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1 Subtitle B—Reducing Health
2 Disparities
3 SEC. 1221. ENSURING EFFECTIVE COMMUNICATION IN

4 MEDICARE.

5 (a) ENSURING EFFECTIVE COMMUNICATION BY THE

6 CENTERS FOR MEDICARE & MEDICAID SERVICES.—

7 (1) STUDY ON MEDICARE PAYMENTS FOR LAN-

8 GUAGE SERVICES.—The Secretary of Health and

9 Human Services shall conduct a study that examines
10 the extent to which Medicare service providers uti-
11 lize, offer, or make available language services for
12 beneficiaries who are limited English proficient and
13 ways that Medicare should develop payment systems
14 for language services.
15 (2) ANALYSES.—The study shall include an
16 analysis of each of the following:
17 (A) How to develop and structure appro-
18 priate payment systems for language services
19 for all Medicare service providers.
20 (B) The feasibility of adopting a payment
21 methodology for on-site interpreters, including
22 interpreters who work as independent contrac-
23 tors and interpreters who work for agencies
24 that provide on-site interpretation, pursuant to
25 which such interpreters could directly bill Medi-

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1 care for services provided in support of physi-
2 cian office services for an LEP Medicare pa-
3 tient.
4 (C) The feasibility of Medicare contracting
5 directly with agencies that provide off-site inter-
6 pretation including telephonic and video inter-
7 pretation pursuant to which such contractors
8 could directly bill Medicare for the services pro-
9 vided in support of physician office services for
10 an LEP Medicare patient.
11 (D) The feasibility of modifying the exist-
12 ing Medicare resource-based relative value scale
13 (RBRVS) by using adjustments (such as multi-
14 pliers or add-ons) when a patient is LEP.
15 (E) How each of options described in a
16 previous paragraph would be funded and how
17 such funding would affect physician payments,
18 a physician’s practice, and beneficiary cost-
19 sharing.
20 (F) The extent to which providers under
21 parts A and B of title XVIII of the Social Secu-
22 rity Act, MA organizations offering Medicare
23 Advantage plans under part C of such title and
24 PDP sponsors of a prescription drug plan
25 under part D of such title utilize, offer, or make

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1 available language services for beneficiaries with
2 limited English proficiency.
3 (G) The nature and type of language serv-
4 ices provided by States under title XIX of the
5 Social Security Act and the extent to which
6 such services could be utilized by beneficiaries
7 and providers under title XVIII of such Act.
8 (3) VARIATION IN PAYMENT SYSTEM DE-

9 SCRIBED.—The payment systems described in para-

10 graph (2)(A) may allow variations based upon types
11 of service providers, available delivery methods, and
12 costs for providing language services including such
13 factors as—
14 (A) the type of language services provided
15 (such as provision of health care or health care
16 related services directly in a non-English lan-
17 guage by a bilingual provider or use of an inter-
18 preter);
19 (B) type of interpretation services provided
20 (such as in-person, telephonic, video interpreta-
21 tion);
22 (C) the methods and costs of providing
23 language services (including the costs of pro-
24 viding language services with internal staff or

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1 through contract with external independent con-
2 tractors or agencies, or both);
3 (D) providing services for languages not
4 frequently encountered in the United States;
5 and
6 (E) providing services in rural areas.
7 (4) REPORT.—The Secretary shall submit a re-
8 port on the study conducted under subsection (a) to
9 appropriate committees of Congress not later than
10 12 months after the date of the enactment of this
11 Act.
12 (5) EXEMPTION FROM PAPERWORK REDUCTION

13 ACT.—Chapter 35 of title 44, United States Code

14 (commonly known as the ‘‘Paperwork Reduction
15 Act’’ ), shall not apply for purposes of carrying out
16 this subsection.
17 (6) AUTHORIZATION OF APPROPRIATIONS.—

18 There is authorized to be appropriated to carry out

19 this subsection such sums as are necessary.
20 (b) HEALTH PLANS.—Section 1857(g)(1) of the So-
21 cial Security Act (42 U.S.C. 1395w–27(g)(1)) is amend-
22 ed—
23 (1) by striking ‘‘or’’ at the end of subparagraph
24 (F);

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1 (2) by adding ‘‘or’’ at the end of subparagraph
2 (G); and
3 (3) by inserting after subparagraph (G) the fol-
4 lowing new subparagraph:
5 ‘‘(H) fails substantially to provide lan-
6 guage services to limited English proficient
7 beneficiaries enrolled in the plan that are re-
8 quired under law;’’.
9 SEC. 1222. DEMONSTRATION TO PROMOTE ACCESS FOR

10 MEDICARE BENEFICIARIES WITH LIMITED

11 ENGLISH PROFICIENCY BY PROVIDING REIM-

12 BURSEMENT FOR CULTURALLY AND LINGUIS-

13 TICALLY APPROPRIATE SERVICES.

14 (a) IN GENERAL.—Not later than 6 months after the

15 date of the completion of the study described in section
16 1221(a), the Secretary, acting through the Centers for
17 Medicare & Medicaid Services, shall carry out a dem-
18 onstration program under which the Secretary shall award
19 not fewer than 24 3-year grants to eligible Medicare serv-
20 ice providers (as described in subsection (b)(1)) to improve
21 effective communication between such providers and Medi-
22 care beneficiaries who are living in communities where ra-
23 cial and ethnic minorities, including populations that face
24 language barriers, are underserved with respect to such
25 services. In designing and carrying out the demonstration

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1 the Secretary shall take into consideration the results of
2 the study conducted under section 1221(a) and adjust, as
3 appropriate, the distribution of grants so as to better tar-
4 get Medicare beneficiaries who are in the greatest need
5 of language services. The Secretary shall not authorize a
6 grant larger than $500,000 over three years for any grant-
7 ee.
8 (b) ELIGIBILITY; PRIORITY.—
9 (1) ELIGIBILITY.—To be eligible to receive a
10 grant under subsection (a) an entity shall—
11 (A) be—
12 (i) a provider of services under part A
13 of title XVIII of the Social Security Act;
14 (ii) a service provider under part B of
15 such title;
16 (iii) a part C organization offering a
17 Medicare part C plan under part C of such
18 title; or
19 (iv) a PDP sponsor of a prescription
20 drug plan under part D of such title; and
21 (B) prepare and submit to the Secretary
22 an application, at such time, in such manner,
23 and accompanied by such additional informa-
24 tion as the Secretary may require.
25 (2) PRIORITY.—

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1 (A) DISTRIBUTION.—To the extent fea-
2 sible, in awarding grants under this section, the
3 Secretary shall award—
4 (i) at least 6 grants to providers of
5 services described in paragraph (1)(A)(i);
6 (ii) at least 6 grants to service pro-
7 viders described in paragraph (1)(A)(ii);
8 (iii) at least 6 grants to organizations
9 described in paragraph (1)(A)(iii); and
10 (iv) at least 6 grants to sponsors de-
11 scribed in paragraph (1)(A)(iv).
12 (B) FOR COMMUNITY ORGANIZATIONS.—

13 The Secretary shall give priority to applicants

14 that have developed partnerships with commu-
15 nity organizations or with agencies with experi-
16 ence in language access.
17 (C) VARIATION IN GRANTEES.—The Sec-
18 retary shall also ensure that the grantees under
19 this section represent, among other factors,
20 variations in—
21 (i) different types of language services
22 provided and of service providers and orga-
23 nizations under parts A through D of title
24 XVIII of the Social Security Act;

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1 (ii) languages needed and their fre-
2 quency of use;
3 (iii) urban and rural settings;
4 (iv) at least two geographic regions,
5 as defined by the Secretary; and
6 (v) at least two large metropolitan
7 statistical areas with diverse populations.
8 (c) USE OF FUNDS.—
9 (1) IN GENERAL.—A grantee shall use grant
10 funds received under this section to pay for the pro-
11 vision of competent language services to Medicare
12 beneficiaries who are limited English proficient.
13 Competent interpreter services may be provided
14 through on-site interpretation, telephonic interpreta-
15 tion, or video interpretation or direct provision of
16 health care or health care related services by a bilin-
17 gual health care provider. A grantee may use bilin-
18 gual providers, staff, or contract interpreters. A
19 grantee may use grant funds to pay for competent
20 translation services. A grantee may use up to 10
21 percent of the grant funds to pay for administrative
22 costs associated with the provision of competent lan-
23 guage services and for reporting required under sub-
24 section (e).

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