Home > 106th Congressional Bills > S. 2218 (is) To amend title 5, United States Code, to provide for the establishment of a program under which long-term care insurance is made available to Federal employees and annuitants and members of the uniformed services, and for other purposes. [Int...S. 2218 (is) To amend title 5, United States Code, to provide for the establishment of a program under which long-term care insurance is made available to Federal employees and annuitants and members of the uniformed services, and for other purposes. [Int...
108th CONGRESS
2d Session
S. 2217
To improve the health of health disparity populations.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 12, 2004
Mr. Frist introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To improve the health of health disparity populations.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Closing the Health
Care Gap Act of 2004''.
(b) Table of contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
TITLE I--IMPROVED HEALTH CARE QUALITY AND EFFECTIVE DATA COLLECTION AND
ANALYSIS
Sec. 101. Standardized measures of quality health care.
Sec. 102. Data collection.
TITLE II--EXPANDED ACCESS TO QUALITY HEALTH CARE
Subtitle A--Access, Awareness, and Outreach
Sec. 201. Access and awareness grants.
Sec. 202. Innovative outreach programs.
Subtitle B--Refundable Health Insurance Credit
Sec. 211. Refundable health insurance costs credit.
Sec. 212. Advance payment of credit to issuers of qualified health
insurance.
TITLE III--STRONG NATIONAL LEADERSHIP, COOPERATION, AND COORDINATION
Sec. 301. Office of Minority Health and Health Disparities.
TITLE IV--PROFESSIONAL EDUCATION, AWARENESS, AND TRAINING
Sec. 401. Workforce diversity and training.
Sec. 402. Higher education technical amendments.
Sec. 403. Model cultural competency curriculum development.
Sec. 404. Internet cultural competency clearinghouse.
TITLE V--ENHANCED RESEARCH
Sec. 501. Agency for Healthcare Research and Quality.
Sec. 502. National Institutes of Health.
TITLE VI--MISCELLANEOUS PROVISIONS
Sec. 601. Definitions.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) The overall health of Americans has dramatically
improved over the last century, and Americans are justifiably
proud of the great strides that have been made in the health
and medical sciences.
(2) As medical science and technology have advanced at a
rapid pace, however, the health care delivery system has not
been able to provide consistently high quality care to all
Americans.
(3) In particular, people of lower socioeconomic status,
racial and ethnic minorities, and medically underserved
populations have experienced poor health and challenges in
accessing high quality health care.
(4) Recent studies have raised significant questions
regarding differences in clinical care provided to racial and
ethnic minorities and other health disparity populations. These
differences are often grouped together under the broad heading
of ``health disparities''.
(5) Studies indicate that a gap exists between ideal health
care and the actual health care that some Americans receive.
(6) Data collection, analysis, and reporting by race,
ethnicity, and primary language across federally supported
health programs are essential for identifying, understanding
the causes of, monitoring, and eventually eliminating health
disparities.
(7) Current health related data collection and reporting
activities largely reflect the efforts of the Department of
Health and Human Services. Despite considerable efforts by the
Department, data collection efforts governing racial, ethnic,
and health disparity populations remain inconsistent and
inadequate. They often quantify disparities but shed little
light on their causes.
(8) Many Americans, and particularly racial and ethnic
minorities and other health disparity populations, miss
opportunities for preventive medical care. Similarly,
management of chronic illnesses in these populations presents
unique challenges to the nation's health care system.
(9) The largest numbers of the medically underserved are
white individuals, and many of them have the same health care
access problems as do members of minority groups. Nearly
22,000,000 white individuals live below the poverty line with
many living in nonmetropolitan, rural areas such as Appalachia,
where the high percentage of countries designated as health
professional shortage areas (47 percent) and the high rate of
poverty contribute to disparity outcomes. However, there is a
higher proportion of racial and ethnic minorities in the United
States represented among the medically underserved.
(10) While much research examines the question of racial
and ethnic differences in health care, less is known about the
magnitude and extent of differences in the quality of health
care related to nonsocioeconomic factors. Only recently have
scientists and quality improvement experts begun to address the
issue of how best to measure, track, and improve quality of
health care in diverse populations. Additional research in
order to understand the causes of disparities and develop
effective approaches to eliminate these gaps in health care
quality will be necessary.
(11) There is a need to ensure appropriate representation
of racial and ethnic minorities, and other health disparity
populations, in the health care professions and in the fields
of biomedical, clinical, behavioral, and health services
research.
(12) Preventable disparities in access to and quality of
health care are unacceptable. Health care delivered in the
United States should be care that is as safe, effective,
patient-centered, timely, efficient and equitable as possible.
TITLE I--IMPROVED HEALTH CARE QUALITY AND EFFECTIVE DATA COLLECTION AND
ANALYSIS
SEC. 101. STANDARDIZED MEASURES OF QUALITY HEALTH CARE.
(a) In General.--
(1) Collaboration.--The Secretary of Health and Human
Services, the Secretary of Defense, the Secretary of Veterans
Affairs, the Director of the Indian Health Service, and the
Director of the Office of Personnel Management (referred to in this
section as the ``Secretaries'') shall work collaboratively to establish
uniform, standardized health care quality measures across all Federal
Government health programs. Such measures shall be designed to assess
quality improvement efforts with regard to the safety, timeliness,
effectiveness, patient-centeredness, and efficiency of health care
delivered across all federally supported health care delivery programs
including those in which health care services are delivered to health
disparity populations.
(2) Development of measures.--Relying on earlier work by
the Secretary of Health and Human Services or others (including
work such as the Healthy People 2010 or the IOM Quality Chasm
reports) and with an emphasis on health conditions
disproportionately affecting health disparity populations and
taking into account health literacy and primary language and
cultural factors, the Secretaries shall develop standardized
sets of quality measures for--
(A) 5 common health conditions by not later than
January 1, 2006; and
(B) an additional 10 common health conditions by
not later than January 1, 2007.
(3) Pilot testing.--Each federally administered health care
program may conduct a pilot test of the quality measures
developed under paragraph (2) that shall include a collection
of patient-level data and a public release of comparative
performance reports.
(b) Public Reporting Requirements.--The Secretaries shall work
collaboratively to establish standardized public reporting requirements
for clinicians, institutional providers, and health plans in each of
the health programs described in subsection (a).
(c) Full Implementation.--The Secretaries shall work
collaboratively to prepare for the full implementation of all
standardized sets of quality measures and reporting systems developed
under subsections (a) and (b) by not later than January 1, 2009.
(d) Progress Report.--The Secretary of Health and Human Services
shall prepare an annual progress report that details the collaborative
efforts carried out under subsection (a).
(e) Comparative Quality Reports.--Beginning on January 1, 2008, in
order to make comparative quality information available to health care
consumers, including members of health disparity populations, health
professionals, public health officials, researchers, and other
appropriate individuals and entities, the Secretaries shall provide for
the pooling and analysis of quality measures collected under this
section. Nothing in this section shall be construed as modifying the
privacy standards under the Health Insurance Portability and
Accountability Act of 1996 (Public Law 104-191).
(f) Ongoing Evaluation of Use.--The Secretary of Health and Human
Services shall ensure the ongoing evaluation of the use of the health
care quality measures established under this section.
(g) Existing Activities.--Notwithstanding any other provision of
law, the standardized measures and reporting activities described in
this section shall replace, to the extent practicable and appropriate,
any existing measurement and reporting activities currently utilized by
federally supported health care delivery programs.
(h) Evaluation.--
(1) Institute of medicine.--
(A) In general.--The Secretary of Health and Human
Services shall request the Institute of Medicine to
conduct an evaluation of the collaborative efforts of
the Secretaries to establish uniform, standardized
health care quality measures and reporting requirements
for federally supported health care delivery programs
as required under this section.
(B) Report.--Not later than 2 years after the date
of enactment of this Act, the Institute of Medicine
shall submit a report concerning the results of the
evaluation under subparagraph (A) to the Secretary.
(2) Regulations.--
(A) Proposed.--Not later than 18 months after the
date on which the report is submitted under paragraph
(1)(B), the Secretary shall publish proposed
regulations regarding the uniform, standardized health
care quality measures and reporting requirements
described in this section.
(B) Final regulations.--Not later than 3 years
after the date on which the report is submitted under
paragraph (1)(B), the Secretary shall publish final
regulations regarding the uniform, standardized health
care quality measures and reporting requirements
described in this section.
SEC. 102. DATA COLLECTION.
(a) In General.--The Secretary of Health and Human Services
(referred to in this section as the ``Secretary'') shall--
(1) ensure that data collected under the medicare program
under title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.) are accurate by race, ethnicity, and primary language and
available for inclusion in the National Health Disparities
Report;
(2) enforce State data collection and reporting by race,
ethnicity, and primary language for enrollees in the medicaid
program under title XIX of the Social Security Act (42 U.S.C.
1396 et seq.) and the State Children's Health Insurance Program
under title XXI of such Act (42 U.S.C. 1397aa et seq.) and
ensure that such data are available for inclusion in the
National Health Disparities Report;
(3) ensure that ongoing and any new program initiatives--
(A) collect and report data by race, ethnicity, and
primary language and provide technical assistance to
promote compliance;
(B) address technological difficulties;
(C) ensure privacy and confidentiality of data
collected; and
(D) implement effective educational strategies;
(4) expand educational programs to inform insurers,
providers, agencies and the public of the importance of data
collection by race, ethnicity, and primary language to
improving health care access and quality;
(5) raise awareness that these data are critical for
achieving Healthy People 2010 goals and essential to the
nondiscrimination requirements of title VI of the Civil Rights
Act (42 U.S.C. 2000d et seq.); and
(6) support research on existing best practices for data
collection.
(b) Grants for Data Collection by Health Plans, Health Centers, and
Hospitals.--
(1) In general.--The Secretary, acting through the Director
of the Agency for Healthcare Research and Quality, may support
or conduct not to exceed 20 demonstration programs to enhance
the collection, analysis, and reporting of the data required
under this section.
(2) Eligibility.--To be eligible to receive a grant under
this section an entity shall--
(A) be a health plan, federally qualified health
center or health center network, or hospital; and
(B) prepare and submit to the Secretary an
application at such time, in such manner, and
containing such as information as the Secretary may
require.
(3) Use of funds.--A grantee shall use amounts received
under a grant under this subsection to--
(A) collect, analyze, and report data by race,
ethnicity, or other health disparity category for
patients served by the grantee, including--
(i) in the case of a hospital, emergency
room patients and patients served on an
inpatient or outpatient basis;
(ii) in the case of a health plan, data for
enrollees; and
(iii) in the case of a federally qualified
health center or health center network, primary
care, specialty care, and referrals;
(B) provide analyses of racial, ethnic and other
disparities in health and health care, including
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