipline of pharmacies or pharmacists, to the extent that such State law or professional obligation provides protections for customers that are greater than the protections provided by this section.
(f) Enforcement
(1) Civil penalty
A pharmacy that violates a requirement of subsection (a) is liable to the United States for a civil penalty in an amount not exceeding $1,000 per day of violation, not to exceed $100,000 for all violations adjudicated in a single proceeding.
(2) Private cause of action
Any person aggrieved as a result of a violation of a requirement of subsection (a) may, in any court of competent jurisdiction, commence a civil action against the pharmacy involved to obtain appropriate relief, including actual and punitive damages, injunctive relief, and a reasonable attorney’s fee and costs.
(3) Limitations
A civil action under paragraph (1) or (2) may not be commenced against a pharmacy after the expiration of the 5-year period beginning on the date on which the pharmacy allegedly engaged in the violation involved.
(g) Definitions
In this section:
(1) Contraception
The term contraception or contraceptive means any drug or device approved by the Food and Drug Administration to prevent pregnancy.
(2) Employee
The term employee means a person hired, by contract or any other form of an agreement, by a pharmacy.
(3) Medication related to a contraceptive
The term medication related to a contraceptive means any drug or device approved by the Food and Drug Administration that a medical professional determines necessary to use before or in conjunction with use of a contraceptive.
(4) Pharmacy
The term pharmacy means an entity that—
(A)
is authorized by a State to engage in the business of selling prescription drugs at retail; and
(B)
employs one or more employees.
(5) Product
The term product means a Food and Drug Administration-approved drug or device.
(6) Professional clinical judgment
The term professional clinical judgment means a clinical judgment, formed with the use of professional knowledge and skills, in accordance with prevailing medical standards.
(7) Without delay
The term without delay, with respect to a pharmacy providing, providing a referral for, or ordering contraception, or transferring the prescription for contraception, means within the usual and customary timeframe at the pharmacy for providing, providing a referral for, or ordering other products, or transferring the prescription for other products, respectively.
(h) Effective date
This section shall take effect on the 31st day after the date of the enactment of this section, without regard to whether the Secretary has issued any guidance or final rule regarding this section.
Sec. 5404. Real Education and Access for Healthy Youth Act
(a) Short title
This section may be cited as the Real Education and Access for Healthy Youth Act
.
(b) Definitions
In this section:
(1) Age and developmentally appropriate
The term age and developmentally appropriate means topics, messages, and teaching methods suitable to particular ages, age groups, or developmental levels, based on cognitive, emotional, social, and behavioral capacity of most young people at that age level.
(2) Consent
The term consent means affirmative, conscious, and voluntary agreement to engage in interpersonal, physical, or sexual activity.
(3) Culturally responsive
The term culturally responsive means education and services that—
(A)
embrace and actively engage and adjust to young people and their various cultural identities;
(B)
recognize the ways in which many marginalized young people face unique barriers in society that result in increased adverse health outcomes and associated stereotypes; and
(C)
may address the ways in which racism has shaped national health care policy, the lasting historical trauma associated with reproductive health experiments and forced sterilizations of Black, Latine, and Indigenous communities, or sexual stereotypes assigned to young People of Color or LGBTQ+ people.
(4) Evidence-informed
The term evidence-informed means incorporates characteristics, content, or skills that have been proven to be effective through evaluation in changing sexual behavior.
(5) Gender expression
The term gender expression means the expression of one's gender, such as through behavior, clothing, haircut, or voice, and which may or may not conform to socially defined behaviors and characteristics typically associated with being either masculine or feminine.
(6) Gender identity
The term gender identity means the gender-related identity, appearance, mannerisms, or other gender-related characteristics of an individual, regardless of the individual's designated sex at birth.
(7) Inclusive
The term inclusive means content and skills that ensure marginalized young people are valued, respected, centered, and supported in sex education instruction and materials.
(8) Institution of higher education
The term institution of higher education has the meaning given the term in section 101 of the Higher Education Act of 1965 (20 U.S.C. 1001).
(9) Interpersonal violence
The term interpersonal violence means abuse, assault, bullying, dating violence, domestic violence, harassment, intimate partner violence, or stalking.
(10) Local educational agency
The term local educational agency has the meaning given the term in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).
(11) Marginalized young people
The term marginalized young people means young people who are disadvantaged by underlying structural barriers and social inequities, including young people who are—
(A)
Black, Indigenous, Latine, Asian American, Native Hawaiian, Pacific Islander, and other People of Color;
(B)
immigrants;
(C)
in contact with the foster care system;
(D)
in contact with the juvenile justice system;
(E)
experiencing homelessness;
(F)
pregnant or parenting;
(G)
lesbian, gay, bisexual, transgender, or queer;
(H)
living with HIV;
(I)
living with disabilities;
(J)
from families with low-incomes; or
(K)
living in rural areas.
(12) Medically accurate and complete
The term medically accurate and complete means that—
(A)
the information provided through the education is verified or supported by the weight of research conducted in compliance with accepted scientific methods and is published in peer-reviewed journals, where applicable; or
(B)
the education contains information that leading professional organizations and agencies with relevant expertise in the field recognize as accurate, objective, and complete.
(13) Resilience
The term resilience means the ability to adapt to trauma and tragedy.
(14) Secretary
The term Secretary means the Secretary of Health and Human Services.
(15) Sex education
The term sex education means high quality teaching and learning that—
(A)
is delivered, to the maximum extent practicable, following the National Sexuality Education Standards of the Future of Sex Ed Initiative;
(B)
is about a broad variety of topics related to sex and sexuality, including—
(i)
puberty and adolescent development;
(ii)
sexual and reproductive anatomy and physiology;
(iii)
sexual orientation, gender identity, and gender expression;
(iv)
contraception, pregnancy, pregnancy options, and reproduction;
(v)
HIV and other STIs;
(vi)
consent and healthy relationships; and
(vii)
interpersonal violence;
(C)
explores values and beliefs about such topics; and
(D)
helps young people in gaining the skills that are needed to navigate relationships and manage one’s own sexual health.
(16) Sexual health services
The term sexual health services includes—
(A)
sexual health information, education, and counseling;
(B)
all methods of contraception approved by the Food and Drug Administration;
(C)
routine gynecological care, including human papillomavirus (HPV) vaccines and cancer screenings;
(D)
pre-exposure prophylaxis or post-exposure prophylaxis;
(E)
substance use and mental health services;
(F)
interpersonal violence survivor services; and
(G)
other pregnancy and STI prevention, care, or treatment services.
(17) Sexual orientation
The term sexual orientation means an individual's romantic, emotional, or sexual attraction to other people.
(18) State educational agency
The term State educational agency has the meaning given the term in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).
(19) Trauma
The term trauma means a response to an event, series of events, or set of circumstances that is experienced or witnessed by an individual or group of people as physically or emotionally harmful or life-threatening with lasting adverse effects on their functioning and mental, physical, social, emotional, or spiritual well-being.
(20) Trauma-informed and resilience-oriented
The term trauma-informed and resilience-oriented means an approach that realizes the prevalence of trauma, recognizes the various ways individuals, organizations, and communities may respond to trauma differently, recognizes that resilience can be built, and responds by putting this knowledge into practice.
(21) Young people
The term young people means individuals who are ages 10 through 29 at the time of commencement of participation in a project supported under this section.
(22) Youth-friendly sexual health services
The term youth-friendly sexual health services means sexual health services that are provided in a confidential, equitable, and accessible manner that makes it easy and comfortable for young people to seek out and receive services.
(c) Grants for sex education at elementary and secondary schools and youth-Serving organizations
(1) Program authorized
The Secretary, in coordination with the Secretary of Education, shall award grants, on a competitive basis, to eligible entities to enable such eligible entities to carry out projects that provide young people with sex education.
(2) Duration
Grants awarded under this section shall be for a period of 5 years.
(3) Eligible entity
In this section, the term eligible entity means a public or private entity that delivers evidence-based sex education to young people.
(4) Applications
An eligible entity desiring 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.
(5) Priority
In awarding grants under this section, the Secretary shall give priority to eligible entities that are—
(A)
State educational agencies or local educational agencies; or
(B)
Indian Tribes or Tribal organizations, as defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304).
(6) Use of funds
Each eligible entity that receives a grant under this section shall use the grant funds to carry out a project that provides young people with sex education.
(d) Grants for sex education at institutions of higher education
(1) Program authorized
The Secretary, in coordination with the Secretary of Education, shall award grants, on a competitive basis, to institutions of higher education or consortia of such institutions to enable such institutions to provide students with age and developmentally appropriate sex education.
(2) Duration
Grants awarded under this section shall be for a period of 5 years.
(3) Applications
An institution of higher education or consortium of such institutions desiring 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.
(4) Priority
In awarding grants under this section, the Secretary shall give priority to an institution of higher education that—
(A)
has an enrollment of needy students, as defined in section 318(b) of the Higher Education Act of 1965 (20 U.S.C. 1059e(b));
(B)
is a Hispanic-serving institution, as defined in section 502(a) of such Act (20 U.S.C. 1101a(a));
(C)
is a Tribal College or University, as defined in section 316(b) of such Act (20 U.S.C. 1059c(b));
(D)
is an Alaska Native-serving institution, as defined in section 317(b) of such Act (20 U.S.C. 1059d(b));
(E)
is a Native Hawaiian-serving institution, as defined in section 317(b) of such Act (20 U.S.C. 1059d(b));
(F)
is a Predominantly Black Institution, as defined in section 318(b) of such Act (20 U.S.C. 1059e(b));
(G)
is a Native American-serving, nontribal institution, as defined in section 319(b) of such Act (20 U.S.C. 1059f(b));
(H)
is an Asian American and Native American Pacific Islander-serving institution, as defined in section 320(b) of such Act (20 U.S.C. 1059g(b)); or
(I)
is a minority institution, as defined in section 365 of such Act (20 U.S.C. 1067k), with an enrollment of needy students, as defined in section 312 of such Act (20 U.S.C. 1058).
(5) Uses of funds
An institution of higher education or consortium of such institutions receiving a grant under this section shall use grant funds to develop and implement a project to integrate sex education into the institution of higher education in order to reach a large number of students, by carrying out 1 or more of the following activities:
(A)
Adopting and incorporating age and developmentally appropriate sex education into student orientation, general education, or courses.
(B)
Developing or adopting and implementing educational programming outside of class that delivers age and developmentally appropriate sex education to students.
(C)
Developing or adopting and implementing innovative technology-based approaches to deliver age and developmentally appropriate sex education to students.
(D)
Developing or adopting and implementing peer-led activities to generate discussion, educate, and raise awareness among students about age and developmentally appropriate sex education.
(E)
Developing or adopting and implementing policies and practices to link students to sexual health services.
(e) Grants for educator training
(1) Program authorized
The Secretary, in coordination with the Secretary of Education, shall award grants, on a competitive basis, to eligible entities to enable such eligible entities to carry out the activities described in paragraph (5).
(2) Duration
Grants awarded under this section shall be for a period of 5 years.
(3) Eligible entity
In this section, the term eligible entity means—
(A)
a State educational agency or local educational agency;
(B)
an Indian Tribe or Tribal organization, as defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304);
(C)
a State or local department of health;
(D)
an educational service agency, as defined in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801);
(E)
a nonprofit institution of higher education or a consortium of such institutions; or
(F)
a national or statewide nonprofit organization or consortium of nonprofit organizations that has as its primary purpose the improvement of provision of sex education through training and effective teaching of sex education.
(4) Application
An eligible entity desiring 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.
(5) Authorized activities
(A) Required activity
Each eligible entity receiving a grant under this section shall use grant funds for professional development and training of relevant teachers, health educators, faculty, administrators, and staff, in order to increase effective teaching of sex education to young people.
(B) Permissible activities
Each eligible entity receiving a grant under this section may use grant funds to—
(i)
provide training and support for educators about the content, skills, and professional disposition needed to implement sex education effectively;
(ii)
develop and provide training and support to educators on incorporating anti-racist and gender inclusive policies and practices in sex education;
(iii)
support the dissemination of information on effective practices and research findings concerning the teaching of sex education;
(iv)
support research on—
(I)
effective sex education teaching practices; and
(II)
the development of assessment instruments and strategies to document—
(aa)
young people’s understanding of sex education; and
(bb)
the effects of sex education;
(v)
convene conferences on sex education, in order to effectively train educators in the provision of sex education; and
(vi)
develop and disseminate appropriate research-based materials to foster sex education.
(C) Subgrants
Each eligible entity receiving a grant under this section may award subgrants to nonprofit organizations that possess a demonstrated record of providing training to teachers, health educators, faculty, administrators, and staff on sex education to—
(i)
train educators in sex education;
(ii)
support internet or distance learning related to sex education;
(iii)
promote rigorous academic standards and assessment techniques to guide and measure student performance in sex education;
(iv)
encourage replication of best practices and model programs to promote sex education;
(v)
develop and disseminate effective, research-based sex education learning materials; or
(vi)
develop academic courses on the pedagogy of sex education at institutions of higher education.
(f) Authorization of grants To support the delivery of sexual health services to marginalized young people
(1) Program authorized
The Secretary shall award grants, on a competitive basis, to eligible entities to enable such entities to provide youth-friendly sexual health services to marginalized young people.
(2) Duration
Grants awarded under this section shall be for a period of 5 years.
(3) Eligible entity
In this section, the term eligible entity means—
(A)
a public or private youth-serving organization; or
(B)
a covered entity, as defined in section 340B of the Public Health Service Act (42 U.S.C. 256b).
(4) Applications
An eligible entity desiring 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.
(5) Uses of funds
Each eligible entity that receives a grant under this section may use the grant funds to—
(A)
develop and implement an evidence-informed project to deliver sexual health services to marginalized young people;
(B)
establish, alter, or modify staff positions, service delivery policies and practices, service delivery locations, service delivery environments, service delivery schedules, or other services components in order to increase youth-friendly sexual health services to marginalized young people;
(C)
conduct outreach to marginalized young people to invite them to participate in the eligible entity’s sexual health services and to provide feedback to inform improvements in the delivery of such services;
(D)
establish and refine systems of referral to connect marginalized young people to other sexual health services and supportive services;
(E)
establish partnerships and collaborations with entities providing services to marginalized young people to link such young people to sexual health services, such as by delivering health services at locations where they congregate, providing transportation to locations where sexual health services are provided, or other linkages to services approaches;
(F)
provide evidence-informed, comprehensive in scope, confidential, equitable, accessible, medically accurate and complete, age and developmentally appropriate, culturally responsive, and trauma-informed and resilience-oriented sexual health information to marginalized young people in the languages and cultural contexts that are most appropriate for the marginalized young people to be served by the eligible entity;
(G)
promote effective communication regarding sexual health among marginalized young people; and
(H)
provide training and support for eligible entity personnel and community members who work with marginalized young people about the content, skills, and professional disposition needed to provide youth-friendly sex education and youth-friendly sexual health services.
(g) Reporting and impact evaluation
(1) Grantee report to secretary
For each year a grantee receives grant funds under subsection (c), (d), (e), or (f) the grantee shall submit to the Secretary a report that includes—
(A)
a description of the use of grant funds by the grantee;
(B)
a description of how the use of grant funds has increased the access of young people to sex education or sexual health services; and
(C)
such other information as the Secretary may require.
(2) Secretary’s report to Congress
Not later than 1 year after the date of the enactment of this section, and annually thereafter for a period of 5 years, the Secretary shall prepare and submit to Congress a report on the activities funded under this section. The Secretary's report to Congress shall include—
(A)
a statement of how grants awarded by the Secretary meet the purposes of the grants; and
(B)
information about—
(i)
the number of grantees that are receiving grant funds under subsections (c), (d), (e), and (f);
(ii)
the specific activities supported by grant funds awarded under subsections (c), (d), (e), and (f);
(iii)
the number of young people served by projects funded under subsections (c),(d), and (f), in the aggregate and disaggregated and cross-tabulated by grant program, race and ethnicity, sex, sexual orientation, gender identity, and other characteristics determined by the Secretary (except that such disaggregation or cross-tabulation shall not be required in a case in which the results would reveal personally identifiable information about an individual young person);
(iv)
the number of teachers, health educators, faculty, school administrators, and staff trained under subsection (e); and
(v)
the status of the evaluation required under paragraph (3).
(3) Multi-Year evaluation
(A) In general
Not later than 6 months after the date of the enactment of this section, the Secretary shall enter into a contract with a nonprofit organization with experience in conducting impact evaluations to conduct a multi-year evaluation on the impact of the projects funded under subsections (c), (d), (e), and (f) and to report to Congress and the Secretary on the findings of such evaluation.
(B) Evaluation
The evaluation conducted under this subsection shall—
(i)
be conducted in a manner consistent with relevant, nationally recognized professional and technical evaluation standards;
(ii)
use sound statistical methods and techniques relating to the behavioral sciences, including quasi-experimental designs, inferential statistics, and other methodologies and techniques that allow for conclusions to be reached;
(iii)
be carried out by an independent organization that has not received a grant under subsection (c), (d), (e), or (f); and
(iv)
be designed to provide information on output measures and outcome measures to be determined by the Secretary.
(C) Report
Not later than 6 years after the date of enactment of this section, the organization conducting the evaluation under this paragraph shall prepare and submit to the appropriate committees of Congress and the Secretary an evaluation report. Such report shall be made publicly available, including on the website of the Department of Health and Human Services.
(h) Nondiscrimination
Activities funded under this section shall not discriminate on the basis of actual or perceived sex (including sexual orientation and gender identity), age, parental status, race, color, ethnicity, national origin, disability, or religion. Nothing in this section shall be construed to invalidate or limit rights, remedies, procedures, or legal standards available under any other Federal law or any law of a State or a political subdivision of a State, including the Civil Rights Act of 1964 (42 U.S.C. 2000a et seq.), title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.), section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.), and section 1557 of the Patient Protection and Affordable Care Act (42 U.S.C. 18116).
(i) Limitation
No Federal funds provided under this section may be used for sex education or sexual health services that—
(1)
withhold health-promoting or life-saving information about sexuality-related topics, including HIV;
(2)
are medically inaccurate or incomplete;
(3)
promote gender or racial stereotypes or are unresponsive to gender or racial inequities;
(4)
fail to address the needs of sexually active young people;
(5)
fail to address the needs of pregnant or parenting young people;
(6)
fail to address the needs of survivors of interpersonal violence;
(7)
fail to address the needs of young people of all physical, developmental, or mental abilities;
(8)
fail to be inclusive of individuals with varying gender identities, gender expressions, and sexual orientations; or
(9)
are inconsistent with the ethical imperatives of medicine and public health.
(j) Amendments to other laws
(1) Amendment to the Public Health Service Act
Section 2500 of the Public Health Service Act (42 U.S.C. 300ee) is amended by striking subsections (b) through (d) and inserting the following:
(b) Contents of programs
All programs of education and information receiving funds under this subchapter shall include information about the potential effects of intravenous substance use.
(2) Amendments to the Elementary and Secondary Education Act of 1965
Section 8526 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7906) is amended—
(A)
by striking paragraphs (3), (5), and (6);
(B)
by redesignating paragraph (4) as paragraph (3);
(C)
in paragraph (3), as redesignated by paragraph (2), by inserting or
after the semicolon; and
(D)
by redesignating paragraph (7) as paragraph (4).
(k) Funding
(1) Authorization
For the purpose of carrying out this section, there is authorized to be appropriated $100,000,000 for each of fiscal years 2027 through 2032. Amounts appropriated under this subsection shall remain available until expended.
(2) Reservations of funds
(A) In general
The Secretary—
(i)
shall reserve not more than 30 percent of the amount authorized under paragraph (1) for the purposes of awarding grants for sex education at elementary and secondary schools and youth-serving organizations under subsection (c);
(ii)
shall reserve not more than 10 percent of the amount authorized under paragraph (1) for the purpose of awarding grants for sex education at institutions of higher education under subsection (d);
(iii)
shall reserve not more than 15 percent of the amount authorized under paragraph (1) for the purpose of awarding grants for educator training under subsection (e);
(iv)
shall reserve not more than 30 percent of the amount authorized under paragraph (1) for the purpose of awarding grants for sexual health services for marginalized youth under subsection (f); and
(v)
shall reserve not less than 5 percent of the amount authorized under paragraph (1) for the purpose of carrying out the reporting and impact evaluation required under subsection (g).
(B) Research, training, and technical assistance
The Secretary shall reserve not less than 10 percent of the amount authorized under paragraph (1) for expenditures by the Secretary to provide, directly or through a competitive grant process, research, training, and technical assistance, including dissemination of research and information regarding effective and promising practices, providing consultation and resources, and developing resources and materials to support the activities of recipients of grants. In carrying out such functions, the Secretary shall collaborate with a variety of entities that have expertise in sex education and sexual health services standards setting, design, development, delivery, research, monitoring, and evaluation.
(3) Reprogramming of abstinence only until marriage program funding
The unobligated balance of funds made available to carry out section 510 of the Social Security Act (42 U.S.C. 710) (as in effect on the day before the date of enactment of this section) are transferred and shall be used by the Secretary to carry out this section. The amounts transferred and made available to carry out this section shall remain available until expended.
(4) Repeal of abstinence only until marriage program
Section 510 of the Social Security Act (42 U.S.C. 710 et seq.) is repealed.
Sec. 5405. Compassionate assistance for rape emergencies
(a) Medicare
(1) Limitation on payment
Section 1866(a)(1) of the Social Security Act (42 U.S.C. 1395cc(a)(1)), as amended by section 5201(e), is amended—
(A)
in subparagraph (W), by moving the indentation 2 ems to the left;
(B)
in subparagraph (X), by moving the indentation 2 ems to the left;
(C)
in subparagraph (Y)(ii)(V), by striking and
at the end;
(D)
in subparagraph (Z)(iii), by striking the period and inserting , and
; and
(E)
by inserting after subparagraph (Z) the following new subparagraph:
(AA)
in the case of a hospital, critical access hospital, or rural emergency hospital, to adopt and enforce a policy to ensure compliance with the requirements of subsection (l) and to meet the requirements of such subsection.
(2) Assistance to victims
Section 1866 of the Social Security Act (42 U.S.C. 1395cc) is amended by adding at the end the following new subsection:
(l) Compassionate assistance for rape emergencies
(1) In general
For purposes of subsection (a)(1)(AA), a hospital meets the requirements of this subsection if the hospital provides each of the services described in paragraph (2) to each individual, whether or not eligible for benefits under this title or under any other form of health insurance, who comes to the hospital on or after January 1, 2027, and—
(A)
who states to hospital personnel that they are victims of sexual assault;
(B)
who is accompanied by an individual who states to hospital personnel that the individual is a victim of sexual assault; or
(C)
whom hospital personnel, during the course of treatment and care for the individual, have reason to believe is a victim of sexual assault.
(2) Required services described
For purposes of paragraph (1), the services described in this subparagraph are the following:
(A)
Provision of medically and factually accurate and unbiased written and oral information about emergency contraception that—
(i)
is written in clear and concise language;
(ii)
is readily comprehensible;
(iii)
includes an explanation that emergency contraceptives—
(I)
have been approved by the Food and Drug Administration for individuals and are a safe and effective way to prevent pregnancy after unprotected intercourse or contraceptive failure if taken in a timely manner;
(II)
are more effective the sooner it is taken; and
(III)
do not cause an abortion and cannot interrupt an established pregnancy;
(iv)
meet such conditions regarding the provision of such information in languages other than English as the Secretary may establish; and
(v)
are provided without regard to the ability of the individual or their family to pay costs associated with the provision of such information to the individual.
(B)
Immediate offer to provide emergency contraception to the individual at the hospital and, in the case that such individual accepts such offer, immediate provision to such individual of such contraception on the same day it is requested without regard to the inability of the individual or their family to pay costs associated with the offer and provision of such contraception.
(C)
Development and implementation of a written policy to ensure that an individual is present at the hospital, or on-call, who—
(i)
has authority to dispense or prescribe emergency contraception, independently, or under a protocol prepared by a physician for the administration of emergency contraception at the hospital to a victim of sexual assault; and
(ii)
is trained to comply with the requirements of this section.
(D)
Provision of medically and factually accurate and unbiased written and oral information and counseling about post-exposure prophylaxis (referred to in this paragraph as
PEP) protocol for the prevention of HIV.(E)
Immediate offer to begin PEP to the individual at the hospital except in cases where the medical professional’s best judgement is that further evaluation is required or that such a regimen will be substantially detrimental to the health of such individual. Such provision shall be offered regardless of the individual’s ability to pay. Hospitals shall be responsible for ensuring adequate supply of PEP medications to provide to patients.
(3) Hospital defined
In this subsection, the term hospital has the meaning given such term in section 1861(e), except that for purposes of this subsection, such term shall include a critical access hospital (as defined in section 1861(mm)(1)) and a rural emergency hospital (as defined in section 1861(kkk)).
(b) Limitation on payment under Medicaid
Section 1903(i) of the Social Security Act (42 U.S.C. 1396b(i)), as amended by section 4106(b)(2), is further amended—
(1)
in paragraph (27), by striking or
after the semicolon;
(2)
in paragraph (28), by striking the period and inserting ; or
; and
(3)
by inserting after paragraph (28) the following new paragraph:
(29)
with respect to any amount expended for care or services furnished under the plan by a hospital on or after January 1, 2027, unless such hospital meets the requirements specified in section 1866(l) for purposes of title XVIII.
Sec. 5406. Menstrual Equity for All Act
(a) Short title
This section may be cited as the Menstrual Equity For All Act
.
(b) Menstrual products for students at elementary and secondary schools
(1) In general
Section 4108(5)(C) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7118(5)(C)) is amended—
(A)
in clause (vi), by striking or
after the semicolon;
(B)
in clause (vii), by inserting or
after the semicolon; and
(C)
by adding at the end the following:
(viii)
provide free menstrual products to students who use menstrual products;
(2) Definitions
Section 4102 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7112) is amended—
(A)
by redesignating paragraphs (6) through (8) as paragraphs (7) through (9), respectively; and
(B)
by inserting after paragraph (5) the following:
(6) Menstrual products
The term menstrual products means sanitary napkins and tampons that conform to applicable industry standards.
(3) Rulemaking
Not later than 1 year after the date of enactment of this section, the Secretary of Education, in consultation with the Secretary of Health and Human Services, shall promulgate rules with respect to the definition of menstrual products
in paragraph (6) of section 4102 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7112), as amended by paragraph (2).
(c) Menstrual products for students at institutions of higher education
(1) Purpose
The purpose of this subsection is to alleviate—
(A)
the barriers to academic success faced by many college and graduate students due to the inability of such students to afford to purchase menstrual products; and
(B)
the unique set of burdens that college and graduate students experiencing period poverty face that can be compounded by lack of access to basic needs such as housing, food, transportation, and access to physical and mental health services.
(2) In general
The Secretary of Education shall establish a program to award grants, on a competitive basis, to not less than 4 institutions of higher education to—
(A)
support programs that provide free menstrual products to students; and
(B)
report on best practices of such programs.
(3) Application
To apply for a grant under this subsection, an institution of higher education shall submit to the Secretary an application in such form, at such time, and containing such information as the Secretary determines appropriate, including an assurance that such grant will be used to carry out the activities described in paragraph (5).
(4) Community colleges
Not less than 50 percent of the grants awarded under this subsection shall be awarded to community colleges.
(5) Grant uses
A grant awarded under this subsection may only be used to—
(A)
carry out or expand activities that fund programs that support direct provision of free menstrual products to students in appropriate campus locations, including—
(i)
campus restroom facilities;
(ii)
wellness centers; and
(iii)
on-campus residential buildings;
(B)
report on best practices of such programs;
(C)
conduct outreach to students to encourage participation in menstrual equity programs and services;
(D)
help eligible students apply for and enroll in local, State, and Federal public assistance programs; and
(E)
coordinate and collaborate with government or community-based organizations to carry out the activities described in subparagraphs (A) through (D).
(6) Priority
In awarding grants under this subsection, the Secretary shall prioritize—
(A)
institutions with respect to which not less than 25 percent of the enrolled students receive a Federal Pell Grant; and
(B)
historically Black colleges and universities, Hispanic-serving institutions, Asian American and Native American Pacific Islander-serving institutions, and other minority serving institutions.
(7) Definitions
In this subsection:
(A) Institution of higher education
The term institution of higher education has the meaning given that term in section 101 of the Higher Education Act of 1965 (20 U.S.C. 1001).
(B) Menstrual product defined
The term menstrual product means a sanitary napkin or tampon that conforms to industry standards.
(8) Authorization of appropriations
There are authorized to be appropriated $5,000,000 out of funds appropriated for a fiscal year to the Fund for the Improvement of Postsecondary Education under section 741 of the Higher Education Act of 1965 (20 U.S.C. 1138) to carry out the grant program under this subsection.
(d) Menstrual products for incarcerated individuals and detainees
(1) Menstrual products defined
In this subsection, the term menstrual products means sanitary napkins and tampons that conform to applicable industry standards.
(2) Requirement for States
Beginning on the date that is 180 days after the date of the enactment of this Act, and annually thereafter, the chief executive officer of each State that receives a grant under subpart 1 of part E of title I of the Omnibus Crime Control and Safe Streets Act of 1968 (34 U.S.C. 10151 et seq.) shall submit to the Attorney General a certification, in such form and containing such information as the Attorney General may require, that—
(A)
all incarcerated individuals and detainees in the State have access to menstrual products—
(i)
on demand; and
(ii)
at no cost to the incarcerated individuals and detainees; and
(B)
no visitor of an incarcerated individual or detainee of the State is prohibited from visiting an incarcerated individual or detainee due to the visitor’s use of menstrual products.
(3) Reduction in Grant Funding
In the case of a State of which the chief executive officer fails to submit a certification required under paragraph (2) in a fiscal year, the Attorney General shall reduce the amount that the State would otherwise receive under section 505 of title I of the Omnibus Crime Control and Safe Streets Act of 1968 (34 U.S.C. 10156) by 20 percent for the following fiscal year.
(4) Reallocation
Amounts not allocated to a State under section 505 of title I of the Omnibus Crime Control and Safe Streets Act of 1968 (34 U.S.C. 10156) for a fiscal year pursuant to paragraph (3) shall be reallocated under such section to States that submit certifications under paragraph (2).
(5) Availability for Federal prisoners
The Attorney General shall make rules requiring, and the Director of the Bureau of Prisons shall take such actions as may be necessary to ensure, the distribution and accessibility without charge of menstrual products to prisoners in the custody of the Bureau of Prisons, including any prisoner in a Federal penal or correctional institution, any Federal prisoner in a State penal or correctional institution, and any Federal prisoner in a facility administered by a private detention entity, to ensure that each prisoner who requires menstrual products may receive them in sufficient quantity.
(6) Availability for detainees
The Secretary of Homeland Security shall take such actions as may be necessary to ensure that menstrual products are distributed and made accessible to each alien detained by the Secretary of Homeland Security, including any alien in a facility administered by a private detention entity, at no expense to the alien.
(e) Menstrual products availability for homeless individuals under Emergency Food and Shelter Grant Program
Subsection (a) of section 316 of the McKinney-Vento Homeless Assistance Act (42 U.S.C. 11346(a)) is amended—
(1)
in paragraph (5), by striking and
at the end;
(2)
in paragraph (6), by striking the period at the end and inserting ; and
; and
(3)
by adding at the end the following new paragraph:
(7)
guidelines that ensure that amounts provided under the program to private nonprofit organizations and local governments may be used to provide sanitary napkins and tampons that conform to applicable industry standards.
(f) Menstrual products covered by Medicaid
(1) In general
Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by section 5201, is further amended—
(A)
in subsection (a)—
(i)
in paragraph (32), by striking ; and
and inserting a semicolon;
(ii)
by redesignating paragraph (33) as paragraph (34); and
(iii)
by inserting after paragraph (32) the following new paragraph:
(33)
menstrual products (as defined in subsection (qq)); and; and
(B)
by adding at the end the following new subsection:
(qq) Menstrual products
For purposes of subsection (a)(33), the term menstrual products means menstrual cups, menstrual discs, menstrual underwear, and sanitary napkins and tampons, that conform to applicable industry standards.
(2) Effective date
(A) In general
Subject to subparagraph (B), the amendments made by this subsection shall apply with respect to medical assistance furnished during or after the first calendar quarter beginning on or after the date that is 1 year after the date of the enactment of this Act.
(B) Exception for State legislation
In the case of a State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) that the Secretary of Health and Human Services determines requires State legislation in order for the respective plan to meet any requirement imposed by amendments made by this subsection, the respective plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session shall be considered to be a separate regular session of the State legislature.
(g) Menstrual products for employees
Section 6 of the Occupational Safety and Health Act of 1970 (29 U.S.C. 655) is amended by adding at the end the following:
(h)
The Secretary shall by rule promulgate a requirement that each employer with not less than 100 employees provide menstrual products free of charge for employees of the employer. For purposes of the preceding sentence,
menstrual productsmeans sanitary napkins and tampons that conform to applicable industry standards.
(h) Menstrual products in Federal buildings
(1) Definitions
In this subsection:
(A) Appropriate authority
The term appropriate authority means the head of a Federal agency, the Architect of the Capitol, or any other official authority responsible for the operation of a covered public building.
(B) Covered public building
(i) In general
The term covered public building means a public building (as defined in section 3301(a) of title 40, United States Code) that is open to the public and contains a public restroom.
(ii) Inclusions
The term covered public building includes specified buildings and grounds (as defined in section 6301 of title 40, United States Code) and the Capitol Buildings (as defined in section 5101 of that title).
(C) Covered restroom
The term covered restroom means a restroom in a covered public building.
(D) Menstrual products
The term menstrual products means sanitary napkins and tampons that conform to applicable industry standards.
(2) Requirement
Each appropriate authority shall ensure that menstrual products are stocked in, and available free of charge in, each covered restroom in each covered public building under the jurisdiction of that authority.
(i) Menstrual products in the Social Services Block Grant Program
(1) Increase in funding for Social Services Block Grant Program
(A) In general
The amount specified in subsection (c) of section 2003 of the Social Security Act (42 U.S.C. 1397b) for purposes of subsections (a) and (b) of such section is deemed to be $1,900,000,000 for each of fiscal years 2027 through 2030, of which, the amount equal to $200,000,000, reduced by the amounts reserved under subparagraph (B)(ii) for each such fiscal year, shall be obligated by States in accordance with paragraph (2).
(B) Appropriation
(i) In general
Out of any money in the Treasury of the United States not otherwise appropriated, there is appropriated $200,000,000 for each of fiscal years 2027 through 2030, to carry out this subsection.
(ii) Reservations
(I) Purposes
The Secretary shall reserve, from the amount appropriated under clause (i) to carry out this subsection—
(aa)
for each of fiscal years 2027 through 2030, not more than 2 percent of the amount appropriated for the fiscal year for purposes of entering into an agreement with an eligible entity described in clause (iii) to assist in providing technical assistance and training, to support effective policy, practice, research, and cross-system collaboration among grantees and subgrantees, and to assist in the administration of the program described in this subsection; and
(bb)
for fiscal year 2027, an amount, not to exceed $2,000,000, for purposes of conducting an evaluation under paragraph (4).
(II) No State entitlement to reserved funds
The State entitlement under section 2002(a) of the Social Security Act (42 U.S.C. 1397a(a)) shall not apply to the amounts reserved under subclause (I).
(iii) Eligible entity described
An eligible entity described in this clause is a nonprofit organization described in section 501(c)(3) of the Internal Revenue Code of 1986 and exempt from taxation under section 501(a) of such Code, that—
(I)
has experience in more than 1 State in the area of community distributions of basic need services, including experience collecting, warehousing, and distributing basic necessities such as menstrual products;
(II)
demonstrates competency to implement a project, provide fiscal accountability, collect data, and prepare reports and other necessary documentation; and
(III)
demonstrates a willingness to share information with researchers, practitioners, and other interested parties.
(2) Rules governing use of additional funds
(A) In general
Funds are used in accordance with this paragraph if—
(i)
the State, in consultation with relevant stakeholders, including agencies, professional associations, and nonprofit organizations, distributes the funds to eligible entities to—
(I)
decrease the unmet need for menstrual products by low-income menstruating individuals through—
(aa)
the distribution of free menstrual products;
(bb)
community outreach to assist in participation in existing menstrual product distribution programs; or
(cc)
improving access to menstrual products among low-income individuals; and
(II)
increase the ability of communities and low-income families in such communities to provide for the need for menstrual products of low-income adults; and
(ii)
the funds are used subject to the limitations in section 2005 of the Social Security Act (42 U.S.C. 1397d).
(B) Allowable uses by eligible entities
(i) In general
An eligible entity receiving funds made available under paragraph (1) shall use the funds for any of the following:
(I)
To pay for the purchase and distribution of menstrual products among low-income individuals.
(II)
To integrate activities carried out under subclause (I) with other basic needs assistance programs serving low-income families, including the following:
(aa)
Programs funded by the temporary assistance for needy families program under part A of title IV of the Social Security Act (42 U.S.C. 601 et seq.), including the State maintenance of effort provisions of such program.
(bb)
Programs designed to support the health of eligible children, such as the Children’s Health Insurance Program under title XXI of the Social Security Act, the Medicaid program under title XIX of such Act, or State funded health care programs.
(cc)
Programs funded through the special supplemental nutrition program for women, infants, and children under section 17 of the Child Nutrition Act of 1966.
(dd)
Programs that offer early home visiting services, including the maternal, infant, and early childhood home visiting program (including the Tribal home visiting program) under section 511 of the Social Security Act (42 U.S.C. 711).
(III)
To provide training or technical assistance in carrying out activities under this subsection.
(IV)
To cover administrative costs.
(ii) Limitation on use of funds for administrative costs
An eligible entity receiving funds made available under this subsection shall not use more than 9 percent of the funds for administrative costs incurred pursuant to this subsection.
(C) Availability of funds
(i) Funds distributed to eligible entities
Funds made available under paragraph (1) that are distributed to an eligible entity by a State for a fiscal year may be expended by the eligible entity only in such fiscal year or the succeeding fiscal year.
(ii) Evaluation
Funds reserved under paragraph (1)(B)(ii)(I)(aa) to carry out the evaluation under paragraph (4) shall be available for expenditure through September 30, 2031.
(D) No effect on other programs
Any assistance or benefits received by a family through funds made available under paragraph (1) shall be disregarded for purposes of determining the family’s eligibility for, or amount of, benefits under any other Federal needs-based programs.
(3) Annual reports
Section 2004 of the Social Security Act shall apply with respect to payments made to a State under this section in the same way it applies with respect to payments made to a State under section 2002 of such Act.
(4) Evaluation
The Secretary, in consultation with States, the eligible entities described in paragraph (1)(B)(iii) receiving funds made available under this subsection, shall—
(A)
not later than December 30, 2031, complete an evaluation of the effectiveness of the assistance program carried out pursuant to this subsection, such as the effect of activities carried out under this Act on mitigating the health risks of unmet menstrual products need among individuals in low-income families;
(B)
not later than March 31, 2032, submit to the Committees on Energy and Commerce and on Ways and Means of the House of Representatives and the Committee on Finance of the Senate a report on the results of the evaluation; and
(C)
not later than April 30, 2032, publish the results of the evaluation on the internet website of the Department of Health and Human Services.
(5) Guidance
Not later than 180 days after the date of the enactment of this Act, the Secretary shall issue guidance regarding how the provisions of this subsection should be carried out, including information regarding eligible entities, allowable use of funds, and reporting requirements.
(6) Best practices
The Secretary of Health and Human Services, in cooperation with the Secretary of Education, shall develop best practices for school officials to use in discussing menstruation with students, and shall publish this information on the internet website of the Department of Health and Human Services.
(7) Definitions
In this subsection:
(A) Menstrual products
The term menstrual products means menstrual cups, menstrual discs, menstrual underwear, and sanitary napkins and tampons, that conform to applicable industry standards.
(B) Eligible entities
The term eligible entity means a State or local governmental entity, an Indian tribe or tribal organization (as defined in section 4 of the Indian Self-Determination and Education Assistance Act), or a nonprofit organization described in section 501(c)(3) of the Internal Revenue Code of 1986 and exempt from taxation under section 501(a) of such Code that—
(i)
has experience in the area of community distributions of basic need services, including experience collecting, warehousing, and distributing basic necessities such as diapers, food, or menstrual products;
(ii)
demonstrates competency to implement a project, provide fiscal accountability, collect data, and prepare reports and other necessary documentation; and
(iii)
demonstrates a willingness to share information with researchers, practitioners, and other interested parties.
(C) State
The term State has the meaning given in section 1101(a)(1) of the Social Security Act for purposes of title XX of such Act.
(8) Limitation on authorization of appropriations
For the administration of this subsection, there are authorized to be appropriated to the Secretary of Health and Human Services not more than $6,000,000 for fiscal years 2027 through 2030.
(9) Exemption from sequestration
Funds made available to carry out this subsection shall be exempt from reduction under any order issued under the Balanced Budget and Emergency Deficit Control Act of 1985.
(j) Menstrual products and taxation
(1) In general
It shall be unlawful for a State, or unit of local government of a State, to impose a tax on the retail sale of a menstrual product.
(2) Definitions
For purposes of this subsection:
(A) Menstrual product
The term menstrual products means menstrual cups, menstrual discs, menstrual underwear, and sanitary napkins and tampons, that conform to applicable industry standards.
(B) State
The term State means any of the several States or the District of Columbia.
(3) Effective Date
This subsection shall take effect 120 days after the date of the enactment of this subsection.
(k) Menstrual products in TANF
(1) In general
Section 403(a) of the Social Security Act (42 U.S.C. 603(a)) is amended by adding at the end the following:
(6) Grants for menstrual products
(A) In general
The Secretary may make grants, on a competitive basis, for each fiscal year to eligible applicants for the grants, in such amounts as the Secretary deems appropriate to enable the eligible applicants to provide, to covered families that include an individual who is capable of menstruating, such benefits as are needed to ensure that the individual can purchase menstrual products for personal use.
(B) Definitions
In subparagraph (A):
(i) Covered families
The term covered families means families eligible for assistance under a State program funded under this part.
(ii) Eligible applicant
The term eligible applicant means—
(I)
a State to which a grant is made under paragraph (1) for a fiscal year; and
(II)
a political subdivision of a State that administers the State program funded under this part in the political subdivision.
(iii) Menstrual products
The term menstrual products means menstrual cups, menstrual discs, menstrual underwear, and sanitary napkins and tampons, that conform to applicable industry standards.
(C) Consideration of applications
The Secretary shall award grants under this paragraph on the basis of how effectively the programs proposed by the eligible applicants will help low-income individuals suffering from material deprivation meet their need for menstrual products.
(D) Administration
A State or political subdivision to which a grant is made under this paragraph may use the grant to provide benefits under this paragraph in such form and in such manner as the State or political subdivision deems appropriate.
(E) Treatment of assistance
Benefits provided using funds made available under this paragraph shall not be considered assistance under any State program funded under this part.
(F) Appropriation
Out of any money in the Treasury of the United States not otherwise appropriated, there are appropriated for fiscal year 2027 and each succeeding fiscal year $10,000,000 for grants under this paragraph.
(2) Evaluations
Section 413 of such Act (42 U.S.C. 613) is amended by redesignating subsection (h) as subsection (i) and inserting after subsection (g) the following:
(h) Evaluations of grants for menstrual products
(1) In general
The Secretary shall submit to the Congress reports, in writing, that evaluate the effectiveness of the benefit program provided for in section 403(a)(6). Each such report shall, for the period covered by the report—
(A)
describe—
(i)
the extent of material deprivation in the population, including lacking sufficient funds to regularly purchase necessities such as menstrual products; and
(ii)
the extent to which the program alleviated such material deprivation;
(B)
specify the number and identity of the entities to which a grant has been made under such section, and the amount of the grant made to each such entity;
(C)
describe how the grantees used the grants to provide benefits under the program;
(D)
specify the number of individuals who received the benefits;
(E)
describe how efficacious the program has been in helping low-income individuals meet their need for menstrual products;
(F)
describe the extent to which the program has improved the economic security of the benefit recipients; and
(G)
include such other relevant information as the Secretary deems appropriate.
(2) Timing
The Secretary shall submit a report that meets the requirements of paragraph (1) within 2 years after the date of the enactment of this paragraph and every 2 years thereafter.
Sec. 5407. Additional focus area for the Office on Women’s Health
Section 229(b) of the Public Health Service Act (42 U.S.C. 237a(b)), as amended by section 5301(b), is further amended by adding at the end the following:
(10)
facilitate the understanding of policymakers, health system leaders and providers, consumers, and other stakeholders concerning optimal maternity care and support for the provision of such care, including the priorities of—
(A)
protecting, promoting, and supporting the innate capacities of childbearing individuals and their newborns for childbirth, breastfeeding, and attachment;
(B)
using obstetric interventions only when such interventions are supported by strong, high-quality evidence, and minimizing overuse of maternity practices that have been shown to have benefit in limited situations and that can expose people, infants, or both to risk of harm if used routinely and indiscriminately, including overuse of continuous electronic fetal monitoring, labor induction, epidural analgesia, primary cesarean section, and routine repeat cesarean birth;
(C)
reliably incorporating noninvasive, evidence-based practices that have a documented correlation with considerable improvement in outcomes with no detrimental side effects, such as incorporation of smoking cessation programs in pregnancy, maternal immunizations, and proven models (including group prenatal care, midwifery care, and doula support) that integrate health assessment, education, and support into a unified program, and supporting evidence-based breastfeeding promotion efforts with respect for a breastfeeding individual’s personal decisionmaking;
(D)
a shared understanding of the qualifications of licensed providers of maternity care and the best evidence about the safety, satisfaction, outcomes, and costs of maternity care, and appropriate deployment of such caregivers within the maternity care workforce to address the needs of childbearing individuals and newborns and the growing shortage of maternity caregivers;
(E)
a shared understanding of the results of the best available research comparing hospital, birth center, and planned home births, including information about each setting’s safety, satisfaction, outcomes, and costs;
(F)
a shared understanding of the importance for the safety and choices of birthing families of an integrated maternity care system with seamless processes for consultation, shared care, transfer and transport across maternity care settings, and use of providers when birthing people and their newborns require a higher level of care;
(G)
advancing high-quality, evidence-based childbirth education that—
(i)
promotes a healthy and safe approach to pregnancy, childbirth, and early parenting;
(ii)
is taught by certified educators, peer counselors, and health professionals; and
(iii)
promotes informed decisionmaking by childbearing individuals; and
(H)
developing measures that enable a more robust, balanced set of standardized maternity care measures, including performance and quality measures.
Sec. 5408. Including services furnished by certain students, interns, and residents supervised by certified nurse midwives or certified midwives within inpatient hospital services under Medicare
(a) In general
Section 1861(b) of the Social Security Act (42 U.S.C. 1395x(b)) is amended—
(1)
in paragraph (6), by striking ; or
at the end and inserting , or in the case of services in a hospital or osteopathic hospital by a student midwife or an intern or resident-in-training under a teaching program previously described in this paragraph who is in the field of obstetrics and gynecology, if such student midwife, intern, or resident-in-training is supervised by a certified nurse-midwife or certified midwife to the extent permitted under applicable State law and as may be authorized by the hospital;
;
(2)
in paragraph (7), by striking the period at the end and inserting ; or
; and
(3)
by adding at the end the following new paragraph:
(8)
a certified nurse-midwife or certified midwife where the hospital has a teaching program approved as specified in paragraph (6), if—
(A)
the hospital elects to receive any payment due under this title for reasonable costs of such services; and
(B)
all certified nurse-midwives or certified midwives in such hospital agree not to bill charges for professional services rendered in such hospital to individuals covered under the insurance program established by this title.
(b) Effective date
The amendments made by subsection (a) shall apply to services furnished on or after the date of the enactment of this Act.
Sec. 5409. Grants to professional organizations and minority-serving institutions to increase diversity in maternal, reproductive, and sexual health professionals
(a) Grants to health professional organizations
(1) In general
The Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration (referred to in this section as the Secretary
), shall carry out a grant program under which the Secretary may make to eligible organizations—
(A)
for fiscal year 2027, planning grants described in paragraph (2); and
(B)
for the subsequent 4-year period, implementation grants described in paragraph (3).
(2) Planning grants
(A) In general
Planning grants described in this paragraph are grants for each of the following purposes:
(i)
To collect data and identify any workforce inequalities, with respect to a health profession, at each of the following stages along the health professional continuum:
(I)
Pipeline availability, with respect to students at the high school and college or university levels considering, and working toward, entrance in the profession, including inequalities due to barriers triggered by criminal records.
(II)
Entrance into the training program for the profession.
(III)
Graduation from such training program.
(IV)
Entrance into practice, including inequalities due to barriers triggered by criminal records.
(V)
Retention in practice for more than a 5-year period.
(ii)
To develop one or more strategies to address the workforce inequalities within the health profession, as identified under (and in response to the findings pursuant to) clause (i).
(B) Application
To be eligible to receive a grant under this paragraph, an eligible health professional organization shall submit to the Secretary an application in such form and manner and containing such information as specified by the Secretary.
(C) Amount
Each grant awarded under this paragraph shall be for an amount not to exceed $300,000.
(D) Report
Each recipient of a grant under this paragraph shall submit to the Secretary a report containing—
(i)
information on the extent and distribution of workforce inequalities identified through the grant; and
(ii)
reasonable objectives and strategies developed to address such inequalities within a 5-, 10-, and 25-year period.
(3) Implementation grants
(A) In general
Implementation grants described in this paragraph are grants to implement one or more of the strategies developed pursuant to a planning grant awarded under paragraph (2).
(B) Application
To be eligible to receive a grant under this paragraph, an eligible health professional organization shall submit to the Secretary an application in such form and manner as specified by the Secretary. Each such application shall contain information on—
(i)
the capability of the organization to carry out a strategy described in subparagraph (A);
(ii)
the involvement of partners or coalitions;
(iii)
the organization’s plans for developing sustainability of the implementation efforts after the culmination of the grant cycle; and
(iv)
any other matter specified by the Secretary.
(C) Amount; duration
Each grant awarded under this paragraph shall be for an amount not to exceed $500,000 for each year of the grant. The term of a grant under this paragraph shall not exceed 4 years.
(D) Reports
For each of the first 3 years for which an eligible health professional organization is awarded a grant under this paragraph, the organization shall submit to the Secretary a report on the activities carried out by such organization through the grant during such year and objectives for the subsequent year. For the fourth year for which an eligible health professional organization is awarded a grant under this paragraph, the organization shall submit to the Secretary a report that includes an analysis of all the activities carried out by the organization through the grant and a detailed plan for the continuation of the organization’s implementation efforts.
(4) Eligible health professional organization defined
For purposes of this subsection, the term eligible health professional organization means a professional organization representing obstetrician-gynecologists, certified nurse midwives, certified midwives, family practice physicians, nurse practitioners whose scope of practice includes pregnancy-related or sexual and reproductive health care, physician assistants whose scope of practice includes obstetrical or sexual and reproductive health care, certified professional midwives, adolescent medicine specialists who provide sexual and reproductive health care, or pediatricians who provide sexual and reproductive health care.
(b) Grants to minority-Serving institutions
(1) In general
The Secretary shall carry out a grant program under which the Secretary may make to eligible minority-serving institutions—
(A)
for fiscal years 2027 and 2028, planning grants described in paragraph (2); and
(B)
for the subsequent 10-year period, implementation grants described in paragraph (3).
(2) Planning grants
(A) In general
Planning grants described in this paragraph are grants for plans relating to 1 or more of the following purposes:
(i)
To develop or expand academic programs to educate maternity care clinicians and maternity care support personnel, including—
(I)
nurses who have the intention of providing maternity, newborn, or sexual and reproductive health care;
(II)
nurse practitioners whose scope of practice includes maternity, newborn, or sexual and reproductive health care; and
(III)
maternity care support personnel, such as doulas and lactation counselors.
(ii)
To develop or expand academic programs to educate obstetrician-gynecologists.
(B) Application
To be eligible to receive a grant under this paragraph, an eligible minority-serving institution shall submit to the Secretary an application in such form and manner and containing such information as specified by the Secretary.
(C) Amount
Each grant awarded under this paragraph shall be for an amount not to exceed $400,000 for each of 2 years.
(D) Report
Each recipient of a grant under this paragraph shall submit to the Secretary an annual report describing the planned development or expansion of academic programs, including—
(i)
the types of clinical or support personnel to be served and the degrees or certificates to be conferred;
(ii)
the associated curricula;
(iii)
the faculty and their capabilities and commitments, including any plans for recruitment;
(iv)
the anticipated number of students to be enrolled and plans for their recruitment and social, emotional, and financial support; and
(v)
the objectives and strategies for addressing inequalities and preparing students to provide high-quality culturally congruent care.
(3) Implementation grants
(A) In general
Implementation grants described in this paragraph are grants to implement the plans developed under paragraph (2).
(B) Application
To be eligible to receive a grant under this paragraph, an eligible minority-serving institution shall submit to the Secretary an application in such form and manner as specified by the Secretary. Each such application shall contain information on the capability of the institution to carry out a plan described in paragraph (2), plans for sustainability of the academic program involved after the culmination of the grant cycle, and any other matter specified by the Secretary.
(C) Amount
Each grant under this paragraph shall be for an amount not to exceed $1,000,000 for each year during the 10-year period of the grant.
(D) Reports
(i) Initial period
For each of the first 9 years for which an eligible minority-serving institution is awarded a grant under this paragraph, the institution shall submit a report to the Secretary on the activities carried out by such institution through the grant during such year and objectives for the subsequent year.
(ii) Final year
For the tenth year for which an eligible minority-serving institution is awarded a grant under this paragraph, the organization shall submit to the Secretary a report that includes an analysis of all the activities carried out by the institution through the grant and a detailed plan for continuation of the academic program.
(4) Minority-serving institution
For the purposes of this subsection, the term minority-serving institution means any of the following:
(A)
A Hispanic-serving institution, as that term is defined in section 502(a) of the Higher Education Act of 1965 (20 U.S.C. 1101a(a)).
(B)
A Tribal College or University, as that term is defined in section 316(b) of the Higher Education Act of 1965 (20 U.S.C. 1059c(b)).
(C)
An Alaska Native-serving institution, as that term is defined in section 317(b) of the Higher Education Act of 1965 (20 U.S.C. 1059d(b)).
(D)
A Native Hawaiian-serving institution, as that term is defined in section 317(b) of the Higher Education Act of 1965 (20 U.S.C. 1059d(b)).
(E)
A Predominantly Black Institution, as that term is defined in section 318(b) of the Higher Education Act of 1965 (20 U.S.C. 1059e(b)).
(F)
A Native American-serving, nontribal institution, as that term is defined in section 319(b) of the Higher Education Act of 1965 (20 U.S.C. 1059f(b)).
(G)
An Asian American and Native American Pacific Islander-serving institution, as that term is defined in section 320(b) of the Higher Education Act of 1965 (20 U.S.C. 1059g(b)).
(c) Authorization of appropriations
There is authorized to be appropriated to carry out—
(1)
subsection (a), $2,000,000 for fiscal year 2027 and $3,000,000 for each of the fiscal years 2028 through 2031; and
(2)
subsection (b), $4,000,000 for each of fiscal years 2027 and 2028 and $10,000,000 for each of fiscal years 2029 through 2038.
Subtitle F Children’s Health
Sec. 5501. CARING for Kids Act
(a) Permanent extension of Children’s Health Insurance Program
(1) In general
Section 2104(a)(28) of the Social Security Act (42 U.S.C. 1397dd(a)(28)) is amended to read as follows:
(28)
for fiscal year 2029 and each subsequent year, such sums as are necessary to fund allotments to States under subsections (c) and (m).
(2) Allotments
(A) In general
Section 2104(m) of the Social Security Act (42 U.S.C. 1397dd(m)) is amended—
(i)
in paragraph (2)(B)—
(I)
in the matter preceding clause (i), by striking through (27)
and inserting through (28)
; and
(II)
in clause (i), by striking 2023, and 2029
and inserting and 2023
;
(ii)
in paragraph (7)—
(I)
in subparagraph (A), by striking and ending with fiscal year 2029,
; and
(II)
in the flush left matter at the end, by striking fiscal year 2026, or fiscal year 2028
and inserting fiscal year 2026, or a subsequent even-numbered fiscal year
;
(iii)
in paragraph (9)—
(I)
by striking (10), or (11)
and inserting or (10)
; and
(II)
by striking 2023, or 2029,
and inserting or 2023
; and
(iv)
by striking paragraph (11).
(B) Conforming amendment
Section 50101(b)(2) of the Bipartisan Budget Act of 2018 (Public Law 115–123) is repealed.
(b) Permanent extensions of other programs and demonstration projects
(1) Pediatric quality measures program
Section 1139A(i)(1) of the Social Security Act (42 U.S.C. 1320b–9a(i)(1)) is amended—
(A)
in subparagraph (D), by striking ; and
and inserting a semicolon;
(B)
in subparagraph (E), by striking the period at the end and inserting ; and
; and
(C)
by adding at the end the following new subparagraph:
(F)
for a subsequent fiscal year, the amount appropriated under this paragraph for the previous fiscal year, increased by the percentage increase in the consumer price index for all urban consumers (all items; United States city average) over such previous fiscal year, for the purpose of carrying out this section (other than subsections (e), (f), and (g)).
(2) Express lane eligibility option
Section 1902(e)(13) of the Social Security Act (42 U.S.C. 1396a(e)(13)) is amended by striking subparagraph (I).
(3) Assurance of affordability standard for children and families
(A) In general
Section 2105(d)(3) of the Social Security Act (42 U.S.C. 1397ee(d)(3)) is amended—
(i)
in the paragraph heading, by striking through September 30, 2029
; and
(ii)
in subparagraph (A), in the matter preceding clause (i)—
(I)
by striking During the period that begins on the date of enactment of the Patient Protection and Affordable Care Act and ends on September 30, 2029
and inserting Beginning on the date of the enactment of the Patient Protection and Affordable Care Act
;
(II)
by striking During the period that begins on October 1, 2019, and ends on September 30, 2029
and inserting Beginning on October 1, 2019
; and
(III)
by striking The preceding sentences shall not be construed as preventing a State during any such periods from
and inserting The preceding sentences shall not be construed as preventing a State from
.
(B) Conforming amendments
Section 1902(gg)(2) of the Social Security Act (42 U.S.C. 1396a(gg)(2)) is amended—
(i)
in the paragraph heading, by striking through September 30, 2029
; and
(ii)
by striking through September 30
and all that follows through ends on September 30, 2029
and inserting (but beginning on October 1, 2019
.
(4) Qualifying states option
Section 2105(g)(4) of the Social Security Act (42 U.S.C. 1397ee(g)(4)) is amended—
(A)
in the paragraph heading, by striking for fiscal years 2009 through 2029
and inserting after fiscal year 2008
; and
(B)
in subparagraph (A), by striking for any of fiscal years 2009 through 2029
and inserting for any fiscal year after fiscal year 2008
.
(5) Outreach and enrollment program
Section 2113 of the Social Security Act (42 U.S.C. 1397mm) is amended—
(A)
in subsection (a)—
(i)
in paragraph (1), by striking during the period of fiscal years 2009 through 2029
and inserting , beginning with fiscal year 2009,
;
(ii)
in paragraph (2)—
(I)
by striking 10 percent of such amounts
and inserting 10 percent of such amounts for the period or the fiscal year for which such amounts are appropriated
; and
(II)
by striking during such period
and inserting , during such period or such fiscal year,
; and
(iii)
in paragraph (3), by striking For the period of fiscal years 2024 through 2029, an amount equal to 10 percent of such amounts
and inserting Beginning with fiscal year 2024, an amount equal to 10 percent of such amounts for the period or the fiscal year for which such amounts are appropriated
; and
(B)
in subsection (g)—
(i)
by striking and $40,000,000
and inserting $40,000,000
; and
(ii)
by inserting after fiscal years 2028 and 2029,
the following: $12,000,000 for fiscal year 2030, and, for each fiscal year after fiscal year 2030, the amount appropriated under this subsection for the previous fiscal year, increased by the percentage increase in the consumer price index for all urban consumers (all items; United States city average) over such previous fiscal year,
.
(6) Child enrollment contingency fund
Section 2104(n) of the Social Security Act (42 U.S.C. 1397dd(n)) is amended—
(A)
in paragraph (2)—
(i)
in subparagraph (A)(ii)—
(I)
by striking and 2024 through 2028
and inserting and for each fiscal year after fiscal year 2023
; and
(II)
by striking 2023, and 2029
and inserting and 2023
; and
(ii)
in subparagraph (B)—
(I)
by striking 2024 through 2028
and inserting and for each fiscal year after fiscal year 2023
; and
(II)
by striking 2023, and 2029
and inserting and 2023
; and
(B)
in paragraph (3)(A)—
(i)
by striking fiscal years 2024 through 2028
and inserting a fiscal year after fiscal year 2023
; and
(ii)
by striking 2023, or 2027
and inserting or 2023
.
Sec. 5502. End Diaper Need Act
(a) Targeted funding for diaper assistance (Including diapering supplies and adult incontinence materials and supplies) through the Social Services Block Grant Program
(1) Increase in funding for Social Services Block Grant Program
(A) In general
The amount specified in subsection (c) of section 2003 of the Social Security Act (42 U.S.C. 1397b) for purposes of subsections (a) and (b) of such section is deemed to be $1,900,000,000 for each of fiscal years 2027 through 2030, of which, the amount equal to $200,000,000, reduced by the amounts reserved under subparagraph (B)(ii) for each such fiscal year, shall be obligated by States in accordance with paragraph (2).
(B) Appropriation
(i) In general
Out of any money in the Treasury of the United States not otherwise appropriated, there is appropriated $200,000,000 for each of fiscal years 2027 through 2030, to carry out this subsection.
(ii) Reservations
(I) Purposes
The Secretary shall reserve, from the amount appropriated under clause (i) to carry out this subsection—
(aa)
for each of fiscal years 2027 through 2030, not more than 2 percent of the amount appropriated for the fiscal year for purposes of entering into an agreement with a national entity described in clause (iii) to assist in providing technical assistance and training, to support effective policy, practice, research, and cross-system collaboration among grantees and subgrantees, and to assist in the administration of the program described in this subsection; and
(bb)
for fiscal year 2027, an amount, not to exceed $2,000,000, for purposes of conducting an evaluation under paragraph (4).
(II) No State entitlement to reserved funds
The State entitlement under section 2002(a) of the Social Security Act (42 U.S.C. 1397a(a)) shall not apply to the amounts reserved under subclause (I).
(iii) National entity described
A national entity described in this clause is a nonprofit organization described in section 501(c)(3) of the Internal Revenue Code of 1986 and exempt from taxation under section 501(a) of such Code, that—
(I)
has experience in more than 1 State in the area of—
(aa)
community distributions of basic need services, including experience collecting, warehousing, and distributing basic necessities such as diapers, food, or menstrual products;
(bb)
child care;
(cc)
child development activities in low-income communities; or
(dd)
motherhood, fatherhood, or parent education efforts serving low-income parents of young children;
(II)
demonstrates competency to implement a project, provide fiscal accountability, collect data, and prepare reports and other necessary documentation; and
(III)
demonstrates a willingness to share information with researchers, practitioners, and other interested parties.
(2) Rules governing use of additional funds
(A) In general
Funds are used in accordance with this paragraph if—
(i)
the State, in consultation with relevant stakeholders, including agencies, professional associations, and nonprofit organizations, distributes the funds to eligible entities to—
(I)
decrease the need for diapers and diapering supplies and adult incontinence materials and supplies in low-income families and meet such unmet needs of infants and toddlers, medically complex children, and low-income adults and adults with disabilities in such families through—
(aa)
the distribution of free diapers and diapering supplies, medically necessary diapers, and adult incontinence materials and supplies;
(bb)
community outreach to assist in participation in existing diaper distribution programs or programs that distribute medically necessary diapers or adult incontinence materials and supplies; or
(cc)
improving access to diapers and diapering supplies, medically necessary diapers, and adult incontinence materials and supplies; and
(II)
increase the ability of communities and low-income families in such communities to provide for the need for diapers and diapering supplies, medically necessary diapers, and adult incontinence materials and supplies, of infants and toddlers, medically complex children, and low-income adults and adults with disabilities;
(ii)
the funds are used subject to the limitations in section 2005 of the Social Security Act (42 U.S.C. 1397d);
(iii)
the funds are used to supplement, not supplant, State general revenue funds provided for the purposes described in clause (i); and
(iv)
the funds are not used for costs that are reimbursable by the Federal Emergency Management Agency, under a contract for insurance, or by self-insurance.
(B) Allowable uses by eligible entities
An eligible entity receiving funds made available under paragraph (1) shall use the funds for any of the following:
(i)
To pay for the purchase and distribution of diapers and diapering supplies, medically necessary diapers, and funding diaper (including medically necessary diapers) distribution that serves low-income families with—
(I)
1 or more children 3 years of age or younger; or
(II)
1 or more medically complex children.
(ii)
To pay for the purchase and distribution of adult incontinence materials and supplies and funding distribution of such materials and supplies that serves low-income families with 1 or more low-income adults or adults with disabilities who rely on adult incontinence materials and supplies.
(iii)
To integrate activities carried out under clause (i) with other basic needs assistance programs serving eligible children and their families, including the following:
(I)
Programs funded by the temporary assistance for needy families program under part A of title IV of the Social Security Act (42 U.S.C. 601 et seq.), including the State maintenance of effort provisions of such program.
(II)
Programs designed to support the health of eligible children, such as the Children’s Health Insurance Program under title XXI of the Social Security Act, the Medicaid program under title XIX of such Act, or State-funded health care programs.
(III)
Programs funded through the special supplemental nutrition program for women, infants, and children under section 17 of the Child Nutrition Act of 1966.
(IV)
Programs that offer early home visiting services, including the maternal, infant, and early childhood home visiting program (including the Tribal home visiting program) under section 511 of the Social Security Act (42 U.S.C. 711).
(V)
Programs to provide improved and affordable access to child care, including programs funded through the Child Care and Development Fund, the temporary assistance for needy families program under part A of title IV of the Social Security Act (42 U.S.C. 601 et seq.), or a State-funded program.
(C) Availability of funds
(i) Funds distributed to eligible entities
Funds made available under paragraph (1) that are distributed to an eligible entity by a State for a fiscal year may be expended by the eligible entity only in such fiscal year or the succeeding fiscal year.
(ii) Evaluation
Funds reserved under paragraph (1)(B)(ii)(I)(aa) to carry out the evaluation under paragraph (4) shall be available for expenditure during the 3-year period that begins on the date of enactment of this Act.
(D) No effect on other programs
Any assistance or benefits received by a family through funds made available under paragraph (1) shall be disregarded for purposes of determining the family’s eligibility for, or amount of, benefits under any other Federal needs-based programs.
(3) Annual reports
A State shall include in the annual report required under section 2006 of the Social Security Act (42 U.S.C. 1397e) covering each of fiscal years 2027 through 2030, information detailing how eligible entities, including subgrantees, used funds made available under paragraph (1) to distribute diapers and diapering supplies and adult incontinence materials and supplies to families in need. Each such report shall include the following:
(A)
The number and age of infants, toddlers, medically complex children, and low-income adults and adults with disabilities who received assistance or benefits through such funds.
(B)
The number of families that have received assistance or benefits through such funds.
(C)
The number of diapers, medically necessary diapers, or adult incontinence materials and supplies (such as adult diapers, briefs, protective underwear, pull-ons, pull-ups, liners, shields, guards, pads, undergarments), and the number of each type of diapering or adult incontinence supply, distributed through the use of such funds.
(D)
The ZIP Code or ZIP Codes where the eligible entity (or subgrantee) distributed diapers and diapering supplies and adult incontinence materials and supplies.
(E)
The method or methods the eligible entity (or subgrantee) uses to distribute diapers and diapering supplies and, adult incontinence materials and supplies.
(F)
Such other information as the Secretary may specify.
(4) Evaluation
The Secretary, in consultation with States, the national entity described in paragraph (1)(B)(iii), and eligible entities receiving funds made available under this subsection, shall—
(A)
not later than 2 years after the date of enactment of this Act—
(i)
complete an evaluation of the effectiveness of the assistance program carried out pursuant to this subsection, such as the effect of activities carried out under this section on mitigating the health and developmental risks of unmet diaper need among infants, toddlers, medically complex children, and other family members in low-income families, including the risks of diaper dermatitis, urinary tract infections, and parental and child depression and anxiety;
(ii)
submit to the relevant congressional committees a report on the results of such evaluation; and
(iii)
publish the results of the evaluation on the internet website of the Department of Health and Human Services;
(B)
not later than 3 years after the date of enactment of this Act, update the evaluation required by subparagraph (A)(i); and
(C)
not later than 90 days after completion of the updated evaluation under subparagraph (B)—
(i)
submit to the relevant congressional committees a report describing the results of such updated evaluation; and
(ii)
publish the results of such evaluation on the internet website of the Department of Health and Human Services.
(5) Guidance
Not later than 180 days after enactment of this Act, the Secretary shall issue guidance regarding how the provisions of this subsection should be carried out, including information regarding eligible entities, allowable use of funds, and reporting requirements.
(6) Definitions
In this subsection:
(A) Adult incontinence materials and supplies
The term adult incontinence materials and supplies means those supplies that are used to assist low-income adults or adults with disabilities and includes adult diapers, briefs, protective underwear, pull-ons, pull-ups, liners, shields, guards, pads, undergarments, disposable wipes, over-the-counter adult diaper rash cream products, intermittent catheterization, indwelling catheters, condom catheters, urinary drainage bags, external collection devices, wearable urinals, and penile clamps.
(B) Adults with disabilities
The term adults with disabilities means individuals who—
(i)
have attained age 18; and
(ii)
have a disability (as such term is defined, with respect to an individual, in section 3 of the Americans with Disabilities Act of 1990 (42 U.S.C. 12102)).
(C) Diaper
The term diaper means an absorbent garment that—
(i)
is washable or disposable that may be worn by an infant or toddler who is not toilet-trained; and
(ii)
if disposable—
(I)
does not use any latex or common allergens; and
(II)
meets or exceeds the quality standards for diapers commercially available through retail sale in the following categories:
(aa)
Absorbency (with acceptable rates for first and second wetting).
(bb)
Waterproof outer cover.
(cc)
Flexible leg openings.
(dd)
Refastening closures.
(D) Diapering supplies
The term diapering supplies means items, including diaper wipes and diaper cream, necessary to ensure that—
(i)
an eligible child using a diaper is properly cleaned and protected from diaper rash; or
(ii)
a medically complex child who uses a medically necessary diaper is properly cleaned and protected from diaper rash.
(E) Eligible child
The term eligible child means a child who—
(i)
has not attained 4 years of age; and
(ii)
is a member of a low-income family.
(F) Eligible entities
The term eligible entity means a State or local governmental entity, an Indian tribe or tribal organization (as defined in section 4 of the Indian Self-Determination and Education Assistance Act), or a nonprofit organization described in section 501(c)(3) of the Internal Revenue Code of 1986 and exempt from taxation under section 501(a) of such Code that—
(i)
has experience in the area of—
(I)
community distributions of basic need services, including experience collecting, warehousing, and distributing basic necessities such as diapers, food, or menstrual products;
(II)
child care;
(III)
child development activities in low-income communities; or
(IV)
motherhood, fatherhood, or parent education efforts serving low-income parents of young children;
(ii)
demonstrates competency to implement a project, provide fiscal accountability, collect data, and prepare reports and other necessary documentation; and
(iii)
demonstrates a willingness to share information with researchers, practitioners, and other interested parties.
(G) Federal poverty line
The term Federal poverty line means the Federal 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.
(H) Low-income
The term low-income, with respect to a family, means a family whose self-certified income is not more than 200 percent of the Federal poverty line.
(I) Medically complex child
The term medically complex child means an individual who has attained age 3 and for whom a licensed health care provider has provided a diagnosis of bowel or bladder incontinence, a bowel or bladder condition that causes excess urine or stool (such as short gut syndrome or diabetes insipidus), or a severe skin condition that causes skin erosions (such as epidermolysis bullosa).
(J) Medically necessary diaper
The term medically necessary diaper means an absorbent garment that is—
(i)
washable or disposable;
(ii)
worn by a medically complex child who has been diagnosed with bowel or bladder incontinence, a bowel or bladder condition that causes excess urine or stool (such as short gut syndrome or diabetes insipidus), or a severe skin condition that causes skin erosions (such as epidermolysis bullosa) and needs such garment to correct or ameliorate such condition; and
(iii)
if disposable—
(I)
does not use any latex or common allergens; and
(II)
meets or exceeds the quality standards for diapers commercially available through retail sale in the following categories:
(aa)
Absorbency (with acceptable rates for first and second wetting).
(bb)
Waterproof outer cover.
(cc)
Flexible leg openings.
(dd)
Refastening closures.
(7) Exemption of program from sequestration
(A) In general
Section 255(h) of the Balanced Budget and Emergency Deficit Control Act of 1985 (2 U.S.C. 905(h)) is amended by inserting after Supplemental Security Income Program (28–0406–0–1–609).
the following:
Targeted funding for States for diaper assistance (including diapering supplies and adult incontinence materials and supplies) through the Social Services Block Grant Program.
(B) Applicability
The amendment made by this paragraph shall apply to any sequestration order issued under the Balanced Budget and Emergency Deficit Control Act of 1985 (2 U.S.C. 900 et seq.) on or after the date of enactment of this Act.
(b) Improving access to diapers for medically complex children
Section 1915(c) of the Social Security Act (42 U.S.C. 1396n(c)) is amended by adding at the end the following new paragraph:
(12)
(A)
In the case of any waiver under this subsection that provides medical assistance to a medically complex child who has been diagnosed with bowel or bladder incontinence, a bowel or bladder condition that causes excess urine or stool (such as short gut syndrome or diabetes insipidus), or a severe skin condition that causes skin erosions (such as epidermolysis bullosa), such medical assistance shall include, for the duration of the waiver, the provision of 200 medically necessary diapers per month and diapering supplies. Such medical assistance may include the provision of medically necessary diapers in amounts greater than 200 if a licensed health care provider (such as a physician, nurse practitioner, or physician assistant) specifies that such greater amounts are necessary for such medically complex child.
(B)
For purposes of this paragraph:
(i)
The term medically complex child means an individual who has attained age 3 and for whom a licensed health care provider has provided a diagnosis of 1 or more significant chronic conditions.
(ii)
The term medically necessary diaper means an absorbent garment that is—
(I)
washable or disposable;
(II)
worn by a medically complex child who has been diagnosed with a condition described in subparagraph (A) and needs such garment to correct or ameliorate such condition; and
(III)
if disposable—
(aa)
does not use any latex or common allergens; and
(bb)
meets or exceeds the quality standards for diapers commercially available through retail sale in the following categories:
(AA)
Absorbency (with acceptable rates for first and second wetting).
(BB)
Waterproof outer cover.
(CC)
Flexible leg openings.
(DD)
Refastening closures.
(iii)
The term diapering supplies means items, including diaper wipes and diaper creams, necessary to ensure that a medically complex child who has been diagnosed with a condition described in subparagraph (A) and uses a medically necessary diaper is properly cleaned and protected from diaper rash.
(c) Inclusion of diapers and diapering supplies as qualified medical expenses
(1) Health savings accounts
Section 223(d)(2) of the Internal Revenue Code of 1986 is amended—
(A)
by inserting , medically necessary diapers, and diapering supplies
after menstrual care products
in the last sentence of subparagraph (A); and
(B)
by adding at the end the following new subparagraph:
(E) Medically necessary diapers and diapering supplies
For purposes of this paragraph—
(i) Medically necessary diapers
The term medically necessary diaper means an absorbent garment which is washable or disposable and which is worn by an individual who has attained 3 years of age because of medical necessity, such as someone who has been diagnosed with bowel or bladder incontinence, a bowel or bladder condition that causes excess urine or stool (such as short gut syndrome or diabetes insipidus), or a severe skin condition that causes skin erosions (such as epidermolysis bullosa) and needs such garment to correct or ameliorate such condition, to serve a preventative medical purpose, or to correct or ameliorate defects or physical or mental illnesses or conditions diagnosed by a licensed health care provider, and, if disposable—
(I)
does not use any latex or common allergens; and
(II)
meets or exceeds the quality standards for diapers commercially available through retail sale in the following categories:
(aa)
Absorbency (with acceptable rates for first and second wetting).
(bb)
Waterproof outer cover.
(cc)
Flexible leg openings.
(dd)
Refastening closures.
(ii) Diapering supplies
The term diapering supplies means items, including diaper wipes and diaper creams, necessary to ensure that an individual wearing medically necessary diapers is properly cleaned and protected from diaper rash.
(2) Archer MSAs
The last sentence of section 220(d)(2)(A) of such Code is amended by inserting , medically necessary diapers (as defined in section 223(d)(2)(E)), and diapering supplies (as defined in section 223(d)(2)(E))
after menstrual care products (as defined in section 223(d)(2)(D))
.
(3) Health flexible spending arrangements and health reimbursement arrangements
Section 106(f) of such Code is amended—
(A)
by inserting , medically necessary diapers (as defined in section 223(d)(2)(E)), and diapering supplies (as defined in section 223(d)(2)(E))
after menstrual care products (as defined in section 223(d)(2)(D))
; and
(B)
in the heading, by inserting , medically necessary diapers, and diapering supplies
after menstrual care products
.
(4) Effective dates
(A) Distributions from certain accounts
The amendments made by paragraphs (1) and (2) shall apply to amounts paid after December 31, 2026.
(B) Reimbursements
The amendment made by paragraph (3) shall apply to expenses incurred after December 31, 2026.
Sec. 5503. Decreasing the risk factors for sudden unexpected infant death and sudden unexplained death in childhood
(a) Establishment
The Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration and in consultation with the Director of the Centers for Disease Control and Prevention and the Director of the National Institutes of Health (in this section referred to as the Secretary), shall establish and implement a culturally and linguistically competent public health awareness and education campaign to provide information that is focused on decreasing the risk factors for sudden unexpected infant death and sudden unexplained death in childhood, including educating individuals about safe sleep environments, sleep positions, and reducing exposure to smoking during pregnancy and after birth.
(b) Targeted Populations
The campaign under subsection (a) shall be designed to reduce health inequalities through the targeting of populations with high rates of sudden unexpected infant death or of sudden unexplained death in childhood.
(c) Consultation
In establishing and implementing the campaign under subsection (a), the Secretary shall consult with national organizations representing (collectively) health care providers, including nurses and physicians, parents, child care providers, children's advocacy and safety organizations, maternal and child health programs, nutrition professionals focusing on (collectively) people, infants, and children, and other individuals and groups determined necessary by the Secretary for such establishment and implementation.
(d) Grants
(1) In general
In carrying out the campaign under subsection (a), the Secretary shall award grants to national organizations, State and local health departments, and community-based organizations for the conduct of education and outreach programs for nurses, parents, child care providers, community health workers, public health agencies, and community organizations.
(2) Application
To be eligible to receive a grant under paragraph (1), an entity shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(e) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
Subtitle G Elder Care
Sec. 5601. Expenses for household and elder care services necessary for gainful employment
(a) In general
Subpart A of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986 is amended by inserting after section 25F the following new section:
25G. Expenses for household and elder care services necessary for gainful employment
(a) Allowance of credit
(1) In general
In the case of an individual for which there are one or more qualifying individuals (as defined in subsection (b)(1)) with respect to such individual, there shall be allowed as a credit against the tax imposed by this chapter for the taxable year an amount equal to the applicable percentage of the employment-related expenses (as defined in subsection (b)(3)) paid by such individual during the taxable year.
(2) Applicable percentage defined
For purposes of paragraph (1), the term applicable percentage means 35 percent reduced (but not below 20 percent) by 1 percentage point for each $2,000 (or fraction thereof) by which the taxpayer’s adjusted gross income for the taxable year exceeds $15,000.
(b) Definitions of qualifying individual and employment-Related expenses
For purposes of this section—
(1) Qualifying individual
The term qualifying individual means an individual who—
(A)
has attained age 50, and
(B)
satisfies the requirements of any of the following clauses:
(i)
An individual who bears a relationship to the taxpayer described in subparagraph (C) or (D) of section 152(d)(2) (relating to fathers, mothers, and ancestors).
(ii)
An individual who would be a dependent of the taxpayer (as defined in section 152, determined without regard to subsections (b)(1) and (b)(2)) as a qualifying relative described in section 152(d)(1) if—
(I)
in lieu of the requirements under subparagraphs (B) and (C) of such section, with respect to such individual—
(aa)
the taxpayer has provided over one-half of the individual’s support for the calendar year in which such taxable year begins and each of the preceding 4 taxable years, and
(bb)
the individual’s modified adjusted gross income for the calendar year in which such taxable year begins is less than the exemption amount (as defined in section 151(d)),
(II)
the individual is physically or mentally incapable of caring for himself or herself, and
(III)
the individual has the same principal place of abode as the taxpayer for more than one-half of such taxable year.
(iii)
The spouse of the taxpayer, if such spouse is physically or mentally incapable of caring for himself or herself.
(2) Modified adjusted gross income
The term modified adjusted gross income means adjusted gross income determined without regard to section 86.
(3) Employment-related expenses
(A) In general
The term employment-related expenses means amounts paid for the following expenses, but only if such expenses are incurred to enable the taxpayer to be gainfully employed for any period for which there are one or more qualifying individuals with respect to the taxpayer:
(i)
Expenses for household services with respect to the qualifying individual.
(ii)
Expenses for the care of a qualifying individual, including expenses for respite care and hospice care.
(B) Exception
The term employment-related expenses shall not include services provided outside the taxpayer’s household unless such expenses are incurred for the care of—
(i)
a qualifying individual described in paragraph (1)(A), or
(ii)
a qualifying individual (not described in paragraph (1)(A)) who regularly spends at least 8 hours each day in the taxpayer’s household.
(C) Dependent care centers
The term employment-related expenses shall not include services provided outside the taxpayer’s household by a dependent care center (as defined in subparagraph (D)) unless—
(i)
such center complies with all applicable laws and regulations of the State and local government in which such center is located, and
(ii)
the requirements of subparagraph (B) are met.
(D) Dependent care center defined
For purposes of this paragraph, the term dependent care center means any facility which—
(i)
provides care for more than 6 individuals (other than individuals who reside at the facility), and
(ii)
receives a fee, payment, or grant for providing services for any of the individuals (regardless of whether such facility is operated for profit).
(c) Dollar limit on amount creditable
The amount of the employment-related expenses incurred during any taxable year which may be taken into account under subsection (a) shall not exceed—
(1)
if there is 1 qualifying individual with respect to the taxpayer for such taxable year, $3,000, or
(2)
if there are 2 or more qualifying individuals with respect to the taxpayer for such taxable year, $6,000.
The amount determined under this subsection shall be reduced by the aggregate amount excludable from gross income under section 129 for the taxable year.
(d) Earned income limitation
The amount of the employment-related expenses incurred during any taxable year which may be taken into account under subsection (a) shall not exceed—
(1)
in the case of an individual who is not married at the close of such year, such individual’s earned income for such year, or
(2)
in the case of an individual who is married at the close of such year, the lesser of such individual’s earned income or the earned income of the individual's spouse for such year.
(e) Special rules
For purposes of this section—
(1) Place of abode
An individual shall not be treated as having the same principal place of abode of the taxpayer if at any time during the taxable year of the taxpayer the relationship between the individual and the taxpayer is in violation of local law.
(2) Married couples must file joint return
In the case of an individual who is married as of the close of the taxable year, the credit shall be allowed under subsection (a) only if a joint return is filed for the taxable year under section 6013.
(3) Marital status
An individual legally separated from the individual's spouse under a decree of divorce or of separate maintenance shall not be considered as married.
(4) Certain married individuals living apart
In the case of an individual who is married and does not file a joint return for the taxable year, if—
(A)
such individual—
(i)
maintains as such individual's home a household which constitutes for more than one-half of the taxable year the principal place of abode of a qualifying individual, and
(ii)
furnishes over half of the cost of maintaining such household during the taxable year, and
(B)
during the last 6 months of such taxable year, such individual’s spouse is not a member of such household,
such individual shall not be considered as married.
(5) Payments to related individuals
No credit shall be allowed under subsection (a) for any amount paid by the taxpayer to an individual—
(A)
with respect to whom, for the taxable year, a deduction under section 151(c) (relating to deduction for personal exemptions for dependents) is allowable either to the taxpayer or the taxpayer's spouse, or
(B)
who—
(i)
is a child of the taxpayer (within the meaning of section 152(f)(1)), and
(ii)
has not attained the age of 19 at the close of the taxable year.
For purposes of this paragraph, the term taxable year means the taxable year of the taxpayer in which the service (as described in clause (i) of subsection (b)(3)(A)) is performed or the care (as described in clause (ii) of such subsection) is provided.
(6) Identifying information required with respect to service provider
No credit shall be allowed under subsection (a) for any amount paid to any person unless—
(A)
the name, address, and taxpayer identification number of such person are included on the return of tax for the taxable year in which the credit under this section is being claimed, or
(B)
if such person is an organization described in section 501(c)(3) and exempt from tax under section 501(a), the name and address of such person are included on the return of tax for the taxable year in which the credit under this section is being claimed.
In the case of a failure to provide the information required under the preceding sentence, the preceding sentence shall not apply if it is shown that the taxpayer exercised due diligence in attempting to provide the information so required.
(7) Identifying information required with respect to qualifying individuals
No credit shall be allowed under this section with respect to any qualifying individual unless the TIN of such individual is included on the return of tax for the taxable year in which the credit under this section is being claimed.
(f) Regulations
The Secretary shall prescribe such regulations as may be necessary to carry out the purposes of this section.
(b) Clerical amendment
The table of sections for subpart A of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986 is amended by inserting after the item relating to section 25F the following new item:
(c) Effective date
The amendments made by this section shall apply to taxable years beginning after the date of the enactment of this Act.
Subtitle H Miscellaneous provisions
Sec. 5701. Clarification supporting permissible use of funds for stillbirth prevention activities
Section 501(a) of the Social Security Act (42 U.S.C. 701(a)) is amended—
(1)
in paragraph (1)(B), by inserting to reduce the incidence of stillbirth,
after among children,
; and
(2)
in paragraph (2), by inserting after follow-up services
the following: , and for evidence-based programs and activities and outcome research to reduce the incidence of stillbirth (including tracking and awareness of fetal movements, improvement of birth timing for pregnancies with risk factors, initiatives that encourage safe sleeping positions during pregnancy, screening and surveillance for fetal growth restriction, efforts to achieve smoking cessation during pregnancy, community-based programs that provide home visits or other types of support, and any other research or evidence-based programming to prevent stillbirths)
.
Title VI Mental health and substance use disorders
Sec. 6001. Sense of Congress
It is the sense of the Congress that it is imperative that a comprehensive public health approach to addressing trauma and mental health care be focused on care delivery that is culturally and linguistically appropriate.
Subtitle A Access to care and funding streams
Sec. 6101. Coverage of substance use disorder counselor services and peer support specialist services under part B of the Medicare program
(a) Coverage of Services
(1) In general
Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)), as amended by section 4251(c)(1), is amended—
(A)
in subparagraph (KK), by striking and
at the end;
(B)
by inserting and
at the end of subparagraph (LL); and
(C)
by adding at the end the following new subparagraph:
(MM)
substance use disorder counselor services (as defined in subsection (rrr)(1)), and peer support specialist services (as defined in subsection (rrr)(3));
(2) Definitions
Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by sections 2007(b), 4221(a), and 4251(c)(2), is amended by adding at the end the following new subsection:
(rrr) Substance use disorder counselor services; substance use disorder counselor; peer support specialist services; peer support specialist
(1)
The term substance use disorder counselor services means services performed by a substance use disorder counselor (as defined in paragraph (2)) for the diagnosis and treatment of substance use disorder and addiction that the substance use disorder counselor is legally authorized to perform under State law (or the State regulatory mechanism provided by the State law) of the State in which such services are performed, as would otherwise be covered if furnished by a physician or as incident to a physician’s professional service, but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services.
(2)
The term substance use disorder counselor means an individual who—
(A)
has performed at least 2 years of supervised substance use disorder counselor practice;
(B)
in the case of an individual performing services in a State that provides for licensure or certification of substance use disorder counselors or professional counselors, is licensed or certified as a substance use disorder counselor or professional counselor in such State; or
(C)
is a drug and alcohol counselor as described in section 40.281(a)(6) of title 49, Code of Federal Regulations.
(3)
The term peer support specialist services means services performed by a peer support specialist (as defined in paragraph (4)) for the well-being of individuals needing mental health support that the peer support specialist is legally authorized to perform under State law (or the State regulatory mechanism provided by the State law) of the State in which such services are performed, as would otherwise be covered if furnished by a physician or as incident to a physician’s professional service, but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services.
(4)
The term peer support specialist means an individual who—
(A)
is an individual living in recovery with mental illness, addiction, or justice system involvement;
(B)
has skills learned in formal training;
(C)
uses assets-based framing in speaking about mental health, recovery, and well-being; and
(D)
delivers services in behavioral health settings to promote mind-body recovery and resiliency.
(3) Provision for payment under part B
Section 1832(a)(2)(B) of the Social Security Act (42 U.S.C. 1395k(a)(2)(B)) is amended by adding at the end the following new clause:
(v)
substance use disorder counselor services and peer support specialist services;
(4) Amount of payment
Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)), as amended by section 4251(c)(3), is amended—
(A)
by striking and
before (II)
; and
(B)
by inserting before the semicolon at the end the following: , and (JJ) with respect to substance use disorder counselor services and peer support specialist services under section 1861(s)(2)(MM), the amounts paid shall be 80 percent of the lesser of the actual charge for the services or 75 percent of the amount determined for payment of a psychologist under subparagraph (L)
.
(5) Exclusion of peer support specialist services from skilled nursing facility prospective payment system
Section 1888(e)(2)(A)(ii) of the Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting peer support specialist services (as defined in section 1861(rrr)(3)),
after mental health counselor services (as defined in section 1861(lll)(3))
.
(6) Inclusion of substance use disorder counselors as practitioners for assignment of claims
Section 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)) is amended by adding at the end the following new clauses:
(ix)
A substance use disorder counselor (as defined in section 1861(rrr)(2)).
(x)
A peer support specialist (as defined in section 1861(rrr)(4)).
(b) Coverage of Certain Mental Health Services Provided in Rural Health Clinics and Federally Qualified Health Centers
Section 1861(aa)(1)(B) of the Social Security Act (42 U.S.C. 1395x(aa)(1)(B)) is amended by striking or by a mental health counselor (as defined in subsection (lll)(4))
and inserting by a mental health counselor (as defined in subsection (lll)(4)), by a substance use disorder counselor (as defined in subsection (rrr)(2)), or by a peer support specialist (as defined in subsection (rrr)(4))
.
(c) Effective Date
The amendments made by this section shall apply with respect to services furnished on or after January 1, 2027.
Sec. 6102. Reauthorization of Minority Fellowship Program
Section 597(c) of the Public Health Service Act (42 U.S.C. 290ll(c)) is amended by striking $25,000,000 for each of fiscal years 2023 through 2027
and inserting $36,700,000 for each of fiscal years 2027 through 2031
.
Sec. 6103. Additional funds for National Institutes of Health
(a) In general
In addition to amounts otherwise authorized to be appropriated to the National Institutes of Health, there is authorized to be appropriated to such Institutes $150,000,000 for each of fiscal years 2027 through 2032—
(1)
to build relations with communities and conduct or support clinical research, including clinical research on racial or ethnic disparities in physical and mental health; and
(2)
to carry out the Strategic Framework For Addressing Youth Mental Health Disparities developed by the National Institute of Mental Health.
(b) Definition
In this section, the term clinical research has the meaning given to such term in section 409 of the Public Health Service Act (42 U.S.C. 284d).
Sec. 6104. Additional funds for National Institute on Minority Health and Health Disparities
In addition to amounts otherwise authorized to be appropriated to the National Institute on Minority Health and Health Disparities, there is authorized to be appropriated to such Institute $750,000,000 for each of fiscal years 2027 through 2032.
Sec. 6105. Grants for increasing racial and ethnic minority access to high-quality trauma support services and mental health care
(a) In general
The Secretary of Health and Human Services (in this section referred to as the Secretary
), acting through the Assistant Secretary for Mental Health and Substance Use, shall award grants to eligible entities to establish or expand programs for the purpose of increasing racial and ethnic minority access to high-quality trauma support services and mental health care.
(b) Eligible entities
To seek a grant under this section, an entity shall be a community-based program or organization that—
(1)
provides culturally and linguistically appropriate programs and resources that are aligned with evidence-based practices for trauma-informed care; and
(2)
has demonstrated expertise in serving communities of color or can partner with a program that has such demonstrated expertise.
(c) Use of funds
As a condition on receipt of a grant under this section, a grantee shall agree to use the grant to increase racial and ethnic minority access to high-quality trauma support services and mental health care, such as by—
(1)
establishing and maintaining community-based programs providing evidence-based services in trauma-informed care and culturally specific services and other resources;
(2)
developing innovative, culturally specific strategies and projects to enhance access to trauma-informed care and resources for racial and ethnic minorities who face obstacles to using more traditional services and resources (such as obstacles in geographic access to providers, insurance coverage, and access to audio and video technologies);
(3)
working with State and local governments and social service agencies to develop and enhance effective strategies to provide culturally specific services to racial and ethnic minorities;
(4)
increasing communities’ capacity to provide culturally specific resources and support for communities of color;
(5)
working in cooperation with the community to develop education and prevention strategies highlighting culturally specific issues and resources regarding racial and ethnic minorities;
(6)
providing culturally specific programs for racial and ethnic minorities exposed to law enforcement violence; and
(7)
examining the dynamics of culture and its impact on victimization and healing.
(d) Priority
In awarding grants under this section, the Secretary shall give priority to eligible entities proposing to serve communities that have faced high rates of community trauma, including from exposure to law enforcement violence, intergenerational poverty, civil unrest, discrimination, or oppression.
(e) Grant period
The period of a grant under this section shall be 4 years.
(f) Evaluation
Not later than 6 months after the end of the period of all grants under this section, the Secretary shall—
(1)
conduct an evaluation of the programs funded by a grant under this section;
(2)
include in such evaluation an assessment of the outcomes of each such program; and
(3)
submit a report on the results of such evaluation to the Congress.
(g) Authorization of appropriations
To carry out this section, there is authorized to be appropriated $20,000,000 for each of fiscal years 2027 through 2031.
Subtitle B Interprofessional care
Sec. 6201. Health professions competencies to address racial and ethnic mental health inequities
(a) In general
The Secretary of Health and Human Services, acting through the Assistant Secretary for Mental Health and Substance Use, shall award grants to qualified national organizations for the purposes of—
(1)
developing, and disseminating to health professional educational programs, culturally and linguistically appropriate curricula or core competencies addressing mental health inequities among racial and ethnic minority groups for use in the training of students in the professions of social work, psychology, psychiatry, marriage and family therapy, mental health counseling, peer support, and substance use disorder counseling; and
(2)
certifying community health workers and peer wellness specialists with respect to such curricula and core competencies and integrating and expanding the use of such workers and specialists into health care and community-based settings to address mental health inequities among racial and ethnic minority groups.
(b) Curricula; core competencies
Organizations receiving funds under subsection (a) may use the funds to engage in the following activities related to the development and dissemination of curricula or core competencies described in subsection (a)(1):
(1)
Formation of committees or working groups composed of experts from accredited health professions schools to identify core competencies relating to mental health inequities among racial and ethnic minority groups.
(2)
Planning of workshops in collaboration with community-based organizations and communities of color in national fora to directly facilitate public input, including input from communities of color with lived experience, into the educational needs associated with mental health inequities among racial and ethnic minority groups.
(3)
Dissemination and promotion of the use of curricula or core competencies in undergraduate and graduate health professions training programs nationwide.
(4)
Establishing external stakeholder advisory boards to provide meaningful input into policy and program development and best practices to reduce mental health inequities among racial and ethnic groups, including participation and leadership from communities of color with lived experience of the impacts of mental health inequities.
(c) Definitions
In this section:
(1) Qualified national organization
The term qualified national organization means a national organization that focuses on the education of students in programs of social work, occupational therapy, psychology, psychiatry, substance use counseling, and marriage and family therapy.
(2) Racial and ethnic minority group
The term racial and ethnic minority group has the meaning given to such term in section 1707(g) of the Public Health Service Act (42 U.S.C. 300u–6(g)).
(d) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
Sec. 6202. Interprofessional health care teams for behavioral health care
Part D of title V of the Public Health Service Act (42 U.S.C. 290dd et seq.) is amended by adding at the end the following:
554. Interprofessional health care teams for provision of behavioral health care in primary care settings
(a) Grants
The Secretary, acting through the Assistant Secretary, shall award grants to eligible entities for the purpose of establishing interprofessional health care teams that provide behavioral health care.
(b) Eligible entities
To be eligible to receive a grant under this section, an entity shall be a Federally qualified health center (as defined in section 1861(aa) of the Social Security Act), rural health clinic, women’s health clinic, or behavioral health program (including any such program operated by a community-based organization) serving a high proportion of individuals from racial and ethnic minority groups (as defined in section 1707(g)).
(c) Loan forgiveness
To encourage qualified and diverse allied health professionals to enter the mental health field, an eligible entity receiving a grant under this section shall agree to use not less than $10,000 of the grant funds on a loan forgiveness program for practitioners who commit to working in the mental health field for a period of 2 years.
(d) Scientifically and culturally based
Integrated health care funded through this section shall be scientifically and culturally based, taking into consideration the results of the most recent peer-reviewed research available, including information on language accessibility, cultural humility, diversity of practitioners, and consideration of social determinants of health.
(e) Authorization of appropriations
To carry out this section, there is authorized to be appropriated $20,000,000 for each of fiscal years 2027 through 2031.
Sec. 6203. Integrated Health Care Demonstration Program
Part D of title V of the Public Health Service Act (42 U.S.C. 290dd et seq.), as amended by section 6202, is amended by adding at the end the following:
555. Interprofessional health care teams for provision of behavioral health care in primary care settings
(a) Grants
The Secretary shall award grants to eligible entities for the purpose of establishing interprofessional health care teams that provide behavioral health care.
(b) Eligible entities
To be eligible to receive a grant under this section, an entity shall be a Federally qualified health center (as defined in section 1861(aa) of the Social Security Act), rural health clinic, or behavioral health program, serving a high proportion of individuals from racial and ethnic minority groups (as defined in section 1707(g)).
(c) Scientifically based
Integrated health care funded through this section shall be scientifically based, taking into consideration the results of the most recent peer-reviewed research available.
(d) Authorization of appropriations
To carry out this section, there is authorized to be appropriated $20,000,000 for each of the first 5 fiscal years following the date of enactment of the Health Equity and Accountability Act 2026.
Subtitle C Workforce development
Sec. 6301. Building an effective workforce in mental health
(a) In general
The Secretary of Health and Human Services, in coordination with the Assistant Secretary for Mental Health and Substance Use, the Administrator of the Health Resources and Services Administration, the Secretary of Labor, and advocacy and behavioral and mental health organizations serving vulnerable populations, including youth and young adults, people with low incomes, and people of color, shall—
(1)
develop, strengthen, and implement strategies to bolster career pathways for diverse mental health professionals;
(2)
identify the breadth of settings where mental health care and behavioral health care can take place; and
(3)
identify current mental health professional workforce shortages, inclusive of shortages of diverse mental health professionals.
(b) Contents
Strategies under subsection (a) shall include—
(1)
the variety of settings where mental health professionals are needed, including community-based organizations, women’s centers, shelters, organizations focused on youth development, workforce agencies, job placement and development centers, emergency rooms, the special supplemental nutrition program for women, infants, and children under section 17 of the Child Nutrition Act of 1966 (42 U.S.C. 1786), food banks, legal aid, and benefit issuers (as defined in section 3 of the Food and Nutrition Act of 2008 (7 U.S.C. 2012));
(2)
defining career pathways in mental and behavioral health, to help diverse communities understand the variety of careers in mental and behavioral health that are available;
(3)
building career pathways in mental and behavioral health as part of the curriculum at the postsecondary education level;
(4)
providing accessible training and certification pathways for diverse lay health workers such as community health workers and other peer support specialists to ensure that careers pay a living wage;
(5)
creating incentives for students in the fields of occupational therapy, social work, psychology, medicine, and nursing to learn more about mental health, and to include a mental health rotation, with a particular focus in racially and ethnically diverse communities, as a part of the health professional curricula;
(6)
including training and education for teachers about the basics of section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794) and individualized education programs (as defined in section 614(d) of the Individuals with Disabilities Education Act (20 U.S.C. 1414(d)));
(7)
researching, developing, and implementing programs for mental and behavioral health professionals to prevent burnout; and
(8)
finding better and increased avenues to ensure equity by providing better loan forgiveness programs, including a focus area within the National Health Service Corps focused on community trauma.
(c) Use of funds
Programs and activities funded under this section shall be consistent with subsection (a)(1) and shall include the following:
(1)
Subgrants to entities serving youth and young adults which demonstrate a need for an increased mental health workforce, using strategies described in subsection (a)(1).
(2)
Funding towards the Health Resources and Services Administration’s Behavioral Health Workforce Education and Training Program.
(3)
Funding towards the development and implementation of a National Health Service Corps program focused on community trauma.
(d) Authorization of appropriations
There are authorized to be appropriated to carry out this section $50,000,000 for each of fiscal years 2027 through 2037.
Sec. 6302. Demonstration program to increase language access at eligible health centers
(a) Grants
The Secretary shall carry out a demonstration program consisting of awarding grants to eligible health centers to recruit, hire, employ, and supervise qualified behavioral health professionals who—
(1)
are proficient in speaking and understanding both spoken English and at least one other spoken language, including any necessary specialized vocabulary, terminology, and phraseology;
(2)
are able to effectively, accurately, and impartially communicate directly with limited English proficient individuals in their primary language; and
(3)
are, or will be, employed—
(A)
directly by the eligible health center; or
(B)
through a contract between the eligible health center and the qualified behavioral health professional under which such professional provides services as part of the eligible health center's workforce or under supervision by the health center, in order to provide behavioral health services in another language.
(b) Preference
In selecting grant recipients under subsection (a), the Secretary shall give preference to eligible health centers at which at least 10 percent of the patients are best served in a language other than English, as indicated by data in the Uniform Data System of the Health Resources and Services Administration (or any successor database).
(c) Outreach
An eligible health center receiving a grant under this section shall use a portion of the grant funds to disseminate information about the behavioral health services supported through the grant.
(d) Reports
(1) Initial report
Not later than 6 months after the first grants are awarded under subsection (a), the Secretary shall submit to the Committee on Appropriations and the Committee on Energy and Commerce of the House of Representatives, the Committee on Appropriations and the Committee on Health, Education, Labor, and Pensions of the Senate, and other appropriate congressional committees, a report on the implementation of the program under this section. Such report shall include—
(A)
the languages spoken by the qualified behavioral health professionals recruited pursuant to a grant under subsection (a);
(B)
the eligible health center at which each such professional was placed;
(C)
how many eligible health centers received grants under subsection (a);
(D)
an analysis, conducted in consultation with the eligible health centers receiving grants under subsection (a), of the effectiveness of such grants at increasing language access to behavioral health services; and
(E)
best practices, developed in consultation with eligible health centers receiving grants under subsection (a), for the recruitment and retention of qualified behavioral health professionals at such health centers.
(2) Final report
Not later than the end of fiscal year 2028, the Secretary shall submit to the Committee on Appropriations and the Committee on Energy and Commerce of the House of Representatives, the Committee on Appropriations and the Committee on Health, Education, Labor, and Pensions of the Senate, and other appropriate congressional committees, a final report on the implementation of the program under this section, including the information, analysis, and best practices described in subparagraphs (A) through (E) of paragraph (1).
(e) Definitions
In this section:
(1)
The term eligible health center means a health center (as defined in section 330 of the Public Health Service Act (42 U.S.C. 254b)) that is already receiving assistance pursuant to one or more grants under such section 330 at the time of the award to such health center of a supplemental grant under subsection (a).
(2)
The term qualified behavioral health professional means—
(A)
a behavioral and mental health professional (as defined in section 331(a)(3)(E)(i) of the Public Health Service Act (42 U.S.C. 254d(a)(3)(E)(i)));
(B)
a substance use disorder counselor;
(C)
an occupational therapist; or
(D)
an individual who—
(i)
has not yet been licensed or certified to serve as a professional listed in any of subparagraphs (A) through (C); and
(ii)
will serve at the eligible health center under the supervision of a licensed individual or certified professional so listed.
(3)
The term Secretary means the Secretary of Health and Human Services.
(f) Funding
Subject to the availability of appropriations, out of amounts otherwise appropriated under section 760(g) of the Public Health Service Act (42 U.S.C. 294k(g)), the Secretary is authorized to use up to $10,000,000 for each of fiscal years 2027 through 2032 to carry out this section.
Sec. 6303. Health professions competencies to address racial and ethnic minority mental health disparities
(a) In general
The Secretary of Health and Human Services may award grants to qualified national organizations for the purposes of—
(1)
developing, and disseminating to health professional educational programs, best practices or core competencies addressing mental health disparities among racial and ethnic minority groups for use in the training of students in the professions of social work, psychology, psychiatry, marriage and family therapy, mental health counseling, and substance use disorder counseling; and
(2)
certifying community health workers and peer wellness specialists with respect to such best practices and core competencies and integrating and expanding the use of such workers and specialists into health care to address mental health disparities among racial and ethnic minority groups.
(b) Best practices; core competencies
Organizations receiving funds under subsection (a) may use the funds to engage in the following activities related to the development and dissemination of best practices or core competencies described in subsection (a)(1):
(1)
Formation of committees or working groups composed of experts from accredited health professions schools to identify best practices and core competencies relating to mental health disparities among racial and ethnic minority groups.
(2)
Planning of workshops at the national level to allow for public input into the educational needs associated with mental health disparities among racial and ethnic minority groups.
(3)
Dissemination and promotion of the use of best practices or core competencies for culturally and linguistically appropriate mental health services in undergraduate and graduate health professions training programs nationwide.
(4)
Establishing external stakeholder advisory boards to provide meaningful input into policy and program development and best practices to reduce mental health disparities among racial and ethnic minority groups.
(c) Definitions
In this section:
(1) Qualified national organization
The term qualified national organization means a national organization that focuses on the education of students in one or more of the professions of social work, psychology, psychiatry, marriage and family therapy, mental health counseling, and substance misuse counseling.
(2) Racial and ethnic minority group
The term racial and ethnic minority group has the meaning given to such term in section 1707(g) of the Public Health Service Act (42 U.S.C. 300u–6(g)).
Subtitle D Children’s mental health
Sec. 6401. Grant programs to support pediatric behavioral health care
Part D of title III of the Public Health Service Act (42 U.S.C. 254b et seq.) is amended by inserting after subpart V the following new subpart:
VI Pediatric behavioral health programs
340A–1. Program to improve access to community-based pediatric behavioral health care
(a) In general
The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall award grants, contracts, or cooperative agreements to eligible entities for the purpose of supporting pediatric behavioral health care integration and coordination within communities to meet local community needs.
(b) Eligible entities
Entities eligible for grants under subsection (a) include—
(1)
health care providers, including family physicians, pediatric medical sub-specialists, and surgical specialists;
(2)
children’s hospitals;
(3)
facilities that are eligible to receive funds under section 340E or 340H;
(4)
nonprofit medical facilities that predominantly treat individuals under the age of 21;
(5)
rural health clinics and Federally qualified health centers (as such terms are defined in section 1861(aa) of the Social Security Act);
(6)
pediatric mental health and substance use disorder providers, such as child and adolescent psychiatrists, psychologists, developmental and behavioral pediatricians, general pediatricians, advanced practice nurses, social workers, licensed professional counselors, and other licensed professionals that provide mental health and substance use disorder services to patients under 21 years of age;
(7)
children's advocacy centers described in section 214(c)(2)(B) of the Victims of Child Abuse Act of 1990;
(8)
school-based health centers; and
(9)
other entities as determined appropriate by the Secretary.
(c) Prioritization
In making awards under subsection (a), the Secretary shall prioritize—
(1)
applicants that provide children and adolescents from high-need, rural, or under-resourced communities with services across the continuum of children's mental health and substance use disorder care; and
(2)
applicants that predominantly provide care to children and adolescents that demonstrate plans to utilize funds to expand provision of care to children, adolescents, and youth under age 21.
(d) Use of funds
Activities that may be funded through an award under subsection (a) include—
(1)
increasing the capacity of pediatric practices, family medicine practices, and school-based health centers to integrate pediatric mental, emotional, and behavioral health services into their practices including through co-location of mental, emotional, and behavioral health providers;
(2)
training for non-clinical pediatric health care workers, including care coordinators and navigators, on child and adolescent mental health and substance use disorder, trauma-informed care, and local resources to support children and caregivers;
(3)
expanding evidence-based, integrated models of care for pediatric mental health and substance use disorder services;
(4)
pediatric practice integration for the provision of pediatric mental health and substance use disorder services;
(5)
addressing surge capacity for pediatric mental health and substance use disorder needs;
(6)
providing pediatric mental, emotional, and behavioral health services to children as delivered by mental health and substance use disorder professionals utilizing telehealth services;
(7)
establishing or maintaining initiatives to allow more children to access care outside of emergency departments, including partial hospitalization, step down residency programs, and intensive outpatient programs;
(8)
supporting, enhancing, or expanding pediatric mental health and substance use disorder preventive and crisis intervention services;
(9)
establishing or maintaining pediatric mental health and substance use disorder urgent care or walk-in clinics;
(10)
establishing or maintaining community-based pediatric mental health and substance use disorder initiatives, such as partnerships with schools and early childhood education programs;
(11)
addressing other access and coordination gaps to pediatric mental health and substance use disorder services in the community for children; and
(12)
supporting the collection of data on children and adolescents’ mental health needs, service utilization and availability, and demographic data, to capture community needs and identify gaps and barriers in children's access to care, in a manner that protects personal privacy, consistent with applicable Federal and State privacy laws.
(e) Authorization of appropriations
To carry out this section, there is authorized to be appropriated such sums as may be necessary for each of fiscal years 2027 through 2031.
340A–2. Pediatric behavioral health workforce training program
(a) In general
The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall award grants, contracts, or cooperative agreements to eligible entities for the purpose of supporting evidence-based pediatric mental health and substance use disorder workforce training.
(b) Eligible entities
Entities eligible for grants under subsection (a) include—
(1)
children’s hospitals;
(2)
facilities that are eligible to receive funds under section 340E or 340H;
(3)
nonprofit medical facilities that predominantly treat individuals under the age of 21;
(4)
rural health clinics and Federally qualified health centers (as such terms are defined in section 1861(aa) of the Social Security Act);
(5)
entities that employ mental health and substance use disorder professionals, such as child and adolescent psychiatrists, psychologists, developmental and behavioral pediatricians, general pediatricians, advanced practice nurses, social workers, licensed professional counselors, or other licensed professionals that provide mental health or substance use disorder services to patients under 21 years of age; and
(6)
other pediatric health care providers as determined appropriate by the Secretary.
(c) Use of funds
Activities that may be supported through an award under subsection (a) include the following:
(1)
Training to enhance the capabilities of the existing pediatric workforce, including pediatricians, primary care physicians, advanced practice registered nurses, and other pediatric health care providers, including expanded training in pediatric mental health and substance use disorders, and culturally and developmentally appropriate care for children with mental health conditions.
(2)
Training to support multi-disciplinary teams to provide pediatric mental health and substance use disorder treatment, including through integrated care models.
(3)
Initiatives to accelerate the time to licensure within the pediatric mental health or substance use disorder workforce.
(4)
Activities to expand recruitment and retention, increase workforce diversity, or enhance workforce training for critical pediatric mental health professions, including—
(A)
child and adolescent psychiatrists;
(B)
psychiatric nurses;
(C)
psychologists;
(D)
family therapists;
(E)
social workers;
(F)
mental health counselors;
(G)
developmental and behavioral pediatricians;
(H)
pediatric substance use disorder specialists; and
(I)
other mental health care providers as determined appropriate by the Secretary.
(d) Authorization of appropriations
To carry out this section, there is authorized to be appropriated such sums as may be necessary for each of fiscal years 2027 through 2031.
Sec. 6402. Increasing Federal investment in pediatric behavioral health services
The Public Health Service Act (42 U.S.C. 201 et seq.) (as amended by section 2004) is amended by adding at the end the following:
XXXV Assistance for construction and modernization of children’s mental health and substance use disorder infrastructure
3501. Increasing Federal investment in pediatric behavioral health services
(a) In general
The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall award grants, contracts, or cooperative agreements to eligible entities for the purpose of improving their ability to provide pediatric behavioral health services, including by—
(1)
constructing or modernizing sites of care for pediatric behavioral health services;
(2)
expanding capacity to provide pediatric behavioral health services, including enhancements to digital infrastructure, telehealth capabilities, or other improvements to patient care infrastructure;
(3)
supporting the reallocation of existing resources to accommodate pediatric behavioral health patients, including by converting or adding a sufficient number of beds to establish or increase the hospital’s inventory of licensed and operational, short-term psychiatric and substance use inpatient beds; and
(4)
addressing gaps in the continuum of care for children, by expanding capacity to provide intermediate levels of care, such as intensive outpatient services, partial hospitalization programs, and day programs that can prevent hospitalizations and support children as they transition back to their homes and communities.
(b) Eligibility
To be eligible to seek an award under this section, an entity shall be a hospital or rural health clinic that predominantly treats individuals under the age of 21, including any hospital that receives funds under section 340E.
(c) Authorization of appropriations
To carry out this section, there is authorized to be appropriated such sums as may be necessary for each of fiscal years 2027 through 2031.
(d) Supplement, not supplant
Funds provided under this section shall be used to supplement, not supplant Federal and non-Federal funds available for carrying out the activities described in this section.
(e) Reporting
(1) Reports from award recipients
Not later than 180 days after the completion of activities funded by an award under this section, the entity that received such award shall submit a report to the Secretary on the activities conducted using funds from such award, and other information as the Secretary may require.
(2) Reports to Congress
Not later than one year after the completion of activities funded by an award under this section, the Secretary shall submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report on the projects and activities conducted with funds awarded under this section, and the outcome of such projects and activities. Such report shall include—
(A)
the number of projects supported by awards made under this section;
(B)
an overview of the impact, if any, of such projects on pediatric health care infrastructure, including any impact on access to pediatric mental health and substance use disorder services;
(C)
recommendations for improving the investment program under this section; and
(D)
any other considerations as the Secretary determines appropriate.
Sec. 6403. Mental health in schools
(a) School-Based mental health and children
Section 581 of the Public Health Service Act (42 U.S.C. 290hh) is amended to read as follows:
581. School-based mental health; children and adolescents
(a) In general
The Secretary, in consultation with the Secretary of Education, shall, through grants, contracts, or cooperative agreements awarded to eligible entities described in subsection (c), provide comprehensive school-based mental health services and supports to assist children in local communities and schools (including schools funded by the Bureau of Indian Education) dealing with traumatic experiences, grief, bereavement, risk of suicide, and violence. Such services and supports shall—
(1)
be developmentally, linguistically, and culturally appropriate;
(2)
be trauma-informed; and
(3)
incorporate positive behavioral interventions and supports.
(b) Activities
Grants, contracts, or cooperative agreements awarded under subsection (a), shall, as appropriate, be used for—
(1)
implementation of school- and community-based mental health programs that—
(A)
build awareness of individual trauma and the intergenerational, continuum of impacts of trauma on populations;
(B)
train appropriate staff to identify, and screen for, signs of trauma exposure, mental health disorders, or risk of suicide; and
(C)
incorporate positive behavioral interventions, family engagement, student treatment, and multigenerational supports to foster the health and development of children, prevent mental health disorders, and ameliorate the impact of trauma;
(2)
technical assistance to local communities with respect to the development of programs described in paragraph (1);
(3)
facilitating community partnerships among families, students, law enforcement agencies, education agencies, mental health and substance use disorder service systems, family-based mental health service systems, child welfare agencies, health care providers (including primary care physicians, mental health professionals, and other professionals who specialize in children’s mental health such as child and adolescent psychiatrists), institutions of higher education, faith-based programs, trauma networks, and other community-based systems to address child and adolescent trauma, mental health issues, and violence; and
(4)
establishing mechanisms for children and adolescents to report incidents of violence or plans by other children, adolescents, or adults to commit violence.
(c) Requirements
(1) In general
To be eligible for a grant, contract, or cooperative agreement under subsection (a), an entity shall be a partnership that includes—
(A)
a State educational agency, as defined in section 8101 of the Elementary and Secondary Education Act of 1965, in coordination with one or more local educational agencies, as defined in section 8101 of the Elementary and Secondary Education Act of 1965, or a consortium of any entities described in subparagraph (B), (C), (D), or (E) of section 8101(30) of such Act; and
(B)
at least 1 community-based mental health provider, including a public or private mental health entity, health care entity, family-based mental health entity, trauma network, or other community-based entity, as determined by the Secretary (and which may include additional entities such as a human services agency, law enforcement or juvenile justice entity, child welfare agency, an institution of higher education, or another entity, as determined by the Secretary).
(2) Compliance with HIPAA
Any patient records developed by covered entities through activities under the grant shall meet the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996.
(3) Compliance with FERPA
Section 444 of the General Education Provisions Act (commonly known as the
Family Educational Rights and Privacy Act of 1974) shall apply to any entity that is a member of the partnership in the same manner that such section applies to an educational agency or institution (as that term is defined in such section).(d) Geographical distribution
The Secretary shall ensure that grants, contracts, or cooperative agreements under subsection (a) will be distributed equitably among the regions of the country and among urban and rural areas.
(e) Duration of awards
With respect to a grant, contract, or cooperative agreement under subsection (a), the period during which payments under such an award will be made to the recipient shall be 5 years, with options for renewal.
(f) Evaluation and measures of outcomes
(1) Development of process
The Assistant Secretary shall develop a fiscally appropriate process for evaluating activities carried out under this section. Such process shall include—
(A)
the development of guidelines for the submission of program data by grant, contract, or cooperative agreement recipients;
(B)
the development of measures of outcomes (in accordance with paragraph (2)) to be applied by such recipients in evaluating programs carried out under this section; and
(C)
the submission of annual reports by such recipients concerning the effectiveness of programs carried out under this section.
(2) Measures of outcomes
The Assistant Secretary shall develop measures of outcomes to be applied by recipients of assistance under this section to evaluate the effectiveness of programs carried out under this section, including outcomes related to the student, family, and local educational systems supported by this Act.
(3) Submission of annual data
An eligible entity described in subsection (c) that receives a grant, contract, or cooperative agreement under this section shall annually submit to the Assistant Secretary a report that includes data to evaluate the success of the program carried out by the entity based on whether such program is achieving the purposes of the program. Such reports shall utilize the measures of outcomes under paragraph (2) in a reasonable manner to demonstrate the progress of the program in achieving such purposes.
(4) Evaluation by assistant secretary
Based on the data submitted under paragraph (3), the Assistant Secretary shall annually submit to Congress a report concerning the results and effectiveness of the programs carried out with assistance received under this section.
(5) Limitation
An eligible entity shall use not more than 20 percent of amounts received under a grant under this section to carry out evaluation activities under this subsection.
(g) Information and education
The Secretary shall disseminate best practices based on the findings of the knowledge development and application under this section.
(h) Amount of grants and authorization of appropriations
(1) Amount of grants
A grant under this section shall be in an amount that is not more than $2,000,000 for each of the first 5 fiscal years following the date of enactment of the Health Equity and Accountability Act 2026. The Secretary shall determine the amount of each such grant based on the population of children up to age 21 of the area to be served under the grant.
(2) Authorization of appropriations
There is authorized to be appropriated to carry out this section, $300,000,000 for each of fiscal years 2027 through 2030.
(b) Conforming amendment
Part G of title V of the Public Health Service Act (42 U.S.C. 290hh et seq.), as amended by subsection (a), is amended by striking the part designation and heading and inserting the following:
G School-based mental health
Sec. 6404. Additional support for youth and young adult mental health service provision
Section 1903 of the Social Security Act (42 U.S.C. 1396b) is amended by adding at the end the following new subsection:
(cc) Youth and young adult intervention services
(1) In general
Notwithstanding section 1902(a)(1) (relating to Statewideness), section 1902(a)(10)(B) (relating to comparability), section 1902(a)(23)(A) (relating to freedom of choice of providers), or section 1902(a)(27) (relating to provider agreements), a State may, during the 5-year period beginning on the first day of the fiscal year quarter that begins on or after January 1, 2027, provide medical assistance for qualifying youth and young adult mental health and substance use intervention services (as defined in paragraph (2)(C)) under a State plan amendment or waiver approved under section 1115 or 1915(c).
(2) Definitions
For the purposes of this subsection:
(A) Priority service
The term priority service means any of the following, if voluntarily received and provided in a manner that maintains the privacy and confidentiality of patient information consistent with Federal and State requirements:
(i)
Qualifying community-based mobile crisis intervention services, as defined in section 1947.
(ii)
Telehealth.
(iii)
Youth peer support.
(iv)
Screening for adverse childhood experiences.
(v)
Trauma responsive care.
(vi)
Other priority services for youth, as defined by the Secretary.
(B) Qualified mental health provider
The term qualified mental health provider means a behavioral health care professional who is capable of conducting an assessment of an individual described in subparagraph (C)(i), in accordance with the professional’s permitted scope of practice under State law, and any other professional or paraprofessional with appropriate expertise in youth and young adult behavioral health or mental health, including a social worker, peer support specialist, recovery coach, community health worker, mental health clinician, and any other provider designated by the State and approved by the Secretary.
(C) Qualifying youth and young adult mental health and substance use intervention services defined
The term qualifying youth and young adult mental health and substance use intervention services means, with respect to a State, items and services for which medical assistance is available under the State plan under this title or a waiver of such plan, that are—
(i)
furnished to an individual 16 to 25 years of age who is—
(I)
experiencing a mental health or substance use disorder crisis;
(II)
an offender, as defined in section 3 of the Workforce Innovation and Opportunity Act;
(III)
(aa)
experiencing homelessness (as defined in section 41403(6) of the Violence Against Women Act of 1994);
(bb)
a homeless child or youth (as defined in section 725(2) of the McKinney-Vento Homeless Assistance Act);
(cc)
a runaway, is in foster care, or has aged out of the foster care system;
(dd)
a child eligible for assistance under section 477; or
(ee)
in an out-of-home placement;
(IV)
an individual who is pregnant or parenting, including—
(aa)
a custodial or non-custodial mother or father; or
(bb)
an expectant mother;
(V)
a youth who is an individual with a disability (as defined in section 3 of the Americans with Disabilities Act of 1990);
(VI)
a low-income youth requiring additional assistance to enter or complete an educational program or to secure or hold employment; or
(VII)
living in a community that has faced acute or long-term exposure to substantial discrimination, historical oppression, intergenerational poverty, civil unrest, or a high rate of violence or drug overdose deaths, as determined by the Secretary;
(ii)
furnished by a qualified mental health provider; and
(iii)
a priority service.
(D) Telehealth
The term telehealth means use of electronic information and telecommunications technologies, including voice only audio, text, remote patient monitoring, and mHealth through applications, to support clinical mental health care, patient and professional health-related education, public health, and health administration.
(3) Payments
Notwithstanding section 1905(b), beginning January 1, 2027, during each of the first 20 fiscal quarters that a State meets the requirements described in paragraph (4), the Federal medical assistance percentage applicable to amounts expended by the State for medical assistance for qualifying youth and young adult mental health and substance use intervention services furnished during such quarter shall be equal to 100 percent.
(4) Requirements
The requirements described in this paragraph are the following:
(A)
The State demonstrates, to the satisfaction of the Secretary, that the State will be able to support—
(i)
the provision of qualifying youth and young adult mental health and substance use intervention services in accordance with paragraph (1); and
(ii)
coordination between qualified mental health providers and substance use teams and community partners, including health care providers, to enable the provision of services, needed referrals, and other activities identified by the Secretary.
(B)
The State provides assurances satisfactory to the Secretary that—
(i)
any additional Federal funds received by the State for qualifying youth and young adult mental health and substance use intervention services provided under this subsection that are attributable to the increased Federal medical assistance percentage under paragraph (3) will be used to supplement, and not supplant, the level of State funds expended for such services for fiscal year 2027;
(ii)
if the State made qualifying youth and young adult mental health and substance use intervention services available in a region of the State in fiscal year 2026 the State will continue to make such services available in such region under this subsection at the same level that the State made such services available in such fiscal year; and
(iii)
the State will conduct the evaluation and assessment, and submit the report, required under paragraph (5).
(5) State evaluation and report
(A) State evaluation
Not later than 4 fiscal quarters after a State begins providing qualifying youth and young adult mental health and substance use intervention services in accordance with this subsection, the State shall enter into a contract with an independent entity or organization to conduct an evaluation for the purposes of—
(i)
determining the effect of the provision of such services on—
(I)
emergency room visits;
(II)
use of ambulatory services;
(III)
hospitalizations;
(IV)
the involvement of law enforcement in mental health or substance use disorder crisis events; and
(V)
the diversion of individuals from jails or similar settings; and
(ii)
assessing—
(I)
the types of services provided to individuals;
(II)
the types of events to which such services responded;
(III)
cost savings or cost-effectiveness attributable to such services;
(IV)
the experiences of individuals who receive such services;
(V)
the successful connection of individuals with follow-up services; and
(VI)
other relevant outcomes identified by the Secretary.
(B) Comparison to historical measures
The contract described in subparagraph (A) shall specify that the evaluation conducted under such contract is based on a comparison of the historical measures of State performance with respect to the outcomes specified under such subparagraph to the State’s performance with respect to such outcomes during the period beginning with the first quarter in which the State begins providing qualifying youth and young adult mental health and substance use intervention services in accordance with this subsection.
(C) Report
Not later than 2 years after a State begins to provide qualifying youth and young adult mental health and substance use intervention services in accordance with this subsection, the State shall submit a report to the Secretary on the following:
(i)
The results of the evaluation conducted under subparagraph (A).
(ii)
The number of individuals who received qualifying youth and young adult mental health and substance use intervention services.
(iii)
Demographic information regarding such individuals when available, including the race and ethnicity, age, sex, sexual orientation, gender identity, and geographic location of such individuals.
(iv)
The processes and models developed by the State to provide qualifying youth and young adult mental health and substance use intervention services under the State plan or a waiver of such plan, including the processes developed to provide referrals for, or coordination with, follow-up care and services.
(v)
Lessons learned regarding the provision of such services.
(D) Public availability
The State shall make the report required under subparagraph (C) publicly available, including on the website of the appropriate State agency, upon submission of such report to the Secretary.
(6) Best practices report
(A) In general
Not later than 3 years after the first State begins to provide qualifying youth and young adult mental health and substance use intervention services in accordance with this subsection, the Secretary shall submit a report to Congress that—
(i)
identifies the States that elected to provide such services in accordance with this subsection;
(ii)
summarizes the information reported by such States under paragraph (5)(C); and
(iii)
identifies best practices for the effective delivery of youth and young adult mental health and substance use intervention services.
(B) Public availability
The report required under subparagraph (A) shall be made publicly available, including on the website of the Department of Health and Human Services, upon submission to Congress.
(7) Nondiscrimination
(A) Federally funded activities
(i)
For the purpose of applying the prohibitions against discrimination on the basis of age under the Age Discrimination Act of 1975, on the basis of handicap under section 504 of the Rehabilitation Act of 1973, on the basis of sex under title IX of the Education Amendments of 1972, or on the basis of race, color, or national origin under title VI of the Civil Rights Act of 1964, programs and activities funded in whole or in part with funds made available under this subsection are considered to be programs and activities receiving Federal financial assistance.
(ii)
No person shall on the ground of sex or religion be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity funded in whole or in part with funds made available under this subsection.
(B) Compliance
(i) In general
Whenever the Secretary finds that a State, or an entity that has received a payment from an allotment to a State for medical assistance for qualifying youth and young adult mental health and substance use intervention services furnished under this subsection, has failed to comply with a provision of law referred to in subparagraph (A)(i), with subparagraph (A)(ii), or with an applicable regulation (including one prescribed to carry out subparagraph (A)(ii)), the Secretary shall notify the chief executive officer of the State and shall request such chief executive officer to secure compliance.
(ii) Failure or refusal to secure compliance
If the chief executive officer of a State fails or refuses to secure compliance within a reasonable period of time, not to exceed 60 days, as requested under clause (i), the Secretary may—
(I)
refer the matter to the Attorney General with a recommendation that an appropriate civil action be instituted;
(II)
exercise the powers and functions provided by title VI of the Civil Rights Act of 1964, the Age Discrimination Act of 1975, or section 504 of the Rehabilitation Act of 1973, as may be applicable; or
(III)
take such other action as may be provided by law.
(C) Authority of attorney general; civil actions
When a matter is referred to the Attorney General pursuant to subparagraph (B)(ii)(I), or whenever the Attorney General has reason to believe that an entity is engaged in a pattern or practice in violation of a provision of law referred to in clause (i) or (ii) of subparagraph (A), the Attorney General may bring a civil action in any appropriate district court of the United States for such relief as may be appropriate, including injunctive relief.
Sec. 6405. Early intervention and prevention programs for transition-age youth
(a) In general
Section 1912(b)(1) of the Public Health Service Act (42 U.S.C. 300x–1(b)(1)) is amended—
(1)
by redesignating subparagraph (E) as subparagraph (F); and
(2)
by inserting after subparagraph (D) the following:
(E) Early intervention and prevention programs for transition-age youth
The plan shall describe the State’s plans to carry out demonstration grants or contracts for early intervention and prevention programs for transition-age youth of 16 to 25 years of age who meet one or more of the criteria specified in section 129(a)(1)(B) of the Workforce Innovation and Opportunity Act to be considered out-of-school youth.
(b) Set-Aside
Section 1920 of the Public Health Service Act (42 U.S.C. 300x–9) is amended by adding at the end the following:
(e) Early intervention and prevention programs for transition-Age youth
(1) In general
Except as provided in paragraph (2), a State shall expend at least 15 percent of the amount of the allotment of the State pursuant to a funding agreement under section 1911 for each fiscal year to support programs described in section 1912(b)(1)(E).
(2) State flexibility
In lieu of expending 15 percent of the amount of the allotment for a fiscal year as required by paragraph (1), a State may elect to expend not less than 30 percent of such amount to support such programs by the end of two consecutive fiscal years.
Sec. 6406. Strategies to increase access to telehealth under Medicaid and the Children’s Health Insurance Program
(a) Guidance
(1) In general
Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall issue and disseminate guidance to States to clarify strategies to overcome existing barriers and increase access to telehealth under the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) and the Children’s Health Insurance Program under title XXI of such Act (42 U.S.C. 1397aa et seq.).
(2) Contents
The guidance described in paragraph (1) shall include technical assistance and best practices regarding—
(A)
telehealth delivery of services furnished under such programs;
(B)
recommended voluntary billing codes, modifiers, and place-of-service designations for telehealth and other virtual health care services;
(C)
the simplification or alignment (including through reciprocity) of provider licensing, credentialing, and enrollment protocols with respect to telehealth across States, State Medicaid plans under such title XIX, and Medicaid managed care organizations, including during national public health emergencies;
(D)
existing strategies States can use to integrate telehealth and other virtual health care services into value-based health care models; and
(E)
examples of States that have used waivers under the Medicaid program to test expanded access to telehealth, including during the emergency period described in section 1135(g)(1)(B) of the Social Security Act (42 U.S.C. 1320b–5(g)(1)(B)).
(b) Studies and reports to Congress
(1) Telehealth impact on health care access
(A) In general
Not later than 1 year after the date of the enactment of this Act, the Medicaid and CHIP Payment and Access Commission shall conduct a study, and submit to Congress a report, on the impact of telehealth on health care access, utilization, cost, and outcomes, broken down by race, ethnicity, sex, age, disability status, and ZIP Code, with respect to a minimum of 10 States across geographic regions of the United States.
(B) Report contents
The report required under subparagraph (A) shall—
(i)
evaluate cost, access, utilization, outcomes, and patient experience data from across the health care field, including States, Medicaid managed care organizations, provider organizations, and other organizations that provide or pay for telehealth under the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) and the Children’s Health Insurance Program under title XXI of such Act (42 U.S.C. 1397aa et seq.);
(ii)
identify barriers and potential solutions to provider entry and participation in telehealth that States are experiencing, as well as barriers to providing telehealth across State lines, including during times of public health crisis or public health emergency;
(iii)
determine the frequency at which out-of-State telehealth is provided to patients enrolled in the Medicaid program under such title XIX and the potential impact on access to telehealth if State Medicaid policies were more aligned; and
(iv)
identify and evaluate opportunities for more alignment among such policies to promote access to telehealth across all States, State Medicaid plans under such title XIX, State child health plans under such title XXI, and Medicaid managed care organizations, including the potential for regional compacts or reciprocity agreements.
(2) Federal agency telehealth collaboration
(A) In general
Not later than 1 year after the date of the enactment of this Act, the Comptroller General of the United States shall conduct a study, and submit to Congress a report, evaluating collaboration between Federal agencies with respect to telehealth services furnished under the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) or the Children's Health Insurance Program under title XXI of such Act (42 U.S.C. 1397aa et seq.) to individuals under the age of 18, including such services furnished to such individuals in early care and education settings.
(B) Report contents
The report required under subparagraph (A) shall include recommendations on—
(i)
opportunities for Federal agencies to improve collaboration with respect to the telehealth services described in such subparagraph; and
(ii)
opportunities for collaboration between Federal agencies to expand telehealth access to individuals under the age of 18 that are enrolled in the programs described in such subparagraph, including in early care and education settings.
Sec. 6407. Youth and young adult mental health promotion, prevention, intervention, and treatment
Part Q of title III of the Public Health Service Act (as amended by section 5001) is amended by adding at the end the following:
399Z–4. Youth and young adult mental health promotion, prevention, intervention, and treatment
(a) Grants
The Secretary shall—
(1)
award grants to eligible entities to develop, maintain, or enhance youth and young adult mental health promotion, prevention, intervention, and treatment programs, including—
(A)
programs for youth and young adults who may be likely to develop, are showing early signs of, or have been diagnosed with a mental health condition, including a serious emotional disturbance; and
(B)
infrastructure and organization change at a State, tribal, or territorial level to improve cross-system collaboration, service capacity, and expertise related to youth and young adults; and
(2)
ensure that programs funded through grants under this section use community-driven, evidence-informed, or evidence-based models, practices, and methods that are, as appropriate, culturally and linguistically appropriate, and can be replicated in other appropriate settings.
(b) Eligible transition age youth and entities
In this section:
(1) Eligible entity
The term eligible entity means—
(A)
a local educational agency;
(B)
a State educational agency;
(C)
an institution of higher education (or consortium of such institutions), which may include a recovery program at an institution of higher education;
(D)
a local board, or a one-stop operator, as defined in section 3 of the Workforce Innovation and Opportunity Act;
(E)
a nonprofit organization with appropriate expertise in providing services or programs for children, adolescents, or young adults, excluding a school;
(F)
a State, political subdivision of a State, Indian tribe, or tribal organization; or
(G)
a high school or dormitory serving high school students that receives funding from the Bureau of Indian Education.
(2) Eligible transition age youth
The term eligible transition age youth means a youth or young adult from age 16 to not more than 25 years of age who is—
(A)
an out-of-school youth as defined in section 129(a)(1)(B) of the Workforce Innovation and Opportunity Act;
(B)
a homeless individual (as defined in section 41403(6) of the Violence Against Women Act of 1994), a homeless child or youth (as defined in section 725(2) of the McKinney-Vento Homeless Assistance Act) a runaway, in foster care or has aged out of the foster care system, a child eligible for assistance under section 477 of the Social Security Act, or in an out-of-home placement;
(C)
an individual who is pregnant or parenting, as referred to in section 129(a)(1)(B) of the Workforce Innovation and Opportunity Act;
(D)
a youth who is an individual with a disability, as referred to in section 129(a)(1)(B) of the Workforce Innovation and Opportunity Act;
(E)
a low-income individual who requires additional assistance to enter or complete an educational program or to secure or hold employment, as referred to in section 129(a)(1)(B) of the Workforce Innovation and Opportunity Act; or
(F)
living in a community that has faced acute or long-term exposure to substantial discrimination, historical oppression, intergenerational poverty, civil unrest, a high rate of violence, or drug overdose deaths.
(c) Application
An eligible entity seeking a grant under subsection (a) shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(d) Use of funds for mental health promotion, prevention, intervention and treatment programs
An eligible entity may use amounts awarded under a grant under subsection (a)(1) to carry out the following:
(1)
Creation, implementation, and expansion of services and supports that are culturally and linguistically appropriate and youth guided, involve and include family and community members (including business leaders and faith-based organizations), and provide for continuity of care between child- and adult-serving systems to ensure seamless transition.
(2)
Infrastructure and organization change at a State, Tribal, or territorial level to improve cross-system collaboration, service capacity, and expertise related to youth and young adults with, or at risk of, mental health conditions and substance use disorders as they transition into adult roles and responsibilities.
(3)
Public awareness and cross-system provider training for individuals employed at institutions of higher education and community colleges, behavioral health providers, individuals working in the criminal justice system, primary care providers, vocational service providers, and child welfare workers.
(e) Matching funds
The Secretary may not award a grant under this section to an eligible entity unless the eligible entity agrees, with respect to the costs to be incurred by the eligible entity in carrying out the activities described in subsection (d), to make available non-Federal contributions (in cash or in kind) toward such costs in an amount that is not less than 10 percent of the total amount of Federal funds provided in the grant.
(f) Authorization of appropriations
To carry out this section, there are authorized to be appropriated $25,000,000 for each of fiscal years 2027 through 2036.
Subtitle E Community-Based care
Sec. 6501. Asian American, African American, Native Hawaiian, Pacific Islander, Indigenous, Middle Eastern and North African, and Hispanic and Latino behavioral health outreach and education strategy
Part D of title V of the Public Health Service Act (42 U.S.C. 290dd et seq.), as amended by section 6203, is amended by adding at the end the following:
556. Behavioral outreach and education strategy
(a) In general
The Secretary, acting through the Assistant Secretary for Mental Health and Substance Use, shall, in coordination with advocacy and behavioral organizations serving populations of Asian American, African American, Native Hawaiian, Pacific Islander, Indigenous, Middle Eastern and North African (in this section referred to as
MENA), and Hispanic and Latino/a/x individuals or communities, develop and implement an outreach and education strategy to promote behavioral health, emphasize that behavioral health conditions are treatable and that reasonable accommodations under section 504 of the Rehabilitation Act of 1973 and titles II and III of the Americans with Disabilities Act of 1990 are necessary and may help, as well as reduce stigma associated with mental health conditions and substance use disorder among the Asian American, African American, Native Hawaiian, Pacific Islander, Indigenous, MENA, and Hispanic and Latino/a/x populations. Such strategy shall—(1)
be designed to—
(A)
meet the diverse cultural and language needs of the various Asian American, African American, Indigenous, MENA, Native Hawaiian, Pacific Islander, and Hispanic and Latino/a/x populations; and
(B)
ensure that approaches recommended in the strategy are developmentally (with respect to the beneficiary’s relative age and experience) and age appropriate, as well as cognitively accessible to persons with cognitive disabilities;
(2)
increase awareness of symptoms of mental illnesses common among such populations, taking into account differences within subgroups (such as gender, gender identity, age, sexual orientation, disability, and ethnicity) of such populations;
(3)
provide information on evidence-based, culturally and linguistically appropriate and adapted interventions and treatments;
(4)
ensure full participation of, and engage, both consumers and community members representing the communities of focus in the development and implementation of materials; and
(5)
seek to broaden the perspective among both individuals in such communities and stakeholders serving such communities to use a comprehensive public health approach to promoting behavioral health that addresses a holistic view of health by focusing on the intersection between behavioral and physical health.
(b) Reports
Beginning not later than 1 year after the date of the enactment of this section and annually thereafter, the Secretary, acting through the Assistant Secretary, shall submit to the Congress, and make publicly available, a report on the extent to which the strategy developed and implemented under subsection (a) increased behavioral health outcomes associated with mental health conditions and substance use disorder among Asian American, African American, Native Hawaiian, Pacific Islander, Indigenous, MENA, and Hispanic and Latino/a/x populations.
(c) Authorization of appropriations
There is authorized to be appropriated to carry out this section $15,000,000 for each of fiscal years 2027 through 2032.
Subtitle F Reports
Sec. 6601. Addressing racial and ethnic minority mental health disparities research gaps
Not later than 9 months after the date of the enactment of this Act, the Director of the National Institutes of Health, in consultation with the Director of the National Institute of Mental Health and the Assistant Secretary of Substance Use and Mental Health, shall enter into an arrangement with the National Academies of Sciences, Engineering, and Medicine (or, if the National Academies of Sciences, Engineering, and Medicine decline to enter into such an arrangement, the Patient-Centered Outcomes Research Institute, the Agency for Healthcare Research and Quality, or another appropriate entity)—
(1)
to conduct a study with respect to mental health disparities research gaps in racial and ethnic minority groups (as defined in section 1707(g) of the Public Health Service Act (42 U.S.C. 300u–6(g))); and
(2)
to submit to the Congress a report on the results of such study, including—
(A)
a compilation of information on the prevalence of mental health outcomes in such racial and ethnic minority groups; and
(B)
an assessment of information on the impact of exposure to community violence, adverse childhood experiences, structural bias, and other psychological traumas on mental health outcomes in such racial and minority groups.
Sec. 6602. Research on adverse health effects associated with interactions with law enforcement
(a) In general
The Secretary of Health and Human Services, acting through the Director of the Office of Minority Health of the Centers for Disease Control and Prevention (established pursuant to section 1707A of the Public Health Service Act (42 U.S.C. 300u–6a)) (in this section referred to as the Secretary
), shall conduct research on the adverse health effects associated with interactions with law enforcement.
(b) Effects among racial and ethnic minorities
The research under subsection (a) shall include research on—
(1)
the health consequences, both individual and community-wide, of trauma related to violence committed by law enforcement among racial and ethnic minorities; and
(2)
the disproportionate burden of morbidity and mortality associated with such trauma.
(c) Report
Not later than 1 year after the date of enactment of this Act, the Secretary shall—
(1)
complete the research under this section; and
(2)
submit to the Congress a report on the findings, conclusions, and recommendations resulting from such research.
Sec. 6603. GeoAccess study
Not later than 180 days after the date of enactment of this Act, the Assistant Secretary for Mental Health and Substance Use shall—
(1)
conduct a study to—
(A)
determine which geographic areas of the United States have shortages of racially and ethnically diverse mental health providers, as well as mental health providers trained to work with racially and ethnically diverse clients and clients with multiple mental health, cognitive, and developmental disabilities; and
(B)
assess the preparedness of mental health providers to deliver culturally and linguistically appropriate, affordable, and accessible services; and
(2)
submit a report to Congress on the results of such study.
Sec. 6604. Co-occurring conditions
(a) GAO report
Not later than 2 years after the date of enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on barriers to care for persons with co-occurring conditions and access to care in the United States. Such report shall include the information and recommendations described in subsection (b).
(b) Content of report
The report under subsection (a) shall include—
(1)
an assessment of current barriers to behavioral health and substance use disorder treatment for low-income, uninsured, and Medicaid-enrolled adults, and recommendations for addressing such barriers, particularly for women and diverse racial and ethnic groups;
(2)
an assessment of—
(A)
how many adults have a behavioral health condition and options for adults to receive behavioral health and substance use disorder treatment in nonexpansion States;
(B)
Medicaid expansion States who provide behavioral health coverage for newly eligible enrollees;
(C)
how enrollment in coverage affects treatment availability; and
(D)
the impacts of COVID–19 to receiving and accessing treatment for behavioral health, substance use disorders, and diverse racial and ethnic groups, and recommendations for addressing such barriers;
(3)
an assessment of current barriers, inclusive of social determinants of health and cultural barriers, that prevent adults from receiving behavioral health and substance use disorder treatment, and recommendations for addressing such barriers, particularly for low-income women and adults from racial and ethnic groups;
(4)
an assessment of disparities in access to addiction counselors and mental or behavioral health care providers acting in accordance with State law, stratified by race, ethnicity, gender identity, geographic location, and insurance type, and recommendations to promote greater access equity; and
(5)
recommendations to promote greater equity in access to care for behavioral services and substance use disorders, particularly for low-income women and adults from diverse racial and ethnic groups.
Sec. 6605. Study and report on the AANHPI youth mental health crisis
(a) Study
(1) In general
The Secretary, acting through the Assistant Secretary for Mental Health and Substance Use (referred to in this section as the Secretary), in coordination with the Director of the National Institutes of Health, the Director of the Centers for Disease Control and Prevention, and the Director of the Office of Minority Health, shall conduct a study on behavioral health among AANHPI youth.
(2) Elements
Such study required under paragraph (1) shall include an assessment of—
(A)
the prevalence, risk factors, and root causes of mental health challenges, substance misuse, and mental health and substance use disorders among AANHPI youth;
(B)
the prevalence among AANHPI youth of attempted suicide, nonfatal substance use overdose, and death by suicide or substance use overdose; and
(C)
AANHPI youth that received treatment for mental health and substance use disorders.
(b) Report
Not later than 1 year after the date of the enactment of this Act, the Secretary shall 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, and make publicly available, a report on the findings of the study conducted under subsection (a), including—
(1)
identification of the barriers to accessing behavioral health services for AANHPI youth;
(2)
identification of root causes of mental health challenges and substance misuse among AANHPI youth;
(3)
recommendations for actions to be taken by the Secretary to improve behavioral health among AANHPI youth;
(4)
recommendations for legislative or administrative action to improve the behavioral health of AANHPI youth experiencing depression, suicide, and overdose, and to reduce the prevalence of depression, suicide, and overdose among AANHPI youth; and
(5)
such other recommendations as the Secretary determines appropriate.
(c) Data
Any data included in the study or report under this section shall be disaggregated by race, ethnicity, age, sex, gender identity, sexual orientation, geographic region, disability status, and other relevant factors, in a manner that protects personal privacy and that is consistent with applicable Federal and State privacy law.
(d) Authorization of appropriations
For purposes of carrying out this section, there is authorized to be appropriated $1,500,000 for fiscal year 2027.
Sec. 6606. Study and report on strategies on the AANHPI behavioral health workforce shortage
(a) Study
(1) In general
The Secretary, acting through the Assistant Secretary for Mental Health and Substance Use (referred to in this section as the Secretary), in coordination with the Administrator of the Health Resources and Services Administration, the Secretary of Labor, and the Director of the Office of Minority Health, shall conduct a study on strategies for increasing the behavioral health professional workforce that identify as AANHPI.
(2) Elements
Such study required under paragraph (1) shall consider—
(A)
the total number of licensed behavioral health providers in the United States who identify as AANHPI;
(B)
with respect to each such provider, information regarding the current type of license, geographic area of practice, and type of employer (such as hospital, Federally qualified health center, school, or private practice);
(C)
information regarding the cultural and linguistic capabilities of such providers, including languages spoken proficiently; and
(D)
the relevant barriers to enrollment in behavioral health professional education programs and entering the behavioral workforce for AANHPI individuals.
(b) Report
Not later than 1 year after the date of the enactment of this Act, the Secretary shall 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, and make publicly available, a report on the findings of the study conducted under subsection (a), including—
(1)
identification of AANHPI licensed behavioral health providers’ knowledge and awareness of the barriers to quality behavioral health care services faced by AANHPI individuals, including stigma, limited English proficiency, and lack of health insurance coverage;
(2)
recommendations for actions to be taken by the Secretary to increase the number of AANHPI licensed behavioral health professionals;
(3)
recommendations for legislative or administrative action to improve the enrollment of AANHPI individuals in behavioral health professional education programs; and
(4)
such other recommendations as the Secretary determines appropriate.
(c) Data
Any data included in the study or report under this section shall be disaggregated by race, ethnicity, age, sex, gender identity, sexual orientation, geographic region, disability status, and other relevant factors, in a manner that protects personal privacy and that is consistent with applicable Federal and State privacy law.
(d) Definition
In this section the term licensed behavioral health provider means any individual licensed to provide mental health or substance use disorder services, including in the professions of social work, psychology, psychiatry, marriage and family therapy, mental health counseling, and substance use disorder counseling.
(e) Authorization of appropriations
For purposes of carrying out this section, there is authorized to be appropriated $1,500,000 for fiscal year 2027.
Subtitle G Miscellaneous provisions
Sec. 6701. Strengthening mental health supports for BIPOC communities
(a) In general
Section 1942(a) of the Public Health Service Act (42 U.S.C. 300x–52(a)) is amended—
(1)
by redesignating paragraphs (2) and (3) as paragraphs (5) and (6), respectively; and
(2)
by inserting after paragraph (1) the following:
(2)
services provided by the State to adults with a serious mental illness and children with a serious emotional disturbance who are members of racial and ethnic minority groups, including—
(A)
the extent to which such services are provided to such adults and children; and
(B)
the outcomes experienced by such adults and children as a result of the provision of such services, including with respect to—
(i)
diversions from hospitalization and criminal justice system involvement;
(ii)
treatment for first episode psychosis or undefined psychosis;
(iii)
reductions in suicide and increased utilization of appropriate treatments and interventions for suicidal ideation;
(iv)
response through crisis services, including mobile crisis services;
(v)
treatment of individuals who are experiencing homelessness or housing insecurity and individuals residing in rural communities; and
(vi)
increased patient family and caregiver engagement and education on serious mental illness to reduce social stigma and promote healthy social support for patients;
(3)
any outreach by the State to, and the hiring of, providers of mental health services from multiple disciplines (such as a psychologist, psychiatrist, peer support provider, or social worker) who are members of racial and ethnic minority groups;
(4)
any outreach by the State to providers from multiple disciplines of mental health services—
(A)
to provide training on culturally effective, culturally affirming, and linguistically competent services; and
(B)
to increase awareness of community-defined practices by practitioners of racial and ethnic minority groups;
(b) Applicability
The amendments made by subsection (a) shall apply with respect to funding agreements entered into under section 1911 or 1921 of the Public Health Service Act (42 U.S.C. 300x; 42 U.S.C. 300x–21) on or after the date of the enactment of this Act.
Sec. 6702. STRONG support for children
(a) Data analysis and strategy implementation To prevent and mitigate childhood trauma
Title XXXI of the Public Health Service Act (42 U.S.C. 300kk) is amended by adding at the end the following:
3102. Data analysis and strategy implementation to prevent and mitigate childhood trauma
(a) In general
The Secretary shall establish a program—
(1)
to support the development and implementation of programs that use data analysis methods to identify and facilitate strategies for early intervention and prevention, in order to prevent and mitigate childhood trauma and support communities and families, including—
(A)
improving connections through care coordination;
(B)
aligning community initiatives in targeted areas of need; and
(C)
expanding community capacity through cross-sector collaboration; and
(2)
to evaluate the effectiveness of these programs in improving outcomes for children.
(b) Grants
The Secretary shall award grants to up to 5 eligible entities to carry out the activities described in subsection (a).
(c) Use of funds
A grant for activities under this section shall be used to support the development and implementation of programs that use data analysis methods to identify and facilitate strategies for early intervention and prevention, in order to prevent and mitigate childhood trauma and support communities and families, including as follows:
(1)
Utilize data analysis methods to—
(A)
identify specific geographic areas, such as census tracts, with a high prevalence of adverse childhood experiences and significant risk factors for poor outcomes for children (such as increased risk of experiencing adverse childhood experiences), including areas with high rates of—
(i)
poor public health outcomes including illness, disease, suicide, and mortality;
(ii)
exclusionary discipline practices, including suspensions, expulsions, and referrals to law enforcement, as well as low graduation rates;
(iii)
substance use disorders;
(iv)
poverty;
(v)
foster system involvement or referrals;
(vi)
housing instability and homelessness;
(vii)
food insecurity;
(viii)
inequity, including disparities in income, wealth, employment, educational attainment, health care access, and public health outcomes, along lines of race, sex, sexuality and gender identity, ethnicity, or nationality;
(ix)
incarceration rates; or
(x)
other indicators of adversity as defined by the Secretary; and
(B)
identify strategies to improve outcomes for children aged 0 through 17 that build on strengths in communities that could be further supported, including—
(i)
existing support networks for families; and
(ii)
enhanced connections to community-based organizations.
(2)
Implement strategies identified pursuant to paragraph (1)(B) to facilitate outreach and involvement of children and their caregivers in Federal, State, or local programs that provide reparative, gender-responsive, culturally specific, and trauma-informed prevention services, and for which children and their caregivers are eligible, including—
(A)
home visiting programs;
(B)
training and education on parenting skills;
(C)
substance use disorder prevention and treatment that is voluntary and noncoercive;
(D)
mental health supports and care that is voluntary and noncoercive;
(E)
family and intimate partner violence prevention services;
(F)
child advocacy center programming;
(G)
economic and nutrition support services;
(H)
housing support services, including emergency and temporary shelter for those experiencing homelessness and housing insecurity, as well as stable, long-term housing;
(I)
voluntary, noncoercive, gender-responsive, and culturally specific mental health supports in school and early childhood education center-based settings;
(J)
wraparound programs for transitioning youth and youth currently in the foster system;
(K)
programming to support the health and well-being of lesbian, gay, bisexual, transgender, and intersex children and their families; and
(L)
family resource center services.
(d) Special rules
(1) Primary payer restriction
The Secretary may not award a grant under this section to an eligible entity for a service if the service to be provided is available pursuant to the State plan approved under title XIX of the Social Security Act for the State in which the program funded by the grant is being conducted unless the State and all eligible subdivisions involved—
(A)
will enter into agreements with public or nonprofit private entities under which the entities will provide the service; and
(B)
demonstrate that the State and all eligible subdivisions will ensure that the entities providing the service—
(i)
will seek payment for each such service rendered in accordance with the usual payment schedule under the State plan; and
(ii)
the entities have entered into a participation agreement and are qualified to receive payments under such plan.
(2) Implementation
An eligible entity that receives a grant under this section may use—
(A)
not more than 25 percent of the amounts made available through the grant for the first 24 months of the grant period to utilize data analysis methods to—
(i)
identify specific geographic areas where care coordination, prevention and early intervention, and facilitation services will be provided; and
(ii)
identify support and intervention services to improve outcomes for children located in a geographic area identified under subsection (c)(1)(A); and
(B)
not more than 10 percent of the grant in each subsequent year to continue data analysis activities.
(3) Administration
An eligible entity that receives a grant under this section may not use more than 5 percent of amounts received through the grant for administration, reporting, and program oversight functions, including the development of systems to improve data collection and data sharing for the purposes of improving services and the provision of care.
(4) Priority
(A) In general
In awarding grants under this section, the Secretary shall give priority, to the extent practical, to eligible entities that use community-based system dynamic modeling as the primary data analysis method.
(B) System dynamic modeling defined
The term system dynamic modeling means a method of data analysis and predictive modeling that includes—
(i)
utilization of community-based participatory research methods for involving community in the process of understanding and changing systems and evaluating outcomes of grants;
(ii)
consideration of a multitude of environmental risk factors and ascertainment of the significance of contributing community risk factors for purposes of identifying strategies to reduce adverse child outcomes, including—
(I)
maltreatment cases;
(II)
involvement with the juvenile criminal legal system or foster system;
(III)
exclusionary school discipline; or
(IV)
exposure to violence; and
(iii)
identification of cross-sector responses involving reparative, trauma-informed, culturally specific, gender-responsive, and community-based organizations to reduce adverse child outcomes.
(5) Subgrant
(A) In general
An eligible entity that receives a grant under this section shall use at least 25 percent of the total amount of the grant to make subgrants to organizations that aid in implementing the strategy identified under subsection (c)(1)(B) for preventing and mitigating childhood trauma and supporting communities and families.
(B) Eligibility
To be eligible to receive a subgrant under this paragraph, an organization shall prepare and submit to the eligible entity an application in such form, and containing such information, as the eligible entity may require, including evidence that the—
(i)
needs of the population to be served are urgent and are not met by the services currently available in the geographic area; and
(ii)
organization has the capacity to provide the services listed in subsection (c)(2).
(C) Supplement, not supplant
Subgrant funds received pursuant to this paragraph by an organization shall be used to supplement and not supplant State or local funds provided to the partnership organization for services listed in subsection (c)(2).
(e) Application
To be eligible to receive a grant under this section, an eligible entity shall submit to the Secretary an application in such form, and containing such information, as the Secretary may require, to include the following:
(1)
A demonstration that—
(A)
the applicant utilizes trauma-informed, culturally specific, and gender-responsive practices, including a demonstration of the extent to which the applicant has trained staff in these practices;
(B)
the applicant has the capacity to administer the grant, including conducting all required data analysis activities; and
(C)
services will be provided to children and families in an accessible, culturally relevant, and linguistically specific manner consistent with local needs.
(2)
A preliminary analysis of how the applicant will use the grant to—
(A)
identify the geographic area or areas to be served using data analysis methods;
(B)
utilize data analysis methods to identify strategies to improve outcomes for children in the geographic area;
(C)
facilitate strategies identified through care coordination efforts; and
(D)
track data for evaluation of outcomes.
(3)
A detailed project plan for the use of the grant that includes anticipated technical assistance needs.
(4)
Additional funding sources, including State and local funds, supporting the prevention and mitigation of adverse childhood experiences.
(f) Grant amount
The amount of a grant under this section shall not exceed $9,500,000.
(g) Period of a grant
The period of a grant under this section shall not exceed 7 years.
(h) Service provision without regard to ability To pay
As a condition on receipt of a grant under this section, an eligible entity shall agree that any assistance provided to an individual through the grant will be provided without regard to—
(1)
the ability of the individual to pay for such services;
(2)
the current or past health condition of the individual to be served;
(3)
the immigration status of the individual to be served;
(4)
the sexual orientation and gender identity of the individual to be served; and
(5)
any prior involvement of the individual in the criminal legal system.
(i) Prohibitions
In addition to any other prohibitions determined by the Secretary, an eligible entity may not use a grant under this section to—
(1)
use data analysis methods to inform individual case decisions, including child removal or placement decisions, or to target services at certain individuals or families;
(2)
require any individual or family to participate in any service or program as a condition of receipt of a benefit to which the individual or family is otherwise eligible;
(3)
increase the presence or funding of law enforcement surveillance, involvement, or activity in implementing the strategies identified under subsection (c)(1)(B); or
(4)
enable the practice of conversion therapy.
(j) Evaluation
(1) Data model evaluation
Not later than 36 months after the date of enactment of this section, the Assistant Secretary for Planning and Evaluation of the Department of Health and Human Services, in coordination with the grantees receiving a grant under this section, shall complete an evaluation of the effectiveness of the data model accuracy of the grant program under this section to address each of the following:
(A)
Determining the effectiveness of the grantees’ use of data analysis methods to identify geographic areas pursuant to subsection (c)(1).
(B)
Examining the grantees’ development and utilization of data analysis methods.
(C)
Examining the grantees’ ability to effectively utilize data analysis methods in future prevention work.
(D)
Establishing a method for rigorously evaluating the activities of grantees and comparing the reduction of child and family exposure to adverse experiences in other communities with similar demographics.
(E)
Examining the grantees’ utilization of community-based system dynamics modeling methods and other community engagement methods.
(2) Program evaluation
Not later than 6 years after the date of enactment of this section, the Assistant Secretary for Planning and Evaluation of the Department of Health and Human Services, in coordination with eligible entities receiving grants under this section, shall complete an evaluation of the effectiveness of the grant program under this section.
(3) Data Collection
(A) In general
The Assistant Secretary for Planning and Evaluation of the Department of Health and Human Services and each eligible entity receiving a grant under this section shall collect any relevant data necessary to complete the evaluations required by paragraphs (1) and (2) to include—
(i)
the activities funded by the grant under this section, including development and implementation data analysis methods;
(ii)
the number of children and of families receiving coordination and facilitation of care and services; and
(iii)
the effect of activities supported by the grant under this section on the local area serviced by the program, including such effects on—
(I)
children and adolescents’ health and well-being;
(II)
the number of children who enter into or depart from foster services; and
(III)
homelessness and housing insecurity.
(B) Study
(i) In general
Not later than 7 years after the date of enactment of this section, the Assistant Secretary for Planning and Evaluation of the Department of Health and Human Services shall—
(I)
complete a study on the results of the grant program under this section using the community-based participatory action research method, which focuses on social, structural, and physical environmental inequities through active involvement of community members, clients, organizational representatives, and researchers in all aspects of the research process; and
(II)
submit a report on the results of the study to the Congress.
(ii) Partners
In conducting the study under clause (i), the Assistant Secretary for Planning and Evaluation of the Department of Health and Human Services shall ensure that partners and persons that have participated in the grant program under this section on every level, especially those such partners or persons receiving services and support through the program, have an opportunity to contribute their expertise to evaluating the strategy and outcomes.
(k) Report
Not later than 3 months after the completion of the evaluation required by subsection (j)(2), the Assistant Secretary for Planning and Evaluation of the Department of Health and Human Services shall submit to Congress and make available to the public on the internet website of the Department of Health and Human Services a report based upon the evaluation under subsection (j)(2), to include—
(1)
the impact of the program under this section on homelessness and housing insecurity, substance use disorder and drug deaths, incarceration, foster system involvement, and other child and family outcomes as identified by the Assistant Secretary for Planning and Evaluation of the Department of Health and Human Services;
(2)
an analysis of which elements of the program should be replicated and scaled by governmental or non-governmental entities; and
(3)
such recommendations for legislation and administrative action as the Secretary determines appropriate.
(l) Definitions
In this section:
(1)
The term adverse childhood experience means a potentially traumatic experience that occurs in childhood and can have a tremendous impact on the child’s lifelong health and opportunity outcomes, such as any of the following:
(A)
Abuse, such as any of the following:
(i)
Emotional and psychological abuse.
(ii)
Physical abuse.
(iii)
Sexual abuse.
(B)
Household challenges such as any of the following:
(i)
A household member is treated violently.
(ii)
A household member has a substance use disorder.
(iii)
A household member has a mental health condition.
(iv)
Parental separation or divorce.
(v)
A household member is incarcerated, is placed in immigrant detention, or has been deported.
(vi)
A household member has a life-threatening illness such as COVID–19.
(C)
Neglect.
(D)
Living in—
(i)
impoverished communities that lack access to human services;
(ii)
areas of high unemployment neighborhoods; or
(iii)
communities experiencing de facto segregation.
(E)
Experiencing food insecurity and poor nutrition.
(F)
Witnessing violence.
(G)
Involvement with the foster system.
(H)
Experiencing discrimination.
(I)
Dealing with historical and ongoing traumas due to systemic and interpersonal racism.
(J)
Dealing with historical and ongoing traumas regarding systemic and interpersonal sexism, homophobia, biphobia, and transphobia.
(K)
Dealing with the threat of deportation or detention as a result of immigration status.
(L)
The impacts of multigenerational poverty resulting from limited educational and economic opportunities.
(M)
Living through natural disasters such as earthquakes, forest fires, floods, or hurricanes.
(2)
The term eligible entity means a State or local health department.
(3)
The term practice of conversion therapy—
(A)
means any practice or treatment by any person that seeks to change another individual’s sexual orientation or gender identity, including efforts to change behaviors or gender expressions, or to eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same gender, if such person receives monetary compensation in exchange for any such practice or treatment; and
(B)
does not include any practice or treatment that does not seek to change sexual orientation or gender identity and—
(i)
provides assistance to an individual undergoing a gender transition; or
(ii)
provides acceptance, support, and understanding of a client or facilitation of a client’s coping, social support, and identity exploration and development.
(m) Authorization of appropriations
There is authorized to be appropriated to carry out this section for the period of fiscal years 2027 through 2033—
(1)
to carry out subsection (a)(1) through the award of grants under subsection (b)—
(A)
$47,500,000 for grants; and
(B)
such sums as may be necessary for the administrative costs of carrying out such subsection; and
(2)
$7,500,000 to carry out the evaluation under subsection (a)(2).
(b) Care coordination grants
Part E of title XII of the Public Health Service Act (42 U.S.C. 300d–51 et seq.) is amended by adding at the end the following new section:
1255. Care coordination grants
(a) In general
The Secretary shall award grants to eligible entities to establish or expand trauma-informed care coordination services to support—
(1)
children aged 0 through 5 at risk of adverse childhood experiences; and
(2)
their caregivers, including prenatal people of any age.
(b) Number of grants
Subject to the availability of appropriations, the Secretary shall award not fewer than 9 and not more than 40 grants under this section.
(c) Amount of grants
Subject to the availability of appropriations, the amount of a grant under this section for a fiscal year shall be—
(1)
not less than $250,000; and
(2)
not more than $1,000,000.
(d) Eligible entities
To be eligible to receive a grant under this section, an entity shall be a local government or Indian Tribe, acting through the public health department thereof if such government or Tribe has a public health department.
(e) Priority
(1) In general
In awarding grants under this section, the Secretary shall give priority to eligible entities proposing to serve communities with a high need for trauma-informed care coordination services, as demonstrated by indicators such as—
(A)
pregnant people who face barriers to prenatal care;
(B)
mortality or morbidity of people giving birth or infants;
(C)
caretakers and parents who are living with a mental health condition or substance use disorder;
(D)
a high prevalence of community violence, including domestic violence, as demonstrated by instances of homicide and public health statistics, including treatment of injury or trauma;
(E)
high proportions of low-income children;
(F)
a high prevalence of child fatalities or near fatalities related to child abuse and neglect;
(G)
significant disparities in health outcomes for people giving birth and infants;
(H)
a high rate of exclusionary discipline and referrals to law enforcement; and
(I)
a high rate of homelessness and housing instability.
(2) Data from Tribal areas
The Secretary, acting through the Director of the Indian Health Service, shall consult with Indian Tribes to establish criteria to measure indicators of need, for purposes of paragraph (1), with respect to Tribal areas.
(f) Use of funds
(1) Required uses
(A) In general
A grant received under this section shall be used to establish or expand gender-responsive, culturally specific, trauma-informed care coordination services, including by instituting and conducting risk and needs assessments including—
(i)
using strengths-based approaches focused on protective factors for children and their caregivers, including prenatal people of any age; and
(ii)
inputting screening results into a centralized intake system to promote a single point of access system across providers and services.
(B) Training
A grant received under this section shall be used to ensure that individuals employed through the grant funds, in whole or in part, have received sufficient and up-to-date training on trauma-informed care and strategies that are reparative, culturally sensitive, gender responsive, and healing centered.
(2) Permissible uses
A grant received under this section may be used for any of the following:
(A)
Employing care coordinators, case managers, community health workers, certified infant mental health specialists, and outreach and engagement specialists to work with children and their caregivers, including prenatal individuals, to prevent and respond to adverse childhood experiences by connecting clients with culturally specific, trauma-informed care treatment services, including economic, social, food, and housing supports.
(B)
Providing training described in paragraph (1)(B) to community health providers and community partners.
(C)
Expanding, enhancing, modifying, and connecting the existing network of community programs and services to achieve a more comprehensive and coordinated system of care approach, including—
(i)
developing local infrastructure to bolster and shape community support systems and map and build access to services in a coordinated and comprehensive way; and
(ii)
creating infrastructure to conduct outreach to children and families, including those experiencing homelessness and housing instability, so they acquire access to the services and supports they need and the benefits to which they are entitled.
(D)
Compiling information on resources (including any referral services) available through community-based organizations and local, State, and Federal agencies, such as—
(i)
programs addressing social determinants of health, including—
(I)
emergency, temporary, and long-term housing;
(II)
programs that offer free or affordable and nutritious food;
(III)
vocational and workforce development; and
(IV)
transportation supports;
(ii)
home visiting programs for new parents and their infants;
(iii)
workforce development programs to support caregivers in skill building;
(iv)
trauma-responsive, parenting skills-building programs;
(v)
the continuum of substance use prevention, intervention, and treatment programs and mental health support programs, including programs with trauma-informed, gender-responsive, and culturally specific counseling; and
(vi)
childcare support and early childhood education, including Head Start and Early Head Start programs.
(E)
Subject to subsection (g)(1), establishing or updating a database that compiles data used to track the effectiveness of the care coordination services funded through the grant.
(F)
Developing and implementing referral partnership agreements with community-based organizations, parent organizations, substance use disorder treatment providers and facilities, housing and shelter providers, health care providers, mental health care providers, and Federal and State offices and programs that implement practices to support children ages 0 through 5 who are at risk of adverse childhood experiences and their caregivers, including prenatal people. Such practices shall include—
(i)
a bilateral
warm handoffsystem whereby a grantee understands the needs of the children and their families, and families are involved in addressing these needs; and(ii)
an active service connection whereby the children and families are each actively connected with a resource in a well-coordinated way that ensures availability and direct contact.
(G)
Supporting cross-system planning and collaboration among employees who may work in emergency medical services, health care services, public health, early childhood education, and substance use disorder treatment and recovery support.
(H)
Providing or subsidizing services to address barriers that children, prenatal individuals, and caregivers face to utilizing community resources and services, such as by providing or subsidizing transportation or childcare costs as applicable and within reasonable amounts.
(I)
Creating or expanding infrastructure and investing in technology, including the provision of communications technology and internet service to children and their caregivers, to enable increased telemedicine capabilities to reach participants.
(3) Indian tribes
In the case of an eligible entity that is an Indian Tribe, the Secretary may waive such provisions of this subsection as the Secretary determines appropriate.
(4) Prohibitions
In addition to any other prohibitions determined by the Secretary, an eligible entity may not use a grant under this section to—
(A)
use data analysis methods to inform individual case decisions, including child removal or placement decisions, or to target services at certain individuals or families;
(B)
require any individual or family to participate in any service or program as a condition of receipt of a benefit to which the individual or family is otherwise eligible; or
(C)
increase the presence or funding of law enforcement surveillance, involvement, or activity in connection with trauma-informed care coordination services supported pursuant to this section.
(g) Requirements
As a condition on receipt of a grant under this section, an eligible entity shall agree to each of the following funding conditions:
(1) Restriction of funding allocation
The eligible entity will not use more than 30 percent of the funds made available to the entity through the grant (for the total grant period) to establish or update a database pursuant to subsection (f)(2)(E).
(2) Accessible setting
(A) In general
The eligible entity will ensure that all care coordination services provided through the grant are provided in a setting that is accessible, including through mobile settings, to—
(i)
low-income or no-income individuals, including individuals experiencing homelessness or housing instability; and
(ii)
individuals in rural areas.
(B) Community outreach
In complying with subparagraph (A), the eligible entity will ensure that at least 50 percent of the care coordination services provided through the grant occur in community settings that are convenient to the children and caregivers who are being served, such as homes, schools, and shelters, whether for initial outreach or as part of long-term care.
(3) Supplement, not supplant
The grant will be used to supplement, not supplant other Federal, State, or local funds available for care coordination services.
(4) Confidentiality
The eligible entity will maintain the confidentiality of individuals receiving services through the grant in a manner consistent with applicable law.
(5) Partnering; risk stratification
In providing care coordination services through the grant, the eligible entity will—
(A)
partner with community-based organizations with experience serving child populations prenatally through age 5;
(B)
coordinate with the local agency responsible for administering the State plan approved under title XIX of the Social Security Act; and
(C)
employ risk stratification to develop different effective models of care for different populations based on their needs.
(h) Application
(1) In general
To seek a grant under this section, an eligible entity shall submit an application to the Secretary at such time, in such manner, and containing such information, as the Secretary may require.
(2) Contents
An application under paragraph (1) shall, at a minimum, contain each of the following:
(A)
Goals to be achieved through the grant, including the activities that will be undertaken to achieve those goals.
(B)
The number of individuals likely to be served through the grant, including demographic data on the populations to be served.
(C)
Existing programs and services that can be used to significantly increase the proportion of children and families who receive needed supports and services.
(D)
A plan for expanding, coordinating, or modifying the existing network of programs and services to meet the needs of children and families for preventing and mitigating the traumatic impact of adverse childhood experiences.
(E)
A demonstration of the ability of the eligible entity to reach the individuals to be served, including by partnering with local stakeholders.
(F)
An indication of how the personnel involved are reflective of the communities to be served.
(G)
A list of stakeholders with whom the entity plans to partner or consult.
(i) Reporting by grantees
Not later than 4 years after the date of enactment of this section, an eligible entity receiving a grant under this section shall submit to the Secretary a report on the activities funded through the grant. Such report shall include, at a minimum, a description of—
(1)
the number of individuals served through activities funded through the grant, including demographics as applicable;
(2)
the number of referrals made through the grant and the rate of such referrals successfully linked or closed;
(3)
a qualitative analysis or number of collaborative partnerships with other organizations in carrying out the activities funded through the grant;
(4)
the number of services provided to individuals through the grant;
(5)
aggregated and de-identified outcomes experienced by individuals served through the grant such as—
(A)
the rate of successful service connections;
(B)
any increases in development of protective factors for children;
(C)
any increase in development of protective factors for the caregivers;
(D)
any mitigation of the negative outcomes associated with adverse childhood experiences or decreased likelihood of children experiencing an adverse childhood experience as evidenced by—
(i)
decreased presence of law enforcement or other punitive State surveillance in the community;
(ii)
a parent completing substance use treatment;
(iii)
a parent receiving voluntary treatment for mental health-related conditions;
(iv)
a family entering into or maintaining a stable housing situation;
(v)
a family achieving or maintaining economic security;
(vi)
a parent achieving or maintaining job stability; or
(vii)
a child meeting developmental markers for school readiness; and
(E)
reports of satisfaction with the coordination of care by people served; and
(6)
any other information required by the Secretary.
(j) Convening participants for sharing lessons learned
After the period of all grants awarded under this section has concluded, the Assistant Secretary for Planning and Evaluation of the Department of Health and Human Services shall provide an in-person or online opportunity for persons participating in the programs funded through this section to share with each other—
(1)
lessons learned;
(2)
challenges experienced; and
(3)
ideas for next steps and solutions.
(k) Compiling findings and conclusions
After providing the opportunity required by subsection (j), the Secretary shall—
(1)
compile the findings and conclusions of grantees under this section on the provision of care coordination services described in subsection (a);
(2)
submit a report on such findings and conclusions to the appropriate congressional committees; and
(3)
make such report publicly available.
(l) Definitions
In this section:
(1) Adverse childhood experience
The term adverse childhood experience means a potentially traumatic experience that occurs in childhood and can have a tremendous impact on the child’s lifelong health and opportunity outcomes, such as any of the following:
(A)
Abuse, such as any of the following:
(i)
Emotional and psychological abuse.
(ii)
Physical abuse.
(iii)
Sexual abuse.
(B)
Household challenges such as any of the following:
(i)
A household member is treated violently.
(ii)
A household member has a substance use disorder.
(iii)
A household member has a mental health condition.
(iv)
Parental separation or divorce.
(v)
A household member is incarcerated, is placed in immigrant detention, or has been deported.
(vi)
A household member has a life-threatening illness such as COVID–19.
(C)
Neglect.
(D)
Living in—
(i)
impoverished communities that lack access to human services;
(ii)
areas of high unemployment neighborhoods; or
(iii)
communities experiencing de facto segregation.
(E)
Experiencing food insecurity and poor nutrition.
(F)
Witnessing violence.
(G)
Involvement with the foster system.
(H)
Experiencing discrimination.
(I)
Dealing with historical and ongoing traumas due to systemic and interpersonal racism.
(J)
Dealing with historical and ongoing traumas regarding systemic and interpersonal sexism, homophobia, biphobia, and transphobia.
(K)
Dealing with the threat of deportation or detention as a result of immigration status.
(L)
The impacts of multigenerational poverty resulting from limited educational and economic opportunities.
(M)
Living through natural disasters such as earthquakes, forest fires, floods, or hurricanes.
(2) Care coordination
The term care coordination means an active, ongoing process that—
(A)
assists children ages 0 through 5 at risk of, or who have experienced, an adverse childhood experience, and their caregivers, including prenatal people of any age, to identify, access, and use community resources and services;
(B)
is client centered and comprehensive of the services a child or caregiver may need;
(C)
ensures a closed loop referral by obtaining feedback from the families served; and
(D)
works across systems and services to promote collaboration to effectively meet the needs of community members.
(3) Indian Tribe
The term Indian Tribe has the meaning given such term in section 4 of the Indian Self-Determination and Education Assistance Act.
(4) Protective factors
The term protective factors refers to any supportive element in a child or caretaker’s life that helps the child or caretaker to withstand trauma such as a stable school environment or supportive peer relationships.
(m) Authorization of appropriations
(1) In general
To carry out this section, there is authorized to be appropriated $15,000,000 for each of the 5 fiscal years following the fiscal year in which this section is enacted.
(2) Grants to Indian tribes
Of the amount made available to carry out this section for a fiscal year, the Secretary shall use not less than 10 percent of such amount for grants to eligible entities that are Indian Tribes.
(3) Administrative expenses
Of the amount made available to carry out this section for a fiscal year, the Secretary may use not more than 15 percent of such amount for administrative expenses, including the expenses of the Assistant Secretary for Planning and Evaluation of the Department of Health and Human Services for compiling and reporting information.
(4) Technical assistance
Of the amount made available to carry out this section for a fiscal year, the Secretary may reserve up to 5 percent of such amount to provide technical assistance to eligible entities in preparing and submitting applications under this section.
Sec. 6703. Improving access to mental health
(a) Access to clinical social workers
Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended—
(1)
in subparagraph (D)(ii), by striking such negotiated rate,,
and inserting such negotiated rate,
; and
(2)
in subparagraph (F)(ii) by striking 75 percent of the amount determined for payment of a psychologist under clause (L)
and inserting 85 percent of the fee schedule amount provided under section 1848
.
(b) Access to clinical social worker services provided to residents of skilled nursing facilities
(1) In general
Section 1888(e)(2)(A)(ii) of the Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)), as amended by section 6101(a)(5), is amended by inserting clinical social worker services,
after peer support specialist services (as defined in section 1861(rrr)(3)),
.
(2) Conforming amendment
Section 1861(hh)(2) of the Social Security Act (42 U.S.C. 1395x(hh)(2)) is amended by striking and other than services furnished to an inpatient of a skilled nursing facility which the facility is required to provide as a requirement for participation
.
(c) Access to the complete set of clinical social worker services
Section 1861(hh)(2) of the Social Security Act (42 U.S.C. 1395x(hh)(2)) is amended by striking for the diagnosis and treatment of mental illnesses (other than services
and inserting (including services for the diagnosis and treatment of mental illnesses or services for health and behavior assessment and intervention (identified as of January 1, 2022, by HCPCS codes 96150 through 96161 (and any succeeding codes)), but not including services
.
(d) Effective date
The amendments made by this section shall apply to items and services furnished on or after January 1, 2027.
Sec. 6704. Program to establish public-private contributions to increase the available workforce of school-based mental health service providers
(a) Program authorized
The Secretary shall carry out a program under which eligible graduate institutions may enter into an agreement with the Secretary to cover a portion of the cost of attendance of a participating student, which contributions shall be matched by equivalent contributions towards such cost of attendance by the Secretary.
(b) Designation of program
The program under this section shall be known as the Mental Health Excellence in Schools Program
.
(c) Agreements
The Secretary shall enter into an agreement with each eligible graduate institution seeking to participate in the program under this section. Each agreement shall specify the following:
(1)
The manner (whether by direct grant, scholarship, or otherwise) in which the eligible graduate institution will contribute to the cost of attendance of a participating student.
(2)
The maximum amount of the contribution to be made by the eligible graduate institution with respect to any particular participating student in any given academic year.
(3)
The maximum number of individuals for whom the eligible graduate institution will make contributions in any given academic year.
(4)
That the eligible graduate institution, in selecting participating students to receive assistance under the program, shall prioritize the participating students described in subsection (d)(2).
(5)
That the eligible graduate institution shall require, as a condition for receiving assistance under the program, participating students to agree to remain in a school-based mental health field for a period of not less than 3 years.
(6)
Such other matters as the Secretary and the eligible graduate institution determine appropriate.
(d) Outreach
The Secretary shall—
(1)
make publicly available and periodically update on the internet website of the Department of Education a list of the eligible graduate institutions participating in the program under this section that shall specify, for each such graduate institution, appropriate information on the agreement between the Secretary and such eligible graduate institution under subsection (c); and
(2)
conduct outreach about the program under this section to participating students who, as undergraduates—
(A)
received a Federal Pell Grant under section 401 of the Higher Education Act of 1965 (20 U.S.C. 1070a); or
(B)
attended an institution listed in section 371(a) of the Higher Education Act of 1965 (20 U.S.C. 1067q(a)).
(e) Matching contributions
The Secretary may provide a contribution of not more than 50 percent of the cost of attendance of a participating student if the eligible graduate institution at which such student is enrolled enters into an agreement under subsection (c) with the Secretary to match such contribution.
(f) Monitoring and evaluation
As a condition of participation in the program under this section, each eligible graduate institution shall agree to submit an annual report to the Secretary describing—
(1)
the number of students served by the program;
(2)
the percentage of tuition cost covered by the program;
(3)
the number of participating students who were also recipients of a Federal Pell Grant; and
(4)
as applicable, the graduation rates and post-graduate employment of participating students.
(g) Interim report
Not later than 2 years after the first contributions are provided under this section, the Secretary shall submit an interim report to Congress based on the annual reports required by subsection (f).
(h) Independent national evaluation
(1) In general
Not later than 4 years after the date of enactment of this Act, the Secretary shall provide for the commencement of an independent national evaluation of the outcomes and effectiveness of the program under this section.
(2) Report to congress
Not later than 90 days after receiving the results of such independent national evaluation, the Secretary shall submit a report to Congress containing the findings of the evaluation and the Secretary’s recommendations for improvements to the program.
(i) Definitions
In this section:
(1) Cost of attendance
The term cost of attendance has the meaning given the term in section 472 of the Higher Education Act of 1965 (20 U.S.C. 1087ll).
(2) Eligible graduate institution
The term eligible graduate institution means an institution of higher education that offers a program of study that leads to a graduate degree—
(A)
in school psychology that is accredited or approved by the National Association of School Psychologists' Program Accreditation Board or the Commission on Accreditation of the American Psychological Association and that prepares students in such program for the State licensing or certification examination in school psychology at the specialist level;
(B)
in an accredited school counseling program that prepares students in such program for the State licensing or certification examination in school counseling;
(C)
in school social work that is accredited by the Council on Social Work Education and that prepares students in such program for the State licensing or certification examination in school social work;
(D)
in another school-based mental health field that prepares students in such program for the State licensing or certification examination in such field, if applicable; or
(E)
in any combination of study described in subparagraphs (A) through (D).
(3) Institution of higher education
The term institution of higher education has the meaning given the term in section 101 of the Higher Education Act of 1965 (20 U.S.C. 1001).
(4) Participating student
The term participating student means an individual who is enrolled in a graduate degree program in a school-based mental health field at a participating eligible graduate institution.
(5) School-based mental health field
The term school-based mental health field means any of the following fields:
(A)
School counseling.
(B)
School social work.
(C)
School psychology.
(D)
Any other field of study that leads to employment as a school-based mental health services provider, as determined by the Secretary.
(6) School-based mental health services provider
The term school-based mental health services provider has the meaning given the term in section 4102 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7112).
(7) Secretary
The term Secretary means the Secretary of Education.
(j) Authorization of appropriations
There are authorized to be appropriated to carry out this section—
(1)
$20,000,000 for fiscal year 2027;
(2)
$30,000,000 for fiscal year 2028; and
(3)
$50,000,000 for each of fiscal years 2029 through 2031.
Sec. 6705. School social workers improving student success
(a) School social worker grants
(1) Purposes
The purpose of this section is to assist States and local educational agencies in hiring additional school social workers in order to increase access to mental health and other student support services to students in elementary schools and secondary schools in the United States to the minimum ratios recommended by the National Association of Social Workers and the School Social Work Association of America of 1 school social worker for every 250 students, and 1 school social worker for every 50 students when a social worker is providing services to students with intensive needs.
(2) ESEA amendments
(A) In general
Subpart 4 of part F of title IV of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7291 et seq.) is amended by adding at the end the following:
4645. Grants for school social workers
(a) Grants authorized
(1) In general
From the amounts appropriated under subsection (h), the Secretary shall award grants to high-need local educational agencies to enable such agencies to retain school social workers employed by such agencies or to hire additional school social workers.
(2) Duration
A grant awarded under this section shall be awarded for a period not to exceed 4 years.
(3) Supplement, not supplant
Funds made available under this section shall be used to supplement, and not to supplant, other Federal, State, or local funds used for hiring and retaining school social workers.
(b) Application
(1) In general
To be eligible to receive a grant under this section, a high-need local educational agency shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(2) Contents
An application submitted under paragraph (1) shall include an assurance that each school social worker who receives assistance under the grant will provide the services described in subsection (d), and a description of the specific services to be provided by such social worker.
(c) Use of funds
A high-need local educational agency receiving a grant under this section—
(1)
shall use the grant—
(A)
to achieve a ratio of not less than 1 school social worker for every 250 students served by the agency, by—
(i)
retaining school social workers employed by such agency; or
(ii)
(I)
employing additional school social workers; or
(II)
hiring contractors to serve as school social workers only in a case in which—
(aa)
the local educational agency demonstrates to the Secretary that the agency—
(AA)
has not been able to employ a sufficient number of school social workers under subclause (I) to achieve such ratio despite strong and continuing efforts to recruit and employ school social workers; and
(BB)
hiring contractors is the only viable option to ensure students have adequate access to school social work services; and
(bb)
each such contractor meets the requirements of subparagraphs (A) and (B) of subsection (g)(2); and
(B)
to ensure that each school social worker who receives assistance under such grant provides the services described in subsection (d); and
(2)
may use the grant to reimburse school social workers who receive assistance under such grant for—
(A)
in the case of a school served by the agency in which the majority of students are higher risk students, to hire or retain additional school social workers in accordance with clauses (i) and (ii) of paragraph (1)(A) to achieve a ratio of not less than 1 school social worker for every 50 students;
(B)
travel expenses incurred during home visits and other school-related trips;
(C)
any additional expenses incurred by such social workers in rendering any service described in subsection (d); and
(D)
the cost of clinical social work supervision for such social workers.
(d) Responsibilities of a school social worker
A school social worker who receives assistance under a grant under this section shall provide the following services:
(1)
Identifying high-need students in each school that the social worker serves, and targeting services provided at the school to such students.
(2)
Providing students, in each school that the school social worker serves, social work services to promote school engagement and improve academic outcomes, including—
(A)
counseling and crisis intervention;
(B)
trauma-informed services;
(C)
evidence-based educational, behavioral, and mental health services (such as implementing multi-tiered programs and practices, monitoring progress, and evaluating service effectiveness);
(D)
addressing the social and emotional learning needs of students;
(E)
promoting a school climate and culture conducive to student learning and teaching excellence (such as promoting effective school policies and administrative procedures, enhancing the professional capacity of school personnel, and facilitating engagement between student, family, school, and community);
(F)
providing access to school-based and community-based resources (such as promoting a continuum of services, mobilizing resources and promoting assets, and providing leadership, interdisciplinary collaboration, systems coordination, professional consultation, and connecting students and families to resource systems);
(G)
working with students, families, schools, and communities to address barriers to educational attainment (such as homelessness and housing insecurity, lack of transportation, food insecurity, equity, social justice issues, access to quality education, and school, family, and community risk factors);
(H)
providing assistance to schools and teachers to design social-emotional, educational, behavioral, and mental health interventions;
(I)
case management activities to coordinate the delivery of and access to the appropriate social work services to the highest-need students;
(J)
home visits to meet the family of students in need of social work services in the home environment;
(K)
supervising or coordinating school social work services at the local educational agency level; and
(L)
other services the Secretary determines, in partnership with students, educators, and community member voices, are necessary to be carried out by such a social worker.
(e) Grant renewal
(1) In general
A grant awarded under this section may be renewed for additional periods with the same duration as the original grant period.
(2) Continuing eligibility application
To be eligible for a renewal under this section, a high-need local educational agency shall submit to the Secretary, for each renewal, a report on the progress of such agency in retaining and hiring school social workers to achieve the ratio of not less than 1 school social worker for every 250 students served by the agency, and shall include—
(A)
a description of the staffing expansion of school social workers funded through the original grant received under this section; and
(B)
a description of the work conducted by such social workers for higher risk students.
(f) Technical assistance
(1) In general
The Secretary shall provide technical assistance to high-need local educational agencies, including such agencies that do not have adequate staff, in applying for grants under this section.
(2) Extension of application period
The Secretary shall extend any application period for a grant under this section for any high-need local educational agency that—
(A)
submits to the Secretary a written notification of the intent to apply for a grant under this section before requesting technical assistance under paragraph (1); and
(B)
after submitting the notification under paragraph (1), requests such technical assistance.
(g) Definitions
In this section:
(1) High-need local educational agency
The term high-need local educational agency has the meaning given the term in section 200 of the Higher Education Act of 1965 (20 U.S.C. 1021).
(2) School social worker
The term school social worker means an individual who—
(A)
has a graduate degree in social work from a social work program that is accredited by the Council on Social Work Education; and
(B)
meets all other State and local credentialing requirements for practicing as a social worker in an elementary school or secondary school.
(h) Authorization for appropriations
There is authorized to be appropriated to carry out this section, $100,000,000 for each of fiscal years 2027 through 2031.
(B) Table of contents
The table of contents in section 2 of the Elementary and Secondary Education Act of 1965 is amended by inserting after the item relating to section 4644 the following:
(b) National technical assistance center for school social work
(1) In general
The Secretary of Education, acting through the Assistant Secretary, shall establish an evaluation, documentation, dissemination, and technical assistance resource center to provide appropriate information, training, and technical assistance to States, political subdivisions of States, federally recognized Indian Tribes, Tribal organizations, institutions of higher education, State and local educational agencies, and individual students and educators with respect to hiring and retaining school social workers at elementary schools and secondary schools served by local educational agencies.
(2) Responsibilities of the Center
The center established under paragraph (1) shall conduct activities for the purpose of—
(A)
developing and continuing statewide or Tribal strategies for improving the effectiveness of the school social work workforce;
(B)
studying the costs and effectiveness of school social work programs at institutions of higher education to identify areas of improvement and provide information on relevant issues of importance to national, Tribal, and State policymakers;
(C)
working with Federal agencies and other national, Tribal, and State stakeholders to collect, evaluate, and disseminate data regarding school social work ratios, outcomes and best practices of school-based mental health services, and the impact of expanding the number of school social workers within elementary schools and secondary schools; and
(D)
establishing partnerships among national, Tribal, State, and local governments, and local educational agencies, institutions of higher education, non-profit organizations, and State and national trade associations, for the purposes of—
(i)
data collection and dissemination;
(ii)
establishing a school social work workforce development program;
(iii)
documenting the success of school social work methods on a national level; and
(iv)
conducting other activities determined appropriate by the Secretary.
(3) Definitions
In this subsection:
(A) ESEA terms
Except as otherwise provided, any term used in this subsection that is defined in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801) shall have the meaning given that term in such section.
(B) School social worker
The term school social worker has the meaning given the term in section 4645(g) of the Elementary and Secondary Education Act of 1965.
Sec. 6706. Opioid grants to support caregivers, kinship care families, and kinship caregivers
(a) Opioid grants
Section 1003(b)(4) of the 21st Century Cures Act (42 U.S.C. 290ee–3a(b)(4)) is amended—
(1)
by redesignating subparagraph (F) as subparagraph (G); and
(2)
by inserting after subparagraph (E) the following:
(F)
Supporting opioid abuse prevention and treatment services within a State provided by State and local agencies for children and caregivers, kinship care families, and kinship caregivers through—
(i)
workforce recruitment and training;
(ii)
health care services (including such services described in subparagraph (D)); and
(iii)
foster and adoptive parent recruitment and training.
(b) Definitions
Section 1003(h) of the 21st Century Cures Act (42 U.S.C. 290ee–3a(h)) is amended—
(1)
by redesignating paragraphs (2) through (4) as paragraphs (4) through (6), respectively; and
(2)
by inserting after paragraph (1) the following:
(2) Kinship care family
The term kinship care family means a family with a kinship caregiver.
(3) Kinship caregiver
The term kinship caregiver means a relative of a child by blood, marriage, or adoption, who—
(A)
lives with the child;
(B)
is the primary caregiver of the child because the biological or adoptive parent of the child is unable or unwilling to serve as the primary caregiver of the child; and
(C)
has a legal relationship to the child or is raising the child informally.
(c) Authorization of appropriations
Section 1003(i)(1) of the 21st Century Cures Act (42 U.S.C. 290ee–3a(i)(1)) is amended by striking 2023 through 2027
and inserting 2027 through 2031
.
(d) Set aside
Section 1003(i)(3) of the 21st Century Cures Act (42 U.S.C. 290ee–3a(i)(3)) is amended by inserting before the period at the end , and set aside 1 percent to carry out subsection (b)(4)(F)
.
Sec. 6707. Substance Use and Mental Health Services Administration and subagencies
(a) Substance Use and Mental Health Services Administration
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended—
(1)
in section 464H(c) (42 U.S.C. 285n(c)), section 464R(c) (42 U.S.C. 285p(c)), and subsections (b) and (c)(1) of section 2303 (42 U.S.C. 300cc–2), by striking Administrator of the Substance Abuse and Mental Health Services Administration
each place it appears and inserting Assistant Secretary for Mental Health and Substance Use
;
(2)
in title V (42 U.S.C. 290aa et seq.)—
(A)
in the title heading, by striking Abuse
and inserting Use
; and
(B)
in section 501 (42 U.S.C. 290aa)—
(i)
in the section heading, by striking Abuse
and inserting Use
; and
(ii)
in subsection (f)(4), by striking Substance Abuse and Mental Health Administration
and inserting Substance Use and Mental Health Services Administration
; and
(3)
by striking Substance Abuse and Mental Health Services Administration
each place it appears and inserting Substance Use and Mental Health Services Administration
.
(b) Center for Substance Use Services; Center for Substance Use Prevention Services
(1) In general
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended—
(A)
in part B of title V (42 U.S.C. 290bb et seq.)—
(i)
in subpart 1, in the subpart heading, by striking Abuse Treatment
and inserting Use Services
;
(ii)
in subpart 2, in the subpart heading, by striking Abuse Prevention
and inserting Use Prevention Services
;
(iii)
in section 507 (42 U.S.C. 290bb), in the section heading, by striking Abuse Treatment
and inserting Use Services
;
(iv)
in section 513(a) (42 U.S.C. 290bb–6(a)), in the subsection heading, by striking Abuse Treatment
and inserting Use Services
; and
(v)
in section 515 (42 U.S.C. 290bb–21), in the section heading, by striking Abuse Prevention
and inserting Use Prevention Services
;
(B)
in section 1932(b)(3) (42 U.S.C. 300x–32(b)(3)), in the paragraph heading, by striking abuse prevention
and inserting use prevention services
;
(C)
in section 1935(b)(2) of the Public Health Service Act (42 U.S.C. 300x–35(b)(2)), in the paragraph heading, by striking abuse prevention
and inserting use prevention services
;
(D)
by striking Center for Substance Abuse Treatment
each place it appears and inserting Center for Substance Use Services
; and
(E)
by striking Center for Substance Abuse Prevention
each place it appears and inserting Center for Substance Use Prevention Services
.
(c) Authorities
The Secretary of Health and Human Services shall delegate to the Substance Use and Mental Health Services Administration, the Center for Substance Use Services, and the Center for Substance Use Prevention Services all duties and authorities that, as of the date of enactment of this Act, were vested in the Substance Abuse and Mental Health Services Administration, the Center for Substance Abuse Treatment, and the Center for Substance Abuse Prevention, respectively.
(d) References
(1) In general
Except as provided in paragraph (2), any reference in any law, regulation, map, document, paper, or other record of the United States—
(A)
to the Substance Abuse and Mental Health Services Administration shall be deemed to be a reference to the Substance Use and Mental Health Services Administration;
(B)
to the Center for Substance Abuse Treatment of such Administration shall be deemed to be a reference to the Center for Substance Use Services of such Administration; and
(C)
to the Center for Substance Abuse Prevention of such Administration shall be deemed to be a reference to the Center for Substance Use Prevention Services of such Administration.
(2) Effect
Paragraph (1) shall not be construed to alter or affect section 6001(d) of the 21st Century Cures Act (42 U.S.C. 290aa note), providing that a reference to the Administrator of the Substance Abuse and Mental Health Services Administration shall be construed to be a reference to the Assistant Secretary for Mental Health and Substance Use.
(3) References to SAMHSA
Notwithstanding this section or the amendments made by this section, the Secretary of Health and Human Services may continue to use the acronym SAMHSA to refer to the Substance Use and Mental Health Services Administration in regulations, maps, documents, papers, and other records of the United States.
Sec. 6708. Mental Health for Latinos Act
Part D of title V of the Public Health Service Act (42 U.S.C. 290dd et seq.), as amended by section 6501, is amended by adding at the end the following new section:
557. Behavioral and mental health outreach and education strategy
(a) In general
The Secretary, acting through the Assistant Secretary, shall, in coordination with advocacy and behavioral and mental health organizations serving populations of Hispanic and Latino individuals or communities, develop and implement an outreach and education strategy to promote behavioral and mental health and reduce stigma associated with mental health conditions and substance abuse among the Hispanic and Latino populations. Such strategy shall—
(1)
be designed to—
(A)
meet the diverse cultural and language needs of the various Hispanic and Latino populations; and
(B)
be developmentally and age appropriate;
(2)
increase awareness of symptoms of mental illnesses common among such populations, taking into account differences within subgroups, such as gender, gender identity, age, sexual orientation, or ethnicity, of such populations;
(3)
provide information on evidence-based, culturally and linguistically appropriate and adapted interventions and treatments;
(4)
ensure full participation of, and engage, both consumers and community members in the development and implementation of materials; and
(5)
seek to broaden the perspective among both individuals in these communities and stakeholders serving these communities to use a comprehensive public health approach to promoting behavioral health that addresses a holistic view of health by focusing on the intersection between behavioral and physical health.
(b) Reports
Beginning not later than 1 year after the date of the enactment of this section and annually thereafter, the Secretary, acting through the Assistant Secretary, shall submit to Congress, and make publicly available, a report on the extent to which the strategy developed and implemented under subsection (a) improved behavioral and mental health outcomes associated with mental health conditions and substance abuse among Hispanic and Latino populations.
(c) Authorization of appropriations
There is authorized to be appropriated to carry out this section $1,000,000 for fiscal year 2027.
Sec. 6709. Supporting farmworkers' mental health
(a) Findings
Congress finds that farmworkers—
(1)
are vital to the economy and food supply of the United States; and
(2)
who are disproportionately affected by stress and anxiety, often lack access to behavioral health care services.
(b) Farm and Ranch Stress Assistance Network
Section 7522 of the Food, Conservation, and Energy Act of 2008 (7 U.S.C. 5936) is amended—
(1)
by inserting farm work,
after ranching,
each place it appears;
(2)
in subsection (b)—
(A)
in paragraph (1)(D), by striking or
at the end;
(B)
by redesignating paragraph (2) as paragraph (3);
(C)
by inserting after paragraph (1) the following:
(2)
to initiate, expand, or sustain programs that deliver peer-to-peer mental health support to individuals who are engaged in farming, ranching, farm work, and other occupations relating to agriculture; or; and
(D)
in paragraph (3) (as so redesignated), by striking paragraph (1) and subsection (a)
and inserting paragraphs (1) and (2) and subsection (a)
; and
(3)
in subsection (d), by striking 2023
and inserting 2031
.
Sec. 6710. Clarifying coverage of occupational therapy under Medicare
Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services shall provide education and outreach to stakeholders about the Medicare Benefit Policy Manual with respect to occupational therapy services furnished to individuals under the Medicare program for the treatment of a substance use or mental health disorder diagnosis using applicable Healthcare Common Procedure Coding System (HCPCS) codes.
Sec. 6711. Training community mental wellness workers
Part D of title V of the Public Health Service Act (42 U.S.C. 290dd), as amended by section 6708, is amended by adding at the end the following:
558. Training community mental wellness workers
(a) In general
The Secretary, acting through the Assistant Secretary, may award grants to eligible entities to implement community mental wellness worker training programs.
(b) Use of funds
An eligible entity that receives a grant under this section shall use the funds received through such grant to carry out a community mental wellness worker training program, which may include—
(1)
supporting training, certification, and supervision during and after training of community mental wellness workers and community mental wellness supervisors—
(A)
to screen for common mental health and substance use conditions; and
(B)
to deliver evidence-informed, culturally and linguistically competent counseling and interviewing interventions addressing basic psychosocial or psychotherapeutic treatment needs of persons with or at risk for mental and substance use disorders, including safety planning and interventions to reduce suicide risk; and
(2)
covering costs associated with—
(A)
the acquisition and use of digital platforms to provide the screening, training, supervision, and ongoing quality assurance monitoring, outcomes evaluation, and delivery of evidence-based treatments;
(B)
the delivery of counseling and interviewing interventions described in paragraph (1)(B); and
(C)
the clinical supervision (during and after training) of community mental wellness workers and the certification of such workers upon the completion of required training.
(c) Community mental wellness technical assistance
(1) In general
The Secretary may provide appropriate training and technical assistance to eligible entities receiving a grant under this section in meeting the requirements of this section, including by—
(A)
consulting with such recipients on evidence-based employment practices for community mental wellness workers, including assistance with integrating community wellness workers into the workflows of such recipients and other eligible entities;
(B)
identifying a diverse array of candidates for community mental wellness worker training; and
(C)
identifying behavioral health providers who may benefit from and employ community mental wellness workers.
(2) Additional dissemination of technical assistance
The information and resources provided by the Secretary under paragraph (1) shall be made available to States, political subdivisions of States, Indian Tribes and Tribal organizations (as defined in section 4 of the Indian Self-Determination and Education Assistance Act), outpatient and inpatient substance use treatment providers, other community-based behavioral health organizations, and other entities as the Secretary determines appropriate.
(d) Priority
In awarding grants under this section, the Secretary shall give priority to eligible entities that are located—
(1)
in an area with rates of poverty and unemployment that exceed the average in the United States, as determined by the survey conducted by the Secretary of Commerce commonly referred to as the ‘American Community Survey’ (or any successor survey);
(2)
in a medically underserved community;
(3)
in an area with rates of substance use that exceed the average in the United States, as determined by the National Institute on Drug Abuse; or
(4)
serving communities with rates of individuals who are dually eligible for both the Medicare program under title XVIII of the Social Security Act and the Medicaid program under title XIX of such Act that exceed the average in the United States.
(e) Malpractice and negligence suits against community behavioral health clinic and community mental health centers
(1) In general
Except as inconsistent with this subsection, the provisions of section 224, including subsections (g), (h), (i), (j), (k), and (l) of such section, shall apply with respect to acts and omissions of a covered entity that occur during the period of the grant under this section, to the same extent and in the same manner as such provisions apply with respect to an entity described in subsection (g)(4) of such section 224, and any officer, governing board member, employee, or contractor of such an entity.
(2) List required
Each covered entity described in paragraph (3)(A) shall submit to the Secretary, and update as necessary, a list of each officer, governing board member, employee, or contractor participating in the entity’s program funded through a grant under this section.
(3) Covered entity defined
In this subsection, the term
covered entitymeans an entity that—(A)
is an eligible entity (as defined in subsection (g)(3)) in receipt of a grant under this section; and
(B)
(i)
is an officer, governing board member, or employee of such an entity or a contractor of such an entity who is a physician or other licensed or certified health care practitioner; and
(ii)
is participating in the entity’s program funded through a grant under this section, as indicated in a list submitted pursuant to paragraph (2).
(4) Delayed applicability
This subsection applies beginning with respect to the first full fiscal year that begins after the date of the enactment of this section.
(f) Report
(1) Submission
The Secretary shall submit to Congress—
(A)
not later than one year after the date of enactment of this section, an interim report on the results of the grant program under this section; and
(B)
not later than the end of fiscal year 2031, a final report of such results.
(2) Contents
The reports required by paragraph (1) shall each include—
(A)
the total number of community mental wellness workers participating in the grant program under this section; and
(B)
the total number of community mental wellness workers who obtained certification through such participation.
(g) Definitions
In this section:
(1)
The term community mental wellness worker means an individual trained and certified by an eligible entity to assist with providing basic screening and evidence-based treatments to individuals with a mild to moderate mental health or substance use disorder, including depression, anxiety, post-traumatic stress disorder, and alcohol use disorder.
(2)
The term culturally and linguistically competent means, with respect to the provision of counseling and interviewing interventions, providing such services in a manner that acknowledges, and is responsive to, cultural differences that may derive from characteristics of the individual receiving such services, including—
(A)
gender;
(B)
sex;
(C)
sexual orientation;
(D)
race or ethnicity;
(E)
nationality;
(F)
socioeconomic level;
(G)
immigration status;
(H)
disability;
(I)
Tribal affiliation; and
(J)
veteran status.
(3)
The term eligible entity means—
(A)
a certified community behavioral health clinic (as described in section 223(a) of the Protecting Access to Medicare Act of 2014);
(B)
a community mental health center (as described in section 1913(c));
(C)
a hospital that is described in section 501(c) of the Internal Revenue Code of 1986 and exempt from taxation under section 501(a) of such Code; and
(D)
such other community behavioral health organizations as the Secretary may specify, in consultation with—
(i)
State authorities responsible for regulating substance use and mental health providers and facilities receiving reimbursement under a State plan under title XIX of the Social Security Act (or a waiver of such plan); and
(ii)
other State substance abuse and mental health agencies.
(4)
The term medically underserved community has the meaning given such term in section 799B.
(h) Funding
(1) Authorization of appropriations
There are authorized to be appropriated to carry out this section, $25,000,000 for each of fiscal years 2027 through 2031.
(2) Allocation
Of the funds authorized to be appropriated to carry out this section for a fiscal year, not less than 20 percent shall be reserved for the provision of training and technical assistance under subsection (c).
Title VII Addressing high-impact minority diseases
Subtitle A Cancer
Sec. 7001. Lung cancer mortality reduction
(a) Sense of congress concerning investment in lung cancer research
It is the sense of the Congress that—
(1)
lung cancer mortality reduction should be made a national public health priority; and
(2)
a comprehensive mortality reduction program coordinated by the Secretary of Health and Human Services is justified and necessary to adequately address and reduce lung cancer mortality.
(b) Lung cancer mortality reduction program
(1) In general
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 the following:
417H. Lung cancer mortality reduction program
(a) In general
Not later than 6 months after the date of the enactment of the Health Equity and Accountability Act of 2026, the Secretary, in consultation with the Secretary of Defense, the Secretary of Veterans Affairs, the Director of the National Institutes of Health, the Director of the Centers for Disease Control and Prevention, the Commissioner of Food and Drugs, the Administrator of the Centers for Medicare & Medicaid Services, the Director of the National Institute on Minority Health and Health Disparities, the Administrator of the Environmental Protection Agency, and other members of the Lung Cancer Advisory Board established under section 7001(d) of the Health Equity and Accountability Act of 2026, shall implement a comprehensive program, to be known as the Lung Cancer Mortality Reduction Program, to achieve a reduction of at least 25 percent in the mortality rate of lung cancer by 2028.
(b) Requirements
The Program shall include at least the following:
(1)
With respect to the National Institutes of Health—
(A)
a strategic review and prioritization by the National Cancer Institute of research grants to achieve the goal specified in subsection (a);
(B)
the provision of funds to enable the Airway Biology and Disease Branch of the National Heart, Lung, and Blood Institute to expand its research programs to include predispositions to lung cancer, the interrelationship between lung cancer and other pulmonary and cardiac disease, the diagnosis and treatment of such diseases, and the investigation of rising rates of lung cancer in populations that have never smoked, such as among Asian American, Native Hawaiian, and Pacific Islander women;
(C)
the provision of funds to enable the National Institute of Biomedical Imaging and Bioengineering to expedite the development of computer-assisted diagnostic, surgical, treatment, and drug-testing innovations to reduce lung cancer mortality, such as through expansion of the Institute’s Quantum Grant Program and Image-Guided Interventions program; and
(D)
the provision of funds to enable the National Institute of Environmental Health Sciences to implement research programs relative to the lung cancer incidence.
(2)
With respect to the Food and Drug Administration—
(A)
activities under section 529B of the Federal Food, Drug, and Cosmetic Act; and
(B)
activities under section 561 of the Federal Food, Drug, and Cosmetic Act to expand access to investigational drugs and devices for the diagnosis, monitoring, or treatment of lung cancer.
(3)
With respect to the Centers for Disease Control and Prevention, the establishment of an early disease research and management program under section 1511.
(4)
With respect to the Agency for Healthcare Research and Quality, the conduct of a biannual review of lung cancer screening, diagnostic, and treatment protocols, and the issuance of updated guidelines.
(5)
The promotion (including education) of lung cancer screening within minority and rural populations and the study of the effectiveness of efforts to increase such screening.
(6)
The cooperation and coordination of all minority and health disparity programs within the Department of Health and Human Services to ensure that all aspects of the Lung Cancer Mortality Reduction Program under this section adequately address the burden of lung cancer on minority and rural populations including among populations who have never smoked, such as Asian American, Native Hawaiian, and Pacific Islander women.
(7)
The cooperation and coordination of all tobacco control and cessation programs within agencies of the Department of Health and Human Services to achieve the goals of the Lung Cancer Mortality Reduction Program under this section with particular emphasis on the coordination of drug and other cessation treatments with early detection protocols.
(2) Federal food, drug, and cosmetic act
Subchapter B of chapter V of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360aaa et seq.) is amended by adding at the end the following:
529B. Drugs relating to lung cancer
(a) In general
The provisions of this subchapter shall apply to a drug described in subsection (b) to the same extent and in the same manner as such provisions apply to a drug for a rare disease or condition (as defined in section 526).
(b) Qualified drugs
A drug described in this subsection is—
(1)
a chemoprevention drug for precancerous conditions of the lung;
(2)
a drug for targeted therapeutic treatments, including any vaccine, for lung cancer; or
(3)
a drug to curtail or prevent nicotine addiction.
(c) Board
The Board established under section 7001(d) of the Health Equity and Accountability Act of 2026 shall monitor the program implemented under this section.
(3) Access to unapproved therapies
Section 561(e) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360bbb(e)) is amended by inserting before the period the following: and shall include expanding access to drugs under section 529B, with substantial consideration being given to whether the totality of information available to the Secretary regarding the safety and effectiveness of an investigational drug, as compared to the risk of morbidity and death from the disease, indicates that a patient may obtain more benefit than risk if treated with the drug
.
(4) CDC
Title XV of the Public Health Service Act (42 U.S.C. 300k et seq.) is amended by adding at the end the following:
1511. Early disease research and management program
The Secretary shall establish and implement an early disease research and management program targeted at the high incidence and mortality rates of lung cancer among minority and low-income populations.
(c) Department of defense and department of veterans affairs
The Secretary of Defense and the Secretary of Veterans Affairs, each in coordination with the Secretary of Health and Human Services, shall engage—
(1)
in the implementation within the Department of Defense and the Department of Veterans Affairs, as the case may be, of an early detection and disease management research program for members of the Armed Forces and veterans whose smoking history and exposure to carcinogens during service on active duty in the Armed Forces has increased their risk for lung cancer; and
(2)
in the implementation of coordinated care programs for members of the Armed Forces and veterans diagnosed with lung cancer.
(d) Lung cancer advisory board
(1) In general
The Secretary of Health and Human Services shall convene a Lung Cancer Advisory Board (referred to in this section as the Board
)—
(A)
to monitor the programs established under this section (and the amendments made by this section); and
(B)
to provide annual reports to the Congress concerning benchmarks, expenditures, lung cancer statistics, and the public health impact of such programs.
(2) Composition
The Board shall be composed of—
(A)
the Secretary of Health and Human Services;
(B)
the Secretary of Defense;
(C)
the Secretary of Veterans Affairs; and
(D)
2 representatives each from the fields of clinical medicine focused on lung cancer, lung cancer research, imaging, drug development, and lung cancer advocacy, to be appointed by the Secretary of Health and Human Services.
(e) Authorization of appropriations
(1) In general
To carry out this section (and the amendments made by this section), there are authorized to be appropriated $75,000,000 for fiscal year 2027 and such sums as may be necessary for each of fiscal years 2028 through 2029.
(2) Lung cancer mortality reduction program
The amounts appropriated under paragraph (1) shall be allocated as follows:
(A)
$25,000,000 for fiscal year 2027, and such sums as may be necessary for each of fiscal years 2028 through 2030, for the activities described in section 417H(b)(1)(B) of the Public Health Service Act, as added by subsection (b);
(B)
$25,000,000 for fiscal year 2027, and such sums as may be necessary for each of fiscal years 2028 through 2030, for the activities described in section 417H(b)(1)(C) of the Public Health Service Act;
(C)
$10,000,000 for fiscal year 2027, and such sums as may be necessary for each of fiscal years 2028 through 2030, for the activities described in section 417H(b)(1)(D) of the Public Health Service Act; and
(D)
$15,000,000 for fiscal year 2027, and such sums as may be necessary for each of fiscal years 2028 through 2030, for the activities described in section 417H(b)(3) of the Public Health Service Act.
Sec. 7002. Expansion of prostate cancer research, outreach, screening, testing, access, and treatment effectiveness
(a) Prostate cancer coordination and education
(1) Interagency Prostate Cancer Coordination and Education Task Force
Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs, in cooperation with the Secretary of Defense and the Secretary of Health and Human Services, shall establish an Interagency Prostate Cancer Coordination and Education Task Force (in this section referred to as the Prostate Cancer Task Force
).
(2) Duties
The Prostate Cancer Task Force shall—
(A)
develop a summary of advances in prostate cancer research supported or conducted by Federal agencies relevant to the diagnosis, prevention, and treatment of prostate cancer, including psychosocial impairments related to prostate cancer treatment, and compile a list of best practices that warrant broader adoption in health care programs;
(B)
consider establishing, and advocating for, a guidance to enable physicians to allow screening of men who are age 74 or older, on a case-by-case basis, taking into account quality of life and family history of prostate cancer;
(C)
share and coordinate information on research and health care program activities by the Federal Government, including activities related to—
(i)
determining how to improve research and health care programs, including psychosocial impairments related to prostate cancer treatment;
(ii)
identifying any gaps in the overall research inventory and in health care programs;
(iii)
identifying opportunities to promote translation of research into practice; and
(iv)
maximizing the effects of Federal Government efforts by identifying opportunities for collaboration and leveraging of resources in research and health care programs that serve individuals who are susceptible to or diagnosed with prostate cancer;
(D)
develop a comprehensive interagency strategy and advise relevant Federal agencies in the solicitation of proposals for collaborative, multidisciplinary research and health care programs, including proposals to evaluate factors that may be related to the etiology of prostate cancer, that would—
(i)
result in innovative approaches to study emerging scientific opportunities or eliminate knowledge gaps in research to improve the prostate cancer research portfolio of the Federal Government; and
(ii)
outline key research questions, methodologies, and knowledge gaps;
(E)
develop a coordinated message related to screening and treatment for prostate cancer to be reflected in educational and beneficiary materials for Federal health programs as such materials are updated; and
(F)
not later than 2 years after the date of the establishment of the Prostate Cancer Task Force, submit to the expert advisory panels appointed under paragraph (4) to be reviewed and returned within 30 days, and then within 90 days submitted to Congress, recommendations—
(i)
regarding any appropriate changes to research and health care programs, including recommendations to improve the research portfolio of the Department of Veterans Affairs, the Department of Defense, the National Institutes of Health, and other Federal agencies to ensure that scientifically based strategic planning is implemented in support of research and health care program priorities;
(ii)
designed to ensure that the research and health care programs and activities of the Department of Veterans Affairs, the Department of Defense, the Department of Health and Human Services, and other Federal agencies are free of unnecessary duplication;
(iii)
regarding public participation in decisions relating to prostate cancer research and health care programs to increase the involvement of patient advocates, community organizations, and medical associations representing a broad geographical area;
(iv)
on how to best disseminate information on prostate cancer research and progress achieved by health care programs;
(v)
on how to expand partnerships between public entities, including Federal agencies, and private entities to encourage collaborative, cross-cutting research and health care delivery;
(vi)
assessing any cost savings and efficiencies realized through the efforts identified in, and supported through, this subsection and recommending expansion of those efforts that have proved most promising while also ensuring against any conflicts in directives in law;
(vii)
identifying key priority action items from among the recommendations specified in clauses (i) through (vi); and
(viii)
with respect to the level of funding needed by each agency to implement such recommendations.
(3) Members of the Prostate Cancer Task Force
The Prostate Cancer Task Force shall be composed of representatives from such Federal agencies as the head of each such applicable agency determines necessary, so as to coordinate a uniform message relating to prostate cancer screening and treatment where appropriate, including representatives of each of the following:
(A)
The Department of Veterans Affairs, including representatives of each relevant program area of the Department of Veterans Affairs.
(B)
The Prostate Cancer Research Program of the Congressionally Directed Medical Research Program of the Department of Defense.
(C)
The Department of Health and Human Services, including, at a minimum, representatives of each of the following:
(i)
The National Institutes of Health.
(ii)
National research institutes and centers, including the National Cancer Institute, the National Institute of Allergy and Infectious Diseases, and the Office of Minority Health.
(iii)
The Centers for Medicare & Medicaid Services.
(iv)
The Food and Drug Administration.
(v)
The Centers for Disease Control and Prevention.
(vi)
The Agency for Healthcare Research and Quality.
(vii)
The Health Resources and Services Administration.
(4) Appointing expert advisory panels
The Prostate Cancer Task Force shall appoint expert advisory panels, as the task force determines appropriate, to provide input and concurrence from—
(A)
individuals and organizations from the medical, prostate cancer patient and advocate, research, and delivery communities with expertise in prostate cancer diagnosis, treatment, and research, including practicing urologists, primary care providers, and others; and
(B)
individuals with expertise in education and outreach to underserved populations affected by prostate cancer.
(5) Meetings
The Prostate Cancer Task Force shall convene not less frequently than twice each year, or more frequently as the Secretary of Veterans Affairs determines to be appropriate.
(6) Federal Advisory Committee Act
The Federal Advisory Committee Act (5 U.S.C. App.) shall apply to the Prostate Cancer Task Force.
(7) Sunset date
The Prostate Cancer Task Force shall terminate on September 30, 2028.
(b) Prostate cancer research
(1) Research coordination program
(A) In general
The Secretary of Veterans Affairs, in coordination with the Secretary of Defense and the Secretary of Health and Human Services, shall establish and carry out a program to coordinate and intensify prostate cancer research.
(B) Elements
The program established under subparagraph (A) shall—
(i)
develop advances in diagnostic and prognostic methods and tests, including biomarkers and an improved prostate cancer screening blood test, including improvements or alternatives to the prostate specific antigen test and additional tests to distinguish indolent from aggressive disease;
(ii)
develop a better understanding of the etiology of the disease (including an analysis of lifestyle factors proven to be involved in higher rates of prostate cancer, such as obesity and diet, and in different ethnic, racial, and socioeconomic groups, such as the African-American, Latino or Hispanic, Asian American, Native Hawaiian, Pacific Islander, and American Indian populations and men with a family history of prostate cancer) to improve prevention efforts;
(iii)
expand basic research into prostate cancer, including studies of fundamental molecular and cellular mechanisms;
(iv)
identify and provide clinical testing of novel agents for the prevention and treatment of prostate cancer;
(v)
establish clinical registries for prostate cancer;
(vi)
use the National Institute of Biomedical Imaging and Bioengineering and the National Cancer Institute for assessment of appropriate imaging modalities; and
(vii)
address such other matters relating to prostate cancer research as may be identified by the Federal agencies participating in such program.
(C) Underserved minority grant program
(i) In general
In carrying out the program established under subparagraph (A), the Secretary shall award grants to eligible entities—
(I)
to carry out components of the research outlined in subparagraph (B);
(II)
to integrate and build upon existing knowledge gained from comparative effectiveness research; and
(III)
to recognize and address—
(aa)
the racial and ethnic disparities in the incidence and mortality rates of prostate cancer and men with a family history of prostate cancer;
(bb)
any barriers in access to care and participation in clinical trials that are specific to racial, ethnic, and other underserved minorities and men with a family history of prostate cancer;
(cc)
outreach and educational efforts to raise awareness among the populations described in item (bb); and
(dd)
appropriate access and utilization of imaging modalities.
(ii) Eligible entity defined
In this subparagraph, the term eligible entity means any public, private, nonprofit, or for-profit organization that the Secretary determines would be capable to conduct medical research and other requirements under this paragraph and is otherwise eligible for research funding from the Federal Government.
(2) Prostate cancer advisory board
(A) In general
There is established in the Office of the Chief Scientist of the Food and Drug Administration a Prostate Cancer Scientific Advisory Board.
(B) Duties
The board established under subparagraph (A) shall be responsible for accelerating real-time sharing of the latest research data and accelerating movement of new medicines for the treatment of prostate cancer to patients.
(c) Telehealth and rural access pilot projects
(1) Establishment of pilot projects
(A) In general
The Secretary of Veterans Affairs, in cooperation with the Secretary of Defense and the Secretary of Health and Human Services (referred to in this subsection collectively as the Secretaries
) shall establish four-year telehealth pilot projects for the purpose of analyzing the clinical outcomes and cost-effectiveness associated with telehealth services in a variety of geographic areas that contain high proportions of medically underserved populations, including African Americans, Latinos or Hispanics, Asian Americans, Native Hawaiians, Pacific Islanders, American Indians, and Alaska Natives, and those in rural areas.
(B) Efficient and effective care
Pilot projects established under subparagraph (A) shall promote efficient use of specialist care through better coordination of primary care and physician extender teams in underserved areas and more effectively employ tumor boards to better counsel patients.
(2) Eligible entities
(A) In general
The Secretaries shall select eligible entities to participate in the pilot projects established under this subsection.
(B) Priority
In selecting eligible entities to participate in the pilot projects under this subsection, the Secretaries shall give priority to entities located in medically underserved areas, particularly those that include African Americans, Asian Americans, Native Hawaiians, Pacific Islanders, Latinos and Hispanics, and facilities of the Indian Health Service, including facilities operated by the Indian Health Service, tribally operated facilities, and facilities administered by an Urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)) pursuant to title V of that Act (25 U.S.C. 1651 et seq.), and those in rural areas.
(3) Evaluation
The Secretaries shall, through the pilot projects established under this subsection, evaluate—
(A)
the effective and economic delivery of care in diagnosing and treating prostate cancer with the use of telehealth services in medically underserved and Tribal areas including collaborative uses of health professionals and integration of the range of telehealth and other technologies;
(B)
the effectiveness of improving the capacity of nonmedical providers and nonspecialized medical providers to provide health services for prostate cancer in medically underserved and Tribal areas, including the exploration of innovative medical home models with collaboration between urologists, other relevant medical specialists, including oncologists, radiologists, and primary care teams, and coordination of care through the efficient use of primary care teams and physician extenders; and
(C)
the effectiveness of using telehealth services to provide prostate cancer treatment in medically underserved areas, including the use of tumor boards to facilitate better patient counseling.
(4) Report
Not later than one year after the completion of the pilot projects under this subsection, the Secretaries shall submit to Congress a report describing the outcomes of such pilot projects, including any cost savings and efficiencies realized, and providing recommendations, if any, for expanding the use of telehealth services.
(d) Education and awareness
(1) Campaign
(A) In general
The Secretary of Veterans Affairs shall develop a national education campaign for prostate cancer.
(B) Elements
The campaign developed under subparagraph (A) shall involve the use of written educational materials and public service announcements consistent with the findings of the Prostate Cancer Task Force under subsection (a) that are intended to encourage men to seek prostate cancer screening when appropriate.
(2) Racial disparities and the population of men with a family history of prostate cancer
In developing the campaign under paragraph (1), the Secretary of Veterans Affairs shall ensure that educational materials and public service announcements used in the campaign are more readily available in communities experiencing racial disparities in the incidence and mortality rates of prostate cancer and to men of any race classification with a family history of prostate cancer.
(3) Grants
In carrying out the campaign under this subsection, the Secretary of Veterans Affairs shall award grants to nonprofit private entities to enable such entities to test alternative outreach and education strategies.
(e) Authorization of appropriations
There is authorized to be appropriated to carry out this section for the period of fiscal years 2027 through 2031 an amount equal to the amount of savings for the Federal Government projected to be achieved over such period by implementation of this section.
Sec. 7003. Prostate research, imaging, and men’s education
(a) Research and development of prostate cancer imaging technologies
(1) Expansion of research
The Secretary of Health and Human Services (referred to in this section as the Secretary
), acting through the Director of the National Institutes of Health and the Administrator of the Health Resources and Services Administration, and in consultation with the Secretary of Defense, shall carry out a program to expand and intensify research to develop innovative advanced imaging technologies for prostate cancer detection, diagnosis, and treatment comparable to state-of-the-art mammography technologies.
(2) Early stage research
In implementing the program under paragraph (1), the Secretary, acting through the Administrator of the Health Resources and Services Administration, shall carry out a grant program to encourage the early stages of research in prostate imaging to develop and implement new ideas, proof of concepts, and pilot studies for high-risk technologic innovation in prostate cancer imaging that would have a high potential impact for improving patient care, including individualized care, quality of life, and cost-effectiveness.
(3) Large scale later stage research
In implementing the program under paragraph (1), the Secretary, acting through the Director of the National Institutes of Health, shall utilize the National Institute of Biomedical Imaging and Bioengineering and the National Cancer Institute for advanced stages of research in prostate imaging, including technology development and clinical trials for projects determined by the Secretary to have demonstrated promising preliminary results and proof of concept.
(4) Interdisciplinary private-public partnerships
In developing the program under paragraph (1), the Secretary, acting through the Administrator of the Health Resources and Services Administration, shall establish interdisciplinary private-public partnerships to develop and implement research strategies for expedited innovation in imaging and image-guided treatment and to conduct such research.
(5) Racial disparities
In developing the program under paragraph (1), the Secretary shall recognize and address—
(A)
the racial disparities in the incidences of prostate cancer and mortality rates with respect to such disease; and
(B)
any barriers in access to care and participation in clinical trials that are specific to racial minorities.
(6) Authorization of appropriations
(A) In general
Subject to subparagraph (B), there is authorized to be appropriated to carry out this subsection, $100,000,000 for each of fiscal years 2027 through 2031.
(B) Specific allocations
Of the amount authorized to be appropriated under subparagraph (A) for each of the fiscal years described in such subparagraph—
(i)
no less than 10 percent may be used to carry out the grant program under paragraph (2); and
(ii)
no more than 1 percent may be used to carry out paragraph (4).
(b) Public awareness and education campaign
(1) National campaign
The Secretary shall carry out a national campaign to increase the awareness and knowledge of individuals in the United States with respect to the need for prostate cancer screening and for improved detection technologies.
(2) Requirements
The national campaign conducted under this subsection shall include—
(A)
roles for the Health Resources Services Administration, the Office of Minority Health of the Department of Health and Human Services, the Centers for Disease Control and Prevention, and the Office of Minority Health and Health Equity of the Centers for Disease Control and Prevention; and
(B)
the development and distribution of written educational materials, and the development and placing of public service announcements, that are intended to encourage men to seek prostate cancer screening and to create awareness of the need for improved imaging technologies for prostate cancer screening and diagnosis, including in-vitro blood testing and imaging technologies.
(3) Racial disparities
In developing the national campaign under paragraph (1), the Secretary shall recognize and address—
(A)
the racial disparities in the incidences of prostate cancer and mortality rates with respect to such disease; and
(B)
any barriers in access to care and participation in clinical trials that are specific to racial minorities.
(4) Grants
The Secretary shall establish a program to award grants to nonprofit private entities to enable such entities to test alternative outreach and education strategies to increase the awareness and knowledge of individuals in the United States with respect to the need for prostate cancer screening and improved imaging technologies.
(5) Authorization of appropriations
There is authorized to be appropriated to carry out this subsection $10,000,000 for each of fiscal years 2027 through 2031.
(c) Improving prostate cancer screening blood tests
(1) In general
The Secretary, in coordination with the Secretary of Defense, shall support research to develop an improved prostate cancer screening blood test using in-vitro detection.
(2) Authorization of appropriations
There is authorized to be appropriated to carry out this subsection, $20,000,000 for each of fiscal years 2027 through 2031.
(d) Reporting and compliance
(1) Report and strategy
Not later than 12 months after the date of the enactment of this Act, the Secretary shall submit to Congress a report that details the strategy of the Secretary for implementing the requirements of this section and the status of such efforts.
(2) Full compliance
Not later than 36 months after the date of the enactment of this Act, and annually thereafter, the Secretary shall submit to Congress a report that—
(A)
describes the research and development and public awareness and education campaigns funded under this section;
(B)
provides evidence that projects involving high-risk, high-impact technologic innovation, proof of concept, and pilot studies are prioritized;
(C)
provides evidence that the Secretary recognizes and addresses any barriers in access to care and participation in clinical trials that are specific to racial minorities in the implementation of this section;
(D)
contains assurances that all the other provisions of this section are fully implemented; and
(E)
certifies compliance with the provisions of this section, or in the case of a Federal agency that has not complied with any of such provisions, an explanation as to such failure to comply.
Sec. 7004. Prostate cancer detection research and education
(a) Plan to develop and validate a test or tests for prostate cancer
(1) In general
The Secretary of Health and Human Services (referred to in this section as the Secretary
), acting through the Director of the National Institutes of Health, shall establish an advisory council on prostate cancer (referred to in this section as the advisory council
) to draft a plan for the development and validation of an accurate test or tests, such as biomarkers or imaging, to detect and diagnose prostate cancer.
(2) Advisory council
(A) Membership
(i) Federal members
The advisory council shall be composed of the following experts:
(I)
A designee of the Centers for Disease Control and Prevention.
(II)
A designee of the Centers for Medicare & Medicaid Services.
(III)
A designee of the Office of the Director of the National Cancer Institute.
(IV)
A designee of the Director of the Department of Defense Congressionally Directed Medical Research Programs.
(V)
A designee of the Director of the National Institute of Biomedical Imaging and Bioengineering.
(VI)
A designee of the Director of the National Institute of General Medical Sciences.
(VII)
A designee of the Director of the National Institute on Minority Health and Health Disparities.
(VIII)
A designee of the Director of the National Institutes of Health.
(IX)
A designee of the Commissioner of Food and Drugs.
(X)
A designee of the Director of the Agency for Healthcare Research and Quality.
(XI)
A designee of the Director of the Telemedicine and Advanced Technology Research Center of the Department of Defense.
(ii) Non-federal members
In addition to the members described in clause (i), the advisory council shall include 8 expert members from outside the Federal Government to be appointed by the Secretary, which shall include—
(I)
2 prostate cancer patient advocates;
(II)
2 health care providers with a range of expertise and experience in prostate cancer; and
(III)
4 leading researchers with prostate cancer-related expertise in a range of clinical disciplines.
(B) Meetings
The advisory council shall meet quarterly and such meetings shall be open to the public.
(C) Advice
The advisory council shall advise the Secretary, or the Secretary’s designee.
(D) Annual report
Not later than 1 year after the date of enactment of this Act, the advisory council shall provide to the Secretary, or the Secretary’s designee, and Congress—
(i)
an initial evaluation of all federally funded efforts in prostate cancer research relating to the development and validation of an accurate test or tests to detect and diagnose prostate cancer;
(ii)
a plan for the development and validation of a reliable test or tests for the detection and accurate diagnosis of prostate cancer; and
(iii)
a set of standards for prostate cancer screening, developed in coordination with the United States Preventive Services Task Force, to ensure that any tools for screening, detection, and diagnosis developed in accordance with the plan under clause (ii) will meet the requirements of the Task Force for recommendation as a proven preventive or diagnostic service.
(E) Termination
The advisory council shall terminate on December 31, 2028.
(3) Funding
Notwithstanding any other provision of law, the Secretary may make available $1,000,000, from any unobligated amounts appropriated to the National Institutes of Health, for each of fiscal years 2027 through 2031 to carry out this subsection.
(b) Coordination and intensification of prostate cancer research
(1) In general
The Director of the National Institutes of Health, in consultation with the Secretary of Defense, shall coordinate and intensify research in accordance with the plan provided under subsection (a)(2)(D)(ii), with particular attention provided to leveraging existing research to develop and validate a test or tests, such as biomarkers or imaging, to detect and accurately diagnose prostate cancer in order to improve quality of life for millions of individuals in the United States, and decrease health care system costs.
(2) Funding
Notwithstanding any other provision of law, the Secretary may make available $30,000,000, from any unobligated amounts appropriated to the National Institutes of Health, for each of fiscal years 2027 through 2031 to carry out this subsection.
Sec. 7005. National prostate cancer council
(a) National prostate cancer council
(1) Establishment
There is established in the Office of the Secretary of Health and Human Services (referred to in this section as the Secretary
) the National Prostate Cancer Council on Screening, Early Detection, Assessment, and Monitoring of Prostate Cancer (referred to in this section as the Council
).
(2) Purpose of the council
The Council shall—
(A)
develop and implement a national strategic plan for the accelerated creation, advancement, and testing of diagnostic tools to improve screening, early detection, assessment, and monitoring of prostate cancer, including—
(i)
early detection of aggressive prostate cancer to save lives;
(ii)
monitoring of tumor response to treatment, including recurrence and progression; and
(iii)
accurate assessment and surveillance of indolent disease to reduce unnecessary biopsies and treatment;
(B)
provide information and coordination of prostate cancer research and services across all Federal agencies;
(C)
review diagnostic tools and their overall effectiveness at screening, detecting, assessing, and monitoring of prostate cancer;
(D)
evaluate all programs in prostate cancer that are in existence on the date of enactment of this Act, including Federal budget requests and approvals and public-private partnerships;
(E)
submit an annual report to the Secretary and Congress on the creation and implementation of the national strategic plan under subparagraph (A); and
(F)
ensure the inclusion of men at high risk for prostate cancer, including men from minority ethnic and racial populations and men who are least likely to receive care, in clinical, research, and service efforts, with the purpose of decreasing health disparities.
(3) Membership
(A) Federal members
The Council shall be led by the Secretary or the Secretary’s designee and composed of the following experts:
(i)
Two representatives of the National Institutes of Health, including 1 representative of the National Institute of Biomedical Imaging and Bioengineering and 1 representative of the National Cancer Institute.
(ii)
A representative of the Centers for Disease Control and Prevention.
(iii)
A representative of the Centers for Medicare & Medicaid Services.
(iv)
A designee of the Director of the Department of Defense Congressionally Directed Medical Research Programs.
(v)
A designee of the Director of the Office of Minority Health.
(vi)
A representative of the Food and Drug Administration.
(vii)
A representative of the Agency for Healthcare Research and Quality.
(B) Non-federal members
In addition to the members described in subparagraph (A), the Council shall include 14 expert members from outside the Federal Government, which shall include—
(i)
6 prostate cancer patient advocates, including—
(I)
2 patient-survivors;
(II)
2 caregivers of prostate cancer patients; and
(III)
2 representatives from national prostate cancer disease organizations that fund research or have demonstrated experience in providing assistance to patients, families, and medical professionals, including information on health care options, education, and referral; and
(ii)
8 health care stakeholders with specific expertise in prostate cancer research in the critical areas of clinical expertise, including medical oncology, radiology, radiation oncology, urology, and pathology.
(4) Meetings
The Council shall meet quarterly and meetings shall be open to the public.
(5) Advice
The Council shall advise the Secretary, or the Secretary’s designee.
(6) Annual report
The Council shall submit annual reports, beginning not later than 1 year after the date of enactment of this Act, to the Secretary or the Secretary’s designee and to Congress. The annual report shall include—
(A)
in the first year—
(i)
an evaluation of all Federally funded efforts in prostate cancer research and gaps relating to the development and validation of diagnostic tools for prostate cancer; and
(ii)
recommendations for priority actions to expand, eliminate, coordinate, or condense programs based on the performance, mission, and purpose of the programs; and
(B)
annually thereafter for 5 years—
(i)
an outline for the development and implementation of a national research plan for creation and validation of accurate diagnostic tools to improve prostate cancer care in accordance with paragraph (1);
(ii)
roles for the National Cancer Institute, National Institute on Minority Health and Health Disparities, and the Office of Minority Health of the Department of Health and Human Services;
(iii)
an analysis of the disparities in the incidence and mortality rates of prostate cancer in men at high risk of the disease, including individuals with family history, increasing age, or African-American heritage; and
(iv)
a review of the progress towards the realization of the proposed strategic plan.
(7) Termination
The Council shall terminate on December 31, 2027.
Sec. 7006. Improved medicaid coverage for certain breast and cervical cancer patients in the territories
(a) Elimination of funding limitations
Section 1108(g)(4) of the Social Security Act (42 U.S.C. 1308(g)(4)) is amended—
(1)
by striking paragraphs (1), (2), (3), and (4) of
; and
(2)
by adding at the end the following: With respect to fiscal years beginning with fiscal year 2027, payment for medical assistance for individuals who are eligible for such assistance only on the basis of section 1902(a)(10)(A)(ii)(XVIII) shall not be taken into account in applying subsection (f) (as increased in accordance with this subsection) to Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa for such fiscal year.
.
(b) Application of enhanced fmap for highest state
Section 1905(b) of such Act (42 U.S.C. 1396d(b)) is amended by adding at the end the following: Notwithstanding the first sentence of this subsection, with respect to medical assistance described in clause (4) of such sentence that is furnished in Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa in a fiscal year, the Federal medical assistance percentage is equal to the highest such percentage applied under such clause for such fiscal year for any of the 50 States or the District of Columbia that provides such medical assistance for any portion of such fiscal year.
.
(c) Effective date
The amendments made by this section shall apply to payment for medical assistance for items and services furnished on or after October 1, 2026.
Sec. 7007. Cancer prevention and treatment demonstration for ethnic and racial minorities
(a) Demonstration
(1) In general
The Secretary of Health and Human Services (in this section referred to as the Secretary
) shall, consistent with subsection (b), conduct demonstration projects for the purpose of developing models and evaluating methods that—
(A)
improve the quality of items and services provided to target individuals in order to facilitate reduced disparities in early detection and treatment of cancer;
(B)
improve clinical outcomes, satisfaction, quality of life, appropriate use of items and services covered under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), and referral patterns with respect to target individuals with cancer;
(C)
eliminate disparities in the rate of preventive cancer screening measures, such as Pap smears, prostate cancer screenings, colon and colorectal cancer screenings, breast cancer screenings, and computed tomography scans, for lung cancer among target individuals;
(D)
promote collaboration with community-based organizations to ensure cultural competency of health care professionals and linguistic access for target individuals with limited English proficiency; and
(E)
encourage the incorporation of community health workers to increase the efficiency and appropriateness of cancer screening programs.
(2) Community health worker defined
In this section, the term community health worker includes a community health advocate, a lay health worker, a community health representative, a peer health promoter, a community health outreach worker, and a promotore de salud, who promotes health or nutrition within the community in which the individual resides.
(3) Target individual defined
In this section, the term target individual means an individual of a racial and ethnic minority group, as defined in section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 300u–6(g)(1)), who is entitled to benefits under part A, and enrolled under part B, of title XVIII of the Social Security Act.
(b) Program design
(1) Initial design
Not later than 1 year after the date of the enactment of this Act, the Secretary shall evaluate best practices in the private sector, community programs, and academic research of methods that reduce disparities among individuals of racial and ethnic minority groups in the prevention and treatment of cancer and shall design the demonstration projects based on such evaluation.
(2) Number and project areas
Not later than 2 years after the date of the enactment of this Act, the Secretary shall implement at least 9 demonstration projects, including the following:
(A)
Two projects, each of which shall target different ethnic subpopulations, for each racial and ethnic minority group described in clauses (i) through (vi) of section 1707(g)(1)(A) of the Public Health Service Act (42 U.S.C. 300u–6(g)(1)(A)).
(B)
One project within the Pacific Islands or United States insular areas.
(C)
At least 1 project in a rural area.
(D)
At least 1 project in an inner-city area.
(3) Expansion of projects; implementation of demonstration project results
The Secretary shall continue the demonstration projects and may expand the number of demonstration projects if the initial report under subsection (c) contains an evaluation that the demonstration projects—
(A)
reduce expenditures under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.); or
(B)
do not increase expenditures under such Medicare program and reduce racial and ethnic health disparities in the quality of health care services provided to target individuals and increase satisfaction of Medicare beneficiaries and health care providers.
(c) Report to congress
(1) In general
Not later than 2 years after the date the Secretary implements the initial demonstration projects under this section, and biannually thereafter, the Secretary shall submit to Congress a report regarding the demonstration projects.
(2) Content of report
Each report under paragraph (1) shall include the following:
(A)
A description of the demonstration projects.
(B)
An evaluation of—
(i)
the cost-effectiveness of the demonstration projects;
(ii)
the quality of the health care services provided to target individuals under the demonstration projects; and
(iii)
beneficiary and health care provider satisfaction under the demonstration projects.
(C)
Any other information regarding the demonstration projects that the Secretary determines to be appropriate.
(d) Waiver authority
The Secretary shall waive compliance with the requirements of title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) to such extent and for such period as the Secretary determines is necessary to conduct the demonstration projects under this section.
Sec. 7008. Reducing cancer disparities within the Medicare program
(a) Development of measures of disparities in quality of cancer care
(1) Development of measures
The Secretary of Health and Human Services (in this section referred to as the Secretary
) shall enter into an agreement with an entity that specializes in developing quality measures for cancer care under which the entity shall develop a uniform set of measures to evaluate disparities in the quality of cancer care and annually update such set of measures.
(2) Measures to be included
Such set of measures shall include, with respect to the treatment of cancer, measures of patient outcomes, the process for delivering medical care related to such treatment, patient counseling and engagement in decision making, patient experience of care, resource use, and practice capabilities, such as care coordination.
(b) Establishment of reporting process
(1) In general
The Secretary shall establish a reporting process that requires, and provides for, a method for health care providers specified under paragraph (2) to submit to the Secretary and make public data on the performance of such providers during each reporting period through use of the measures developed pursuant to subsection (a). Such data shall be submitted in a form and manner and at a time specified by the Secretary.
(2) Specification of providers to report on measures
The Secretary shall specify the classes of Medicare providers of services and suppliers, including hospitals, cancer centers, physicians, primary care providers, and specialty providers, that will be required under such process to publicly report on the measures specified under subsection (a).
(3) Assessment of changes
Under such reporting process, the Secretary shall establish a format that assesses changes in both the absolute and relative disparities in cancer care over time. These measures shall be presented in an easily comprehensible format, such as those presented in the final publications relating to Healthy People 2010 or the National Healthcare Disparities Report.
(4) Initial implementation
The Secretary shall implement the reporting process under this subsection for reporting periods beginning not later than 6 months after the date that measures are first established under subsection (a).
Subtitle B Viral hepatitis and liver cancer control and prevention
Sec. 7101. Biennial assessment of HHS hepatitis b and hepatitis c prevention, education, research, and medical management plan
Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) is amended—
(1)
by striking section 317N (42 U.S.C. 247b–15); and
(2)
by adding after part W the following:
X Biennial assessment of HHS Hepatitis B and Hepatitis C prevention, education, research, and medical management plan
399PP. Biennial update of the plan
(a) In general
The Secretary shall conduct a biennial assessment of the Secretary’s plan for the prevention, control, and medical management of, and education and research relating to, hepatitis B and hepatitis C, for the purposes of—
(1)
incorporating into such plan new knowledge or observations relating to hepatitis B and hepatitis C (such as knowledge and observations that may be derived from clinical, laboratory, and epidemiological research and disease detection, prevention, and surveillance outcomes);
(2)
addressing gaps in the coverage or effectiveness of the plan; and
(3)
evaluating and, if appropriate, updating recommendations, guidelines, or educational materials of the Centers for Disease Control and Prevention or the National Institutes of Health for health care providers or the public on viral hepatitis in order to be consistent with the plan.
(b) Publication of notice of assessments
Not later than October 1 of the first even-numbered year beginning after the date of the enactment of this part, and October 1 of each even-numbered year thereafter, the Secretary shall publish in the Federal Register a notice of the results of the assessments conducted under subsection (a). Such notice shall include—
(1)
a description of any revisions to the plan referred to in subsection (a) as a result of the assessment;
(2)
an explanation of the basis for any such revisions, including the ways in which such revisions can reasonably be expected to further promote the original goals and objectives of the plan; and
(3)
in the case of a determination by the Secretary that the plan does not need revision, an explanation of the basis for such determination.
399PP–1. Elements of program
(a) Education and awareness programs
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, the Administrator of the Health Resources and Services Administration, and the Assistant Secretary for Mental Health and Substance Use, and in accordance with the plan referred to in section 399PP(a), shall implement programs to increase awareness and enhance knowledge and understanding of hepatitis B and hepatitis C. Such programs shall include—
(1)
the conduct of culturally and linguistically appropriate health education in primary and secondary schools, college campuses, public awareness campaigns, and community outreach activities (especially to the ethnic communities with high rates of chronic hepatitis B and chronic hepatitis C and other high-risk groups) to promote public awareness and knowledge about—
(A)
the value of hepatitis A and hepatitis B immunization, including the importance of universal birth dose hepatitis B vaccination and universal childhood and adult hepatitis B vaccination;
(B)
risk factors, transmission, and prevention of hepatitis B and hepatitis C;
(C)
the value of screening for the early detection of hepatitis B and hepatitis C; and
(D)
options available for the treatment of chronic hepatitis B and chronic hepatitis C;
(2)
the promotion of immunization programs that increase awareness and access to hepatitis A and hepatitis B vaccines for susceptible adults and children;
(3)
the training of health care professionals regarding the importance of vaccinating individuals regarding the importance of hepatitis B screening in individuals infected with hepatitis C and the importance of vaccinating individuals who are at risk for hepatitis C infection against hepatitis A and hepatitis B;
(4)
the training of health care professionals regarding the importance of vaccinating individuals chronically infected with hepatitis B and individuals who are at risk for chronic hepatitis B infection against the hepatitis A virus;
(5)
the training of health care professionals and health educators to make them aware of the high rates of chronic hepatitis B and chronic hepatitis C in certain adult ethnic populations, and the importance of prevention, detection, and medical management of hepatitis B and hepatitis C and of liver cancer screening;
(6)
the development and distribution of health education curricula (including information relating to the special needs of individuals infected with or at risk of hepatitis B and hepatitis C, such as the importance of prevention and early intervention, regular monitoring, the recognition of psychosocial needs, appropriate treatment, and liver cancer screening) for individuals providing hepatitis B and hepatitis C counseling; and
(7)
support for the implementation of the curricula described in paragraph (6) by State and local public health agencies.
(b) Immunization, prevention, and control programs
(1) In general
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall support the integration of activities described in paragraph (3) into existing clinical and public health programs at State, local, territorial, and Tribal levels (including community health clinics, programs for the prevention and treatment of HIV/AIDS, sexually transmitted infections, and substance use disorder, and programs for individuals in correctional settings).
(2) Coordination of development of federal screening guidelines
(A) References
For purposes of this subsection, the term CDC Director means the Director of the Centers for Disease Control and Prevention, and the term AHRQ Director means the Director of the Agency for Healthcare Research and Quality.
(B) Agency for healthcare research and quality
Due to the rapidly evolving standard of care associated with diagnosing and treating viral hepatitis infection, the AHRQ Director shall convene the Preventive Services Task Force under section 915(a) to review its recommendation for screening for HBV and HCV infection every 3 years.
(3) Activities
(A) Voluntary testing programs
(i) In general
The Secretary shall establish a mechanism by which to support and promote the development of State, local, territorial, and Tribal voluntary hepatitis B and hepatitis C testing programs to screen the high-prevalence populations to aid in the early identification of chronically infected individuals.
(ii) Confidentiality of the test results
The Secretary shall prohibit the use of the results of a hepatitis B or hepatitis C test conducted by a testing program developed or supported under this subparagraph for any of the following:
(I)
Issues relating to health insurance.
(II)
To screen or determine suitability for employment.
(III)
To discharge a person from employment with issues relating to immigration status.
(B) Counseling regarding viral hepatitis
The Secretary shall support State, local, territorial, and Tribal programs in a wide variety of settings, including those providing primary and specialty health care services in nonprofit private and public sectors, to—
(i)
provide individuals with ongoing risk factors for hepatitis B and hepatitis C infection with client-centered education and counseling which concentrates on—
(I)
promoting testing of individuals that have been exposed to their blood, family members, and their sexual partners; and
(II)
changing behaviors that place individuals at risk for infection;
(ii)
provide individuals chronically infected with hepatitis B or hepatitis C with education, health information, and counseling to reduce their risk of—
(I)
dying from end-stage liver disease and liver cancer; and
(II)
transmitting viral hepatitis to others; and
(iii)
provide people chronically infected with hepatitis B or hepatitis C who are pregnant or of childbearing age with culturally and linguistically appropriate health information, such as how to prevent hepatitis B perinatal infection, and to alleviate fears associated with pregnancy or raising a family.
(C) Immunization
The Secretary shall support State, local, territorial, and Tribal efforts to expand the current vaccination programs to protect every child in the Nation and all susceptible adults, particularly those infected with hepatitis C and high-prevalence ethnic populations and other high-risk groups, from the risks of acute and chronic hepatitis B infection by—
(i)
ensuring continued funding for hepatitis B vaccination for all children 18 years of age or younger through the Vaccines for Children program;
(ii)
ensuring that the recommendations of the American Academy of Pediatrics and American College of Physicians are followed regarding hepatitis B vaccination for infants, children, and adults;
(iii)
requiring proof of hepatitis B vaccination for entry into public or private daycare, preschool, elementary school, secondary school, and institutions of higher education for those not infected with hepatitis B;
(iv)
expanding the availability of hepatitis B vaccination for all adults to protect them from becoming acutely or chronically infected, including ethnic and other populations with high prevalence rates of chronic hepatitis B infection;
(v)
expanding the availability of hepatitis B vaccination for all adults, particularly those of reproductive age, to protect them from the risk of hepatitis B infection;
(vi)
ensuring the vaccination of individuals infected, or at risk for infection, with hepatitis C against hepatitis A, hepatitis B, and other infectious diseases, as appropriate, for which such individuals may be at increased risk; and
(vii)
ensuring the vaccination of individuals infected, or at risk for infection, with hepatitis B against hepatitis A virus and other infectious diseases, as appropriate, for which such individuals may be at increased risk.
(D) Medical referral
The Secretary shall support State, local, territorial, and Tribal programs that support—
(i)
referral of persons chronically infected with hepatitis B or hepatitis C—
(I)
for medical evaluation to determine the appropriateness for antiviral treatment to reduce the risk of progression to cirrhosis and liver cancer; and
(II)
for ongoing medical management including regular monitoring of liver function and screening for liver cancer; and
(ii)
referral of persons infected with acute or chronic hepatitis B infection or acute or chronic hepatitis C infection for drug and alcohol abuse treatment where appropriate.
(4) Increased support for adult viral hepatitis prevention coordinators
The Secretary, acting through the CDC Director, shall provide increased support to adult viral hepatitis prevention coordinators in State, local, territorial, and Tribal health departments in order to enhance the additional management, networking, and technical expertise needed to ensure successful integration of hepatitis B and hepatitis C prevention and control activities into existing public health programs.
(c) Epidemiological surveillance
(1) In general
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall support the establishment and maintenance of a national chronic and acute hepatitis B and hepatitis C surveillance program, in order to identify—
(A)
trends in the incidence of acute and chronic hepatitis B and acute and chronic hepatitis C;
(B)
trends in the prevalence of acute and chronic hepatitis B and acute and chronic hepatitis C infection among groups that may be disproportionately affected; and
(C)
trends in liver cancer and end-stage liver disease incidence and deaths, caused by chronic hepatitis B and chronic hepatitis C in the high-risk ethnic populations.
(2) Seroprevalence and liver cancer studies
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall prepare a report outlining the population-based seroprevalence studies currently underway, future planned studies, the criteria involved in determining which seroprevalence studies to conduct, defer, or suspend, and the scope of those studies, the economic and clinical impact of hepatitis B and hepatitis C, and the impact of chronic hepatitis B and chronic hepatitis C infections on the quality of life. Not later than one year after the date of the enactment of this part, the Secretary shall submit the report to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives.
(3) Confidentiality
The Secretary shall not disclose any individually identifiable information identified under paragraph (1) or derived through studies under paragraph (2).
(d) Research
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, the Director of the National Cancer Institute, and the Director of the National Institutes of Health, shall—
(1)
conduct epidemiologic and community-based research to develop, implement, and evaluate best practices for hepatitis B and hepatitis C prevention especially in the ethnic populations with high rates of chronic hepatitis B and chronic hepatitis C and other high-risk groups;
(2)
conduct research on hepatitis B and hepatitis C natural history, pathophysiology, improved treatments and prevention (such as the hepatitis C vaccine), and noninvasive tests that help to predict the risk of progression to liver cirrhosis and liver cancer;
(3)
conduct research that will lead to better noninvasive or blood tests to screen for liver cancer, and more effective treatments of liver cancer caused by chronic hepatitis B and chronic hepatitis C; and
(4)
conduct research comparing the effectiveness of screening, diagnostic, management, and treatment approaches for chronic hepatitis B, chronic hepatitis C, and liver cancer in the affected communities.
(e) Underserved and disproportionately affected populations
In carrying out this section, the Secretary shall provide expanded support for individuals with limited access to health education, testing, and health care services and groups that may be disproportionately affected by hepatitis B and hepatitis C.
(f) Evaluation of program
The Secretary shall develop benchmarks for evaluating the effectiveness of the programs and activities conducted under this section and make determinations as to whether such benchmarks have been achieved.
399PP–2. Grants
(a) In general
The Secretary may award grants to, or enter into contracts or cooperative agreements with, States, political subdivisions of States, territories, Indian Tribes, or nonprofit entities that have special expertise relating to hepatitis B, hepatitis C, or both, to carry out activities under this part.
(b) Application
To be eligible for a grant, contract, or cooperative agreement under subsection (a), an entity shall prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
399PP–3. Authorization of appropriations
There are authorized to be appropriated to carry out this part $90,000,000 for fiscal year 2027, $110,000,000 for fiscal year 2028, $130,000,000 for fiscal year 2029, and $150,000,000 for fiscal year 2030.
Sec. 7102. Liver cancer and disease prevention, awareness, and patient tracking grants
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:
330Q. Liver cancer and disease prevention, awareness, and patient tracking grants
(a) Prevention initiative grant program
(1) In general
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, may award grants and enter into cooperative agreements with entities for the purpose of expanding and supporting—
(A)
prevention activities (including providing screenings, vaccinations, or other preventative interventions) for conditions known to increase an individual’s risk of developing a major liver disease, such as liver cancer, hepatitis B, hepatitis C, nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and cirrhosis of the liver;
(B)
activities relating to detection and provision of guidance for individuals at high risk for contracting liver cancer and other liver diseases; and
(C)
viral hepatitis surveillance to provide for timely and accurate information regarding progress to eliminate viral hepatitis.
(2) Report
An entity that receives a grant or cooperative agreement under paragraph (1) shall submit to the Secretary, at a time specified by the Secretary, a report describing each activity carried out pursuant to such paragraph and evaluating the effectiveness of such activity in promoting prevention and treatment of liver cancer and other liver diseases.
(3) Authorization of appropriations
For purposes of carrying out this subsection, there is authorized to be appropriated $90,000,000 for each of fiscal years 2027 through 2031.
(b) Awareness initiative grant program
(1) In general
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, may award grants to eligible entities for the purpose of raising awareness for liver cancer and other liver diseases, which may include the production, dissemination, and distribution of informational materials targeted towards communities and populations with a higher risk for developing liver cancer and other liver diseases.
(2) Eligible entities
To be eligible to receive a grant under paragraph (1), an entity shall submit to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require, including a description of how the entity, in disseminating information on liver cancer and other liver diseases pursuant to paragraph (1), will—
(A)
with respect to any community or population, consult with members of such community or population and provide such information in a manner that is culturally and linguistically appropriate for such community or population;
(B)
highlight the range of preventative measures and treatments available for liver cancer and other liver diseases;
(C)
integrate information on available hepatitis B and hepatitis C testing programs into any liver cancer presentations carried out by the entity; and
(D)
address communities and populations with a higher risk for contracting liver cancer and other liver diseases.
(3) Preference
In awarding grants under paragraph (1), the Secretary shall give preference to entities that—
(A)
work with a Federally qualified health center;
(B)
are community-based organizations; or
(C)
serve communities and populations with a higher risk for contracting liver cancer and other liver diseases.
(4) Report
An entity that receives a grant under paragraph (1) shall submit to the Secretary, at a time specified by the Secretary, a report describing each activity carried out pursuant to such paragraph and evaluating the effectiveness of such activity in raising awareness for liver cancer and other liver diseases.
(5) Authorization of appropriations
For purposes of carrying out this subsection, there is authorized to be appropriated $10,000,000 for each of fiscal years 2027 through 2031.
Subtitle C Acquired bone marrow failure diseases
Sec. 7201. Acquired bone marrow failure diseases
(a) National acquired bone marrow failure disease registry
Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) is amended by inserting after section 317W, as added by section 1009, the following:
317X. National Acquired Bone Marrow Failure Disease Registry
(a) Establishment of registry
(1) In general
Not later than 6 months after the date of the enactment of this section, the Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall—
(A)
develop a system to collect data on acquired bone marrow failure diseases; and
(B)
establish and maintain a national and publicly available registry, to be known as the National Acquired Bone Marrow Failure Disease Registry, in accordance with paragraph (3).
(2) Recommendations of advisory committee
In carrying out this subsection, the Secretary shall take into consideration the recommendations of the Advisory Committee on Acquired Bone Marrow Failure Diseases established under subsection (b).
(3) Purposes of registry
The National Acquired Bone Marrow Failure Disease Registry shall—
(A)
identify the incidence and prevalence of acquired bone marrow failure diseases in the United States;
(B)
be used to collect and store data on acquired bone marrow failure diseases, including data concerning—
(i)
the age, race or ethnicity, general geographic location, sex, and family history of individuals who are diagnosed with acquired bone marrow failure diseases, and any other characteristics of such individuals determined appropriate by the Secretary;
(ii)
the genetic and environmental factors that may be associated with developing acquired bone marrow failure diseases;
(iii)
treatment approaches for dealing with acquired bone marrow failure diseases;
(iv)
outcomes for individuals treated for acquired bone marrow failure diseases, including outcomes for recipients of stem cell therapeutic products as contained in the database established pursuant to section 379A; and
(v)
any other factors pertaining to acquired bone marrow failure diseases determined appropriate by the Secretary; and
(C)
be made available—
(i)
to the general public; and
(ii)
to researchers to facilitate further research into the causes of, and treatments for, acquired bone marrow failure diseases in accordance with standard practices of the Centers for Disease Control and Prevention.
(b) Advisory committee
(1) Establishment
Not later than 6 months after the date of the enactment of this section, the Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall establish an advisory committee, to be known as the Advisory Committee on Acquired Bone Marrow Failure Diseases.
(2) Members
The members of the Advisory Committee on Acquired Bone Marrow Failure Diseases shall be appointed by the Secretary, acting through the Director of the Centers for Disease Control and Prevention, and shall include at least one representative from each of the following:
(A)
A national patient advocacy organization with experience advocating on behalf of patients suffering from acquired bone marrow failure diseases.
(B)
The National Institutes of Health, including at least one representative from each of—
(i)
the National Cancer Institute;
(ii)
the National Heart, Lung, and Blood Institute; and
(iii)
the Office of Rare Diseases.
(C)
The Centers for Disease Control and Prevention.
(D)
Clinicians with experience in—
(i)
diagnosing or treating acquired bone marrow failure diseases; or
(ii)
medical data registries.
(E)
Epidemiologists who have experience with data registries.
(F)
Publicly or privately funded researchers who have experience researching acquired bone marrow failure diseases.
(G)
The entity operating the C.W. Bill Young Cell Transplantation Program established pursuant to section 379 and the entity operating the C.W. Bill Young Cell Transplantation Program Outcomes Database.
(3) Responsibilities
The Advisory Committee on Acquired Bone Marrow Failure Diseases shall provide recommendations to the Secretary on the establishment and maintenance of the National Acquired Bone Marrow Failure Disease Registry, including recommendations on the collection, maintenance, and dissemination of data.
(4) Public availability
The Secretary shall make the recommendations of the Advisory Committee on Acquired Bone Marrow Failure Disease publicly available.
(c) Grants
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, may award grants to, and enter into contracts and cooperative agreements with, public or private nonprofit entities for the management of, as well as the collection, analysis, and reporting of data to be included in, the National Acquired Bone Marrow Failure Disease Registry.
(d) Definition
In this section, the term acquired bone marrow failure disease means—
(1)
myelodysplastic syndromes;
(2)
aplastic anemia;
(3)
paroxysmal nocturnal hemoglobinuria;
(4)
pure red cell aplasia;
(5)
acute myeloid leukemia that has progressed from myelodysplastic syndromes; or
(6)
large granular lymphocytic leukemia.
(e) Authorization of appropriations
There is authorized to be appropriated to carry out this section $3,000,000 for each of fiscal years 2027 through 2031.
(b) Pilot studies through the agency for toxic substances and disease registry
(1) Pilot studies
The Secretary of Health and Human Services, acting through the Director of the Agency for Toxic Substances and Disease Registry, shall conduct pilot studies to determine which environmental factors, including exposure to toxins, may cause acquired bone marrow failure diseases.
(2) Collaboration with the radiation injury treatment network
In carrying out the directives of this section, the Secretary of Health and Human Services may collaborate with the Radiation Injury Treatment Network of the C.W. Bill Young Cell Transplantation Program established pursuant to section 379 of the Public Health Service Act (42 U.S.C. 274k) to—
(A)
augment data for the pilot studies authorized by this section;
(B)
access technical assistance that may be provided by the Radiation Injury Treatment Network; or
(C)
perform joint research projects.
(3) Authorization of appropriations
There is authorized to be appropriated to carry out this subsection $1,000,000 for each of fiscal years 2027 through 2031.
(c) Minority-Focused programs on acquired bone marrow failure diseases
Title XVII of the Public Health Service Act (42 U.S.C. 300u et seq.) is amended by inserting after section 1707A the following:
1707B. Minority-focused programs on acquired bone marrow failure disease
(a) Information and referral services
(1) In general
Not later than 6 months after the date of the enactment of this section, the Secretary, acting through the Deputy Assistant Secretary for Minority Health, shall establish and coordinate outreach and informational programs targeted to minority populations affected by acquired bone marrow failure diseases.
(2) Program requirements
Minority-focused outreach and informational programs authorized by this section at the National Minority Health Resource Center supported under section 1707(b)(8) (including by means of the Center’s website, through appropriate locations such as the Center’s knowledge center, and through appropriate programs such as the Center’s resource persons network) and through minority health consultants located at each Department of Health and Human Services regional office—
(A)
shall make information about treatment options and clinical trials for acquired bone marrow failure diseases publicly available; and
(B)
shall provide referral services for treatment options and clinical trials.
(b) Hispanic and asian-American and pacific islander outreach
(1) In general
The Secretary, acting through the Deputy Assistant Secretary for Minority Health, shall undertake a coordinated outreach effort to connect Hispanic, Asian-American, and Pacific Islander communities with comprehensive services focused on treatment of, and information about, acquired bone marrow failure diseases.
(2) Collaboration
In carrying out this subsection, the Secretary may collaborate with public health agencies, nonprofit organizations, community groups, and online entities to disseminate information about treatment options and clinical trials for acquired bone marrow failure diseases.
(c) Grants and cooperative agreements
(1) In general
Not later than 6 months after the date of the enactment of this section, the Secretary, acting through the Deputy Assistant Secretary for Minority Health, shall award grants to, or enter into cooperative agreements with, entities to perform research on acquired bone marrow failure diseases.
(2) Requirement
Grants and cooperative agreements authorized by this subsection shall be awarded or entered into on a competitive, peer-reviewed basis.
(3) Scope of research
Research funded under this subsection shall examine factors affecting the incidence of acquired bone marrow failure diseases in minority populations.
(d) Definition
In this section, the term acquired bone marrow failure disease has the meaning given to such term in section 317X(d).
(e) Authorization of appropriations
There is authorized to be appropriated to carry out this section $2,000,000 for each of fiscal years 2027 through 2031.
(d) Diagnosis and quality of care for acquired bone marrow failure diseases
(1) Grants
The Secretary of Health and Human Services, acting through the Director of the Agency for Healthcare Research and Quality, shall award grants to entities to improve diagnostic practices and quality of care with respect to patients with acquired bone marrow failure diseases.
(2) Authorization of appropriations
There is authorized to be appropriated to carry out this subsection $2,000,000 for each of fiscal years 2027 through 2031.
(e) Definition
In this section, the term acquired bone marrow failure disease has the meaning given such term in section 317X(d) of the Public Health Service Act, as added by subsection (a).
Subtitle D Cardiovascular disease, chronic disease, obesity, and other disease issues
Sec. 7301. Guidelines for disease screening for minority patients
(a) In general
The Secretary of Health and Human Services (in this section referred to as the Secretary
), acting through the Director of the Agency for Healthcare Research and Quality, shall convene a series of meetings to develop guidelines for disease screening for minority patient populations that have a higher than average risk for many chronic diseases and cancers.
(b) Participants
In convening meetings under subsection (a), the Secretary shall ensure that meeting participants include representatives of—
(1)
professional societies and associations;
(2)
minority health organizations;
(3)
health care researchers and providers, including those with expertise in minority health;
(4)
Federal health agencies, including the Office of Minority Health, the National Institute on Minority Health and Health Disparities, and the National Institutes of Health; and
(5)
other experts as the Secretary determines appropriate.
(c) Diseases
Screening guidelines for minority populations shall be developed as appropriate under subsection (a) for—
(1)
hypertension;
(2)
hypercholesterolemia;
(3)
diabetes;
(4)
cardiovascular disease;
(5)
cancers, including breast, prostate, colon, cervical, and lung cancer;
(6)
other pulmonary problems including sleep apnea;
(7)
asthma;
(8)
kidney diseases;
(9)
eye diseases and disorders, including glaucoma;
(10)
HIV/AIDS and sexually transmitted infections;
(11)
uterine fibroids;
(12)
autoimmune diseases, including lupus;
(13)
mental health conditions;
(14)
dental health conditions and oral diseases, including oral cancer;
(15)
environmental and related health illnesses and conditions;
(16)
sickle cell disease and sickle cell trait;
(17)
violence and injury prevention and control;
(18)
genetic and related conditions;
(19)
heart disease and stroke;
(20)
tuberculosis;
(21)
chronic obstructive pulmonary disease;
(22)
musculoskeletal diseases, arthritis, and obesity; and
(23)
other diseases determined appropriate by the Secretary.
(d) Dissemination
Not later than 2 years after the date of enactment of this Act, the Secretary shall publish and disseminate to health care provider organizations the guidelines developed under subsection (a).
(e) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
Sec. 7302. Cdc wisewoman screening program
Section 1509 of the Public Health Service Act (42 U.S.C. 300n–4a) is amended—
(1)
in subsection (a)—
(A)
by striking the heading and inserting In general
; and
(B)
in the matter preceding paragraph (1), by striking may make grants
and all that follows through purpose
and inserting the following: may make grants to such States for the purpose
; and
(2)
in subsection (d)(1), by striking there are authorized
and all that follows through the period and inserting there are authorized to be appropriated $23,000,000 for fiscal year 2027, $25,300,000 for fiscal year 2028, $27,800,000 for fiscal year 2029, $30,800,000 for fiscal year 2030, and $34,000,000 for fiscal year 2031.
.
Sec. 7303. Report on cardiovascular care for women and minorities
Part P of title III of the Public Health Service Act (42 U.S.C. 280g et seq.), as amended by section 5201(c)(3), is amended by adding at the end the following:
399V–10. Report on cardiovascular care for women and minorities
Not later than September 30, 2027, and annually thereafter, the Secretary shall prepare and submit to Congress a report on the quality of and access to care for women and minorities with heart disease, stroke, and other cardiovascular diseases. The report shall contain recommendations for eliminating disparities in, and improving the treatment of, heart disease, stroke, and other cardiovascular diseases in women, racial and ethnic minorities, those for whom English is not their primary language, and individuals with disabilities.
Sec. 7304. GAO report on structural and systemic factors that perpetuate cardiovascular disparities
(a) In general
Not later than September 30, 2027, the Comptroller General of the United States shall prepare and submit a report to Congress that contains the results of an investigation of—
(1)
the structural and systemic factors that perpetuate disparities in access to screenings, care, and treatment of cardiovascular disease; and
(2)
how care navigation, including community-based health workers, can improve cardiovascular disease management and improve health outcomes.
(b) Contents
The report shall—
(1)
identify the challenges and barriers facing health care providers and patients, which contribute to postponed, delayed, or suboptimal treatments for cardiovascular disease;
(2)
examine efforts by Federal agencies and Federal programs to improve screening and management of patients with cardiovascular disease;
(3)
identify and examine existing quality measures from the Centers for Medicare & Medicaid Services related to cholesterol management and whether these measures encourage providers and health systems to—
(A)
perform appropriate and timely low-density-lipoprotein cholesterol (LDL-C) testing on patients at risk of a cardiovascular event; and
(B)
better manage patients’ elevated LDL-C levels in concordance with clinical guidelines prescribing directives to ensure patients are progressing towards guideline-recommended LDL-C levels;
(4)
identify actions the Federal Government could take to promote collaboration with community-based organizations to ensure improvement in clinical outcomes for patients with cardiovascular disease, including by building on recommendations from the National Academy of Medicine and the Centers for Disease Control to include community health workers to improve health care delivery for underserved and high-risk communities; and
(5)
assess whether racial and ethnic minority groups, as defined in section 1707(g) of the Public Health Service Act (42 U.S.C. 300g–6(g)), have higher prior authorization rejection rates of prescription drugs to treat or prevent cardiovascular disease by health insurance providers and, if so, identify the resulting impacts on cardiovascular disease medication adherence, morbidity, and mortality, as well as resulting postponed, delayed, or suboptimal treatment prescribing for cardiovascular disease among racial and ethnic minorities.
Sec. 7305. Coverage of comprehensive tobacco cessation services in medicaid, chip, and private health insurance
(a) Requiring medicaid coverage of counseling and pharmacotherapy for cessation of tobacco use and temporary enhanced FMAP for coverage of tobacco cessation services
Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by section 5201(b)(2)(A)(i), is amended—
(1)
in subsection (a)(4), by striking (D)
and all that follows through subsection (bb))
and inserting the following: (D) counseling and pharmacotherapy for cessation of tobacco use by individuals who are eligible under the State plan (as defined in subsection (bb))
;
(2)
in subsection (b), by inserting (bb)(2),
after (aa),
; and
(3)
by striking subsection (bb) and inserting the following:
(bb) Counseling and pharmacotherapy for cessation of tobacco use
(1) In general
For purposes of this title, the term counseling and pharmacotherapy for cessation of tobacco use by individuals who are eligible under the State plan means diagnostic, therapy, and counseling services and pharmacotherapy (including the coverage of prescription and nonprescription tobacco cessation agents approved by the Food and Drug Administration) for the cessation of tobacco use by individuals who use tobacco products or who are being treated for tobacco use that is furnished—
(A)
by or under the supervision of a physician; or
(B)
by any other health care professional who—
(i)
is legally authorized to furnish such services under State law (or the State regulatory mechanism provided by State law) of the State in which the services are furnished; and
(ii)
is authorized to receive payment for other services under this title or is designated by the Secretary for this purpose, which is recommended in the guideline entitled,
Treating Tobacco Use and Dependence: 2008 Update: A Clinical Practice Guidelinepublished by the Public Health Service in May 2008 (or any subsequent modification of such guideline) or is recommended for the cessation of tobacco use by the United States Preventive Services Task Force or any additional intervention approved by the Food and Drug Administration as safe and effective in helping smokers quit.(2) Temporary enhanced fmap for coverage of tobacco cessation services
Notwithstanding subsection (b), for calendar quarters occurring during the period beginning on the date of the enactment of this paragraph and ending 5 years after the date of enactment of this paragraph, the Federal medical assistance percentage with respect to amounts expended by a State for medical assistance for counseling and pharmacotherapy for cessation of tobacco use by individuals who are eligible under the State plan (as defined in paragraph (1)) shall be equal to 90 percent.
(b) No cost sharing
(1) In general
Subsections (a)(2) and (b)(2) of section 1916 of the Social Security Act (42 U.S.C. 1396o), as amended by section 2007(d)(4), are each amended—
(A)
in subparagraph (B), by striking , and counseling
and all that follows through section 1905(bb)(2)(A)
;
(B)
in subparagraph (J), by striking or
after the comma;
(C)
in subparagraph (K), by striking ; and
and inserting , or
; and
(D)
by adding at the end the following new subparagraph:
(L)
counseling and pharmacotherapy for cessation of tobacco use by individuals who are eligible under the State plan (as defined in section 1905(bb)) and covered outpatient drugs (as defined in subsection (k)(2) of section 1927 and including nonprescription drugs described in subsection (d)(2) of such section) that are prescribed for purposes of promoting tobacco cessation in accordance with the guideline specified in section 1905(bb); and
(2) Application to alternative cost sharing
Section 1916A(b)(3)(B) of the Social Security Act (42 U.S.C. 1396o–1(b)(3)(B)) is amended—
(A)
in clause (iii), by striking , and counseling and pharmacotherapy for cessation of tobacco use by pregnant women (as defined in section 1905(bb))
; and
(B)
by adding at the end the following new clause:
(xv)
Counseling and pharmacotherapy for cessation of tobacco use by individuals who are eligible under the State plan (as defined in section 1905(bb)) and covered outpatient drugs (as defined in subsection (k)(2) of section 1927 and including nonprescription drugs described in subsection (d)(2) of such section) that are prescribed for purposes of promoting tobacco cessation in accordance with the guideline specified in section 1905(bb).
(c) Exception from optional restriction under medicaid prescription drug coverage
Section 1927(d)(2)(F) of the Social Security Act (42 U.S.C. 1396r–8(d)(2)(F)) is amended to read as follows:
(F)
Nonprescription drugs, except, when recommended in accordance with the guideline referred to in section 1905(bb), agents approved by the Food and Drug Administration under the over-the-counter monograph process for purposes of promoting tobacco cessation.
(d) State monitoring and promoting of comprehensive tobacco cessation services under medicaid
Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)), as amended by section 5201(c)(2)(B), is amended—
(1)
in paragraph (90)(C), by striking and
at the end;
(2)
in paragraph (91), by striking the period at the end and inserting ; and
; and
(3)
by inserting after paragraph (91) the following new paragraph:
(92)
provide that the State will monitor and promote the use of comprehensive tobacco cessation services under the State plan (including conducting an outreach campaign to increase awareness of the benefits of using such services) among—
(A)
individuals entitled to medical assistance under the State plan who use tobacco products; and
(B)
clinicians and others who provide services to individuals entitled to medical assistance under the State plan.
(e) Federal reimbursement for outreach campaign
Section 1903(a) of the Social Security Act (42 U.S.C. 1396b(a)) is amended—
(1)
in paragraph (6)(B), by striking plus
at the end;
(2)
in paragraph (7), by striking the period at the end and inserting ; plus
; and
(3)
by inserting after paragraph (7) the following new paragraph:
(8)
with respect to the development, implementation, and evaluation of an outreach campaign to—
(A)
increase awareness of comprehensive tobacco cessation services covered in the State plan among—
(i)
individuals who are likely to be eligible for medical assistance under the State plan; and
(ii)
clinicians and others who provide services to individuals who are likely to be eligible for medical assistance under the State plan; and
(B)
increase awareness of the benefits of using comprehensive tobacco cessation services covered in the State plan among—
(i)
individuals who are likely to be eligible for medical assistance under the State plan; and
(ii)
clinicians and others who provide services to individuals who are likely to be eligible for medical assistance under the State plan about the benefits of using comprehensive tobacco cessation services, for calendar quarters occurring during the period beginning on the date of the enactment of this paragraph and ending on the date that is 5 years after the date of enactment of this paragraph, an amount equal to 90 percent of the sums expended during each quarter which are attributable to such development, implementation, and evaluation, and for calendar quarters succeeding such period, an amount equal to Federal medical assistance percentage determined under section 1905(b) of the sums expended during each quarter which are so attributable.
(f) No prior authorization for tobacco cessation drugs under medicaid
Section 1927(d) of the Social Security Act (42 U.S.C. 1396r–8(d)) is amended—
(1)
in paragraph (1)(A), by striking A State
and inserting Subject to paragraph (8), a State
; and
(2)
by adding at the end the following new paragraph:
(8) No prior authorization programs for tobacco cessation drugs
A State plan may not require, as a condition of coverage or payment for a covered outpatient drug, the approval of an agent to promote smoking cessation (including agents approved by the Food and Drug Administration) or tobacco cessation.
(g) Exclusion of enhanced payments from territorial caps
Notwithstanding any other provision of law, for purposes of section 1108 of the Social Security Act (42 U.S.C. 1308), with respect to any additional amount paid to a territory as a result of the application of section 1905(bb)(2) of the Social Security Act (42 U.S.C. 1396d(bb)(2))—
(1)
the limitation on payments to territories under subsections (f) and (g) of such section 1108 shall not apply to such additional amounts; and
(2)
such additional amounts shall be disregarded in applying such subsections.
(h) Requiring CHIP coverage of counseling and pharmacotherapy for cessation of tobacco use
(1) In general
Section 2103(c)(2) of the Social Security Act (42 U.S.C. 1397cc(c)(2)) is amended by adding at the end the following new subparagraph:
(D)
Counseling and pharmacotherapy for cessation of tobacco use by individuals who are eligible under the State child health plan.
(2) Counseling and pharmacotherapy for cessation of tobacco use defined
Section 2110(c) of the Social Security Act (42 U.S.C. 1397jj(c)) is amended by adding at the end the following new paragraph:
(10) Counseling and pharmacotherapy for cessation of tobacco use
The term counseling and pharmacotherapy for cessation of tobacco use means diagnostic, therapy, and counseling services and pharmacotherapy (including the coverage of prescription and nonprescription tobacco cessation agents approved by the Food and Drug Administration) for the cessation of tobacco use by individuals who use tobacco products or who are being treated for tobacco use that are furnished—
(A)
by or under the supervision of a physician; or
(B)
by any other health care professional who—
(i)
is legally authorized to furnish such services under State law (or the State regulatory mechanism provided by State law) of the State in which the services are furnished; and
(ii)
is authorized to receive payment for other services under this title or is designated by the Secretary for this purpose, which is recommended in the guideline entitled,
Treating Tobacco Use and Dependence: 2008 Update: A Clinical Practice Guidelinepublished by the Public Health Service in May 2008 (or any subsequent modification of such guideline) or is recommended for the cessation of tobacco use by the United States Preventive Services Task Force or any additional intervention approved by the Food and Drug Administration as safe and effective in helping smokers quit.
(i) No cost sharing
Section 2103(e) of the Social Security Act (42 U.S.C. 1397cc(e)) is amended by adding at the end the following new paragraph:
(5) No cost sharing on benefits for counseling and pharmacotherapy for cessation of tobacco use
The State child health plan may not impose deductibles, coinsurance, or other cost sharing with respect to benefits for counseling and pharmacotherapy for cessation of tobacco use (as defined in section 2110(c)(10)) and prescription drugs that are covered under a State child health plan that are prescribed for purposes of promoting tobacco cessation in accordance with the guideline specified in section 2110(c)(10)(B).
(j) Exception from optional restriction under CHIP prescription drug coverage
Section 2103 of the Social Security Act (42 U.S.C. 1397cc) is amended by adding at the end the following new subsection:
(g) Exception from optional restriction under CHIP prescription drug coverage
The State child health plan may exclude or otherwise restrict nonprescription drugs, except, in the case of—
(1)
pregnant women when recommended in accordance with the guideline specified in section 2110(c)(10)(B), agents approved by the Food and Drug Administration under the over-the-counter monograph process for purposes of promoting tobacco cessation; and
(2)
individuals who are eligible under the State child health plan when recommended in accordance with the Guideline referred to in section 2110(c)(10)(B), agents approved by the Food and Drug Administration under the over-the-counter monograph process for purposes of promoting tobacco cessation.
(k) State monitoring and promoting of comprehensive tobacco cessation services under CHIP
Section 2102 of the Social Security Act (42 U.S.C. 1397bb) is amended by adding at the end the following new subsection:
(e) State monitoring and promoting of comprehensive tobacco cessation services under CHIP
A State child health plan shall include a description of the procedures to be used by the State to monitor and promote the use of comprehensive tobacco cessation services under the State plan (including conducting an outreach campaign to increase awareness of the benefits of using such services) among—
(1)
individuals entitled to medical assistance under the State child health plan who use tobacco products; and
(2)
clinicians and others who provide services to individuals entitled to medical assistance under the State child health plan.
(l) Federal reimbursement for CHIP coverage and outreach campaign
(1) In general
Section 2105(a) of the Social Security Act (42 U.S.C. 1397ee(a)) is amended by adding at the end the following new paragraph:
(5) Federal reimbursement for CHIP coverage of comprehensive tobacco cessation services and outreach campaign
In addition to the payments made under paragraph (1) for calendar quarters occurring during the period beginning on the date of the enactment of this paragraph and ending 5 years after such date, the Secretary shall pay—
(A)
an amount equal to 90 percent of the sums expended during each quarter which are attributable to the cost of furnishing counseling and pharmacotherapy for cessation of tobacco use by individuals who are eligible under the State child health plan (net of any payments made to the State under paragraph (1) with respect to such counseling and pharmacotherapy); plus
(B)
an amount equal to 90 percent of the sums expended during each quarter which are attributable to the development, implementation, and evaluation of an outreach campaign to—
(i)
increase awareness of comprehensive tobacco cessation services covered in the State child health plan among—
(I)
individuals who are likely to be eligible for medical assistance under the State child health plan; and
(II)
clinicians and others who provide services to individuals who are likely to be eligible for medical assistance under the State child health plan; and
(ii)
increase awareness of the benefits of using comprehensive tobacco cessation services covered in the State child health plan among—
(I)
individuals who are likely to be eligible for medical assistance under the State child health plan; and
(II)
clinicians and others who provide services to individuals who are likely to be eligible for medical assistance under the State child health plan about the benefits of using comprehensive tobacco cessation services.
(2) Adjustment of CHIP allotments
Section 2104(m) of the Social Security Act (42 U.S.C. 1397dd(m)) is amended—
(A)
in paragraph (2)(B), by striking and (12)
and inserting (12), and (13)
; and
(B)
by adding at the end the following new paragraph:
(13) Adjusting allotments to account for federal payments for chip coverage of comprehensive tobacco cessation services and outreach campaign
If a State (including the District of Columbia and each commonwealth and territory) receives a payment for a fiscal year under section 2105(a)(5), the allotment determined for the State for such fiscal year shall be increased by the amount of such payment.
(m) No prior authorization for tobacco cessation drugs under CHIP
Section 2103 of the Social Security Act (42 U.S.C. 1397cc), as amended by subsection (h), is further amended—
(1)
in subsection (c)(2)(A), by inserting (in accordance with subsection (h))
after Coverage of prescription drugs
; and
(2)
by adding at the end the following new subsection:
(h) No prior authorization programs for tobacco cessation drugs
A State child health plan may not require, as a condition of coverage or payment for prescription drugs, the approval of an agent to promote smoking cessation (including agents approved by the Food and Drug Administration) or tobacco cessation.
(n) Comprehensive coverage of tobacco cessation coverage in private health insurance
Section 2713 of the Public Health Service Act (42 U.S.C. 300gg–13) is amended by adding at the end the following:
(d) No prior authorization
A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not impose any prior authorization requirement for tobacco cessation counseling and pharmacotherapy that has in effect a rating of
AorBin the current recommendations of the United States Preventive Services Task Force.
(o) Rule of construction
None of the amendments made by this section shall be construed to limit coverage of any counseling or pharmacotherapy for individuals under 18 years of age.
(p) Effective date
The amendments made by this section shall take effect on the first day of the first fiscal year that begins on or after the date of enactment of this Act.
Sec. 7306. Clinical research funding for oral health
(a) In general
The Secretary of Health and Human Services shall expand and intensify the conduct and support of the research activities of the National Institutes of Health and the National Institute of Dental and Craniofacial Research to improve the oral health of the population through the prevention and management of oral diseases and conditions.
(b) Included research activities
Research activities under subsection (a) shall include—
(1)
comparative effectiveness research and clinical disease management research addressing early childhood cancer and oral cancer; and
(2)
awarding of grants and contracts to support the training and development of health services researchers, comparative effectiveness researchers, and clinical researchers whose research improves the oral health of the population.
Sec. 7307. Guide on evidence-based strategies for public health department obesity prevention programs
(a) Development and dissemination of an evidence-Based strategies guide
The Secretary of Health and Human Services (referred to in this section as the Secretary
), acting through the Director of the Centers for Disease Control and Prevention, not later than 2 years after the date of enactment of this Act, shall—
(1)
develop a guide on evidence-based strategies for State, territorial, and local health departments to use to build and maintain effective obesity prevention and reduction programs, and, in consultation with stakeholders that have expertise in Tribal health, a guide on such evidence-based strategies with respect to Indian Tribes and Tribal organizations for such Indian Tribes and Tribal organizations to use for such purpose, both of which guides shall—
(A)
describe an integrated program structure for implementing interventions proven to be effective in preventing and reducing the incidence of obesity; and
(B)
recommend—
(i)
optimal resources, including staffing and infrastructure, for promoting nutrition and obesity prevention and reduction; and
(ii)
strategies for effective obesity prevention programs for State and local health departments, Indian Tribes, and Tribal organizations, including strategies related to—
(I)
the application of evidence-based and evidence-informed practices to prevent and reduce obesity rates;
(II)
the development, implementation, and evaluation of obesity prevention and reduction strategies for specific communities and populations;
(III)
demonstrated knowledge of obesity prevention practices that reduce associated preventable diseases, health conditions, death, and health care costs;
(IV)
best practices for the coordination of efforts to prevent and reduce obesity and related chronic diseases;
(V)
addressing the underlying risk factors and social determinants of health that impact obesity rates; and
(VI)
interdisciplinary coordination between relevant public health officials specializing in fields such as nutrition, physical activity, epidemiology, communications, and policy implementation, and collaboration between public health officials and community-based organizations; and
(2)
disseminate the guides and current research, evidence-based practices, tools, and educational materials related to obesity prevention, consistent with the guides, to State and local health departments, Indian Tribes, and Tribal organizations.
(b) Technical assistance
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall provide technical assistance to State and local health departments, Indian Tribes, and Tribal organizations to support such health departments in implementing the guides developed under subsection (a)(1).
(c) Indian tribes; tribal organizations
In this section, the terms Indian Tribe and Tribal organization have the meanings given the terms in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304).
Sec. 7308. Stephanie Tubbs Jones Uterine Fibroid Research and Education Act
(a) Research with respect to uterine fibroids
(1) Research
The Secretary of Health and Human Services (referred to in this section as the Secretary
) shall expand, intensify, and coordinate programs for the conduct and support of research with respect to uterine fibroids.
(2) Administration and coordination
The Secretary shall carry out the conduct and support of research pursuant to paragraph (1), in coordination with the appropriate institutes, offices, and centers of the National Institutes of Health and any other relevant Federal agency, as determined by the Director of the National Institutes of Health.
(3) Authorization of appropriations
For the purpose of carrying out this subsection, there are authorized to be appropriated $30,000,000 for each of fiscal years 2027 through 2031.
(b) Research with respect to medicaid coverage of uterine fibroids treatment
(1) Research
The Secretary (or the Secretary’s designee) shall establish a research database, or expand an existing research database, to collect data on services furnished to individuals diagnosed with uterine fibroids under a State plan (or a waiver of such a plan) under the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) or under a State child health plan (or a waiver of such a plan) under the Children’s Health Insurance Program under title XXI of such Act (42 U.S.C. 1397aa et seq.) for the treatment of such fibroids for purposes of assessing the frequency at which such individuals are furnished such services.
(2) Report
(A) In general
Not later than 2 years after the date of enactment of this Act, the Secretary shall submit to Congress a report on the amount of Federal and State expenditures with respect to services furnished for the treatment of uterine fibroids under State plans (or waivers of such plans) under the Medicaid program under such title XIX and State child health plans (or waivers of such plans) under the Children’s Health Insurance Program under such title XXI.
(B) Coordination
The Secretary shall coordinate the development and submission of the report required under paragraph (1) with any other relevant Federal agency, as determined by the Secretary.
(c) Education and dissemination of information with respect to uterine fibroids
(1) Uterine fibroids public education program
The Secretary shall develop and disseminate to the public information regarding uterine fibroids, including information on—
(A)
the awareness, incidence, and prevalence of uterine fibroids among individuals, including all minority individuals;
(B)
the elevated risk for minority individuals to develop uterine fibroids; and
(C)
the availability, as medically appropriate, of the range of treatment options for symptomatic uterine fibroids, including non-hysterectomy treatments and procedures.
(2) Dissemination of information
The Secretary may disseminate information under paragraph (1) directly or through arrangements with intra-agency initiatives, nonprofit organizations, consumer groups, institutions of higher education (as defined in section 101 of the Higher Education Act of 1965 (20 U.S.C. 1001)), or Federal, State, or local public private partnerships.
(3) Authorization of appropriations
For the purpose of carrying out this subsection, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2027 through 2031.
(d) Information to health care providers with respect to uterine fibroids
(1) Dissemination of information
The Secretary shall, in consultation and in accordance with guidelines from relevant medical societies, work with health care-related specialty societies and health systems to promote evidence-based care for individuals with fibroids. Such efforts shall include minority individuals who have an elevated risk to develop uterine fibroids and the range of available options for the treatment of symptomatic uterine fibroids, including non-hysterectomy drugs and devices approved under the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.).
(2) Authorization of appropriations
For the purpose of carrying out this subsection, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2027 through 2031.
(e) Definition
In this section, the term minority individuals means individuals who are members of a racial and ethnic minority group, as defined in section 1707(g) of the Public Health Service Act (42 U.S.C. 300u–6(g)).
Subtitle E HIV/AIDS
Sec. 7401. Statement of policy
It is the policy of the United States to achieve an AIDS-free generation, and to—
(1)
expand access to lifesaving antiretroviral therapy for people living with HIV and immediately link people to continuous and coordinated high-quality care when they learn they are living with HIV;
(2)
expand targeted efforts to prevent HIV infection using a combination of effective, evidence-based approaches, including routine HIV screening, and universal access to HIV prevention tools, including preexposure prophylaxis, in communities disproportionately impacted by HIV, particularly communities of color;
(3)
ensure laws, policies, and regulations do not impede access to prevention, treatment, and care for people living with HIV or disproportionately impacted by HIV;
(4)
accelerate research for more efficacious HIV prevention and treatments, tools, a cure, and a vaccine; and
(5)
respect the human rights and dignity of persons living with HIV.
Sec. 7402. Additional funding for AIDS drug assistance program treatments
Section 2623 of the Public Health Service Act (42 U.S.C. 300ff–31b) is amended by adding at the end the following:
(c) Additional funding for AIDS drug assistance program treatments
In addition to amounts otherwise authorized to be appropriated for carrying out this subpart, there are authorized to be appropriated such sums as may be necessary to carry out sections 2612(b)(3)(B) and 2616 for each of fiscal years 2027 through 2030.
Sec. 7403. Enhancing the national HIV surveillance system
(a) Grants
The Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention, shall make grants to States to support integration of public health surveillance systems into all electronic health records in order to allow rapid communications between the clinical setting and health departments, by means that include—
(1)
providing technical assistance and policy guidance to State and local health departments, clinical providers, and other agencies serving individuals with HIV to improve the interoperability of data systems relevant to monitoring HIV care and supportive services;
(2)
capturing longitudinal data pertaining to the initiation and ongoing prescription or dispensing of antiretroviral therapy for individuals diagnosed with HIV (such as through pharmacy-based reporting);
(3)
obtaining information—
(A)
on a voluntary basis, on sexual orientation and gender identity; and
(B)
on sources of coverage (or the lack of coverage) for medical treatment (including coverage through the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), the Medicare program under title XVIII of such Act (42 U.S.C. 1395 et seq.), the program under title XXVI of the Public Health Service Act (42 U.S.C. 300ff–11 et seq.; commonly referred to as the Ryan White HIV/AIDS Program
), other public funding, private insurance, and health maintenance organizations); and
(4)
obtaining and using current geographic markers of residence (such as current address, ZIP Code, partial ZIP Code, and census block).
(b) Privacy and security safeguards
In carrying out this section, the Secretary of Health and Human Services shall ensure that appropriate privacy and security safeguards are met to prevent unauthorized disclosure of protected health information and compliance with the HIPAA privacy and security law (as defined in section 3009 of the Public Health Service Act (42 U.S.C. 300jj–19)) and other relevant laws and regulations.
(c) Prohibition against improper use of data
No grant under this section may be used to allow or facilitate the collection or use of surveillance or clinical data or records—
(1)
for punitive measures of any kind, civil or criminal, against the subject of such data or records; or
(2)
for imposing any requirement or restriction with respect to an individual without the individual’s written consent.
(d) Authorization of appropriations
To carry out this section, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2027 through 2030.
Sec. 7404. Evidence-based strategies for improving linkage to, and retention in, appropriate care
(a) Strategies
The Secretary of Health and Human Services, in collaboration with the Director of the Centers for Disease Control and Prevention, the Assistant Secretary for Mental Health and Substance Use, the Director of the Office of AIDS Research, the Administrator of the Health Resources and Services Administration, and the Administrator of the Centers for Medicare & Medicaid Services, shall—
(1)
identify evidence-based strategies most effective at addressing the multifaceted issues that impede disease status awareness with respect to HIV/AIDS and linkage to, and retention in, appropriate care, taking into consideration health care systems issues, clinic and provider issues, and individual psychosocial, environmental, and other contextual factors;
(2)
support the wide-scale implementation of the evidence-based strategies identified pursuant to paragraph (1), including through incorporating such strategies into health care coverage supported by the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), the program under title XXVI of the Public Health Service Act (42 U.S.C. 300ff–11 et seq.; commonly referred to as the Ryan White HIV/AIDS Program
), and health plans purchased through an Exchange established under title I of the Patient Protection and Affordable Care Act (Public Law 111–148); and
(3)
not later than 1 year after the date of the enactment of this Act, submit a report to the Congress on the status of activities under paragraphs (1) and (2).
(b) Authorization of appropriations
To carry out this section, there are authorized to be appropriated such sums as may be necessary for fiscal years 2027 through 2030.
Sec. 7405. Improving entry into, and retention in, care and antiretroviral adherence for persons with HIV
(a) Sense of congress
It is the sense of Congress that AIDS research has led to scientific advancements that have—
(1)
saved the lives of millions of people living with HIV;
(2)
prevented millions of individuals from receiving new diagnoses of HIV; and
(3)
had broad benefits that extend far beyond helping people at risk for, or living with, HIV.
(b) In general
The Secretary of Health and Human Services, acting through the Director of the National Institutes of Health, shall expand, intensify, and coordinate operational and translational research and other activities of the National Institutes of Health regarding methods—
(1)
to increase adoption of evidence-based adherence strategies within HIV care and treatment programs;
(2)
to increase HIV testing and case detection rates;
(3)
to reduce HIV-related health disparities;
(4)
to ensure that research to improve adherence to HIV care and treatment programs address the unique concerns of women;
(5)
to integrate HIV prevention and care services with mental health and substance use prevention and treatment delivery systems;
(6)
to increase knowledge on the implementation of preexposure prophylaxis (referred to in this section as PrEP
), including with respect to—
(A)
who can benefit most from PrEP;
(B)
how to provide PrEP safely and efficiently;
(C)
how to integrate PrEP with other essential prevention methods such as condoms; and
(D)
how to ensure high levels of adherence; and
(7)
to increase knowledge of undetectable and untransmittable
, when a person living with HIV who is on antiretroviral therapy and is durably virally suppressed (defined as having a consistent viral load of less than 200 copies/ml) cannot sexually transmit HIV.
(c) Authorization of appropriations
To carry out this section, there are authorized to be appropriated such sums as may be necessary for fiscal years 2027 through 2030.
Sec. 7406. Services to reduce HIV/AIDS in racial and ethnic minority communities
(a) In general
For the purpose of reducing new HIV diagnoses in racial and ethnic minority communities, the Secretary of Health and Human Services, acting through the Deputy Assistant Secretary for Minority Health, may make grants to public health agencies and faith-based organizations to conduct—
(1)
outreach activities related to HIV prevention and testing activities;
(2)
HIV prevention activities;
(3)
HIV testing activities; and
(4)
public health education campaigns on accessing HIV prevention medication.
(b) Authorization of appropriations
To carry out this section, there are authorized to be appropriated such sums as may be necessary for fiscal years 2027 through 2030.
Sec. 7407. Minority AIDS initiative
(a) Expanded funding
The Secretary of Health and Human Services, in collaboration with the Deputy Assistant Secretary for Minority Health, the Director of the Centers for Disease Control and Prevention, the Administrator of the Health Resources and Services Administration, and the Assistant Secretary for Mental Health and Substance Use, shall provide funds and carry out activities to expand the Minority AIDS Initiative.
(b) Use of funds
The additional funds made available under this section may be used, through the Minority AIDS Initiative, to support the following activities:
(1)
Providing technical assistance and infrastructure support to reduce HIV/AIDS in minority populations.
(2)
Increasing minority populations’ access to HIV prevention and care services.
(3)
Building strong community programs and partnerships to address HIV prevention and the health care needs of specific racial and ethnic minority populations.
(c) Priority interventions
Within the racial and ethnic minority populations referred to in subsection (b), priority in conducting intervention services shall be given to—
(1)
men who have sex with men;
(2)
youth;
(3)
persons who engage in intravenous drug abuse;
(4)
women;
(5)
homeless individuals;
(6)
individuals incarcerated or in the penal system;
(7)
transgender individuals; and
(8)
nonbinary individuals.
(d) Authorization of appropriations
For carrying out this section, there are authorized to be appropriated $610,000,000 for fiscal year 2027 and such sums as may be necessary for each of fiscal years 2028 through 2031.
Sec. 7408. Health care professionals treating individuals with HIV
(a) In general
The Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration, shall expand, intensify, and coordinate workforce initiatives of the Health Resources and Services Administration to increase the capacity of the health workforce focusing primarily on HIV to meet the demand for culturally competent care, and may award grants for any of the following:
(1)
Development of curricula for training primary care providers in HIV/AIDS prevention and care, including routine HIV testing.
(2)
Support to expand access to culturally and linguistically accessible benefits counselors, trained peer navigators, and mental and behavioral health professionals with expertise in HIV.
(3)
Training health care professionals to provide care to individuals living with HIV.
(4)
Development by grant recipients under title XXVI of the Public Health Service Act (42 U.S.C. 300ff–11 et seq.; commonly referred to as the Ryan White HIV/AIDS Program
) and other persons, of policies for providing culturally relevant and sensitive treatment to individuals living with HIV, with particular emphasis on treatment to racial and ethnic minorities, men who have sex with men, and women, young people, and children living with HIV.
(5)
Development and implementation of programs to increase the use of telehealth to respond to HIV-specific health care needs in rural and minority communities, with particular emphasis given to medically underserved communities and insular areas.
(6)
Evaluating interdisciplinary medical provider care team models that promote high-quality care, with particular emphasis on care to racial and ethnic minorities.
(7)
Training health care professionals to make them aware of the high rates of chronic hepatitis B and chronic hepatitis C in adult racial and ethnic minority populations, and the importance of prevention, detection, and medical management of hepatitis B and hepatitis C and of liver cancer screening.
(8)
Development of curricula for training primary care providers that HIV and tuberculosis are significant mutual comorbidities, and that a patient who tests positive for one disease should be offered and encouraged to receive testing for the other.
(b) Authorization of appropriations
To carry out this section, there are authorized to be appropriated such sums as may be necessary for fiscal years 2027 through 2030.
Sec. 7409. HIV/AIDS provider loan repayment program
(a) In general
The Secretary may enter into an agreement with any physician, nurse practitioner, or physician assistant under which—
(1)
the physician, nurse practitioner, or physician assistant agrees to serve as a medical provider for a period of not less than 2 years—
(A)
at a Ryan White-funded or title X-funded facility with a critical shortage of doctors (as determined by the Secretary); or
(B)
in an area with a high incidence of HIV/AIDS; and
(2)
the Secretary agrees to make payments in accordance with subsection (b) on the professional education loans of the physician, nurse practitioner, or physician assistant.
(b) Manner of payments
The payments described in subsection (a) shall be made by the Secretary as follows:
(1)
Upon completion by the physician, nurse practitioner, or physician assistant for whom the payments are to be made of the first year of the service specified in the agreement entered into with the Secretary under subsection (a), the Secretary shall pay 30 percent of the principal of and the interest on the individual’s professional education loans.
(2)
Upon completion by the physician, nurse practitioner, or physician assistant of the second year of such service, the Secretary shall pay another 30 percent of the principal of and the interest on such loans.
(3)
Upon completion by that individual of a third year of such service, the Secretary shall pay another 25 percent of the principal of and the interest on such loans.
(c) Applicability of certain provisions
Subpart III of part D of title III of the Public Health Service Act (42 U.S.C. 254l et seq.) shall, except as inconsistent with this section, apply to the program carried out under this section in the same manner and to the same extent as such provisions apply to the National Health Service Corps loan repayment program.
(d) Reports
Not later than 18 months after the date of the enactment of this Act, and annually thereafter, the Secretary shall prepare and submit to Congress a report describing the program carried out under this section, including statements regarding the following:
(1)
The number of physicians, nurse practitioners, and physician assistants enrolled in the program.
(2)
The number and amount of loan repayments provided through the program.
(3)
The placement location of loan repayment recipients at facilities described in subsection (a)(1).
(4)
The default rate on such loans and actions required.
(5)
The amount of outstanding default funds with respect to such loans.
(6)
To the extent that it can be determined, the reason for the default on such a loan.
(7)
The demographics of individuals participating in the program.
(8)
An evaluation of the overall costs and benefits of the program.
(e) Definitions
In this section:
(1) HIV/AIDS
The term HIV/AIDS means human immunodeficiency virus and acquired immune deficiency syndrome.
(2) Nurse practitioner
The term nurse practitioner means a registered nurse who has completed an accredited graduate degree program in advanced nurse practice and has successfully passed a national certification exam.
(3) Physician
The term physician means a graduate of a school of medicine who has completed postgraduate training in general or pediatric medicine.
(4) Physician assistant
The term physician assistant means a medical provider who completed an accredited physician assistant training program and successfully passed the Physician Assistant National Certifying Examination.
(5) Professional education loan
The term professional education loan—
(A)
means a loan that is incurred for the cost of attendance (including tuition, other reasonable educational expenses, and reasonable living costs) at a school of medicine, school of nursing, or physician assistant training program; and
(B)
includes only the portion of the loan that is outstanding on the date the physician, nurse practitioner, or physician assistant involved begins the service specified in the agreement under subsection (a).
(6) Ryan white-funded
The term Ryan White-funded means, with respect to a facility, receiving funds under title XXVI of the Public Health Service Act (42 U.S.C. 300ff–11 et seq.).
(7) Secretary
The term Secretary means the Secretary of Health and Human Services.
(8) School of medicine
The term school of medicine has the meaning given to that term in section 799B of the Public Health Service Act (42 U.S.C. 295p).
(9) Title x-funded
The term title X-funded means, with respect to a facility, receiving funds under title X of the Public Health Service Act (42 U.S.C. 300 et seq.).
(f) Authorization of appropriations
To carry out this section, there are authorized to be appropriated such sums as may be necessary for fiscal years 2027 through 2030.
Sec. 7410. Dental education loan repayment program
(a) In general
The Secretary may enter into an agreement with any dentist under which—
(1)
the dentist agrees to serve as a dentist for a period of not less than 2 years at a facility with a critical shortage of dentists (as determined by the Secretary) in an area with a high incidence of HIV/AIDS; and
(2)
the Secretary agrees to make payments in accordance with subsection (b) on the dental education loans of the dentist.
(b) Manner of payments
The payments described in subsection (a) shall be made by the Secretary as follows:
(1)
Upon completion by the dentist for whom the payments are to be made of the first year of the service specified in the agreement entered into with the Secretary under subsection (a), the Secretary shall pay 30 percent of the principal of and the interest on the dental education loans of the dentist.
(2)
Upon completion by the dentist of the second year of such service, the Secretary shall pay another 30 percent of the principal of and the interest on such loans.
(3)
Upon completion by that individual of a third year of such service, the Secretary shall pay another 25 percent of the principal of and the interest on such loans.
(c) Applicability of certain provisions
Subpart III of part D of title III of the Public Health Service Act (42 U.S.C. 254l et seq.) shall, except as inconsistent with this section, apply to the program carried out under this section in the same manner and to the same extent as such provisions apply to the National Health Service Corps Loan Repayment Program.
(d) Reports
Not later than 18 months after the date of the enactment of this Act, and annually thereafter, the Secretary shall prepare and submit to the Congress a report describing the program carried out under this section, including statements regarding the following:
(1)
The number of dentists enrolled in the program.
(2)
The number and amount of loan repayments provided through the program.
(3)
The placement location of loan repayment recipients at facilities described in subsection (a)(1).
(4)
The default rate on such loans and actions required.
(5)
The amount of outstanding default funds with respect to such loans.
(6)
To the extent that it can be determined, the reason for the default on such a loan.
(7)
The demographics of individuals participating in the program.
(8)
An evaluation of the overall costs and benefits of the program.
(e) Definitions
In this section:
(1) Dental education loan
The term dental education loan—
(A)
means a loan that is incurred for the cost of attendance (including tuition, other reasonable educational expenses, and reasonable living costs) at a school of dentistry; and
(B)
includes only the portion of the loan that is outstanding on the date the dentist involved begins the service specified in the agreement under subsection (a).
(2) Dentist
The term dentist means a graduate of a school of dentistry who has completed postgraduate training in general or pediatric dentistry.
(3) HIV/AIDS
The term HIV/AIDS means human immunodeficiency virus and acquired immune deficiency syndrome.
(4) School of dentistry
The term school of dentistry has the meaning given to that term in section 799B of the Public Health Service Act (42 U.S.C. 295p).
(5) Secretary
The term Secretary means the Secretary of Health and Human Services.
(f) Authorization of appropriations
To carry out this section, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2027 through 2030.
Sec. 7411. Reducing new HIV infections among injecting drug users
(a) Sense of congress
It is the sense of Congress that providing sterile syringes and sterilized equipment to injecting drug users substantially reduces risk of HIV infection, increases the probability that they will initiate drug treatment, and does not increase drug use.
(b) In general
The Secretary of Health and Human Services may provide grants and technical assistance for the purpose of reducing the rate of HIV infections among injecting drug users through a comprehensive package of services for such users, including the provision of sterile syringes, education and outreach, access to infectious disease testing, overdose prevention, and treatment for drug dependence.
(c) Authorization of appropriations
To carry out this section, there are authorized to be appropriated such sums as may be necessary for fiscal years 2027 through 2030.
Sec. 7412. Report on impact of HIV/AIDS in vulnerable populations
(a) In general
The Secretary of Health and Human Services shall submit to Congress and the President an annual report on the impact of HIV/AIDS for racial and ethnic minority communities, women, and youth aged 24 and younger.
(b) Contents
The report under subsection (a) shall include information on the—
(1)
progress that has been made in reducing the impact of HIV/AIDS in such communities;
(2)
opportunities that exist to make additional progress in reducing the impact of HIV/AIDS in such communities;
(3)
challenges that may impede such additional progress; and
(4)
Federal funding necessary to achieve substantial reductions in HIV/AIDS in racial and ethnic minority communities.
Sec. 7413. National HIV/AIDS observance days
(a) National observance days
It is the sense of Congress that national observance days highlighting the impact of HIV on communities of color include the following:
(1)
National Black HIV/AIDS Awareness Day.
(2)
National Latino AIDS Awareness Day.
(3)
National Asian and Pacific Islander HIV/AIDS Awareness Day.
(4)
National Native American HIV/AIDS Awareness Day.
(5)
National Youth HIV/AIDS Awareness Day.
(b) Call to action
It is the sense of Congress that the President should call on members of communities of color—
(1)
to become involved at the local community level in HIV testing, policy, and advocacy;
(2)
to become aware, engaged, and empowered on the HIV epidemic within their communities; and
(3)
to urge members of their communities to reduce risk factors, practice safe sex and other preventive measures, be tested for HIV, and seek care when appropriate.
Sec. 7414. Review of all Federal and state laws, policies, and regulations regarding the criminal prosecution of individuals for HIV-related offenses
(a) Sense of congress regarding laws or regulations directed at people living with HIV
It is the sense of Congress that Federal and State laws, policies, and regulations regarding people living with HIV—
(1)
should not place unique or additional burdens on such individuals solely as a result of their HIV status; and
(2)
should instead demonstrate a public health-oriented, evidence-based, medically accurate, and contemporary understanding of—
(A)
the multiple factors that lead to HIV transmission;
(B)
the relative risk of demonstrated HIV transmission routes;
(C)
the current health implications of living with HIV;
(D)
the associated benefits of treatment and support services for people living with HIV; and
(E)
the impact of punitive HIV-specific laws, policies, regulations, and judicial precedents and decisions on public health, on people living with or affected by HIV, and on their families and communities.
(b) Review of federal and state laws
(1) Review of federal and state laws
(A) In general
Not later than 90 days after the date of the enactment of this Act, the Attorney General, the Secretary of Health and Human Services, and the Secretary of Defense acting jointly (in this section referred to as the designated officials
) shall initiate a national review of Federal and State laws, including the Uniform Code of Military Justice (referred to in this section as the UCMJ
), policies, regulations, and judicial precedents and decisions regarding criminal and related civil commitment cases involving people living with HIV/AIDS.
(B) Consultation
In carrying out the review under subparagraph (A), the designated officials shall seek to include diverse participation from, and consultation with, each of the following:
(i)
Each State.
(ii)
State attorneys general (or their representatives).
(iii)
State public health officials (or their representatives).
(iv)
State judicial and court system officers, including judges, district attorneys, prosecutors, defense attorneys, law enforcement, and correctional officers.
(v)
Members of the United States Armed Forces, including members of other Federal services subject to the UCMJ.
(vi)
People living with HIV/AIDS, particularly those who have been subject to HIV-related prosecution or who are from minority communities whose members have been disproportionately subject to HIV-specific arrests and prosecution.
(vii)
Legal advocacy and HIV/AIDS service organizations that work with people living with HIV/AIDS.
(viii)
Nongovernmental health organizations that work on behalf of people living with HIV/AIDS, including syringe services programs, LGBTQ-focused health organizations, and organizations who serve people who engage in sex work.
(ix)
Trade organizations or associations representing persons or entities described in clauses (i) through (vii).
(C) Relation to other reviews
In carrying out the review under subparagraph (A), the designated officials may utilize other existing reviews of criminal and related civil commitment cases involving people living with HIV, including any such review conducted by any Federal or State agency or any public health, legal advocacy, or trade organization or association if the designated officials determines that such reviews were conducted in accordance with the principles set forth in subsection (a).
(2) Report
Not later than 180 days after initiating the review required under paragraph (1), the Attorney General shall transmit to the Congress and make publicly available a report containing the results of the review, which includes the following:
(A)
For each State and for the UCMJ, a summary of the relevant laws, policies, regulations, and judicial precedents and decisions regarding criminal cases involving people living with HIV, including the following:
(i)
A determination of whether such laws, policies, regulations, and judicial precedents and decisions place any unique or additional burdens upon people living with HIV.
(ii)
A determination of whether such laws, policies, regulations, and judicial precedents and decisions demonstrate a public health-oriented, evidence-based, medically accurate, and contemporary understanding of—
(I)
the multiple factors that lead to HIV transmission;
(II)
the relative risk of HIV transmission routes, including that a person that has an undetectable viral load cannot transmit HIV;
(III)
the current health implications of living with HIV, including data disaggregated by race and ethnicity;
(IV)
the current status of providing protection to people who engage in survival sex work against whom condom possession has been used as evidence of intent to commit a crime;
(V)
States that have the classification of mandatory sex offenders;
(VI)
the associated benefits of treatment and support services for people living with HIV; and
(VII)
the impact of punitive HIV-specific laws and policies on public health, on people living with or affected by HIV, and on their families and communities, including people who are in abusive, dependent, violent, or nonconsensual relationships and are unable to both negotiate the use of condoms and status disclosure.
(iii)
An analysis of the public health and legal implications of such laws, policies, regulations, and judicial precedents and decisions, including an analysis of the consequences of having a similar penal scheme applied to comparable situations involving other communicable diseases.
(iv)
An analysis of the proportionality of punishments imposed under HIV-specific laws, policies, regulations, and judicial precedents, taking into consideration penalties attached to violation of State laws against similar degrees of endangerment or harm, such as driving while intoxicated or transmission of other communicable diseases, or more serious harms, such as vehicular manslaughter offenses.
(B)
An analysis of common elements shared between State laws, policies, regulations, and judicial precedents.
(C)
A set of best practice recommendations directed to State governments, including State attorneys general, public health officials, and judicial officers, in order to ensure that laws, policies, regulations, and judicial precedents regarding people living with HIV are in accordance with the principles set forth in subsection (a).
(D)
Recommendations for adjustments to the UCMJ, including discontinuing the use of a service member’s HIV diagnosis as the basis for prosecution, enhanced penalties, or discharge from military service, in order to ensure that laws, policies, regulations, and judicial precedents regarding people living with HIV are in accordance with the principles set forth in subsection (a). Such recommendations should include any necessary and appropriate changes to Orders to Follow Preventative Medicine Requirements
.
(3) Guidance
Not later than 90 days after the date of the release of the report required by paragraph (2), the Attorney General and the Secretary of Health and Human Services shall jointly develop and publicly release updated guidance for States based on the set of best practice recommendations required under paragraph (2)(C) in order to assist States dealing with criminal and related civil commitment cases regarding people living with HIV.
(4) Monitoring and evaluation system
Not later than 60 days after the date of the release of the guidance required under paragraph (3), the Attorney General and the Secretary of Health and Human Services shall jointly establish an integrated monitoring and evaluation system that includes, where appropriate, objective and quantifiable performance goals and indicators to measure progress toward statewide implementation in each State of the best practice recommendations required under paragraph (2)(C).
(5) Modernization of federal laws, policies, and regulations
Not later than 90 days after the date of the release of the report required under paragraph (2), the designated officials shall develop and transmit to the President and the Congress, and make publicly available, such proposals as may be necessary to implement adjustments to Federal laws, policies, or regulations, including the UCMJ, based on the recommendations required under paragraph (2)(D), either through Executive order or through changes to statutory law.
(c) Rule of construction
Nothing in this section shall be construed to discourage the prosecution of individuals who intentionally transmit or attempt to transmit HIV to another individual.
(d) No additional appropriations authorized
This section shall not be construed to increase the amount of appropriations that are authorized to be appropriated for any fiscal year.
Sec. 7415. Expanding support for condoms in prisons
(a) Sense of congress regarding distribution of sexual barrier protection devices in state prison systems
It is the sense of Congress that States shall allow for the legal distribution of sexual barrier protection devices in State correctional facilities to reduce the prevalence and spread of STIs in those facilities.
(b) Authority To allow community organizations To provide STI counseling, STI prevention education, and sexual barrier protection devices in federal correctional facilities
(1) Directive to attorney general
Not later than 30 days after the date of enactment of this Act, the Attorney General shall direct the Director of the Bureau of Prisons to allow community organizations to, in accordance with all relevant Federal laws and regulations that govern visitation in Federal correctional facilities—
(A)
distribute sexual barrier protection devices in Federal correctional facilities; and
(B)
engage in STI counseling and STI prevention education in Federal correctional facilities.
(2) Information requirement
Any community organization permitted to distribute sexual barrier protection devices under paragraph (1) shall ensure that the individuals to whom the devices are distributed are informed about the proper use and disposal of sexual barrier protection devices in accordance with established public health practices. Any community organization conducting STI counseling or STI prevention education under paragraph (1) shall offer comprehensive sexuality education.
(3) Possession of device protected
A Federal correctional facility may not, because of the possession or use of a sexual barrier protection device—
(A)
take adverse action against an incarcerated individual; or
(B)
consider possession or use as evidence of prohibited activity for the purpose of any Federal correctional facility administrative proceeding.
(4) Implementation
The Attorney General and the Director of the Bureau of Prisons shall implement this section according to established public health practices in a manner that protects the health, safety, and privacy of incarcerated individuals and of correctional facility staff.
(c) Survey of and report on correctional facility programs aimed at reducing the spread of STIs
(1) Survey
Not later than 180 days after the date of enactment of this Act, and annually thereafter for 5 years, the Attorney General, after consulting with the Secretary of Health and Human Services, State officials, and community organizations, shall, to the maximum extent practicable, conduct a survey of all Federal and State correctional facilities, to determine the following:
(A) Counseling, treatment, and supportive services
Whether the correctional facility—
(i)
requires incarcerated individuals to participate in counseling, treatment, and supportive services relating to STIs; or
(ii)
offers such programs to incarcerated individuals.
(B) Access to sexual barrier protection devices
Whether incarcerated individuals can—
(i)
possess sexual barrier protection devices;
(ii)
purchase sexual barrier protection devices;
(iii)
purchase sexual barrier protection devices at a reduced cost; or
(iv)
obtain sexual barrier protection devices without cost.
(C) Incidence of sexual violence
The incidence of sexual violence and assault committed by incarcerated individuals and by correctional facility staff.
(D) Prevention education offered
The type of prevention education, information, or training offered to incarcerated individuals and correctional facility staff regarding sexual violence and the spread of STIs, including whether such education, information, or training—
(i)
constitutes comprehensive sexuality education;
(ii)
is compulsory for new incarcerated individuals and for new correctional facility staff; and
(iii)
is offered on an ongoing basis.
(E) STI testing
Whether the correctional facility tests incarcerated individuals for STIs or gives them the option to undergo such testing—
(i)
at intake;
(ii)
on a regular basis; and
(iii)
prior to release.
(F) STI test results
The number of incarcerated individuals who are tested for STIs and the outcome of such tests at each correctional facility, disaggregated to include results for—
(i)
the type of STI tested for;
(ii)
the race and ethnicity of an individual tested;
(iii)
the age of an individual tested; and
(iv)
the gender of the individual tested.
(G) Prerelease referral policy
Whether incarcerated individuals are informed prior to release about STI-related services or other health services in their communities, including free and low-cost counseling and treatment options.
(H) Prerelease referrals made
The number of referrals to community-based organizations or public health facilities offering STI-related or other health services provided to incarcerated individuals prior to release, and the type of counseling or treatment for which the referral was made.
(I) Reinstatement of medicaid benefits
Whether—
(i)
the correctional facility assists incarcerated individuals that were enrolled in the State Medicaid program prior to their incarceration in reinstating their enrollment upon release; and
(ii)
such individuals receive referrals as described in subparagraph (G) to entities that accept the State Medicaid program, including, if applicable—
(I)
the number of such individuals, including those diagnosed with HIV, that have been reinstated;
(II)
a list of obstacles to reinstating enrollment or to making determinations of eligibility for reinstatement, if any; and
(III)
the number of individuals denied enrollment.
(J) Other actions taken
Whether the correctional facility has taken any other action, in conjunction with community organizations or otherwise, to reduce the prevalence and spread of STIs in that facility.
(2) Privacy
In conducting the survey under paragraph (1), the Attorney General shall not request or retain the identity of any individual who has sought or been offered counseling, treatment, testing, or prevention education information regarding an STI (including information about sexual barrier protection devices), or who has tested positive for an STI.
(3) Report
(A) In general
The Attorney General shall transmit to Congress and make publicly available the results of the survey required under paragraph (1), both for the United States as a whole and disaggregated as to each State and each correctional facility.
(B) Deadlines
To the maximum extent possible, the Attorney General shall—
(i)
issue the first report under subparagraph (A) not later than 1 year after the date of enactment of this Act; and
(ii)
issue reports under subparagraph (A) annually thereafter for 5 years.
(d) Strategy
(1) Directive to attorney general
The Attorney General, in consultation with the Secretary of Health and Human Services, State officials, and community organizations, shall develop and implement a 5-year strategy to reduce the prevalence and spread of STIs in Federal and State correctional facilities. To the maximum extent possible, the strategy shall be developed, transmitted to Congress, and made publicly available not later than 180 days after the transmission of the first report required under subsection (c)(3).
(2) Contents of strategy
The strategy developed under paragraph (1) shall include the following:
(A) Prevention education
A plan for improving prevention education, information, and training offered to incarcerated individuals and correctional facility staff, including information and training on sexual violence and the spread of STIs, and comprehensive sexuality education.
(B) Sexual barrier protection device access
A plan for expanding access to sexual barrier protection devices in correctional facilities.
(C) Sexual violence reduction
A plan for reducing the incidence of sexual violence among incarcerated individuals and correctional facility staff.
(D) Counseling and supportive services
A plan for expanding access to counseling and supportive services related to STIs in correctional facilities.
(E) Testing
A plan for testing incarcerated individuals for STIs during intake, during regular health exams, and prior to release that—
(i)
is conducted in accordance with guidelines established by the Centers for Disease Control and Prevention;
(ii)
includes pretest counseling;
(iii)
requires that incarcerated individuals are notified of their option to decline testing at any time;
(iv)
requires that incarcerated individuals are confidentially notified of their test results in a timely manner; and
(v)
ensures that incarcerated individuals testing positive for STIs receive post-test counseling, care, treatment, and supportive services.
(F) Treatment
A plan for ensuring that correctional facilities have the necessary medicine and equipment to treat and monitor STIs and for ensuring that incarcerated individuals living with or testing positive for STIs receive and have access to care and treatment services.
(G) Strategies for demographic groups
A plan for developing and implementing culturally appropriate, sensitive, and specific strategies to reduce the spread of STIs among demographic groups heavily impacted by STIs.
(H) Linkages with communities and facilities
A plan for establishing and strengthening linkages to local community and health facilities that—
(i)
provide counseling, testing, care, and treatment services;
(ii)
may receive individuals recently released from incarceration who are living with STIs; and
(iii)
accept payment through the State Medicaid program.
(I) Enrollment in state medicaid programs
Plans to ensure that—
(i)
incarcerated individuals who were enrolled in their State Medicaid program prior to incarceration in a correctional facility are automatically reenrolled in such program upon their release; and
(ii)
incarcerated individuals who were not enrolled in their State Medicaid program prior to incarceration, and who are diagnosed with HIV while incarcerated in a correctional facility, are automatically enrolled in such program upon their release.
(J) Other plans
Any other plans developed by the Attorney General for reducing the spread of STIs or improving the quality of health care in correctional facilities.
(K) Monitoring system
A monitoring system that establishes performance goals related to reducing the prevalence and spread of STIs in correctional facilities and which, where feasible, expresses such goals in quantifiable form.
(L) Monitoring system performance indicators
Performance indicators that measure or assess the achievement of the performance goals described in subparagraph (K).
(M) Cost estimate
A detailed estimate of the funding necessary to implement the strategy at the Federal and State levels for all 5 years, including the amount of funds required by community organizations to implement the parts of the strategy in which they take part.
(3) Report
Not later than 1 year after the date of the enactment of this Act, and annually thereafter, the Attorney General shall transmit to Congress and make publicly available an annual progress report regarding the implementation and effectiveness of the strategy described in paragraph (1). The progress report shall include an evaluation of the implementation of the strategy using the monitoring system and performance indicators provided for in subparagraphs (K) and (L) of paragraph (2).
(e) Authorization of appropriations
(1) In general
There are authorized to be appropriated such sums as may be necessary to carry out this section for each of fiscal years 2027 through 2031.
(2) Availability of funds
Amounts made available under paragraph (1) are authorized to remain available until expended.
(f) Definitions
In this section:
(1) Community organization
The term community organization means a public health care facility or a nonprofit organization that provides health- or STI-related services according to established public health standards.
(2) Comprehensive sexuality education
The term comprehensive sexuality education means sexuality education—
(A)
that includes information about abstinence and about the proper use and disposal of sexual barrier protection devices; and
(B)
that is—
(i)
evidence based;
(ii)
medically accurate;
(iii)
age and developmentally appropriate;
(iv)
gender and identity sensitive;
(v)
culturally and linguistically appropriate; and
(vi)
structured to promote critical thinking, self-esteem, respect for others, and the development of healthy attitudes and relationships.
(3) Correctional facility
The term correctional facility means any prison, penitentiary, adult detention facility, juvenile detention facility, jail, or other facility to which individuals may be sent after conviction of a crime or act of juvenile delinquency within the United States.
(4) Incarcerated individual
The term incarcerated individual means any individual who is serving a sentence in a correctional facility after conviction of a crime.
(5) Sexual barrier protection device
The term sexual barrier protection device means any physical device approved, cleared, or otherwise authorized by the Food and Drug Administration that has not been tampered with and which reduces the probability of STI transmission or infection between sexual partners, including female condoms, male condoms, and dental dams.
(6) Sexually transmitted infection
The term sexually transmitted infection or STI
means any disease or infection that is commonly transmitted through sexual activity, including HIV, gonorrhea, chlamydia, syphilis, genital herpes, viral hepatitis, and human papillomavirus.
(7) State
The term State includes the District of Columbia, American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, Puerto Rico, and the United States Virgin Islands.
(8) State medicaid program
The term State Medicaid program means the State plan (or a waiver of such plan) under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).
Sec. 7416. Automatic reinstatement or enrollment in Medicaid for people who test positive for HIV before reentering communities
(a) In general
Section 1902(e) of the Social Security Act (42 U.S.C. 1396a(e)) is amended by adding at the end the following:
(17) Enrollment of ex-offenders
(A) Automatic enrollment or reinstatement
(i) In general
The State plan shall provide for the automatic enrollment or reinstatement of enrollment of an eligible individual—
(I)
if such individual is scheduled to be released from a public institution due to the completion of sentence, not less than 30 days prior to the scheduled date of the release; and
(II)
if such individual is to be released from a public institution on parole or on probation, as soon as possible after the date on which the determination to release such individual was made, and before the date such individual is released.
(ii) Exception
If a State makes a determination that an individual is not eligible to be enrolled under the State plan—
(I)
on or before the date by which the individual would be enrolled under clause (i), such clause shall not apply to such individual; or
(II)
after such date, the State may terminate the enrollment of such individual.
(B) Relationship of enrollment to payment for services
(i) In general
Subject to subparagraph (A)(ii), an eligible individual who is enrolled, or whose enrollment is reinstated, under subparagraph (A) shall be eligible for all services for which medical assistance is provided under the State plan after the date that the eligible individual is released from the public institution.
(ii) Relationship to payment prohibition for inmates
No provision of this paragraph may be construed to permit payment for care or services for which payment is excluded under subparagraph (A) following the last numbered paragraph of section 1905(a).
(C) Treatment of continuous eligibility
(i) Suspension for inmates
Any period of continuous eligibility under this title shall be suspended on the date an individual enrolled under this title becomes an inmate of a public institution (except as a patient of a medical institution).
(ii) Determination of remaining period
Notwithstanding any changes to State law related to continuous eligibility during the time that an individual is an inmate of a public institution (except as a patient of a medical institution), subject to clause (iii), with respect to an eligible individual who was subject to a suspension under clause (i), on the date that such individual is released from a public institution the suspension of continuous eligibility under such clause shall be lifted for a period that is equal to the time remaining in the period of continuous eligibility for such individual on the date that such period was suspended under such clause.
(iii) Exception
If a State makes a determination that an individual is not eligible to be enrolled under the State plan—
(I)
on or before the date that the suspension of continuous eligibility is lifted under clause (ii), such clause shall not apply to such individual; or
(II)
after such date, the State may terminate the enrollment of such individual.
(D) Automatic enrollment or reinstatement of enrollment defined
For purposes of this paragraph, the term automatic enrollment or reinstatement of enrollment means that the State determines eligibility for medical assistance under the State plan without a program application from, or on behalf of, the eligible individual, but an individual can only be automatically enrolled in the State Medicaid plan if the individual affirmatively consents to being enrolled through affirmation in writing, by telephone, orally, through electronic signature, or through any other means specified by the Secretary.
(E) Eligible individual defined
For purposes of this paragraph, the term eligible individual means an individual who is an inmate of a public institution (except as a patient in a medical institution)—
(i)
who was enrolled under the State plan for medical assistance immediately before becoming an inmate of such an institution; or
(ii)
who is diagnosed with human immunodeficiency virus.
(b) Supplemental funding for state implementation of automatic reinstatement of medicaid benefits
(1) In general
Subject to paragraph (3), with respect to a State, for each of the first 4 calendar quarters in which the State plan meets the requirements of paragraph (17) of section 1902(e) of the Social Security Act (42 U.S.C. 1396a(e)) (as added by subsection (a)), the Federal matching payments (including payments based on the Federal medical assistance percentage) made to such State under section 1903 of the Social Security Act (42 U.S.C. 1396b) for the State expenditures described in paragraph (2) shall be increased by 5 percentage points.
(2) Expenditures
The expenditures described in this paragraph are the following:
(A)
Expenditures for which payment is available under section 1903 of the Social Security Act (42 U.S.C. 1396b) and which are attributable to strengthening the State’s enrollment and administrative resources for the purpose of improving processes for enrolling (or reinstating the enrollment of) eligible individuals (as such term is defined in subparagraph (E) of paragraph (17) of section 1902(e) of the Social Security Act (42 U.S.C. 1396a(e)) (as amended by subsection (a))).
(B)
Expenditures for medical assistance (as such term is defined in section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a))) provided to such eligible individuals.
(3) Requirements; limitation
(A) Report
A State is not eligible for an increase in its Federal matching payments under paragraph (1) unless the State agrees to submit to the Secretary of Health and Human Services, and make publicly available, a report that contains the information required under paragraph (4) by the end of the 1-year period during which the State receives increased Federal matching payments in accordance with that paragraph.
(B) Maintenance of eligibility
(i) In general
Subject to clause (ii), a State is not eligible for an increase in its Federal matching payments under paragraph (1) if eligibility standards, methodologies, or procedures under its State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), or waiver of such a plan, are more restrictive than the eligibility standards, methodologies, or procedures, respectively, under such plan or waiver as in effect on the date of enactment of this Act.
(ii) State reinstatement of eligibility permitted
A State that has restricted eligibility standards, methodologies, or procedures under its State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), or a waiver of such plan, after the date of enactment of this Act, is no longer ineligible under clause (i) beginning with the first calendar quarter in which the State has reinstated eligibility standards, methodologies, or procedures that are no more restrictive than the eligibility standards, methodologies, or procedures, respectively, under such plan (or waiver) as in effect on such date.
(C) Limitation of matching payments to 100 percent
In no case shall an increase in Federal matching payments under paragraph (1) result in Federal matching payments that exceed 100 percent of State expenditures.
(4) Required report information
The information that is required in the report under paragraph (3)(A) shall include—
(A)
the results of an evaluation of the impact of the implementation of the requirements of paragraph (17) of section 1902(e) of the Social Security Act (42 U.S.C. 1396a(e)) on improving the State’s processes for enrolling individuals who are released from public institutions under the State Medicaid plan;
(B)
the number of individuals who were automatically enrolled (or whose enrollment was reinstated) under such paragraph during the 1-year period during which the State received increased payments under this subsection; and
(C)
any other information that is required by the Secretary of Health and Human Services.
(c) Effective date
(1) In general
Except as provided in paragraph (2), the amendments made by subsection (a) shall take effect 180 days after the date of the enactment of this Act.
(2) Rule for changes requiring state legislation
In the case of a State plan for medical assistance under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirement imposed by the amendments made by subsection (a), the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.
Sec. 7417. Stop HIV in prison
(a) HIV policy
The Director of the Bureau of Prisons (referred to in this section as the Director
) shall develop a comprehensive policy to provide HIV testing, treatment, and prevention for inmates within the correctional setting and upon reentry.
(b) Purpose
The purposes of the policy required to be developed under subsection (a) shall be as follows:
(1)
To stop the spread of HIV among inmates.
(2)
To protect guards and other personnel at correctional facilities from HIV infection.
(3)
To provide comprehensive medical treatment to inmates who are living with HIV.
(4)
To promote HIV awareness and prevention among inmates.
(5)
To encourage inmates to take personal responsibility for their health.
(6)
To reduce the risk that inmates will transmit HIV to other persons in the community following their release from a correctional facility.
(c) Consultation
The Director shall consult with appropriate officials of the Department of Health and Human Services, the Office of National Drug Control Policy, the Office of National AIDS Policy, and the Centers for Disease Control and Prevention regarding the development of the policy required under subsection (a).
(d) Time limit
Not later than 1 year after the date of enactment of this Act, the Director shall draft appropriate regulations to implement the policy required to be developed under subsection (a).
(e) Requirements for policy
The policy required to be developed under subsection (a) shall provide for the following:
(1) Testing and counseling upon intake
(A)
Health care personnel shall provide routine HIV testing to all inmates as a part of a comprehensive medical examination immediately following admission to a facility. Health care personnel need not provide routine HIV testing to an inmate who is transferred to a facility from another facility if the inmate’s medical records are transferred with the inmate and indicate that the inmate has been tested previously.
(B)
With respect to all inmates admitted to a facility prior to the effective date of the policy—
(i)
health care personnel shall provide routine HIV testing by not later than 180 days after such effective date; and
(ii)
HIV testing described in clause (i) may be performed in conjunction with other health services provided to these inmates by health care personnel.
(C)
All HIV tests under this paragraph shall comply with the opt-out provision under paragraph (9).
(2) Pre-test and post-test counseling
Health care personnel shall provide confidential pre-test and post-test counseling to all inmates who are tested for HIV. Counseling may be included with other general health counseling provided to inmates by health care personnel.
(3) HIV prevention education
(A)
Health care personnel shall improve HIV awareness through frequent educational programs for all inmates. HIV educational programs may be provided by community-based organizations, local health departments, and inmate peer educators.
(B)
HIV educational materials shall be made available to all inmates at orientation, at health care clinics, at regular educational programs, and prior to release. Both written and audiovisual materials shall be made available to all inmates.
(C)
(i)
The HIV educational programs and materials under this paragraph shall include information on—
(I)
modes of transmission, including transmission through tattooing, sexual contact, and intravenous drug use;
(II)
prevention methods;
(III)
treatment; and
(IV)
disease progression.
(ii)
The programs and materials shall be culturally sensitive, written or designed for low-literacy levels, available in a variety of languages, and present scientifically accurate information in a clear and understandable manner.
(4) HIV testing upon request
(A)
Health care personnel shall allow inmates to obtain HIV tests upon request once per year or whenever an inmate has a reason to believe the inmate may have been exposed to HIV. Health care personnel shall, both orally and in writing, inform inmates, during orientation and periodically throughout incarceration, of their right to obtain HIV tests.
(B)
Health care personnel shall encourage inmates to request HIV tests if the inmate is sexually active, has been raped, uses intravenous drugs, receives a tattoo, or if the inmate is concerned that the inmate may have been exposed to HIV.
(C)
An inmate’s request for an HIV test shall not be considered an indication that the inmate has put themselves at risk of infection or committed a violation of the rules of the correctional facility.
(5) HIV testing of pregnant woman
(A)
Health care personnel shall provide routine HIV testing to all inmates who become pregnant.
(B)
All HIV tests under this paragraph shall comply with the opt-out provision under paragraph (9).
(6) Comprehensive treatment
(A)
Health care personnel shall provide all inmates who test positive for HIV—
(i)
timely, comprehensive medical treatment;
(ii)
confidential counseling on managing their medical condition and preventing its transmission to other persons; and
(iii)
voluntary partner notification services.
(B)
Health care provided under this paragraph shall be consistent with Department of Health and Human Services guidelines and standard medical practice. Health care personnel shall discuss treatment options, the importance of adherence to antiretroviral therapy, and the side effects of medications with inmates receiving treatment.
(C)
Health care personnel and pharmacy personnel shall ensure that the facility formulary contains all Food and Drug Administration-approved medications necessary to provide comprehensive treatment for inmates living with HIV, and that the facility maintains adequate supplies of such medications to meet inmates’ medical needs. Health care personnel and pharmacy personnel shall also develop and implement automatic renewal systems for these medications to prevent interruptions in care.
(D)
Correctional staff, health care personnel, and pharmacy personnel shall develop and implement distribution procedures to ensure timely and confidential access to medications.
(7) Protection of confidentiality
(A)
Health care personnel shall develop and implement procedures to ensure the confidentiality of inmate tests, diagnoses, and treatment. Health care personnel and correctional staff shall receive regular training on the implementation of these procedures. Penalties for violations of inmate confidentiality by health care personnel or correctional staff shall be specified and strictly enforced.
(B)
HIV testing, counseling, and treatment shall be provided in a confidential setting where other routine health services are provided and in a manner that allows the inmate to request and obtain these services as routine medical services.
(8) Testing, counseling, and referral prior to reentry
(A)
Health care personnel shall provide routine HIV testing to all inmates not earlier than 90 days prior to their release and reentry into the community. Inmates who are already known to be infected need not be tested again. This requirement may be waived if an inmate’s release occurs without sufficient notice to the Director to allow health care personnel to perform a routine HIV test and notify the inmate of the results.
(B)
All HIV tests under this paragraph shall comply with the opt-out provision under paragraph (9).
(C)
With respect to all inmates who test positive for HIV and all inmates who already are known to have HIV, health care personnel shall provide—
(i)
confidential prerelease counseling on managing their medical condition in the community, accessing appropriate treatment and services in the community, and preventing the transmission of their condition to family members and other persons in the community;
(ii)
referrals to appropriate health care providers and social service agencies in the community that meet the inmate’s individual needs, including voluntary partner notification services and prevention counseling services for people living with HIV; and
(iii)
a 30-day supply of any medically necessary medications the inmate is currently receiving.
(9) Opt-out provision
Inmates shall have the right to refuse routine HIV testing. Inmates shall be informed both orally and in writing of this right. Oral and written disclosure of this right may be included with other general health information and counseling provided to inmates by health care personnel. If an inmate refuses a routine test for HIV, health care personnel shall make a note of the inmate’s refusal in the inmate’s confidential medical records. However, the inmate’s refusal shall not be considered a violation of the rules of the correctional facility or result in disciplinary action.
(10) Exclusion of tests performed under section 4014(b) from the definition of routine HIV testing
HIV testing of an inmate under section 4014(b) of title 18, United States Code, is not routine HIV testing for the purposes of the opt-out provision under paragraph (9). Health care personnel shall document the reason for testing under section 4014(b) of title 18, United States Code, in the inmate’s confidential medical records.
(11) Timely notification of test results
Health care personnel shall provide timely notification to inmates of the results of HIV tests.
(f) Changes in existing law
(1) Screening in general
Section 4014(a) of title 18, United States Code, is amended—
(A)
by striking for a period of 6 months or more
;
(B)
by striking , as appropriate,
; and
(C)
by striking if such individual is determined to be at risk for infection with such virus in accordance with the guidelines issued by the Bureau of Prisons relating to infectious disease management.
and inserting unless the individual declines. The Attorney General shall also cause such individual to be so tested before release from that incarceration unless the individual declines.
.
(2) Inadmissibility of HIV test results in civil and criminal proceedings
Section 4014(d) of title 18, United States Code, is amended by inserting or under section 7417 of the Health Equity and Accountability Act of 2026
after under this section
.
(3) Screening as part of routine screening
Section 4014(e) of title 18, United States Code, is amended by adding at the end the following: Such rules shall also provide that the initial test under this section be performed as part of the routine health screening conducted at intake.
.
(g) Reporting requirements
(1) Report on hepatitis, liver, and other diseases
Not later than 1 year after the date of enactment of this Act, the Director shall submit to Congress a report on the policies and procedures of the Bureau of Prisons to provide testing, treatment, and prevention education programs for hepatitis, liver failure, and other liver-related diseases transmitted through sexual activity, intravenous drug use, or other means. The Director shall consult with appropriate officials of the Department of Health and Human Services, the Office of National Drug Control Policy, the Office of National AIDS Policy, and the Centers for Disease Control and Prevention regarding the development of this report.
(2) Annual reports
(A) Generally
Not later than 2 years after the date of enactment of this Act, and annually thereafter, the Director submit to Congress a report on the incidence among inmates of diseases transmitted through sexual activity and intravenous drug use.
(B) Matters pertaining to various diseases
Each report under subparagraph (A) shall discuss—
(i)
the incidence among inmates of HIV, hepatitis, and other diseases transmitted through sexual activity and intravenous drug use; and
(ii)
updates on the testing, treatment, and prevention education programs for these diseases conducted by the Bureau of Prisons.
(C) Matters pertaining to hiv only
Each report under subparagraph (A) shall also include—
(i)
the number of inmates who tested positive for HIV upon intake;
(ii)
the number of inmates who tested positive for HIV prior to reentry;
(iii)
the number of inmates who were not tested for HIV prior to reentry because they were released without sufficient notice;
(iv)
the number of inmates who opted out of taking an HIV test;
(v)
the number of inmates who were tested under section 4014(b) of title 18, United States Code; and
(vi)
the number of inmates under treatment for HIV.
(D) Consultation
The Director shall consult with appropriate officials of the Department of Health and Human Services, the Office of National Drug Control Policy, the Office of National AIDS Policy, and the Centers for Disease Control and Prevention regarding the development of each report under subparagraph (A).
Sec. 7418. Transfer of funds for implementation of ending the HIV epidemic: A plan for America
Title II of the Public Health Service Act (42 U.S.C. 202 et seq.) is amended by inserting after section 241 (42 U.S.C. 238j) the following:
241A. Transfer of funds for implementation of National HIV/AIDS Strategy
(a) Transfer authorization
Of the discretionary appropriations made available to the Department of Health and Human Services for any fiscal year for programs and activities that, as determined by the Secretary, pertain to HIV, the Secretary may transfer up to 1 percent of such appropriations to the Office of the Assistant Secretary for Health for implementation of the Ending the HIV Epidemic: A Plan for America.
(b) Congressional notification
Not less than 30 days before making any transfer under this section, the Secretary shall give notice of the transfer to the Congress.
(c) Definitions
In this section, the term Ending the HIV Epidemic: A Plan for America means the initiative of the Department of Health and Human Services that seeks to reduce the number of new HIV infections in the United States by 75 percent by 2027, and then by at least 90 percent by 2032, for an estimated 250,000 total HIV infections averted.
Sec. 7419. PrEP access and coverage
(a) Coverage of HIV testing and prevention services
(1) Private insurance
(A) In general
Section 2713(a) of the Public Health Service Act (42 U.S.C. 300gg–13(a)) is amended to read as follows:
(a) Coverage of preventive health services
(1) In general
A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum, provide coverage for and shall not impose any cost sharing requirements for—
(A)
evidence-based items or services that have in effect a rating of
AorBin the current recommendations of the United States Preventive Services Task Force;(B)
immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved;
(C)
with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration;
(D)
with respect to women, such additional preventive care and screenings not described in subparagraph (A) as provided for in comprehensive guidelines supported by the Health Resources and Services Administration for purposes of this subparagraph;
(E)
any prescription drug approved by the Food and Drug Administration for the prevention of HIV (other than a drug subject to preauthorization requirements consistent with section 2729A), administrative fees for such drugs, laboratory and other diagnostic procedures associated with the use of such drugs, and clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, without limitation; and
(B) Prohibition on preauthorization requirements
(i) PHSA
Part D of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–111 et seq.) is amended by adding at the end the following:
2799A–12. Prohibition on preauthorization requirements with respect to certain services
A group health plan or a health insurance issuer offering group or individual health insurance coverage shall not impose any preauthorization requirements with respect to coverage of the services described in section 2713(a)(1)(E), except that a plan or issuer may impose preauthorization requirements with respect to coverage of a particular drug approved under section 505(c) of the Federal Food, Drug, and Cosmetic Act or section 351(a) of this Act if such plan or issuer provides coverage without any preauthorization requirements for a drug that is therapeutically equivalent.
(ii) ERISA
(I) In general
Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended by adding at the end the following:
727. Prohibition on preauthorization requirements with respect to certain services
A group health plan or a health insurance issuer offering group health insurance coverage shall not impose any preauthorization requirements with respect to coverage of the services described in section 2713(a)(1)(E), except that a plan or issuer may impose preauthorization requirements with respect to coverage of a particular drug approved under section 505(c) of the Federal Food, Drug, and Cosmetic Act or section 351(a) of this Act if such plan or issuer provides coverage without any preauthorization requirements for a drug that is therapeutically equivalent.
(II) Clerical amendment
The table of contents in section 1 of such Act is amended by inserting after the item relating to section 726 the following new item:
(iii) IRC
(I) In general
Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following:
9827. Prohibition on preauthorization requirements with respect to certain services
A group health plan shall not impose any preauthorization requirements with respect to coverage of the services described in section 2713(a)(1)(E), except that a plan may impose preauthorization requirements with respect to coverage of a particular drug approved under section 505(c) of the Federal Food, Drug, and Cosmetic Act or section 351(a) of this Act if such plan provides coverage without any preauthorization requirements for a drug that is therapeutically equivalent.
(C) Clerical amendment
The table of sections for subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new item:
(2) Coverage under federal employees health benefits program
Section 8904 of title 5, United States Code, is amended by adding at the end the following:
(c)
Any health benefits plan offered under this chapter shall include benefits for, and may not impose any cost sharing requirements for, any prescription drug approved by the Food and Drug Administration for the prevention of HIV, administrative fees for such drugs, laboratory and other diagnostic procedures associated with the use of such drugs, and clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, without limitation.
(3) Medicaid
(A) In general
Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by section 5201(b)(2)(A)(i) and 5406(f), is amended—
(i)
in subsection (a)(4)—
(I)
by striking ; and (G)
and inserting ; (G)
; and
(II)
by striking the semicolon at the end and inserting ; and (H) HIV prevention services;
; and
(ii)
by adding at the end the following new subsection:
(rr) HIV prevention services
For purposes of subsection (a)(4)(H), the term HIV prevention services means prescription drugs for the prevention of HIV acquisition, administrative fees for such drugs, laboratory and other diagnostic procedures associated with the use of such drugs, and clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, without limitation.
(B) No cost-sharing
Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is amended—
(i)
in section 1916, by inserting HIV prevention services described in section 1905(a)(4)(H),
after section 1905(a)(4)(C),
each place it appears; and
(ii)
in section 1916A(b)(3)(B), as amended by section 7305, by adding at the end the following new clause:
(xvi)
HIV prevention services described in section 1905(a)(4)(H).
(C) Inclusion in benchmark coverage
Section 1937(b)(7) of the Social Security Act (42 U.S.C. 1396u–7(b)(7)) is amended—
(i)
in the paragraph header, by inserting and HIV prevention services
after supplies
; and
(ii)
by striking includes for any individual described in section 1905(a)(4)(C), medical assistance for family planning services and supplies in accordance with such section
and inserting includes medical assistance for HIV prevention services described in section 1905(a)(4)(H), and includes, for any individual described in section 1905(a)(4)(C), medical assistance for family planning services and supplies in accordance with such section
.
(4) CHIP
(A) In general
Section 2103 of the Social Security Act (42 U.S.C. 1397cc), as amended by section 2007(d)(5), is amended—
(i)
in subsection (a), by striking through (13)
and inserting through (14)
; and
(ii)
in subsection (c), by adding at the end the following new paragraph:
(14) HIV prevention services
Regardless of the type of coverage elected by a State under subsection (a), the child health assistance provided for a targeted low-income child, and, in the case of a State that elects to provide pregnancy-related assistance pursuant to section 2112, the pregnancy-related assistance provided for a targeted low-income pregnant woman (as such terms are defined for purposes of such section), shall include coverage of HIV prevention services (as defined in section 1905(rr)).
(B) No cost-sharing
Section 2103(e)(2) of the Social Security Act (42 U.S.C. 1397cc(e)(2)) is amended by inserting HIV prevention services described in subsection (c)(14),
before or for pregnancy-related assistance
.
(C) Effective date
(i) In general
Subject to clause (ii), the amendments made by paragraph (3) and this paragraph shall take effect on January 1, 2027.
(ii) Delay permitted if state legislation required
In the case of a State plan approved under title XIX or XXI of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by this subsection, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of the failure of the plan to meet such additional requirements before the 1st day of the 1st calendar quarter beginning after the close of the 1st regular session of the State legislature that ends after the 1-year period beginning with the date of the enactment of this Act. For purposes of the preceding sentence, in the case of a State that has a 2-year legislative session, each year of the session is deemed to be a separate regular session of the State legislature.
(5) Coverage and elimination of cost-sharing under Medicare
(A) Coverage of HIV prevention services under part B
(i) Coverage
(I) In general
Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)), as amended by section 4251(c)(1) and 6101(a)(1), is amended—
(aa)
by striking and
at the end of subparagraph (LL);
(bb)
by inserting and
at the end of subparagraph (MM); and
(cc)
by adding at the end the following new subparagraph:
(NN)
HIV prevention services (as defined in subsection (sss));
(II) Definition
Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by sections 2007(b), 4221(a), 4251(c)(2), and 6101(a)(2), is amended by adding at the end the following new subsection:
(sss) HIV prevention services
The term HIV prevention services means—
(1)
drugs or biologicals approved by the Food and Drug Administration for the prevention of HIV;
(2)
administrative fees for such drugs;
(3)
laboratory and other diagnostic procedures associated with the use of such drugs; and
(4)
clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, without limitation.
(ii) Elimination of coinsurance
Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)), as amended by sections 4251(c)(3) and 6101(a)(4), is amended—
(I)
by striking and
before (JJ)
; and
(II)
by inserting before the semicolon at the end the following: and (KK) with respect to HIV prevention services (as defined in section 1861(sss)), the amount paid shall be 100 percent of (i) except as provided in clause (ii), the lesser of the actual charge for the service or the amount determined under the fee schedule that applies to such services under this part, and (ii) in the case of such services that are covered OPD services (as defined in subsection (t)(1)(B)), the amount determined under subsection (t)
.
(iii) Exemption from part B deductible
Section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)) is amended—
(I)
in paragraph (12), by striking section 1861(s)(10)(A),, and
and inserting section 1861(s)(10)(A),
;
(II)
in paragraph (13), by striking section 1861(n)..
and inserting section 1861(n), and (14) such deductible shall not apply with respect to HIV prevention services (as defined in section 1861(sss).
.
(iv) Effective date
The amendments made by this subparagraph shall apply to items and services furnished on or after January 1, 2027.
(B) Elimination of cost-sharing for drugs for the prevention of HIV under part D
(i) In general
Section 1860D–2 of the Social Security Act (42 U.S.C. 1395w–102) is amended—
(I)
in subsection (b)—
(aa)
in paragraph (1)(A), in the matter preceding clause (i), by striking (8) and (9)
and inserting (8), (9), and (10)
;
(bb)
in paragraph (2)(A), in subparagraph (A), in the matter preceding clause (i), by striking (8) and (9)
and inserting (8), (9), and (10)
; and
(cc)
by adding at the end the following new paragraph:
(10) Elimination of cost-sharing for drugs for the prevention of HIV
For plan years beginning on or after January 1, 2027, with respect to a covered part D drug that is for the prevention of HIV—
(A)
the deductible under paragraph (1) shall not apply; and
(B)
there shall be no coinsurance or other cost-sharing under this part with respect to such drug.; and
(II)
in subsection (c), by adding at the end the following new paragraph:
(7) Treatment of cost-sharing for drugs for the prevention of hiv
The coverage is in accordance with subsection (b)(10).
(ii) Conforming amendments to cost-sharing for low-income individuals
Section 1860D–14(a)(1)(D) of the Social Security Act (42 U.S.C. 1395w–114(a)(1)(D)) is amended in each of clauses (ii) and (iii), by striking paragraph (6)
and inserting paragraph (6) and section 1860D–2(b)(10)
.
(6) Coverage of HIV prevention treatment by Department of Veterans Affairs
(A) Elimination of medication copayments
Section 1722A(a) of title 38, United States Code, is amended by adding at the end the following new paragraph:
(5)
Paragraph (1) does not apply to a medication for the prevention of HIV.
(B) Elimination of hospital care and medical services copayments
Section 1710 of such title is amended—
(i)
in subsection (f)—
(I)
by redesignating paragraph (5) as paragraph (6); and
(II)
by inserting after paragraph (4) the following new paragraph (5):
(5)
A veteran shall not be liable to the United States under this subsection for any amounts for laboratory and other diagnostic procedures associated with the use of any prescription drug approved by the Food and Drug Administration for the prevention of HIV, administrative fees for such drugs, or for laboratory or other diagnostic procedures associated with the use of such drugs, or clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, without limitation.; and
(ii)
in subsection (g)(3), by adding at the end the following new subparagraph:
(C)
Any prescription drug approved by the Food and Drug Administration for the prevention of HIV, administrative fees for such drugs, laboratory and other diagnostic procedures associated with the use of such drugs, and clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, without limitation.
(C) Inclusion as preventive health service
Section 1701(9) of such title is amended—
(i)
in subparagraph (K), by striking ; and
and inserting a semicolon;
(ii)
by redesignating subparagraph (L) as subparagraph (M); and
(iii)
by inserting after subparagraph (K) the following new subparagraph (L):
(L)
any prescription drug approved by the Food and Drug Administration for the prevention of HIV, administrative fees for such drugs, laboratory and other diagnostic procedures associated with the use of such drugs, and clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, without limitation; and
(7) Coverage of HIV prevention treatment by Department of Defense
(A) In general
Chapter 55 of title 10, United States Code, is amended by inserting after section 1079c the following new section:
1079d. Coverage of HIV prevention treatment
(a) In general
The Secretary of Defense shall ensure coverage under the TRICARE program of HIV prevention treatment described in subsection (b) for any beneficiary under section 1074(a) of this title.
(b) HIV prevention treatment described
HIV prevention treatment described in this subsection includes any prescription drug approved by the Food and Drug Administration for the prevention of HIV, administrative fees for such drugs, laboratory and other diagnostic procedures associated with the use of such drugs, and clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, without limitation.
(c) No cost-Sharing
Notwithstanding section 1075, 1075a, or 1074g(a)(6) of this title or any other provision of law, there is no cost-sharing requirement for HIV prevention treatment covered under this section.
(B) Clerical amendment
The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1079c the following new item:
(8) Indian health service testing, monitoring, and prescription drugs for the prevention of hiv
Title II of the Indian Health Care Improvement Act is amended by inserting after section 223 (25 U.S.C. 1621v) the following:
224. Testing, monitoring, and prescription drugs for the prevention of HIV
(a) In general
The Secretary, acting through the Service, Indian tribes, and tribal organizations, shall provide, without limitation, funding for any prescription drug approved by the Food and Drug Administration for the prevention of human immunodeficiency virus (commonly known as
HIV), administrative fees for that drug, laboratory and other diagnostic procedures associated with the use of that drug, and clinical follow-up and monitoring, including any related services recommended in current Public Health Service clinical practice guidelines.(b) Authorization of appropriations
There are authorized to be appropriated such sums as are necessary to carry out this section.
(b) Prohibition on denial of coverage or increase in premiums of life, disability, or long-Term care insurance for individuals taking medication for the prevention of HIV acquisition
(1) Prohibition
Notwithstanding any other provision of law, it shall be unlawful to—
(A)
decline or limit coverage of a person under any life insurance policy, disability insurance policy, or long-term care insurance policy, on account of the individual taking medication for the purpose of preventing the acquisition of HIV;
(B)
preclude an individual from taking medication for the purpose of preventing the acquisition of HIV as a condition of receiving a life insurance policy, disability insurance policy, or long-term care insurance policy;
(C)
consider whether an individual is taking medication for the purpose of preventing the acquisition of HIV in determining the premium rate for coverage of such individual under a life insurance policy, disability insurance policy, or long-term care insurance policy; or
(D)
otherwise discriminate in the offering, issuance, cancellation, amount of such coverage, price, or any other condition of a life insurance policy, disability insurance policy, or long-term care insurance policy for an individual, based solely and without any additional actuarial risks upon whether the individual is taking medication for the purpose of preventing the acquisition of HIV.
(2) Enforcement
A State insurance regulator may take such actions to enforce paragraph (1) as are specifically authorized under the laws of such State.
(3) Definitions
In this subsection:
(A) Disability insurance policy
The term disability insurance policy means a contract under which an entity promises to pay a person a sum of money in the event that an illness or injury resulting in a disability prevents such person from working.
(B) Life insurance policy
The term life insurance policy means a contract under which an entity promises to pay a designated beneficiary a sum of money upon the death of the insured.
(C) Long-term care insurance policy
The term long-term care insurance policy means a contract for which the only insurance protection provided under the contract is coverage of qualified long-term care services (as defined in section 7702B(c) of the Internal Revenue Code of 1986).
(c) Patient confidentiality
The Secretary of Health and Human Services shall amend the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1320d–2 note), as necessary, to ensure that individuals are able to access the benefits described in section 2713(a)(1)(E) of the Public Health Service Act under a family plan without any other individual enrolled in such family plan, including a primary subscriber or policyholder of such plan, being informed of such use of such benefits.
(d) Pre-Exposure prophylaxis and post-Exposure prophylaxis funding
Part P of title III of the Public Health Service Act (42 U.S.C. 280g et seq.), as amended by section 7303, is amended by adding at the end the following:
399V–11. Pre-exposure prophylaxis and post-exposure prophylaxis funding
(a) In general
Not later than 1 year after the date of enactment of this section, the Secretary shall establish a program that awards grants to States, territories, Indian Tribes, and directly eligible entities for the establishment and support of pre-exposure prophylaxis (referred to in this section as
PrEP) and post-exposure prophylaxis (referred to in this section asPEP) HIV programs.(b) Applications
To be eligible to receive a grant under subsection (a), a State, territory, Indian Tribe, or directly eligible entity shall—
(1)
submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require, including a plan describing how any funds awarded will be used to increase access to PrEP for uninsured and underinsured individuals and reduce disparities in access to PrEP and PEP for uninsured and underinsured individuals and reduce disparities in access to PrEP and PEP; and
(2)
appoint a PrEP and PEP grant administrator to manage the program.
(c) Directly eligible entity
For purposes of this section, the term directly eligible entity—
(1)
means a Federally qualified health center or other nonprofit entity engaged in providing PrEP and PEP information and services; and
(2)
may include—
(A)
a Federally qualified health center (as defined in section 1861(aa)(4) of the Social Security Act);
(B)
a family planning grantee (other than States) funded under section 1001;
(C)
a rural health clinic (as defined in section 1861(aa)(2) of the Social Security Act);
(D)
a health facility operated by or pursuant to a contract with the Indian Health Service;
(E)
a community-based organization, clinic, hospital, or other health facility that provides services to individuals at risk for or living with HIV; and
(F)
a nonprofit private entity providing comprehensive primary care to populations at risk of HIV, including faith-based and community-based organizations.
(d) Awards
In determining whether to award a grant, and the grant amount for each grant awarded, the Secretary shall consider the grant application and the need for PrEP and PEP services in the area, the number of uninsured and underinsured individuals in the area, and how the State, territory, or Indian Tribe coordinates PrEP and PEP activities with the directly funded entity, if the State, territory, or Indian Tribe applies for the funds.
(e) Use of funds
(1) In general
Any State, territory, Indian Tribe, or directly eligible entity that is awarded funds under subsection (a) shall use such funds for eligible PrEP and PEP expenses.
(2) Eligible prep expenses
The Secretary shall publish a list of expenses that qualify as eligible PrEP and PEP expenses for purposes of this section, which shall include—
(A)
any prescription drug approved by the Food and Drug Administration for the prevention of HIV, administrative fees for such drugs, laboratory and other diagnostic procedures associated with the use of such drugs, and clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, without limitation;
(B)
outreach and public education activities directed toward populations overrepresented in the domestic HIV epidemic that increase awareness about the existence of PrEP and PEP, provide education about access to and health care coverage of PrEP and PEP, PrEP and PEP adherence programs, and counter stigma associated with the use of PrEP and PEP; and
(C)
outreach activities directed toward physicians and other providers that provide education about PrEP and PEP.
(f) Report to congress
The Secretary shall, in each of the first 5 years beginning one year after the date of the enactment of this section, submit to Congress, and make public on the internet website of the Department of Health and Human Services, a report on the impact of any grants provided to States, territories, and Indian Tribes and directly eligible entities for the establishment and support of pre-exposure prophylaxis programs under this section.
(g) Authorization of appropriations
To carry out this section, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2027 through 2032.
(e) Clarification
This section, including the amendments made by this section, shall apply notwithstanding any other provision of law, including Public Law 103–141.
(f) Private right of action
Any person aggrieved by a violation of this section, including the amendments made by this section, may commence a civil action in an appropriate United States District Court or other court of competent jurisdiction to obtain relief as allowed by law as either an individual or member of a class. If the plaintiff is the prevailing party in such an action, the court shall order the defendant to pay the costs and reasonable attorney fees of the plaintiff.
Subtitle F Diabetes
Sec. 7501. Research, treatment, and education
Subpart 3 of part C of title IV of the Public Health Service Act (42 U.S.C. 285c et seq.) is amended by adding at the end the following:
434B. Diabetes in minority populations
(a) In general
The Director of NIH shall expand, intensify, and support ongoing research and other activities with respect to prediabetes and diabetes, particularly type 2, in minority populations.
(b) Research
(1) Description
Research under subsection (a) shall include investigation into—
(A)
the causes of diabetes, including socioeconomic, geographic, clinical, environmental, genetic, and other factors that may contribute to increased rates of diabetes in minority populations; and
(B)
the causes of increased incidence of diabetes complications in minority populations, and possible interventions to decrease such incidence.
(2) Inclusion of minority participants
In conducting and supporting research described in subsection (a), the Director of NIH shall seek to include minority participants as study subjects in clinical trials.
(c) Report; comprehensive plan
(1) In general
The Diabetes Mellitus Interagency Coordinating Committee shall—
(A)
prepare and submit to Congress, not later than 6 months after the date of enactment of this section, a report on Federal research and public health activities with respect to prediabetes and diabetes in minority populations; and
(B)
develop and submit to Congress, not later than 1 year after the date of enactment of this section, an effective and comprehensive Federal plan (including all appropriate Federal health programs) to address prediabetes and diabetes in minority populations.
(2) Contents
The report under paragraph (1)(A) shall at minimum address each of the following:
(A)
Research on diabetes and prediabetes in minority populations, including such research on—
(i)
genetic, behavioral, socioeconomic, and environmental factors;
(ii)
prevention of diabetes within these populations and which of the populations have individuals at increased risk of developing diabetes;
(iii)
prevention of complications among individuals in these populations who have already developed diabetes; and
(iv)
barriers to health care access and diabetes treatment within populations at increased risk of developing diabetes.
(B)
Surveillance and data collection on diabetes and prediabetes in minority populations, including with respect to—
(i)
efforts to better determine the prevalence of diabetes among Asian-American, Native Hawaiian, and Pacific Islander subgroups; and
(ii)
efforts to coordinate data collection on the American Indian population.
(C)
Community-based interventions to address diabetes and prediabetes targeting minority populations, including—
(i)
the evidence base for such interventions;
(ii)
the cultural appropriateness of such interventions; and
(iii)
efforts to educate the public on the causes and consequences of diabetes.
(D)
Education and training programs for health professionals (including community health workers) on the prevention and management of diabetes and its related complications that is supported by the Health Resources and Services Administration, including such programs supported by—
(i)
the National Health Service Corps; or
(ii)
the community health centers program under section 330.
(d) Education
The Director of NIH shall—
(1)
through the National Institute on Minority Health and Health Disparities and the National Diabetes Education Program—
(A)
make grants to programs funded under section 464z–4 for the purpose of establishing a medical education program for health care professionals to be more involved in weight counseling, obesity research, nutrition, and shared decision making; and
(B)
provide for the participation of minority health professionals in diabetes-focused research programs; and
(2)
make grants to programs that establish a professional pipeline that will increase the participation of minority individuals in diabetes-focused health fields by expanding Minority Access to Research Careers program internships and mentoring opportunities for the purposes of recruitment.
(e) Definitions
For purposes of this section:
(1) Diabetes mellitus interagency coordinating committee
The
Diabetes Mellitus Interagency Coordinating Committeemeans the Diabetes Mellitus Interagency Coordinating Committee established under section 429.(2) Minority population
The term minority population means a racial and ethnic minority group, as defined in section 1707.
Sec. 7502. Research, education, and other activities
Part B of title III of the Public Health Service Act (42 U.S.C. 243 et seq.), as amended by section 7201, is amended by inserting after section 317X the following:
317Y. Diabetes in minority populations
(a) Research and other activities
(1) In general
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall conduct and support research and public health activities with respect to diabetes in minority populations.
(2) Certain activities
Activities under paragraph (1) regarding diabetes in minority populations shall include the following:
(A)
Further enhancing the National Health and Nutrition Examination Survey by oversampling Asian Americans, Native Hawaiians, and Pacific Islanders in appropriate geographic areas to better determine the prevalence of diabetes in such populations as well as to improve the data collection of diabetes penetration disaggregated into major ethnic groups within such populations. The Secretary shall ensure that any such oversampling does not reduce the oversampling of other minority populations including African-American and Latino populations.
(B)
Through the Division of Diabetes Translation—
(i)
providing for prevention research to better understand how to influence health care systems changes to improve quality of care being delivered to such populations;
(ii)
carrying out model demonstration projects to design, implement, and evaluate effective diabetes prevention and control interventions for minority populations, including culturally appropriate community-based interventions;
(iii)
developing and implementing a strategic plan to reduce diabetes in minority populations through applied research to reduce disparities and culturally and linguistically appropriate community-based interventions;
(iv)
supporting, through the national diabetes prevention program under section 399V–3, diabetes prevention program sites in underserved regions highly impacted by diabetes; and
(v)
implementing, through the national diabetes prevention program under section 399V–3, a demonstration program developing new metrics measuring health outcomes related to diabetes that can be stratified by specific minority populations.
(b) Education
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall direct the Division of Diabetes Translation to conduct and support both programs to educate the public on diabetes in minority populations and programs to educate minority populations about the causes and effects of diabetes.
(c) Diabetes; health promotion, prevention initiatives, and access
The Secretary, acting through the Director of the Centers for Disease Control and Prevention and the National Diabetes Education Program, shall conduct and support programs to educate specific minority populations through culturally appropriate and linguistically appropriate information campaigns and initiatives about prevention of, and managing, diabetes.
(d) Definition
For purposes of this section, the term minority population means a racial and ethnic minority group, as defined in section 1707.
Sec. 7503. Programs to educate health providers on the causes and effects of diabetes in minority populations
Part P of title III of the Public Health Service Act (42 U.S.C. 280g et seq.), as amended by section 7419(d), is amended by adding at the end the following:
399V–12. Programs to educate health providers on the causes and effects of diabetes in minority populations
(a) In general
The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall conduct and support programs described in subsection (b) to educate health professionals on the causes and effects of diabetes in minority populations.
(b) Programs
Programs described in this subsection, with respect to education on diabetes in minority populations, shall include the following:
(1)
Giving priority, under the primary care training and enhancement program under section 747—
(A)
to awarding grants to focus on or address diabetes; and
(B)
to adding minority populations to the list of vulnerable populations that should be served by such grants.
(2)
Providing additional funds for the Health Careers Opportunity Program and the Centers of Excellence to partner with the Office of Minority Health under section 1707 and the National Institutes of Health to strengthen programs for career opportunities focused on diabetes treatment and care within underserved regions highly impacted by diabetes.
(3)
Developing a diabetes focus within, and providing additional funds for, the National Health Service Corps scholarship program—
(A)
to place individuals in areas that are disproportionately affected by diabetes and to provide diabetes treatment and care in such areas; and
(B)
to provide such individuals continuing medical education specific to diabetes care.
Sec. 7504. Research, education, and other activities regarding diabetes in american indian populations
Part P of title III of the Public Health Service Act (42 U.S.C. 280g et seq.), as amended by section 7503, is amended by adding at the end the following:
399V–13. Research, education, and other activities regarding diabetes in American Indian populations
In addition to activities under sections 317X, 399V–12, and 434B, the Secretary, acting through the Indian Health Service and in collaboration with other appropriate Federal agencies, shall—
(1)
conduct and support research and other activities with respect to diabetes; and
(2)
coordinate the collection of data on clinically and culturally appropriate diabetes treatment, care, prevention, and services by health care professionals to the American Indian population.
Sec. 7505. Updated report on health disparities
The Secretary of Health and Human Services shall seek to enter into an arrangement with the National Academy of Medicine under which the National Academy will—
(1)
not later than 1 year after the date of enactment of this Act, submit to Congress an updated version of the 2003 report entitled Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
; and
(2)
in such updated version, address how racial and ethnic health disparities have changed since the publication of the original report.
Subtitle G Lung disease
Sec. 7601. Asthma-related activities of the Centers for Disease Control and Prevention
Section 317I of the Public Health Service Act (42 U.S.C. 247b–10) is amended to read as follows:
317I. Asthma-related activities of the Centers for Disease Control and Prevention
(a) Program for providing information and education to the public
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall collaborate with State and local health departments to conduct activities, including the provision of information and education to the public, regarding asthma including—
(1)
deterring the harmful consequences of uncontrolled asthma; and
(2)
disseminating health education and information regarding prevention of asthma episodes and strategies for managing asthma.
(b) Development of state asthma plans
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall collaborate with State and local health departments to develop State plans incorporating public health responses to reduce the burden of asthma, particularly regarding disproportionately affected populations.
(c) Compilation of data
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall, in cooperation with State and local public health officials—
(1)
conduct asthma surveillance activities to collect data on the prevalence and severity of asthma, the effectiveness of public health asthma interventions, and the quality of asthma management, including—
(A)
collection of data among people with asthma to monitor the impact on health and quality of life;
(B)
surveillance of health care facilities; and
(C)
collection of data not containing individually identifiable information from electronic health records or other electronic communications;
(2)
compile and annually publish data regarding the prevalence and incidence of childhood asthma, the child mortality rate, and the number of hospital admissions and emergency department visits by children associated with asthma nationally and in each State and at the county level by age, sex, race, and ethnicity, as well as lifetime and current prevalence; and
(3)
compile and annually publish data regarding the prevalence and incidence of adult asthma, the adult mortality rate, and the number of hospital admissions and emergency department visits by adults associated with asthma nationally and in each State and at the county level by age, sex, race, ethnicity, industry, and occupation, as well as lifetime and current prevalence.
(d) Coordination of data collection
The Director of the Centers for Disease Control and Prevention, in conjunction with State and local health departments, shall coordinate data collection activities under paragraphs (2) and (3) of subsection (c) so as to maximize comparability of results.
(e) Collaboration
(1) In general
The Centers for Disease Control and Prevention may collaborate with national, State, and local nonprofit organizations to provide information and education about asthma, and to strengthen such collaborations when possible.
(2) Specific activities
The Director of the Centers for Disease Control and Prevention, acting through the Division of Population Health of the Centers, may expand activities relating to asthma with non-Federal partners, especially State-level entities.
(f) Reports to congress
(1) In general
Not later than 3 years after the date of the enactment of the Health Equity and Accountability Act of 2026, and once 2 years thereafter, the Secretary shall, in consultation with patient groups, nonprofit organizations, medical societies, and other relevant governmental and nongovernmental entities, submit to Congress a report that—
(A)
catalogs, with respect to asthma prevention, management, and surveillance—
(i)
the activities of the Federal Government, including an assessment of the progress of the Federal Government and States, with respect to achieving the goals of the Healthy People 2030 initiative; and
(ii)
the activities of other entities that participate in the program under this section, including nonprofit organizations, patient advocacy groups, and medical societies; and
(B)
makes recommendations for the future direction of asthma activities, in consultation with researchers from the National Institutes of Health and other member bodies of the Asthma Disparities Subcommittee, including—
(i)
a description of how the Federal Government may improve its response to asthma, including identifying any barriers that may exist;
(ii)
a description of how the Federal Government may continue, expand, and improve its private-public partnerships with respect to asthma, including identifying any barriers that may exist;
(iii)
identification of steps that may be taken to reduce the—
(I)
morbidity, mortality, and overall prevalence of asthma;
(II)
financial burden of asthma on society;
(III)
burden of asthma on disproportionately affected areas, particularly those in medically underserved populations (as defined in section 330(b)(3)); and
(IV)
burden of asthma as a chronic disease that can be worsened by environmental exposures;
(iv)
the identification of programs and policies that have achieved the steps described under clause (iii), and steps that may be taken to expand such programs and policies to benefit larger populations; and
(v)
recommendations for future research and interventions.
(2) Subsequent reports
(A) Congressional request
During the 5-year period following the submission of the second report under paragraph (1), the Secretary shall submit updates and revisions of the report upon the request of the Congress.
(B) Five-year reevaluation
At the end of the 5-year period referred to in subparagraph (A), the Secretary shall—
(i)
evaluate the analyses and recommendations made in previous reports; and
(ii)
determine whether an additional report is needed and if so submit such an updated report to the Congress, including appropriate recommendations.
(g) Authorization of appropriations funding
In addition to any other authorization of appropriations that is available to the Centers for Disease Control and Prevention for the purpose of carrying out this section, there is authorized to be appropriated to such Centers $65,000,000 for the period of fiscal years 2027 through 2031 for the purpose of carrying out this section.
Sec. 7602. Influenza and pneumonia vaccination campaign
(a) In general
The Secretary of Health and Human Services shall—
(1)
enhance the annual campaign by the Department of Health and Human Services to increase the number of people vaccinated each year for influenza and pneumonia; and
(2)
include in such campaign the use of written educational materials, public service announcements, physician education, and any other means which the Secretary determines effective.
(b) Materials and announcements
In carrying out the annual campaign described in subsection (a), the Secretary of Health and Human Services shall ensure that—
(1)
educational materials and public service announcements are readily and widely available in communities experiencing disparities in the incidence and mortality rates of influenza and pneumonia; and
(2)
the campaign uses targeted, culturally appropriate messages and messengers to reach underserved communities.
(c) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
Sec. 7603. Chronic obstructive pulmonary disease
(a) In general
The Director of the Centers for Disease Control and Prevention shall conduct, support, and expand public health strategies and prevention, diagnosis, surveillance, and public and professional awareness activities regarding chronic obstructive pulmonary disease.
(b) Chronic disease prevention programs
The Director of the National Heart, Lung, and Blood Institute shall carry out the following:
(1)
Conduct public education and awareness activities with patient and professional organizations to stimulate earlier diagnosis and improve patient outcomes from treatment of chronic obstructive pulmonary disease. To the extent known and relevant, such public education and awareness activities shall reflect differences in chronic obstructive pulmonary disease by cause (tobacco, environmental, occupational, biological, and genetic) and include a focus on outreach to undiagnosed and, as appropriate, minority populations.
(2)
Supplement and expand upon the activities of the National Heart, Lung, and Blood Institute by making grants to nonprofit organizations, State and local jurisdictions, and Indian Tribes for the purpose of reducing the burden of chronic obstructive pulmonary disease, especially in disproportionately impacted communities, through public health interventions and related activities.
(3)
Coordinate with the Centers for Disease Control and Prevention, the Indian Health Service, the Health Resources and Services Administration, and the Department of Veterans Affairs to develop pilot programs to demonstrate best practices for the diagnosis and management of chronic obstructive pulmonary disease.
(4)
Develop improved techniques and identify best practices, in coordination with the Secretary of Veterans Affairs, for assisting chronic obstructive pulmonary disease patients to successfully stop smoking, including identification of subpopulations with different needs. Initiatives under this paragraph may include research to determine whether successful smoking cessation strategies are different for chronic obstructive pulmonary disease patients compared to such strategies for patients with other chronic diseases.
(c) Environmental and occupational health programs
The Director of the Centers for Disease Control and Prevention shall—
(1)
support research into the environmental and occupational causes and biological mechanisms that contribute to chronic obstructive pulmonary disease; and
(2)
develop and disseminate public health interventions that will lessen the impact of environmental and occupational causes of chronic obstructive pulmonary disease.
(d) Data collection
Not later than 180 days after the date of enactment of this Act, the Director of the National Heart, Lung, and Blood Institute and the Director of the Centers for Disease Control and Prevention, acting jointly, shall assess the depth and quality of information on chronic obstructive pulmonary disease that is collected in surveys and population studies conducted by the Centers for Disease Control and Prevention, including whether there are additional opportunities for information to be collected in the National Health and Nutrition Examination Survey, the National Health Interview Survey, and the Behavioral Risk Factors Surveillance System surveys.
(e) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
Subtitle H Tuberculosis
Sec. 7701. United States Government assistance to combat tuberculosis
Section 104B of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b–3) is amended to read as follows:
104B. Assistance to combat tuberculosis
(a) Policy
(1) In general
It is a major objective of the foreign assistance program of the United States to help end the TB public health emergency through accelerated actions—
(A)
to support the diagnosis and treatment of all adults and children with all forms of TB; and
(B)
to prevent new TB infections from occurring.
(2) Support for global plans and objectives
In countries in which the United States Government has established foreign assistance programs under this Act, particularly in countries with the highest burden of TB and other countries with high rates of infection and transmission of TB, it is the policy of the United States—
(A)
to support the objectives of the World Health Organization End TB Strategy, including its goals—
(i)
to reduce TB deaths by 95 percent by 2035;
(ii)
to reduce the TB incidence rate by 90 percent by 2035; and
(iii)
to reduce the number of families facing catastrophic health costs due to TB by 100 percent by 2035;
(B)
to support the Stop TB Partnership’s Global Plan to End TB 2023–2030, including by providing support for—
(i)
developing and using innovative new technologies and therapies to increase active case finding and rapidly diagnose and treat children and adults with all forms of TB, alleviate suffering, and ensure TB treatment completion;
(ii)
expanding diagnosis and treatment in line with the goals established by the Political Declaration of the High-Level Meeting of the General Assembly on the Fight Against Tuberculosis, including—
(I)
successfully treating 40,000,000 people with active TB by 2023, including 3,500,000 children, and 1,500,000 people with drug-resistant TB; and
(II)
diagnosing and treating latent tuberculosis infection, in support of the global goal of providing preventive therapy to at least 30,000,000 people by 2023, including 4,000,000 children younger than 5 years of age, 20,000,000 household contacts of people affected by TB, and 6,000,000 people living with HIV;
(iii)
ensuring high-quality TB care by closing gaps in care cascades, implementing continuous quality improvement at all levels of care, and providing related patient support; and
(iv)
sustainable procurements of TB commodities to avoid interruptions in supply, the procurement of commodities of unknown quality, or payment of excessive commodity costs in countries impacted by TB; and
(C)
to ensure, to the greatest extent practicable, that United States funding supports activities that simultaneously emphasize—
(i)
the development of comprehensive person-centered programs, including diagnosis, treatment, and prevention strategies to ensure that—
(I)
all people sick with TB receive quality diagnosis and treatment through active case finding; and
(II)
people at high risk for TB infection are found and treated with preventive therapies in a timely manner;
(ii)
robust TB infection control practices are implemented in all congregate settings, including hospitals and prisons;
(iii)
the deployment of diagnostic and treatment capacity—
(I)
in areas with the highest TB burdens; and
(II)
for highly at-risk and impoverished populations, including patient support services;
(iv)
program monitoring and evaluation based on critical TB indicators, including indicators relating to infection control, the numbers of patients accessing TB treatment and patient support services, and preventative therapy for those at risk, including all close contacts, and treatment outcomes for all forms of TB;
(v)
training and engagement of health care workers on the use of new diagnostic tools and therapies as they become available, and increased support for training frontline health care workers to support expanded TB active case finding, contact tracing, and patient support services;
(vi)
coordination with domestic agencies and organizations to support an aggressive research agenda to develop vaccines as well as new tools to diagnose, treat, and prevent TB globally;
(vii)
linkages with the private sector on—
(I)
research and development of a vaccine, and on new tools for diagnosis and treatment of TB;
(II)
improving current tools for diagnosis and treatment of TB, including telehealth solutions for prevention and treatment; and
(III)
training healthcare professionals on use of the newest and most effective diagnostic and therapeutic tools;
(viii)
the reduction of barriers to care, including stigma and treatment and diagnosis costs, including through—
(I)
training health workers;
(II)
sensitizing policy makers;
(III)
requiring that all relevant grants and funding agreements include access and affordability provisions;
(IV)
supporting education and empowerment campaigns for TB patients regarding local TB services;
(V)
monitoring barriers to accessing TB services; and
(VI)
increasing support for patient-led and community-led TB outreach efforts;
(ix)
support for country-level, sustainable accountability mechanisms and capacity to measure progress and ensure that commitments made by governments and relevant stakeholders are met; and
(x)
support for the integration of TB diagnosis, treatment, and prevention activities into primary health care, as appropriate.
(b) Definitions
In this section:
(1) Appropriate congressional committees
The term appropriate congressional committees means the Committee on Foreign Relations of the Senate and the Committee on Foreign Affairs of the House of Representatives.
(2) End tb strategy
The term End TB Strategy means the strategy to eliminate TB that was approved by the World Health Assembly in May 2014, and is described in
The End TB Strategy: Global Strategy and Targets for Tuberculosis Prevention, Care and Control After 2015.(3) Global alliance for tuberculosis drug development
The term Global Alliance for Tuberculosis Drug Development means the public-private partnership that bring together leaders in health, science, philanthropy, and private industry to devise new approaches to TB.
(4) Global tuberculosis drug facility
The term Global Tuberculosis Drug Facility means the initiative of the Stop Tuberculosis Partnership to increase access to the most advanced, affordable, quality-assured TB drugs and diagnostics.
(5) MDR–TB
The term MDR–TB means multi-drug-resistant TB.
(6) Stop tuberculosis partnership
The term Stop Tuberculosis Partnership means the partnership of 1,600 organizations (including international and technical organizations, government programs, research and funding agencies, foundations, nongovernmental organizations, civil society and community groups, and the private sector), donors, including the United States, high TB burden countries, multilateral agencies, and nongovernmental and technical agencies, which is governed by the Stop TB Partnership Coordinating Board and hosted by a United Nations entity, committed to short- and long-term measures required to control and eventually eliminate TB as a public health problem in the world.
(7) XDR–TB
The term XDR–TB means extensively drug-resistant TB.
(c) Authorization
To carry out this section, the President is authorized, consistent with section 104(c), to furnish assistance, on such terms and conditions as the President may determine, for the prevention, treatment, control, and elimination of TB.
(d) Goals
In consultation with the appropriate congressional committees, the President shall establish goals, based on the policy and indicators described in subsection (a), for—
(1)
United States TB programs to detect, cure, and prevent all forms of TB globally for the period between 2023 and 2030 that are aligned with the End TB Strategy’s 2030 targets and the USAID’s Global Tuberculosis (TB) Strategy 2023–2030; and
(2)
updating the National Action Plan for Combating Multidrug-Resistant Tuberculosis.
(e) Coordination
(1) In general
In carrying out this section, the President shall coordinate with the World Health Organization, the Stop TB Partnership, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and other organizations with respect to the development and implementation of a comprehensive global TB response program.
(2) Bilateral assistance
In providing bilateral assistance under this section, the President shall—
(A)
catalyze support for research and development of new tools to prevent, diagnose, treat, and control TB worldwide, particularly to reduce the incidence of, and mortality from, all forms of drug-resistant TB;
(B)
ensure United States programs and activities focus on finding individuals with active TB disease and provide quality diagnosis and treatment, including through digital health solutions, and reaching those at high risk with preventive therapy; and
(C)
ensure coordination among relevant United States Government agencies, including the Department of State, the Centers for Disease Control and Prevention, the National Institutes of Health, the Biomedical Advanced Research and Development Authority, the Food and Drug Administration, the National Science Foundation, the Department of Defense (through its Congressionally Directed Medical Research Programs), and other relevant Federal departments and agencies that engage in international TB activities—
(i)
to ensure accountability and transparency;
(ii)
to reduce duplication of efforts; and
(iii)
to ensure appropriate integration and coordination of TB services into other United States-supported health programs.
(f) Priority To end TB strategy
In furnishing assistance under subsection (c), the President shall prioritize—
(1)
building and strengthening TB programs—
(A)
to increase the diagnosis and treatment of everyone who is sick with TB; and
(B)
to ensure that such individuals have access to quality diagnosis and treatment;
(2)
direct, high-quality integrated services for all forms of TB, as described by the World Health Organization, which call for the coordination of active case finding, treatment of all forms of TB disease and infection, patient support, and TB prevention;
(3)
treating individuals co-infected with HIV and other co-morbidities, and other individuals with TB who may be at risk of stigma;
(4)
strengthening the capacity of health systems to detect, prevent, and treat TB, including MDR–TB and XDR–TB, as described in the latest international guidance related to TB;
(5)
researching and developing innovative diagnostics, drug therapies, and vaccines, and program-based research;
(6)
support for the Stop Tuberculosis Partnership’s Global Drug Facility, the Global Alliance for Tuberculosis Drug Development, and other organizations promoting the development of new products and drugs for TB; and
(7)
ensuring that TB programs can serve as key platforms for supporting national respiratory pandemic response against existing and new infectious respiratory disease.
(g) Assistance for the World Health Organization and the Stop Tuberculosis Partnership
In carrying out this section, the President is authorized—
(1)
to provide resources to the World Health Organization and the Stop Tuberculosis Partnership to improve the capacity of countries with high burdens or rates of TB and other affected countries to implement the End TB Strategy, the Stop TB Global Plan to End TB, their own national strategies and plans, other global efforts to control MDR–TB and XDR–TB; and
(2)
to leverage the contributions of other donors for the activities described in paragraph (1).
(h) Annual report on TB activities
Not later than December 15 of each year until the earlier of the date on which the goals specified in subsection (a)(2)(A) are met or the last day of 2032, the President shall submit an annual report to the appropriate congressional committees that describes United States foreign assistance to control TB and the impact of such efforts, including—
(1)
the number of individuals with active TB disease that were diagnosed and treated, including the rate of treatment completion and the number receiving patient support;
(2)
the number of persons with MDR–TB and XDR–TB that were diagnosed and treated, including the rate of completion, in countries receiving United States bilateral foreign assistance for TB control programs;
(3)
the number of people trained by the United States Government in TB surveillance and control;
(4)
the number of individuals with active TB disease identified as a result of engagement with the private sector and other nongovernmental partners in countries receiving United States bilateral foreign assistance for TB control programs;
(5)
a description of the collaboration and coordination of United States anti-TB efforts with the World Health Organization, the Stop TB Partnership, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and other major public and private entities;
(6)
a description of the collaboration and coordination among the United States Agency for International Development and other United States departments and agencies, including the Centers for Disease Control and Prevention and the Office of the Global AIDS Coordinator, for the purposes of combating TB and, as appropriate, its integration into primary care;
(7)
the constraints on implementation of programs posed by health workforce shortages, health system limitations, barriers to digital health implementation, other challenges to successful implementation, and strategies to address such constraints;
(8)
a breakdown of expenditures for patient services supporting TB diagnosis, treatment, and prevention, including procurement of drugs and other commodities, drug management, training in diagnosis and treatment, health systems strengthening that directly impacts the provision of TB services, and research; and
(9)
for each country, and when practicable, each project site receiving bilateral United States assistance for the purpose of TB prevention, treatment, and control—
(A)
a description of progress toward the adoption and implementation of the most recent World Health Organization guidelines to improve diagnosis, treatment, and prevention of TB for adults and children, disaggregated by sex, including the proportion of health facilities that have adopted the latest World Health Organization guidelines on strengthening monitoring systems and preventative, diagnostic, and therapeutic methods, including the use of rapid diagnostic tests and orally administered TB treatment regimens;
(B)
the number of individuals screened for TB disease and the number evaluated for TB infection using active case finding outside of health facilities;
(C)
the number of individuals with active TB disease that were diagnosed and treated, including the rate of treatment completion and the number receiving patient support;
(D)
the number of adults and children, including people with HIV and close contacts, who are evaluated for TB infection, the number of adults and children started on treatment for TB infection, and the number of adults and children completing such treatment, disaggregated by sex and, as possible, income or wealth quintile;
(E)
the establishment of effective TB infection control in all relevant congregant settings, including hospitals, clinics, and prisons;
(F)
a description of progress in implementing measures to reduce TB incidence, including actions—
(i)
to expand active case finding and contact tracing to reach vulnerable groups; and
(ii)
to expand TB preventive therapy, engagement of the private sector, and diagnostic capacity;
(G)
a description of progress to expand diagnosis, prevention, and treatment for all forms of TB, including in pregnant women, children, and individuals and groups at greater risk of TB, including migrants, prisoners, miners, people exposed to silica, and people living with HIV/AIDS, disaggregated by sex;
(H)
the rate of successful completion of TB treatment for adults and children, disaggregated by sex, and the number of individuals receiving support for treatment completion;
(I)
the number of people, disaggregated by sex, receiving treatment for MDR–TB, the proportion of those treated with the latest regimens endorsed by the World Health Organization, factors impeding scale up of such treatment, and a description of progress to expand community-based MDR–TB care;
(J)
a description of TB commodity procurement challenges, including shortages, stockouts, or failed tenders for TB drugs or other commodities;
(K)
the proportion of health facilities with specimen referral linkages to quality diagnostic networks, including established testing sites and reference labs, to ensure maximum access and referral for second line drug resistance testing, and a description of the turnaround time for test results;
(L)
the number of people trained by the United States Government to deliver high-quality TB diagnostic, preventative, monitoring, treatment, and care services;
(M)
a description of how supported activities are coordinated with—
(i)
country national TB plans and strategies; and
(ii)
TB control efforts supported by the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and other international assistance programs and funds, including in the areas of program development and implementation; and
(N)
for the first 3 years of the report required under this subsection, a description of the progress in recovering from the negative impact of COVID–19 on TB, including—
(i)
whether there has been the development and implementation of a comprehensive plan to recover TB activities from diversion of resources;
(ii)
the continued use of bidirectional TB–COVID testing; and
(iii)
progress on increased diagnosis and treatment of active TB.
(i) Annual report on TB research and development
The President, in coordination with the National Institutes of Health, the Centers for Disease Control and Prevention, the Biomedical Advanced Research and Development Authority, the Food and Drug Administration, the National Science Foundation, and the Office of the Global AIDS Coordinator, shall submit to the appropriate congressional committees until 2032 an annual report that—
(1)
describes the current progress and challenges to the development of new tools for the purpose of TB prevention, treatment, and control;
(2)
identifies critical gaps and emerging priorities for research and development, including for rapid and point-of-care diagnostics, shortened treatments and prevention methods, telehealth solutions for prevention and treatment, and vaccines; and
(3)
describes research investments by type, funded entities, and level of investment.
(j) Evaluation report
Not later than 3 years after the date of the enactment of the Health Equity and Accountability Act of 2026, and 5 years thereafter, the Comptroller General of the United States shall submit a report to the appropriate congressional committees that evaluates the performance and impact on TB prevention, diagnosis, treatment, and care efforts that are supported by United States bilateral assistance funding, including recommendations for improving such programs.
Subtitle I Osteoarthritis and Musculoskeletal Diseases
Sec. 7801. Osteoarthritis and other musculoskeletal health-related activities of the Centers for Disease Control and Prevention
(a) Education and awareness activities
The Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention, shall direct the National Center for Chronic Disease Prevention and Health Promotion to conduct and expand the Health Community Program and Arthritis Program to educate the public on—
(1)
the causes of, preventive health actions for, and effects of arthritis, lupus, and other musculoskeletal conditions in minority patient populations; and
(2)
the effects of such conditions on other comorbidities including obesity, hypertension, and cardiovascular disease.
(b) Programs on arthritis and musculoskeletal conditions
Education and awareness programs of the Centers for Disease Control and Prevention on arthritis and other musculoskeletal conditions in minority communities shall—
(1)
be culturally and linguistically appropriate to minority patients, targeting musculoskeletal health promotion and prevention programs of each major ethnic group, including—
(A)
Native Americans and Alaska Natives;
(B)
Asian Americans;
(C)
African Americans and Blacks;
(D)
Hispanic and Latino Americans; and
(E)
Native Hawaiians and Pacific Islanders; and
(2)
include public awareness campaigns directed toward these patient populations that emphasize the importance of musculoskeletal health, physical activity, diet and healthy lifestyle, and weight reduction for overweight and obese patients.
(c) Authorization of appropriations
To carry out this section, there are authorized to be appropriated such sums as are necessary for fiscal year 2027 and each subsequent fiscal year.
Sec. 7802. Grants for comprehensive osteoarthritis and musculoskeletal disease health education within health professions schools
(a) Program authorized
The Secretary of Health and Human Services (in this section referred to as the Secretary
), in coordination with the Secretary of Education, shall award grants, on a competitive basis, to academic health science centers, health professions schools, and institutions of higher education to enable such centers, schools, and institutions to provide people with comprehensive education on arthritis and musculoskeletal health, particularly—
(1)
obesity-related musculoskeletal diseases;
(2)
arthritis and osteoarthritis;
(3)
arthritis and musculoskeletal health disparities; and
(4)
the relationship between arthritis and musculoskeletal diseases and metabolic activity, psychological health, and comorbidities such as diabetes, cardiovascular disease, lupus, and hypertension.
(b) Duration
Grants awarded under this section shall be for a period of 5 years.
(c) Applications
An academic health science center, health professions school, or institution of higher education seeking a grant under this section shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.
(d) Priority
In awarding grants under this section, the Secretary shall give priority to an institution of higher education that—
(1)
has an enrollment of needy students, as defined in section 318(b) of the Higher Education Act of 1965 (20 U.S.C. 1059e(b));
(2)
is a Hispanic-serving institution, as defined in section 502(a) of such Act (20 U.S.C. 1101a(a));
(3)
is a Tribal College or University, as defined in section 316(b) of such Act (20 U.S.C. 1059c(b));
(4)
is an Alaska Native-serving institution, as defined in section 317(b) of such Act (20 U.S.C. 1059d(b));
(5)
is a Native Hawaiian-serving institution, as defined in section 317(b) of such Act (20 U.S.C. 1059d(b));
(6)
is a Predominately Black Institution, as defined in section 318(b) of such Act (20 U.S.C. 1059e(b));
(7)
is a Native American-serving, nontribal institution, as defined in section 319(b) of such Act (20 U.S.C. 1059f(b));
(8)
is an Asian American and Native American Pacific Islander-serving institution, as defined in section 320(b) of such Act (20 U.S.C. 1059g(b)); or
(9)
is a minority institution, as defined in section 365 of such Act (20 U.S.C. 1067k), with an enrollment of needy students, as defined in section 312 of such Act (20 U.S.C. 1058).
(e) Uses of funds
An academic health science center, health professions school, or institution of higher education receiving a grant under this section may use the grant funds to integrate issues relating to comprehensive arthritis and musculoskeletal health into the academic or support sectors of the center, school, or institution in order to reach a large number of students, by carrying out 1 or more of the following activities:
(1)
Developing educational content for issues relating to comprehensive arthritis and musculoskeletal health education that will be incorporated into first-year orientation or core courses.
(2)
Creating innovative technology-based approaches to deliver arthritis and musculoskeletal health education to students, faculty, and staff.
(3)
Developing and employing peer-outreach and education programs to generate discussion, educate, and raise awareness among students about issues relating to arthritis and musculoskeletal health disorders, and their relationship to diabetes, hypertension, cardiovascular disease, psychological health, and other comorbid conditions.
(f) Report to congress
(1) In general
Not later than 1 year after the date of the enactment of this Act, and annually thereafter for a period of 5 years, the Secretary shall prepare and submit to the appropriate committees of Congress a report on the activities to provide health professions students with comprehensive arthritis and musculoskeletal health education funded under this section.
(2) Report elements
The report described in paragraph (1) shall include information about—
(A)
the number of entities that are receiving a grant under this section;
(B)
the specific activities supported by grants under this section;
(C)
the number of students served by programs supported by grants under this section; and
(D)
the status of evaluations of such programs.
(g) Definition of institution of higher education
In this section, the term institution of higher education has the meaning given such term in section 101 of the Higher Education Act of 1965 (20 U.S.C. 1001).
Subtitle J Sleep and circadian rhythm disorders
Sec. 7901. Sleep and circadian rhythm disorders research activities of the national institutes of health
(a) In general
The Director of the National Institutes of Health, acting through the Director of the National Heart, Lung, and Blood Institute, shall—
(1)
continue to expand research activities addressing sleep health disparities; and
(2)
continue implementation of the NIH Sleep Disorders Research Plan across all institutes and centers of the National Institutes of Health to improve treatment and prevention of sleep health disparities.
(b) Required research activities
In conducting or supporting research relating to sleep and circadian rhythm, the Director of the National Heart, Lung, and Blood Institute shall—
(1)
advance epidemiology and clinical research to achieve a more complete understanding of disparities in domains of sleep health and across population subgroups for which cardiovascular and metabolic health disparities exist, including—
(A)
prevalence and severity of sleep apnea;
(B)
habitual sleep duration;
(C)
sleep timing and regularity; and
(D)
insomnia;
(2)
develop study designs and analytical approaches to explain and predict multilevel and life-course determinants of sleep health and to elucidate the sleep-related causes of cardiovascular and metabolic health disparities across the age spectrum, including such determinants and causes that are—
(A)
environmental;
(B)
biological or genetic;
(C)
psychosocial;
(D)
societal;
(E)
political; or
(F)
economic;
(3)
determine the contribution of sleep impairments such as sleep apnea, insufficient sleep duration, irregular sleep schedules, and insomnia to unexplained disparities in cardiovascular and metabolic risk and disease outcomes;
(4)
develop study designs, data sampling and collection tools, and analytical approaches to optimize understanding of mediating and moderating factors, and feedback mechanisms coupling sleep to cardiovascular and metabolic health disparities;
(5)
advance research to understand cultural and linguistic barriers (on the person, provider, or system level) to access to care, medical diagnosis, and treatment of sleep disorders in diverse population groups;
(6)
develop and test multilevel interventions (including sleep health education in diverse communities) to reduce disparities in sleep health that will impact the ability to improve disparities in cardiovascular and metabolic risk or disease;
(7)
create opportunities to integrate sleep and health disparity science by strategically utilizing resources (involving existing or anticipated cohorts) and exchanging scientific data and ideas (including through cross-over into scientific meetings); and
(8)
enhance the diversity and foster career development of young investigators involved in sleep and health disparities science.
(c) Authorization of appropriations
To carry out this section, there are authorized to be appropriated such sums as may be necessary for fiscal year 2027 and each subsequent fiscal year.
Sec. 7902. Sleep and circadian rhythm health disparities-related activities of the Centers for Disease Control and Prevention
(a) In general
The Director of the Centers for Disease Control and Prevention shall conduct, support, and expand public health strategies and prevention, diagnosis, surveillance, and public and professional awareness activities regarding sleep and circadian rhythm disorders.
(b) Required surveillance and education awareness activities
In conducting or supporting research relating to sleep and circadian rhythm disorders surveillance and education awareness activities, the Director of the Centers for Disease Control and Prevention shall—
(1)
ensure that such activities are culturally and linguistically appropriate to minority patients, targeting sleep and circadian rhythm health promotion and prevention programs of each major ethnic group, including—
(A)
Native Americans and Alaska Natives;
(B)
Asian Americans;
(C)
African Americans and Blacks;
(D)
Hispanic and Latino-Americans; and
(E)
Native Hawaiians and Pacific Islanders;
(2)
collect and compile national and State surveillance data on sleep disorders health disparities;
(3)
continue to develop and implement new sleep questions in public health surveillance systems to increase public awareness of sleep health and sleep disorders and their impact on health;
(4)
publish monthly reports highlighting geographic, racial, and ethnic disparities in sleep health, as well as relationships between insufficient sleep and chronic disease, health risk behaviors, and other outcomes as determined necessary by the Director; and
(5)
include public awareness campaigns that inform patient populations from major ethnic groups about the prevalence of sleep and circadian rhythm disorders and emphasize the importance of sleep health.
(c) Authorization of appropriations
To carry out this section, there are authorized to be appropriated such sums as may be necessary for fiscal year 2027 and each subsequent fiscal year.
Sec. 7903. Grants for comprehensive sleep and circadian health education within health professions schools
(a) Program authorized
The Secretary of Health and Human Services (referred to in this section as the Secretary
), in coordination with the Secretary of Education, shall award grants, on a competitive basis, to academic health science centers, health professions schools, and institutions of higher education to enable such centers, schools, and institutions to provide people with comprehensive education on sleep and circadian health, particularly—
(1)
poor sleep health;
(2)
sleep disorders;
(3)
sleep health disparities; and
(4)
the relationship between sleep and circadian health on metabolic activity, neurological activity, comorbidities, and other diseases.
(b) Duration
Grants awarded under this section shall be for a period of 5 years.
(c) Applications
An academic health science center, health professions school, or institution of higher education seeking a grant under this section shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.
(d) Priority
In awarding grants under this section, the Secretary shall give priority to an institution of higher education that—
(1)
has an enrollment of needy students, as defined in section 318(b) of the Higher Education Act of 1965 (20 U.S.C. 1059e(b));
(2)
is a Hispanic-serving institution, as defined in section 502(a) of such Act (20 U.S.C. 1101a(a));
(3)
is a Tribal College or University, as defined in section 316(b) of such Act (20 U.S.C. 1059c(b));
(4)
is an Alaska Native-serving institution, as defined in section 317(b) of such Act (20 U.S.C. 1059d(b));
(5)
is a Native Hawaiian-serving institution, as defined in section 317(b) of such Act (20 U.S.C. 1059d(b));
(6)
is a Predominately Black Institution, as defined in section 318(b) of such Act (20 U.S.C. 1059e(b));
(7)
is a Native American-serving, nontribal institution, as defined in section 319(b) of such Act (20 U.S.C. 1059f(b));
(8)
is an Asian American and Native American Pacific Islander-serving institution, as defined in section 320(b) of such Act (20 U.S.C. 1059g(b)); or
(9)
is a minority institution, as defined in section 365 of such Act (20 U.S.C. 1067k), with an enrollment of needy students, as defined in section 312 of such Act (20 U.S.C. 1058).
(e) Uses of funds
An academic health science center, health professions school, or institution of higher education receiving a grant under this section may use the grant funds to integrate issues relating to comprehensive sleep and circadian health into the academic or support sectors of the center, school, or institution, in order to reach a large number of students, by carrying out 1 or more of the following activities:
(1)
Developing educational content for issues relating to comprehensive sleep and circadian health education that will be incorporated into first-year orientation or core courses.
(2)
Creating innovative technology-based approaches to deliver sleep health education to students, faculty, and staff.
(3)
Developing and employing peer-outreach and education programs to generate discussion, educate, and raise awareness among students about issues relating to poor quality sleep, sleep and circadian disorders, and the role sleep health plays in other diseases and comorbidities.
(f) Report to congress
(1) In general
Not later than 1 year after the date of the enactment of this Act, and annually thereafter for a period of 5 years, the Secretary shall prepare and submit to the appropriate committees of Congress a report on the activities to provide health professions students with comprehensive sleep and circadian health education funded under this section.
(2) Report elements
The report described in paragraph (1) shall include information about—
(A)
the number of entities that are receiving a grant under this section;
(B)
the specific activities supported by grants under this section;
(C)
the number of students served by programs supported by grants under this section; and
(D)
the status of evaluations of programs supported by such grants.
(g) Definition of institution of higher education
In this section, the term institution of higher education has the meaning given such term in section 101 of the Higher Education Act of 1965 (20 U.S.C. 1001).
Sec. 7904. Report on impact of sleep and circadian health disorders in vulnerable and racial/ethnic populations
(a) In general
Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services shall submit to Congress and the President a report on the impact of sleep and circadian health disorders for racial and ethnic minority communities and other vulnerable populations.
(b) Contents
The report under subsection (a) shall include information on the—
(1)
progress that has been made in reducing the impact of sleep and circadian health disorders in such communities and populations;
(2)
opportunities that exist to make additional progress in reducing the impact of sleep and circadian health disorders in such communities and populations;
(3)
challenges that may impede such additional progress; and
(4)
Federal funding necessary to achieve substantial reductions in sleep and circadian health disorders in racial and ethnic minority communities.
Subtitle K Kidney disease research, surveillance, prevention, and treatment
Sec. 7901A. Kidney disease research in minority populations
(a) In general
(1) Research and training centers
Section 431(c)(3) of the Public Health Service Act (42 U.S.C. 285c–5(c)(3)) is amended—
(A)
in subparagraph (B), by striking and
at the end;
(B)
in subparagraph (C), by striking and
at the end; and
(C)
by adding at the end the following:
(D)
improving data science through improvement in bioinformatics, data integration, and data sharing;
(E)
defining the chronic kidney disease mechanism and identifying new therapeutic targets for chronic kidney disease using specific tools, including mapping the genetic architecture of kidney function and disease and translating genetic maps to disease-causing genes and mechanisms, especially among minority populations;
(F)
improving models of human disease including better humanized animal models, improved reproducibility, and functional characterization of kidney organoids, and accelerating the development of in vivo imaging technologies; and
(G)
developing cell-specific drug delivery systems and gene editing, including targeted systems for the delivery of therapeutic compounds to specific kidney compartments or cell types and accelerating the implementation of gene editing and gene therapy for the treatment of kidney diseases in vivo; and
(2) Inclusion of minority participants
In conducting and supporting research described in the amendment made by paragraph (1), the Director of the National Institutes of Health shall work with the Director of the National Institute on Minority Health and Health Disparities to improve the number of minority participants as study subjects in clinical trials. Such work may include—
(A)
developing and sustaining clinical trial consortia that can recruit patients with chronic kidney disease to ensure adequate capacity for assessment of kidney outcomes and increase the enrollment of underrepresented populations;
(B)
encouraging the use of novel designs in clinical trials to enhance the recruitment and retention of underrepresented populations which will enhance the generalizability of study findings;
(C)
supporting outreach initiatives that incorporate acknowledgment of both historical and current grounds for participation reluctance, and that prioritize demonstrating trustworthiness, in order to enhance the ability to promote and effectively convey the benefits of clinical research participation;
(D)
completing clinical trials that test interventions to improve patient quality of life and address patient-reported outcomes; and
(E)
encouraging inclusion of persons with chronic kidney disease in clinical trials of treatments for nonkidney diseases.
(b) Report; comprehensive plan
Section 429 of the Public Health Services Act (42 U.S.C. 285c–3) is amended by adding at the end the following:
(c) Report by kidney, urologic, and hematologic diseases coordinating committee
(1) In general
The Kidney, Urologic, and Hematologic Diseases Coordinating Committee, in coordination with the Chronic Kidney Disease Initiative at the Centers for Disease Control and Prevention, shall—
(A)
prepare and submit to the Congress, not later than 6 months after the date of enactment of this subsection, a report on Federal research and public health activities with respect to kidney disease in minority populations; and
(B)
develop and submit to the Congress, the Secretary, the Director of the National Institutes of Health, and the Advisory Board established under section 430 for the diseases for which the Committee was established, not later than 1 year after the date of enactment of this subsection, an effective and comprehensive Federal plan (including all appropriate Federal health programs) to address kidney disease in minority populations.
(2) Contents
The report under paragraph (1)(A) shall at minimum address each of the following:
(A)
Research on kidney disease in minority populations, including such research on—
(i)
genetic, behavioral, and environmental factors;
(ii)
prevention and complications among individuals within these populations who have already developed kidney disease;
(iii)
the delivery of evidenced-based care for all chronic kidney disease stages, especially in underrepresented and underserved populations;
(iv)
expanding support for a root-cause analysis approach to disparities, including causes, detection, and management of chronic kidney disease for underserved populations;
(v)
developing research teams that engage with community organizations to develop and implement interventions which halt or delay development and progression of chronic kidney disease; and
(vi)
continued support of observational studies of kidney disease measures and outcomes.
(B)
Surveillance and data collection on kidney disease in minority populations, including with respect to—
(i)
efforts to better determine the prevalence of kidney disease among Asian-American, Native Hawaiian, and Pacific Islander subgroups; and
(ii)
efforts to coordinate data collection on the American Indian population.
(C)
Community-based interventions to address kidney disease targeting minority populations, including—
(i)
the evidence bases for such interventions;
(ii)
the cultural appropriateness of such interventions; and
(iii)
efforts to educate the public on the causes and consequences of kidney disease.
(D)
Education and training programs for health professionals (including community health workers) on the prevention and management of kidney disease and its related complications that are supported by the Health Resources and Services Administration, including such programs supported by the Bureau of Health Workforce, the Bureau of Primary Health Care, and the Health Systems Bureau. This shall include—
(i)
identification of effective strategies to increase implementation of proven therapies to slow chronic kidney disease incidence and progression, especially in high-risk underrepresented populations; and
(ii)
identification of effective practice improvement strategies in large and small health systems to reduce chronic kidney disease incidence and progression.
Sec. 7901A–1. Kidney disease action plan
(a) In general
The Director of the Centers for Disease Control and Prevention shall conduct, support, and expand public health strategies, prevention, diagnosis, surveillance, and public and professional awareness activities regarding kidney disease.
(b) National action plan
(1) Development
Pursuant to section 426 of the Public Health Service Act (42 U.S.C. 285c), not later than 2 years after the date of the enactment of this Act, the Director of the National Institute of Diabetes and Digestive and Kidney Diseases, in consultation with the Director of the National Institute on Minority Health and Health Disparities and the Director of the Centers for Disease Control and Prevention, shall develop a national action plan to address kidney disease in the United States with participation from patients, caregivers, health professionals, patient advocacy organizations, researchers, providers, public health professionals, and other stakeholders.
(2) Contents
At a minimum, such plan shall include recommendations for—
(A)
public health interventions for the purpose of implementation of the national plan;
(B)
biomedical, health services, and public health research on kidney disease; and
(C)
inclusion of kidney disease in the health data collections of all Federal agencies.
(c) Kidney disease prevention programs
The Director of the Centers for Disease Control and Prevention, through the Chronic Kidney Disease Initiative, shall carry out the following:
(1)
Conduct public education and awareness activities with patient and professional organizations to stimulate earlier diagnosis and improve patient outcomes from treatment of kidney disease. To the extent known and relevant, such public education and awareness activities shall reflect differences in kidney disease by cause (such as hypertension, diabetes, lupus nephritis, COVID–19, and polycystic kidney disease) and include a focus on outreach to undiagnosed and, as appropriate, minority populations.
(2)
Supplement and expand upon the activities of the Centers for Disease Control and Prevention by making grants to nonprofit organizations, State and local jurisdictions, and Indian Tribes for the purpose of reducing the burden of kidney disease, especially in disproportionately impacted communities, through public health interventions and related activities.
(3)
Coordinate with the National Institute of Diabetes and Digestive and Kidney Diseases, the Indian Health Service, the Health Resources and Services Administration, and the Department of Veterans Affairs to develop pilot programs to demonstrate best practices for the diagnosis and management of kidney disease.
(4)
Develop improved techniques and identify best practices, in coordination with the Secretary of Veterans Affairs, for assisting kidney disease patients.
(d) Data collection
Not later than 180 days after the date of enactment of this Act, the Director of the National Institute of Diabetes and Digestive and Kidney Diseases and the Director of the Centers for Disease Control and Prevention, acting jointly, shall assess the depth and quality of information on kidney disease that is collected in surveys and population studies conducted by the Centers for Disease Control and Prevention, including whether there are additional opportunities for information to be collected in the National Health and Nutrition Examination Survey, the National Health Interview Survey, and the Behavioral Risk Factor Surveillance System surveys. The Director of the National Institute of Diabetes and Digestive and Kidney Diseases shall include the results of such assessment in the national action plan under subsection (b).
(e) Authorization of appropriations
There are authorized to be appropriated to carry out this section $1,000,000 for fiscal year 2027, $1,000,000 for fiscal year 2028, $1,000,000 for fiscal year 2029, $1,000,000 for fiscal year 2030, and $1,000,000 for fiscal year 2031.
Sec. 7901A–2. Providing for staff-assisted home dialysis for certain hemodialysis and peritoneal dialysis patients
(a) In general
Section 1881(b)(14) of the Social Security Act (42 U.S.C. 1395rr(b)(14)) is amended by adding at the end the following new subparagraph:
(J)
(i)
With respect to staff-assisted home dialysis (as defined in clause (iv)(IV)) furnished on or after the date that is 1 year after the date of the enactment of this subparagraph, subject to the succeeding provisions of this subparagraph, the Secretary shall increase the single payment that would otherwise apply under this paragraph for renal dialysis services by the add-on payment amount established pursuant to clause (iii).
(ii)
(I)
Subject to subclause (II), staff-assisted home dialysis may only be furnished—
(aa)
with respect to an initializing patient (as defined in clause (iv)(I)) or a returning patient (as defined in clause (iv)(III)), for a period of up to 90 days, referred to as the
initial period, which may be extended as determined necessary by the care team of the individual in not more than 2 intervals of up to 30 days each, each of which is referred to as anextended interval; and(bb)
with respect to a temporary assistance patient (as defined in clause (iv)(V)), for any 30-day period as determined necessary by the care team of the individual, notwithstanding whether such an individual receives any routine dialysis respite care during such period.
(II)
Notwithstanding subclause (I), staff-assisted home dialysis may be furnished for as long as the Secretary determines appropriate to an individual who—
(aa)
is blind;
(bb)
has a cognitive or neurological impairment (including a stroke, Alzheimer’s Disease, dementia, amyotrophic lateral sclerosis, or any other impairment determined by the Secretary); or
(cc)
has any other illness or injury that reduces mobility (including cerebral palsy, spinal cord injuries, an injury or illness that requires the individual to be on a ventilator, or any other illness or injury determined by the Secretary).
(iii)
The Secretary shall, by regulation, establish an add-on payment amount for staff-assisted home dialysis to determine the amounts payable to a qualified provider (as defined in clause (iv)(II)) for assisting in the furnishing of staff-assisted home dialysis on a frequency as determined by the Secretary and in consultation with clinicians, patients, and care partners to ensure maximum patient choice, access, and flexibility. In establishing the add-on payment under this clause, the Secretary shall consult with stakeholders, including providers of renal dialysis services, individuals receiving home dialysis, qualified providers, private insurance payers, and Medicare Advantage plans under part C.
(iv)
In this subparagraph:
(I)
The term initializing patient means an individual who initiates a home dialysis modality, including home hemodialysis and peritoneal dialysis.
(II)
The term qualified provider means a trained professional (as determined by the Secretary, including a registered or licensed practical nurse and a certified patient care technician) who—
(aa)
furnishes renal dialysis services;
(bb)
meets requirements (as determined by the Secretary) that ensure competency in patient care and modality usage; and
(cc)
during a period described in clause (ii)(I), provides in-person assistance to an individual for an appropriate number of dialysis sessions, as determined by the care team of the individual based on the needs of the individual, caregiver availability, prescription, and mode of home dialysis.
(III)
The term returning patient means an individual who is returning to home dialysis after a period of hospitalization or other non-home dialysis modality.
(IV)
(aa)
The term staff-assisted home dialysis means dialysis furnished by the individual in a home, residence, or other approved setting with the assistance of a qualified provider, the frequency of which is determined by the qualified provider in coordination with the individual, the care partner, and the care team of the individual and outlined in a patient plan of care.
(bb)
In this subclause, the term care partner means a friend or family member who is designated by the individual who is trained to assist the individual with the furnishing of home dialysis.
(cc)
In this subclause, the term patient plan of care has the meaning given such term in section 494.90 of title 42, Code of Federal Regulations (or any successor regulations).
(V)
The term temporary assistance patient means an individual who is receiving home dialysis and is temporarily unable to perform functions necessary to self-furnish unassisted home dialysis due to illness, injury, caregiver unavailability, or other temporary circumstances not to exceed 30 days.
(b) Patient education and training relating to staff-Assisted home dialysis
(1) In general
Section 1881(b)(5) of the Social Security Act (42 U.S.C. 1395rr(b)(5)) is amended—
(A)
in subparagraph (C), by striking at the end and
;
(B)
in subparagraph (D), by striking the period at the end and inserting a semicolon; and
(C)
by adding at the end the following new subparagraphs:
(E)
educate individuals on the opportunity to receive staff-assisted home dialysis (as defined in paragraph (14)(J)(iv)(IV)) during the periods described in paragraph (14)(J)(ii); and
(F)
provide for registered or licensed nurses, certified patient care technicians, or other qualified providers (as determined by a physician) to train individuals and their care partners in skills and procedures needed to furnish staff-assisted home dialysis, including—
(i)
in a group-training environment with other individuals and their care partners when appropriate and in accordance with Federal regulations (concerning the privacy of individually identifiable health information) promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996;
(ii)
via telehealth (following an initial period of in-person competency training, in accordance with standards specified by the Secretary);
(iii)
through interdisciplinary team training (as described in the interpretive guidance relating to tag number V590 of
Advance Copy—End Stage Renal Disease (ESRD) Program Interpretive Guidance Version 1.1(published on October 3, 2008)); and(iv)
in the home or residence of an individual, in a dialysis facility, in a stand-alone training facility, or the place in which the individual has been approved to perform home dialysis by the care team.
(2) Effective date
The amendments made by this subsection shall take effect on the date that is 1 year after the date of the enactment of this Act.
(c) Other provisions
(1) Anti-kickback statute
Section 1128B(b)(3) of the Social Security Act (42 U.S.C. 1320a–7b(b)(3)) is amended—
(A)
by moving subparagraphs (J) and (K) 2 ems to the left;
(B)
in subparagraph (K), by striking and
at the end;
(C)
in subparagraph (L), by striking the period at the end and inserting ; and
; and
(D)
by adding at the end the following new subparagraph:
(M)
any remuneration relating to the furnishing of staff-assisted home dialysis (as defined in section 1881(b)(14)(J)(iv)(IV)).
(2) Study
Not later than 2 years after the date of the enactment of this Act, the Secretary of Health and Human Services (in this subsection referred to as the Secretary
) shall submit to the Committee on Finance of the Senate and the Committees on Energy and Commerce and Ways and Means of the House of Representatives a report that—
(A)
examines racial disparities in the utilization of home dialysis (as defined in section 1881(b)(14)(J)(iv)(IV) of the Social Security Act (42 U.S.C. 1395rr(b)(14)(J)(iv)(IV)), as added by subsection (a)), and makes recommendations on how to improve access to home dialysis for communities of color;
(B)
examines coverage for, and utilization of, home dialysis in rural communities, and makes recommendations on how to improve access to home dialysis for such rural communities; and
(C)
analyzes clinical and quality of life outcomes for patients, disaggregated by geographic and demographic indicators, who receive different dialysis modalities, including staff-assisted home dialysis, unassisted home dialysis, and dialysis furnished in a facility.
(3) Patient decision tool
Not later than December 31, 2027, for the purposes of section 1881(b)(14)(J) of the Social Security Act (42 U.S.C. 1395rr(b)(14)(J)), as added by subsection (a), the Secretary shall convene a patient panel to develop a patient-centered decision tool to assist dialysis patients in evaluating their lifestyle and goals and in choosing the dialysis setting and modality. Such tool shall include an acknowledgment that the patient is capable of home dialysis and wants home dialysis, if that is the modality such patient chooses.
(4) Patient quality of life metric
Section 1881(h)(2)(A)(iv) of the Social Security Act (42 U.S.C. 1395rr(h)(2)(A)(iv)) is amended—
(A)
in subclause (II), by striking and
at the end;
(B)
in subclause (III), by striking the period at the end and inserting ; and
; and
(C)
by adding at the end the following new subclause:
(IV)
patient quality of life for all individuals utilizing dialysis regardless of modality, with the intent of measuring and improving patient quality of life on dialysis.
Sec. 7901A–3. Increasing kidney transplants in minority populations
(a) In general
The Director of the National Institutes of Health shall expand, intensify, and support ongoing research and other activities with respect to kidney transplants in minority populations.
(b) CMS data collection and reporting
The Centers for Medicare & Medicaid Services shall collect and report annual data on dialysis facility and nephrologist performance on transplant referral, with an emphasis on data relating to patients of color.
(c) OPTN data collection and reporting
The Organ Procurement and Transplantation Network shall collect and the Scientific Registry of Transplant Recipients shall report annual data, broken down by demographic and socioeconomic characteristics, on individual transplant center performance as it relates to patients referred, evaluated, waitlisted, and successfully transplanted.
(d) Transplant center data
Each organ transplant center shall report on the percent of appropriate waitlisted patients (including socioeconomic and demographic data) giving and receiving annual informed consent for offers for suboptimal kidneys (such as kidneys with a kidney donor profile index of greater than 85 percent or kidney age 50 with diabetes, or age greater than 60).
(e) Organ procurement organization data
Each organ procurement organization shall report annual data on referrals, refusals (patient or doctor), and acceptance of organs by hospital, ZIP Code, race, ethnicity, and age strata except as prohibited by need for confidentiality.
(f) Data transparency for patients
Each organ transplant center shall provide to each patient of such center, on an annual basis—
(1)
the number of times an organ was offered to the patient, declined, and transplanted into another patient from organs within a 500-mile radius; and
(2)
the number of times an organ was offered to and declined for the patient from a low-risk donor which was subsequently transplanted into another patient.
(g) Improved transplantation education
The Centers for Medicare & Medicaid Services shall certify a nonbiased, third-party organization to accredit organ transplant education.
(h) Research
Research under subsection (a) shall include investigation into—
(1)
the causes of lower rates of kidney transplants in minority populations, including socioeconomic, geographic, clinical, environmental, genetic, and other factors that may contribute to lower rates of kidney transplants in minority populations; and
(2)
possible interventions to increase kidney transplants.
(i) Report; comprehensive plan
(1) In general
The Secretary of Health and Human Services shall—
(A)
prepare and submit to the Congress, not later than 6 months after the date of enactment of this section, a report on Federal research and public health activities with respect to kidney transplants as a treatment for end-stage renal disease in minority populations; and
(B)
develop and submit to the Congress, not later than 1 year after the date of enactment of this section, an effective and comprehensive Federal plan (including all appropriate Federal health programs) to increase the number of kidney transplants in minority populations.
(2) Contents
The report under paragraph (1)(A) shall at a minimum address each of the following:
(A)
Research on kidney transplants in minority populations, including such research on financial, insurance coverage, genetic, behavioral, and environmental factors.
(B)
Surveillance and data collection on kidney transplants in minority populations, including with respect to—
(i)
efforts to increase kidney transplants among Asian-American, Native Hawaiian, and Pacific Islander subgroups with end-stage renal disease; and
(ii)
efforts to increase kidney transplants in the American Indian population.
(C)
Community-based efforts to increase kidney transplants targeting minority populations, including—
(i)
the evidence base for such increases;
(ii)
the cultural appropriateness of such increases; and
(iii)
efforts to educate the public on kidney transplants.
(D)
Education and training programs for health professionals (including community health workers) on the kidney transplants that are supported by the Health Resources and Services Administration, including such programs supported by the Bureau of Health Workforce, the Bureau of Primary Health Care, and the Health Systems Bureau.
Sec. 7901A–4. Environmental and occupational health programs
The Director of the Centers for Disease Control and Prevention shall—
(1)
support research into the environmental and occupational causes and biological mechanisms that contribute to kidney disease; and
(2)
develop and disseminate public health interventions that will lessen the impact of environmental and occupational causes of kidney disease.
Sec. 7901A–5. Understanding the treatment patterns associated with providing care and treatment of kidney failure in minority populations
(a) Study
The Secretary of Health and Human Services (in this section referred to as the Secretary
) shall conduct a study on treatment patterns associated with providing care, under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), under the Medicaid program under title XIX of such Act (42 U.S.C. 1396 et seq.), and through private health insurance, to minority populations that are disproportionately affected by kidney failure.
(b) Report
Not later than 1 year after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the study conducted under subsection (a), together with such recommendations as the Secretary determines to be appropriate.
Sec. 7901A–6. Encouraging kidney care workforce in underserved areas
(a) Definition of primary health services
Section 331(a)(3)(D) of the Public Health Service Act (42 U.S.C. 254d(a)(3)(D)) is amended by inserting nephrology,
after dentistry,
.
(b) National health service corps scholarship program
Section 338A(a)(2) of the Public Health Service Act (42 U.S.C. 254l(a)(2)) is amended by inserting , which may include kidney health professionals
before the period at the end.
(c) National health service corps loan repayment program
Section 338B(a)(2) of the Public Health Service Act (42 U.S.C. 254l–1(a)(2)) is amended by inserting , which may include kidney health professionals
before the period at the end.
Sec. 7901A–7. The Jack Reynolds Memorial Medigap Expansion Act; Medigap coverage for beneficiaries with end-stage renal disease
(a) Guaranteed availability of medigap policies to all ESRD medicare beneficiaries
(1) In general
Section 1882(s) of the Social Security Act (42 U.S.C. 1395ss(s)) is amended—
(A)
in paragraph (2)—
(i)
in subparagraph (A), by striking is 65
and all that follows through the period at the end and inserting the following: “is—
(i)
65 years of age or older and is enrolled for benefits under part B; or
(ii)
is entitled to benefits under 226A(b) and is enrolled for benefits under part B.; and
(ii)
in subparagraph (D), in the matter preceding clause (i), by inserting (or is entitled to benefits under 226A(b))
after is 65 years of age or older
; and
(B)
in paragraph (3)(B)—
(i)
in clause (ii), by inserting (or is entitled to benefits under 226A(b))
after is 65 years of age or older
; and
(ii)
in clause (vi), by inserting (or under 226A(b))
after at age 65
.
(2) Effective date
The amendments made by paragraph (1) shall apply to Medicare supplemental policies effective on or after January 1, 2027.
(b) Additional enrollment period for certain individuals
(1) One-time enrollment period
(A) In general
In the case of an individual described in paragraph (2), the Secretary of Health and Human Services shall establish a one-time enrollment period during which such an individual may enroll in any Medicare supplemental policy under section 1882 of the Social Security Act (42 U.S.C. 1395ss) of the individual’s choosing.
(B) Enrollment period
The enrollment period established under subparagraph (A) shall begin on January 1, 2027, and shall end June 30, 2027.
(2) Individual described
An individual described in this paragraph is an individual who—
(A)
is entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act (42 U.S.C. 1395c et seq.) or under section 226A(b) of such Act (42 U.S.C. 426–1(b));
(B)
is enrolled for benefits under part B of such title XVIII (42 U.S.C. 1395j et seq.); and
(C)
would not, but for the provisions of, and amendments made by, subsection (a) be eligible for the guaranteed issue of a Medicare supplemental policy under paragraph (2) or (3) of section 1882(s) of such Act (42 U.S.C. 1395ss(s)).
Subtitle L Diversity in clinical trials
Sec. 7901B. FDA review of clinical trial best practices
The Commissioner of Food and Drugs shall—
(1)
aggregate information on the accumulated experience of sponsors of drugs that develop and execute clinical trial diversity plans during drug development;
(2)
include in such aggregated information an analysis from the perspectives of the Food and Drug Administration and such sponsors of which actions worked or which did not work to enhance clinical trial diversity;
(3)
not later than September 30, 2027, convene a public meeting, including representatives from the regulated industry and patient organizations, to discuss findings and recommendations for specific actions that have led to measurable improvements in the representation of racial and ethnic populations in clinical research; and
(4)
not later than September 30, 2028, update the guidance of the Food and Drug Administration titled Enhancing the Diversity of Clinical Trial Populations—Eligibility Criteria, Enrollment Practices, and Trial Designs
to align such guidance with findings and recommendations that were discussed at the meeting under paragraph (3).
Sec. 7901B–1. Diversifying investigations via equitable research studies for everyone trials Act
(a) Encouragement of clinical trial enrollment by racially and ethnically diverse populations
(1) No cost provision of digital health technologies
The free provision of digital health technologies by drug or device manufacturers to their clinical trial participants shall not be considered a violation of section 1128A of the Social Security Act (commonly known as the Civil Monetary Penalties Law
) (42 U.S.C. 1320a–7a), section 1128B of the Social Security Act (42 U.S.C. 1320a–7b), or sections 3729 through 3733 of title 31, United States Code (commonly known as the False Claims Act
), provided that—
(A)
the use of digital health technologies will facilitate in any phase of clinical development the inclusion of diversity of patient populations, such as underrepresented racial and ethnic minorities, low-income populations, and the elderly;
(B)
the digital health technologies will facilitate individuals’ participation, or are necessary to such participation;
(C)
all features of the digital health technologies that are unrelated to use in the clinical trial are disabled or only allowed to remain activated to model real-world usage of the digital technology; and
(D)
the clinical trial sponsor requires participants to return, purchase, or disable the digital health technologies by the conclusion of the trial.
(2) Grants and contracts
(A) In general
The Secretary of Health and Human Services (in this section referred to as the Secretary
) may issue grants to, and enter into contracts with, entities to support community education, outreach, and recruitment activities for clinical trials with respect to drugs, including vaccines for diseases or conditions which have a disproportionate impact on underrepresented populations (including on racial and ethnic minority populations), including for the diagnosis, prevention, or treatment of COVID–19. Such activities may include—
(i)
working with community clinical trial sites, including community health centers, academic health centers, and other facilities;
(ii)
training health care personnel including potential clinical trial investigators, with a focus on significantly increasing the number of underrepresented racial and ethnic minority health care personnel who are clinical trial investigators at the community sites for ongoing clinical trials;
(iii)
engaging community stakeholders to encourage participation in clinical trials, especially in underrepresented racial and ethnic minority communities; and
(iv)
fostering partnerships with community-based organizations serving underrepresented racial and ethnic minority populations, including labor organizations and frontline health care workers.
(B) Priority for grant and contract awards
In awarding grants and contracts under this paragraph, the Secretary shall prioritize entities that—
(i)
develop educational, recruitment, and training materials in multiple languages; or
(ii)
undertake clinical trial outreach efforts in more diverse racial and ethnic communities that are traditionally underrepresented in clinical trials, such as Tribal areas.
(C) Authorization of appropriations
There is authorized to be appropriated for fiscal years 2027 and 2028 such sums as may be necessary to carry out this paragraph.
(b) Clarification that certain remuneration related to participation in clinical trials does not constitute remuneration under the federal civil money penalties law
(1) In general
Section 1128A(i)(6)(F) of the Social Security Act (42 U.S.C. 1320a–7a(i)(6)(F)) is amended by inserting (including remuneration offered or transferred to an individual to promote the participation in an approved clinical trial, as defined in subsection (d) of the first section 2709 of the Public Health Service Act (42 U.S.C. 300gg–8) (relating to coverage for individuals participating in approved clinical trials), as so designated by section 1563(c)(10)(C) of the Patient Protection and Affordable Care Act, that is registered with the database of clinical trials maintained by the National Library of Medicine (or any successor database), so long as such remuneration facilitates equitable inclusion of patients from all relevant demographic and socioeconomic populations and is related to patient participation in the approved clinical trial)
after promotes access to care
.
(2) Effective date
The amendment made by paragraph (1) shall apply to remuneration provided on or after the date of the enactment of this Act.
(c) National academy of medicine study
(1) In general
The Secretary shall seek to enter into an arrangement with the National Academy of Medicine under which the National Academy agrees to study and propose a design for a national interoperable data platform to improve access to health data, and other relevant data needs, during public health emergencies.
(2) Report
The arrangement under paragraph (1) shall provide that the National Academy of Medicine, not later than 180 days after the date of enactment of this Act, shall submit a report to the Secretary and Congress on the results of the study under paragraph (1) and the design proposed based on such study.
Sec. 7901B–2. Clinical trial diversity
(a) Diversity requirements for applications for federal funding for clinical trials
(1) Applications
Beginning on the date of the enactment of this Act, the Secretary of Health and Human Services, acting through the Director of the National Institutes of Health (in this subsection referred to as the Secretary
), shall require that an entity seeking to conduct a clinical trial investigating a drug or device (as those terms are defined in section 201 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321)) or biological product (as defined in section 351(i) of the Public Health Service Act (42 U.S.C. 262(i))) that is funded by the National Institutes of Health and conducted at any national research institute or national center, submit an application (or renewal thereof) for such funding that includes—
(A)
clear and measurable goals for the recruitment and retention of participants that reflect—
(i)
the race, ethnicity, age, and gender or sex of patients with the disease or condition being investigated; or
(ii)
the race, ethnicity, age, and gender or sex of the general population of the United States if the prevalence of the disease or condition is not known;
(B)
a rationale for the goals specified under subparagraph (A) that specifies—
(i)
how investigators will calculate the number of participants for each population category that reflect the population groups specified in subparagraph (A); and
(ii)
strategies that will be used to enroll and retain participants across the different racial, ethnic, age, and gender or sex categories;
(C)
a detailed plan for how the clinical trial will achieve the goals specified under subparagraph (A) that specifies—
(i)
the requirements for researchers, in conducting the trial to analyze the population groups specified in subparagraph (A) separately;
(ii)
the role of community partners or community institutional review boards in reviewing the plans; and
(iii)
how the trial will recruit a study population that is—
(I)
in proportion to the prevalence of the disease or condition in such groups relative to the prevalence of the disease or condition in the overall population of the United States;
(II)
in sufficient numbers to obtain clinically and statistically meaningful determinations of the safety and effectiveness of the drug being studied in the respective race, ethnicity, age, and gender or sex groups; and
(III)
consistent with the guidance under section 505(b)(1) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355(b)(1)) and guidance issued by the National Institutes of Health on the inclusion of women and minorities in clinical trials;
(D)
the entity’s plan for implementing, or an explanation of why the entity cannot implement, alternative clinical trial follow-up requirements that are less burdensome for trial participants, such as—
(i)
requiring fewer follow-up visits;
(ii)
allowing phone follow-up or home visits by nurse trial coordinators (in lieu of in-person visits by patients);
(iii)
allowing for online follow-up options;
(iv)
permitting the patient’s primary care provider to perform some of the follow-up visit requirements and to reimburse the patient for any out-of-pocket costs incurred by the patient for such follow-up visits;
(v)
allowing for weekend hours for required follow-up visits;
(vi)
allowing virtual or telemedicine visits;
(vii)
use of wearable technology to record key health parameters; and
(viii)
use of alternate labs or imaging centers, which may be closer to the residence of the patients participating in the trial; and
(E)
the entity’s education and training requirements for researchers and other individuals conducting or supporting the clinical trial with respect to diversity and health inequities in underrepresented populations, including a requirement to consult with, and review materials made available by, such committees, task forces, and working groups other entities the Secretary determines are appropriate, including the following:
(i)
The Equity Committee of the National Institutes of Health.
(ii)
The National Advisory Council on Minority Health and Health Disparities.
(iii)
The Advisory Committee on Research on Women’s Health.
(iv)
The Sexual & Gender Minority Research Coordinating Committee of the National Institutes of Health.
(v)
The Tribal Health Research Coordinating Committee of the National Institutes of Health.
(2) Terms
(A) In general
As a condition on the receipt of funding through the National Institutes of Health, as described in paragraph (1), with respect to a clinical trial, the sponsor of the clinical trial shall agree to terms requiring that—
(i)
the aggregate demographic information of trial participants be shared on an annual basis with the Secretary while participant recruitment and data collection in such trial is ongoing, and that such information is provided with respect to—
(I)
underrepresented populations, including populations grouped by race, ethnicity, age, sex, gender identity and expression, geographic region, primary written and spoken language, disability status, sexual orientation, socioeconomic status, occupation, and other relevant factors; and
(II)
such populations that reflect the prevalence of the disease or condition that is the subject of the clinical trial involved (as available and as appropriate to the scientific objective for the study, as determined by the Director of the National Institutes of Health);
(ii)
the sponsor submits to the program officer and grants management specialist of the specific National Institutes of Health national research institute or national center, as frequently as such officer or specialist determines necessary, the retention rate of participants in the clinical trial, disaggregated by race, ethnicity, gender or sex, and age;
(iii)
both the clinical trial researchers and the applicant reviewers complete education and training programs on diversity in clinical trials; and
(iv)
at the conclusion of the trial, the sponsor submits to the Secretary the number of participants in the trial, disaggregated by race, ethnicity, age, and gender or sex.
(B) Privacy protections
Any data shared under subparagraph (A) may not include any individually identifiable information or protected health information with respect to clinical trial participants and shall only be disclosed to the extent allowed under Federal privacy laws.
(3) Exception
In lieu of submitting an application under paragraph (1) and documentation of goals as required by subparagraph (A) of such paragraph, an applicant may provide reasoning (other than cost) for why the recruitment of each of the population groups specified in subparagraph (A) of paragraph (1) is not necessary and why such recruitment is not scientifically justified or possible.
(4) Publication
The Secretary shall—
(A)
publish on a public website of the National Institutes of Health, upon receipt of an application to which paragraph (1) applies or reasoning under paragraph (3)—
(i)
a summary of the disease being targeted in the clinical trial that is the subject of the application and the prevalence of such disease across race, ethnicity, gender or sex, age, and clinical trial representation in each such category;
(ii)
the goals specified in such application, as required by paragraph (1)(A); or
(iii)
the reasoning described in paragraph (3); and
(B)
ensure that, in publishing information relating to an application or reasoning under subparagraph (A), the design of the study involved is not disclosed.
(5) Remediation
(A) In general
In the case of a clinical trial subject to paragraph (1) that fails to meet the condition specified pursuant to paragraph (1) by such date as may be agreed upon by the sponsor of the trial and the program officer and grants management specialist of the specific National Institutes of Health national research institute or national center, the Secretary shall require the sponsor of that clinical trial, not later than 60 days after such date occurs—
(i)
to develop, in consultation with the Secretary and advocacy and community-based organizations representing individuals who are members of relevant demographic groups specified in paragraph (1)(A), a strategic plan to increase participation in such clinical trial of such individuals; and
(ii)
to submit to the Secretary, such strategic plan.
(B) Publication
The Secretary shall make publicly available on the website of the National Institutes of Health, the strategic plan received under subparagraph (A) as soon as possible after receipt. The Secretary shall ensure that, in publishing such plan under the preceding sentence, the design of the study involved is not disclosed.
(C) Implementation
The sponsor of the clinical trial that is the subject of the strategic plan published under subparagraph (B), shall, not later than 60 days after such date as may be agreed upon by the sponsor of the trial and the appropriate program officer and grants management specialist of the National Institutes of Health, implement the strategic plan.
(D) Technical assistance
The Secretary may provide technical assistance to a sponsor of a clinical trial, as necessary for the sponsor to meet the requirements of subparagraph (C).
(6) Penalties in case of failure of remediation
(A) In general
In the case of a clinical trial subject to paragraph (1) that, after the close of the 60-day period specified in paragraph (5)(C), continues to fail to meet the condition specified pursuant to paragraph (1)(A), the Secretary shall—
(i)
hold the noncompeting continuation of funding received through the grant involved;
(ii)
apply specific conditions on the award of funds to such sponsor to conduct such clinical trial; or
(iii)
terminate such funding.
(B) Waiver
(i) In general
In the case of a clinical trial subject to the penalty under subparagraph (A) that fails to meet the condition referred to in such subparagraph, the sponsor of such clinical trial may, prior to the conclusion of the 60-day period referred to in subparagraph (A), submit an application to the relevant program officer and grants specialist requesting a waiver of such condition. Such an application shall specify reasoning for why the recruitment of each of the population groups specified in subparagraph (A) of paragraph (1) is not necessary or why such recruitment is not scientifically justified or possible.
(ii) Review
Not later than 30 days after a date agreed upon by the sponsor of the trial and the appropriate program officer and grants management specialist of the National Institutes of Health, the Secretary shall—
(I)
complete the review of such application; and
(II)
make a determination to approve or deny the application.
(iii) No additional penalties
No additional penalties may be applied with respect to a sponsor of a clinical trial under subparagraph (A) during the 30-day period specified in clause (ii).
(C) Termination of funding
In the case of a clinical trial described in subparagraph (B)(i), the Secretary may elect to terminate funding described in paragraph (1) for the clinical trial if no request for a waiver under subparagraph (B) is received by the conclusion 60-day period referred to in subparagraph (A).
(7) Waiver for certain clinical trials
(A) In general
In the case of a clinical trial that received funding through the National Institutes of Health and is ongoing as of the date of the enactment of this Act, the sponsor of such clinical trial is exempt from the requirements of (and associated penalties imposed by) this section.
(B) Report
The Secretary shall include in the triennial report required to be submitted under section 403 of the Public Health Service Act (42 U.S.C. 283), a list of all clinical trials receiving funding through the National Institutes of Health—
(i)
that requested and received waivers under this subsection; or
(ii)
with respect to which funding has been terminated pursuant to this subsection.
(8) Nondiscrimination
Section 1557 of the Patient Protection and Affordable Care Act (42 U.S.C. 18116) shall apply with respect to a clinical trial subject to paragraph (1).
(b) Eliminating cost barriers
(1) Study on modernization of human subject regulations
Not later than 2 years after the date of the enactment of this Act, the Secretary of Health and Human Services, acting through the Director of the National Institutes of Health (referred to in this subsection as the Secretary
), shall conduct and complete a study on—
(A)
the need for review of human subject regulations specified in part 46 of title 45, Code of Federal Regulations (or successor regulations), and related guidance;
(B)
the modernization of such regulations and guidance to establish updated guidelines for reimbursement of out-of-pocket expenses of human subjects, compensation of human subjects for time spent participating in the clinical trial, and incentives for recruitment of human subjects; and
(C)
the need for updated safe harbor rules under section 1001.952 of title 42, Code of Federal Regulations (or successor regulations), and section 1128B of the Social Security Act (commonly referred to as the Federal Anti-Kickback Statute (42 U.S.C. 1320a–7b)) with respect to the assistance provided under this subsection.
(2) Reimbursement for costs associated with clinical trial participation
As a condition on receipt of any funding provided through the National Institutes of Health to conduct a clinical trial investigating a drug or device (as those terms are defined in section 201 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321)) or biological product (as defined in section 351(i) of the Public Health Service Act (42 U.S.C. 262(i))), the Secretary shall require that the sponsor of such clinical trial—
(A)
works with institutional review boards and program officers of the National Institutes of Health to determine when reimbursement for the costs associated with clinical trial participation is warranted; and
(B)
subject to paragraph (3), provides to clinical trial participants reimbursement for expenses (using funds other than funds supplied through the National Institutes of Health) incurred as a result of that participation, which may include—
(i)
missed or forgone salary;
(ii)
language assistance, including interpreter services;
(iii)
food expenses;
(iv)
childcare expenses;
(v)
lodging expenses;
(vi)
transportation expenses; or
(vii)
other expenses as identified by the participant, subject to review by the clinical trial sponsor, at its discretion, on a case-by-case basis.
(3) Provision of costs associated with clinical trial participation
(A) Application and documentation
(i) In general
A sponsor of a clinical trial to which subsection (a)(1) applies, may require that, in order to receive reimbursement as described in paragraph (2), a participant complete an application and share with the sponsor such documentation of expenses described in such paragraph, as the sponsor may require.
(ii) Timing
Not later than 30 days after the date on which a sponsor of a clinical trial receives an application under clause (i), the sponsor shall—
(I)
review the application; and
(II)
provide for reimbursement of eligible expenses documented in such application, as determined at the discretion of the clinical trial sponsor on a case-by-case basis.
(B) Enforcement
A sponsor of a clinical trial to which subsection (a)(1) applies, shall submit on an annual basis, as part of the progress reports submitted to the Secretary pursuant to section 402(j) of the Public Health Service Act (42 U.S.C. 282(j)), during the data collection period of the clinical trial, to the Secretary an accounting of the reimbursements made to clinical trial participants under subparagraph (A). Such data shall—
(i)
include relevant aggregate data with respect to each population group specified in subsection (a)(2)(A)(i) when such data will not compromise the identities of study participants and in a manner consistent with applicable privacy protections; and
(ii)
not later than 6 months after receipt by the Secretary, be published on a public website of the National Institutes of Health.
(c) Public awareness and education campaign
(1) National campaign
The Secretary of Health and Human Services, acting through the Director of the National Institutes of Health and the Commissioner of Food and Drugs (referred to in this subsection as the Secretary
), in consultation with the stakeholders specified in paragraph (5), shall carry out a national campaign to increase the awareness and knowledge of individuals in the United States with respect to the need for diverse clinical trials among the demographic groups identified pursuant to subsection (a)(1)(A).
(2) Requirements
The national campaign conducted shall include—
(A)
the development and distribution of written educational materials, and the development and placing of public service announcements, that are intended to encourage individuals who are members of the demographic groups identified pursuant to subsection (a)(2)(A)(i)(I) to seek to participate in clinical trials;
(B)
such efforts as are reasonable and necessary to ensure meaningful access by consumers with limited English proficiency;
(C)
the development and distribution of best practices and training for recruiting underrepresented study populations, including a method for sharing such best practices among clinical trial sponsors, providers, community-based organizations who assist with recruitment, and with the public; and
(D)
the conduct of focus groups to better understand the concerns and fears of certain underrepresented groups who may be reluctant to participate in clinical trials.
(3) Health inequities
In developing the national campaign under paragraph (1), the Secretary shall recognize and address—
(A)
health inequities among individuals who are members of the population groups specified in subsection (a)(2)(A)(i) with respect to access to care and participation in clinical trials; and
(B)
any barriers in access to care and participation in clinical trials that are specific to individuals who are members of such groups.
(4) Grants
The Secretary shall establish a program to award grants to nonprofit private entities, including community-based organizations and faith communities, institutions of higher education eligible to receive funds under section 371 of the Higher Education Act of 1965 (20 U.S.C. 1067q) and national organizations that serve underrepresented populations and community pharmacies to enable such entities—
(A)
to test alternative outreach and education strategies to increase the awareness and knowledge of individuals in the United States, with respect to the need for diverse clinical trials that reflect the race, ethnicity, age, and gender or sex of patients with the disease or condition being investigated; and
(B)
to cover administrative costs of such entities in assisting in diversifying clinical trials subject to subsection (a).
(5) Stakeholders specified
The stakeholders specified in this paragraph are the following:
(A)
Representatives of the Health Resources Services Administration, the Office of Minority Health of the Department of Health and Human Services, the Centers for Disease Control and Prevention, and the National Institutes of Health.
(B)
Community-based resources and advocates.
(6) Authorization of appropriations
There is authorized to be appropriated to carry out this subsection $10,000,000 for each of fiscal years 2027 through 2031.
(d) Definitions
In this section:
(1) Clinical trial
The term clinical trial means a research study in which one or more human subjects are prospectively assigned to one or more interventions (which may include placebo or other control) to evaluate the effects of those interventions on health-related biomedical or behavioral outcomes.
(2) Sponsor
The term sponsor has the meaning given such term in section 50.3 of title 21, Code of Federal Regulations (or successor regulations).
Sec. 7901B–3. Patient experience data
(a) Policy
Section 569C of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360bbb–8c) is amended—
(1)
by redesignating subsections (b) and (c) as subsections (c) and (d), respectively; and
(2)
by inserting after subsection (a) the following:
(b) Collection, submission, and use of data
(1) In general
The Secretary shall—
(A)
for any drug for which an exemption is granted for investigational use under section 505(i) of this Act or section 351(a) of the Public Health Service Act, require the sponsor of the drug to collect standardized patient experience data as part of the clinical trials conducted pursuant to such exemption;
(B)
require any application for the approval or licensing of such drug under section 505(b) of this Act or section 351(a) of the Public Health Service Act to include—
(i)
the standardized patient experience data so collected; and
(ii)
such related information as the Secretary may require; and
(C)
consider patient experience data and related information that is submitted pursuant to subparagraph (B) in deciding whether to approve or license, as applicable, the drug involved.
(2) Applicability
Paragraph (1) applies only with respect to drugs for which a request for an exemption described in paragraph (1)(A) is submitted on or after the date of the enactment of the Health Equity and Accountability Act of 2026, or an application under section 505(b) of this Act or section 351(a) of the Public Health Service Act is filed, as applicable, on or after the day that is 2 years after the date of the enactment of the Health Equity and Accountability Act of 2026.
(b) Regulations
Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services, acting through the Commissioner of Food and Drugs, shall promulgate final regulations to implement section 569C(b) of the Federal Food, Drug, and Cosmetic Act, as added by this section.
Subtitle M Additional provisions addressing high-impact minority diseases
Sec. 7901C. Medicare coverage of multi-cancer early detection screening tests
(a) Coverage
Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by sections 2007, 4221, 4251, 6101, and 7419, is amended—
(1)
in subsection (s)(2)—
(A)
in subparagraph (MM), by striking and
at the end;
(B)
by inserting and
at the end of subparagraph (NN); and
(C)
by adding at the end the following new subparagraph:
(OO)
multi-cancer early detection screening tests (as defined in subsection (ttt));; and
(2)
by adding at the end the following new subsection:
(ttt) Multi-Cancer early detection screening tests
The term multi-cancer early detection screening test means any of the following tests, approved or cleared by the Food and Drug Administration, furnished to an individual for the purpose of early detection of cancer across many cancer types (as categorized in the Annual Report to the Nation on the Status of Cancer issued by the National Cancer Institute):
(1)
A genomic sequencing blood or blood product test that includes the analysis of cell-free nucleic acids.
(2)
Such other equivalent tests (which are based on urine or another sample of biological material) as the Secretary determines appropriate.
(b) Payment and frequency limit
(1) Payment under fee schedule
Section 1833(h) of the Social Security Act (42 U.S.C. 1395l(h)) is amended—
(A)
in paragraph (1)(A), by inserting after (including
the following: multi-cancer early detection screening tests under section 1861(ttt) and including
; and
(B)
by adding at the end the following new paragraph:
(10)
No payment may be made under this part for a multi-cancer early detection screening test (as defined in section 1861(ttt)) for an individual if such a test was furnished to the individual during the previous 11 months.
(2) Conforming amendment
Section 1862(a) of the Social Security Act (42 U.S.C. 1395y(a)) is amended—
(A)
in paragraph (1)—
(i)
in subparagraph (O), by striking and
at the end;
(ii)
in subparagraph (P), by striking the semicolon at the end and inserting , and
; and
(iii)
by adding at the end the following new subparagraph:
(Q)
in the case of multi-cancer early detection screening tests (as defined in section 1861(ttt)), which are performed more frequently than is covered under section 1833(h)(10);; and
(B)
in paragraph (7), by striking or (P)
and inserting (P), or (Q)
.
(c) Rule of construction relating to other cancer screening tests
Nothing in this section, including the amendments made by this section, shall be construed—
(1)
in the case of an individual who undergoes a multi-cancer early detection screening test, to affect coverage under part B for other cancer screening tests covered under this section, such as screening tests for breast, cervical, colorectal, lung, or prostate cancer; or
(2)
in the case of an individual who undergoes another cancer screening test, to affect coverage for a multi-cancer early detection screening test or the use of such a test as a diagnostic or confirmatory test for a result of the other cancer screening test.
Sec. 7901C–1. Amputation Reduction and Compassion Act
(a) Peripheral artery disease education program
Part P of title III of the Public Health Service Act (42 U.S.C. 280g et seq.), as amended by section 7504, is amended by adding at the end the following:
399V–14. Peripheral artery disease education program
(a) Establishment
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, in collaboration with the Administrator of the Centers for Medicare & Medicaid Services and the Administrator of the Health Resources and Services Administration, shall establish and coordinate a peripheral artery disease education program to support, develop, and implement educational initiatives and outreach strategies that inform health care professionals and the public about the existence of peripheral artery disease and methods to reduce amputations related to such disease, particularly with respect to at-risk populations.
(b) Authorization of appropriations
There is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.
(b) Medicare coverage of peripheral artery disease screening tests furnished to at-Risk beneficiaries without imposition of cost sharing requirements
(1) In general
Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by sections 2007, 4221, 4251, 6101, 7419, and 7901C, is amended—
(A)
in subsection (s)(2)—
(i)
in subparagraph (NN), by striking and
at the end;
(ii)
in subparagraph (OO), by striking the period at the end and inserting ; and
; and
(iii)
by adding at the end the following new subparagraph:
(PP)
peripheral artery disease screening tests furnished to at-risk beneficiaries (as such terms are defined in subsection (uuu)).; and
(B)
by adding at the end the following new subsection:
(uuu) Peripheral artery disease screening test; at-Risk beneficiary
(1)
The term peripheral artery disease screening test means—
(A)
noninvasive physiologic studies of extremity arteries (commonly referred to as ankle-brachial index testing);
(B)
arterial duplex scans of lower extremity arteries vascular; and
(C)
such other items and services as the Secretary determines, in consultation with relevant stakeholders, to be appropriate for screening for peripheral artery disease for at-risk beneficiaries.
(2)
The term at-risk beneficiary means an individual entitled to, or enrolled for, benefits under part A and enrolled for benefits under part B—
(A)
who is 65 years of age or older;
(B)
who is at least 50 years of age but not older than 64 years of age with risk factors for atherosclerosis (such as diabetes mellitus, a history of smoking, hyperlipidemia, and hypertension) or a family history of peripheral artery disease;
(C)
who is younger than 50 years of age with diabetes mellitus and 1 additional risk factor for atherosclerosis; or
(D)
with a known atherosclerotic disease in another vascular bed such as coronary, carotid, subclavian, renal, or mesenteric artery stenosis, or abdominal aortic aneurysm.
(3)
The Secretary shall, in consultation with appropriate organizations, establish standards regarding the frequency for peripheral artery disease screening tests described in subsection (s)(2)(PP) for purposes of coverage under this title.
(2) Inclusion of peripheral artery disease screening tests in initial preventive physical examination
Section 1861(ww)(2) of the Social Security Act (42 U.S.C. 1395x(ww)(2)) is amended—
(A)
in subparagraph (N), by moving the margins of such subparagraph 2 ems to the left;
(B)
by redesignating subparagraph (O) as subparagraph (P); and
(C)
by inserting after subparagraph (N) the following new subparagraph:
(O)
Peripheral artery disease screening tests furnished to at-risk beneficiaries (as such terms are defined in subsection (uuu)).
(3) Payment
(A) In general
Section 1833(a) of the Social Security Act (42 U.S.C. 1395l(a)), as amended by sections 4251(c)(3), 6101(a)(4), and 7419, is amended—
(i)
in paragraph (1)—
(I)
in subparagraph (N), by inserting and other than peripheral artery disease screening tests furnished to at-risk beneficiaries (as such terms are defined in section 1861(uuu))
after other than personalized prevention plan services (as defined in section 1861(hhh)(1))
;
(II)
by striking and
before (KK)
; and
(III)
by inserting before the semicolon at the end the following: , and (LL) with respect to peripheral artery disease screening tests furnished to at-risk beneficiaries (as such terms are defined in section 1861(uuu)), the amount paid shall be 100 percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section 1848
; and
(ii)
in paragraph (2)—
(I)
in subparagraph (G), by striking and
at the end;
(II)
in subparagraph (H), by inserting and
at the end; and
(III)
by inserting after subparagraph (H) the following new subparagraph:
(I)
with respect to peripheral artery disease screening tests (as defined in paragraph (1) of section 1861(uuu)) furnished by an outpatient department of a hospital to at-risk beneficiaries (as defined in paragraph (2) of such section), the amount determined under paragraph (1)(EE),
(B) No deductible
Section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)), as amended by section 7419(a)(5)(A)(iii), is amended, in the first sentence—
(i)
by striking and
before (14)
; and
(ii)
by inserting , and (15) such deductible shall not apply with respect to peripheral artery disease screening tests furnished to at-risk beneficiaries (as such terms are defined in section 1861(uuu))
before the period at the end.
(C) Exclusion from prospective payment system for hospital outpatient department services
Section 1833(t)(1)(B)(iv) of the Social Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)) is amended—
(i)
by striking , or personalized
and inserting , personalized
; and
(ii)
by inserting , or peripheral artery disease screening tests furnished to at-risk beneficiaries (as such terms are defined in section 1861(uuu))
after personalized prevention plan services (as defined in section 1861(hhh)(1))
.
(D) Payment under physician fee schedule
Section 1848(j)(3) of the Social Security Act (42 U.S.C. 1395w–4(j)(3)), as amended by section 4251(c)(4), is amended by inserting , (2)(PP),
after (2)(KK)
.
(4) Exclusion from coverage and medicare as secondary payer for tests performed more frequently than allowed
Section 1862(a)(1) of the Social Security Act (42 U.S.C. 1395y(a)(1)), as amended by subsection (b)(2), is amended—
(A)
in subparagraph (P), by striking and
at the end;
(B)
in subparagraph (Q), by striking the semicolon at the end and inserting , and
; and
(C)
by adding at the end the following new subparagraph:
(R)
in the case of peripheral artery disease screening tests furnished to at-risk beneficiaries (as such terms are defined in section 1861(uuu)), which are performed more frequently than is covered under such section;
(5) Authority to modify or eliminate coverage of certain preventive services
Section 1834(n) of the Social Security Act (42 U.S.C. 1395m(n)) is amended—
(A)
by redesignating subparagraphs (A) and (B) of paragraph (1) as clauses (i) and (ii), respectively, and moving the margins of such clauses, as so redesignated, 2 ems to the right;
(B)
by redesignating paragraphs (1) and (2) as subparagraphs (A) and (B), respectively, and moving the margins of such subparagraphs, as so redesignated, 2 ems to the right;
(C)
by striking Certain Preventive Services
and all that follows through any other provision of this title
and inserting:
Certain Preventive Services.—
(1) In general
Notwithstanding any other provision of this title; and
(D)
by adding at the end the following new paragraph:
(2) Inapplicability
The Secretarial authority described in paragraph (1) shall not apply with respect to preventive services described in section 1861(ww)(2)(O).
(6) Effective date
The amendments made by this subsection shall apply with respect to items and services furnished on or after January 1, 2027.
(c) Medicaid coverage of peripheral artery disease screening tests furnished to at-Risk beneficiaries without imposition of cost sharing requirements
(1) In general
Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by section 5406(f) and 7419(a)(3)(A)(ii), is amended—
(A)
in subsection (a)—
(i)
in paragraph (33), by striking and
after the semicolon;
(ii)
by redesignating paragraph (34) as paragraph (35); and
(iii)
by inserting after paragraph (33) the following new paragraph:
(34)
peripheral artery disease screening tests furnished to at-risk beneficiaries (as such terms are defined in subsection (ss)); and; and
(B)
by adding at the end the following new subsection:
(ss) Peripheral artery disease screening test; at-Risk beneficiary
(1) Peripheral artery disease screening test
The term peripheral artery disease screening test means—
(A)
noninvasive physiologic studies of extremity arteries (commonly referred to as ankle-brachial index testing);
(B)
arterial duplex scans of lower extremity arteries vascular; and
(C)
such other items and services as the Secretary determines, in consultation with relevant stakeholders, to be appropriate for screening for peripheral artery disease for at-risk beneficiaries.
(2) At-risk beneficiary
The term at-risk beneficiary means an individual enrolled under a State plan (or a waiver of such plan)—
(A)
who is 65 years of age or older;
(B)
who is at least 50 years of age but not older than 64 years of age with risk factors for atherosclerosis (such as diabetes mellitus, a history of smoking, hyperlipidemia, and hypertension) or a family history of peripheral artery disease;
(C)
who is younger than 50 years of age with diabetes mellitus and one additional risk factor for atherosclerosis; or
(D)
with a known atherosclerotic disease in another vascular bed such as coronary, carotid, subclavian, renal, or mesenteric artery stenosis, or abdominal aortic aneurysm.
(3) Frequency
The Secretary shall, in consultation with appropriate organizations, establish standards regarding the frequency for peripheral artery disease screening tests described in subsection (a)(34) for purposes of coverage under a State plan under this title.
(2) No cost sharing
(A) In general
Subsections (a)(2) and (b)(2) of section 1916 of the Social Security Act (42 U.S.C. 1396o), as amended by section 7305(b)(1), are each amended—
(i)
in subparagraph (K), by striking or
after the comma at the end;
(ii)
in subparagraph (L), by striking ; and
and inserting , or
; and
(iii)
by adding at the end the following new subparagraph:
(M)
peripheral artery disease screening tests furnished to at-risk beneficiaries (as such terms are defined in section 1905(ss)); and
(B) Application to alternative cost sharing
Section 1916A(b)(3)(B) of the Social Security Act (42 U.S.C. 1396o–1(b)(3)(B)), as amended by section 7305(b)(2), is amended by adding at the end the following new clause:
(xv)
Peripheral artery disease screening tests furnished to at-risk beneficiaries (as such terms are defined in section 1905(ss)).
(3) Mandatory coverage
Section 1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)), as amended by section 2007(d)(2), is amended by striking and (32)
and inserting (32), and (34)
.
(d) Requirement for group health plans and health insurance issuers offering group or individual health insurance coverage To provide coverage for peripheral artery disease screening tests furnished to at-Risk enrollees without imposition of cost sharing requirements
(1) In general
Section 2713 of the Public Health Service Act (42 U.S.C. 300gg–13), as amended by section 7419(a)(1)(A), is further amended—
(A)
by adding at the end of subsection (a)(1) of such section, as redesignated by section 7419(a)(1)(A), the following:
(F)
with respect to at-risk enrollees, peripheral artery disease screening tests.
(2) Frequency
The Secretary, in consultation with appropriate organizations, shall establish standards regarding the frequency for peripheral artery disease screening tests for purposes of coverage under this section.
(3) Clarification regarding breast cancer screening, mammography, and prevention recommendations
For the purposes of this Act, and for the purposes of any other provision of law, the current recommendations of the United States Preventive Services Task Force regarding breast cancer screening, mammography, and prevention shall be considered the most current other than those issued in or around November 2009.
(4) Definitions
In this subsection:
(A) At-risk enrollee
The term at-risk enrollee means an individual enrolled in a group health plan or group or individual health insurance coverage—
(i)
who is 65 years of age or older;
(ii)
who is at least 50 years of age but not older than 64 years of age with risk factors for atherosclerosis (such as diabetes mellitus, a history of smoking, hyperlipidemia, and hypertension) or a family history of peripheral artery disease;
(iii)
who is younger than 50 years of age with diabetes mellitus and one additional risk factor for atherosclerosis; or
(iv)
with a known atherosclerotic disease in another vascular bed such as coronary, carotid, subclavian, renal, or mesenteric artery stenosis, or abdominal aortic aneurysm.
(B) Peripheral artery disease screening test
The term peripheral artery disease screening test means—
(i)
noninvasive physiologic studies of extremity arteries (commonly referred to as ankle-brachial index testing);
(ii)
arterial duplex scans of lower extremity arteries vascular; and
(iii)
such other items and services as the Secretary determines, in consultation with relevant stakeholders, to be appropriate for screening for peripheral artery disease for at-risk enrollees.
(5) Rule of construction
Nothing in this subsection shall be construed to prohibit a plan or issuer from providing coverage for services in addition to those recommended by the United States Preventive Services Task Force or to deny coverage for services that are not recommended by such Task Force.; and
(B)
in subsection (b)(1)—
(i)
by striking subsection (a)(1) or (a)(2) or a guideline under subsection (a)(3)
and inserting subparagraph (A) or (B) of subsection (a)(1) or a guideline under subparagraph (C) of such subsection
; and
(ii)
by striking described in subsection (a)
and inserting described in subsection (a)(1)
.
(2) Effective date
The amendments made by paragraph (1) shall apply with respect to plan years beginning on or after January 1, 2027.
(e) Disallowance of payment for nontraumatic amputation services furnished without anatomical testing services
Section 1834 of the Social Security Act (42 U.S.C. 1395m), as amended by section 4221(b)(2), is amended by adding at the end the following new subsection:
(bb) Disallowance of payment for nontraumatic amputation services furnished without anatomical testing services
(1) In general
In the case of nontraumatic amputation services furnished by a supplier on or after January 1, 2027, to an individual entitled to, or enrolled for, benefits under part A and enrolled for benefits under this part, for which payment is made under this part, payment may only be made under this part if—
(A)
such supplier furnishes anatomical testing services to such individual during the 3-month period preceding the date on which such nontraumatic amputation services is furnished; or
(B)
such individual has a pre-existing dysfunctional or unsalvageable limb, life-threatening sepsis, intractable infection, extensive gangrene or necrotic tissue loss beyond salvage, a poor functional status, severe dementia, or a short life expectancy after shared decision making with a health care team and patient, family, or caregiver.
(2) Definitions
In this subsection:
(A) Anatomical testing services
The term anatomical testing services means arterial duplex scanning, computed tomography angiography, and magnetic resonance angiography.
(B) Nontraumatic amputation services
The term nontraumatic amputation services means amputations as a result of atherosclerotic vascular disease or a related comorbidity of such disease (including diabetes).
(f) Development and implementation of quality measures
(1) Development
The Secretary of Health and Human Services (in this subsection referred to as the Secretary
) shall, in consultation with relevant stakeholders, develop quality measures for nontraumatic, lower-limb, major amputation that utilize appropriate diagnostic screening (including peripheral artery disease screening) in order to encourage alternative treatments (including revascularization) in lieu of such an amputation.
(2) Implementation
After appropriate testing and validation of the measures developed under paragraph (1), the Secretary shall incorporate such measures in quality reporting programs for appropriate providers of services and suppliers under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), including for purposes of—
(A)
the merit-based incentive payment system under section 1848(q) of such Act (42 U.S.C. 1395w–4(q));
(B)
incentive payments for participation in eligible alternative payment models under section 1833(z) of such Act (42 U.S.C. 1395l(z));
(C)
the shared savings program under section 1899 of such Act (42 U.S.C. 1395jjj);
(D)
models under section 1115A of such Act (42 U.S.C. 1315a); and
(E)
such other payment systems or models as the Secretary may specify.
Sec. 7901C–2. Eliminating the coinsurance requirement for certain colorectal cancer screening tests furnished under the Medicare program
Section 1833(dd) of the Social Security Act (42 U.S.C. 1395l(dd)) is amended—
(1)
in paragraph (1), by striking and before January 1, 2030,
; and
(2)
in paragraph (2), by striking subparagraph (C) and inserting the following:
(C)
for 2027 and each subsequent year, 100 percent.
Sec. 7901C–3. Expanding the availability of medical nutrition therapy services under the Medicare program
(a) In general
Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended—
(1)
in subsection (s)(2)(V), by striking in the case of
and all that follows through organizations
; and
(2)
in subsection (vv)—
(A)
in paragraph (1)—
(i)
by striking disease management
and inserting the prevention, management, or treatment of a disease or condition specified in paragraph (4)
; and
(ii)
by striking by a physician
and all that follows through the period at the end and inserting the following: “by a—
(A)
physician (as defined in subsection (r)(1));
(B)
physician assistant;
(C)
nurse practitioner;
(D)
clinical nurse specialist (as defined in subsection (aa)(5)(B)); or
(E)
in the case of such services furnished to manage such a disease or condition that is an eating disorder, a clinical psychologist (as defined by the Secretary).
Such term shall not include any services furnished to an individual for the prevention, management, or treatment of a renal disease if such individual is receiving maintenance dialysis for which payment is made under section 1881.; and
(B)
by adding at the end the following new paragraph:
(4)
For purposes of paragraph (1), the diseases and conditions specified in this paragraph are the following:
(A)
Diabetes and prediabetes.
(B)
A renal disease.
(C)
Obesity (as defined for purposes of subsection (yy)(2)(C) or as otherwise defined by the Secretary).
(D)
Hypertension.
(E)
Dyslipidemia.
(F)
Malnutrition.
(G)
Eating disorders.
(H)
Cancer.
(I)
Gastrointestinal diseases, including celiac disease.
(J)
HIV.
(K)
AIDS.
(L)
Cardiovascular disease.
(M)
Any other disease or condition—
(i)
specified by the Secretary relating to unintentional weight loss;
(ii)
for which the Secretary determines the services described in paragraph (1) to be medically necessary and appropriate for the prevention, management, or treatment of such disease or condition, consistent with any applicable recommendations of the United States Preventive Services Task Force; or
(iii)
for which the Secretary determines the services described in paragraph (1) are medically necessary, consistent with either protocols established by registered dietitians or nutrition professional organizations or with accepted clinical guidelines identified by the Secretary.
(b) Exclusion modification
Section 1862(a)(1) of the Social Security Act (42 U.S.C. 1395y(a)(1)), as amended by sections 7901C(b)(2) and 7901C–1(b)(4), is amended—
(1)
in subparagraph (Q), by striking and
at the end;
(2)
in subparagraph (R), by striking the semicolon at the end and inserting , and
; and
(3)
by adding at the end the following new subparagraph:
(S)
in the case of medical nutrition therapy services (as defined in section 1861(vv)), which are not furnished for the prevention, management, or treatment of a disease or condition specified in paragraph (4) of such section;
(c) Effective date
The amendments made by this section shall apply with respect to items and services furnished on or after January 1, 2027.
Sec. 7901C–4. Encouraging the development and use of disarm antimicrobial drugs
(a) Additional payment for disarm antimicrobial drugs under Medicare
(1) In general
Section 1886(d)(5) of the Social Security Act (42 U.S.C. 1395ww(d)(5)) is amended by adding at the end the following new subparagraph:
(N)
(i)
(I)
Effective for discharges beginning on or after October 1, 2027, or such sooner date as specified by the Secretary, subject to subclause (II), the Secretary shall, after notice and opportunity for public comment (in the publications required by subsection (e)(5) for a fiscal year or otherwise), provide for an additional payment under a mechanism (separate from the mechanism established under subparagraph (K)), with respect to such discharges involving any DISARM antimicrobial drug, in an amount equal to—
(aa)
the amount payable under section 1847A for such drug during the calendar quarter in which the discharge occurred; or
(bb)
if no amount for such drug is determined under section 1847A, an amount to be determined by the Secretary in a manner similar to the manner in which payment amounts are determined under section 1847A based on information submitted by the manufacturer or sponsor of such drug (as required under clause (v)).
(II)
In determining the amount payable under section 1847A for purposes of items (aa) and (bb) of subclause (I), subparagraphs (A) and (B) of subsection (b)(1) of such section shall be applied by substituting
102 percentfor106 percenteach place it appears and paragraph (8)(B) of such section shall be applied by substituting2 percentfor6 percent.(ii)
For purposes of this subparagraph, a DISARM antimicrobial drug is—
(I)
a drug—
(aa)
that—
(AA)
is approved by the Food and Drug Administration;
(BB)
is designated by the Food and Drug Administration as a qualified infectious disease product under subsection (d) of section 505E of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355f(d)); and
(CC)
has received an extension of its exclusivity period pursuant to subsection (a) of such section; and
(bb)
that has been designated by the Secretary pursuant to the process established under clause (iv)(I)(bb); or
(II)
an antibacterial or antifungal biological product—
(aa)
that is licensed for use, or an antibacterial or antifungal biological product for which an indication is first licensed for use, by the Food and Drug Administration on or after June 5, 2014, under section 351(a) of the Public Health Service Act for human use to treat serious or life-threatening infections, as determined by the Food and Drug Administration, including those caused by, or likely to be caused by—
(AA)
an antibacterial or antifungal resistant pathogen, including novel or emerging infectious pathogens; or
(BB)
a qualifying pathogen (as defined under section 505E(f) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355f(f))); and
(bb)
has been designated by the Secretary pursuant to the process established under clause (iv)(I)(bb).
(iii)
The mechanism established pursuant to clause (i) shall provide that the additional payment under clause (i) shall—
(I)
with respect to a discharge, only be made to a subsection (d) hospital that, as determined by the Secretary—
(aa)
is participating in the National Healthcare Safety Network Antimicrobial Use and Resistance Module of the Centers for Disease Control and Prevention; and
(bb)
has an antimicrobial stewardship program that aligns with the Core Elements of Hospital Antibiotic Stewardship Programs of the Centers for Disease Control and Prevention or the Antimicrobial Stewardship Standard set by the Joint Commission; and
(II)
apply to discharges occurring on or after October 1 of the year in which the drug or biological product is designated by the Secretary as a DISARM antimicrobial drug.
For purposes of this clause, in the case of a similar reporting program described in item (aa), a subsection (d) hospital shall be treated as participating in such a program if the entity maintaining such program identifies to the Secretary such hospital as so participating.
(iv)
(I)
The mechanism established pursuant to clause (i) shall provide for a process for—
(aa)
a manufacturer or sponsor of a drug or biological product to request the Secretary to designate the drug or biological product as a DISARM antimicrobial drug; and
(bb)
the designation (and removal of such designation) by the Secretary of drugs and biological products as DISARM antimicrobial drugs.
(II)
A designation of a drug or biological product as a DISARM antimicrobial drug may be revoked by the Secretary if the Secretary determines that—
(aa)
the drug or biological product no longer meets the requirements for a DISARM antimicrobial drug under clause (ii);
(bb)
the request for such designation contained an untrue statement of material fact; or
(cc)
clinical or other information that was not available to the Secretary at the time such designation was made shows that—
(AA)
such drug or biological product is unsafe for use or not shown to be safe for use for individuals who are entitled to benefits under part A; or
(BB)
an alternative to such drug or biological product is an advance that substantially improves the diagnosis or treatment of such individuals.
(III)
Not later than October 1, 2026, the Secretary shall publish in the Federal Register a list of the DISARM antimicrobial drugs designated under this subparagraph pursuant to the process established under subclause (I)(bb). The Secretary shall annually update such list.
(v)
(I)
For purposes of determining additional payment amounts under clause (i), a manufacturer or sponsor of a drug or biological product that submits a request described in clause (iv)(I)(aa) shall submit to the Secretary information described in section 1927(b)(3)(A)(iii).
(II)
The penalties for failure to provide timely information under clause (i) of subparagraph (C) section 1927(b)(3) and for providing false information under clause (ii) of such subparagraph shall apply to manufacturers and sponsors of a drug or biological product under this section with respect to information under subclause (I) in the same manner as such penalties apply to manufacturers under such clauses with respect to information under subparagraph (A) of such section.
(vi)
(I)
The mechanism established pursuant to clause (i) shall provide that—
(aa)
except as provided in item (bb), no additional payment shall be made under this subparagraph for discharges involving a DISARM antimicrobial drug if any additional payments have been made for discharges involving such drug as a new medical service or technology under subparagraph (K);
(bb)
additional payments may be made under this subparagraph for discharges involving a DISARM antimicrobial drug if any additional payments have been made for discharges occurring prior to the date of enactment of this subparagraph involving such drug as a new medical service or technology under subparagraph (K); and
(cc)
no additional payment shall be made under subparagraph (K) for discharges involving a DISARM antimicrobial drug as a new medical service or technology if any additional payments for discharges involving such drug have been made under this subparagraph.
(2) Conforming amendment
Section 1886(d)(5)(K)(ii)(III) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(K)(ii)(III)) is amended by striking
provideand insertingsubject to subparagraph (N)(vi), provide.
(b) Authorization of appropriations for the centers for disease control and prevention
There is authorized to be appropriated to the Centers for Disease Control and Prevention $500,000,000, to remain available until expended, to support the establishment and implementation of antimicrobial stewardship programs and data reporting capabilities to the Antimicrobial Use and Resistance option of the CDC National Healthcare Safety Network, especially in critical access hospitals, rural hospitals, and community hospitals, to support detection, surveillance, containment, and prevention of resistant pathogens in the United States and overseas.
(c) Study and reports on removing barriers to the development of disarm antimicrobial drugs
(1) Study
The Comptroller General of the United States (in this subsection referred to as the Comptroller General
), in consultation with the Director of the National Institutes of Health, the Commissioner of Food and Drugs, the Administrator of the Centers for Medicare & Medicaid Services, and the Director of the Centers for Disease Control and Prevention, shall conduct a study over a 5-year period of the barriers that prevent the development of DISARM antimicrobial drugs (as defined in section 1886(d)(5)(N)(ii) of the Social Security Act, as added by subsection (a)), including—
(A)
patient outcomes in conjunction with the use of DISARM drugs, including—
(i)
duration of stay in the intensive care unit;
(ii)
recidivism within 30 days; and
(iii)
measures of additional follow-up care;
(B)
the effectiveness of antimicrobial stewardship and surveillance programs, including—
(i)
changes in the percentage of hospitals in the United States with an antimicrobial stewardship program in place that aligns with the Core Elements of Hospital Antibiotic Stewardship Programs, as outlined by the Centers for Disease Control and Prevention;
(ii)
changes in inpatient care of clostridioides difficile infection; and
(iii)
changes in inpatient rates of resistance to key pathogens; and
(C)
considerations relating to Medicare payment reform, including—
(i)
changes in the number of qualified antimicrobial products approved;
(ii)
changes in wholesale acquisition cost of individual qualified antimicrobial products over time;
(iii)
changes in year-over-year volume of individual qualified antimicrobial products sold; and
(iv)
the overall cost of qualified antimicrobial products to the Medicare program as a proportion of total Medicare part A spending.
(2) Report
Not later than 5 years after the date of the enactment of this section, the Comptroller General shall submit to Congress a report containing the results of the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.
Sec. 7901C–5. Treat and Reduce Obesity Act
(a) Authority To expand health care providers qualified To furnish intensive behavioral therapy
Section 1861(ddd) of the Social Security Act (42 U.S.C. 1395x(ddd)) is amended by adding at the end the following new paragraph:
(4)
(A)
Subject to subparagraph (B), the Secretary may, in addition to qualified primary care physicians and other primary care practitioners, cover intensive behavioral therapy for obesity furnished by any of the following:
(i)
A physician (as defined in subsection (r)(1)) who is not a qualified primary care physician.
(ii)
Any other appropriate health care provider (including a physician assistant, nurse practitioner, or clinical nurse specialist (as those terms are defined in subsection (aa)(5)), a clinical psychologist, a registered dietitian or nutrition professional (as defined in subsection (vv))).
(iii)
An evidence-based, community-based lifestyle counseling program approved by the Secretary.
(B)
In the case of intensive behavioral therapy for obesity furnished by a provider described in clause (ii) or (iii) of subparagraph (A), the Secretary may only cover such therapy if such therapy is furnished—
(i)
upon referral from, and in coordination with, a physician or primary care practitioner operating in a primary care setting or any other setting specified by the Secretary; and
(ii)
in an office setting, a hospital outpatient department, a community-based site that complies with the Federal regulations concerning the privacy of individually identifiable health information promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996, or another setting specified by the Secretary.
(C)
In order to ensure a collaborative effort, the coordination described in subparagraph (B)(i) shall include the health care provider or lifestyle counseling program communicating to the referring physician or primary care practitioner any recommendations or treatment plans made regarding the therapy.
(b) Medicare part d coverage of obesity medication
(1) In general
Section 1860D–2(e)(2)(A) of the Social Security Act (42 U.S.C. 1395w–102(e)(2)(A)) is amended, in the first sentence—
(A)
by striking and other than
and inserting other than
; and
(B)
by inserting after benzodiazepines),
the following: and other than subparagraph (A) of such section if the drug is used for the treatment of obesity (as defined in section 1861(yy)(2)(C)) or for weight loss management for an individual who is overweight (as defined in section 1861(yy)(2)(F)(i)) and has 1 or more related comorbidities,
.
(2) Effective date
The amendments made by paragraph (1) shall apply to plan years beginning on or after the date that is 2 years after the date of the enactment of this section.
(c) Report to congress
(1) In general
Not later than the date that is 1 year after the date of the enactment of this section, and every 2 years thereafter, the Secretary of Health and Human Services shall submit a report to Congress describing the steps the Secretary has taken to implement the provisions of, and amendments made by, this section.
(2) Recommendations
Such report shall also include recommendations for better coordination and leveraging of programs within the Department of Health and Human Services and other Federal agencies that relate in any way to supporting appropriate research and clinical care (such as any interactions between physicians and other health care providers and their patients) to treat, reduce, and prevent obesity in the adult population.
Sec. 7901C–6. Incentives, improvements, and outreach to increase diversity in Alzheimer’s disease research
(a) Improving access for and outreach to underrepresented populations
(1) Expanding access to alzheimer’s research centers
(A) In general
Section 445(a)(1) of the Public Health Service Act (42 U.S.C. 285e–2(a)(1)) is amended—
(i)
by striking (a)(1) The Director of the Institute may
and inserting the following:
(a)
(1)
The Director of the Institute—
(A)
may;
(ii)
by striking disease.
and inserting disease; and
; and
(iii)
by adding at the end the following:
(B)
beginning January 1, 2027, shall enter into cooperative agreements and make grants to public or private nonprofit entities under this subsection for the planning, establishment, and operation of new such centers that are located in areas with a higher concentration of minority groups (as determined under section 444(d)(3)(D)), such as entities that are historically Black colleges and universities, Hispanic-serving institutions, Tribal colleges and universities, or centers of excellence for other minority populations.
(B) Use of funding for clinics to operate clinical trials
Section 445(b) of the Public Health Service Act (42 U.S.C. 285e–2(b)) is amended by adding at the end the following:
(3)
Federal payments made under a cooperative agreement or grant under subsection (a) from funds made available under section 7901C–6(g) of the Health Equity and Accountability Act of 2026 shall, with respect to Alzheimer’s disease, be used in part to establish and operate diagnostic and treatment clinics designed—
(A)
to meet the special needs of minority and rural populations and other underserved populations; and
(B)
to operate clinical trials.
(2) Outreach
(A) Alzheimer’s disease centers
Section 445(b) of the Public Health Service Act (42 U.S.C. 285e–2(b)), as amended by paragraph (1)(B), is amended by adding at the end the following:
(4)
Federal payments made under a cooperative agreement or grant under subsection (a) shall be used to establish engagement centers to carry out public outreach, education efforts, and dissemination of information for members of minority groups about clinical trial participation. Activities funded pursuant to the preceding sentence shall include—
(A)
using established mechanisms to encourage members of minority groups to participate in clinical trials on Alzheimer’s disease;
(B)
expanding education efforts to make members of minority groups aware of ongoing clinical trials;
(C)
working with trial sponsors to increase the number of recruitment events for members of minority groups;
(D)
conducting outreach to national, State, and local physician professional organizations, especially for members of such organizations who are primary care physicians or physicians who specialize in dementia, to increase awareness of clinical research opportunities for members of minority groups; and
(E)
using community-based participatory research methodologies to engage with minority populations.
(B) Resource centers for minority aging research
Section 444(c) of the Public Health Service Act (42 U.S.C. 285e–1(c)) is amended—
(i)
by striking (c) The Director
and inserting (c)(1) The Director
; and
(ii)
by adding at the end the following new paragraph:
(2)
The Director of the Institute, acting through the Resource Centers for Minority Aging Research of the Institute, shall carry out public outreach, education efforts, and dissemination of information for members of minority groups about participation in clinical research on Alzheimer’s disease carried out or supported under this subpart.
(b) Incentives To increase diversity in alzheimer’s disease research through principal investigators and researchers from underrepresented populations
(1) Alzheimer’s clinical research and training awards
Section 445I of the Public Health Service Act (42 U.S.C. 285e–10a) is amended by adding at the end the following:
(d) Enhancing the participation of principal investigators and researchers who are members of underrepresented populations
(1) In general
The Director of the Institute shall enhance diversity in the conduct or support of clinical research on Alzheimer’s disease under this subpart by encouraging the participation of individuals from groups that are underrepresented in the biomedical, clinical, behavioral, and social sciences as principal investigators of such clinical research, as researchers for such clinical research, or both.
(2) Training for principal investigators
The Director of the Institute shall provide training for principal investigators who are members of a minority group with respect to skills for—
(A)
the design and conduct of clinical research and clinical protocols;
(B)
applying for grants for clinical research; and
(C)
such other areas as the Director of the Institute determines to be appropriate.
(2) Senior researcher awards
Section 445B(a) of the Public Health Service Act (42 U.S.C. 285e–4(a)) is amended by inserting , including senior researchers who are members of a minority group
before the period at the end of the first sentence.
(c) Incentives To increase diversity in alzheimer’s disease research through trial sites
Section 444(d) of the Public Health Service Act (42 U.S.C. 285e–1(d)) is amended—
(1)
by striking (d) The Director
and inserting (d)(1) The Director
; and
(2)
by adding at the end the following:
(2)
In conducting or supporting clinical research on Alzheimer’s disease for purposes of this subpart, in addition to requirements otherwise imposed under this title, including under section 492B, the Director of the Institute shall increase the participation of members of minority groups in such clinical research through one or more of the activities described in paragraph (3).
(3)
(A)
The Director of the Institute shall provide incentives for the support of clinical research on Alzheimer’s disease with clinical trial sites established in areas with a higher concentration of minority groups, including rural areas if practicable.
(B)
In determining whether to conduct or support clinical research on Alzheimer’s disease, the Director of the Institute shall encourage the conduct of clinical research with clinical trial sites in areas described in subparagraph (A) as a higher-level priority criterion among the criteria established to evaluate whether to conduct or support clinical research.
(C)
In determining the amount of funding to be provided for the conduct or support of such clinical research, the Director of the Institute shall provide additional funding for the conduct of such clinical research with clinical trial sites in areas described in subparagraph (A).
(D)
In determining whether an area is an area with a higher concentration of minority groups, the Director of the Institute—
(i)
shall consider the most recent data collected by the Bureau of the Census; and
(ii)
may also consider—
(I)
data from the Centers for Medicare & Medicaid Services on the incidence of Alzheimer’s disease in the United States by region; and
(II)
such other data as the Director determines appropriate.
(4)
In order to facilitate the participation of members of minority groups in clinical research supported under this subpart, in addition to activities described in paragraph (3), the Director of the Institute shall—
(A)
ensure that such clinical research uses community-based participatory research methodologies; and
(B)
encourage the use of remote health technologies, including telehealth, remote patient monitoring, and mobile technologies, that reduce or eliminate barriers to participation of members of minority groups in such clinical research.
(5)
(A)
Clinical research on Alzheimer’s disease conducted or supported under this subpart shall ensure that such research includes outreach activities designed to increase the participation of members of minority groups in such research.
(B)
(i)
Each applicant for a grant under this subpart for clinical research on Alzheimer’s disease shall submit to the Director of the Institute in the application for such grant—
(I)
a budget for outreach activities to members of minority populations with respect to participation in such clinical research; and
(II)
a description of the plan to conduct such outreach.
(ii)
The Director of the Institute shall encourage applicants for, and recipients of, grants under this subpart to conduct clinical research on Alzheimer’s disease to engage with community-based organizations to increase participation of minority populations in such research.
(6)
For purposes of this subpart:
(A)
The term clinical research includes a clinical trial.
(B)
The term minority group has the meaning given such term under section 492B(g).
(d) Participant eligibility criteria
Section 445I of the Public Health Service Act (42 U.S.C. 285e–10a), as amended by subsection (b)(1), is amended by adding at the end the following:
(e) Participant eligibility criteria
The Director of the Institute shall take such actions as are necessary to ensure that clinical research on Alzheimer’s disease conducted or supported under this subpart is designed with eligibility criteria that ensure the clinical trial population reflects the diversity of the prospective patient population. Such actions may include the following:
(1) Examination of criteria
(A) In general
An examination of each exclusion criterion to determine if the criterion is necessary to ensure the safety of trial participants or to achieve the study objectives.
(B) Modification of criteria
In the case of an exclusion criterion that is not necessary to ensure the safety of trial participants or to achieve the study objectives—
(i)
encouraging the modification or elimination of the criterion; or
(ii)
encouraging tailoring the criterion as narrowly as possible to avoid unnecessary limits to the population of the clinical study.
(2) Requirement for strong justification for exclusion
A review of each exclusion criterion to ensure that populations are included in clinical trials, such as older adults, individuals with a mild form of disease, individuals at the extremes of the weight range, or children, unless there is a strong clinical or scientific justification to exclude them.
(3) Use of adaptive design
Encouraging the use of an adaptive clinical trial design that—
(A)
starts with a defined population where there are concerns about safety; and
(B)
may expand to a broader population based on initial data from the trial and external data.
(e) Resource center for successful strategies To increase participation of underrepresented populations in alzheimer’s disease clinical research
Section 444 of the Public Health Service Act (42 U.S.C. 285e–1) is amended by adding at the end the following:
(e)
(1)
The Director of the Institute, acting through the Office of Special Populations and in consultation with the Division of Extramural Activities, shall support resource information and technical assistance to grantees under section 445 (relating to Alzheimer’s disease centers), other grantees, and prospective grantees, designed to increase the participation of minority populations in clinical research on Alzheimer’s disease conducted or supported under this subpart.
(2)
The resource information and technical assistance provided under paragraph (1) shall include the maintenance of a central resource library in order to collect, prepare, analyze, and disseminate information relating to strategies and best practices used by recipients of grants under this subpart and other researchers in the development of the clinical research designed to increase the participation of minority populations in such clinical research.
(f) Annual reports
Section 444 of the Public Health Service Act (42 U.S.C. 285e–1), as amended by subsection (e), is amended by adding at the end the following:
(f)
(1)
(A)
The Director of the Institute shall submit annual reports to the Congress on the impact of the amendments made to this subpart by the Health Equity and Accountability Act of 2026.
(B)
The Secretary shall transmit a copy of each such report to the Advisory Council on Alzheimer’s Research, Care, and Services established under section 2(e) of the National Alzheimer’s Project Act.
(2)
In each report under paragraph (1), the Director of the Institute shall include information and data on the following matters with respect to clinical trials on Alzheimer’s disease conducted during the preceding year:
(A)
The number of participants who are members of a minority group in such clinical trials.
(B)
The number of such clinical trials for which incentives under subsection (d)(3) were made available, the nature of such incentives, the amount of increased funding (if any) made available for research on Alzheimer’s disease, and the training provided to principal investigators who are members of a minority group and the amount of funding (if any) for such training.
(C)
The number of such clinical trials for which the principal investigator is a member of a minority group.
(D)
The number of such clinical trials for which a significant percentage of researchers are members of a minority group.
(E)
Modifications to patient eligibility criteria in clinical trial designs under section 445I(e).
(F)
Outreach and education efforts conducted under section 445(b)(4).
(3)
The Director of the Institute shall make each report under paragraph (1) available to the public, including through posting on the appropriate website of the Department of Health and Human Services.
(g) Authorization of appropriations
For each of fiscal years 2027 through 2031, there is authorized to be appropriated to the Secretary of Health and Human Services $60,000,000 to carry out the amendments made by this section, to remain available until expended.
Sec. 7901C–7. Stomach Cancer Prevention and Early Detection Act
(a) NCI review on current state of stomach cancer incidence, prevention, screening, awareness, and future public health importance
(1) Review
The Director of the National Cancer Institute shall conduct a review of—
(A)
the current incidence of stomach cancer in the United States;
(B)
the risk factors for stomach cancer, including the incidence of such risk factors among high-risk populations and the general public;
(C)
the optimal age range to test for and treat Helicobacter pylori (H. pylori) infection, as a risk factor, for the purpose of primary prevention in high-risk populations and the general population;
(D)
the availability and frequency of screening for stomach cancer, including utilization and effectiveness, among high-risk populations;
(E)
the availability and effectiveness of endoscopic screenings in high-risk populations;
(F)
the availability and effectiveness of endoscopic resection and surveillance endoscopy for patients with confirmed gastric intestinal metaplasia (GIM) with high-grade dysplasia and early gastric cancer;
(G)
the benefits of surveillance endoscopy for patients at elevated risk, including patients with gastric intestinal metaplasia (GIM) who are at increased risk of gastric cancer due to ethnic background, family history, or other risk stratification parameters such as smoking and H. pylori infection;
(H)
current awareness and education about stomach cancer risk factors, prevention, symptoms, screening, and treatment options among high-risk populations and the general public; and
(I)
current Federal efforts to increase awareness and education of stomach cancer among high-risk populations and the general public.
(2) Report
Not later than 18 months after the date of enactment of this Act, the Director of the National Cancer Institute shall—
(A)
submit to the Congress a report on the results of the review under paragraph (1); and
(B)
include in such report recommendations for—
(i)
establishing a clear definition of high-risk populations in the United States;
(ii)
informing researchers, clinicians, physicians, patients, and other relevant stakeholders on—
(I)
identifying high-risk individuals; and
(II)
effective methods for detecting precancerous lesions and early gastric cancer;
(iii)
establishing routine screening guidelines for stomach cancer; and
(iv)
actions to improve research on, prevention and early diagnosis of, and screening and treatment for stomach cancer.
(b) Department of Defense study on stomach cancer incidence and risk factors among military personnel
(1) Study
The Secretary of Defense, in coordination with the Director of the National Cancer Institute and the Director of the Centers for Disease Control and Prevention, shall conduct a study on the incidence, risk factors, prevention, and early detection of stomach cancer among members of the Armed Forces and former members of the Armed Forces.
(2) Elements
The study under paragraph (1) shall include—
(A)
an examination of—
(i)
the incidence, prevalence, and mortality rates of stomach cancer among members of the Armed Forces serving on active duty and former members of the Armed Forces who served on active duty;
(ii)
the identification of service-related or deployment-related risk factors, including exposure to burn pits, hazardous chemicals, contaminated water, occupational hazards, and endemic infections such as Helicobacter pylori (H. pylori);
(iii)
disparities in stomach cancer outcomes based on race, ethnicity, gender, Armed Force, or geographic deployment history within military populations;
(iv)
the availability and use of stomach cancer screening, diagnostic, and treatment services within the military health system and the health system of the Department of Veterans Affairs; and
(v)
opportunities to improve prevention and early detection strategies within the military health system and the health system of the Department of Veterans Affairs; and
(B)
relevant coordination with the Surveillance, Epidemiology, and End Results Program and other national cancer registries to ensure comprehensive data collection and analysis.
(3) Report
Not later than 18 months after the date of the enactment of this Act, the Secretary of Defense shall submit to Congress a report on the findings of the study under paragraph (1), including—
(A)
policy and programmatic recommendations to reduce stomach cancer incidence and mortality among members of the Armed Forces and former members of the Armed Forces; and
(B)
proposed strategies for integrating stomach cancer awareness, screening, and treatment protocols into the military health system and the health system of the Department of Veterans Affairs.
Subtitle N Health Equity and Rare Disease Act
Sec. 7901D. Short title
This subtitle may be cited as the Health Equity and Rare Disease Act
or the HEARD Act
.
Sec. 7901D–1. NIH expansion, intensification, and coordination of research on rare diseases health equity
Part B of title IV of the Public Health Service Act (42 U.S.C. 284 et seq.) is amended by adding at the end the following:
409K. Rare diseases health equity
(a) Expansion, intensification, and coordination of activities
(1) In general
The Director of NIH shall expand, intensify, and coordinate research and other activities of the National Institutes of Health with respect to rare diseases health equity.
(2) Allocations by Director of NIH
With respect to amounts appropriated to carry out this section for a fiscal year, the Director of NIH shall allocate the amounts among the national research institutes that are carrying out paragraph (1).
(b) Coordinating Committee
(1) In general
The Secretary shall maintain a coordinating committee with respect to rare diseases health equity (referred to in this section as the
Coordinating Committee) to coordinate activities across the National Institutes and with other Federal health programs and activities relating to rare diseases health equity.(2) Composition
The Coordinating Committee shall be composed of—
(A)
the directors (or their designees) of each of the national research institutes involved in research with respect to rare diseases and minority health or health equity; and
(B)
representatives of all other Federal departments and agencies whose programs involve health functions or responsibilities relevant to such rare diseases, including the Centers for Disease Control and Prevention and the Food and Drug Administration.
(3) Chair
(A) In general
With respect to rare diseases health equity, the Chair of the Coordinating Committee shall serve as the principal advisor to the Secretary, the Assistant Secretary for Health, and the Director of NIH, and shall provide advice to the Director of the Centers for Disease Control and Prevention, the Commissioner of Food and Drugs, and other relevant agencies.
(B) Director of NIH
The Chair of the Coordinating Committee shall be directly responsible to the Director of NIH.
(c) Plan for NIH Activities
(1) In general
Not later than 1 year after the date of the enactment of this section, the Coordinating Committee shall develop a plan for conducting and supporting research and education on rare diseases health equity, and rare diseases or conditions in minority populations, through the national research institutes. The Coordinating Committee shall periodically review and revise the plan. The plan shall—
(A)
provide for a broad range of research and education activities relating to biomedical, psychosocial, and rehabilitative issues, including studies of the disproportionate impact of such diseases or conditions on minority populations;
(B)
identify priorities among the programs and activities of the National Institutes of Health regarding such diseases or conditions; and
(C)
reflect input from a broad range of scientists, patients, and advocacy groups.
(2) Certain elements of plan
The plan under paragraph (1) shall, with respect to rare diseases or conditions in minority populations, provide for the following as appropriate:
(A)
Research to determine the reasons underlying the incidence and prevalence of the diseases or conditions, including among subpopulations.
(B)
Basic research concerning the etiology and causes of the diseases or conditions.
(C)
Epidemiological studies to address the frequency and natural history of the diseases or conditions, including any differences among the sexes and among racial and ethnic groups.
(D)
The development of improved screening techniques.
(E)
Clinical research for the development and evaluation of new treatments, including new biological agents.
(F)
Information and education programs for health care professionals and the public.
(3) Implementation of plan
The Director of NIH shall ensure that programs and activities of the National Institutes of Health regarding rare diseases or conditions in minority populations are implemented in accordance with the plan under paragraph (1).
(d) Definitions
In this section:
(1)
The term minority has the meaning given such term in section 464z–3.
(2)
The term rare disease or condition has the meaning given such term in section 526 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360bb).
Sec. 7901D–2. Collaborative comprehensive plan to address rare diseases and conditions in minority populations
Subpart 20 of part C of title IV of the Public Health Service Act (42 U.S.C. 285t et seq.) is amended by adding at the end the following:
464z–7. Collaborative comprehensive plan to address rare diseases and conditions in minority populations
Not later than 180 days after the date of enactment of this section, the Director of NIH, the Director of the Institute, the Director of the National Center for Advancing Translational Sciences, the Director of the National Heart, Lung, and Blood Institute, and the directors of the other agencies of the National Institutes of Health in collaboration (and in consultation with the advisory council for the Institute) shall—
(1)
develop a comprehensive Federal plan to address rare diseases and conditions in minority populations (as those terms are defined in section 409K), including a strategy to increase diversity in genetic programs at the program for Therapeutics for Rare and Neglected Diseases at the National Institutes of Health;
(2)
conduct or support through grants or cooperative agreements basic, clinical, and translational research on rare diseases and conditions in minority populations, including research on—
(A)
early detection, diagnosis, and treatment of such diseases and conditions in such populations; and
(B)
improving the quality of life for individuals with rare diseases or conditions and their families;
(3)
conduct or support clinical training programs for physicians and other health care practitioners with respect to detecting, diagnosing, and treating such diseases and conditions in such populations; and
(4)
develop guidance for increasing participation of health professionals who are members of minority groups (as defined in section 464z–3) in research conducted or supported by the National Institutes of Health on such diseases and conditions in such populations.
Sec. 7901D–3. Grants to collect and analyze data on rare diseases and conditions in minority populations
Section 1707(b) of the Public Health Service Act (42 U.S.C. 300u–6(b)) is amended by adding at the end the following:
(11)
In coordination with the Director of the Centers for Disease Control and Prevention, award grants to public and private nonprofit entities to—
(A)
collect, analyze, and report data on rare diseases and conditions in minority populations, including on epidemiological data with respect to incidence of such diseases and conditions in such populations;
(B)
conduct outreach and engagement activities with the minority populations impacted by such rare diseases and conditions by—
(i)
improving health literacy with respect to rare diseases and conditions;
(ii)
disseminating information on health and community services related to rare diseases and conditions; and
(iii)
providing information regarding the maintenance of rare diseases and conditions.
(12)
Submit to Congress, on a biannual basis (beginning not later than 2 years after the date of the enactment of the HEARD Act), a report describing the activities carried out pursuant to paragraph (11).
Sec. 7901D–4. Physician training programs with respect to rare diseases
Subpart II of part C of title VII of the Public Health Service Act (42 U.S.C. 293m et seq.), as amended by section 3016, is further amended by adding at the end the following:
749D. Physician training programs with respect to rare diseases
(a) In general
The Secretary shall establish a program to award grants to accredited schools of allopathic medicine, osteopathic medicine, and nursing, and other health professional training programs for the training of health care professionals—
(1)
to improve the provision of care to individuals who have rare diseases or conditions (as defined in section 526 of the Federal Food, Drug, and Cosmetic Act);
(2)
to improve the provision of care to such individuals via telehealth; and
(3)
to conduct research relevant to rare diseases and conditions.
(b) Eligibility
To be eligible for a grant under subsection (a), an entity described in such subsection shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(c) Reporting requirements
(1) Periodic reports
Each entity awarded a grant under this section shall periodically submit to the Secretary a report on the status of activities conducted using the grant, including a description of the impact of such training on patient outcomes, as applicable.
(2) Report to Congress
Not later than 2 years after the date of enactment of this section, the Secretary shall submit a report to Congress on the activities conducted using grants under subsection (a) and any best practices identified and disseminated under subsection (d).
(d) Best practices
The Secretary may identify and disseminate best practices for the training described in subsection (a).
749E. Health professionals education on rare diseases and conditions in minority populations
(a) In general
The Secretary may award grants, cooperative agreements, and contracts to accredited schools of medicine and nursing, and other health professional training programs, for the development and implementation of programs to provide education and training to health care professionals on the causes and effects of rare diseases and conditions in minority populations.
(b) Definitions
In this section:
(1)
The term minority has the meaning given such term in section 464z–3.
(2)
The term rare disease or condition has the meaning given such term in section 526 of the Federal Food, Drug, and Cosmetic Act.
749F. Mentoring program for health care professionals seeking to work in rare diseases and conditions
The Secretary, acting through the Administrator of the Health Resources and Services Administration, may award grants, contracts, or cooperative agreements to public and nonprofit private entities (including Tribal entities) for the establishment of a mentoring program for health care professionals seeking to treat patients with rare diseases and conditions.
749G. Scholarship and loan repayment program for physicians and genetic counselors serving populations with rare diseases and conditions
(a) Loan repayment program
(1) In general
The Secretary shall establish a program of entering into contracts with eligible individuals under which the individuals agree to serve as health care professionals serving populations with rare diseases or conditions in consideration of the Federal Government agreeing to pay, for each year of such service, up to $50,000 (plus an amount determined by the Secretary on an annual basis to reflect inflation) of the principal and interest of the educational loans of such individuals.
(2) Determination of amount
In making a determination of the amount to pay for a year of such service by an individual, the Secretary shall consider the extent to which each such determination—
(A)
affects the ability of the Secretary to maximize the number of contracts that can be provided under the program from the amounts appropriated for such contracts;
(B)
provides an incentive to serve as health care professionals serving populations with rare diseases or conditions; and
(C)
provides an incentive with respect to the health professional involved to remain serving populations with rare diseases or conditions, including after the completion of the period of obligated service under the program.
(3) Eligible individuals
In this subsection, the term eligible individual means an individual who is enrolled or accepted for enrollment as a full-time or part-time student in a school of medicine.
(4) Applicability of certain provisions
With respect to the National Health Service Corps Loan Repayment Program established in subpart III of part D of title III of this Act, the provisions of such subpart shall, except as inconsistent with paragraph (1), apply to the program established in this section in the same manner and to the same extent as such provisions apply to the National Health Service Corps Loan Repayment Program.
(b) Scholarship program
(1) In general
The Secretary shall carry out a program of entering into contracts with eligible individuals under which each such individual agrees to serve, for a period of not less than 5 years, as a health care professional primarily serving populations with rare diseases or conditions, in consideration of the Federal Government agreeing to provide to the individual a scholarship for attendance at a school of medicine.
(2) Eligible individuals
In this subsection, the term eligible individual means an individual who is enrolled or accepted for enrollment as a full-time or part-time student in a school of medicine.
(3) Applicability of certain provisions
The provisions of subpart III of part D of title III shall, except as inconsistent with this section, apply to the program established in paragraph (1) in the same manner and to the same extent as such provisions apply to the National Health Service Corps Scholarship Program established in such subpart.
Sec. 7901D–5. Increasing minority representation in research on rare diseases and conditions
Part G of title IV of the Public Health Service Act (42 U.S.C. 288 et seq.) is amended by adding at the end the following:
487E. Increasing minority representation in research on rare diseases and conditions
(a) Grant program
In carrying out section 487, the Secretary may award grants to eligible entities involved in research on rare diseases and minority health to establish programs to increase the recruitment and retention of members of minority groups to conduct research in matters relating to the cause, diagnosis, prevention, and treatment of rare diseases or conditions, including by expanding the number of internships and mentoring opportunities.
(b) Eligible entities
In subsection (a), the term eligible entities means accredited schools of allopathic medicine, osteopathic medicine, and nursing, and other health professional training programs.
Sec. 7901D–6. Report to Congress on Federal efforts on rare diseases and conditions in minority populations
Not later than 2 years after the date of enactment of this Act, the Secretary of Health and Human Services, acting through the Director of the National Institutes of Health and in consultation with the Director of the Centers for Disease Control and Prevention, shall submit to Congress—
(1)
a report on research and public health activities carried out by the Federal Government with respect to rare diseases or conditions in minority populations (as those terms are defined in section 409K of the Public Health Service Act, as added by section 7901D–1 of this Act);
(2)
a comprehensive list of known rare diseases and conditions that impact minority populations heavily or disproportionately; and
(3)
an analysis of data gaps with respect to rare diseases and conditions and the effect of such diseases and conditions on minority populations.
Sec. 7901D–7. Research and awareness campaigns with respect to rare diseases and conditions in minority populations
Part B of title III of the Public Health Service Act (42 U.S.C. 243 et seq.) is amended by inserting after section 317Y of such Act, as added by section 7502, the following:
317Z. Research and awareness campaigns with respect to rare diseases and conditions in minority populations
(a) Research
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall conduct or support research and carry out public health awareness campaigns with respect to rare diseases and conditions in minority populations (as defined in section 409K).
(b) Awareness campaign
The Secretary shall, directly or through grants or contracts, establish a public education program in cooperation with existing national public awareness campaigns to increase awareness about rare diseases and conditions in minority populations through culturally and linguistically appropriate information campaigns about prevention and management of rare diseases and conditions.
Sec. 7901D–8. FDA survey and report on clinical trial diversity
Not later than 2 years after the date of enactment of this Act, the Secretary of Health and Human Services, acting through the Commissioner of Food and Drugs, shall—
(1)
conduct a survey of policies and programs of the Food and Drug Administration to support an increase the availability of clinical trial data on minority populations, with an emphasis on minority populations with rare diseases and conditions; and
(2)
submit to Congress a report containing—
(A)
the findings of such survey;
(B)
the Secretary’s recommendations for statutory or regulatory changes to increase the availability of such data;
(C)
the Secretary’s recommendations for strategies to encourage drug manufacturers to address racial equity and inclusion in research and development of treatments of rare diseases or conditions that disproportionately impact minority populations; and
(D)
the Secretary's recommendations for strategies to address research and development of treatments of rare diseases or conditions that disproportionately impact minority populations.
Sec. 7901D–9. Tribal epidemiology center grant program
Title II of the Indian Health Care Improvement Act (25 U.S.C. 1621 et seq.) is amended by adding at the end the following:
227. Tribal epidemiology center grant program
(a) In general
The Secretary, acting through the Service, shall award grants to Tribal Epidemiology Centers and Tribal and Urban Indian Health Centers to support clinically and culturally appropriate research and other activities with respect to rare diseases and conditions in Native American or Tribal communities.
(b) Permissible activities
The activities funded through a grant under subsection (a) may include coordination of data collection on the prevention, diagnosis, treatment, and care of rare diseases and conditions by health care professionals serving American Indian and Alaska Native populations.
Sec. 7901D–10. Medicare review and report
Not later than 180 days after the date of enactment of this Act, the Secretary of Health and Human Service shall conduct a review of and submit to Congress a report on the following:
(1)
Regulatory barriers under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) that inhibit access to the treatment of rare diseases for Medicare beneficiaries of color, including barriers that inhibit health care providers from improving care related to such diseases for such beneficiaries.
(2)
Requirements relating to the furnishing of telehealth services under such title insofar as such services relate to the treatment of rare diseases.
Such report shall include any recommendations determined appropriate by the Secretary based on such review.
Subtitle O Asunción Valdivia Heat Illness, Injury, and Fatality Prevention
Sec. 7901E. Employer duties
Each employer shall—
(1)
furnish employment and a place of employment free from conditions that may reasonably be anticipated to cause death or serious physical harm from heat stress; and
(2)
comply with standards, regulations, rules, and orders promulgated under this subtitle.
Sec. 7901E–1. Worker heat protection standards
(a) Design of standards
(1) In general
The Secretary shall promulgate a worker heat protection standard that, in accordance with the best available evidence, establishes the maximum protective program of measures an employer shall implement to regulate employees’ exposure to heat stress and prevent heat-related illness and injury that attains the highest degree of health and safety protection to the extent feasible.
(2) Considerations
(A) Demonstrably achievable measures
The Secretary may presume that any requirement substantially equivalent to a requirement adopted by a State plan approved by the Occupational Safety and Health Administration pursuant to section 18(c) of the Occupational Safety and Health Act of 1970 (29 U.S.C. 667(c)) and that has been in effect for at least 1 year is feasible.
(B) Prioritizing worker protection
In weighing any considerations during rulemaking, the Secretary shall place preeminent value on assuring employees a safe and healthful working environment.
(C) Available expertise
If the Secretary adopts any finding or recommendation by the Institute, the American Conference of Governmental Industrial Hygienists, or the National Academies of Sciences, Engineering, and Medicine relevant to heat stress in a rulemaking pursuant to this subtitle, such finding or recommendation shall be considered the best available evidence.
(D) Employer categories
The Secretary may, in any rulemaking analysis or design of standards, cluster relevant employers in any categories such as standard industry or occupational classifications or any common or related features of heat sources, conditions of employment, employer practices, employee characteristics, or nature of place of employment that, in the Secretary’s reasonable determination, are useful for designing an effective and practicable program of standards, regulations, and enforcement that maximizes the health and safety of employees.
(3) Protective programs
(A) In general
In addition to measures specified by this subtitle, the Secretary may develop a worker heat protection standard with such additional requirements that, in the Secretary’s reasonable judgment, are necessary or appropriate to achieve the purposes of this subtitle. Such measures may include the following:
(i) Engineering controls
Requirements to eliminate hazardous levels of heat stress through engineering controls, such as isolation or shielding of employees from sources of heat, exhaust ventilation, insulation of hot surfaces, or climate-control technologies, as well as technology-based standards that encourage the development of such controls.
(ii) Administrative controls
Requirements to limit exposure to hazardous levels of heat stress by adjustment of work procedures, work schedules, or other work practices.
(iii) Personal protective equipment
Requirements to provide, at the employer’s expense, personal protective equipment such as water-cooled garments, air-cooled garments, heat-reflective clothing, and cooling vests.
(iv) Health-related protocols
Requirements to conduct medical symptom monitoring, emergency response protocols, medical removal protection, or training of employees and supervisors in recognition of symptoms of heat-related illness and appropriate responses.
(v) Training requirements
Requirements to train employees and supervisors in topics reasonable or necessary to achieve the implementation of the requirements of a standard or the purposes of this subtitle, including—
(I)
training of employees in signs and symptoms of heat-related illness, emergency response procedures, and their rights under this subtitle; and
(II)
training of supervisors in monitoring heat conditions and environmental forecasts, recognizing signs of heat-related illness, and protocols for responding to likely heat-related illness.
(vi) Planning requirements
Requirements for a heat illness and injury prevention plan that—
(I)
is of sufficient quality to effectuate the purposes of this subtitle and to effectuate the requirements of the standard that apply to the employer;
(II)
is developed, updated, and implemented with the meaningful participation of the employer’s employees and, where applicable, such employees’ representatives, for all aspects of the plan;
(III)
is produced and maintained in writing and updated in light of changing conditions or practices; and
(IV)
is made available, upon request, to any employee, the employee’s representative, and the Secretary.
(vii) Standard health and safety measures
Any measures described in section 6(B)(7) of the Occupational Safety and Health Act of 1970 (29 U.S.C. 655(B)(7)).
(B) Innovative solutions
As the relevant scientific evidence develops, technological solutions improve, and environmental conditions or new work practices aggravate the risk of heat-related illness or injury, the Secretary may modify, supplement, or revise a worker heat protection standard by rule in order to improve such standard in light of such changes, even if it departs from long-standing past practice, provided that the resulting standard is consistent with this subtitle.
(C) Core practices
The Secretary shall establish criteria under which an employer who exposes or may reasonably be anticipated to expose an employee to heat or heat stress that is not reduced below hazardous levels by engineering controls or personal protective equipment shall implement a reasonable program that includes—
(i)
suitably cool potable water or appropriate hydration, provided at employer expense;
(ii)
periodic paid rest breaks scheduled to reduce heat stress below hazardous levels;
(iii)
access to shade or suitable cool-down spaces;
(iv)
acclimatization policies; and
(v)
such measures that are necessary or appropriate to ensure effective implementation of the requirements of this subparagraph.
(4) Other specifications
(A) Protection of pay
The Secretary shall require that, for any required duration such as rest breaks, medical removal protection, and training, an employee shall receive compensation at the regular rate at which such employee is employed.
(B) Language access
Any required training, poster, label, hazard alert, or written plan shall be provided in English and a language understood by the employees, if such is not English, and prepared appropriately for the vocabulary, educational level, and literacy of the employees.
(C) Temporary labor camps
The Secretary shall revise the Secretary’s standard for temporary labor camps to the extent necessary to achieve the purposes of this subtitle.
(5) Maintaining protection
No worker heat protection standard promulgated under this subtitle may reduce the protection afforded employees by an existing worker heat protection standard.
(b) Initial standards
Not later than 1 year after the date of enactment of this Act, the Secretary shall promulgate, without regard to the requirements of chapters 5 and 6 of title 5, United States Code, subchapter I of chapter 35 of title 44, United States Code (commonly known as the Paperwork Reduction Act
), or the National Environmental Policy Act of 1969 (42 U.S.C. 431 et seq.), an interim final rule establishing a worker heat protection standard and related recordkeeping and reporting requirements. Such rule shall take effect upon issuance (except that it may include a reasonable delay in the effective date), shall have the legal effect of an occupational safety and health standard as defined by section 3(8) of the Occupational Safety and Health Act of 1970 (29 U.S.C. 652(8)), and shall remain in effect until superseded by a final rule promulgated pursuant to this subtitle.
(c) Rulemaking procedures
For any rulemaking pursuant to this subtitle after publication of the interim final rule in subsection (b), the following procedures shall apply:
(1) In general
The Secretary shall, upon a showing by a petitioner pursuant to paragraph (2) or the Secretary’s own determination that a worker heat protection standard is necessary or appropriate to regulate employees’ exposure to conditions known to cause or that may reasonably be anticipated to cause heat-related illness or injury, promulgate any worker heat protection standard in accordance with the policies set forth in this section and in accordance with section 553 of title 5, United States Code (without regard to any reference in such section to sections 556 and 557 of such title).
(2) Petitions for rulemaking
Any person may petition the Secretary to promulgate or modify a worker heat protection standard. Not later than 18 months after receipt of a petition, the Secretary shall either grant or deny the petition by publishing a written explanation of the reasons for the Secretary’s decision. The Secretary may not deny a petition solely on the basis of inadequate resources or insufficient time for review.
(3) Timelines
Except as otherwise provided in subsection (b), the Secretary shall observe the following schedule for rulemaking:
(A) Proposed standards
Not later than one year after granting a petition for rulemaking under paragraph (2), the Secretary shall publish a proposed worker heat protection standard consistent with this section.
(B) Final standards
The Secretary shall promulgate, not later than one year after such publication, such standards with such modifications as the Secretary determines appropriate.
(C) Effect
Standards or revisions thereof shall become effective upon promulgation, except that the Secretary may include a reasonable delay in the effective date.
(4) Transparency in rulemaking
For any rulemaking notice pursuant to this subtitle, the Secretary shall place in the public record not later than the date of such rulemaking notice the following:
(A)
The drafts of such rulemakings prepared before publication and submitted by the Secretary to the Office of Management and Budget for any interagency review process prior to publication, all documents accompanying such drafts, all written comments thereon by other agencies, and all written responses to such written comments by the Secretary.
(B)
A summary of the substance of any changes between the text of the draft rulemaking that the agency provided to the Office of Management and Budget under section 6(a)(3)(B)(i) of Executive Order 12866 (58 Fed. Reg. 51735; relating to regulatory planning and review) and the text published in the Federal Register, excluding any non-substantive changes such as spelling or grammatical corrections or re-ordering of text that has no legal effect.
(C)
A statement identifying any party or entity at whose request any such change was made.
(5) Judicial review
(A) Filing of petition
A petition for review in accordance with section 702 of title 5, United States Code, of action of the Secretary in promulgating any worker heat protection standard or any other nationally applicable regulation or final action taken by the Secretary pursuant to this subtitle may be filed only in the United States Court of Appeals for the District of Columbia. The filing of a petition for review shall not postpone the effectiveness of such rule or action.
(B) Timely filing
Any petition for review under this paragraph shall be filed not later than sixty days after the date notice of such promulgation, approval, or action appears in the Federal Register.
(C) Not subject to review
Action of the Secretary with respect to which review could have been obtained under this paragraph shall not be subject to judicial review in civil or criminal proceedings for enforcement. Failure to promulgate any standard pursuant to the schedule established by this section shall be subject to review.
Sec. 7901E–2. Implementation and enforcement
(a) In general
Except as otherwise provided by this section—
(1)
a worker heat protection standard shall have the same legal effect as an occupational safety and health standard as defined by section 3(8) of the Occupational Safety and Health Act of 1970 (29 U.S.C. 652(8)); and
(2)
any rule, regulation, or order promulgated pursuant to this subtitle shall have the same legal effect as a rule, regulation, or order promulgated pursuant to the Occupational Safety and Health Act of 1970 (29 U.S.C. 651 et seq.).
(b) Enforcement
(1) Statute of limitations for citation
No citation for any violation of section 7901E or any standard, rule, regulation, or order pursuant to this subtitle may be issued under this section later than 4 years after the occurrence of any violation.
(2) Review
The Commission shall grant substantial deference to any reasonable interpretation by the Secretary of this subtitle or any standard, regulation, or order pursuant to this subtitle.
(c) Recordkeeping and reporting
(1) In general
With regard to recordkeeping and reporting, the Secretary and Secretary of Health and Human Services shall have the same authority to prescribe regulations related to this subtitle as under section 8 of the Occupational Safety and Health Act (29 U.S.C. 657).
(2) Consolidating requirements
The Secretary may incorporate recordkeeping and reporting requirements under this section into existing recordkeeping and reporting requirements promulgated pursuant to section 8 of the Occupational Safety and Health Act (29 U.S.C. 657), provided that a violation of such a requirement with regard to implementation of this subtitle shall be enforced as a distinct violation separate and apart from any other simultaneous violation of a requirement pursuant to the Occupational Safety and Health Act.
(d) Whistleblower protections
(1) Complaint
Any employee who believes that such employee has been discharged or otherwise discriminated against by any person in violation of section 11(c)(1) of the Occupational Safety and Health Act (29 U.S.C. 660(c)(1)) with regard to any matter under or related to this subtitle may, not later than 180 days after such violation occurs, file a complaint with the Secretary following the procedures in paragraph (2) of such section alleging such discrimination.
(2) Action
If the Secretary fails to notify the complainant of the Secretary’s determination on the complaint within 90 days after such determination pursuant to section 11(c)(3) of the Occupational Safety and Health Act (29 U.S.C. 660(c)(3)) or determines not to bring an action pursuant to paragraph (2) of such section, such employee may bring an action in any appropriate United States District Court against such person for all appropriate relief in accordance with paragraph (2) of such section as well as reasonable attorney’s fees and costs.
Sec. 7901E–3. General provisions
(a) Severability
If any provision of this subtitle is held invalid, the remainder of this subtitle shall not be affected thereby. If the application of any provision of this subtitle to any person or circumstance is held invalid, the application of such provision to other persons or circumstances shall not be affected thereby.
(b) Authorization of appropriations
There are authorized to be appropriated from sums not otherwise appropriated, for each fiscal year, such sums as may be necessary to carry out this subtitle.
Sec. 7901E–4. Agenda for further review and action
The Secretary shall update the National Agricultural Workers Survey with such questions that, in the Secretary’s judgment, are useful to identify the incidence and prevalence of heat-related illness and injury and assess the impact of standards and enforcement pursuant to this subtitle. Not later than one year after the date of enactment of this Act, the Secretary shall submit to the Committee on Education and Workforce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report on the Secretary’s implementation of this section.
Sec. 7901E–5. Definitions
For purposes of this subtitle:
(1)
The term Commission means the Occupational Safety and Health Review Commission.
(2)
The term employee has the meaning given such term in section 3 of the Occupational Safety and Health Act of 1970 (29 U.S.C. 652).
(3)
The term employer has the meaning given such term in section 3 of the Occupational Safety and Health Act of 1970 (29 U.S.C. 652).
(4)
The term heat stress means the load of heat that a person experiences due to—
(A)
sources of heat or heat retention (including the combined contributions of metabolic heat, environmental factors, and clothing or personal protective equipment); or
(B)
the presence of heat in a work setting.
(5)
The term heat-related illness means a material impairment of health that occurs due to heat stress.
(6)
The term heat-related injury means an injury caused by exposure to heat or sources of heat or occurring as a result of heat stress.
(7)
The term Institute means the National Institute for Occupational Safety and Health.
(8)
The term Secretary means the Secretary of Labor.
(9)
The term worker heat protection standard means a standard that regulates employee exposure to heat stress and prevents heat-related illness and injury by requiring conditions or the adoption or use of one or more practices, means, methods, operations, or processes reasonably necessary or appropriate to provide employment and places of employment that are safe or healthful.
Subtitle P New Era of Preventing End-Stage Kidney Disease
Sec. 7901F. Centers of Excellence on Rare Kidney Disease Research in the National Institute of Diabetes and Digestive and Kidney Diseases
Subpart 3 of part C of title IV of the Public Health Service Act (42 U.S.C. 281 et seq.) is amended by inserting after section 426 (42 U.S.C. 285c) the following new section:
426A. Centers of Excellence on Rare Kidney Disease Research in the National Institute of Diabetes and Digestive and Kidney Diseases
(a) Cooperative agreements and grants
(1) In general
The Director of the Institute may enter into cooperative agreements with, and make grants to, public and private nonprofit entities to pay all or part of the cost of planning, establishing, or strengthening, and providing basic operating support for, regional centers of excellence for rare kidney diseases, including primary glomerular disease. Such centers of excellence shall be known as NIDDK Centers of Excellence on Rare Kidney Disease Research (referred to in this section as
Centers of Excellence).(2) Purposes of centers
The purposes of the Centers of Excellence funded pursuant to paragraph (1) shall be—
(A)
to conduct research on the causes, etiology, symptoms, diagnosis, progression, and treatment of rare kidney diseases, including glomerular diseases;
(B)
to increase public awareness of rare kidney diseases, particularly in rural and underserved communities; and
(C)
to develop resources for clinical research into, training in, and demonstration of diagnostic, prevention, control, and treatment methods for, rare kidney diseases.
(3) Policies
A cooperative agreement or grant under paragraph (1) shall be entered into in accordance with policies established by the Director of the National Institutes of Health.
(b) Coordination with other institutes
The Director of the Institute shall coordinate the activities under this section with similar activities that are related to rare kidney disease and conducted by other national research institutes, centers, and agencies of the National Institutes of Health and by the Food and Drug Administration.
(c) Use of funds
An entity that enters into a cooperative agreement or receives a grant under subsection (a) may use funds received through such agreement or grant—
(1)
to cover patient care costs required to conduct research described in subsection (a)(2)(A);
(2)
to provide, for the purpose described in subsection (a)(2)(B)—
(A)
clinical training and continuing education for health professionals and related personnel with respect to rare kidney diseases; and
(B)
information programs for the public, with respect to rare kidney diseases; and
(3)
to provide, for the purpose described in subsection (a)(2)(B)—
(A)
for education of members of the public, particularly through outreach to rural and underserved communities, on the diagnosis (including through routine urinalysis and through genetic testing), prevention, control, and treatment of rare kidney diseases; and
(B)
for education of individuals diagnosed with rare kidney diseases on renal diet and lifestyle, genetic testing, and programs to promote urinalysis, and on mental and emotional health resources for families of rare kidney disease patients.
(d) Research funded
Research conducted using funds awarded through a cooperative agreement or grant under this section—
(1)
shall include study of genotype-phenotype relation to disease progression; and
(2)
with respect the populations studied in such research, may not include any consideration of quality-adjusted life years or disability adjusted life years, or other similar mechanisms that discriminate against individuals with disabilities in value and cost-effectiveness assessments.
(e) Period of support; additional periods
The period of support for a center of excellence under subsection (a) may not exceed 5 years, except that such period may be extended by the Director of the Institute for additional periods of not more than 5 years for each center if—
(1)
the operations of such center have been reviewed by an appropriate technical and scientific peer review group established by the Director of the Institute; and
(2)
such group has recommended to the Director of the Institute that such period should be extended.
(f) Authorization of appropriations
To carry out this section, there are authorized to be appropriated $6,000,000 for each of fiscal years 2027 through 2031.
Sec. 7901F–1. Understanding and Slowing the Progression of Rare Kidney Disease Through Early Intervention, Testing, and Treatment
(a) In general
The Secretary of Health and Human Services (in this section referred to as the Secretary
) shall conduct a study on testing, preventative care, precision medicine, and treatment, with respect to rare kidney disease. Such study shall review—
(1)
the impact of routine urinalysis on the timely diagnosis of rare kidney disease and on the quality of patient care following a diagnosis of such disease;
(2)
the quality and reliability of kidney biopsy in the diagnosis of rare kidney disease;
(3)
the utility and appropriate use of genetic and genomic tests in detecting kidney disease, including—
(A)
advances in genetic and genomic testing, and in particular testing of the APOL1 gene, and whether such testing may improve the diagnosis and treatment of rare kidney disease;
(B)
barriers to genetic and genomic testing, such as diagnostic, predictive, presymptomatic testing, and DNA sequencing clinical services, including an analysis of any existing barriers related to health insurance coverage of such testing and access to genetic counselors, pathologists, and other relevant professions; and
(C)
strategies to increase routine urinalysis and other diagnostic testing and to improve technologies to diagnose such disease, including genetic testing, and to improve access to health insurance coverage of such diagnostic testing and technologies;
(4)
the social, behavioral, and biological factors leading to rare kidney disease;
(5)
treatment patterns associated with providing care, under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), the Medicaid program under title XIX of such Act (42 U.S.C. 1396 et seq.), and through private health insurance, to populations that are disproportionately affected by such disease;
(6)
access to nephrologists among populations that are disproportionately affected by such disease;
(7)
ongoing efforts and recommendations to slow the progression of end-stage kidney disease in populations that are disproportionately affected by rare kidney disease; and
(8)
patient trust of treating providers among populations that are disproportionately affected by such disease.
(b) Report
(1) In general
Not later than 18 months after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the results of the study under subsection (a), together with such recommendations as the Secretary determines to be appropriate.
(2) Consultation
In conducting the study under subsection (a) and developing the report required by paragraph (1), the Secretary shall consult with relevant stakeholders, including health care providers, medical professional societies, State-based societies, public health experts, health educators, health professional organizations, drug and device manufacturers, patient organizations, pharmacists, payors, State and local public health departments, State medical boards, and other entities with experience in health care, public health, nephrology, and rare disease, as appropriate.
(c) Coordination
In carrying out the activities under subsections (a) and (b), the Secretary shall coordinate with the Director of NIH, the Administrator of the Centers for Medicare & Medicaid Services, the Administrator of the Health Resources and Services Administration, and the Director of the Center for Medicare and Medicaid Innovation.
(d) Authorization of appropriations
To carry out this section, there is authorized to be appropriated $1,000,000 for each of fiscal years 2027 through 2031.
Sec. 7901F–2. Provider education
(a) Primary care training
Section 747(b)(3)(E) of the Public Health Service Act (42 U.S.C. 293k(b)(3)(E)) is amended—
(1)
by striking and individuals
and inserting , individuals
; and
(2)
by inserting , and individuals with kidney disease (including rare kidney disease)
after disabilities
.
(b) Nephrology fellowships
Section 736(b) of the Public Health Service Act (42 U.S.C. 293) is amended—
(1)
by redesignating paragraph (7) as paragraph (8);
(2)
in paragraph (6)(B), by striking ; and
and inserting a semicolon; and
(3)
by inserting after paragraph (6) the following:
(7)
to award fellowships, which may include stipends, for postgraduate training in the field of nephrology, for the purposes of—
(A)
increasing providers’ knowledge of issues related to prevention, diagnosis, and treatment of rare kidney disease for populations disproportionately impacted by the disease, including the prevalence of the gene APOL1;
(B)
improving the quality of rare kidney disease prevention, diagnosis, and treatment delivered to racial and ethnic minorities; and
(C)
increasing the number of nephrologists trained to provide care to such populations; and
Sec. 7901F–3. Delaying kidney disease impact
Section 1881(f) of the Social Security Act (42 U.S.C. 1395rr(f)) is amended by adding at the end the following new paragraph:
(9)
(A)
The Secretary shall conduct experiments to evaluate methods for treating rare kidney disease, giving particular attention to treatments that would delay or eliminate the need for dialysis and transplant.
(B)
The Secretary shall conduct a comprehensive study of methods to increase public awareness of rare kidney disease.
(C)
The Secretary shall submit to Congress, not later than 24 months after the date of the enactment of the Health Equity and Accountability Act of 2026, a report on the experiments and study conducted under subparagraphs (A) and (B). Such report shall include recommendations for legislative changes that the Secretary finds necessary or desirable as a result of such experiments and study.
Title VIII Health Information Technology
Sec. 8001. Definitions
In this title:
(1) Access
The term access, with respect to health information, means access described in section 164.524 of title 45, Code of Federal Regulations (or any successor regulations).
(2) Certified electronic health record technology
The term certified EHR technology—
(A)
has the meaning given such term in section 3000 of the Public Health Service Act (42 U.S.C. 300jj);
(B)
includes the health information infrastructure for interoperability, access, exchange, and use of electronic health information required under title XXX of the Public Health Service Act (42 U.S.C. 300jj et seq.); and
(C)
is not limited to electronic health records maintained by doctors.
(3) EHR
The term EHR—
(A)
means an electronic health record;
(B)
includes the health information infrastructure for interoperability, access, exchange, and use of electronic health information required under title XXX of the Public Health Service Act (42 U.S.C. 300jj et seq.); and
(C)
is not limited to electronic health records maintained by doctors.
(4) Electronic health record
The term electronic health record has the meaning given the term qualified electronic health record
in section 3000 of the Public Health Service Act (42 U.S.C. 300jj).
(5) Interoperability
The term interoperability has the meaning given such term in section 3000 of the Public Health Service Act (42 U.S.C. 300jj).
Subtitle A Reducing Health Disparities Through Health IT
Sec. 8101. HRSA assistance to health centers for promotion of Health IT
(a) In general
The Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration, shall expand and intensify the programs and activities of the Administration (directly or through grants or contracts) to provide technical assistance and resources to health centers (as defined in section 330(a) of the Public Health Service Act (42 U.S.C. 254b(a))) to adopt and meaningfully use certified EHR technology for the management of chronic diseases and health conditions and reduction of health disparities.
(b) Funding initiatives
The activities under subsection (a) may include funding initiatives, including establishing basic connectivity such as 5G internet for telemedicine capabilities, grant funding to implement the next generation of EHR, and funding for technology hardware.
Sec. 8102. Assessment of impact of Health IT on racial and ethnic minority communities; outreach and adoption of Health IT in such communities
(a) National Coordinator for Health Information Technology
(1) In general
Not later than 18 months after the date of enactment of this Act, the National Coordinator for Health Information Technology (referred to in this title as the National Coordinator
) shall—
(A)
conduct an evaluation of the level of interoperability, access, use, and accessibility of EHRs in racial and ethnic minority communities, focusing on whether patients in such communities have providers who use EHRs, and the degree to which patients in such communities can access, exchange, and use without special effort their health information in those EHRs;
(B)
include in such evaluation an indication of whether such providers—
(i)
are participating in the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) or a State plan under title XIX of such Act (42 U.S.C. 1396 et seq.) (or a waiver of such plan);
(ii)
have received incentive payments or incentive payment adjustments under Medicare and Medicaid Electronic Health Records Incentive Programs (as defined in subsection (c)(2));
(iii)
are MIPS eligible professionals, as defined in paragraph (1)(C) of section 1848(q) of the Social Security Act (42 U.S.C. 1395w–4(q)), for purposes of the Merit-Based Incentive Payment System under such section; or
(iv)
have been recruited by any of the Health Information Technology Regional Extension Centers established under section 3012 of the Public Health Service Act (42 U.S.C. 300jj–32); and
(C)
publish the results of such evaluation, including the indications under subparagraph (B), the race and ethnicity of such providers, and the populations served by such providers.
(2) Evaluation of interoperability
The evaluation of the level of interoperability described in paragraph (1)(A) shall consider exchange of electronic health information, usability of exchanged electronic health information, effective application and use of the exchanged electronic health information, and impact on outcomes of interoperability.
(3) Certification criterion
Not later than 1 year after the date of enactment of this Act, the National Coordinator shall—
(A)
promulgate a certification criterion and module of certified EHR technology that stratifies quality measures for purposes of the Merit-Based Incentive Payment System by disparity characteristics, including race, ethnicity, language, gender, gender identity, sexual orientation, socio-economic status, and disability status, as such characteristics are defined for purposes of certified EHR technology; and
(B)
report to the Centers for Medicare & Medicaid Services the quality measures stratified by race and at least 2 other disparity characteristics.
(b) National Center for Health Statistics
Not later than one year after the date of enactment of this Act, the Director of the National Center for Health Statistics shall provide to Congress a report that details the adoption of certified electronic health record systems and electronic information sharing in physicians’ offices in communities of color and rural communities during fiscal years 2023 thorough 2026.
(c) Centers for Medicare & Medicaid Services
(1) In general
As part of the process of collecting information, with respect to a provider, at registration and attestation for purposes of Medicare and Medicaid Electronic Health Records Incentive Programs (as defined in paragraph (2)) or the Merit-Based Incentive Payment System under section 1848(q) of the Social Security Act (42 U.S.C. 1395w–4(q)), the Secretary of Health and Human Services shall collect the race and ethnicity of such provider.
(2) Medicare and Medicaid Electronic Health Records Incentive Programs defined
For purposes of paragraph (1), the term Medicare and Medicaid Electronic Health Records Incentive Programs means the incentive programs under the following:
(A)
Subsection (l)(3) of section 1814(l)(3) of the Social Security Act (42 U.S.C. 1395f).
(B)
Subsections (a)(7) and (o) of section 1848 of such Act (42 U.S.C. 1395w–4).
(C)
Subsections (l) and (m) of section 1853 of such Act (42 U.S.C. 1395w–23).
(D)
Subsections (b)(3)(B)(ix)(I) and (n) of section 1886 of such Act (42 U.S.C. 1395ww).
(E)
Subsections (a)(3)(F) and (t) of section 1903 such Act (42 U.S.C. 1396b).
(d) National Coordinator’s assessment of impact of HIT
Section 3001(c)(6)(C) of the Public Health Service Act (42 U.S.C. 300jj–11(c)(6)(C)) is amended—
(1)
in the heading by inserting , racial and ethnic minority communities,
after health disparities
;
(2)
by inserting , in communities with a high proportion of individuals from racial and ethnic minority groups (as defined in section 1707(g)), including people with disabilities in such groups,
after communities with health disparities
;
(3)
by striking The National Coordinator
and inserting the following:
(i) In general
The National Coordinator; and
(4)
by adding at the end the following:
(ii) Criteria
In any publication under clause (i), the National Coordinator shall include best practices for encouraging partnerships between the Federal Government, States, private entities, national nonprofit intermediaries, and community-based organizations to expand outreach and education for and the adoption of certified EHR technology in communities with a high proportion of individuals from racial and ethnic minority groups (as defined in section 1707(g)), while also maintaining the accessibility requirements of section 508 of the Rehabilitation Act of 1973 to encourage patient involvement in patient health care. The National Coordinator shall—
(I)
not later than 6 months after the submission of the report required under section 8302(b) of the Health Equity and Accountability Act of 2026, establish criteria for evaluating the impact of health information technology on communities with a high proportion of individuals from racial and ethnic minority groups (as so defined) taking into account the findings in such report; and
(II)
not later than 1 year after the submission of such report, publish the results of an evaluation of such impact.
Sec. 8103. Nondiscrimination and health equity in health information technology
(a) In general
Covered entities shall ensure that electronic and information technology in their health programs or activities does not exclude individuals from participation in, deny individuals the benefits of, or subject individuals to discrimination under any health program or activity on the basis of race, color, national origin, sex, age, or disability.
(b) Covered entities
In this section, the term covered entity means—
(1)
an entity that operates a health program or activity, any part of which receives Federal financial assistance;
(2)
an entity established under title I of the Patient Protection and Affordable Care Act (Public Law 114–148) that administers a health program or activity; or
(3)
the Department of Health and Human Services.
Sec. 8104. Language access in health information technology
The National Coordinator shall—
(1)
not later than 18 months after the date of enactment of this Act, propose a rule for providing access to patients, through certified EHR technology, to their personal health information in a computable format, including using patient portals or third-party applications (as described in section 3009(e) of the Public Health Service Act (42 U.S.C. 300jj–19(e))), in the 10 most common non-English languages;
(2)
hold a public hearing to identify best practices for carrying out paragraph (1); and
(3)
not later than 6 months after the public hearing under paragraph (2), promulgate a final regulation with respect to paragraph (1).
Subtitle B Modifications To Achieve Parity in Existing Programs
Sec. 8201. Extending funding to strengthen the Health IT infrastructure in racial and ethnic minority communities
Section 3011 of the Public Health Service Act (42 U.S.C. 300jj–31) is amended—
(1)
in subsection (a), in the matter preceding paragraph (1), by inserting , including with respect to communities with a high proportion of individuals from racial and ethnic minority groups (as defined in section 1707(g))
before the colon at the end; and
(2)
by adding at the end the following new subsection:
(e) Annual report on expenditures
The National Coordinator shall report annually to Congress on activities and expenditures under this section.
Sec. 8202. Extending competitive grants for the development of loan programs to facilitate adoption of certified EHR technology by providers serving racial and ethnic minority groups
Section 3014(e) of the Public Health Service Act (42 U.S.C. 300jj–34(e)) is amended, in the matter preceding paragraph (1), by inserting , including with respect to communities with a high proportion of individuals from racial and ethnic minority groups (as defined in section 1707(g))
after health care provider to
.
Sec. 8203. Authorization of appropriations
Section 3018 of the Public Health Service Act (42 U.S.C. 300jj–38) is amended by striking fiscal years 2009 through 2013
and inserting fiscal years 2027 through 2032
.
Subtitle C Additional Research and Studies
Sec. 8301. Data collection and assessments conducted in coordination with minority-serving institutions
Section 3001(c)(6) of the Public Health Service Act (42 U.S.C. 300jj–11(c)(6)) is amended by adding at the end the following new subparagraph:
(F) Data collection and assessments conducted in coordination with minority-serving institutions
(i) In general
In carrying out subparagraph (C) with respect to communities with a high proportion of individuals from racial and ethnic minority groups (as defined in section 1707(g)), the National Coordinator shall, to the greatest extent possible, coordinate with an entity described in clause (ii).
(ii) Minority-serving institutions
For purposes of clause (i), an entity described in this clause is a historically Black college or university, a Hispanic-serving institution, a Tribal College or University, or an Asian-American-, Native American-, or Pacific Islander-serving institution with an accredited public health, health policy, or health services research program.
Sec. 8302. Study of health information technology in medically underserved communities
(a) In general
Not later than 2 years after the date of enactment of this Act, the Secretary of Health and Human Services shall—
(1)
enter into an agreement with the National Academies of Sciences, Engineering, and Medicine to conduct a study on the development, implementation, and effectiveness of health information technology within medically underserved areas; and
(2)
submit a report to Congress describing the results of such study, including any recommendations for legislative or administrative action.
(b) Study
The study described in subsection (a)(1) shall—
(1)
identify barriers to successful implementation of health information technology in medically underserved areas;
(2)
survey a cross-section of individuals in medically underserved areas and report their opinions about the various topics of study;
(3)
examine the degree of interoperability among health information technology and users of health information technology in medically underserved areas, including patients, providers, and community services, which such examination shall consider the exchange of electronic health information, usability of exchanged electronic health information, effective application and use of the exchanged electronic health information, and impact on outcomes of interoperability;
(4)
examine the impact of health information technology on providing quality care and reducing the cost of care to individuals in such areas, including the impact of such technology on improved health outcomes for individuals, including which technology worked for which population and how it improved health outcomes for that population;
(5)
examine the impact of health information technology on improving health care-related decisions by both patients and providers in such areas;
(6)
identify specific best practices for using health information technology to foster the consistent provision of accessibility and reasonable policy accommodations in health care to individuals with disabilities in such areas;
(7)
assess the feasibility and costs associated with the use of health information technology in such areas;
(8)
evaluate whether the adoption and use of electronic health records is effective in reducing health disparities, including analysis of clinical quality measures reported by providers who are participating in the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) or a State plan under title XIX of such Act (42 U.S.C. 1396 et seq.) (or a waiver of such plan), pursuant to programs to encourage the adoption and use of certified EHR technology;
(9)
identify providers in medically underserved areas that are not electing to adopt and use EHRs and determine what barriers are preventing those providers from adopting and using such records; and
(10)
examine urban and rural community health systems and determine the impact that health information technology may have on the capacity of primary health providers in those systems.
(c) Medically underserved area
In this section, the term medically underserved area means—
(1)
a population that has been designated as a medically underserved population under section 330(b)(3) of the Public Health Service Act (42 U.S.C. 254b(b)(3));
(2)
an area that has been designated as a health professional shortage area under section 332 of the Public Health Service Act (42 U.S.C. 254e);
(3)
an area or population that has been designated as a medically underserved community under section 799B of the Public Health Service Act (42 U.S.C. 295p); or
(4)
another area or population that—
(A)
experiences significant barriers to accessing quality health services; and
(B)
has a high prevalence of diseases or conditions described in title VII, with such diseases or conditions having a disproportionate impact on racial and ethnic minority groups (as defined in section 1707(g) of the Public Health Service Act (42 U.S.C. 300u–6(g))) or a subgroup of people with disabilities who have specific functional impairments.
Sec. 8303. Assessment of use and misuse of de-identified health data
(a) In general
Not later than 18 months after the date of enactment of this Act, the Secretary of Health and Human Services shall—
(1)
enter into an agreement with the Office of the National Coordinator of Health Information Technology to conduct a study, in consultation with relevant stakeholders, on the impact of digital health technology on medically underserved areas (as defined in section 8302(c)); and
(2)
submit a report to Congress describing the results of such study, including any recommendations for legislative or administrative action.
(b) Study
The study described in subsection (a)(1) shall—
(1)
examine the overall prevalence, and historical and existing practices and their respective prevalence, of use and misuse of de-identified protected health information to discriminate against or benefit medically underserved areas;
(2)
identify best practices and tools to leverage the benefits and prevent misuse of de-identified protected health information to discriminate against medically underserved areas;
(3)
examine the overall prevalence, and historical and existing practices and their respective prevalence, of use and misuse of de-identified personal health information other than protected health information to discriminate against or benefit medically underserved areas; and
(4)
identify best practices and tools to leverage the benefits and prevent misuse of de-identified personal health information other than protected health information to discriminate against medically underserved areas.
(c) Definition of protected health information
In this section, the term protected health information has the meaning given such term in section 160.103 of title 45, Code of Federal Regulations (or any successor regulations).
Subtitle D Closing Gaps in Funding To Adopt Certified EHRs
Sec. 8401. Extending Medicaid EHR incentive payments to rehabilitation facilities, long-term care facilities, and home health agencies
(a) In general
Section 1903(t)(2)(B) of the Social Security Act (42 U.S.C. 1396b(t)(2)(B)) is amended—
(1)
in clause (i), by striking , or
and inserting a semicolon;
(2)
in clause (ii), by striking the period at the end and inserting a semicolon; and
(3)
by inserting after clause (ii) the following new clauses:
(iii)
a rehabilitation facility (as defined in section 1886(j)(1)) that furnishes acute or subacute rehabilitation services;
(iv)
a long-term care hospital described in section 1886(d)(1)(B)(iv); or
(v)
a home health agency (as defined in section 1861(o)).
(b) Effective date
The amendments made by subsection (a) shall apply with respect to amounts expended under section 1903(a)(3)(F) of the Social Security Act (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters beginning on or after the date of the enactment of this Act.
Sec. 8402. Extending physician assistant eligibility for Medicaid electronic health record incentive payments
(a) In general
Section 1903(t)(3)(B)(v) of the Social Security Act (42 U.S.C. 1396b(t)(3)(B)(v)) is amended to read as follows:
(v)
physician assistant.
(b) Effective date
The amendment made by subsection (a) shall apply with respect to amounts expended under section 1903(a)(3)(F) of the Social Security Act (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters beginning on or after the date of the enactment of this Act.
Subtitle E Expanding Access to Telehealth Services
Sec. 8501. Removing geographic requirements for telehealth services
Section 1834(m)(4)(C) of the Social Security Act (42 U.S.C. 1395m(m)(4)(C)) is amended—
(1)
in clause (i), in the matter preceding subclause (I), by striking clause (iii)
and inserting clauses (iii) and (iv)
; and
(2)
by adding at the end the following new clause:
(iv) Removal of geographic requirements
The geographic requirements described in clause (i) shall not apply with respect to telehealth services furnished on or after the first day after the end of the period for which clause (iii) applies.
Sec. 8502. Expanding originating sites
(a) Expanding the home as an originating site
Section 1834(m)(4)(C)(ii)(X) of the Social Security Act (42 U.S.C. 1395m(m)(4)(C)(ii)(X)) is amended to read as follows:
(X)
(aa)
Prior to the date described in item (bb), the home of an individual but only for purposes of section 1881(b)(3)(B) or telehealth services described in paragraph (7) or clause (iii).
(bb)
On or after the first day after the end of the period for which clause (iii) applies, the home of an individual.
(b) Allowing additional originating sites
Section 1834(m)(4)(C)(ii) of the Social Security Act (42 U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at the end the following new subclause:
(XII)
Any other site determined appropriate by the Secretary at which an eligible telehealth individual is located at the time a telehealth service is furnished via a telecommunications system.
(c) Parameters for new originating sites
Section 1834(m)(4)(C) of the Social Security Act (42 U.S.C. 1395m(m)(4)(C)), as amended by section 8501, is amended by adding at the end the following new clause:
(v) Requirements for new sites
(I) In general
The Secretary may establish requirements for the furnishing of telehealth services at sites described in clause (ii)(XII) to provide for beneficiary and program integrity protections.
(II) Clarification
Nothing in this clause shall be construed to preclude the Secretary from establishing requirements for other originating sites described in clause (ii).
(d) No originating site facility fee for new sites
Section 1834(m)(2)(B)(ii) of the Social Security Act (42 U.S.C. 1395m(m)(2)(B)(ii)) is amended—
(1)
in the heading, by striking if originating site is the home
and inserting for certain sites
; and
(2)
by striking paragraph (4)(C)(ii)(X)
and inserting subclause (X) or (XII) of paragraph (4)(C)
.
Title IX Accountability and Evaluation
Sec. 9001. Prohibition on discrimination in Federal assisted health care services and research on the basis of sex (including sexual orientation, gender identity, and pregnancy, including termination of pregnancy), race, color, national origin, marital status, familial status, or disability status
(a) In general
No person in the United States shall, on the basis of sex (including sexual orientation, gender identity, and pregnancy, including termination of pregnancy), race, color, national origin, marital status, familial status, sexual orientation, gender identity, or disability status, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under—
(1)
any health program or activity, including any health research program or activity, receiving Federal financial assistance, including credits, subsidies, or contracts of insurance; or
(2)
any health program or activity that is administered by an executive agency.
(b) Definition
In this section, the term familial status means, with respect to one or more individuals—
(1)
being domiciled with any individual related by blood or affinity whose close association with the individual is the equivalent of a family relationship;
(2)
being in the process of securing legal custody of any individual; or
(3)
being pregnant.
Sec. 9002. Treatment of Medicare payments under title VI of the Civil Rights Act of 1964
For the purposes of title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), a payment made under part A, B, C, or D of title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) to a provider of services, physician, or other supplier (including a payment made to a subcontractor of the provider of services, physician, or other supplier) shall be deemed a grant, not a contract of insurance or guaranty.
Sec. 9003. Accountability and transparency within the Department of Health and Human Services
Title XXXIV of the Public Health Service Act, as amended by titles I, II, III, and IV of this Act, is further amended by inserting after subtitle D the following:
E Strengthening accountability
3451. Elevation of the Office for Civil Rights and Health Equity
(a) In general
(1) Name of Office
Beginning on the date of enactment of this subtitle, the Office for Civil Rights of the Department of Health and Human Services shall be known as the
Office for Civil Rights and Health Equityof the Department of Health and Human Services. Any reference to the Office for Civil Rights of the Department of Health and Human Services in any law, regulation, map, document, record, or other paper of the United States shall be deemed to be a reference to the Office for Civil Rights and Health Equity.(2) Head of Office
The head of the Office for Civil Rights and Health Equity shall be the Director for Civil Rights and Health Equity, to be appointed by the President. Any reference to the Director of the Office for Civil Rights of the Department of Health and Human Services in any law, regulation, map, document, record, or other paper of the United States shall be deemed to be a reference to the Director for Civil Rights and Health Equity.
(b) Purpose
The Director for Civil Rights and Health Equity shall ensure that the health programs, activities, policies, projects, procedures, and operations of health entities that receive Federal financial assistance are in compliance with title VI of the Civil Rights Act of 1964, including through the following activities:
(1)
The development and implementation of an action plan to address racial and ethnic health care disparities. Such plan shall—
(A)
address concerns relating to the Office for Civil Rights and Health Equity as released by the United States Commission on Civil Rights in the report entitled
Health Care Challenge: Acknowledging Disparity, Confronting Discrimination, and Ensuring Equity(September 1999), in conjunction with existing and future reports of the National Academy of Medicine (formerly known as the Institute of Medicine) including the reports titledUnequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,Crossing the Quality Chasm: A New Health System for the 21st Century,In the Nation’s Compelling Interest: Ensuring Diversity in the Health Care Workforce,The National Partnership for Action to End Health Disparities, andThe Health of Lesbian, Gay, Bisexual, and Transgender People, and other related reports of the National Academies of Sciences, Engineering, and Medicine;(B)
be issued in proposed form for public review and comment; and
(C)
be finalized taking into consideration any comments or concerns that are received by the Office.
(2)
Investigative and enforcement actions against intentional or in effect discrimination and policies and practices that have a disparate impact on racial and ethnic minority groups and communities of color pursuant to section 9007 of the Health Equity and Accountability Act of 2026.
(3)
The review of racial, ethnic, gender identity, sexual orientation, sex, disability status, socioeconomic status, and primary language health data collected by Federal health agencies to assess health care disparities related to intentional discrimination and policies and practices that have a disparate impact on minorities. Such review shall include an assessment of health disparities in communities with a combination of these classes.
(4)
Outreach and education activities relating to compliance with title VI of the Civil Rights Act of 1964, including the process of filing a complaint in accordance with section 9007 of the Health Equity and Accountability Act of 2026.
(5)
The provision of technical assistance for health entities to facilitate compliance with title VI of the Civil Rights Act of 1964.
(6)
Coordination and oversight of activities of the civil rights compliance offices established under section 3452.
(7)
Ensuring—
(A)
at a minimum, compliance with the most recent version of the Office of Management and Budget statistical policy directive entitled
Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity; and(B)
consideration of available data and language standards such as—
(i)
the standards for collecting, monitoring, and reporting data under section 3101; and
(ii)
the National Standards on Culturally and Linguistically Appropriate Services of the Office of Minority Health.
(c) Funding and staff
The Secretary shall ensure the effectiveness of the Office for Civil Rights and Health Equity by ensuring that the Office is provided with—
(1)
adequate funding to enable the Office to carry out its duties under this section; and
(2)
staff with expertise in—
(A)
epidemiology;
(B)
statistics;
(C)
health quality assurance;
(D)
minority health and health disparities;
(E)
health equity;
(F)
cultural and linguistic competency;
(G)
civil rights; and
(H)
social, political, mental, behavioral, economic, and related determinants of health, including education access and quality, health care access and quality, neighborhood and built environment, and social and community context.
(d) Advisory board
(1) Establishment
The Secretary, in collaboration with the Director Civil Rights and Health Equity and the Deputy Assistant Secretary for Minority Health, shall establish an advisory board (in this subsection referred to as the
advisory board) to report in accordance with paragraph (2).(2) Reports to Congress
Not later than December 31, 2027, and annually thereafter, the advisory board shall publish and submit to the Office, other Federal agencies, and the Congress a report that includes—
(A)
the number of complaints filed in accordance with section 9007 of the Health Equity and Accountability Act of 2026 during the reporting period under title VI of the Civil Rights Act of 1964, broken down by category;
(B)
the number of such complaints investigated and closed by the Office;
(C)
the outcomes of such complaints investigated;
(D)
the staffing levels of the Office, including staff credentials;
(E)
the number of such complaints that are pending (including backlogged complaints) in which civil rights inequities can be demonstrated and an explanation of why such complaints remain pending; and
(F)
trends among filed complaints and other systemic patterns or themes, including an analysis from the Department of Justice about litigation concerning such complaints.
(3) Composition
The members of the advisory board shall include—
(A)
representatives of stakeholders; and
(B)
subject matter- and disciplinary-appropriate experts.
(e) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2030.
3452. Establishment of health program offices for civil rights within agencies of Department of Health and Human Services
(a) In general
The Secretary shall establish civil rights compliance offices in each agency within the Department of Health and Human Services that administers health programs.
(b) Purpose of offices
Each office established under subsection (a) shall ensure that recipients of Federal financial assistance under Federal health programs administer programs, and determine and implement policies, services, and activities, in a manner that—
(1)
does not discriminate, either intentionally or in effect, on the basis of race, color, national origin, language, ethnicity, sex, age, disability status, sexual orientation, or gender identity; and
(2)
promotes the reduction and elimination of disparities in health and health care based on race, color, national origin, language, ethnicity, sex, age, disability status, sexual orientation, or gender identity.
(c) Powers and duties
The offices established in subsection (a) shall, with respect to the applicable agency, have the following powers and duties:
(1)
The establishment of compliance and program participation standards for recipients of Federal financial assistance under each program administered by the agency, including the establishment of disparity reduction standards to encompass disparities in health and health care related to race, color, national origin, language, ethnicity, sex, age, disability, sexual orientation, or gender identity.
(2)
The development and implementation of policies, procedures, and program-specific guidelines that interpret and apply Department of Health and Human Services guidance under title VI of the Civil Rights Act of 1964 and section 1557 of the Patient Protection and Affordable Care Act to each Federal health program administered by the agency.
(3)
The development of a disparity-reduction impact analysis methodology that shall—
(A)
be applied to every rule issued by the agency and published as part of the formal rulemaking process under sections 555, 556, and 557 of title 5, United States Code; and
(B)
include an analysis of the intersecting forms of discrimination.
(4)
Oversight of data collection, reporting, analysis, and publication requirements for all recipients of Federal financial assistance under each Federal health program administered by the agency, compliance with, at a minimum, the most recent version of the Office of Management and Budget statistical policy directive entitled
Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity, and consideration of available data and language standards such as—(A)
the standards for collecting and reporting data under section 3101;
(B)
the National Standards on Culturally and Linguistically Appropriate Services of the Office of Minority Health; and
(C)
the disaggregation of all health and health care data by racial and ethnic minority group.
(5)
The conduct of publicly available studies regarding discrimination within Federal health programs administered by the agency as well as disparity reduction initiatives by recipients of Federal financial assistance under Federal health programs.
(6)
Annual reports to the Committee on Health, Education, Labor, and Pensions and the Committee on Finance of the Senate and the Committee on Energy and Commerce and the Committee on Ways and Means of the House of Representatives on the progress in reducing disparities in health and health care through the Federal programs administered by the agency.
(d) Relationship to Office for Civil Rights in the Department of Justice
(1) Department of Health and Human Services
The Office for Civil Rights of the Department of Health and Human Services shall provide standard-setting and compliance review investigation support services to each civil rights compliance office established under subsection (a), subject to paragraph (2).
(2) Department of Justice
The Office for Civil Rights of the Department of Justice may, as appropriate, institute formal proceedings when a civil rights compliance office established under subsection (a) determines that a recipient of Federal financial assistance is not in compliance with the disparity reduction standards of the applicable agency.
(e) Definition
In this section, the term Federal health programs mean programs—
(1)
under the Social Security Act that pay for health care and services; and
(2)
under this Act that—
(A)
provide Federal financial assistance for health care, biomedical research, or health services research; or
(B)
are designed to improve the public’s health, including health service programs.
Sec. 9004. United States Commission on Civil Rights
(a) Coordination within Department of Justice of activities regarding Health disparities
Section 3(a) of the Civil Rights Commission Act of 1983 (42 U.S.C. 1975a(a)) is amended—
(1)
in paragraph (1), by striking and
at the end;
(2)
in paragraph (2), by striking the period at the end and inserting ; and
; and
(3)
by adding at the end the following:
(3)
shall, with respect to activities carried out in health care and correctional facilities, toward the goal of eliminating health disparities between the general population and members of minority groups based on race or color, promote coordination of such activities of—
(A)
the Office of Justice Programs of the Department of Justice, including the Office for Civil Rights within that Office;
(B)
the Office for Civil Rights within the Department of Health and Human Services; and
(C)
the Office of Minority Health within the Department of Health and Human Services.
(b) Authorization of appropriations
Section 5 of the Civil Rights Commission Act of 1983 (42 U.S.C. 1975c) is amended by striking the first sentence and inserting the following: For the purpose of carrying out this Act, there are authorized to be appropriated $30,000,000 for fiscal year 2027, and such sums as may be necessary for each of the fiscal years 2028 through 2032.
.
Sec. 9005. Sense of Congress concerning full funding of activities to eliminate racial and ethnic health disparities
It is the sense of the Congress that—
(1)
health disparities negatively impact outcomes for health and human security of the Nation;
(2)
reducing racial, ethnic, age, sexual, and gender disparities in prevention and treatment are unique civil and human rights challenges and, as such, Federal agencies and health care entities and systems receiving Federal funds should be accountable for their role in causing disparities and inequity;
(3)
funding for the National Institute on Minority Health and Health Disparities, the Office of Civil Rights in the Department of Health and Human Services, the National Institute of Nursing Research, and the Office of Minority Health should be doubled by fiscal year 2027, to effectively address racial and ethnic disparities elimination in health and health care as a matter of health and national security;
(4)
adequate funding by fiscal year 2027, and subsequent funding increases, should be provided for health and human service professions training programs, the Racial and Ethnic Approaches to Community Health Initiative at the Centers for Disease Control and Prevention, the Minority HIV/AIDS Initiative, the Excellence Centers to Eliminate Ethnic/Racial Disparities Program at the Agency for Healthcare Research and Quality, and the National Health Service Corps Scholarship Program initiatives, programs, policies, projects, and activities that are the backbone of the Nation’s agenda to eliminate racial and ethnic health disparities and inequities;
(5)
adequate funding for fiscal year 2027 and increased funding for future years should be provided for the Racial and Ethnic Approaches to Community Health Initiative’s United States Risk Factor Survey to ensure adequate data collection to track health disparities, and there should be appropriate avenues provided to disseminate findings to the general public;
(6)
current and newly created health disparity elimination incentives, programs, agencies, and departments under this Act (and the amendments made by this Act) should receive adequate staffing and funding by fiscal year 2027; and
(7)
stewardship and accountability should be provided to the Congress and the President for measurable and sustainable progress toward health disparity elimination under programs under this Act, including increased data collection and reporting, capacity building for impacted communities, technical assistance, training programs, and avenues to disseminate program details and successes to the public and to policymakers.
Sec. 9006. GAO and NIH reports
(a) GAO report on NIH grant racial and ethnic diversity
(1) In general
The Comptroller General of the United States shall conduct a study on the racial and ethnic diversity among the following groups:
(A)
All applicants for grants, contracts, and cooperative agreements awarded by the National Institutes of Health during the period beginning on January 1, 2027, and ending December 31, 2035.
(B)
All recipients of such grants, contracts, and cooperative agreements during such period.
(C)
All members of the peer review panels of such applicants and recipients, respectively.
(2) Report
Not later than 6 months after the date of enactment of this Act, the Comptroller General shall complete the study under paragraph (1) and submit to Congress a report containing the results of such study.
(b) NIH report on certain authority of National Institute on Minority Health and Health Disparities
Not later than 6 months after the date of enactment of this Act, and biennially thereafter, the Director of the National Institutes of Health, in collaboration with the Director of the National Institute on Minority Health and Health Disparities, shall submit to Congress a report that details and evaluates—
(1)
the steps taken during the applicable report period by the Director of the National Institutes of Health to plan, coordinate, review, and evaluate all minority health and health disparity research that is conducted or supported by the institutes and centers at the National Institutes of Health; and
(2)
the outcomes of such steps.
(c) GAO report related to recipients of PPACA funding
Not later than one year after the date of enactment of this Act and biennially thereafter, the Comptroller General of the United States shall submit to Congress a report that identifies—
(1)
the racial and ethnic diversity of community-based organizations that applied for Federal enrollment funding provided pursuant to the Patient Protection and Affordable Care Act (Public Law 111–148) (including the amendments made by such Act);
(2)
the percentage of such organizations that were awarded such funding; and
(3)
the impact of such community-based organizations’ enrollment efforts on the insurance status of their communities.
(d) Annual report on activities of National Institute on Minority Health and Health Disparities
The Director of the National Institute on Minority Health and Health Disparities shall prepare an annual report on the activities carried out or to be carried out by such institute, and shall submit each such report to the Committee on Health, Education, Labor, and Pensions of the Senate, the Committee on Energy and Commerce of the House of Representatives, the Secretary of Health and Human Services, and the Director of the National Institutes of Health. With respect to the fiscal year involved, the report shall—
(1)
describe and evaluate the progress made in health disparities research conducted or supported by institutes and centers of the National Institutes of Health;
(2)
summarize and analyze expenditures made for activities with respect to health disparities research conducted or supported by the National Institutes of Health;
(3)
include a separate statement applying the requirements of paragraphs (1) and (2) specifically to minority health disparities research; and
(4)
contain such recommendations as the Director of the Institute considers appropriate.
Sec. 9007. Investigative and enforcement actions
(a) In general
In carrying out the investigative and enforcement actions of section 3451(b)(2) of the Public Health Service Act, as added by section 9003 of this Act, the Director for Civil Rights and Health Equity (referred to in this section as the Director
) shall pursue such investigative and enforcement actions pursuant to this section.
(b) Administrative complaint and conciliation process
(1) Complaints and answers
(A) In general
An aggrieved person may, not later than 1 year after an alleged violation of subsection (a) has occurred or concluded, file a complaint with the Director alleging inequitable provision of health care by a provider described in subsection (a).
(B) Complaint
A complaint submitted pursuant to subparagraph (A) shall be in writing and shall contain such information and be in such form as the Director requires.
(C) Oath or affirmation
The complaint and any answer made under this subsection shall be made under oath or affirmation, and may be reasonably and fairly modified at any time.
(2) Response to complaints
(A) In general
Upon the filing of a complaint under this subsection, the following procedures shall apply:
(i) Complainant notice
The Director shall serve notice upon the complainant acknowledging receipt of such filing and advising the complainant of the time limits and procedures provided under this section.
(ii) Respondent notice
The Director shall, not later than 30 days after receipt of such filing—
(I)
serve on the respondent a notice of the complaint, together with a copy of the original complaint; and
(II)
advise the respondent of the procedural rights and obligations of respondents under this section.
(iii) Answer
The respondent may file, not later than 60 days after receipt of the notice from the Director, an answer to such complaint.
(iv) Investigative duties
The Director shall—
(I)
make an investigation of the alleged inequitable provision of health care; and
(II)
complete such investigation within 180 days (unless it is impracticable to complete such investigation within 180 days) after the filing of the complaint.
(B) Investigations
(i) Pattern or practice
In the course of investigating the complaint, the Director may seek records of care provided to patients other than the complainant if necessary to demonstrate or disprove an allegation of inequitable provision of health care or to determine whether there is a pattern or practice of such care.
(ii) Accounting for social determinants of health
In investigating the complaint and reaching a determination on the validity of the complaint, the Director shall account for social determinants of health and the effect of such social determinants on health care outcomes.
(iii) Inability to complete investigation
If the Director is unable to complete (or finds it is impracticable to complete) the investigation within 180 days after the filing of the complaint (or, if the Secretary takes further action under paragraph (6)(B) with respect to a complaint, within 180 days after the commencement of such further action), the Director shall notify the complainant and respondent in writing of the reasons involved.
(C) Report
(i) Final report
On completing each investigation under this paragraph, the Director shall prepare a final investigative report.
(ii) Modification of report
A final report under this subparagraph may be modified if additional evidence is later discovered.
(3) Conciliation
(A) In general
During the period beginning on the date on which a complaint is filed under this subsection and ending on the date of final disposition of such complaint (including during an investigation under paragraph (2)(B)), the Director shall, to the extent feasible, engage in conciliation with respect to such complaint.
(B) Conciliation agreement
A conciliation agreement arising out of such conciliation shall be an agreement between the respondent and the complainant, and shall be subject to approval by the Director.
(C) Rights protected
The Director shall approve a conciliation agreement only if the agreement protects the rights of the complainant and other persons similarly situated.
(D) Publicly available agreement
(i) In general
Subject to clause (ii), the Secretary shall make available to the public a copy of a conciliation agreement entered into pursuant to this subsection unless the complainant and respondent otherwise agree, and the Secretary determines, that disclosure is not required to further the purposes of this subsection.
(ii) Limitation
A conciliation agreement that is made available to the public pursuant to clause (i) may not disclose individually identifiable health information.
(4) Failure to comply with conciliation agreement
Whenever the Director has reasonable cause to believe that a respondent has breached a conciliation agreement, the Director shall refer the matter to the Attorney General to consider filing a civil action to enforce such agreement.
(5) Written consent for disclosure of information
Nothing said or done in the course of conciliation under this subsection may be made public, or used as evidence in a subsequent proceeding under this subsection, without the written consent of the parties to the conciliation.
(6) Prompt judicial action
(A) In general
If the Director determines at any time following the filing of a complaint under this subsection that prompt judicial action is necessary to carry out the purposes of this subsection, the Director may recommend that the Attorney General promptly commence a civil action under subsection (d).
(B) Immediate suit
If the Director determines at any time following the filing of a complaint under this subsection that the public interest would be served by allowing the complainant to bring a civil action under subsection (c) in a State or Federal court immediately, the Director shall certify that the administrative process has concluded and that the complainant may file such a suit immediately.
(7) Annual report
Not later than 1 year after the date of enactment of this Act, and annually thereafter, the Director shall make publicly available a report detailing the activities of the Office for Civil Rights and Health Equity under this subsection, including—
(A)
the number of complaints filed and the basis on which the complaints were filed;
(B)
the number of investigations undertaken as a result of such complaints; and
(C)
the disposition of all such investigations.
(c) Enforcement by private persons
(1) In general
(A) Civil action
(i) In suit
A complainant under subsection (b) may commence a civil action to obtain appropriate relief with respect to an alleged violation of subsection (a), or for breach of a conciliation agreement under subsection (b), in an appropriate district court of the United States or State court—
(I)
not sooner than the earliest of—
(aa)
the date a conciliation agreement is reached under subsection (b);
(bb)
the date of a final disposition of a complaint under subsection (b); or
(cc)
180 days after the first day of the alleged violation; and
(II)
not later than 2 years after the final day of the alleged violation.
(ii) Statute of limitations
The computation of such 2-year period shall not include any time during which an administrative proceeding (including investigation or conciliation) under subsection (b) was pending with respect to a complaint under such subsection.
(B) Barring suit
If the Director has obtained a conciliation agreement under subsection (b) regarding an alleged violation of subsection (a), no action may be filed under this paragraph by the complainant involved with respect to the alleged violation except for the purpose of enforcing the terms of such an agreement.
(2) Relief which may be granted
(A) In general
In a civil action under paragraph (1), if the court finds that a violation of subsection (a) or breach of a conciliation agreement has occurred, the court may award to the plaintiff actual and punitive damages, and may grant as relief, as the court determines to be appropriate, any permanent or temporary injunction, temporary restraining order, or other order (including an order enjoining the defendant from engaging in a practice violating subsection (a) or ordering such affirmative action as may be appropriate).
(B) Fees and costs
In a civil action under paragraph (1), the court, in its discretion, may allow the prevailing party, other than the United States, a reasonable attorney’s fee and costs. The United States shall be liable for such fees and costs to the same extent as a private person.
(3) Intervention by Attorney General
Upon timely application, the Attorney General may intervene in a civil action under paragraph (1), if the Attorney General certifies that the case is of general public importance.
(d) Enforcement by the Attorney General
(1) Commencement of actions
(A) Pattern or practice cases
The Attorney General may commence a civil action in any appropriate district court of the United States if the Attorney General has reasonable cause to believe that any health care provider covered by subsection (a)—
(i)
is engaged in a pattern or practice that violates such subsection; or
(ii)
is engaged in a violation of such subsection that raises an issue of significant public importance.
(B) Cases by referral
The Director may determine, based on a pattern of complaints, a pattern of violations, a review of data reported by a health care provider covered by subsection (a), or any other means, that there is reasonable cause to believe a health care provider is engaged in a pattern or practice that violates subsection (a). If the Director makes such a determination, the Director shall refer the related findings to the Attorney General. If the Attorney General finds that such reasonable cause exists, the Attorney General may commence a civil action in any appropriate district court of the United States.
(2) Enforcement of subpoenas
The Attorney General, on behalf of the Director, or another party at whose request a subpoena is issued under this subsection, may enforce such subpoena in appropriate proceedings in the district court of the United States for the district in which the person to whom the subpoena was addressed resides, was served, or transacts business.
(3) Relief which may be granted in civil actions
(A) In general
In a civil action under paragraph (1), the court—
(i)
may award such preventive relief, including a permanent or temporary injunction, temporary restraining order, or other order against the person responsible for a violation of subsection (a) as is necessary to assure the full enjoyment of the rights granted by this subsection;
(ii)
may award such other relief as the court determines to be appropriate, including monetary damages, to aggrieved persons; and
(iii)
may, to vindicate the public interest, assess punitive damages against the respondent—
(I)
in an amount not exceeding $500,000, for a first violation; and
(II)
in an amount not exceeding $1,000,000, for any subsequent violation.
(B) Fees and costs
In a civil action under this subsection, the court, in its discretion, may allow the prevailing party, other than the United States, a reasonable attorney’s fee and costs. The United States shall be liable for such fees and costs to the extent provided by section 2412 of title 28, United States Code.
(4) Intervention in civil actions
Upon timely application, any person may intervene in a civil action commenced by the Attorney General under paragraphs (1) and (2) if the action involves an alleged violation of subsection (a) with respect to which such person is an aggrieved person (including a person who is a complainant under subsection (b)) or a conciliation agreement to which such person is a party.
Sec. 9008. Federal Health Equity Commission
(a) Establishment of Commission
(1) In general
There is established the Federal Health Equity Commission (hereinafter in this section referred to as the Commission
).
(2) Membership
(A) In general
The Commission shall be composed of—
(i)
8 voting members appointed under subparagraph (B); and
(ii)
the nonvoting, ex officio members listed in subparagraph (C).
(B) Voting members
Not more than 4 of the members described in subparagraph (A)(i) shall at any one time be of the same political party. Such members shall have recognized expertise in and personal experience with racial and ethnic health inequities, health care needs of vulnerable and marginalized populations, and health equity as a vehicle for improving health status and health outcomes. Such members shall be appointed to the Commission as follows:
(i)
Four members of the Commission shall be appointed by the President.
(ii)
Two members of the Commission shall be appointed by the President pro tempore of the Senate, upon the recommendations of the majority leader and the minority leader of the Senate. Each member appointed to the Commission under this clause shall be appointed from a different political party.
(iii)
Two members of the Commission shall be appointed by the Speaker of the House of Representatives upon the recommendations of the majority leader and the minority leader of the House of Representatives. Each member appointed to the Commission under this clause shall be appointed from a different political party.
(C) Ex officio member
The Commission shall have the following nonvoting, ex officio members:
(i)
The Director for Civil Rights and Health Equity of the Department of Health and Human Services.
(ii)
The Deputy Assistant Secretary for Minority Health of the Department of Health and Human Services.
(iii)
The Director of the National Institute on Minority Health and Health Disparities.
(iv)
The Chairperson of the Advisory Committee on Minority Health established under section 1707(c) of the Public Health Service Act (42 U.S.C. 300u–6(c)).
(3) Terms
The term of office of each member appointed under paragraph (2)(B) of the Commission shall be 6 years.
(4) Chairperson; Vice Chairperson
(A) Chairperson
The President shall, with the concurrence of a majority of the members of the Commission appointed under paragraph (2)(B), designate a Chairperson from among the members of the Commission appointed under such paragraph.
(B) Vice Chairperson
(i) Designation
The Speaker of the House of Representatives shall, in consultation with the majority leaders and the minority leaders of the Senate and the House of Representatives and with the concurrence of a majority of the members of the Commission appointed under paragraph (2)(B), designate a Vice Chairperson from among the members of the Commission appointed under such paragraph. The Vice Chairperson may not be a member of the same political party as the Chairperson.
(ii) Duty
The Vice Chairperson shall act in place of the Chairperson in the absence of the Chairperson.
(5) Removal of members
The President may remove a member of the Commission only for neglect of duty or malfeasance in office.
(6) Quorum
A majority of members of the Commission appointed under paragraph (2)(B) shall constitute a quorum of the Commission, but a lesser number of members may hold hearings.
(b) Duties of the Commission
(1) In general
The Commission shall—
(A)
monitor and report on the implementation of this Act; and
(B)
investigate, monitor, and report on progress towards health equity and the elimination of health disparities.
(2) Annual report
The Commission shall—
(A)
submit to the President and Congress at least one report annually on health equity and health disparities; and
(B)
include in such report—
(i)
a description of actions taken by the Department of Health and Human Services and any other Federal agency related to health equity or health disparities; and
(ii)
recommendations on ensuring equitable health care and eliminating health disparities.
(c) Powers
(1) Hearings
(A) In general
The Commission or, at the direction of the Commission, any subcommittee or member of the Commission, may, for the purpose of carrying out this section, as the Commission or the subcommittee or member considers advisable—
(i)
hold such hearings, meet and act at such times and places, take such testimony, receive such evidence, and administer such oaths; and
(ii)
require, by subpoena or otherwise, the attendance and testimony of such witnesses and the production of such books, records, correspondence, memoranda, papers, documents, tapes, and materials.
(B) Limitation on hearings
The Commission may hold a hearing under subparagraph (A)(i) only if the hearing is approved—
(i)
by a majority of the members of the Commission appointed under subsection (a)(2)(B); or
(ii)
by a majority of such members present at a meeting when a quorum is present.
(2) Issuance and enforcement of subpoenas
(A) Issuance
A subpoena issued under paragraph (1) shall—
(i)
bear the signature of the Chairperson of the Commission; and
(ii)
be served by any person or class of persons designated by the Chairperson for that purpose.
(B) Enforcement
In the case of contumacy or failure to obey a subpoena issued under paragraph (1), the United States district court for the district in which the subpoenaed person resides, is served, or may be found may issue an order requiring the person to appear at any designated place to testify or to produce documentary or other evidence.
(C) Noncompliance
Any failure to obey the order of the court may be punished by the court as a contempt of court.
(3) Witness allowances and fees
(A) In general
Section 1821 of title 28, United States Code, shall apply to a witness requested or subpoenaed to appear at a hearing of the Commission.
(B) Expenses
The per diem and mileage allowances for a witness shall be paid from funds available to pay the expenses of the Commission.
(4) Postal services
The Commission may use the United States mails in the same manner and under the same conditions as other agencies of the Federal Government.
(5) Gifts
The Commission may accept, use, and dispose of gifts or donations of services or property.
(d) Administrative Provisions
(1) Staff
(A) Director
There shall be a full-time staff director for the Commission who shall—
(i)
serve as the administrative head of the Commission; and
(ii)
be appointed by the Chairperson with the concurrence of the Vice Chairperson.
(B) Other personnel
The Commission may—
(i)
appoint such other personnel as it considers advisable, subject to the provisions of title 5, United States Code, governing appointments in the competitive service, and the provisions of chapter 51 and subchapter III of chapter 53 of that title relating to classification and General Schedule pay rates; and
(ii)
may procure temporary and intermittent services under section 3109(b) of title 5, United States Code, at rates for individuals not in excess of the daily equivalent paid for positions at the maximum rate for GS–15 of the General Schedule under section 5332 of title 5, United States Code.
(2) Compensation of members
(A) Non-Federal employees
Each member of the Commission who is not an officer or employee of the Federal Government shall be compensated at a rate equal to the daily equivalent of the annual rate of basic pay prescribed for level IV of the Executive Schedule under section 5315 of title 5, United States Code, for each day (including travel time) during which the member is engaged in the performance of the duties of the Commission.
(B) Federal employees
Each member of the Commission who is an officer or employee of the Federal Government shall serve without compensation in addition to the compensation received for the services of the member as an office or employee of the Federal Government.
(C) Travel expenses
A member of the Commission shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for an employee of an agency under subchapter I of chapter 57 of title 5, United States Code, while away from the home or regular place of business of the member in the performance of the duties of the Commission.
(3) Cooperation
The Commission may secure directly from any Federal department or agency such information as the Commission considers necessary to carry out this Act. Upon request of the Chairman of the Commission, the head of such department or agency shall furnish such information to the Commission.
(e) Permanent Commission
Section 14 of the Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to the Commission.
(f) Authorization of appropriations
There are authorized to be appropriated for fiscal year 2027 and each fiscal year thereafter such sums as may be necessary to carry out the duties of the Commission.
Title X Addressing Social Determinants and Improving Environmental Justice
Subtitle A In General
Sec. 10001. Definitions
In this title:
(1) Administrator
The term Administrator means the Administrator of the Environmental Protection Agency.
(2) Agency
The term Agency means the Environmental Protection Agency.
(3) Built environment
The term built environment means the components of the environment, and the location of those components in a geographically defined space, that are created or modified by individuals to form the physical and social characteristics of a community or enhance quality of human life, including—
(A)
homes, schools, and places of work and worship;
(B)
parks, recreation areas, and greenways;
(C)
transportation systems;
(D)
business, industry, and agriculture; and
(E)
land-use plans, projects, and policies that impact the physical or social characteristics of a community, including access to services and amenities.
(4) Determinants of health
The term determinants of health—
(A)
means the range of nonclinical factors inclusive of personal, social, economic, and environmental factors that directly influence health status; and
(B)
includes social determinants of health.
(5) Economic determinants of health
The term economic determinants of health means income and social status.
(6) Environmental determinants of health
The term environmental determinants of health means the broad physical (including manmade and natural), psychological, social, spiritual, cultural, and aesthetic environment.
(7) Personal determinants of health
The term personal determinants of health means an individual’s behavior, biology, and genetics.
(8) Secretary
The term Secretary means the Secretary of Health and Human Services.
(9) Social determinants of health
The term social determinants of health—
(A)
means a subset of determinants of the health of individuals and environments (such as communities, neighborhoods, and societies) that describe an individual’s or group of people’s social identity, describe the social and economic resources to which such individual or group has access, and describe the conditions in which an individual or group of people works, lives, and plays; and
(B)
are sometimes referred to as social and economic determinants of health
, socioeconomic determinants of health
, environmental determinants of health
, social drivers of inequality
, or personal determinants of health
.
Sec. 10002. Health impact assessments
Part P of title III of the Public Health Service Act (42 U.S.C. 280g et seq.), as amended by section 7901C–1(a), is further amended by adding at the end the following:
399V–15. Health impact assessments
(a) Definitions
In this section:
(1) Administrator
The term Administrator means the Administrator of the Environmental Protection Agency.
(2) Director
The term Director means the Director of the Centers for Disease Control and Prevention.
(3) Health impact assessment
The term health impact assessment means a systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a proposed policy, plan, program, or project on the health of a population and the distribution of those effects within the population. Such term includes identifying and recommending appropriate actions on monitoring and maximizing potential benefits and minimizing potential harms.
(4) Health inequity
The term health inequity means a particular type of health difference that is closely linked with social, economic, or environmental disadvantage and that adversely affects groups of people who have systematically experienced greater obstacles to health based on their—
(A)
racial or ethnic group;
(B)
religion;
(C)
socioeconomic status;
(D)
gender;
(E)
age;
(F)
mental health;
(G)
cognitive, sensory, or physical disability;
(H)
sexual orientation or gender identity;
(I)
geographic location;
(J)
citizenship status; or
(K)
other characteristics historically linked to discrimination or exclusion.
(b) Establishment
The Secretary, acting through the Director and in collaboration with the Administrator, shall—
(1)
in consultation with the Director of the National Center for Chronic Disease Prevention and Health Promotion and the heads of relevant offices within the Department of Housing and Urban Development, the Department of Transportation, and the Department of Agriculture, establish a program at the National Center for Environmental Health of the Centers for Disease Control and Prevention focused on advancing the field of health impact assessment that includes—
(A)
collecting and disseminating best practices;
(B)
administering capacity building grants to States, Indian Tribes, and Tribal organizations to support subgrantees in initiating health impact assessments, in accordance with subsection (d);
(C)
providing technical assistance;
(D)
developing training tools and providing training on conducting a health impact assessment and the implementation of built environment and health indicators;
(E)
making information available, as appropriate, regarding the existence of other community healthy living tools, checklists, and indices that help connect public health to other sectors, and tools to help examine the effect of the indoor built environment and building codes on population health;
(F)
conducting research and evaluations of health impact assessments; and
(G)
awarding competitive extramural research grants;
(2)
develop guidance and guidelines to conduct health impact assessments in accordance with subsection (c); and
(3)
establish a grant program to allow States, Indian Tribes, and Tribal organizations to award subgrants to eligible entities to conduct health impact assessments.
(c) Guidance
(1) In general
Not later than 1 year after the date of enactment of the Health Equity and Accountability Act of 2026, the Secretary, acting through the Director, shall issue final guidance for conducting health impact assessments. In developing such guidance, the Secretary shall—
(A)
consult with the Director of the National Center for Environmental Health, the Director of the National Center for Chronic Disease Prevention and Health Promotion, and the heads of relevant offices within the Department of Housing and Urban Development, the Department of Transportation, and the Department of Agriculture; and
(B)
consider available international health impact assessment guidance, North American health impact assessment practice standards, and recommendations from the National Academy of Sciences.
(2) Content
The guidance under this subsection shall include—
(A)
background on national and international efforts to bridge urban planning, climate forecasting, and public health institutions and disciplines, including a review of health impact assessment best practices internationally;
(B)
evidence-based direct and indirect pathways that link land-use planning, transportation, and housing policy and objectives to human health outcomes;
(C)
data resources and quantitative and qualitative forecasting methods to evaluate both the status of health determinants and health effects, including identification of existing programs that can disseminate these resources;
(D)
best practices for inclusive public involvement in conducting health impact assessments; and
(E)
technical assistance for other agencies seeking to develop their own guidelines and procedures for health impact assessment.
(d) Grant program
(1) In general
The Secretary, acting through the Director and in collaboration with the Administrator, shall—
(A)
award grants to States, Indian Tribes, and Tribal organizations to award subgrants to eligible entities for capacity building or to prepare health impact assessments; and
(B)
ensure that States, Indian Tribes, and Tribal organizations receiving a grant under this subsection further support training and technical assistance for subgrantees under subparagraph (A) by funding and overseeing appropriate experts on health impact assessments from local, State, and Tribal governments, the Federal Government, institutions of higher education, and nonprofit organizations to provide such training and technical assistance.
(2) Applications for subgrants
(A) In general
To be eligible to receive a subgrant under this subsection, an eligible entity shall—
(i)
be a community-based organization serving individuals or populations, the health of which are, or will be, affected by an activity or a proposed activity; and
(ii)
submit to the grantee an application in accordance with this subsection, at such time, in such manner, and containing such additional information as the Secretary (acting through the Director and in collaboration with the Administrator) and the grantee may require.
(B) Inclusion
An application for a subgrant under this subsection shall include—
(i)
a list of proposed activities that require or would benefit from conducting a health impact assessment by not later than 180 days after receiving the subgrant;
(ii)
supporting documentation, including letters of support, from potential conductors of health impact assessments for the listed proposed activities;
(iii)
an assessment by the applicant of the health of the population to be served through the subgrant; and
(iv)
a description of potential adverse or positive effects on health that the proposed activities may create.
(C) Preference
In awarding subgrants under this subsection, a State may give preference to eligible entities that demonstrate the potential to significantly improve population health or lower health care costs as a result of potential health impact assessment work.
(3) Use of funds
(A) In general
A State, Indian Tribe, or Tribal organization receiving a grant under this subsection shall use such grant to conduct health impact assessment capacity building in support of a subgrantee conducting a health impact assessment for a proposed activity in accordance with this subsection.
(B) Purposes
The purposes of a health impact assessment under this subsection are—
(i)
to facilitate the involvement of Tribal, State, and local public health officials in community planning, transportation, housing, and land use decisions and other decisions affecting the built environment to identify any potential health concern or health benefit relating to an activity or proposed activity;
(ii)
to provide for an investigation of any health-related issue of concern raised in a planning process, an environmental impact assessment process, or policy appraisal relating to a proposed activity;
(iii)
to describe and compare alternatives (including no-action alternatives) to a proposed activity to provide clarification with respect to the potential health outcomes associated with the proposed activity and, where appropriate, to the related benefit-cost or cost-effectiveness of the proposed activity and alternatives;
(iv)
to contribute, when applicable, to the findings of a planning process, policy appraisal, or an environmental impact statement with respect to the terms and conditions of implementing a proposed activity or related mitigation recommendations, as necessary;
(v)
to ensure that the disproportionate distribution of negative impacts among vulnerable populations is minimized as much as possible;
(vi)
to engage affected community members and ensure adequate opportunity for public comment on all stages of the health impact assessment;
(vii)
where appropriate, to consult with local and county health departments and appropriate organizations, including planning, transportation, and housing organizations, and provide them information and tools regarding how to conduct and integrate health impact assessment into their work; and
(viii)
to inspect homes, water systems, and other elements that pose risks to lead exposure, with an emphasis on areas that pose a higher risk to children.
(4) Assessments
Health impact assessments carried out using funds under this section shall—
(A)
take appropriate health factors into consideration as early as practicable during the planning, review, or decision-making processes;
(B)
assess the effect on the health of individuals and populations of proposed policies, projects, or plans that result in modifications to the built environment; and
(C)
assess the distribution of health effects across various factors, such as race, income, ethnicity, age, disability status, gender, and geography.
(5) Eligible activities
(A) In general
A State, Indian Tribe, or Tribal organization receiving a grant under this section shall conduct an evaluation of any activity proposed to be funded through the grant, including through a subgrant, to determine whether such activity will have a significant adverse or positive effect on the health of the affected population to be served, based on the criteria described in subparagraph (B).
(B) Criteria
The criteria described in this subparagraph include, as applicable to the proposed activity, the following:
(i)
Any substantial adverse effect or significant health benefit on health outcomes or factors known to influence health, including the following:
(I)
Physical activity.
(II)
Injury.
(III)
Mental health.
(IV)
Accessibility to health-promoting goods and services.
(V)
Respiratory health.
(VI)
Chronic disease.
(VII)
Nutrition.
(VIII)
Land use changes that promote local, sustainable food sources.
(IX)
Infectious disease.
(X)
Health inequities.
(XI)
Existing air quality, ground or surface water quality or quantity, or noise levels.
(XII)
Lead exposure.
(XIII)
Drinking water quality and accessibility.
(ii)
Other factors that may be considered, including—
(I)
the potential for a proposed activity to result in systems failure that leads to a public health emergency;
(II)
the probability that the proposed activity will result in a significant increase in tourism, economic development, or employment in the population to be served;
(III)
any other significant potential hazard or enhancement to human health, as determined by the grantee; or
(IV)
whether the evaluation of a proposed activity would duplicate another analysis or study being undertaken in conjunction with the proposed activity.
(C) Factors for consideration
In evaluating a proposed activity under subparagraph (A), a grantee may take into consideration any reasonable, direct, indirect, or cumulative effect that can be clearly related to potential health effects and that is related to the proposed activity, including the effect of any action that is—
(i)
included in the long-range plan relating to the proposed activity;
(ii)
likely to be carried out in coordination with the proposed activity;
(iii)
dependent on the occurrence of the proposed activity; or
(iv)
likely to have a disproportionate impact on high-risk or vulnerable populations.
(6) Requirements
A health impact assessment prepared with funds awarded under this subsection shall incorporate the following, after conducting the screening phase (identifying projects or policies for which a health impact assessment would be valuable and feasible) through the application process:
(A) Scoping
Identifying which health effects to consider and the research methods to be utilized.
(B) Assessing risks and benefits
Assessing the baseline health status and factors known to influence the health status in the affected community, which may include aggregating and synthesizing existing health assessment evidence and data from the community.
(C) Developing recommendations
Suggesting changes to proposals to promote positive or mitigate adverse health effects.
(D) Reporting
Synthesizing the assessment and recommendations and communicating the results to decision makers.
(E) Monitoring and evaluating
Tracking the decision and implementation effect on health determinants and health status.
(7) Plan
A subgrantee under this subsection shall develop and implement a plan, to be approved by the Secretary (acting through the Director and in collaboration with the Administrator) and the grantee, for meaningful and inclusive stakeholder involvement in all phases of the health impact assessment. Stakeholders may include community leaders, community-based organizations, youth-serving organizations, planners, public health experts, State and local public health departments and officials, health care experts or officials, housing experts or officials, and transportation experts or officials.
(8) Submission of findings
A grantee under this subsection shall submit the findings of any funded health impact assessment activities to the Secretary and make these findings publicly available.
(9) Assessment of impacts
A subgrantee under this subsection shall ensure the assessment of the distribution of health impacts (related to the proposed activity) across race, ethnicity, income, age, gender, disability status, and geography.
(10) Conduct of assessment
To the greatest extent feasible, a health impact assessment shall be conducted under this section in a manner that respects the needs and timing of the decision-making process such assessment evaluates.
(11) Methodology
In preparing a health impact assessment funded under this subsection, a subgrantee under this subsection shall follow the guidance published under subsection (c).
(e) Health impact assessment database
The Secretary, acting through the Director and in collaboration with the Administrator, shall establish, maintain, and make publicly available a health impact assessment database, including—
(1)
a catalog of health impact assessments received under this section;
(2)
an inventory of tools used by subgrantees to conduct health impact assessments; and
(3)
guidance for subgrantees with respect to the selection of appropriate tools described in paragraph (2).
(f) Evaluation of grantee activities
The Secretary shall award competitive grants to Prevention Research Centers, or nonprofit organizations or academic institutions with expertise in health impact assessments, to—
(1)
assist grantees and subgrantees with the provision of training and technical assistance in the conducting of health impact assessments;
(2)
evaluate the activities carried out with grants and subgrants under subsection (d); and
(3)
assist the Secretary in disseminating evidence, best practices, and lessons learned from grantees and subgrantees.
(g) Report to Congress
Not later than 1 year after the date of enactment of the Health Equity and Accountability Act of 2026, the Secretary shall submit to Congress a report concerning the evaluation of the programs under this section, including recommendations as to how lessons learned from such programs can be incorporated into future guidance documents developed and provided by the Secretary and other Federal agencies, as appropriate.
(h) Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary.
399V–16. Implementation of research findings to improve health outcomes through the built environment
(a) Research grant program
The Secretary, in collaboration with the Administrator of the Environmental Protection Agency (referred to in this section as the
Administrator), shall award grants to public agencies or private nonprofit institutions to implement evidence-based programming to improve human health through improvements to the built environment and subsequently human health, by addressing—(1)
levels of physical activity;
(2)
consumption of nutritional foods;
(3)
rates of crime;
(4)
air, water, and soil quality;
(5)
risk or rate of injury;
(6)
accessibility to health-promoting goods and services;
(7)
chronic disease rates;
(8)
community design;
(9)
housing;
(10)
transportation options; and
(11)
other factors as the Secretary determines appropriate.
(b) Applications
A public agency or private nonprofit institution desiring a grant under this section shall submit to the Secretary an application at such time, in such manner, and containing such agreements, assurances, and information as the Secretary, in consultation with the Administrator, may require.
(c) Research
The Secretary, in consultation with the Administrator, shall support, through grants awarded under this section, research that—
(1)
uses evidence-based research to improve the built environment and human health;
(2)
examines—
(A)
the scope and intensity of the impacts that the built environment (including the various characteristics of the built environment) has on human health; or
(B)
the distribution of such impacts by—
(i)
location; and
(ii)
population subgroup;
(3)
is used to develop—
(A)
measures and indicators to address health impacts and the connection of health to the built environment;
(B)
efforts to link the measures to transportation, land use, and health databases; and
(C)
efforts to enhance the collection of built environment surveillance data;
(4)
distinguishes carefully between personal attitudes and choices and external influences on behavior to determine how much the association between the built environment and the health of residents, versus the lifestyle preferences of the people that choose to live in the neighborhood, reflects the physical characteristics of the neighborhood; and
(5)
(A)
identifies or develops effective intervention strategies focusing on enhancements to the built environment that promote increased use, physical activity, access to nutritious foods, or other health-promoting activities by residents; and
(B)
in developing the intervention strategies under subparagraph (A), ensures that the intervention strategies will reach out to high-risk or vulnerable populations, including low-income urban and rural communities and aging populations, in addition to the general population.
(d) Surveys
The Secretary may allow recipients of grants under this section to use such grant funds to support the expansion of national surveys and data tracking systems to provide more detailed information about the connection between the built environment and health.
(e) Priority
In awarding grants under this section, the Secretary and the Administrator shall give priority to entities with programming that incorporates—
(1)
interdisciplinary approaches; or
(2)
the expertise of the public health, physical activity, urban planning, land use, and transportation research communities in the United States and abroad.
(f) Authorization of appropriations
There are authorized to be appropriated such sums as may be necessary to carry out this section. The Secretary may allocate not more than 20 percent of the amount so appropriated for a fiscal year for purposes of conducting research under subsection (c).
Sec. 10003. Grant program to conduct environmental health improvement activities and to improve social determinants of health
(a) Definitions
In this section:
(1) Director
The term Director means the Director of the Centers for Disease Control and Prevention, acting in collaboration with the Administrator and the Director of the National Institute of Environmental Health Sciences.
(2) Eligible entity
The term eligible entity means a State, Indian Tribe, Tribal organization, or local community that—
(A)
bears a disproportionate burden of exposure to environmental health hazards;
(B)
bears a disproportionate burden of exposure to unhealthy living conditions, low standard housing conditions, low socioeconomic status, poor nutrition, less opportunity for educational attainment, disproportionately high unemployment rates, or lower literacy levels and access to information;
(C)
has established a coalition—
(i)
with not less than 1 community-based organization or demonstration program; and
(ii)
with not less than 1—
(I)
public health entity;
(II)
health care provider organization;
(III)
academic institution, including any minority-serving institution described in section 371(a) of the Higher Education Act of 1965 (20 U.S.C. 1067q(a));
(IV)
child-serving institution; or
(V)
landlord or housing provider working on lead remediation;
(D)
ensures planned activities and funding streams are coordinated to improve community health; and
(E)
submits an application in accordance with subsection (c).
(b) Establishment
The Director shall establish a grant program under which eligible entities shall receive grants to conduct environmental health improvement activities and to improve social determinants of health.
(c) Application
To receive a grant under this section, an eligible entity shall submit an application to the Director at such time, in such manner, and accompanied by such information as the Director may require.
(d) Use of grant funds
An eligible entity may use a grant under this section—
(1)
to promote environmental health;
(2)
to address environmental health inequities among all populations, including children; and
(3)
to address racial and ethnic inequities in social determinants of health.
(e) Amount of grants
The Director shall award grants to eligible entities at the following 3 funding levels:
(1) Level 1 grants
(A) In general
An eligible entity awarded a grant under this paragraph shall use the funds to identify environmental health problems and solutions by—
(i)
establishing a planning and prioritizing council in accordance with subparagraph (B); and
(ii)
conducting an environmental health assessment in accordance with subparagraph (C).
(B) Planning and prioritizing council
(i) In general
A planning and prioritizing council established under subparagraph (A)(i) (referred to in this paragraph as a PPC) shall assist the environmental health assessment process and environmental health promotion activities of the eligible entity.
(ii) Membership
Membership of a PPC shall consist of representatives from various organizations within public health, planning, development, and environmental services and shall include stakeholders from vulnerable groups such as children, the elderly, disabled, and minority ethnic groups that are often not actively involved in democratic or decision-making processes.
(iii) Duties
A PPC shall—
(I)
identify key stakeholders and engage and coordinate potential partners in the planning process;
(II)
establish a formal advisory group to plan for the establishment of services;
(III)
conduct an in-depth review of the nature and extent of the need for an environmental health assessment, including a local epidemiological profile, an evaluation of the service provider capacity of the community, and a profile of any target populations; and
(IV)
define the components of care and form essential programmatic linkages with related providers in the community.
(C) Environmental health assessment
(i) In general
A PPC shall carry out an environmental health assessment to identify environmental health concerns.
(ii) Assessment process
The PPC shall—
(I)
define the goals of the assessment;
(II)
generate the environmental health issue list;
(III)
analyze issues with a systems framework;
(IV)
develop appropriate community environmental health indicators;
(V)
rank the environmental health issues;
(VI)
set priorities for action;
(VII)
develop an action plan;
(VIII)
implement the plan; and
(IX)
evaluate progress and planning for the future.
(D) Evaluation
Each eligible entity that receives a grant under this paragraph shall evaluate, report, and disseminate program findings and outcomes.
(E) Technical assistance
The Director may provide such technical and other non-financial assistance to eligible entities as the Director determines to be necessary.
(2) Level 2 grants
(A) Eligibility
(i) In general
The Director shall award grants under this paragraph to eligible entities that have already—
(I)
established broad-based collaborative partnerships; and
(II)
completed environmental assessments.
(ii) No level 1 requirement
To be eligible to receive a grant under this paragraph, an eligible entity is not required to have successfully completed a Level 1 grant (as described in paragraph (1)).
(B) Use of grant funds
An eligible entity awarded a grant under this paragraph shall use the funds to further activities to carry out environmental health improvement activities, including—
(i)
addressing community environmental health priorities in accordance with paragraph (1)(C)(ii), including—
(I)
geography;
(II)
the built environment;
(III)
air quality;
(IV)
water quality;
(V)
land use;
(VI)
solid waste;
(VII)
housing;
(VIII)
violence;
(IX)
socioeconomic status;
(X)
ethnicity, social construct, and language preference;
(XI)
educational attainment;
(XII)
employment;
(XIII)
food safety, accessibility, and affordability;
(XIV)
nutrition;
(XV)
health care services; and
(XVI)
injuries;
(ii)
building partnerships between planning, public health, and other sectors, including child-serving institutions, to address how the built environment impacts food availability and access and physical activity to promote healthy behaviors and lifestyles and reduce overweight and obesity, musculoskeletal diseases, respiratory conditions, infectious diseases, dental, oral, and mental health conditions, poverty, and related co-morbidities;
(iii)
establishing programs to address—
(I)
how environmental and social conditions of work and living choices influence physical activity and dietary intake; or
(II)
how the conditions described in subclause (I) influence the concerns and needs of people who have impaired mobility and use assistance devices, including wheelchairs, lower limb prostheses, and hip, knee, and other joint replacements; and
(iv)
convening intervention and demonstration programs that examine the role of the social environment in connection with the physical and chemical environment in—
(I)
determining access to nutritional food;
(II)
improving physical activity to reduce overweight, obesity, and co-morbidities and increase quality of life; and
(III)
location and access to medical facilities.
(3) Level 3 grants
(A) In general
An eligible entity awarded a grant under this paragraph shall use the funds to identify and address racial and ethnic inequities in social determinants of health by creating demonstration programs that assess the feasibility of establishing a federally funded comprehensive program and describe key outcomes that address racial and ethnic inequities in social determinants of health.
(B) Program Design
(i) Evaluation
Not later than 1 year after the date of enactment of this Act, the Director shall evaluate the best practices of existing programs from the private, public, community-based, and academically supported initiatives focused on reducing inequities in the social determinants of health for racial and ethnic populations.
(ii) Demonstration projects
Not later than 2 years after the date of enactment of this Act, the Director shall implement at least 12 demonstration projects, including at least one project for each major racial and ethnic minority group, each of which is unique to the cultural and linguistic needs of each of the following groups:
(I)
Native Americans and Alaska Natives.
(II)
Asian Americans.
(III)
African Americans/Blacks.
(IV)
Hispanic/Latino-Americans.
(V)
Native Hawaiians and Pacific Islanders.
(VI)
Middle Eastern and Northern African communities.
(iii) Report to Congress
No later than 2 years after the implementation of the initial demonstration projects under this paragraph, the Director shall submit to Congress a report that includes—
(I)
a description of each demonstration project and design;
(II)
an evaluation of the cost-effectiveness of each project’s prevention and treatment efforts;
(III)
an evaluation of the cultural and linguistic appropriateness of each project by racial and ethnic group; and
(IV)
an evaluation of the beneficiary’s health status improvement under the demonstration project.
(iv) Any other information determined appropriate by the Director
The Director shall require eligible entities awarded a grant under this paragraph to report any other information the Director determines appropriate to be shared by or developed by such entity, including the following:
(I)
Developing models and evaluating methods that improve the cultural and linguistically appropriate services provided through the Centers for Disease Control and Prevention to target individuals impacted by health inequities based on their race, ethnicity, gender, or sexual orientation.
(II)
Promoting the collaboration between primary and specialty care health care providers and patients, to ensure patients impacted by health inequities based on race, ethnicity, gender, or sexual orientation are receiving comprehensive and organized treatment and care.
(III)
Educating health care professionals on the causes and effects of inequities in the social determinants of health in relation to minority and racial and ethnic communities and the need for culturally and linguistically appropriate care in the prevention and treatment of high-impact diseases.
(IV)
Encouraging collaboration among community- and patient-based organizations that work to address inequities in the social determinants of health in relation to high-impact diseases in minority and racial and ethnic populations.
(f) Authorization of appropriations
There are authorized to be appropriated to carry out this section—
(1)
$25,000,000 for fiscal year 2027; and
(2)
such sums as may be necessary for fiscal years 2028 through 2030.
Sec. 10004. Additional research on the relationship between the built environment and the health of community residents
(a) Definition of eligible institution
In this section, the term eligible institution means a public or private nonprofit institution that submits to the Secretary and the Administrator an application for a grant under the grant program authorized under subsection (b)(2) at such time, in such manner, and containing such agreements, assurances, and information as the Secretary and Administrator may require.
(b) Research grant program
(1) Definition of health
In this section, the term health includes—
(A)
levels of physical activity;
(B)
degree of mobility due to factors such as musculoskeletal diseases, arthritis, and obesity;
(C)
consumption of nutritional foods;
(D)
rates of crime;
(E)
air, water, and soil quality;
(F)
risk of injury;
(G)
accessibility to health care services;
(H)
levels of educational attainment; and
(I)
other indicators as determined appropriate by the Secretary.
(2) Grants
The Secretary, in collaboration with the Administrator, shall provide grants to eligible institutions to conduct and coordinate research on the built environment and its influence on individual and population-based health.
(3) Research
The Secretary shall support research that—
(A)
investigates and defines the causal links between all aspects of the built environment and the health of residents;
(B)
examines—
(i)
the extent of the impact of the built environment (including the various characteristics of the built environment) on the health of residents;
(ii)
the variation in the health of residents by—
(I)
location (such as inner cities, inner suburbs, outer suburbs, reservations, and rural areas); and
(II)
population subgroup (including children, young adults, the elderly, the disadvantaged); or
(iii)
the importance of the built environment to the total health of residents, which is the primary variable of interest from a public health perspective;
(C)
is used to develop—
(i)
measures to address health and the connection of health to the built environment; and
(ii)
efforts to link the measures to travel and health databases;
(D)
distinguishes carefully between personal attitudes and choices and external influences on observed behavior to determine how much an observed association between the built environment and the health of residents, versus the lifestyle preferences of the people that choose to live in the neighborhood, reflects the physical characteristics of the neighborhood; and
(E)
(i)
identifies or develops effective intervention strategies to promote better health among residents with a focus on behavioral interventions and enhancements of the built environment that promote increased use by residents; and
(ii)
in developing the intervention strategies under clause (i), ensures that the intervention strategies will reach out to high-risk populations, including racial and ethnic minorities, low-income urban and rural communities, and children.
(4) Priority
In providing assistance under the grant program authorized under paragraph (2), the Secretary and the Administrator shall give priority to research that incorporates—
(A)
minority-serving institutions as grantees;
(B)
interdisciplinary approaches; or
(C)
the expertise of the public health, physical activity, nutrition and health care (including child health), urban planning, and transportation research communities in the United States and abroad.
Sec. 10005. Environment and public health restoration
(a) Statement of policy
It is the policy of the Federal Government to work in conjunction with States, territories, Tribal governments, international organizations, and foreign governments as a steward of the environment for the benefit of public health, to maintain air quality and water quality, to sustain the diversity of plant and animal species, to combat global climate change, and to protect the environment for future generations.
(b) Study and report on public health or environmental impact of revised rules, regulations, laws, or other agency decisions
(1) Study
Not later than 30 days after the date of enactment of this Act, the President shall seek to enter into an arrangement under which the National Academy of Sciences shall conduct a study to determine the effects on public health, air quality, water quality, wildlife, and the environment of the following regulations, laws, and other agency decisions:
(A) Clean water
(i)
The final rule of the Environmental Protection Agency and the Corps of Engineers entitled Final Revisions to the Clean Water Act Regulatory Definitions of Fill Material and Discharge of Fill Material
and published in the Federal Register on May 9, 2002 (67 Fed. Reg. 31129).
(ii)
The final rule of the Environmental Protection Agency entitled National Pollutant Discharge Elimination System Permit Regulation for Concentrated Animal Feeding Operations: Removal of Vacated Elements in Response to 2011 Court Decision
and published in the Federal Register on July 30, 2012 (77 Fed. Reg. 44494).
(iii)
The final rule of the Environmental Protection Agency entitled Withdrawal of Revisions to the Water Quality Planning and Management Regulation and Revisions to the National Pollutant Discharge Elimination System Program in Support of Revisions to the Water Quality Planning and Management Regulation
and published in the Federal Register on March 19, 2003 (68 Fed. Reg. 13608).
(iv)
The final rule of the Environmental Protection Agency entitled Consolidated Permit Regulations: RCRA Hazardous Waste; SDWA Underground Injection Control; CWA National Pollutant Discharge Elimination System; CWA Section 404 Dredge or Fill Programs; and CAA Prevention of Significant Deterioration
and published in the Federal Register on May 19, 1980 (45 Fed. Reg. 33290), with respect to the definition of the waters of the United States
.
(v)
The final rule of the Corps of Engineers and the Environmental Protection Agency entitled Definition of
and published in the Federal Register on October 22, 2019 (84 Fed. Reg. 56626).Waters of the United States
—Recodification of Pre-Existing Rules
(vi)
The final rule of the Corps of Engineers and the Environmental Protection Agency entitled The Navigable Waters Protection Rule: Definition of
and published in the Federal Register on April 21, 2020 (85 Fed. Reg. 22250).Waters of the United States
(B) Forests and land management
(i)
The Healthy Forests Restoration Act of 2003 (16 U.S.C. 6501 et seq.).
(ii)
The application of section 553(e) of title 5, United States Code, such that a State may petition for a special rule for the inventoried roadless areas within National Forest System land within the State.
(iii)
The final rules of the Forest Service entitled National Forest System Land Management Planning
(77 Fed. Reg. 21162), National Forest System Land Management Planning; Correction
(78 Fed. Reg. 23491), and National Forest System Land Management Planning
(81 Fed. Reg. 90723), published on April 9, 2012, April 19, 2013, and December 15, 2016, respectively.
(iv)
The final rule of the Bureau of Land Management entitled Oil Shale Management—General
and published on November 18, 2008 (73 Fed. Reg. 69414).
(v)
The record of decision described in the notice of availability of the Bureau of Land Management entitled Notice of Availability of Approved Land Use Plan Amendments/Record of Decision for Allocation of Oil Shale and Tar Sands Resources on Lands Administered by the Bureau of Land Management in Colorado, Utah, and Wyoming and Final Programmatic Environmental Impact Statement
and published on April 1, 2013 (78 Fed. Reg. 19518).
(C) Scientific review
The final rule of the United States Fish and Wildlife Service and the National Oceanic and Atmospheric Administration entitled Interagency Cooperation Under the Endangered Species Act
and published on December 16, 2008 (73 Fed. Reg. 76272), as amended by the final rule of the United States Fish and Wildlife Service and the National Oceanic and Atmospheric Administration entitled Endangered and Threatened Wildlife and Plants; Regulations for Interagency Cooperation
and published on August 27, 2019 (84 Fed. Reg. 44976).
(2) Method
In conducting the study under paragraph (1), the National Academy of Sciences may use and compare existing scientific studies regarding the regulations, laws, and other agency decisions described in paragraph (1).
(3) Report
Not later than 270 days after the date on which the President enters into the arrangement under paragraph (1), the National Academy of Sciences shall make publicly available and shall submit to Congress and to the head of each department and agency of the Federal Government that issued, implements, or would implement a regulation, law, or other agency decision described in paragraph (1), a report that includes—
(A)
a description of the effects of each regulation, law, or other agency decision described in paragraph (1) on public health, air quality, water quality, wildlife, and the environment, compared to the impact of preexisting regulations, laws, or other agency decisions in effect, as applicable, including—
(i)
any negative impacts to air quality or water quality;
(ii)
any negative impacts to wildlife;
(iii)
any delays in hazardous waste cleanup that are projected to be hazardous to public health; and
(iv)
any other negative impact on public health or the environment; and
(B)
any recommendations that the National Academy of Sciences considers appropriate to maintain, restore, or improve in whole or in part protections for public health, air quality, water quality, wildlife, and the environment for each of the regulations, laws, and other agency decisions described in paragraph (1), which may include recommendations for the adoption of any regulation or law in place or proposed prior to January 1, 2001.
(c) Department and agency revision of existing rules, regulations, or laws
Not later than 180 days after the date on which the report is submitted pursuant to subsection (b)(3), the head of each department or agency that has issued or implemented a regulation, law, or other agency decision described in subsection (b)(1) shall submit to Congress a plan describing the steps the department or agency will take, or has taken, to restore or improve protections for public health and the environment in whole or in part that were in existence prior to the issuance of the applicable regulation, law, or other agency decision.
Sec. 10006. GAO report on health effects of Deepwater Horizon oil rig explosion in the Gulf Coast
(a) Study
The Comptroller General of the United States shall conduct a study on the type and scope of health care services administered through the Department of Health and Human Services addressing the provision of health care to racial and ethnic minorities, including residents, cleanup workers, and volunteers, affected by the blowout and explosion of the mobile offshore drilling unit Deepwater Horizon that occurred on April 20, 2010, and resulting hydrocarbon releases into the environment.
(b) Specific components
In carrying out subsection (a), the Comptroller General of the United States shall—
(1)
assess the type, size, and scope of programs administered by the Secretary that focus on the provision of health care to communities on the Gulf Coast;
(2)
identify the merits and disadvantages associated with each of the programs;
(3)
perform an analysis of the costs and benefits of the programs; and
(4)
determine whether there is any duplication of programs.
(c) Report
Not later than 180 days after the date of enactment of this Act, the Comptroller General of the United States shall submit to Congress a report that includes—
(1)
the findings of the study conducted under subsection (a); and
(2)
recommendations for improving access to health care for racial and ethnic minorities.
Sec. 10007. Establish an interagency council and grant programs on social determinants of health
(a) Purposes
The purposes of this section are as follows:
(1)
To establish effective, coordinated Federal technical assistance to help State and local governments to improve outcomes and cost-effectiveness of, and return on investment from, health and social services programs.
(2)
To build a pipeline of State and locally designed, cross-sector interventions and strategies that generate rigorous evidence about how to improve health and social outcomes, and increase the cost-effectiveness of, and return on investment from, Federal, State, local, and Tribal health and social services programs.
(3)
To enlist State and local governments and the service providers of such governments as partners in identifying Federal statutory, regulatory, and administrative challenges in improving the health and social outcomes of, cost-effectiveness of, and return on investment from, Federal spending on individuals enrolled in Medicaid.
(4)
To develop strategies to improve health and social outcomes without denying services to, or restricting the eligibility of, vulnerable populations.
(b) Social determinants accelerator council
(1) Establishment
The Secretary, in coordination with the Administrator of the Centers for Medicare & Medicaid Services (referred to in this section as the Administrator
), shall establish an interagency council, to be known as the Social Determinants Accelerator Interagency Council (referred to in this section as the Council
) to achieve the purposes listed in subsection (a).
(2) Membership
(A) Federal composition
The Council shall be composed of at least one designee from each of the following Federal agencies:
(i)
The Office of Management and Budget.
(ii)
The Department of Agriculture.
(iii)
The Department of Education.
(iv)
The Indian Health Service.
(v)
The Department of Housing and Urban Development.
(vi)
The Department of Labor.
(vii)
The Department of Transportation.
(viii)
Any other Federal agency the Chair of the Council determines necessary.
(B) Designation
(i) In general
The head of each agency specified in subparagraph (A) shall designate at least one employee described in clause (ii) to serve as a member of the Council.
(ii) Responsibilities
An employee described in this clause shall be a senior employee of the agency—
(I)
whose responsibilities relate to authorities, policies, and procedures with respect to the health and well-being of individuals receiving medical assistance under a State plan (or a waiver of such plan) under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.); or
(II)
who has authority to implement and evaluate transformative initiatives that harness data or conduct rigorous evaluation to improve the impact and cost-effectiveness of federally funded services and benefits.
(C) HHS representation
In addition to the designees under subparagraph (A), the Council shall include designees from at least 3 agencies within the Department of Health and Human Services, including the Centers for Medicare & Medicaid Services, at least one of whom shall meet the criteria under subparagraph (B)(ii).
(D) OMB role
The Director of the Office of Management and Budget shall facilitate the timely resolution of Federal Government-wide and multiagency issues to help the Council achieve consensus recommendations described under this section.
(E) Non-Federal composition
The Comptroller General of the United States may designate up to 6 Council designees—
(i)
who have relevant subject matter expertise, including expertise implementing and evaluating transformative initiatives that harness data and conduct evaluations to improve the impact and cost-effectiveness of Federal Government services; and
(ii)
that each represent—
(I)
State, local, and Tribal health and human services agencies;
(II)
public housing authorities or State housing finance agencies;
(III)
State and local government budget offices;
(IV)
State Medicaid agencies; or
(V)
national consumer advocacy organizations.
(F) Chair
(i) In general
The Secretary shall select the Chair of the Council from among the members of the Council.
(ii) Initiating guidance
The Chair, on behalf of the Council, shall identify and invite individuals from diverse entities to provide the Council with advice and information pertaining to addressing social determinants of health, including—
(I)
individuals from State and local government health and human services agencies;
(II)
individuals from State Medicaid agencies;
(III)
individuals from State and local government budget offices;
(IV)
individuals from public housing authorities or State housing finance agencies;
(V)
individuals from nonprofit organizations, small businesses, and philanthropic organizations;
(VI)
advocates;
(VII)
researchers; and
(VIII)
any other individuals the Chair determines to be appropriate.
(3) Duties
The duties of the Council are—
(A)
to make recommendations to the Secretary and the Administrator regarding the criteria for making awards under this section;
(B)
to identify Federal authorities and opportunities for use by States or local governments to improve coordination of funding and administration of Federal programs, the beneficiaries of whom include individuals, and which may be unknown or underutilized, and to make information on such authorities and opportunities publicly available;
(C)
to provide targeted technical assistance to States developing a social determinants accelerator plan under this section, including identifying potential statutory or regulatory pathways for implementation of the plan and assisting in identifying potential sources of funding to implement the plan;
(D)
to report to Congress annually on the subjects set forth in this section;
(E)
to develop and disseminate evaluation guidelines and standards that can be used to reliably assess the impact of an intervention or approach that may be implemented pursuant to this section on outcomes and cost-effectiveness of, and return on investment from, Federal, State, local, and Tribal governments, and to facilitate technical assistance, where needed, to help to improve State and local evaluation designs and implementation;
(F)
to seek feedback from State, local, and Tribal governments, including through an annual survey by an independent third party, on how to improve the technical assistance the Council provides to better equip State, local, and Tribal governments to coordinate health and social service programs;
(G)
to solicit applications for grants under subsection (c); and
(H)
to coordinate with other cross-agency initiatives focused on improving the health and well-being of low-income and at-risk populations in order to prevent unnecessary duplication between agency initiatives.
(4) Schedule
Not later than 60 days after the date of enactment of this Act, the Council shall convene to develop a schedule and plan for carrying out the duties described in this section, including solicitation of applications for the grants under this section.
(5) Report to Congress
The Council shall submit an annual report to Congress, which shall include—
(A)
a list of the Council members;
(B)
activities and expenditures of the Council;
(C)
summaries of the interventions and approaches that will be supported by State, local, and Tribal governments that received a grant under this section, including—
(i)
the best practices and evidence-based approaches such governments plan to employ to achieve the purposes listed in this section; and
(ii)
a description of how the practices and approaches will impact the outcomes and cost-effectiveness of, and return on investment from, Federal, State, local, and Tribal governments with respect to such purposes;
(D)
the feedback received from State and local governments on ways to improve the technical assistance of the Council, including findings from a third-party survey and actions the Council plans to take in response to such feedback; and
(E)
the major statutory, regulatory, and administrative challenges identified by State, local, and Tribal governments that received a grant under subsection (c), and the actions that Federal agencies are taking to address such challenges.
(6) FACA inapplicability
Chapter 10 of title 5, United States Code, shall not apply to the Council.
(7) Council procedures
The Secretary, in consultation with the Comptroller General of the United States and the Director of the Office of Management and Budget, shall establish procedures for the Council to—
(A)
ensure that adequate resources are available to effectively execute the responsibilities of the Council;
(B)
effectively coordinate with other relevant advisory bodies and working groups to avoid unnecessary duplication;
(C)
create transparency to the public and Congress with regard to Council membership, costs, and activities, including through use of modern technology and social media to disseminate information; and
(D)
avoid conflicts of interest that would jeopardize the ability of the Council to make decisions and provide recommendations.
(c) Social determinants accelerator grants to States or local governments
(1) Grants to States, local governments, and Tribes
Not later than 180 days after the date of enactment of this Act, the Administrator, in consultation with the Secretary and the Council, shall award on a competitive basis not more than 25 grants to eligible applicants described in this subsection, for the development of social determinants accelerator plans, as described in this subsection.
(2) Eligible applicant
An eligible applicant described in this subsection is a State, local, or Tribal health or human services agency that—
(A)
demonstrates the support of relevant parties across relevant State, local, or Tribal jurisdictions; and
(B)
in the case of an applicant that is a local government agency, provides to the Secretary a letter of support from the lead State health or human services agency for the State in which the local government is located.
(3) Amount of grant
The Administrator, in coordination with the Council, shall determine the total amount that the Administrator will make available to each grantee under this subsection.
(4) Application
An eligible applicant seeking a grant under this subsection shall include in the application the following information:
(A)
The target population (or populations) that would benefit from implementation of the social determinants accelerator plan proposed to be developed by the applicant.
(B)
A description of the objective or objectives and outcome goals of such proposed plan, which shall include at least one health outcome and at least one other important social outcome.
(C)
The sources and scope of inefficiencies that, if addressed by the plan, could result in improved cost-effectiveness of or return on investment from Federal, State, local, and Tribal governments.
(D)
A description of potential interventions that could be designed or enabled using such proposed plan.
(E)
The State, local, and Tribal governments, academic institutions, nonprofit organizations, community-based organizations, and other public and private sector partners that would participate in the development of the proposed plan and subsequent implementation of programs or initiatives included in such proposed plan.
(F)
Such other information as the Administrator, in consultation with the Secretary and the Council, determines necessary to achieve the purposes of this section.
(5) Use of funds
A recipient of a grant under this subsection may use funds received through the grant for the following purposes:
(A)
To convene and coordinate with relevant government entities and other stakeholders across sectors to assist in the development of a social determinant accelerator plan.
(B)
To identify populations of individuals receiving medical assistance under a State plan (or a waiver of such plan) under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) who may benefit from the proposed approaches to improving the health and well-being of such individuals through the implementation of the proposed social determinants accelerator plan.
(C)
To engage qualified research experts to advise on relevant research and to design a proposed evaluation plan, in accordance with the standards and guidelines issued by the Administrator.
(D)
To collaborate with the Council to support the development of social determinants accelerator plans.
(E)
To prepare and submit a final social determinants accelerator plan to the Council.
(6) Contents of plans
A social determinant accelerator plan developed under this subsection shall include the following:
(A)
A description of the target population (or populations) that would benefit from implementation of the social determinants accelerator plan, including an analysis describing the projected impact on the well-being of individuals described in paragraph (5)(B).
(B)
A description of the interventions or approaches designed under the social determinants accelerator plan and the evidence for selecting such interventions or approaches.
(C)
The objectives and outcome goals of such interventions or approaches, including at least one health outcome and at least one other important social outcome.
(D)
A plan for accessing and linking relevant data to enable coordinated benefits and services for the jurisdictions described in this section and an evaluation of the proposed interventions and approaches.
(E)
A description of the State, local, and Tribal governments, academic institutions, nonprofit organizations, or any other public or private sector organizations that would participate in implementing the proposed interventions or approaches, and the role each would play to contribute to the success of the proposed interventions or approaches.
(F)
The identification of the funding sources that would be used to finance the proposed interventions or approaches.
(G)
A description of any financial incentives that may be provided, including outcome-focused contracting approaches to encourage service providers and other partners to improve outcomes of, cost-effectiveness of, and return on investment from, Federal, State, local, or Tribal government spending.
(H)
The identification of the applicable Federal, State, local, or Tribal statutory and regulatory authorities, including waiver authorities, to be leveraged to implement the proposed interventions or approaches.
(I)
A description of potential considerations that would enhance the impact, scalability, or sustainability of the proposed interventions or approaches and the actions the grant awardee would take to address such considerations.
(J)
A proposed evaluation plan, to be carried out by an independent evaluator, to measure the impact of the proposed interventions or approaches on the outcomes of, cost-effectiveness of, and return on investment from, Federal, State, local, and Tribal governments.
(K)
Precautions for ensuring that vulnerable populations will not be denied access to Medicaid or other essential services as a result of implementing the proposed plan.
(d) Funding
(1) In general
Out of any money in the Treasury not otherwise appropriated, there is appropriated to carry out this section $25,000,000, to remain available for obligation until the date that is 5 years after the date of enactment of this section.
(2) Reservation of funds
(A) In general
Of the funds made available under paragraph (1), the Secretary shall reserve not less than 20 percent to award grants to eligible applicants for the development of social determinants accelerator plans under this section intended to serve rural populations.
(B) Exception
In the case of a fiscal year for which the Secretary determines that there are not sufficient eligible applicants to award up to 25 grants under subsection (c) that are intended to serve rural populations and the Secretary cannot satisfy the 20-percent requirement, the Secretary may reserve an amount that is less than 20 percent of amounts made available under paragraph (1) to award grants for such purpose.
(3) Rule of construction
Nothing in this section shall prevent Federal agencies represented on the Council from contributing additional funding from other sources to support activities to improve the effectiveness of the Council.
Sec. 10008. Correcting Hurtful and Alienating Names in Government Expression (CHANGE)
(a) Short title
This section may be cited as the Correcting Hurtful and Alienating Names in Government Expression Act
or the CHANGE Act
.
(b) Definitions
In this section:
(1) Employee
The term employee has the meaning given the term in section 2105 of title 5, United States Code.
(2) Executive agency
The term Executive agency has the meaning given the term in section 105 of title 5, United States Code.
(3) Officer
The term officer has the meaning given the term in section 2104 of title 5, United States Code.
(4) Prohibited term
The term prohibited term means—
(A)
the term alien, when used to refer to an individual who is not a citizen or national of the United States; and
(B)
the term illegal alien, when used to refer to an individual who—
(i)
is unlawfully present in the United States; or
(ii)
lacks a lawful immigration status in the United States.
(c) Modernization of language referring to individuals who are not citizens or nationals of the United States
(1) In general
Except as provided in paragraph (2), on and after the date of enactment of this Act, an Executive agency may not use a prohibited term in any proposed or final rule, regulation, interpretation, publication, other document, display, or sign issued by the Executive agency.
(2) Exception
An Executive agency may use a prohibited term under paragraph (1) if the Executive agency uses the prohibited term while quoting or reproducing text written by a source that is not an officer or employee of the Executive agency.
(d) Uniform definition
(1) In general
Chapter 1 of title 1, United States Code, is amended by adding at the end the following:
9. Definition of foreign national
In determining the meaning of any Act of Congress or any ruling, regulation, or interpretation of an administrative bureau or agency of the United States, the term foreign national means any individual who is not an individual who—
(1)
is a citizen of the United States; or
(2)
though not a citizen of the United States, owes permanent allegiance to the United States.
(2) Technical amendment
The table of sections for chapter 1 of title 1, United States Code, is amended by adding at the end the following:
(e) References
Any reference in any Federal statute, rule, regulation, Executive order, publication, or other document of the United States—
(1)
to the term alien, when used to refer to an individual who is not a citizen or national of the United States, is deemed to refer to the term foreign national; and
(2)
to the term illegal alien is deemed to refer to the term undocumented foreign national, when used to refer to an individual who—
(A)
is unlawfully present in the United States; or
(B)
lacks a lawful immigration status in the United States.
Sec. 10009. Andrew Kearse Accountability for Denial of Medical Care
(a) In general
Chapter 13 of title 18, United States Code, is amended by adding at the end the following:
251. Medical attention for individuals in Federal custody displaying medical distress
(a) Definitions
In this section—
(1)
the term appropriate Inspector General, with respect to a covered official, means—
(A)
the Inspector General of the Federal agency that employs the covered official; or
(B)
in the case of a covered official employed by a Federal agency that does not have an Inspector General, the Inspector General of the Department of Justice;
(2)
the term covered official means—
(A)
a Federal law enforcement officer (as defined in section 115);
(B)
an officer or employee of the Bureau of Prisons; or
(C)
an officer or employee of the United States Marshals Service; and
(3)
the term medical distress includes breathing difficulties.
(b) Requirement
(1) Offense
It shall be unlawful for a covered official to negligently fail to obtain or provide immediate medical attention to an individual in Federal custody who displays medical distress in the presence of the covered official if the individual suffers unnecessary pain, injury, or death as a result of that failure.
(2) Penalty
A covered official who violates paragraph (1) shall be fined under this title, imprisoned for not more than 1 year, or both.
(3) State civil enforcement
Whenever an attorney general of a State has reasonable cause to believe that a resident of the State has been aggrieved by a violation of paragraph (1) by a covered official, the attorney general, or another official, agency, or entity designated by the State, may bring a civil action in any appropriate district court of the United States to obtain appropriate equitable and declaratory relief.
(c) Inspector General investigation
(1) In general
The appropriate Inspector General shall investigate any instance in which—
(A)
a covered official fails to obtain or provide immediate medical attention to an individual in Federal custody who displays medical distress in the presence of the covered official; and
(B)
the individual suffers unnecessary pain, injury, or death as a result of the failure to obtain or provide immediate medical attention.
(2) Referral for prosecution
If an appropriate Inspector General, in conducting an investigation under paragraph (1), concludes that the covered official acted negligently in failing to obtain or provide immediate medical attention to the individual in Federal custody, the appropriate Inspector General shall refer the case to the Attorney General for prosecution under this section.
(3) Confidential complaint process
The Inspector General of a Federal agency that employs covered officials shall establish a process under which an individual may confidentially submit a complaint to the Inspector General regarding an incident described in paragraph (1) involving a covered official employed by the Federal agency (or, in the case of the Inspector General of the Department of Justice, involving a covered official employed by a Federal agency that does not have an Inspector General).
(d) Training
The head of an agency that employs covered officials shall provide training to each such covered official on obtaining or providing medical assistance to individuals in medical distress.
(b) Technical and conforming amendment
The table of sections for chapter 13 of title 18, United States Code, is amended by adding at the end the following:
Sec. 10010. Investing in community healing
(a) Sense of Congress
It is the sense of Congress that it is imperative that a comprehensive public health approach to addressing trauma and mental health care be focused on care delivery that is culturally sensitive and competent.
(b) Research on adverse health effects associated with interactions with law enforcement
(1) In general
The Secretary, acting through the Director of the Office of Minority Health of the Centers for Disease Control and Prevention (established pursuant to section 1707A of the Public Health Service Act (42 U.S.C. 300u–6a)), shall conduct research on the adverse health effects associated with interactions with law enforcement.
(2) Effects among racial and ethnic minorities
The research under paragraph (1) shall include research on—
(A)
the health consequences, both individual and community-wide, of trauma related to violence committed by law enforcement among racial and ethnic minorities; and
(B)
the disproportionate burden of morbidity and mortality associated with such trauma.
(3) Report
Not later than 1 year after the date of enactment of this Act, the Secretary shall—
(A)
complete the research under this subsection; and
(B)
submit to Congress a report on the findings, conclusions, and recommendations resulting from such research.
(c) Grants for increasing racial and ethnic minority access to high-Quality trauma support services and mental health care
(1) In general
The Secretary, acting through the Assistant Secretary for Mental Health and Substance Use, shall award grants to eligible entities to establish or expand programs for the purpose of increasing racial and ethnic minority access to high-quality trauma support services and mental health care.
(2) Eligible entities
To seek a grant under this subsection, an entity shall be a community-based program or organization that—
(A)
provides culturally competent programs and resources that are aligned with evidence-based practices for trauma-informed care; and
(B)
has demonstrated expertise in serving communities of color or can partner with a program that has such demonstrated expertise.
(3) Use of funds
As a condition on receipt of a grant under this subsection, a grantee shall agree to use the grant to increase racial and ethnic minority access to high-quality trauma support services and mental health care, such as by—
(A)
establishing and maintaining community-based programs providing evidence-based services in trauma-informed care and culturally specific services and other resources;
(B)
developing innovative culturally specific strategies and projects to enhance access to trauma-informed care and resources for racial and ethnic minorities who face obstacles to using more traditional services and resources (such as obstacles in geographic access to providers, insurance coverage, and access to audio and video technologies);
(C)
working with State and local governments and social service agencies to develop and enhance effective strategies to provide culturally specific services to racial and ethnic minorities;
(D)
increasing communities’ capacity to provide culturally specific resources and support for communities of color;
(E)
working in cooperation with the community to develop education and prevention strategies highlighting culturally specific issues and resources regarding racial and ethnic minorities;
(F)
providing culturally specific programs for racial and ethnic minorities exposed to law enforcement violence; and
(G)
examining the dynamics of culture and its impact on victimization and healing.
(4) Priority
In awarding grants under this subsection, the Secretary shall give priority to eligible entities proposing to serve communities that have faced high rates of community trauma, including from exposure to law enforcement violence, intergenerational poverty, civil unrest, discrimination, or oppression.
(5) Grant period
The period of a grant under this subsection shall be 4 years.
(6) Evaluation
Not later than 6 months after the end of the period of all grants under this subsection, the Secretary shall—
(A)
conduct an evaluation of the programs funded by a grant under this subsection;
(B)
include in such evaluation an assessment of the outcomes of each such program; and
(C)
submit a report on the results of such evaluation to Congress.
(7) Authorization of appropriations
To carry out this subsection, there is authorized to be appropriated $20,000,000 for each of fiscal years 2027 through 2031.
(d) Behavioral and mental health outreach education strategy
(1) In general
The Secretary, in coordination with advocacy and behavioral and mental health organizations serving racial and ethnic minority groups, shall develop and implement an outreach and education strategy to promote behavioral and mental health, and reduce stigma associated with mental health conditions, among racial and ethnic minorities.
(2) Design
The strategy under this subsection shall be designed to—
(A)
meet the diverse cultural and language needs of racial and ethnic minority groups;
(B)
provide information on evidence-based, culturally and linguistically appropriate and adapted interventions and treatments;
(C)
increase awareness of symptoms of mental illness among racial and ethnic minority groups; and
(D)
ensure full participation of, and engage, both consumers and community members in the development and implementation of materials.
(3) Report
Not later than 1 year after the date of enactment of this Act, the Secretary shall submit to Congress, and make publicly available, a report detailing the outreach and education strategy that is developed and implemented under this subsection and the results of such implementation.
Sec. 10011. Environmental justice mapping and data collection
(a) Definitions
In this section:
(1) Advisory council
The term advisory council means the advisory council established under subsection (b)(4)(B)(i).
(2) Committee
The term Committee means the Environmental Justice Mapping Committee established by subsection (b)(1).
(3) Environmental justice
The term environmental justice means the fair treatment and meaningful involvement of all people regardless of race, color, culture, national origin, or income, with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies to ensure that each person enjoys—
(A)
the same degree of protection from environmental and health hazards; and
(B)
equal access to any Federal agency action relating to the development, implementation, and enforcement of environmental laws, regulations, and policies for the purpose of having a healthy environment in which to live, learn, work, and recreate.
(4) Environmental justice community
The term environmental justice community means a community with significant representation of communities of color, low-income communities, or Tribal and indigenous communities, that experiences, or is at risk of experiencing, higher or more adverse human health or environmental effects, as compared to other communities.
(5) Ground-truthing
The term ground-truthing means a community fact-finding process by which residents of a community supplement technical information with local knowledge for the purpose of better informing policy and project decisions.
(6) Relevant stakeholder
The term relevant stakeholder means—
(A)
a representative of a regional, State, Tribal, or local government agency;
(B)
a representative of a nongovernmental organization with experience in areas that may include Tribal relations, environmental conservation, city and regional planning, and public health;
(C)
a representative of a labor union;
(D)
a representative or member of—
(i)
an environmental justice community; or
(ii)
a community-based organization for an environmental justice community;
(E)
an individual with expertise in cumulative impacts, geospatial data, and environmental justice, particularly such an individual from an academic or research institution; and
(F)
an advocate with experience in environmental justice who represents an environmental justice community.
(b) Establishment of Committee
(1) In general
There is established a committee, to be known as the Environmental Justice Mapping Committee
.
(2) Membership
(A) In general
The Committee shall be composed of not fewer than 1 representative of each of the following:
(i)
Of the Environmental Protection Agency—
(I)
the Office of Air and Radiation;
(II)
the Office of Chemical Safety and Pollution Prevention;
(III)
the Office of International and Tribal Affairs;
(IV)
the Office of Land and Emergency Management;
(V)
the Office of Water;
(VI)
the Office of Environmental Justice and External Civil Rights;
(VII)
the Office of Research and Development; and
(VIII)
the Office of Public Engagement and Environmental Education.
(ii)
The Council on Environmental Quality.
(iii)
Of the Department of Commerce—
(I)
the Office of Oceanic and Atmospheric Research of the National Oceanic and Atmospheric Administration, including not fewer than 1 representative of the Climate Program Office;
(II)
the Bureau of Economic Analysis; and
(III)
the National Institute of Standards and Technology.
(iv)
Of the Department of Health and Human Services—
(I)
the Centers for Disease Control and Prevention, not including the Agency for Toxic Substances and Disease Registry;
(II)
the Agency for Toxic Substances and Disease Registry;
(III)
the Administration for Children and Families;
(IV)
of the National Institutes of Health—
(aa)
the National Institute of Environmental Health Sciences;
(bb)
the National Institute of Mental Health; and
(cc)
the National Institute on Minority Health and Health Disparities; and
(V)
the Office for Civil Rights.
(v)
Of the Department of the Interior—
(I)
the Bureau of Indian Affairs;
(II)
the Office of Diversity, Inclusion, and Civil Rights; and
(III)
the United States Geological Survey.
(vi)
The Forest Service.
(vii)
The Department of Housing and Urban Development.
(viii)
The Department of Energy.
(ix)
The Department of Transportation.
(x)
The Department of Justice.
(xi)
The Federal Energy Regulatory Commission.
(xii)
The Department of the Treasury.
(xiii)
Such other Federal departments, agencies, and offices as the Administrator determines to be appropriate, particularly offices relating to public engagement.
(B) Selection of representatives
The head of a department or agency described in subparagraph (A) shall, in appointing to the Committee a representative of the department or agency, select a representative—
(i)
of a component of the department or agency that is among the components that are the most relevant to the responsibilities of the Committee; or
(ii)
who has expertise in areas relevant to those responsibilities, such as demographic indicators relating to socioeconomic hardship, environmental justice, public engagement, public health, exposure to pollution, future climate and extreme weather mapping, affordable energy, sustainable transportation, and access to water, food, and green space.
(C) Co-chairs
(i) In general
The members of the Committee shall select 3 members to serve as co-chairs of the Committee—
(I)
1 of whom shall be a representative of the Environmental Protection Agency;
(II)
1 of whom shall be a representative of the Council on Environmental Quality; and
(III)
1 of whom shall have substantial experience in public engagement.
(ii) Terms
Each co-chair shall serve for a term of not more than 3 years.
(iii) Responsibilities of co-chairs
The co-chairs of the Committee shall—
(I)
determine the agenda of the Committee, in consultation with other members of the Committee;
(II)
direct the work of the Committee, including the oversight of a meaningful public engagement process; and
(III)
convene meetings of the Committee not less frequently than once each fiscal quarter.
(3) Administrative support
(A) In general
The Administrator shall provide technical and administrative support to the Committee.
(B) Funding
The Administrator may carry out subparagraph (A) using, in addition to any amounts made available under subsection (e), amounts authorized to be appropriated to the Administrator before the date of enactment of this Act and available for obligation as of that date of enactment.
(4) Consultation
(A) In general
In carrying out the duties of the Committee, the Committee shall consult with relevant stakeholders.
(B) Advisory council
(i) In general
The Committee shall establish an advisory council composed of a balanced proportion of relevant stakeholders, at least ½ of whom shall represent environmental justice communities.
(ii) Chair
The advisory council shall be chaired by an environmental justice advocate or other relevant stakeholder with substantial experience in environmental justice.
(iii) Requirements
Consultation described in subparagraph (A) shall include—
(I)
early and regular engagement with the advisory council, including in carrying out public engagement under subparagraph (C); and
(II)
consideration of the recommendations of the advisory council.
(iv) Recommendations not used
If the Committee does not use a recommendation of the advisory council, not later than 60 days after the date on which the Committee receives notice of the recommendation, the Committee shall—
(I)
make available to the public on an internet website of the Environmental Protection Agency a written report describing the rationale of the Committee for not using the recommendation; and
(II)
submit the report described in subclause (I) to the Committee on Environment and Public Works of the Senate and the Committee on Energy and Commerce of the House of Representatives.
(v) Outreach
The advisory council may carry out public outreach activities using amounts made available under subsection (e) to supplement public engagement carried out by the Committee under subparagraph (C).
(C) Public engagement
(i) In general
The Committee shall, throughout the process of carrying out the duties of the Committee described in subsection (c)—
(I)
meaningfully engage with relevant stakeholders, particularly—
(aa)
members and representatives of environmental justice communities;
(bb)
environmental justice advocates; and
(cc)
individuals with expertise in cumulative impacts and geospatial data; and
(II)
ensure that the input of the stakeholders described in subclause (I) is central to the activities of the Committee.
(ii) Plan
(I) In general
In carrying out clause (i), the Committee shall develop a plan, in consultation with the advisory council, for comprehensive public engagement with, and incorporation of feedback from, environmental justice advocates and members of environmental justice communities.
(II) Strategies to overcome barriers to public engagement
The plan developed under subclause (I) shall include strategies to overcome barriers to public engagement, including—
(aa)
language barriers;
(bb)
transportation barriers;
(cc)
economic barriers; and
(dd)
lack of internet access.
(III) Consideration
In developing the plan under subclause (I), the Committee shall consider the diverse and varied experiences of environmental justice communities relating to the scope and types of environmental hazards and socioeconomic injustices.
(iii) Consultation and solicitation of public comment
(I) In general
In carrying out clause (i), not less frequently than once each fiscal quarter, the Committee shall consult with the advisory council and solicit meaningful public comment, particularly from relevant stakeholders, on the activities of the Committee.
(II) Requirements
The Committee shall carry out subclause (I) through means including—
(aa)
public notice of a meeting of the Committee occurring during the applicable fiscal quarter, which shall include—
(AA)
notice in publications relevant to environmental justice communities;
(BB)
notification to environmental justice communities through direct means, such as community centers and schools; and
(CC)
direct outreach to known environmental justice groups;
(bb)
public broadcast of that meeting, including soliciting and receiving comments by virtual means; and
(cc)
public availability of a transcript of that meeting through publication on an accessible website.
(III) Languages
The Committee shall provide each notice, notification, direct outreach, broadcast, and transcript described in subclause (II) in each language commonly used in the applicable environmental justice community, including through oral interpretation, if applicable.
(iv) Funding
Of amounts made available under subsection (e), the Administrator shall make available to the Committee such sums as are necessary for participation by relevant stakeholders in public engagement under this paragraph, as determined by the Administrator, in consultation with the advisory council.
(c) Duties of Committee
(1) In general
The Committee shall—
(A)
establish a tool described in paragraph (2) to identify environmental justice communities, including the identification of—
(i)
criteria to be used in the tool; and
(ii)
a methodology to determine the cumulative impacts of those criteria;
(B)
assess and address data gaps in accordance with paragraph (4); and
(C)
collect data for the environmental justice data repository established under subsection (d).
(2) Establishment of tool
(A) In general
The Committee, in consultation with relevant stakeholders and the advisory council, shall establish an interactive, transparent, integrated, and Federal Government-wide tool for assessing and mapping environmental justice communities based on the cumulative impacts of all indicators selected by the Committee to be integrated into the tool.
(B) Requirements
In establishing the tool under subparagraph (A), the Committee shall—
(i)
integrate into the tool multiple data layers of indicators that fall into categories including—
(I)
demographics, particularly relating to socioeconomic hardship and social stressors, such as—
(aa)
race and ethnicity;
(bb)
low income;
(cc)
high unemployment;
(dd)
low levels of home ownership;
(ee)
high rent burden;
(ff)
high transportation burden;
(gg)
low levels of educational attainment;
(hh)
linguistic isolation;
(ii)
energy insecurity or high utility rate burden;
(jj)
food insecurity;
(kk)
health insurance status and access to health care; and
(ll)
membership in an Indian Tribe;
(II)
public health, particularly data that are indicative of sensitive populations, such as—
(aa)
rates of asthma;
(bb)
rates of cardiovascular disease;
(cc)
childhood leukemia or other cancers that correlate with environmental hazards;
(dd)
low birth weight;
(ee)
maternal mortality;
(ff)
rates of lead poisoning; and
(gg)
rates of diabetes;
(III)
pollution burdens, such as pollution burdens created by—
(aa)
toxic chemicals;
(bb)
air pollutants;
(cc)
water pollutants;
(dd)
soil contaminants; and
(ee)
perfluoroalkyl and polyfluoroalkyl substances; and
(IV)
environmental effects, such as effects created by proximity to—
(aa)
risk management plan sites;
(bb)
hazardous waste facilities;
(cc)
sites on the National Priorities List developed by the President in accordance with section 105(a)(8)(B) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (42 U.S.C. 9605(a)(8)(B)); and
(dd)
fossil fuel infrastructure;
(ii)
investigate how further indicators of vulnerability to the impacts of climate change (including proximity and exposure to sea level rise, wildfire smoke, flooding, drought, rising average temperatures, extreme storms, and extreme heat, and financial burdens from flood and fire insurance) should be incorporated into the tool as an additional set of layers;
(iii)
identify and consider the effects of other indicators relating to environmental justice for integration into the tool as layers, including—
(I)
safe, sufficient, and affordable drinking water, sanitation, and stormwater services;
(II)
access to and the quality of—
(aa)
green space and tree canopy cover;
(bb)
healthy food;
(cc)
affordable energy and water;
(dd)
transportation;
(ee)
reliable communication systems, such as broadband internet;
(ff)
child care;
(gg)
high-quality public schools, early childhood education, and child care; and
(hh)
health care facilities;
(III)
length of commute;
(IV)
indoor air quality in multiunit dwellings;
(V)
mental health;
(VI)
labor market categories, particularly relating to essential workers; and
(VII)
each type of utility expense;
(iv)
consider the implementation of specific regional indicators, with the potential—
(I)
to create regionally and locally downscaled maps in addition to a national map;
(II)
to provide incentives for States to collect data and conduct additional analyses to capture conditions specific to their localities;
(III)
to provide resources for and engage in ground-truthing to identify and verify important data with community members; and
(IV)
to develop companion resources for, and provide technical support to, regional, State, local, or Tribal governments to create their own maps and environmental justice scores with relevant regional, State, local, and Tribal data;
(v)
identify a methodology to account for the cumulative impacts of all indicators selected by the Committee under clause (i), in addition to other indicators as the Committee determines to be necessary, to provide relative environmental justice scores for regions that are—
(I)
as small as practicable to identify communities; and
(II)
not larger than a census tract;
(vi)
ensure that the tool is capable of providing maps of environmental justice communities based on environmental justice scores described in clause (v);
(vii)
ensure that users of the tool are able to map available layers together or independently as desired;
(viii)
implement a method for users of the tool to generate a map and environmental justice score based on a subset of indicators, particularly for the purpose of using the tool in addressing various policy needs, permitting processes, and investment goals;
(ix)
make the tool customizable to address specific policy needs, permitting processes, and investment goals;
(x)
account for conditions that are not captured by the quantitative data used to develop the 1 or more maps and environmental justice scores comprising the tool, by—
(I)
developing and executing a plan to perform outreach to relevant communities; and
(II)
establishing a mechanism by which communities can self-identify as environmental justice communities to be included in the tool, which may include citing qualitative data on conditions for which quantitative data are lacking, such as cultural loss in Tribal communities;
(xi)
consider that the tool—
(I)
will be used across the Federal Government in screening Federal policies, permitting processes, and investments for environmental and climate justice impacts; and
(II)
may be used to assess communities for pollution reduction programs; and
(xii)
carry out such other activities as the Committee determines to be appropriate.
(3) Transparency and updates
(A) In general
(i) Notice and comment
The Committee shall establish the tool described in paragraph (2) after providing notice and an opportunity for public comment.
(ii) Hearings
In carrying out clause (i), the Committee shall hold hearings, which shall be time and language appropriate, in communities affected by environmental justice issues in geographically disparate States and Tribal areas.
(B) Updates
(i) Annual updates
The Committee shall update the tool described in paragraph (2) not less frequently than annually to account for data sets that are updated annually.
(ii) Other updates
Not less frequently than once every 3 years, the Committee shall—
(I)
update the indicators, methodology, or both for the tool described in paragraph (2); and
(II)
reevaluate data submitted by Federal departments and agencies that is used for the tool.
(iii) Reports
After the initial establishment of the tool described in paragraph (2) and each update under clause (i) or (ii), the Committee shall publish a report describing—
(I)
the process for identifying indicators relating to environmental justice in the development of the tool;
(II)
the methodology described in paragraph (2)(B)(v); and
(III)
the use of public input and community engagement in that process.
(C) Training tutorials and sessions
(i) In general
The Committee shall—
(I)
develop virtual training tutorials and sessions for environmental justice communities for the use of the tool described in paragraph (2); and
(II)
where practicable, provide in-person training sessions for environmental justice communities for the use of that tool.
(ii) Languages
The tutorials and sessions under clause (i) shall be made available in each language commonly used in the applicable environmental justice community.
(D) Public availability
(i) In general
The Committee shall make available to the public on an internet website of the Environmental Protection Agency—
(I)
the tool described in paragraph (2);
(II)
each update under clauses (i) and (ii) of subparagraph (B);
(III)
each report under subparagraph (B)(iii); and
(IV)
the training tutorials and sessions developed under subparagraph (C)(i)(I).
(ii) Accessibility
The Committee shall make the tool, updates, and reports described in clause (i) accessible to the public by publication in relevant languages and with accessibility functions, as appropriate.
(iii) Requirement
In carrying out clause (i)(I), the Committee shall take measures to prevent the tool from being misused to discriminate against environmental justice communities, such as by providing safeguards against the use of downscaled data that may enable the identification of individuals.
(4) Data gap audit
(A) In general
In establishing the tool described in paragraph (2), the Committee shall direct relevant Federal departments and agencies to conduct an audit of data collected by the department or agency to identify any data that are relevant to environmental justice concerns, including data relating to—
(i)
public health metrics;
(ii)
toxic chemicals;
(iii)
socioeconomic demographics;
(iv)
air quality;
(v)
water quality; and
(vi)
killings of individuals by law enforcement officers.
(B) Requirements
An audit described in subparagraph (A) shall—
(i)
examine the granularity and accessibility of the data;
(ii)
address the need for improved air quality monitoring; and
(iii)
include recommendations to other Federal departments and agencies on means to improve the quality, granularity, and transparency of, and public involvement in, data collection and dissemination.
(C) Improvements
The Committee shall direct a Federal department or agency, in conducting an audit under subparagraph (A), to address gaps in existing data collection that will assist the Committee in establishing and operating the tool described in paragraph (2), including by providing to the department or agency—
(i)
benchmarks to meet in addressing the gaps;
(ii)
instructions for consistency in data formatting that will allow for inclusion of data in the environmental justice data repository described in subsection (d); and
(iii)
best practices for collecting data in collaboration with local organizations and partners, such as engaging in ground-truthing.
(D) Reports
Not later than 180 days after a Federal department or agency has conducted an audit under subparagraph (A), the Committee shall—
(i)
make available to the public on an internet website of the Environmental Protection Agency a report describing the findings and conclusions of the audit, including the progress made by the Federal department or agency in addressing environmental justice data gaps; and
(ii)
submit the report described in clause (i) to—
(I)
the Committee on Environment and Public Works of the Senate;
(II)
the Committee on Health, Education, Labor, and Pensions of the Senate;
(III)
the Committee on Energy and Commerce of the House of Representatives; and
(IV)
the Committee on Education and Workforce of the House of Representatives.
(d) Environmental justice data repository
(1) In general
The Administrator shall establish an environmental justice data repository to maintain—
(A)
the data collected by the Committee through the establishment of the tool described in subsection (c)(2) and the audits conducted under subsection (c)(4)(A); and
(B)
any subnational data collected under paragraph (3)(B).
(2) Updates
The Administrator shall update the data in the data repository described in paragraph (1) as frequently as practicable, including every year if practicable, but not less frequently than once every 3 years.
(3) Availability; inclusion of subnational data
The Administrator—
(A)
shall make the data repository described in paragraph (1) available to regional, State, local, and Tribal governments; and
(B)
may collaborate with the governments described in subparagraph (A) to include within that data repository subnational data in existence before the establishment of the tool described in subsection (c)(2) and the completion of the audits under subsection (c)(4)(A).
(4) Requirement
The Administrator shall take measures to prevent the data in the data repository described in paragraph (1) from being misused to discriminate against environmental justice communities, such as by providing safeguards against the use of downscaled data that may enable the identification of individuals.
(e) Authorization of appropriations
There are authorized to be appropriated to the Administrator to carry out this section, including any necessary administrative costs of the Committee—
(1)
$20,000,000 for each of fiscal years 2027 and 2028; and
(2)
$18,000,000 for each of fiscal years 2029 through 2031.
(f) Effect
Nothing in any provision of this section relating to the tool described in subsection (c)(2) prohibits a State from developing a map relating to environmental justice or pollution burden that relies on different data, or analyzes data differently, than that tool.
Sec. 10012. Antiracism in public health
(a) Public health research and investment in dismantling structural racism
Part B of title III of the Public Health Service Act (42 U.S.C. 243 et seq.), as amended by section 5201(d), is further amended by adding at the end the following:
320D. National Center on Antiracism and Health
(a) In general
(1) National center
There is established within the Centers for Disease Control and Prevention a center to be known as the
National Center on Antiracism and Health(referred to in this section as theCenter). The Director of the Centers for Disease Control and Prevention shall appoint a director to head the Center who has experience living in and working with racial and ethnic minority communities. The Center shall promote public health by—(A)
declaring racism a public health crisis and naming racism as an historical and present threat to the physical and mental health and well-being of the United States and world;
(B)
aiming to develop new knowledge in the science and practice of antiracism, including by identifying the mechanisms by which racism operates in the provision of health care and in systems that impact health and well-being;
(C)
transferring that knowledge into practice, including by developing interventions that dismantle the mechanisms of racism and replace such mechanisms with equitable structures, policies, practices, norms, and values so that a healthy society can be realized; and
(D)
contributing to a national and global conversation regarding the impacts of racism on the health and well-being of the United States and world.
(2) General duties
The Secretary, acting through the Center, shall undertake activities to carry out the mission of the Center as described in paragraph (1), such as the following:
(A)
Conduct research into, collect, analyze and make publicly available data on, and provide leadership and coordination for the science and practice of antiracism, the public health impacts of structural racism, and the effectiveness of intervention strategies to address these impacts. Topics of research and data collection under this subparagraph may include identifying and understanding—
(i)
policies and practices that have a disparate impact on the health and well-being of communities of color;
(ii)
the public health impacts of implicit racial bias, White supremacy, weathering, xenophobia, discrimination, and prejudice;
(iii)
the social determinants of health resulting from structural racism, including poverty, housing, employment, political participation, and environmental factors; and
(iv)
the intersection of racism and other systems of oppression, including as related to age, sexual orientation, gender identity, and disability status.
(B)
Award noncompetitive grants and cooperative agreements to eligible public and nonprofit private entities, including State, local, territorial, and Tribal health agencies and organizations, for the research and collection, analysis, and reporting of data on the topics described in subparagraph (A).
(C)
Establish, through grants or cooperative agreements, at least 3 regional centers of excellence, located in racial and ethnic minority communities, in antiracism for the purpose of developing new knowledge in the science and practice of antiracism in health by researching, understanding, and identifying the mechanisms by which racism operates in the health space, racial and ethnic inequities in health care access and outcomes, the history of successful antiracist movements in health, and other antiracist public health work.
(D)
Establish a clearinghouse within the Centers for Disease Control and Prevention for the collection and storage of data generated under the programs implemented under this section for which there is not an otherwise existing surveillance system at the Centers for Disease Control and Prevention. Such data shall—
(i)
be comprehensive and disaggregated, to the extent practicable, by including racial, ethnic, primary language, sex, gender identity, sexual orientation, age, socioeconomic status, and disability disparities;
(ii)
be made publicly available;
(iii)
protect the privacy of individuals whose information is included in such data; and
(iv)
comply with privacy protections under the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996.
(E)
Provide information and education to the public on the public health impacts of structural racism and on antiracist public health interventions.
(F)
Consult with other Centers and National Institutes within the Centers for Disease Control and Prevention, including the Office of Health Equity, the Office of Tribal Affairs and Strategic Alliances, the Office of Rural Health, and the Office of Island Affairs, to ensure that scientific and programmatic activities initiated by the agency consider structural racism in their designs, conceptualizations, and executions, which shall include—
(i)
putting measures of racism in population-based surveys;
(ii)
establishing a Federal Advisory Committee on racism and health for the Centers for Disease Control and Prevention;
(iii)
developing training programs, curricula, and seminars for the purposes of training public health professionals and researchers around issues of race, racism, and antiracism;
(iv)
providing standards and best practices for programming and grant recipient compliance with Federal data collection standards, including section 3101 of the Public Health Service Act; and
(v)
establishing leadership and stakeholder councils with experts and leaders in racism and public health disparities.
(G)
Coordinate with the Indian Health Service and with the Tribal Advisory Committee of the Centers for Disease Control and Prevention to ensure meaningful Tribal consultation, the gathering of information from Tribal authorities, and respect for Tribal data sovereignty.
(H)
Engage in government to government consultation with Indian Tribes and Tribal organizations.
(I)
At least every 2 years, produce and publicly post on the Centers for Disease Control and Prevention’s website a report on antiracist activities completed by the Center, which may include newly identified antiracist public health practices.
(b) Definitions
In this section:
(1) Antiracism
The term antiracism is a collection of antiracist policies that lead to racial equity, and are substantiated by antiracist ideas.
(2) Antiracist
The term antiracist is any measure that produces or sustains racial equity between racial groups.
(c) Authorization of appropriations
There is authorized to be appropriated such sums as may be necessary to carry out this section.
(b) Public health research and investment in police violence
(1) In general
The Secretary shall establish within the National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention (referred to in this subsection as the Center
) a law enforcement violence prevention program.
(2) General duties
In implementing the program under paragraph (1), the Center shall conduct research into, and provide leadership and coordination for—
(A)
the understanding and promotion of knowledge about the public health impacts of uses of force by law enforcement, including police brutality and violence;
(B)
developing public health interventions and perspectives for eliminating deaths, injury, trauma, and negative mental health effects from police presence and interactions, including police brutality and violence; and
(C)
ensuring comprehensive data collection, analysis, and reporting regarding police violence and misconduct, in consultation with the Department of Justice and independent researchers.
(3) Functions
Under the program under paragraph (1), the Center shall—
(A)
summarize and enhance the knowledge of the distribution, status, and characteristics of law enforcement-related death, trauma, and injury;
(B)
conduct research and prepare, with the assistance of State public health departments—
(i)
statistics on law enforcement-related death, injury, and brutality;
(ii)
studies of the factors, including legal, socioeconomic, discrimination, and other factors that correlate with or influence police brutality;
(iii)
public information about uses of force by law enforcement, including police brutality and violence, for the practical use of the public health community, including publications that synthesize information relevant to the national goal of understanding police violence and methods for its control;
(iv)
information to identify socioeconomic groups, communities, and geographic areas in need of study, and a strategic plan for research necessary to comprehend the extent and nature of police uses of force by law enforcement, including police brutality and violence, and determine what options exist to reduce or eradicate death and injury that result; and
(v)
best practices in police violence prevention in other countries;
(C)
award grants, contracts, and cooperative agreements to provide for the conduct of epidemiologic research on uses of force by law enforcement, including police brutality and violence, by Federal, State, local, and private agencies, institutions, organizations, and individuals;
(D)
award grants, contracts, and cooperative agreements to community groups, independent research organizations, academic institutions, and other entities to support, execute, or conduct research on interventions to reduce or eliminate uses of force by law enforcement, including police brutality and violence;
(E)
coordinate with the Department of Justice and other Federal, State, and local agencies on the standardization of data collection, storage, and retrieval necessary to collect, evaluate, analyze, and disseminate information about the extent and nature of uses of force by law enforcement, including police brutality and violence, as well as options for the eradication of such practices;
(F)
submit an annual report to Congress on research findings with recommendations to improve data collection and standardization and to disrupt processes in policing that preserve and reinforce racism and racial disparities in public health;
(G)
conduct primary research and explore uses of force by law enforcement, including police brutality and violence, and options for its control; and
(H)
study alternatives to law enforcement response as a method of reducing police violence.
(4) Authorization of appropriations
There is authorized to be appropriated such sums as may be necessary to carry out this subsection.
Sec. 10013. LGBTQ essential data
(a) Improving data collection on the sexual orientation and gender identity of deceased individuals through the National Violent Death Reporting System
(1) Collection of sexual orientation and gender identity data
(A) In general
Not later than 120 days after the date of enactment of this Act, the Director of the Centers for Disease Control and Prevention shall take measures to improve the incidence of the collection of information on the sexual orientation and gender identity of deceased individuals through the National Violent Death Reporting System or any successor programs.
(B) Confidentiality
Any information collected relating to the sexual orientation or gender identity of a decedent shall be maintained in accordance with the confidentiality and privacy standards and policies for the protection of individuals applicable to all other data collected for purposes of the National Violent Death Reporting System.
(2) Definitions
In this subsection:
(A) Gender identity
The term gender identity means an individual’s sense of being male, female, transgender, or another gender, as distinct from the individual’s sex assigned at birth.
(B) Sexual orientation
The term sexual orientation means how a person identifies in terms of their emotional, romantic, or sexual attractions, and includes identification as straight, heterosexual, gay, lesbian, or bisexual, among other terms.
(3) Authorization
There is authorized to be appropriated $25,000,000 for fiscal year 2027 to carry out this subsection.
(b) Sense of Congress
It is the sense of Congress that—
(1)
the Centers for Disease Control and Prevention has made significant efforts to encourage States and other jurisdictions to collect data on sexual orientation and gender identity through the National Violent Death Reporting System; and
(2)
jurisdictions that participate in the collection of such data through the National Violent Death Reporting System should be commended for their participation.
Sec. 10014. Social determinants accelerator
(a) Purposes
The purposes of this section are as follows:
(1)
To establish effective, coordinated Federal technical assistance to help State and local governments to improve outcomes and cost-effectiveness of, and return on investment from, health and social services programs.
(2)
To build a pipeline of State and locally designed, cross-sector interventions and strategies that generate rigorous evidence about how to improve health and social outcomes, and increase the cost-effectiveness of, and return on investment from, Federal, State, local, and Tribal health and social services programs.
(3)
To enlist State and local governments and the service providers of such governments as partners in identifying Federal statutory, regulatory, and administrative challenges in improving the health and social outcomes of, cost-effectiveness of, and return on investment from, Federal spending on individuals enrolled in the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).
(4)
To develop strategies to improve health and social outcomes without denying services to, or restricting the eligibility of, vulnerable populations.
(b) Social determinants accelerator council
(1) Establishment
The Secretary, in coordination with the Administrator of the Centers for Medicare & Medicaid Services (referred to in this section as the Administrator
), shall establish an interagency council, to be known as the Social Determinants Accelerator Interagency Council (referred to in this section as the Council
), to achieve the purposes listed in subsection (a).
(2) Membership
(A) Federal composition
The Council shall be composed of at least one designee from each of the following Federal agencies:
(i)
The Office of Management and Budget.
(ii)
The Department of Agriculture.
(iii)
The Department of Education.
(iv)
The Indian Health Service.
(v)
The Department of Housing and Urban Development.
(vi)
The Department of Labor.
(vii)
The Department of Transportation.
(viii)
Any other Federal agency the Chair of the Council determines necessary.
(B) Designation
(i) In general
The head of each agency specified in subparagraph (A) shall designate at least one employee described in clause (ii) to serve as a member of the Council.
(ii) Responsibilities
An employee described in this clause shall be a senior employee of the agency—
(I)
whose responsibilities relate to authorities, policies, and procedures with respect to the health and well-being of individuals receiving medical assistance under a State plan (or a waiver of such plan) under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.); or
(II)
who has authority to implement and evaluate transformative initiatives that harness data or conducts rigorous evaluation to improve the impact and cost-effectiveness of federally funded services and benefits.
(C) HHS representation
In addition to the designees under subparagraph (A), the Council shall include designees from at least three agencies within the Department of Health and Human Services, including the Centers for Medicare & Medicaid Services, at least one of whom shall meet the criteria under subparagraph (B)(ii).
(D) OMB role
The Director of the Office of Management and Budget shall facilitate the timely resolution of Government-wide and multiagency issues to help the Council achieve consensus recommendations described under paragraph (3)(A).
(E) Non-Federal composition
The Comptroller General of the United States may designate up to 6 Council designees—
(i)
who have relevant subject matter expertise, including expertise implementing and evaluating transformative initiatives that harness data and conduct evaluations to improve the impact and cost-effectiveness of Federal Government services; and
(ii)
that each represent—
(I)
State, local, and Tribal health and human services agencies;
(II)
public housing authorities or State housing finance agencies;
(III)
State and local government budget offices;
(IV)
State Medicaid agencies; or
(V)
national consumer advocacy organizations.
(F) Chair
(i) In general
The Secretary shall select the Chair of the Council from among the members of the Council.
(ii) Initiating guidance
The Chair, on behalf of the Council, shall identify and invite individuals from diverse entities to provide the Council with advice and information pertaining to addressing social determinants of health, including—
(I)
individuals from State and local government health and human services agencies;
(II)
individuals from State Medicaid agencies;
(III)
individuals from State and local government budget offices;
(IV)
individuals from public housing authorities or State housing finance agencies;
(V)
individuals from nonprofit organizations, small businesses, and philanthropic organizations;
(VI)
advocates;
(VII)
researchers; and
(VIII)
any other individuals the Chair determines to be appropriate.
(3) Duties
The duties of the Council are—
(A)
to make recommendations to the Secretary and the Administrator regarding the criteria for making awards under subsection (b);
(B)
to identify Federal authorities and opportunities for use by States or local governments to improve coordination of funding and administration of Federal programs, the beneficiaries of whom include individuals described in subsection (a), and which may be unknown or underutilized and to make information on such authorities and opportunities publicly available;
(C)
to provide targeted technical assistance to States developing a social determinants accelerator plan under subsection (c), including identifying potential statutory or regulatory pathways for implementation of the plan and assisting in identifying potential sources of funding to implement the plan;
(D)
to report to Congress annually on the subjects set forth in paragraph (5);
(E)
to develop and disseminate evaluation guidelines and standards that can be used to reliably assess the impact of an intervention or approach that may be implemented pursuant to this section on outcomes, cost-effectiveness of, and return on investment from Federal, State, local, and Tribal governments, and to facilitate technical assistance, where needed, to help to improve State and local evaluation designs and implementation;
(F)
to seek feedback from State, local, and Tribal governments, including through an annual survey by an independent third party, on how to improve the technical assistance the Council provides to better equip State, local, and Tribal governments to coordinate health and social service programs;
(G)
to solicit applications for grants under subsection (c); and
(H)
to coordinate with other cross-agency initiatives focused on improving the health and well-being of low-income and at-risk populations in order to prevent unnecessary duplication between agency initiatives.
(4) Schedule
Not later than 60 days after the date of enactment of this Act, the Council shall convene to develop a schedule and plan for carrying out the duties described in paragraph (3), including solicitation of applications for the grants under subsection (c).
(5) Report to Congress
The Council shall submit an annual report to Congress, which shall include—
(A)
a list of the Council members;
(B)
a description of the activities and expenditures of the Council;
(C)
summaries of the interventions and approaches that will be supported by State, local, and Tribal governments that received a grant under subsection (c), including—
(i)
the best practices and evidence-based approaches such governments plan to employ to achieve the purposes listed in subsection (a); and
(ii)
a description of how the practices and approaches will impact the outcomes, cost-effectiveness of, and return on investment from, Federal, State, local, and Tribal governments with respect to such purposes;
(D)
the feedback received from State and local governments on ways to improve the technical assistance of the Council, including findings from a third-party survey and actions the Council plans to take in response to such feedback; and
(E)
the major statutory, regulatory, and administrative challenges identified by State, local, and Tribal governments that received a grant under subsection (c), and the actions that Federal agencies are taking to address such challenges.
(6) FACA applicability
Chapter 10 of title 5, United States Code, shall not apply to the Council.
(7) Council procedures
The Secretary, in consultation with the Comptroller General of the United States and the Director of the Office of Management and Budget, shall establish procedures for the Council to—
(A)
ensure that adequate resources are available to effectively execute the responsibilities of the Council;
(B)
effectively coordinate with other relevant advisory bodies and working groups to avoid unnecessary duplication;
(C)
create transparency to the public and Congress with regard to Council membership, costs, and activities, including through use of modern technology and social media to disseminate information; and
(D)
avoid conflicts of interest that would jeopardize the ability of the Council to make decisions and provide recommendations.
(c) Social determinants accelerator grants to States or local governments
(1) Grants to States, local governments, and tribes
Not later than 180 days after the date of enactment of this Act, the Administrator, in consultation with the Secretary and the Council, shall award on a competitive basis not more than 25 grants to eligible applicants described in paragraph (2), for the development of social determinants accelerator plans, as described in paragraph (6).
(2) Eligible applicant
An eligible applicant described in this subsection is a State, local, or Tribal health or human services agency that—
(A)
demonstrates the support of relevant parties across relevant State, local, or Tribal jurisdictions; and
(B)
in the case of an applicant that is a local government agency, provides to the Secretary a letter of support from the lead State health or human services agency for the State in which the local government is located.
(3) Amount of grant
The Administrator, in coordination with the Council, shall determine the total amount that the Administrator will make available to each grantee under this subsection.
(4) Application
An eligible applicant seeking a grant under this subsection shall include in the application the following information:
(A)
The target population (or populations) that would benefit from implementation of the social determinants accelerator plan proposed to be developed by the applicant.
(B)
A description of the objective or objectives and outcome goals of such proposed plan, which shall include at least one health outcome and at least one other important social outcome.
(C)
The sources and scope of inefficiencies that, if addressed by the plan, could result in improved cost-effectiveness of or return on investment from Federal, State, local, and Tribal governments.
(D)
A description of potential interventions that could be designed or enabled using such proposed plan.
(E)
The State, local, Tribal, academic, nonprofit, community-based organizations, and other private sector partners that would participate in the development of the proposed plan and subsequent implementation of programs or initiatives included in such proposed plan.
(F)
Such other information as the Administrator, in consultation with the Secretary and the Council, determines necessary to achieve the purposes of this section.
(5) Use of funds
A recipient of a grant under this subsection may use funds received through the grant for the following purposes:
(A)
To convene and coordinate with relevant government entities and other stakeholders across sectors to assist in the development of a social determinants accelerator plan.
(B)
To identify populations of individuals receiving medical assistance under a State plan (or a waiver of such plan) under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) who may benefit from the proposed approaches to improving the health and well-being of such individuals through the implementation of the proposed social determinants accelerator plan.
(C)
To engage qualified research experts to advise on relevant research and to design a proposed evaluation plan, in accordance with the standards and guidelines issued by the Administrator.
(D)
To collaborate with the Council to support the development of social determinants accelerator plans.
(E)
To prepare and submit a final social determinants accelerator plan to the Council.
(6) Contents of plans
A social determinants accelerator plan developed under this subsection shall include the following:
(A)
A description of the target population (or populations) that would benefit from implementation of the social determinants accelerator plan, including an analysis describing the projected impact on the well-being of individuals described in paragraph (5)(B).
(B)
A description of the interventions or approaches designed under the social determinants accelerator plan and the evidence for selecting such interventions or approaches.
(C)
The objectives and outcome goals of such interventions or approaches, including at least one health outcome and at least one other important social outcome.
(D)
A plan for accessing and linking relevant data to enable coordinated benefits and services for the jurisdictions described in paragraph (2)(A) and an evaluation of the proposed interventions and approaches.
(E)
A description of the State, local, Tribal, academic, nonprofit, or community-based organizations, or any other private sector organizations that would participate in implementing the proposed interventions or approaches, and the role each would play to contribute to the success of the proposed interventions or approaches.
(F)
The identification of the funding sources that would be used to finance the proposed interventions or approaches.
(G)
A description of any financial incentives that may be provided, including outcome-focused contracting approaches to encourage service providers and other partners to improve outcomes of, cost-effectiveness of, and return on investment from, Federal, State, local, or Tribal government spending.
(H)
The identification of the applicable Federal, State, local, or Tribal statutory and regulatory authorities, including waiver authorities, to be leveraged to implement the proposed interventions or approaches.
(I)
A description of potential considerations that would enhance the impact, scalability, or sustainability of the proposed interventions or approaches and the actions the grant awardee would take to address such considerations.
(J)
A proposed evaluation plan, to be carried out by an independent evaluator, to measure the impact of the proposed interventions or approaches on the outcomes of, cost-effectiveness of, and return on investment from, Federal, State, local, and Tribal governments.
(K)
Precautions for ensuring that vulnerable populations will not be denied access to Medicaid or other essential services as a result of implementing the proposed plan.
(d) Funding
(1) In general
Out of any money in the Treasury not otherwise appropriated, there is appropriated to carry out this section $25,000,000 for the period of fiscal years 2027 through 2031, of which up to $5,000,000 may be used to carry out this section, to remain available for obligation until the date that is 5 years after the date of enactment of this Act.
(2) Reservation of funds
(A) In general
Of the funds made available under paragraph (1), the Secretary shall reserve not less than 20 percent to award grants to eligible applicants for the development of social determinants accelerator plans under subsection (c) intended to serve rural populations.
(B) Exception
In the case of a fiscal year for which the Secretary determines that there are not sufficient eligible applicants for grants under subsection (c) that are intended to serve rural populations and the Secretary cannot satisfy the 20-percent requirement, the Secretary may reserve an amount that is less than 20 percent of amounts made available under paragraph (1) to award grants for such purpose.
(3) Rule of construction
Nothing in this section shall prevent Federal agencies represented on the Council from contributing additional funding from other sources to support activities to improve the effectiveness of the Council.
Sec. 10015. Improving social determinants of health
(a) Social Determinants of Health Program
(1) Program
To the extent and in the amounts made available in advance in appropriations Acts, the Director of the Centers for Disease Control and Prevention (in this section referred to as the Director
) shall carry out a program, to be known as the Social Determinants of Health Program (in this section referred to as the Program
), to achieve the following goals:
(A)
Improve health outcomes and reduce health inequities by coordinating social determinants of health activities across the Centers for Disease Control and Prevention.
(B)
Improve the capacity of public health agencies and community organizations to address social determinants of health in communities.
(2) Activities
To achieve the goals listed in paragraph (1), the Director shall carry out activities including the following:
(A)
Coordinating across the Centers for Disease Control and Prevention to ensure that relevant programs consider and incorporate social determinants of health in grant awards and other activities.
(B)
Awarding grants under subsection (b) to State, local, territorial, and Tribal health agencies and organizations, and to other eligible entities, to address social determinants of health in target communities.
(C)
Awarding grants under subsection (c) to nonprofit organizations and public or other nonprofit institutions of higher education—
(i)
to conduct research on best practices to improve social determinants of health;
(ii)
to provide technical assistance, training, and evaluation assistance to grantees under subsection (b); and
(iii)
to disseminate best practices to grantees under subsection (b).
(D)
Coordinating, supporting, and aligning activities of the Centers for Disease Control and Prevention related to social determinants of health with activities of other Federal agencies related to social determinants of health, including such activities of agencies in the Department of Health and Human Services such as the Centers for Medicare & Medicaid Services.
(E)
Collecting and analyzing data related to the social determinants of health.
(b) Grants To address social determinants of health
(1) In general
The Director, as part of the Program, shall award grants to eligible entities to address social determinants of health in their communities.
(2) Eligibility
To be eligible to apply for a grant under this subsection, an entity shall be—
(A)
a State, local, territorial, or Tribal health agency or organization;
(B)
a qualified nongovernmental entity, as defined by the Director; or
(C)
a consortium of entities that includes a State, local, territorial, or Tribal health agency or organization.
(3) Use of funds
(A) In general
A grant under this subsection shall be used to address social determinants of health in a target community by designing and implementing innovative, evidence-based, cross-sector strategies.
(B) Target community
For purposes of this subsection, a target community shall be a State, county, city, or other municipality.
(4) Priority
In awarding grants under this subsection, the Director shall prioritize applicants proposing to serve target communities with significant unmet health and social needs, as defined by the Director.
(5) Application
To seek a grant under this subsection, an eligible entity shall—
(A)
submit an application at such time, in such manner, and containing such information as the Director may require;
(B)
propose a set of activities to address social determinants of health through evidence-based, cross-sector strategies, which activities may include—
(i)
collecting quantifiable data from health care, social services, and other entities regarding the most significant gaps in health-promoting social, economic, and environmental needs;
(ii)
identifying evidence-based approaches to meeting the nonmedical, social needs of populations identified by data collection described in clause (i), such as unstable housing or food insecurity;
(iii)
developing scalable methods to meet patients’ social needs identified in clinical settings or other sites;
(iv)
convening entities such as local and State governmental and nongovernmental organizations, health systems, payors, and community-based organizations to review, plan, and implement community-wide interventions and strategies to advance health-promoting social conditions;
(v)
monitoring and evaluating the impact of activities funded through the grant on the health and well-being of the residents of the target community and on the cost of health care; and
(vi)
such other activities as may be specified by the Director;
(C)
demonstrate how the eligible entity will collaborate with—
(i)
health systems;
(ii)
payors, including, as appropriate, Medicaid managed care organizations (as defined in section 1903(m)(1)(A) of the Social Security Act (42 U.S.C. 1396b(m)(1)(A))), Medicare Advantage plans under part C of title XVIII of such Act (42 U.S.C. 1395w–21 et seq.), and health insurance issuers and group health plans (as such terms are defined in section 2791 of the Public Health Service Act (42 U.S.C. 300gg–91));
(iii)
other relevant stakeholders and initiatives in areas of need, such as the Accountable Health Communities Model of the Centers for Medicare & Medicaid Services, health homes under the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), community-based organizations, and human services organizations;
(iv)
other non-health care sector organizations, including organizations focusing on transportation, housing, or food access; and
(v)
local employers; and
(D)
identify key health inequities in the target community and demonstrate how the proposed efforts of the eligible entity would address such inequities.
(6) Monitoring and evaluation
As a condition of receipt of a grant under this subsection, a grantee shall agree to submit an annual report to the Director describing the activities carried out through the grant and the outcomes of such activities.
(7) Independent national evaluation
(A) In general
Not later than 5 years after the first grants are awarded under this subsection, the Director shall provide for the commencement of an independent national evaluation of the program under this subsection.
(B) Report to Congress
Not later than 60 days after receiving the results of such independent national evaluation, the Director shall report such results to Congress.
(c) Research and training
The Director, as part of the Program—
(1)
shall award grants to nonprofit organizations and public or other nonprofit institutions of higher education—
(A)
to conduct research on best practices to improve social determinants of health;
(B)
to provide technical assistance, training, and evaluation assistance to grantees under subsection (b); and
(C)
to disseminate best practices to grantees under subsection (b); and
(2)
may require a grantee under paragraph (1) to provide technical assistance and capacity building to entities that are eligible entities under subsection (b) but not receiving funds through such subsection.
(d) Funding
(1) In general
There is authorized to be appropriated to carry out this section, $50,000,000 for each of fiscal years 2027 through 2032.
(2) Allocation
Of the amount made available to carry out this section for a fiscal year, not less than 75 percent shall be used for grants under subsections (b) and (c).
Sec. 10016. Notification regarding SNAP for students receiving Federal work-study assistance
Section 443 of the Higher Education Act of 1965 (20 U.S.C. 1087–53) is amended by adding at the end the following:
(f) Notification regarding SNAP
(1) In general
An institution receiving a grant under this part shall send a notification (by email or other electronic means) to each eligible student informing the student of their potential eligibility for participation in SNAP and the process for obtaining more information, confirming eligibility, and accessing benefits under that program. The notification shall be developed by the Secretary of Education in consultation with the Secretary of Agriculture, and shall include details on eligibility requirements for participation in SNAP that a student must satisfy. The notification shall be, to the extent practicable, specific to the student’s State of residence and shall provide contact information for the local office where an application for SNAP may be made.
(2) Evidence of participation in federally financed work-study program
The notification under paragraph (1) shall include an official document confirming that the recipient is an eligible student sufficient for purposes of demonstrating that the exclusion from ineligibility for participation in SNAP under section 6(e)(4) of the Food and Nutrition Act of 2008 (7 U.S.C. 2015(e)(4)) applies to the student.
(3) Guidance
The Secretary of Education, in consultation with the Secretary of Agriculture, shall provide guidance to States and institutions of higher education on how to identify and communicate with students who are likely to be eligible for SNAP, including those eligible for a State or federally financed work-study program.
(4) Definitions
For purposes of this subsection:
(A)
The term
eligible studentmeans a student receiving work-study assistance under this part.(B)
The term
SNAPmeans the supplemental nutrition assistance program (as defined in section 3(t) of the Food and Nutrition Act of 2008 (7 U.S.C. 2012(t))).
Subtitle B Gun Violence
Sec. 10101. Reaffirming research authority of the Centers for Disease Control and Prevention
(a) In general
Section 391 of the Public Health Service Act (42 U.S.C. 280b) is amended—
(1)
in subsection (a)(1), by striking research relating to the causes, mechanisms, prevention, diagnosis, treatment of injuries, and rehabilitation from injuries;
and inserting the following:
research, including data collection, relating to—
(A)
the causes, mechanisms, prevention, diagnosis, and treatment of injuries, including with respect to gun violence; and
(B)
rehabilitation from such injuries;; and
(2)
by adding at the end the following:
(c) No advocacy or promotion of gun control
Nothing in this section shall be construed to—
(1)
authorize the Secretary to give assistance, make grants, or enter into cooperative agreements or contracts for the purpose of advocating or promoting gun control; or
(2)
permit a recipient of any assistance, grant, cooperative agreement, or contract under this section to use such assistance, grant, agreement, or contract for the purpose of advocating or promoting gun control.
Sec. 10102. National Violent Death Reporting System
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall improve the National Violent Death Reporting System (as authorized by sections 301(a) and 391(a) of the Public Service Health Act (42 U.S.C. 241(a), 280b(a))), particularly through the inclusion of additional States and activities to increase the quality, type, and timeliness of reported data. Participation in the System by the States shall be voluntary.
Sec. 10103. Report on effects of gun violence on public health
Not later than one year after the date of enactment of this Act, and annually thereafter, the Surgeon General shall submit to Congress a report on the effects on public health, including mental health, of gun violence in the United States during the preceding year, and the status of actions taken to address such effects.
Sec. 10104. Report on effects of gun violence on mental health in minority communities
Not later than one year after the date of enactment of this Act, the Deputy Assistant Secretary for Minority Health shall submit to Congress a report on the effects of gun violence on public health, including mental health, in minority communities in the United States, and the status of actions taken to address such effects.
Subtitle C Nutrition for women, children, families
Chapter 1 Senior hunger prevention
Sec. 10201. Short title
This chapter may be cited as the Senior Hunger Prevention Act
.
Sec. 10202. Improving SNAP efficacy
(a) Certification period
Section 3(f) of the Food and Nutrition Act of 2008 (7 U.S.C. 2012(f)) is amended, in the second sentence, by striking 24
and inserting 36
.
(b) Standard medical expense deduction
Section 5(e)(5) of the Food and Nutrition Act of 2008 (7 U.S.C. 2014(e)(5)) is amended—
(1)
in the paragraph heading, by striking Excess medical
and inserting Medical
;
(2)
in subparagraph (A), by striking an excess medical
and all that follows through the period at the end and inserting a standard medical deduction or a medical expense deduction of actual costs for the allowable medical expenses incurred by the elderly or disabled member, exclusive of special diets.
;
(3)
in subparagraph (B)(i), by striking excess
; and
(4)
by adding at the end the following:
(D) Standard medical expense deduction amount
(i) In general
Except as provided in clause (ii), the standard medical expense deduction shall be equal to—
(I)
for fiscal year 2027, $155; and
(II)
for each subsequent fiscal year, the applicable amount for the immediately preceding fiscal year, as adjusted to reflect changes for the 12-month period ending the preceding June 30 in the Consumer Price Index for All Urban Consumers: Medical Care published by the Bureau of Labor Statistics of the Department of Labor.
(ii) Exception
For any fiscal year, a State agency may establish a greater standard medical expense deduction than the deduction described in clause (i) if the greater deduction satisfies the applicable cost-neutrality standards established by the Secretary for that fiscal year.
(c) Value of allotment
Section 8(a) of the Food and Nutrition Act of 2008 (7 U.S.C. 2017(a)) is amended, in the proviso, by striking 8 percent
and inserting 1/3
.
Sec. 10203. Streamlining nutrition access for older adults and adults with disabilities
(a) Definition of elderly and disabled
Section 3(j) of the Food and Nutrition Act of 2008 (7 U.S.C. 2012(j)) is amended—
(1)
in the matter preceding paragraph (1), by striking the subsection designation and all that follows through who
and inserting the following:
(j) Elderly or disabled
The term elderly or disabled, with respect to an individual or member of a household, means that the individual or member of the household; and
(2)
in paragraph (2)(B), by inserting (which includes medical assistance provided to an individual described in section 1902(e)(14)(D)(i)(III) of that Act (42 U.S.C. 1396a(e)(14)(D)(i)(III)))
after (42 U.S.C. 1396 et seq.)
.
(b) Elderly simplified application program
The Food and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.) is amended by adding at the end the following:
31. Elderly simplified application program
(a) In general
Not later than 180 days after the date of enactment of this section, the Secretary shall establish a program, to be known as the
elderly simplified application program(referred to in this section as ESAP), under which a State, in carrying out the supplemental nutrition assistance program, may elect to implement a streamlined application and certification process for households in which all adult members—(1)
are elderly or disabled members; and
(2)
have no earned income.
(b) Certification period
The certification period for participants in ESAP shall be 36 months.
(c) Income and other data verification
(1) In general
A State agency determining the eligibility for an applicant household under ESAP shall, notwithstanding section 11(e)(3)—
(A)
to the maximum extent practicable, use data matching for income verification and household size; and
(B)
(i)
allow self-declaration by the applicant of the information required under section 273.2(f) of title 7, Code of Federal Regulations (or a successor regulation); but
(ii)
verify, prior to certification of the household, factors of eligibility provided by the applicant that the State agency determines are questionable.
(2) Accountability and fraud prevention
In carrying out paragraph (1), a State agency shall establish accountability and fraud protection measures to deter fraud and ensure the integrity of ESAP and the supplemental nutrition assistance program.
(d) Interviews
(1) In general
Notwithstanding section 11(e)(6)(A), for recertification of a household under ESAP, a State agency shall not require an interview unless requested by the household.
(2) Virtual interviews
An interview under paragraph (1) may be conducted virtually.
(e) Guidance
Prior to the establishment of ESAP under subsection (a), the Administrator of the Food and Nutrition Service shall develop guidance for States, including by consulting with States, to carry out ESAP, which shall include—
(1)
general implementation guidelines;
(2)
reporting requirements;
(3)
quality control requirements; and
(4)
best practices.
(c) Combined application program
The Food and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.) (as amended by subsection (b)) is amended by adding at the end the following:
32. Combined application program
(a) In general
Not later than 180 days after the date of enactment of this section, the Secretary, in coordination with the Commissioner of Social Security, shall establish a program, to be known as the
combined application program(referred to in this section as CAP), under which a State, in carrying out the supplemental nutrition assistance program, may elect to implement a streamlined application process for households in which all adult members are applicants for or recipients of benefits under title II of the Social Security Act (42 U.S.C. 401 et seq.) on the basis of a disability or supplemental security income under title XVI of that Act (42 U.S.C. 1381 et seq.).(b) Purposes
The purposes of CAP are—
(1)
to reduce the need for households described in subsection (a) to have in-person interviews with State offices administering the supplemental nutrition assistance program; and
(2)
to increase participation in the supplemental nutrition assistance program by simplifying the application process for the supplemental nutrition assistance program through increased automation and simplified calculation of benefits.
(c) CAP models
The Secretary, in coordination with the Commissioner of the Social Security Administration, shall offer, at a minimum, each of the following models for States to implement CAP:
(1) Standard model
(A) In general
Under the standard model, the Commissioner of the Social Security Administration and the State agency administering the supplemental nutrition assistance program shall coordinate—
(i)
to develop a simplified joint application process for the supplemental nutrition assistance program that uses standardized benefit amounts or standardized shelter expenses, in accordance with this paragraph; and
(ii)
to conduct outreach to adult members receiving supplemental security income under title XVI of the Social Security Act (42 U.S.C. 1381 et seq.) that are not receiving benefits under the supplemental nutrition assistance program.
(B) Standardized benefit amounts
(i) In general
Under the standardized model described in subparagraph (A), applicants shall receive a standardized or automated benefit level under the supplemental nutrition assistance program based on the shelter expenses and other income of the applicants.
(ii) Minimum standardized benefit levels
At a minimum, there shall be in effect 2 standardized benefit levels under clause (i), including, as determined by the State—
(I)
a level for participants with low shelter expenses; and
(II)
a level for participants with high shelter expenses.
(iii) Comparable amount
A State shall ensure that the amount provided under a standardized benefit level under clause (i) is comparable to an amount that a participant would otherwise receive under the supplemental nutrition assistance program.
(iv) Referral
A State shall refer a household described in subsection (a) to the supplemental nutrition assistance program instead of enrolling that household in CAP if the standardized amount that the household would receive under CAP would be significantly less than the amount of benefits that the household would receive under the supplemental nutrition assistance program.
(C) Standardized shelter expenses
In computing an excess shelter expense deduction under section 5(e)(6), a State agency may use a standard utility allowance in accordance with regulations promulgated by the Secretary.
(2) Modified model
Under the modified model, a State agency administering the supplemental nutrition assistance program shall—
(A)
conduct outreach to prospective participants in the supplemental nutrition assistance program using information from the Social Security Administration to identify households described in subsection (a) that are not participants in the supplemental nutrition assistance program; and
(B)
send to those households simplified application forms for the supplemental nutrition assistance program.
Sec. 10204. Enrollment and outreach pilot program for older adults, kinship families, and adults with disabilities
The Food and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.) (as amended by section 10203(c)) is amended by adding at the end the following:
33. Enrollment and outreach pilot program for older adults, kinship families, and adults with disabilities
(a) Definitions
In this section:
(1) Disability
The term disability has the meaning given the term in section 3 of the Americans with Disabilities Act of 1990 (42 U.S.C. 12102).
(2) Eligible entity
The term eligible entity means—
(A)
a State or local government agency;
(B)
an Indian tribe or Tribal organization;
(C)
a nonprofit organization, including a public or nonprofit provider of services;
(D)
a community-based organization; and
(E)
an educational provider.
(3) Kinship family
The term kinship family means a family in which a child resides with, and is being raised by, a grandparent, another extended family member, or an adult with whom the child has a close family-like relationship, such as a godparent or a close family friend.
(4) Older adult
The term older adult has the meaning given the term older individual in section 102 of the Older Americans Act of 1965 (42 U.S.C. 3002).
(5) Pilot program
The term pilot program means the Enrollment and Outreach Pilot Program for Older Adults, Kinship Families, and Adults with Disabilities established under subsection (b).
(b) Establishment
Not later than 180 days after the date of enactment of this section, the Secretary shall establish a pilot program, to be known as the
Enrollment and Outreach Pilot Program for Older Adults, Kinship Families, and Adults with Disabilities, under which the Secretary shall award grants to eligible entities—(1)
to raise awareness among older adults, kinship families, and adults with disabilities of the availability, eligibility requirements, application procedures, and benefits of the supplemental nutrition assistance program; and
(2)
to support older adults, kinship families, and adults with disabilities in enrolling in the supplemental nutrition assistance program.
(c) Priority
In awarding grants under the pilot program, the Secretary shall give priority to—
(1)
eligible entities that—
(A)
provide services to older adults or adults with disabilities;
(B)
provide services to kinship families, including kinship navigator programs;
(C)
have experience implementing programs that receive funding under the Older Americans Act of 1965 (42 U.S.C. 3001 et seq.);
(D)
have experience implementing programs administered by the Food and Nutrition Service; or
(E)
receive, plan to receive, or demonstrate an ability to partner with a program that receives, funding under—
(i)
the Older Americans Act of 1965 (42 U.S.C. 3001 et seq.);
(ii)
the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.); or
(iii)
1 or more nutrition programs administered by the Secretary; and
(2)
projects that will—
(A)
serve communities with—
(i)
high rates of food insecurity or malnutrition; or
(ii)
low food access;
(B)
serve rural communities, indigenous communities, or communities of color;
(C)
serve members of the lesbian, gay, bisexual, transgender, and queer community;
(D)
serve adults with limited English proficiency;
(E)
serve veterans;
(F)
serve residents in federally subsidized housing, including federally subsidized housing units for older adults and adults with disabilities;
(G)
serve residents living in housing serving kinship families; and
(H)
incorporate nutrition education activities that promote healthy eating and active lifestyles.
(d) Eligible activities
An eligible entity receiving a grant under the pilot program shall use the grant to carry out 1 or more of the following activities:
(1)
Application assistance, including—
(A)
eligibility prescreening;
(B)
assistance in completing an application for the supplemental nutrition assistance program;
(C)
assistance in obtaining application verification documents;
(D)
medical expense deduction counseling; and
(E)
translation of materials and bilingual accommodation.
(2)
Tailored dissemination of information relating to the supplemental nutrition assistance program, including through—
(A)
community-based outreach workshops and events;
(B)
a toll-free hotline to provide information relating to Federal, State, and local food resources;
(C)
informational websites and other social media sites; and
(D)
printed or digital informational content.
(3)
Transportation, including—
(A)
transportation to or from a local office of the supplemental nutrition assistance program; and
(B)
administration of vouchers or similar items for the transportation described in subparagraph (A).
(4)
Identification, implementation, analysis, and dissemination of replicable and scalable models for increasing enrollment in the supplemental nutrition assistance program among older adults, kinship families, and adults with disabilities.
(e) Grants
(1) Maximum amount
A grant awarded under the pilot program to an eligible entity for a fiscal year shall be—
(A)
not less than $50,000; and
(B)
not more than $250,000.
(2) Duration
An eligible entity may be awarded a grant under the pilot program for not more than 5 years.
(f) Evaluation
Not later than 2 years after the date of establishment of the pilot program, the Secretary shall conduct an evaluation of the pilot program.
(g) Funding
(1) In general
In addition to amounts otherwise available, there is appropriated, out of any funds in the Treasury not otherwise appropriated, $12,250,000, to remain available until expended, to carry out the pilot program, of which not more than $250,000 shall be used to carry out the evaluation under subsection (f).
(2) Administrative costs
Of the amounts made available under paragraph (1) (excluding the amount made available to carry out subsection (f)), not more than 3 percent may be used by the Secretary for administrative costs.
Sec. 10205. Food delivery under supplemental nutrition assistance program
The Food and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.) (as amended by section 10204) is amended by adding at the end the following:
34. Food delivery
(a) Definitions
In this section:
(1) Covered retail food store
The term covered retail food store means a retail food store, a public or private nonprofit meal delivery service, or a public or nonprofit meal delivery provider participating in the supplemental nutrition assistance program that is unable to cover the cost of food delivery for participants of the supplemental nutrition assistance program.
(2) Employee
The term employee has the meaning given the term in section 3 of the Fair Labor Standards Act of 1938 (29 U.S.C. 203).
(b) Program modifications
(1) In general
In carrying out the supplemental nutrition assistance program, the Secretary shall—
(A)
notify retail food stores participating in the supplemental nutrition assistance program of existing opportunities through which the retail food stores can deliver food to program participants, including by—
(i)
allowing an EBT card to be swiped with a mobile device on delivery of food to the home; and
(ii)
preparing food for pickup;
(B)
authorize public-private partnerships between the Department of Agriculture, retail food stores participating in the supplemental nutrition assistance program, and community-based organizations to provide free or low-cost food delivery, including through the use of private funds;
(C)
in the case of a covered retail food store, use funds made available under subparagraph (E) of paragraph (3) to provide, in accordance with that paragraph, free grocery delivery for participants in the supplemental nutrition assistance program who are older adults or adults with disabilities (as those terms are defined in section 33(a)) who are unable to shop for food or lack safe and accessible transportation options to the covered retail food store; and
(D)
require each State to submit to the Secretary a plan that describes the methods by which the State will—
(i)
work with retail food stores participating in the supplemental nutrition assistance program and other community-based partners to establish a process for food delivery for program participants;
(ii)
administer the reimbursements described in paragraph (3), including timing, eligibility, and distribution processes; and
(iii)
ensure that retail food stores participating in the supplemental nutrition assistance program that are reimbursed for delivery costs under paragraph (3) adhere to the requirements described in subparagraph (B) of that paragraph.
(2) State plans
Not later than 10 days after the date on which the Secretary receives a State plan under paragraph (1)(D), the Secretary shall—
(A)
determine whether to approve or disapprove the State plan; and
(B)
make publicly available on the website of the Department of Agriculture—
(i)
the State plan;
(ii)
the determination made under subparagraph (A) with respect to that plan; and
(iii)
any guidance issued to the State with respect to that plan.
(3) Reimbursement of covered retail food stores
(A) In general
Notwithstanding any other provision of law (including sections 274.7(f) and 278.2(b) of title 7, Code of Federal Regulations (or successor regulations), and any other regulations), subject to the availability of funds, a State agency shall reimburse a covered retail food store for the cost of food delivery to participants described in paragraph (1)(C) if—
(i)
the covered retail food store meets the requirements under subparagraph (B); and
(ii)
the majority of the number of food items delivered by the covered retail food store are eligible for redemption using benefits under the supplemental nutrition assistance program, regardless of whether the delivery includes nonfood items, subject to the condition that those nonfood items shall be of de minimis value.
(B) Requirements
A covered retail food store may receive reimbursement for the cost of food delivery to participants described in paragraph (1)(C) if the following requirements are met:
(i)
Food delivery is performed by employees of the covered retail food store or employees of an entity contracted by the covered retail food store to perform deliveries.
(ii)
Before any employee described in clause (i) begins making food deliveries, that employee receives employer-provided health and safety training that reflects the most recent guidelines of the Centers for Disease Control and Prevention.
(iii)
All employees described in clause (i) performing deliveries are paid at a rate that is not less than the greater of—
(I)
the minimum wage rate established under section 6(a)(1) of the Fair Labor Standards Act of 1938 (29 U.S.C. 206(a)(1)); and
(II)
the minimum wage rate established by the applicable State or locality in which the employee works.
(iv)
The covered retail food store meets the size standard determined by the Small Business Administration for a supermarket or other grocery retailer or a convenience retailer under section 121.201 of title 13, Code of Federal Regulations (or a successor regulation).
(v)
The covered retail food store does not—
(I)
charge the supplemental nutrition assistance program participant for delivery costs for which the covered retail food store will be reimbursed;
(II)
require minimum purchase thresholds in order to provide free delivery;
(III)
restrict delivery times to least-favorable windows for those participants; or
(IV)
charge surge pricing.
(C) Reimbursable costs
Reimbursable costs under subparagraph (A) include costs associated with purchasing point-of-sale devices or receiving technical assistance relating to point-of-sale devices.
(D) Maximum reimbursement per delivery
The maximum amount of reimbursement under subparagraph (A) for a food delivery fee shall be $10 per delivery, which may be adjusted by the Secretary for inflation.
(E) Authorization of appropriations
There is authorized to be appropriated to the Secretary $500,000,000 for fiscal year 2027, and each fiscal year thereafter, to remain available until expended, to cover the cost of food delivery described in paragraph (1)(C), to be distributed among States to fund reimbursements by States under subparagraph (A).
(4) Report
Not later than April 30, 2027, and April 30 of each year thereafter, the Secretary shall submit to the Committee on Agriculture, Nutrition, and Forestry of the Senate and the Committee on Agriculture of the House of Representatives a report that describes, for the period covered by the report, as applicable—
(A)
the number of supplemental nutrition assistance program participants using food delivery services, including the percentage of those participants that are older adults and adults with disabilities (as those terms are defined in section 33(a));
(B)
the covered retail food stores that were reimbursed under paragraph (3), including the amount of each reimbursement;
(C)
any complications or difficulties experienced by States in administering reimbursements under paragraph (3); and
(D)
recommendations or best practices to assist States in implementing food delivery programs similar to the program under this section.
Sec. 10206. Commodity supplemental food program
(a) Funds
Section 4 of the Agriculture and Consumer Protection Act of 1973 (7 U.S.C. 612c note; Public Law 93–86) is amended—
(1)
in subsection (a), in the first sentence, by striking 2023
and inserting 2031
; and
(2)
by adding at the end the following:
(d) Funds
In addition to amounts otherwise available, there is appropriated, out of any funds in the Treasury not otherwise appropriated, to carry out the program under this section $10,000,000 for each of fiscal years 2027 through 2031.
(b) Adults with disabilities
Section 5 of the Agriculture and Consumer Protection Act of 1973 (7 U.S.C. 612c note; Public Law 93–86) is amended—
(1)
by striking 2023
each place it appears and inserting 2031
;
(2)
in subsection (g)—
(A)
in paragraph (1), by striking to low-income persons aged 60 and older.
and inserting the following:
to—
(A)
low-income persons aged 60 and older; and
(B)
low-income adults with disabilities (as defined in section 3 of the Americans with Disabilities Act of 1990 (42 U.S.C. 12102)).;
(B)
by redesignating paragraph (2) as paragraph (3);
(C)
by inserting after paragraph (1) the following:
(2) Income eligibility
For purposes of paragraph (1), a low-income individual described in subparagraph (A) or (B) of that paragraph shall have a gross income level that is less than 185 percent of the Federal poverty line.; and
(D)
in subparagraph (B) of paragraph (3) (as so redesignated), in the matter preceding clause (i), by striking of—
and all that follows through the period at the end of clause (ii) and inserting of 36 months.
; and
(3)
in subsection (i), in the matter preceding paragraph (1)—
(A)
by inserting or low-income adults with disabilities described in subsection (g)(1)(B)
after elderly persons
; and
(B)
by striking to each elderly participant in, or applicant for, the commodity supplemental food program for the elderly
and inserting to each participant in, or applicant for, such a program
.
Sec. 10207. Seniors farmers' market nutrition program
(a) In general
Section 4402 of the Farm Security and Rural Investment Act of 2002 (7 U.S.C. 3007) is amended—
(1)
in subsection (a)—
(A)
by striking Of the funds
and inserting the following:
(1) Mandatory funding
Of the funds;
(B)
in paragraph (1) (as so designated), by inserting (referred to in this section as the Secretary)
after Agriculture
; and
(C)
by adding at the end the following:
(2) Authorization of appropriations
There are authorized to be appropriated to the Secretary to carry out and expand the seniors farmers' market nutrition program—
(A)
not less than $60,000,000 for fiscal year 2027;
(B)
not less than $70,000,000 for fiscal year 2028; and
(C)
not less than $100,000,000 for each of fiscal years 2029 through 2031.;
(2)
in subsection (b)(1), by inserting and adults with disabilities (as defined in section 3 of the Americans with Disabilities Act of 1990 (42 U.S.C. 12102))
before the semicolon at the end;
(3)
by redesignating subsections (c) through (f) as subsections (f) through (i), respectively; and
(4)
by inserting after subsection (b) the following:
(c) Benefit amounts
Under the seniors farmers' market nutrition program—
(1)
the minimum individual benefit shall be $35; and
(2)
the maximum individual benefit shall be $80.
(d) Certification period
The certification period for participants in the seniors farmers' market nutrition program shall be 36 months.
(e) Modernization grants
(1) In general
Not later than 180 days after the date of enactment of the Senior Hunger Prevention Act, the Secretary shall establish a grant program under which the Secretary shall award grants to State agencies, including Tribal organizations (as defined in section 3 of the Food and Nutrition Act of 2008 (7 U.S.C. 2012)) and territories, that administer the senior farmers’ market nutrition program to modernize program operations, including—
(A)
by transitioning from paper-based coupons to an electronic transaction technology, such as a web-based service or installable software; and
(B)
by increasing benefit use at farmers’ markets.
(2) Grant amount
(A) In general
The amount of a grant awarded under paragraph (1) shall not exceed $350,000.
(B) Supplies
Not more than $25,000 may be used to carry out subparagraph (F) of paragraph (3).
(3) Eligible expenses
An entity receiving a grant under paragraph (1) may use the grant for—
(A)
costs associated with the procurement of electronic transaction technology;
(B)
planning costs, including personnel costs, relating to electronic transaction technology procurement and implementation;
(C)
costs associated with evaluating the impact of transitioning from coupon-based operations to an electronic transaction technology;
(D)
training, outreach, and promotional material costs, including the costs associated with translating materials;
(E)
maintenance and operation of electronic transaction technology procured using the grant during the period of performance of the grant;
(F)
subject to paragraph (2)(B), the purchase of supplies needed to perform electronic transactions onsite; and
(G)
additional costs associated with modernizing program operations, as determined appropriate by the Secretary.
(4) Reports
Each entity that receives a grant under paragraph (1) shall submit to the Secretary and the Administrator of the Food and Nutrition Service quarterly performance progress reports on the use of the grant.
(5) Authorization of appropriations
There is authorized to be appropriated to the Secretary to carry out this subsection $15,000,000 for fiscal year 2027 and each fiscal year thereafter.
(b) Income guidelines
The Secretary of Agriculture shall revise section 249.6(a)(3) of title 7, Code of Federal Regulations, to ensure that income eligibility under that section is at or below 200 percent of the poverty income guidelines.
Sec. 10208. Infrastructure funding for farmers’ markets; local procurement pilot program
The Farm Security and Rural Investment Act of 2002 is amended by inserting after section 4402 (7 U.S.C. 3007) the following:
4403. Infrastructure funding for farmers’ markets; local procurement pilot program
(a) Definitions
In this section:
(1) Disability
The term disability has the meaning given the term in section 3 of the Americans with Disabilities Act of 1990 (42 U.S.C. 12102).
(2) Older adult
The term older adult has the meaning given the term older individual in section 102 of the Older Americans Act of 1965 (42 U.S.C. 3002).
(3) Secretary
The term Secretary means the Secretary of Agriculture.
(b) Infrastructure funding for farmers’ markets
(1) Definition of eligible entity
In this subsection, the term eligible entity means an entity that—
(A)
is—
(i)
an agricultural cooperative or other agricultural business entity or a producer network or association, including a community-supported agriculture network or association;
(ii)
a local or Tribal government;
(iii)
a nonprofit corporation;
(iv)
a public benefit corporation;
(v)
an economic development corporation;
(vi)
a regional farmers’ market authority;
(vii)
a food council; or
(viii)
any other entity as determined by the Secretary; and
(B)
can demonstrate financial need, as determined by the Secretary.
(2) Establishment
Not later than 180 days after the date of enactment of the Senior Hunger Prevention Act, the Secretary shall establish a program under which the Secretary shall provide financial assistance, in the form of loans, loan guarantees, and grants, to eligible entities for—
(A)
the establishment of new farmers’ markets;
(B)
the improvement or rehabilitation of existing farmers’ markets, including by adding or improving payment technologies used in those farmers’ markets; and
(C)
the expansion of community supported agriculture to serve older adults and adults with disabilities.
(3) Requirements
An eligible entity that receives financial assistance under paragraph (2) shall be required—
(A)
to host farmers’ markets or related activities at locations accessible—
(i)
by public transportation;
(ii)
by paratransit; or
(iii)
through transportation services provided under the Older Americans Act of 1965 (42 U.S.C. 3001 et seq.); and
(B)
to reserve not less than 50 percent of the floor area of an applicable farmers’ market for the sale of products that are produced locally, as determined by the Secretary, by—
(i)
farmers, ranchers, or aquaculture, mariculture, or fisheries operators; or
(ii)
associations of farmers, ranchers, or aquaculture, mariculture, or fisheries operators.
(4) Cost sharing
The non-Federal share of a grant provided under this subsection shall be 20 percent of the amount of the grant, which may comprise transportation costs, volunteer contributions, and in-kind staffing.
(5) Funding
Of the funds of the Commodity Credit Corporation, the Secretary shall use to carry out this subsection $50,000,000 for each of fiscal years 2027 through 2031.
(c) Local procurement pilot program
(1) Definitions
In this subsection:
(A) Agricultural producer
The term agricultural producer includes—
(i)
an agricultural cooperative;
(ii)
a person engaged in farming, ranching, or aquaculture;
(iii)
a person engaged in the packing of a food product; and
(iv)
a person engaged in the minimal processing of a food product, as determined by the Secretary.
(B) Eligible entity
The term eligible entity means an entity that—
(i)
(I)
coordinates enrollment in, and distribution of, benefits under the seniors farmers’ market nutrition program; or
(II)
demonstrates an ability to partner with an entity that coordinates enrollment in and distribution of benefits under the seniors farmers’ market nutrition program; and
(ii)
is—
(I)
a public or nonprofit provider of nutrition services or support to older adults or adults with disabilities, including—
(aa)
an Aging and Disability Resource Center (as defined in section 102 of the Older Americans Act of 1965 (42 U.S.C. 3002));
(bb)
an area agency on aging (as defined in that section);
(cc)
a State health insurance program;
(dd)
a State unit on aging;
(ee)
a center for independent living;
(ff)
a community health center;
(gg)
a multipurpose senior center; and
(hh)
federally subsidized housing, including federally subsidized housing units for older adults and adults with disabilities; or
(II)
a local, State, or national parks and recreation department.
(2) Establishment
Not later than 180 days after the date of enactment of the Senior Hunger Prevention Act, the Secretary shall establish a pilot program under which the Secretary shall award grants to eligible entities to contract with agricultural producers that will grow produce to support the local procurement and contracting of produce for eligible entities.
(3) Priority
In awarding grants under paragraph (2), the Secretary shall give priority to an eligible entity that will use grant funds to benefit underserved communities, including communities that are located in areas of concentrated poverty with limited access to fresh locally or regionally grown food.
(4) Methods
Under a contract described in paragraph (2), an agricultural producer may grow produce through traditional or controlled environmental agriculture.
(5) Evaluation
Not later than 2 years after the date of establishment of the pilot program under paragraph (2), the Secretary shall conduct an evaluation of the pilot program.
(6) Funding
(A) In general
Of the funds of the Commodity Credit Corporation, the Secretary shall use to carry out this subsection $350,000 for each of fiscal years 2027 through 2031.
(B) Administrative costs
Of the amounts made available under subparagraph (A) for a fiscal year, not more than 5 percent may be used for administrative costs.
(C) Evaluation
In addition to amounts made available under subparagraph (A), there is appropriated to the Secretary, out of any funds in the Treasury not otherwise appropriated, $25,000 to carry out paragraph (5).
Chapter 2 Closing the meal gap
Sec. 10211. Elimination of time limit
(a) In general
Section 6 of the Food and Nutrition Act of 2008 (7 U.S.C. 2015) is amended—
(1)
by striking subsection (o); and
(2)
by redesignating subsections (p) through (s) as subsections (o) through (r), respectively.
(b) Conforming amendments
(1)
Section 5(a) of the Food and Nutrition Act of 2008 (7 U.S.C. 2014(a)) is amended, in the second sentence, by striking (r)
and inserting (q)
.
(2)
Section 6(d)(4) of the Food and Nutrition Act of 2008 (7 U.S.C. 2015(d)(4)) is amended—
(A)
in subparagraph (B)(ii)(I)(bb)(DD), by striking or subsection (o)
; and
(B)
in subparagraph (N), by striking or subsection (o)
each place it appears.
(3)
Section 7(i)(1) of the Food and Nutrition Act of 2008 (7 U.S.C. 2016(i)(1)) is amended by striking section 6(o)(2) of this Act or
.
(4)
Section 16(h) of the Food and Nutrition Act of 2008 (7 U.S.C. 2025(h)) is amended—
(A)
in paragraph (1)—
(i)
in subparagraph (B), in the matter preceding clause (i), by striking that—
and all that follows through the period at the end of clause (ii) and inserting that is determined and adjusted by the Secretary.
;
(ii)
by striking subparagraph (E);
(iii)
by redesignating subparagraph (F) as subparagraph (E); and
(iv)
in clause (ii)(III)(ee)(AA) of subparagraph (E) (as so redesignated), by striking , individuals subject to the requirements under section 6(o),
; and
(B)
in paragraph (5)(C)—
(i)
in clause (ii), by adding and
at the end;
(ii)
in clause (iii), by striking ; and
and inserting a period; and
(iii)
by striking clause (iv).
(5)
Section 51(d)(8)(A)(ii) of the Internal Revenue Code of 1986 is amended—
(A)
in subclause (I), by striking , or
at the end and inserting a period;
(B)
in the matter preceding subclause (I), by striking family—
and all that follows through receiving
in subclause (I) and inserting family receiving
; and
(C)
by striking subclause (II).
(6)
Section 103(a)(2) of the Workforce Innovation and Opportunity Act (29 U.S.C. 3113) is amended—
(A)
by striking subparagraph (D); and
(B)
by redesignating subparagraphs (E) through (K) as subparagraphs (D) through (J), respectively.
(7)
Section 121(b)(2)(B) of the Workforce Innovation and Opportunity Act (29 U.S.C. 3151) is amended—
(A)
by striking clause (iv); and
(B)
by redesignating clauses (v) through (vii) as clauses (iv) through (vi), respectively.
Sec. 10212. Inclusion of Puerto Rico in supplemental nutritional assistance program
(a) Definitions
Section 3 of the Food and Nutrition Act of 2008 (7 U.S.C. 2012) is amended—
(1)
in subsection (r), by inserting the Commonwealth of Puerto Rico,
after Guam,
; and
(2)
in subsection (u)(3)(B), by striking Guam and
and inserting Guam, the Commonwealth of Puerto Rico, and
after Guam,
.
(b) Eligible households
Section 5 of the Food and Nutrition Act of 2008 (7 U.S.C. 2014) is amended—
(1)
in subsection (b), in the first sentence, by inserting the Commonwealth of Puerto Rico,
after Guam,
;
(2)
in subsection (c)—
(A)
in paragraph (1), by striking and Guam,
and inserting Guam, and the Commonwealth of Puerto Rico,
; and
(B)
in the undesignated matter at the end, by striking States or Guam
and inserting States, Guam, or the Commonwealth of Puerto Rico
; and
(3)
in subsection (e)—
(A)
in paragraph (1)(A), by inserting the Commonwealth of Puerto Rico,
after Hawaii,
each place it appears; and
(B)
in paragraph (6)(B), in the matter preceding clause (i), by inserting the Commonwealth of Puerto Rico,
after Guam,
.
(c) Effective date
(1) In general
The amendments made by subsections (a) and (b) shall be effective with respect to the Commonwealth of Puerto Rico on the date described in paragraph (2) if the Secretary of Agriculture submits to Congress a certification under subsection (f)(2)(C) of section 19 of the Food and Nutrition Act of 2008 (7 U.S.C. 2028) (as added by subsection (d)).
(2) Date described
The date referred to in paragraph (1) is the date established by the Commonwealth of Puerto Rico in the applicable plan of operation submitted to the Secretary of Agriculture under subsection (f)(1) of section 19 of the Food and Nutrition Act of 2008 (7 U.S.C. 2028) (as added by subsection (d)).
(d) Transition of Puerto Rico to supplemental nutrition assistance program
Section 19 of the Food and Nutrition Act of 2008 (7 U.S.C. 2028) is amended by adding at the end the following:
(f) Transition of Puerto Rico to supplemental nutrition assistance program
(1) Request for participation
The Commonwealth of Puerto Rico may submit to the Secretary a request to participate in the supplemental nutrition assistance program, which shall include a plan of operation described in section 11(d), including a description of the date on which the Commonwealth of Puerto Rico intends to begin participation in the supplemental nutrition assistance program.
(2) Certification by Secretary
(A) In general
On submission of a request by the Commonwealth of Puerto Rico under paragraph (1), the Secretary shall certify the Commonwealth of Puerto Rico as qualified to participate in the supplemental nutrition assistance program if the Secretary—
(i)
approves the plan of operation submitted with the request, in accordance with this subsection; and
(ii)
approves the applications described in paragraph (4) in accordance with that paragraph.
(B) Deadline
The Secretary shall certify or deny the request of the Commonwealth of Puerto Rico under paragraph (1) not later than 90 days after the date on which the Secretary receives the request.
(C) Submission to Congress
The Secretary shall submit a certification under subparagraph (A) to Congress.
(3) Determination of plan of operation
(A) Approval
The Secretary shall approve a plan of operation submitted with a request under paragraph (1) if the plan satisfies the requirements under this Act.
(B) Disapproval
If the Secretary does not approve a plan of operation submitted with a request under paragraph (1), the Secretary shall provide a statement that describes each requirement under this Act that is not satisfied by the plan.
(4) Approval of retail food stores
If the Secretary approves a plan of operation under paragraph (3)(A) for the Commonwealth of Puerto Rico, the Secretary shall accept applications from retail food stores located in the Commonwealth of Puerto Rico to be authorized under section 9 to participate in the supplemental nutrition assistance program.
(5) Family Market Program
Notwithstanding subsection (g), the Secretary shall allow the Commonwealth of Puerto Rico to continue to carry out under the supplemental nutrition assistance program the Family Market Program established pursuant to this section.
(6) Temporary funding
If the Commonwealth of Puerto Rico has a request under paragraph (1) pending before the Secretary (including a plan of operation pending under paragraph (3)), the Commonwealth of Puerto Rico shall receive block grants under this section, in amounts determined by the Secretary, until the date on which the Secretary certifies the Commonwealth of Puerto Rico under paragraph (2)(B).
(7) Authorization of appropriations
There are authorized to be appropriated to the Secretary such sums as are necessary to carry out this subsection for fiscal year 2027, to remain available until expended.
(g) Technical infrastructure implementation
(1) In general
The Commonwealth of Puerto Rico may request from the Secretary a 1-time grant to pay for the cost of the technology infrastructure necessary to implement the supplemental nutrition assistance program, including the cost of information technology, information technology personnel, and training relating to program implementation.
(2) Application
In making a request under paragraph (1), the Commonwealth of Puerto Rico shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require, including—
(A)
a description of the costs to be paid for by the grant; and
(B)
a plan for implementing the technology infrastructure described in paragraph (1)—
(i)
within 1 year of receiving the grant; and
(ii)
that is reasonably cost efficient, as determined by the Secretary.
(3) Determination
(A) Time limit
The Secretary shall approve or deny an application submitted under paragraph (2) not later than 90 days after the date on which the application is submitted.
(B) Denial
If the Secretary denies an application submitted under paragraph (2), the Commonwealth of Puerto Rico may amend the plan described in subparagraph (B) of that paragraph, in coordination with the Secretary, to resubmit to the Secretary for approval.
(4) Funding
(A) In general
There is appropriated to the Secretary, out of funds in the Treasury not otherwise appropriated, $112,500,000 to carry out this subsection, to remain available until 3 years after the date of enactment of this subsection.
(B) Reversion of funds
Any funds appropriated to the Secretary under subparagraph (A) that remain available by the date described in that subparagraph shall revert to the Treasury.
(h) Termination of effectiveness
(1) In general
Subsections (a) through (e) shall cease to be effective with respect to the Commonwealth of Puerto Rico on the date described in paragraph (2) if the Secretary submits to Congress a certification under subsection (f)(2)(C) for the Commonwealth of Puerto Rico.
(2) Date described
The date referred to in paragraph (1) is the date established by the Commonwealth of Puerto Rico in the applicable plan of operation submitted to the Secretary under subsection (f)(1).
Subtitle D Universal school meals
Sec. 10301. Short title
This subtitle may be cited as the Universal School Meals Program Act of 2026
.
Sec. 10302. Effective date
Except as otherwise provided, this subtitle, and the amendments made by this subtitle, shall take effect on the date that is 1 year after the date of enactment of this Act.
Chapter 1 School breakfast program
Sec. 10311. Free school breakfast program
(a) In general
Section 4(a) of the Child Nutrition Act of 1966 (42 U.S.C. 1773(a)) is amended, in the first sentence—
(1)
by striking is hereby
and inserting are
; and
(2)
by inserting to provide free breakfast to all children enrolled at those schools
before in accordance
.
(b) Apportionment to States
Section 4(b) of the Child Nutrition Act of 1966 (42 U.S.C. 1773(b)) is amended—
(1)
in paragraph (1)—
(A)
in subparagraph (A)(i), by striking subclause (II) and inserting the following:
(II)
the national average payment for free breakfasts, as specified in subparagraph (B).;
(B)
by striking subparagraph (B) and inserting the following:
(B) Payment amounts
(i) In general
The national average payment for each free breakfast shall be $2.80, adjusted annually for inflation in accordance with clause (ii) and rounded in accordance with clause (iii).
(ii) Inflation adjustment
(I) In general
The annual inflation adjustment under clause (i) shall reflect changes in the cost of operating the free breakfast program under this section, as indicated by the change in the Consumer Price Index for food away from home for all urban consumers.
(II) Basis
Each inflation annual adjustment under clause (i) shall reflect the changes in the Consumer Price Index for food away from home for the most recent 12-month period for which those data are available.
(iii) Rounding
On July 1, 2027, and annually thereafter, the national average payment rate for free breakfast shall be—
(I)
adjusted to the nearest lower-cent increment; and
(II)
based on the unrounded amounts for the preceding 12-month period.;
(C)
by striking subparagraphs (C) and (E); and
(D)
by redesignating subparagraph (D) as subparagraph (C);
(2)
by striking paragraphs (2) and (3);
(3)
by redesignating paragraphs (4) and (5) as paragraphs (2) and (3), respectively; and
(4)
in paragraph (3) (as so redesignated), by striking paragraph (3) or (4)
and inserting paragraph (2)
.
(c) State disbursement to schools
Section 4 of the Child Nutrition Act of 1966 (42 U.S.C. 1773) is amended by striking subsection (c) and inserting the following:
(c) State disbursement to schools
Funds apportioned and paid to any State for the purpose of this section shall be disbursed by the State educational agency to schools selected by the State educational agency to assist those schools in operating a breakfast program.
(d) No collection of debt
(1) In general
Notwithstanding any other provision of the Child Nutrition Act of 1966 (42 U.S.C. 1771 et seq.) or any other provision of law, effective beginning on the date of enactment of this Act, as a condition of participation in the breakfast program under section 4 of that Act (42 U.S.C. 1773), a school—
(A)
shall not collect any debt owed to the school for unpaid meal charges; and
(B)
shall continue to accrue debt for unpaid meal charges—
(i)
for the purpose of receiving reimbursement under section 10332; and
(ii)
until the effective date specified in section 10302.
(2) Child Nutrition Act of 1966
(A) In general
Section 4 of the Child Nutrition Act of 1966 (42 U.S.C. 1773) is amended by striking subsection (d) and inserting the following:
(d) No collection of debt
A school participating in the free breakfast program under this section shall not collect any debt owed to the school for unpaid meal charges.
(B) Conforming amendment
Section 23(a) of the Child Nutrition Act of 1966 (42 U.S.C. 1793(a)) is amended by striking a school in severe need, as described in section 4(d)(1)
and inserting the following:
a school—
(1)
participating in the free breakfast program under section 4, or seeking to initiate a free breakfast program under that section; and
(2)
not less than 40 percent of the students of which are economically disadvantaged students (as identified under a measure described in section 1113(a)(5) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6313(a)(5)))
(e) Nutritional and other program requirements
Section 4(e) of the Child Nutrition Act of 1966 (42 U.S.C. 1773(e)) is amended—
(1)
in paragraph (1)(A), in the second sentence, by striking free or
and all that follows through the period at the end and inserting free to all children enrolled at a school participating in the school breakfast program.
; and
(2)
in paragraph (2), in the second sentence, by striking the full charge to the student for a breakfast meeting the requirements of this section or
.
(f) Prohibition on breakfast shaming, meal denial
(1) In general
Effective beginning on the date of enactment of this Act, a school or school food authority—
(A)
shall not—
(i)
physically segregate for the purpose of debt shaming or otherwise discriminate against any child participating in the breakfast program under section 4 of the Child Nutrition Act of 1966 (42 U.S.C. 1773); or
(ii)
overtly identify a child described in clause (i) by a special token or ticket, an announced or published list of names, or any other means; and
(B)
shall provide the program meal to each child eligible under the program described in subparagraph (A)(i).
(2) Child Nutrition Act of 1966
Section 4 of the Child Nutrition Act of 1966 (42 U.S.C. 1773) is amended by adding at the end the following:
(f) Prohibition on breakfast shaming
A school or school food authority shall not—
(1)
physically segregate for the purpose of debt shaming or otherwise discriminate against any child participating in the free breakfast program under this section; or
(2)
overtly identify a child described in paragraph (1) by a special token or ticket, an announced or published list of names, or any other means.
(g) Department of Defense overseas dependents’ schools
Section 20(b) of the Child Nutrition Act of 1966 (42 U.S.C. 1789(b)) is amended by striking by this section
and all that follows through the period at the end and inserting by this section.
.
(h) Conforming amendments
The Child Nutrition Act of 1966 (42 U.S.C. 1771 et seq.) is amended—
(1)
by striking or reduced price
each place it appears;
(2)
by striking and reduced price
each place it appears; and
(3)
by striking a reduced price
each place it appears.
Chapter 2 School lunch program
Sec. 10321. Apportionment to States
Section 4(b) of the Richard B. Russell National School Lunch Act (42 U.S.C. 1753(b)) is amended—
(1)
in paragraph (1)—
(A)
in subparagraph (A), by striking of this Act
; and
(B)
in subparagraph (B), by striking of this subsection
; and
(2)
by striking paragraphs (2) and (3) and inserting the following:
(2) Payment amounts
(A) In general
The national average payment for each free lunch shall be $4.63, adjusted annually for inflation in accordance with subparagraph (C) and rounded in accordance with subparagraph (D).
(B) Additional payment for local food
(i) In general
During a school year, a school food authority shall receive an additional payment described in clause (ii) if the State certifies that the school food authority served meals (including breakfasts, lunches, suppers, and supplements) during the preceding school year not less than 25 percent of which were made with farm products that were—
(I)
produced and distributed—
(aa)
in the State in which the school food authority is located; or
(bb)
not more than 250 miles from the location of the school food authority; and
(II)
marketed to consumers—
(aa)
directly; or
(bb)
through an intermediated channel (such as a food hub or cooperative).
(ii) Payment amount
(I) In general
The additional payment amount under this subparagraph shall be—
(aa)
$0.30 for each free lunch and supper;
(bb)
$0.21 for each free breakfast; and
(cc)
$0.08 for each free supplement.
(II) Adjustments
Each additional payment amount under subclause (I) shall be adjusted annually in accordance with subparagraph (C) and rounded in accordance with subparagraph (D).
(iii) Disbursement
The State agency shall disburse funds made available under this subparagraph to school food authorities eligible to receive additional reimbursement.
(C) Inflation adjustment
(i) In general
The annual inflation adjustment under subparagraphs (A) and (B)(ii) shall reflect changes in the cost of operating the free lunch program under this Act, as indicated by the change in the Consumer Price Index for food away from home for all urban consumers.
(ii) Basis
Each annual inflation adjustment under subparagraphs (A) and (B)(ii) shall reflect the changes in the Consumer Price Index for food away from home for the most recent 12-month period for which those data are available.
(D) Rounding
On July 1, 2027, and annually thereafter, the national average payment rate for free lunch and the additional payment amount for free breakfast, lunch, supper, and supplement under subparagraph (B) shall be—
(i)
adjusted to the nearest lower-cent increment; and
(ii)
based on the unrounded amounts for the preceding 12-month period.
Sec. 10322. Nutritional and other program requirements
(a) Elimination of free lunch eligibility requirements
(1) In general
Section 9 of the Richard B. Russell National School Lunch Act (42 U.S.C. 1758) is amended by striking subsection (b) and inserting the following:
(b) Eligibility
All children enrolled in a school that participates in the school lunch program under this Act shall be eligible to receive free lunch under this Act.
(2) Conforming amendments
(A)
Section 9 of the Richard B. Russell National School Lunch Act (42 U.S.C. 1758) is amended—
(i)
in subsection (c), in the third sentence, by striking or at a reduced cost
; and
(ii)
in subsection (e), by striking , reduced price,
.
(B)
Section 18 of the Richard B. Russell National School Lunch Act (42 U.S.C. 1769) is amended—
(i)
in subsection (b), by striking (b)(1) Upon
and inserting the following:
(a) Extension of eligibility of certain school districts To receive cash or commodity letters of credit assistance for school lunch programs
(1) In general
On;
(ii)
in subsection (c), by striking (c)(1) The
and inserting the following:
(b) Alternative counting and claiming procedures
(1) In general
The;
(iii)
in subsection (g), by striking the subsection designation and heading and inserting the following:
;(c) Access to local foods: Patrick Leahy Farm to School Program
(iv)
by striking subsection (j); and
(v)
by redesignating subsections (h), (i), and (k) as subsections (d), (e), and (f), respectively.
(C)
Section 17(r)(5) of the Richard B. Russell National School Lunch Act (42 U.S.C. 1766(r)(5)) is amended by striking 18(h)
and inserting 18(d)
.
(D)
Section 19(i)(2) of the Richard B. Russell National School Lunch Act (42 U.S.C. 1769a(i)(2)) is amended by striking State that received funding under section 18(f) on the day before the date of enactment of the Food, Conservation, and Energy Act of 2008
and inserting State that, on the day before the date of enactment of the Food, Conservation, and Energy Act of 2008 (Public Law 110–246; 122 Stat. 1651), received funding under section 18(f) (as in effect on the day before that date of enactment)
.
(E)
Section 413(b)(2) of the Agricultural Research, Extension, and Education Reform Act of 1998 (7 U.S.C. 7633(b)(2)) is amended by striking section 18(g) of the Richard B. Russell National School Lunch Act (42 U.S.C. 1769(g))
and inserting subsection (c) of section 18 of the Richard B. Russell National School Lunch Act (42 U.S.C. 1769)
.
(F)
Section 28 of the Richard B. Russell National School Lunch Act (42 U.S.C. 1769i) is amended—
(i)
by striking subsection (b); and
(ii)
by redesignating subsection (c) as subsection (b).
(G)
Section 1154(a)(2)(A)(i) of title 10, United States Code, is amended by striking in accordance with section 9(b)(1) of the Richard B. Russell National School Lunch Act (42 U.S.C. 1758(b)(1)
.
(H)
Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) is amended by striking paragraph (7) and inserting the following:
(7)
provide safeguards that restrict the use or disclosure of information concerning applicants and recipients to purposes directly connected with the administration of the plan;
(I)
Section 4301 of the Food, Conservation, and Energy Act of 2008 (42 U.S.C. 1758a) is repealed.
(J)
Section 17 of the Child Nutrition Act of 1966 (42 U.S.C. 1786) is amended—
(i)
in subsection (d)—
(I)
in paragraph (2)(A)—
(aa)
by striking clause (i); and
(bb)
by redesignating clauses (ii) and (iii) as clauses (i) and (ii), respectively; and
(II)
in paragraph (3)—
(aa)
by striking subparagraph (D);
(bb)
by redesignating subparagraphs (E) and (F) as subparagraphs (D) and (E), respectively; and
(cc)
in subparagraph (D) (as so redesignated), by striking clause (ii) or (iii)
and inserting clause (i) or (ii)
; and
(ii)
in subsection (f)(17), by striking Notwithstanding subsection (d)(2)(A)(i), not later
and inserting Not later
.
(b) No collection of debt
(1) In general
Notwithstanding any other provision of the Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et seq.) or any other provision of law, effective beginning on the date of enactment of this Act, as a condition of participation in the school lunch program under that Act, a school—
(A)
shall not collect any debt owed to the school for unpaid meal charges; and
(B)
shall continue to accrue debt for unpaid meal charges—
(i)
for the purpose of receiving reimbursement under section 10332; and
(ii)
until the effective date specified in section 10302.
(2) National School Lunch Act
Section 9 of the Richard B. Russell National School Lunch Act (42 U.S.C. 1758) is amended by striking subsection (d) and inserting the following:
(d) No collection of debt
A school participating in the school lunch program under this Act shall not collect any debt owed to the school for unpaid meal charges.
Sec. 10323. Special assistance program
(a) In general
Section 11 of the Richard B. Russell National School Lunch Act (42 U.S.C. 1759a) is repealed.
(b) Conforming amendments
(1)
Section 6 of the Richard B. Russell National School Lunch Act (42 U.S.C. 1755) is amended—
(A)
in subsection (a)(2), by striking sections 11 and 13
and inserting section 13
; and
(B)
in subsection (e)(1), in the matter preceding subparagraph (A), by striking section 4, this section, and section 11
and inserting this section and section 4
.
(2)
Section 7(d) of the Richard B. Russell National School Lunch Act (42 U.S.C. 1756(d)) is amended by striking or 11
.
(3)
Section 8(g) of the Richard B. Russell National School Lunch Act (42 U.S.C. 1757(g)) is amended by striking and under section 11 of this Act
.
(4)
Section 12(f) of the Richard B. Russell National School Lunch Act (42 U.S.C. 1760(f)) is amended by striking 11,
.
(5)
Section 7(a) of the Child Nutrition Act of 1966 (42 U.S.C. 1766(a)) is amended—
(A)
in paragraph (1)(A), by striking 4, 11, and 17
and inserting 4 and 17
; and
(B)
in paragraph (2)(A), by striking sections 4 and 11
and inserting section 4
.
(6)
Section 1101(j)(3) of the Families First Coronavirus Response Act (7 U.S.C. 2011 note; Public Law 116–127) is amended—
(A)
by striking or served under section 11(a)(1) of the Richard B. Russell National School Lunch Act (42 U.S.C. 1760(d), 1759(a)(1))
and inserting of the Richard B. Russell National School Lunch Act (42 U.S.C. 1760(d))
; and
(B)
by striking or reduced price
.
Sec. 10324. Price for paid lunch
Section 12 of the Richard B. Russell National School Lunch Act (42 U.S.C. 1760) is amended—
(1)
in subsection (l)(4)—
(A)
by striking subparagraph (D); and
(B)
by redesignating subparagraphs (E) through (M) as subparagraphs (D) through (L), respectively;
(2)
by striking subsection (p); and
(3)
by redesignating subsections (q) and (r) as subsections (p) and (q), respectively.
Sec. 10325. Summer food service program for children
Section 13 of the Richard B. Russell National School Lunch Act (42 U.S.C. 1761) is amended—
(1)
in subsection (a)—
(A)
in paragraph (1)(A)(i)—
(i)
in subclause (I), by striking have been determined eligible for free or reduced price school meals under this Act and the Child Nutrition Act of 1966 (42 U.S.C. 1771 et seq.)
and inserting are economically disadvantaged students (as identified under a measure described in section 1113(a)(5) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6313(a)(5)))
;
(ii)
in subclause (II), by striking are eligible for free or reduced price school meals under this Act and the Child Nutrition Act of 1966 (42 U.S.C. 1771 et seq.)
and inserting are economically disadvantaged students (as identified under a measure described in section 1113(a)(5) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6313(a)(5)))
;
(iii)
in subclause (III)(bb), by striking meet the income standards for free or reduced price school meals under this Act and the Child Nutrition Act of 1966 (42 U.S.C. 1771 et seq.)
and inserting are economically disadvantaged students (as identified under a measure described in section 1113(a)(5) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6313(a)(5)))
;
(iv)
in subclause (IV), by striking are eligible for free or reduced price school meals under this Act and the Child Nutrition Act of 1966 (42 U.S.C. 1771 et seq.)
and inserting are economically disadvantaged students (as identified under a measure described in section 1113(a)(5) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6313(a)(5)))
; and
(v)
in subclause (V), by striking are eligible for free or reduced price school meals under this Act and the Child Nutrition Act of 1966 (42 U.S.C. 1771 et seq.)
and inserting are economically disadvantaged students (as identified under a measure described in section 1113(a)(5) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6313(a)(5)))
;
(B)
in paragraph (2), by adding at the end the following:
(C) Waiver
If the Secretary determines that a program requirement under this section limits the access of children to meals served under this section, the Secretary may waive that program requirement.
(D) Eligibility
All children shall be eligible to participate in the program under this section.;
(C)
in paragraph (5), by striking only for
and all that follows through the period at the end and inserting for meals served to all children.
; and
(D)
in paragraph (13)—
(i)
in subparagraph (C)(ii), by striking eligible for a free or reduced price lunch under this Act or a free or reduced price breakfast under section 4 of the Child Nutrition Act of 1966 (42 U.S.C. 1773)
and inserting an economically disadvantaged student (as identified under a measure described in section 1113(a)(5) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6313(a)(5)))
; and
(ii)
in subparagraph (D)(ii), by striking eligible for free or reduced price lunch under this Act or free or reduced price breakfast under section 4 of the Child Nutrition Act of 1966 (42 U.S.C. 1773)
and inserting economically disadvantaged students (as identified under a measure described in section 1113(a)(5) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6313(a)(5)))
;
(2)
in subsection (b)(2), by striking may only serve
and all that follows through migrant children
;
(3)
by striking subsection (c) and inserting the following:
(c) Payments
(1) In general
Payments shall be made to service institutions for meals served—
(A)
during the months of May through September;
(B)
during school vacation at any time during an academic school year;
(C)
during a teacher in-service day; and
(D)
on days that school is closed due to a natural disaster, building repair, court order, or similar cause, as determined by the Secretary.
(2) Limitation on payments
A service institution shall receive payments under this section for not more than 3 meals and 1 supplement per child per day.; and
(4)
in subsection (f)(3), by striking , except that
and all that follows through of this section
.
Sec. 10326. Summer electronic benefit transfer for children program
Section 13A of the Richard B. Russell National School Lunch Act (42 U.S.C. 1762) is amended—
(1)
in subsection (b)(2)(A)(i), by striking $40
and inserting $60
;
(2)
in subsection (c)(1)—
(A)
in subparagraph (A), by striking directly certified
and all that follows through this section
and inserting an economically disadvantaged student (as identified under a measure described in section 1113(a)(5) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6313(a)(5)))
;
(B)
by striking subparagraph (B); and
(C)
by redesignating subparagraphs (C) through (E) as subparagraphs (B) through (D), respectively;
(3)
in subsection (f)—
(A)
in paragraph (3), in the matter preceding subparagraph (A), by striking processes—
and all that follows through to reliably
in subparagraph (B) and inserting processes to reliably
; and
(B)
in paragraph (4), in the matter preceding subparagraph (A), by striking by—
and all that follows through establishing
in subparagraph (B) and inserting by establishing
; and
(4)
in subsection (h), by striking paragraph (2) and inserting the following:
(2) Eligible child
The term eligible child means any child residing in a State or on land under the jurisdiction of a covered Indian Tribal organization that participates in the program established under this section.
Sec. 10327. Child and adult care food program
Section 17 of the Richard B. Russell National School Lunch Act (42 U.S.C. 1766) is amended—
(1)
in subsection (a)(2), by striking subparagraph (B) and inserting the following:
(B)
any other private organization providing nonresidential child care or day care outside school hours for school children;;
(2)
by striking subsection (c) and inserting the following:
(c) Free meals
Notwithstanding any other provision of law—
(1)
all meals and supplements served under the program authorized under this section shall be provided for free to participants of the program; and
(2)
an institution that serves those meals and supplements shall be reimbursed—
(A)
in the case of breakfast, at the rate established for free breakfast under section 4(b)(1)(B)(i) of the Child Nutrition Act of 1966 (42 U.S.C. 1773(b)(1)(B)(i));
(B)
in the case of lunch, at the rate established for free lunch under section 4(b)(2)(A); and
(C)
in the case of a supplemental meal, $1.20, adjusted for inflation in accordance with section 4(b)(2)(C).;
(3)
in subsection (f)—
(A)
in paragraph (2), by striking subparagraph (B) and inserting the following:
(B) Limitation to reimbursements
An institution may claim reimbursement under this paragraph for not more than 3 meals and 1 supplement per day per child.;
(B)
by striking paragraph (3); and
(C)
by redesignating paragraph (4) as paragraph (3);
(4)
in subsection (o)—
(A)
by striking paragraph (4); and
(B)
by redesignating paragraphs (5) and (6) as paragraphs (4) and (5), respectively; and
(5)
in subsection (r)—
(A)
in the subsection heading, by striking Program for at-risk school children
and inserting Afterschool meal and snack program
;
(B)
by striking at-risk school
each place it appears and inserting eligible
;
(C)
in paragraph (1)—
(i)
in the paragraph heading, by striking at-risk school
and inserting eligible
; and
(ii)
in subparagraph (B), by striking operated
and all that follows through the period at the end and inserting a period; and
(D)
in paragraph (4)(A), by striking only for
and all that follows through the period at the end and inserting the following:
for—
(i)
not more than 1 meal and 1 supplement per child per day served on a regular school day; and
(ii)
not more than 3 meals and 1 supplement per child per day served on any day other than a regular school day.
Sec. 10328. Meals and supplements for children in afterschool care
Section 17A of the Richard B. Russell National School Lunch Act (42 U.S.C. 1766a) is amended—
(1)
in the section heading, by striking Meal supplements
and inserting Meals and supplements
;
(2)
in subsection (a)(1), by striking meal supplements
and inserting free meals and supplements
;
(3)
in subsection (b), by inserting meals and
before supplements
; and
(4)
by striking subsection (c) and inserting the following:
(c) Reimbursement
(1) In general
(A) Meals
A free meal provided under this section to a child shall be reimbursed at a rate of $4.63, adjusted annually for inflation in accordance with paragraph (3)(A) and rounded in accordance with paragraph (3)(B).
(B) Supplements
A free supplement provided under this section to a child shall be reimbursed at the rate at which free supplements are reimbursed under section 17(c)(2)(C).
(2) Limitation to reimbursements
An institution may claim reimbursement under this section for not more than 1 meal and 1 supplement per day per child served on a regular school day.
(3) Inflation; rounding
(A) Inflation adjustment
(i) In general
The annual inflation adjustment under paragraph (1)(A) shall reflect changes in the cost of operating the program under this section, as indicated by the change in the Consumer Price Index for food away from home for all urban consumers.
(ii) Basis
Each inflation annual adjustment under paragraph (1)(A) shall reflect the changes in the Consumer Price Index for food away from home for the most recent 12-month period for which those data are available.
(B) Rounding
On July 1, 2027, and annually thereafter, the reimbursement rate for a free meal under this section shall be—
(i)
adjusted to the nearest lower-cent increment; and
(ii)
based on the unrounded amounts for the preceding 12-month period.
Sec. 10329. Pilot projects
Section 18 of the Richard B. Russell National School Lunch Act (42 U.S.C. 1769) is amended—
(1)
in paragraph (5) of subsection (c) (as redesignated by section 10322(a)(2)(B)(i)(III)), by striking subparagraph (B) and inserting the following:
(B)
serve a high proportion of economically disadvantaged students (as identified under a measure described in section 1113(a)(5) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6313(a)(5)));; and
(2)
in paragraph (1)(A)(ii) of subsection (d) (as redesignated by section 10322(a)(2)(B)(i)(V)), by striking eligible for free or reduced price meals under this Act
and inserting economically disadvantaged students (as identified under a measure described in section 1113(a)(5) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6313(a)(5)))
.
Sec. 10330. Fresh fruit and vegetable program
Section 19(d) of the Richard B. Russell National School Lunch Act (42 U.S.C. 1769a(d)) is amended—
(1)
in paragraph (1)—
(A)
in the matter preceding subparagraph (A), by striking paragraph (2) of this subsection and
;
(B)
in subparagraph (A), in the matter preceding clause (i), by striking school—
and all that follows through submits
in clause (ii) and inserting school that submits
;
(C)
in subparagraph (B), by striking schools
and all that follows through Act
and inserting high-need schools (as defined in section 2211(b) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6631(b)))
; and
(D)
in subparagraph (D)—
(i)
by striking clause (i); and
(ii)
by redesignating clauses (ii) through (iv) as clauses (i) through (iii), respectively; and
(2)
by striking paragraphs (2) and (3) and inserting the following:
(2) Outreach to high-need schools
Prior to making decisions regarding school participation in the program, a State agency shall inform high-need schools (as defined in section 2211(b) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6631(b))), including Tribal schools, of the eligibility of the schools for the program.
Sec. 10331. Training, technical assistance, and Food Service Management Institute
Section 21(a)(1)(B) of the Richard B. Russell National School Lunch Act (42 U.S.C. 1769b–1(a)(1)(B)) is amended, in the matter preceding clause (i), by striking certified to receive free or reduced price meals
and inserting who are economically disadvantaged students (as identified under a measure described in section 1113(a)(5) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6313(a)(5)))
.
Sec. 10332. Reimbursement of school meal delinquent debt program
(a) Definitions
In this section:
(1) Delinquent debt
The term delinquent debt means the debt owed by a parent or guardian of a child to a school—
(A)
as of the effective date specified in section 10302; and
(B)
for meals served by the school under—
(i)
the school breakfast program under section 4 of the Child Nutrition Act of 1966 (42 U.S.C. 1773);
(ii)
the school lunch program established under the Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et seq.); or
(iii)
both of the programs described in clauses (i) and (ii).
(2) Program
The term program means the program established under subsection (b)(1).
(3) Secretary
The term Secretary means the Secretary of Agriculture.
(b) Reimbursement program
(1) Establishment
Not later than 60 days after the effective date specified in section 10302, the Secretary shall establish a program under which the Secretary shall reimburse each school participating in a program described in clause (i) or (ii) of subsection (a)(1)(B) for all delinquent debt.
(2) Form for reimbursement
To carry out the program, the Secretary shall design and distribute to State agencies a form to collect data relating to all delinquent debt in applicable schools in the State, organized by school food authority.
(3) Completion date
The Secretary shall provide all reimbursements under the program not later than 180 days after the effective date specified in section 10302.
(c) Report
Not later than 2 years after the effective date specified in section 10302, the Comptroller General of the United States shall submit to Congress and make publicly available a report that describes the successes and challenges of the program.
Sec. 10333. Conforming amendments
The Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et seq.) is amended—
(1)
by striking or reduced price
each place it appears;
(2)
by striking or a reduced price
each place it appears;
(3)
by striking and reduced price
each place it appears; and
(4)
by striking a reduced price
each place it appears.
Chapter 3 Elementary and secondary education data
Sec. 10341. Measure of poverty
Section 1113(a)(5) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6313(a)(5)) is amended—
(1)
in subparagraph (A), by striking the number of children eligible for a free or reduced price lunch under the Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et seq.)
and inserting the number of children from low-income backgrounds, identified under subparagraph (D)
; and
(2)
by adding at the end the following:
(D) Identification of children from low-income backgrounds
(i) In general
A local educational agency or State agency, for the purpose of identifying children from low-income backgrounds enrolled in a school served by a local educational agency, may—
(I)
maintain a record, with respect to each student for whom the local educational agency provides a free public education that contains the information collected from the survey described in clause (iii);
(II)
distribute and collect a student survey based on the template developed under clause (iii) to identify children from low-income backgrounds; and
(III)
utilize direct certification data described in clause (iv)(I) to identify children from low-income backgrounds.
(ii) Privacy
(I) In general
All individual data collected under this subparagraph shall be protected by the local educational agency or State agency in a manner consistent with all applicable local, State, and Federal privacy laws.
(II) Reporting data
Only aggregated data, which may include data disaggregated at the school, local educational agency, or State level, shall be reported to the Secretary at such time and in such manner as the Secretary may reasonably require.
(iii) Survey
Not later than 180 days after the date of enactment of the Universal School Meals Program Act of 2026, the Secretary, in consultation with the Secretary of Agriculture, shall develop a template survey—
(I)
to identify children from low-income backgrounds that contains only the information necessary to identify a child as a child from a low-income background by using the criteria of eligibility for a free or reduced priced lunch under the Richard B. Russell National School Lunch Act, as such criteria were in effect on September 30, 2022; and
(II)
that shall be designed to be easily accessible and in a user-friendly manner.
(iv) Transition authority from FRPL to ESEA measures
The Secretary, in coordination with the Secretary of Agriculture, shall have the authority to take such steps as are necessary to provide for the orderly transition to, and implementation of—
(I)
activities that are necessary for the continuity of direct certification carried out by local educational agencies and State agencies specified in paragraphs (4), (5), and (15) section 9(b) of the Richard B. Russell National School Lunch Act, as in effect on September 30, 2022, for the purposes of identifying any child eligible for free or reduced priced lunch under such Act, as in effect on such date, as a child from a low-income background;
(II)
procedures for verification of information collected under this subparagraph, which may include procedures modeled on the requirement specified in section 9(b)(3) of the Richard B. Russell National School Lunch Act, as in effect on September 30, 2022; and
(III)
data privacy provisions for information collected under this subparagraph, in accordance with the requirements specified in section 9(b)(6) of the Richard B. Russell National School Lunch Act, as in effect on September 30, 2022.
(v) Special rule
For the purposes of subparagraph (A), a local educational agency may determine the number of children from low-income backgrounds enrolled in a school served by such agency using one or more of the following methods:
(I)
Results from surveys specified in clause (i)(II).
(II)
Direct certification data specified in clause (i)(III).
(III)
Utilization of both methods described in subclauses (I) and (II).
Chapter 4 Amendments to other programs and laws
Sec. 10351. Supplemental nutrition assistance program
(a) Agreement for direct certification
(1) In general
Section 11 of the Food and Nutrition Act of 2008 (7 U.S.C. 2020) is amended—
(A)
by striking subsection (u); and
(B)
by redesignating subsections (v) through (x) as subsections (u) through (w), respectively.
(2) Conforming amendments
Section 11(e) of the Food and Nutrition Act of 2008 (7 U.S.C. 2020(e)) is amended—
(A)
in paragraph (8)(F), by striking or subsection (u)
; and
(B)
in paragraph (26)(B), by striking (x)
and inserting (w)
.
(b) Nutrition education and obesity prevention grant program
Section 28(a) of the Food and Nutrition Act of 2008 (7 U.S.C. 2036a(a)) is amended by striking paragraph (1) and inserting the following:
(1)
an individual eligible for benefits under this Act;
Sec. 10352. Higher Education Act of 1965
(a) Teacher quality enhancement
Section 200(11) of the Higher Education Act of 1965 (20 U.S.C. 1021(11)) is amended by striking subparagraph (A) and inserting the following:
(A) In general
The term high-need school means a school that is in the highest quartile of schools in a ranking of all schools served by a local educational agency, ranked in descending order by percentage of students from low-income families enrolled in such schools, as determined by the local educational agency based on one of the following measures of poverty:
(i)
The percentage of students aged 5 through 17 in poverty counted in the most recent census data approved by the Secretary.
(ii)
The percentage of students in families receiving assistance under the State program funded under the program of block grants to States for temporary assistance for needy families established under part A of title IV of the Social Security Act (42 U.S.C. 601 et seq.).
(iii)
The percentage of students eligible to receive medical assistance under the program of medical assistance established under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).
(iv)
A composite of 2 or more of the measures described in clauses (i) through (iii).
(b) GEAR Up
Section 404B(d)(1) of the Higher Education Act of 1965 (20 U.S.C. 1070a–22(d)(1)) is amended by striking subparagraph (A) and inserting the following:
(A)
provide services under this chapter to at least one grade level of students, beginning not later than 7th grade, in a participating school—
(i)
that has a 7th grade; and
(ii)
in which—
(I)
at least 50 percent of the students enrolled are economically disadvantaged students (as identified under a measure described in section 1113(a)(5) of the Elementary and Secondary Education Act of 1965); or
(II)
if an eligible entity determines that it would promote the effectiveness of a program, an entire grade level of students, beginning not later than the 7th grade, reside in public housing, as defined in section 3(b)(1) of the United States Housing Act of 1937 (42 U.S.C. 1437a(b)(1)).
(c) Simplified Application for Federal Student Financial Aid
(1) In General
Section 483(a)(2)(B)(ii)(XVII) of the Higher Education Act of 1965 (20 U.S.C. 1090(a)(2)(B)(ii)(XVII)) is amended—
(A)
by striking item (cc); and
(B)
by redesignating items (dd) through (jj) as items (cc) through (ii), respectively.
(2) Effective date
The amendments made by this section shall take effect as if included in section 702 of division FF of the Consolidated Appropriations Act, 2021 (Public Law 116–260) and subject to the effective date of section 701(b) of such FAFSA Simplification Act, as amended by section 102(a) of the FAFSA Simplification Act Technical Corrections Act (division R of Public Law 117–103) (including the authorization provided under section 102(c)(1)(A) of such Act).
(d) Early Federal Pell Grant commitment demonstration program
Section 894(b) of the Higher Education Act of 1965 (20 U.S.C. 1161y(b)) is amended—
(1)
in paragraph (1)(B), by striking qualify for a free or reduced price school lunch under the Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et seq.) or the Child Nutrition Act of 1966 (42 U.S.C. 1771 et seq.)
and inserting are economically disadvantaged students (as identified under a measure described in section 1113(a)(5) of the Elementary and Secondary Education Act of 1965)
; and
(2)
in paragraph (5), by striking eligible for a free or reduced price school lunch under the Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et seq.) or the Child Nutrition Act of 1966 (42 U.S.C. 1771 et seq.)
and inserting economically disadvantaged students (as identified under a measure described in section 1113(a)(5) of the Elementary and Secondary Education Act of 1965)
.
Sec. 10353. Elementary and Secondary Education Act of 1965
(a) Literacy education for all
Section 2221(b)(3)(B) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6641(b)(3)(B)) is amended—
(1)
by striking clause (i); and
(2)
by redesignating clauses (ii) and (iii) as clauses (i) and (ii), respectively.
(b) Grants for education innovation and research
Section 4611(d)(2) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7261(d)(2)) is amended—
(1)
by striking subparagraph (B); and
(2)
by redesignating subparagraphs (C) and (D) as subparagraphs (B) and (C), respectively.
Sec. 10354. America COMPETES Act
Section 6122(3) of the America COMPETES Act (20 U.S.C. 9832(3)) is amended by striking data on children eligible for free or reduced-price lunches under the Richard B. Russell National School Lunch Act,
.
Sec. 10355. Workforce Innovation and Opportunity Act
Section 3(36)(A) of the Workforce Innovation and Opportunity Act (29 U.S.C. 3102(36)(A)) is amended—
(1)
by striking clause (iv); and
(2)
by redesignating clauses (v) and (vi) as clauses (iv) and (v), respectively.
Sec. 10356. National Science Foundation Authorization Act of 2002
Section 4(8) of the National Science Foundation Authorization Act of 2002 (42 U.S.C. 1862n note; Public Law 107–368) is amended—
(1)
by striking subparagraph (A); and
(2)
by redesignating subparagraphs (B) and (C) as subparagraphs (A) and (B), respectively.
Sec. 10357. Child care and development block grant
Section 658O(b) of the Child Care and Development Block Grant Act of 1990 (42 U.S.C. 9858m(b)) is amended—
(1)
in paragraph (1)(B), by striking school lunch factor
and inserting economically disadvantaged students factor
; and
(2)
by striking paragraph (3) and inserting the following:
(3) Economically disadvantaged students factor
In this subsection, the term economically disadvantaged students factor means the ratio of the number of children in the State who are economically disadvantaged students (as identified under a measure described in section 1113(a)(5) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6313(a)(5))) to the number of such children in all the States as determined annually by the Secretary of Education.
Sec. 10358. Children’s Health Act of 2000
Section 1404(b) of the Children’s Health Act of 2000 (42 U.S.C. 9859c(b)) is amended—
(1)
in paragraph (1)(B), by striking school lunch factor
and inserting economically disadvantaged students factor
; and
(2)
by striking paragraph (3) and inserting the following:
(3) Economically disadvantaged students factor
In this subsection, the term economically disadvantaged students factor means the ratio of the number of children in the State who are economically disadvantaged students (as identified under a measure described in section 1113(a)(5) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6313(a)(5))) to the number of such children in all the States as determined annually by the Secretary of Education.
Sec. 10359. Juvenile justice and delinquency prevention
Section 252 of the Juvenile Justice and Delinquency Prevention Act of 1974 (34 U.S.C. 11162) is amended by striking subsection (i) and inserting the following:
(i) Free school lunches for incarcerated juveniles
(1) Definition of eligible juvenile detention center
In this subsection, the term eligible juvenile detention center does not include any private, for-profit detention center.
(2) Free lunch
A juvenile who is incarcerated in an eligible juvenile detention center is eligible to receive free lunch under the Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et seq.).
(3) Guidance
Not later than 1 year after the date of enactment of the Universal School Meals Program Act of 2026, the Attorney General, in consultation with the Secretary of Agriculture, shall provide guidance to States relating to the options for school food authorities in the States to apply for reimbursement for free lunches under the Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et seq.) for juveniles who are incarcerated.
Title XI Protections to combat regulatory harm to health equity
Sec. 11001. Repeal of Executive orders
(a) In general
The Executive orders described in subsection (b) shall have no force or effect, and no Federal funds may be used to implement, administer, enforce, or carry out any of those Executive orders.
(b) Executive orders described
The Executive orders described in this subsection are the following:
(1)
Executive Order 14148 (90 Fed. Reg. 8237; relating to initial rescissions of harmful executive orders and actions).
(2)
Executive Order 14158 (90 Fed. Reg. 8441; relating to establishing and implementing the President’s Department of Government Efficiency
).
(3)
Executive Order 14151 (90 Fed. Reg. 8339; relating to ending radical and wasteful Government DEI programs and preferencing).
(4)
Executive Order 14168 (90 Fed. Reg. 8615; relating to defending women from gender ideology extremism and restoring biological truth to the Federal Government).
(5)
Executive Order 14173 (90 Fed. Reg. 8633; relating to ending illegal discrimination and restoring merit-based opportunity).
(6)
Executive Order 14183 (90 Fed. Reg. 8757; relating to prioritizing military excellence and readiness).
(7)
Executive Order 14185 (90 Fed. Reg. 8763; relating to restoring America’s fighting force).
(8)
Executive Order 14201 (90 Fed. Reg. 9279; relating to keeping men out of women's sports).
(9)
Executive Order 14212 (90 Fed. Reg. 9833; relating to establishing the President’s Make America Healthy Again Commission).
(10)
Executive Order 14321 (90 Fed. Reg. 35817; relating to ending crime and disorder on America’s streets).
(c) Reinstatement
To the extent that any Executive order described in subsection (b) revoked or rescinded another Executive order or other Executive action, such revoked or rescinded Executive order or Executive action is hereby reinstated and restored to full legal force and effect.
Sec. 11002. Statutory restoration and reestablishment of Federal offices and programs
(a) Offices of minority health and health equity
(1) In general
Not later than 30 days after the date of enactment of this Act, each office described in paragraph (2) shall—
(A)
employ not less than the number of staff as such office employed as of January 19, 2025; and
(B)
carry out all functions as such office carried out as of such date.
(2) Offices
The offices described in this paragraph are each of the following:
(A)
The Office of Minority Health of the Department of Health and Human Services, established by section 1707 of the Public Health Service Act (42 U.S.C. 300u–6).
(B)
The Office of Minority Health of the Centers for Medicare & Medicaid Services, established pursuant to section 1707A of such Act (42 U.S.C. 300u–6a).
(C)
The Office of Minority Health and Health Equity of the Food and Drug Administration, established pursuant to such section 1707A.
(3) Resources
Not later than 30 days after the date of enactment of this Act, all websites, data portals, and public-facing resources of the offices described in paragraph (2), removed pursuant to any Executive order described in section 11001(b), shall be fully restored to their forms as in existence on January 19, 2025.
(4) Funding
The Secretary of Health and Human Services shall ensure that any amounts appropriated or otherwise made available for an office described in paragraph (2) as of January 19, 2025, that were retracted or otherwise withheld from such office during the period beginning on January 19, 2025, and ending on the date of enactment of this Act are transferred to, or otherwise reinstated for, such office. Any such amounts shall be used by the office to carry out paragraph (1) with respect to such office.
(b) National Institute on Minority Health and Health Disparities
(1) In general
Not later than 30 days after the date of enactment of this Act, the National Institute on Minority Health and Health Disparities, established by section 401(b)(24) of the Public Health Service Act (42 U.S.C. 281(b)(24)), shall—
(A)
employ not less than the number of staff as such Institute employed as of January 19, 2025; and
(B)
carry out all functions as such Institute carried out as of such date.
(2) Director
The Director of the National Institute on Minority Health and Health Disparities, or any Acting Director of such Institute, placed on administrative leave or terminated pursuant to any Executive order described in section 11001(b), or a related Executive action, is reinstated, subject to the consent of such Director, for a term of 5 years beginning on the date of enactment of this Act. Nothing in this paragraph shall limit the authority of the Secretary or the Director of the National Institutes of Health described in section 405(a)(2)(E) of the Public Health Service Act (42 U.S.C. 284(a)(2)(E)).
(3) Functions
No provision of Federal statutory law may eliminate the National Institute on Minority Health and Health Disparities without specifying how the statutory functions of the Institute will be carried out.
(4) Funding
The Secretary of Health and Human Services shall ensure that any amounts appropriated or otherwise made available for the National Institute on Minority Health and Health Disparities as of January 19, 2025, that were retracted or otherwise withheld from such Institute during the period beginning on January 19, 2025, and ending on the date of enactment of this Act are transferred to, or otherwise reinstated for, such Institute. Any such amounts shall be used by the Institute to carry out paragraph (1).
(c) Offices of health equity; Health Equity Advisory Committee
Title XVII of the Public Health Service Act (42 U.S.C. 300u et seq.) is amended by inserting after section 1707A (42 U.S.C. 300ua–6a) the following:
1707B. Individual Offices of Health Equity within the Department
(a) In general
The head of each agency specified in subsection (b) shall establish within the agency an office to be known as the Office of Health Equity. The head of each such Office shall be a Director appointed by the head of the agency within which the Office is established, and such Director shall report directly to the head of the agency. The head of such agency shall carry out all functions (as this section relates to the agency) acting through such Director.
(b) Agencies
The agencies described in this subsection are each of the following:
(1)
The Centers for Disease Control and Prevention.
(2)
The Health Resources and Services Administration.
(c) Functions and staff
(1) CDC
The Office of Health Equity of the Centers for Disease Control and Prevention established by this section shall—
(A)
employ not less than the number of staff the Office of Health Equity of the Centers for Disease Control and Prevention operating on January 19, 2025, employed as of such date; and
(B)
carry out all functions that the Office of Health Equity of the Centers for Disease Control and Prevention operating on January 19, 2025, carried out as of such date.
(2) HRSA
The Office of Health Equity of the Health Resources and Services Administration established by this section shall—
(A)
employ not less than the number of staff the Office of Health Equity of the Health Resources and Services Administration operating on January 19, 2025, employed as of such date; and
(B)
carry out all functions that the Office of Health Equity of the Health Resources and Services Administration operating on January 19, 2025, carried out as of such date.
(d) Funding
(1) CDC
The Secretary shall ensure that any amounts appropriated or otherwise made available for the Office of Health Equity of the Centers for Disease Control and Prevention operating on January 19, 2025, that were retracted or otherwise withheld from such office during the period beginning on January 19, 2025, and ending on the date of enactment of the Health Equity and Accountability Act of 2026 are transferred to, or otherwise reinstated for, the Office of Health Equity of the Centers for Disease Control and Prevention established under this section. Any such amounts shall be used by such Office to carry out subsection (c)(1).
(2) HRSA
The Secretary shall ensure that any amounts appropriated or otherwise made available for the Office of Health Equity of the Health Resources and Services Administration operating on January 19, 2025, that were retracted or otherwise withheld from such office during the period beginning on January 19, 2025, and ending on the date of enactment of the Health Equity and Accountability Act of 2026 are transferred to, or otherwise reinstated for, the Office of Health Equity of the Health Resources and Services Administration established under this section. Any such amounts shall be used by such Office to carry out subsection (c)(2).
1707C. Health Equity Advisory Committee
(a) Establishment
There is established in the Department of Health and Human Services an advisory committee to be known as the
Health Equity Advisory Committee(referred to in this section as theAdvisory Committee).(b) Members
The Advisory Committee shall be composed of 20 members, all of whom shall be appointed by the Secretary not later than 90 days after the date of enactment of the Health Equity and Accountability Act of 2026.
(c) Duties
The Advisory Committee shall—
(1)
advise the Secretary on the priorities and concerns of populations experiencing health disparities;
(2)
recommend actions, standards, and methodologies that are data-driven, evidence-based, and culturally and linguistically appropriate for the identification, measurement, and elimination of health disparities;
(3)
advise the Secretary on the design, collection, analysis, disaggregation, and public reporting of data necessary to identify and monitor health disparities, including data on race, ethnicity, primary language, sexual orientation, gender identity, disability status, and socioeconomic status;
(4)
review, and recommend revisions to, departmental policies, standards, regulations, and procedures that may create, perpetuate, or fail to mitigate health inequities;
(5)
assist the Secretary in developing, implementing, and monitoring performance measures related to the advancement of health equity across the programs of the Department;
(6)
increase public awareness of the existence, causes, and consequences of health disparities;
(7)
carry out such other duties as the Secretary may assign to advance the purposes of the Health Equity and Accountability Act of 2026; and
(8)
carry out any other duty that the Health Equity Advisory Committee of the Department of Health and Human Services, operating on January 19, 2025, carried out as of such date.
(d) SAMHSA and other health agencies
(1) In general
Not later than 30 days after the date of enactment of this Act, each of the agencies of the Department of Health and Human Services described in paragraph (2) shall—
(A)
employ not less than the number of staff as such agency employed as of January 19, 2025; and
(B)
carry out all functions (including by carrying out all grants and programs) that such agency carried out as of such date.
(2) Agencies
The agencies described in this paragraph are each of the following:
(A)
The Substance Use and Mental Health Services Administration established by title V of the Public Health Service Act (42 U.S.C. 290aa et seq.) and renamed pursuant to the amendments made by section 6707.
(B)
The Office of Infectious Diseases and HIV/AIDS Policy.
(C)
The National Institute of Nursing Research, established by section 401(b)(17) of the Public Health Service Act (42 U.S.C. 281(b)(17)).
(D)
The John E. Fogarty International Center for Advanced Study in the Health Sciences, established by section 401(b)(22) of such Act.
(E)
The National Center for Complementary and Integrative Health, established by section 401(b)(23) of such Act.
(3) Funding
The Secretary of Health and Human Services shall ensure that any amounts appropriated or otherwise made available for an agency described in paragraph (2) as of January 19, 2025, that were retracted or otherwise withheld from such agency during the period beginning on January 19, 2025, and ending on the date of enactment of this Act are transferred to, or otherwise reinstated for, such agency. Any such amounts shall be used by the agency to carry out paragraph (1) with respect to such agency.
(e) Office of Federal Contract Compliance Programs
(1) In general
Not later than 30 days after the date of enactment of this Act, the Office of Federal Contract Compliance Programs of the Department of Labor shall—
(A)
employ not less than the number of staff as such Office employed as of January 19, 2025; and
(B)
carry out all functions that such Office carried out as of such date.
(2) Funding
The Secretary of Labor shall ensure that any amounts appropriated or otherwise made available for the Office of Federal Contract Compliance Programs of the Department of Labor as of January 19, 2025, that were retracted or otherwise withheld from such Office during the period beginning on January 19, 2025, and ending on the date of enactment of this Act are transferred to, or otherwise reinstated for, such Office. Any such amounts shall be used by the Office to carry out paragraph (1).
(f) United States Agency for International Development health programs
(1) In general
Not later than 30 days after the date of the enactment of this Act, the Secretary of State shall—
(A)
reestablish the Bureau for Global Health of the United States Agency for International Development as an independent agency of the Federal Government;
(B)
initiate the hiring or rehiring of staff in the Bureau for Global Health so that the number of such staff and the positions occupied by such staff are roughly equivalent to the number and positions of such staff that were employed by the Bureau as of January 19, 2025; and
(C)
establish a detailed strategy for ensuring the Bureau for Global Health resumes the responsibility of carrying out all of the functions that were assigned to the Bureau as of such date.
(2) Funding
The Secretary of State shall ensure that any amounts appropriated or otherwise made available for the Bureau for Global Health as of January 19, 2025, which were subsequently withheld from the Bureau, are made available to the Bureau to carry out the actions required under paragraph (1), including implementing the strategy referred to in paragraph (1)(C).
Sec. 11003. Reinstatement of Federal data collection standards
(a) Reinstatement
Not later than 60 days after the date of enactment of this Act, each Federal agency shall restore all Federal sociodemographic data collection systems (including survey instruments), datasets, and reporting mechanisms relating to race, ethnicity, sex, sexual orientation, gender identity, disability status, income, and other characteristics protected by Federal law, to the systems, datasets, and mechanisms of the Federal agency as in existence on January 19, 2025.
(b) Data restoration
Not later than 30 days after the date of enactment of this Act, all datasets, publications, and web resources removed from public access, modified, or restricted by any Federal agency pursuant to any Executive order described in section 11001(b) shall be fully restored as in existence on January 19, 2025, with no data permanently deleted.
(c) Reporting
Not later than 90 days after the date of enactment of this Act, the Director of the Office of Management and Budget shall submit to Congress a comprehensive report—
(1)
identifying every Federal dataset, publication, and web resource that was removed, modified, or restricted pursuant to an Executive order described in section 11001(b); and
(2)
certifying that each such dataset, publication, or resource has been restored as in existence on January 19, 2025.
Sec. 11004. Reinstatement of anti-discrimination requirements for Federal contractors
(a) Affirmative action requirements
Without an express provision of Federal statutory law, no Executive action, including any Executive order, guidance or directive of the Office of Management and Budget, or other Federal agency guidance or directive, may relieve any Federal contractor of equal employment opportunity and affirmative action obligations under Executive Order 11246 (42 U.S.C. 2000e note; relating to equal employment opportunity), as reinstated pursuant to section 11001(c) or under other applicable law.
(b) Certification requirements
Any certification requirement imposed by Executive Order 14173 (90 Fed. Reg. 8633; relating to ending illegal discrimination and restoring merit-based opportunity) requiring Federal contractors, including subcontractors, to certify that such contractors do not maintain any diversity, equity, and inclusion programs that violate any applicable Federal anti-discrimination laws shall have no force or effect. No such certification, or any similar certification, may be required as a condition of any Federal contract.
(c) Enforcement
The Office of Federal Contract Compliance Programs of the Department of Labor shall resume full enforcement of equal employment opportunity and affirmative action requirements for Federal contractors under Executive Order 11246 (42 U.S.C. 2000e note; relating to equal employment opportunity), and any other applicable law, consistent with the law as in effect on January 19, 2025.
Sec. 11005. Reaffirmation and codification of disparate impact liability
(a) Enforcement
All Federal agencies shall actively enforce disparate impact discrimination prohibitions under Federal statutory law to the full extent of applicable law, consistent with the regulations, guidance, and enforcement policies of the Federal Government in effect on January 19, 2025.
(b) Statutory codification
No Executive action, including any Executive order, presidential memorandum, or Federal agency guidance or directive, may direct any Federal agency to deprioritize, suspend, or cease enforcement of disparate impact discrimination liability under any Federal statutory law. Any such direction in such an Executive action to deprioritize, suspend, or cease enforcement is contrary to law and shall have no force or effect.
Sec. 11006. Limitations on future Executive action
(a) Prohibition
Notwithstanding any other provision of law, without an express provision of Federal statutory law, no Executive action, including any Executive order, presidential memorandum, or directive of the Office of Management and Budget, may—
(1)
abolish, eliminate, defund (or otherwise reduce funding for), or reduce below legally mandated minimum staffing levels (including as provided in this title) any Federal office, agency, or program established by a provision of Federal statutory law, or otherwise described in section 11002;
(2)
direct a Federal agency to remove sociodemographic data from any Federal survey, dataset, or public health surveillance system relating to characteristics protected under Federal law; or
(3)
direct any Federal agency to terminate, suspend, or cease enforcement of any provision of the Civil Rights Act of 1964 (42 U.S.C. 2000a et seq), the Fair Housing Act (42 U.S.C. 3601 et seq.), the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.), the Age Discrimination in Employment Act of 1967 (29 U.S.C. 621 et seq.), the Voting Rights Act of 1965 (52 U.S.C. 10301 et seq.), or any other Federal civil rights statute.
(b) Congressional notification requirement
Not later than 5 days after the issuance of any Executive order that the President contends affects Federal offices or programs relating to health equity, civil rights, anti-discrimination, or sociodemographic data collection, the Director of the Office of Management and Budget shall submit a written notification to the relevant congressional oversight committees describing the actions directed by such order and their projected effects on the affected offices and programs.
(c) Private right of action
Any person aggrieved by a violation of subsection (a) may bring a civil action in an appropriate Federal district court for declaratory and injunctive relief. A court in such an action may award reasonable attorneys’ fees to prevailing plaintiffs.
Sec. 11007. Severability
If any provision of this title, or the application of any provision of this title to any person or circumstance, is held to be invalid, the remainder of this title and the application of its provisions to other persons or circumstances shall not be affected thereby.
Sec. 11008. Authorization of appropriations
(a) In general
There are authorized to be appropriated such sums as may be necessary to carry out this title, including to restore all offices, programs, staffing levels, and data systems described in this title to the status as of January 19, 2025, and to make whole all persons harmed by unlawful impoundment or agency actions pursuant to any Executive order described in section 11001(b).
(b) Retroactive payments
There are authorized to be appropriated such sum as may be necessary to provide retroactive payment of all grants, contracts, awards, and employee compensation withheld or cancelled pursuant to any Executive order described in section 11001(b).
(c) Prohibition on impoundment
No funds appropriated pursuant to this Act may be withheld, deferred, or rescinded by the Executive branch without compliance with the procedures set forth in the Impoundment Control Act of 1974 (2 U.S.C. 681 et seq.).