I 118TH CONGRESS 1ST SESSION H. R. 3068 To prohibit discrimination in health care and require the provision of equitable health care, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MAY 2, 2023 Mr. SCHIFF (for himself, Ms. BROWN, Ms. BUSH, Ms. CLARKE of New York, Mr. GRIJALVA, Ms. NORTON, Ms. LEE of California, Mr. MULLIN, Mr. NADLER, Mr. PAYNE, Mr. QUIGLEY, Ms. SCANLON, Ms. SEWELL, Mr. SMITH of Washington, Mr. TAKANO, Mr. THOMPSON of Mississippi, Ms. VELA´ZQUEZ, Mrs. WATSON COLEMAN, and Mr. JOHNSON of Georgia) in- troduced the following bill; which was referred to the Committee on En- ergy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdic- tion of the committee concerned A BILL To prohibit discrimination in health care and require the provision of equitable health care, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Equal Health Care 4 for All Act’’. 5 VerDate Sep 11 2014 03:10 May 13, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3068.IH H3068 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 3068 IH SEC. 2. FINDINGS. 1 Congress finds the following: 2 (1) In 1966, Dr. Martin Luther King, Jr., said 3 ‘‘Of all the forms of inequality, injustice in health 4 care is the most shocking and inhuman because it 5 often results in physical death.’’. 6 (2) Inequity in health care remains a persistent 7 and devastating reality for many communities, but, 8 in particular, communities of color. 9 (3) The provision of inequitable health care has 10 complex causes, many stemming from systemic in- 11 equality in access to health care, housing, nutrition, 12 economic opportunity, education, and other factors. 13 (4) Health care outcomes for Black commu- 14 nities in particular lag far behind those of the popu- 15 lation as a whole. 16 (5) Dr. Anthony Fauci, Director of the Na- 17 tional Institute of Allergy and Infectious Diseases, 18 said on April 7, 2020, the coronavirus outbreak is 19 ‘‘shining a bright light’’ on ‘‘unacceptable’’ health 20 disparities in the Black community. 21 (6) A contributing factor in health disparities is 22 explicit and implicit bias in the delivery of health 23 care, resulting in inferior care and poorer outcomes 24 for some patients on the basis of factors including 25 VerDate Sep 11 2014 03:10 May 13, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3068.IH H3068 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 3068 IH race, national origin, sex (including sexual orienta- 1 tion or gender identity), disability, age, or religion. 2 (7) The National Academy of Medicine (for- 3 merly known as the ‘‘Institute of Medicine’’) issued 4 a report in 2002 titled ‘‘Unequal Treatment’’, find- 5 ing that racial and ethnic minorities receive lower- 6 quality health care than Whites do, even when insur- 7 ance status, income, age, and severity of condition is 8 comparable. 9 (8) Just as Congress has sought to eliminate 10 bias, both explicit and implicit, in employment, hous- 11 ing, and other parts of our society, the elimination 12 of bias and the legacy of structural racism in health 13 care is of paramount importance. 14 SEC. 3. DATA COLLECTION AND REPORTING. 15 (a) REQUIRED REPORTING.— 16 (1) IN GENERAL.—The Secretary of Health and 17 Human Services, in consultation with the Director of 18 Civil Rights and Health Equity, the Director of the 19 National Institutes of Health, the Administrator of 20 the Center for Medicare & Medicaid Services, the 21 Director of the Agency for Healthcare Research and 22 Quality, the Deputy Assistant Secretary for Minority 23 Health, and the Director of the Centers for Disease 24 Control and Prevention, shall by regulation require 25 VerDate Sep 11 2014 03:10 May 13, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3068.IH H3068 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 3068 IH all health care providers and facilities that are re- 1 quired under other provisions of law to report data 2 on specific health outcomes to the Department of 3 Health and Human Services in aggregate form, to 4 disaggregate such data by demographic characteris- 5 tics, including by race, national origin, sex (including 6 sexual orientation and gender identity), disability, 7 and age, as well as any other factor that the Sec- 8 retary determines would be useful for determining a 9 pattern of provision of inequitable health care. 10 (2) PROPOSED REGULATIONS.—Not later than 11 90 days after the date of enactment of this Act, the 12 Secretary of Health and Human Services shall issue 13 proposed regulations to carry out paragraph (1). 14 (b) REPOSITORY.—The Secretary of Health and 15 Human Services shall— 16 (1) not later than 1 year after the date of en- 17 actment of this Act, establish a repository of the 18 disaggregated data reported pursuant to subsection 19 (a); 20 (2) subject to paragraph (3), make the data in 21 such repository publicly available; and 22 (3) ensure that such repository does not contain 23 any data that is individually identifiable. 24 VerDate Sep 11 2014 03:10 May 13, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3068.IH H3068 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HR 3068 IH SEC. 4. REQUIRING EQUITABLE HEALTH CARE IN THE HOS- 1 PITAL VALUE-BASED PURCHASING PRO- 2 GRAM. 3 (a) EQUITABLE HEALTH CARE AS VALUE MEASURE- 4 MENT.—Section 1886(b)(3)(B)(viii) of the Social Security 5 Act (42 U.S.C. 1395ww(b)(3)(B)(viii)) is amended by 6 adding at the end the following new subclause: 7 ‘‘(XIII)(aa) Effective for payments beginning with 8 fiscal year 2025, in expanding the number of measures 9 under subclause (III), the Secretary shall adopt measures 10 that relate to equitable health care furnished by hospitals 11 in inpatient settings. 12 ‘‘(bb) In carrying out this subclause, the Secretary 13 shall solicit input and recommendations from individuals 14 and groups representing communities of color and other 15 protected classes and ensure measures adopted pursuant 16 to this subclause account for social determinants of health, 17 as defined in section 7(e)(10) of the Equal Health Care 18 for All Act. 19 ‘‘(cc) For purposes of this subclause, the term ‘equi- 20 table health care’ refers to the principle that high-quality 21 care should be provided to all individuals and health care 22 treatment and services should not vary on account of the 23 real or perceived race, national origin, sex (including sex- 24 ual orientation and gender identity), disability, or age of 25 an individual, as well as any other factor that the Sec- 26 VerDate Sep 11 2014 03:10 May 13, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3068.IH H3068 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •HR 3068 IH retary determines would be useful for determining a pat- 1 tern of provision of inequitable health care.’’. 2 (b) INCLUSION OF EQUITABLE HEALTH CARE MEAS- 3 URES.—Section 1886(o)(2)(B) of the Social Security Act 4 (42 U.S.C. 1395ww(o)(2)(B)) is amended by adding at the 5 end the following new clause: 6 ‘‘(iv) INCLUSION OF EQUITABLE 7 HEALTH CARE MEASURES.—Beginning in 8 fiscal year 2025, measures selected under 9 subparagraph (A) shall include the equi- 10 table health care measures described in 11 subsection (b)(3)(B)(viii)(XIII).’’. 12 SEC. 5. PROVISION OF INEQUITABLE HEALTH CARE AS A 13 BASIS FOR PERMISSIVE EXCLUSION FROM 14 MEDICARE AND STATE HEALTH CARE PRO- 15 GRAMS. 16 Section 1128(b) of the Social Security Act (42 U.S.C. 17 1320a–7(b)) is amended by adding at the end the fol- 18 lowing new paragraph: 19 ‘‘(18) PROVISION OF INEQUITABLE HEALTH 20 CARE.— 21 ‘‘(A) IN GENERAL.—Subject to subpara- 22 graph (B), any health care provider that the 23 Secretary determines has engaged in a pattern 24 of providing inequitable health care (as defined 25 VerDate Sep 11 2014 03:10 May 13, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3068.IH H3068 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •HR 3068 IH in section 7(e)(7) of the Equal Health Care for 1 All Act) on the basis of race, national origin, 2 sex (including sexual orientation and gender 3 identity), disability, or age of an individual. 4 ‘‘(B) EXCEPTION.—For purposes of car- 5 rying out subparagaph (A), the Secretary shall 6 not exclude any health care provider from par- 7 ticipation in the Medicare program under title 8 XVIII of the Social Security Act or the Med- 9 icaid program under title XIX of such Act if 10 the exclusion of such health care provider would 11 result in increased difficulty in access to health 12 care services for underserved or low-income 13 communities.’’. 14 SEC. 6. OFFICE FOR CIVIL RIGHTS AND HEALTH EQUITY OF 15 THE DEPARTMENT OF HEALTH AND HUMAN 16 SERVICES. 17 (a) NAME OF OFFICE.—Beginning on the date of en- 18 actment of this Act, the Office for Civil Rights of the De- 19 partment of Health and Human Services shall be known 20 as the ‘‘Office for Civil Rights and Health Equity’’ of the 21 Department of Health and Human Services. Any ref- 22 erence to the Office for Civil Rights of the Department 23 of Health and Human Services in any law, regulation, 24 map, document, record, or other paper of the United 25 VerDate Sep 11 2014 03:10 May 13, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3068.IH H3068 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •HR 3068 IH States shall be deemed to be a reference to the Office for 1 Civil Rights and Health Equity. 2 (b) HEAD OF OFFICE.—The head of the Office for 3 Civil Rights and Health Equity shall be the Director for 4 Civil Rights and Health Equity, to be appointed by the 5 President. Any reference to the Director of the Office for 6 Civil Rights of the Department of Health and Human 7 Services in any law, regulation, map, document, record, 8 or other paper of the United States shall be deemed to 9 be a reference to the Director for Civil Rights and Health 10 Equity. 11 SEC. 7. PROHIBITING DISCRIMINATION IN HEALTH CARE. 12 (a) PROHIBITING DISCRIMINATION.— 13 (1) IN GENERAL.—No health care provider 14 may, on the basis, in whole or in part, of race, sex 15 (including sexual orientation and gender identity), 16 disability, age, or religion, subject an individual to 17 the provision of inequitable health care. 18 (2) NOTICE OF PATIENT RIGHTS.—The Sec- 19 retary shall provide to each patient a notice of a pa- 20 tient’s rights under this section. 21 (b) ADMINISTRATIVE COMPLAINT AND CONCILIATION 22 PROCESS.— 23 (1) COMPLAINTS AND ANSWERS.— 24 VerDate Sep 11 2014 03:10 May 13, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3068.IH H3068 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •HR 3068 IH (A) IN GENERAL.—An aggrieved person 1 may, not later than 1 year after an alleged vio- 2 lation of subsection (a) has occurred or con- 3 cluded, file a complaint with the Director alleg- 4 ing inequitable provision of health care by a 5 provider described in subsection (a). 6 (B) COMPLAINT.—A complaint submitted 7 pursuant to subparagraph (A) shall be in writ- 8 ing and shall contain such information and be 9 in such form as the Director requires. 10 (C) OATH OR AFFIRMATION.—The com- 11 plaint and any answer made under this sub- 12 section shall be made under oath or affirmation, 13 and may be reasonably and fairly modified at 14 any time. 15 (2) RESPONSE TO COMPLAINTS.— 16 (A) IN GENERAL.—Upon the filing of a 17 complaint under this subsection, the following 18 procedures shall apply: 19 (i) COMPLAINANT NOTICE.—The Di- 20 rector shall serve notice upon the com- 21 plainant acknowledging receipt of such fil- 22 ing and advising the complainant of the 23 time limits and procedures provided under 24 this section. 25 VerDate Sep 11 2014 03:10 May 13, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3068.IH H3068 pbinns on DSKJLVW7X2PROD with $$_JOB 10 •HR 3068 IH (ii) RESPONDENT NOTICE.—The Di- 1 rector shall, not later than 30 days after 2 receipt of such filing— 3 (I) serve on the respondent a no- 4 tice of the complaint, together with a 5 copy of the original complaint; and 6 (II) advise the respondent of the 7 procedural rights and obligations of 8 respondents under this section. 9 (iii) ANSWER.—The respondent may 10 file, not later than 60 days after receipt of 11 the notice from the Director, an answer to 12 such complaint. 13 (iv) INVESTIGATIVE DUTIES.—The Di- 14 rector shall— 15 (I) make an investigation of the 16 alleged inequitable provision of health 17 care; and 18 (II) complete such investigation 19 within 180 days (unless it is impracti- 20 cable to complete such investigation 21 within 180 days) after the filing of 22 the complaint. 23 (B) INVESTIGATIONS.— 24 VerDate Sep 11 2014 03:10 May 13, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3068.IH H3068 pbinns on DSKJLVW7X2PROD with $$_JOB 11 •HR 3068 IH (i) PATTERN OR PRACTICE.—In the 1 course of investigating the complaint, the 2 Director may seek records of care provided 3 to patients other than the complainant if 4 necessary to demonstrate or disprove an 5 allegation of inequitable provision of health 6 care or to determine whether there is a 7 pattern or practice of such care. 8 (ii) ACCOUNTING FOR SOCIAL DETER- 9 MINANTS OF HEALTH.—In investigating 10 the complaint and reaching a determina- 11 tion on the validity of the complaint, the 12 Director shall account for social deter- 13 minants of health and the effect of such 14 social determinants on health care out- 15 comes. 16 (iii) INABILITY TO COMPLETE INVES- 17 TIGATION.—If the Director is unable to 18 complete (or finds it is impracticable to 19 complete) the investigation within 180 20 days after the filing of the complaint (or, 21 if the Secretary takes further action under 22 paragraph (6)(B) with respect to a com- 23 plaint, within 180 days after the com- 24 mencement of such further action), the Di- 25 VerDate Sep 11 2014 03:10 May 13, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3068.IH H3068 pbinns on DSKJLVW7X2PROD with $$_JOB 12 •HR 3068 IH rector shall notify the complainant and re- 1 spondent in writing of the reasons in- 2 volved. 3 (iv) REPORT TO STATE LICENSING 4 AUTHORITIES.—On concluding each inves- 5 tigation under this subparagraph, the Di- 6 rector shall provide to the State licensing 7 authorities that were notified under sub- 8 paragraph (A), information specifying the 9 results of the investigation. 10 (C) REPORT.— 11 (i) FINAL REPORT.—On completing 12 each investigation under this [Text truncated for display. 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