S. 5066 — Health Equity and Accountability Act of 2026

This section expands the authorities of the Agency for Healthcare Research and Quality to include activities on the cultural and linguistic competence of health care services and of data collection activities described under section 3101.

This section eliminates the prerequisite of direct appropriations for data collection and analysis under section 3101 of the Public Health Service Act. The requirements to collect and report data on race, ethnicity, sex, primary language, and disability status for applicants, recipients, or participants in federally supported health programs now apply without that condition.

This section requires the Commissioner of Social Security, in consultation with the CMS Administrator, to 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 title II or Medicare title XVIII benefits. It mandates use of OMB Statistical Policy Directive No. 15 or Public Health Service Act section 3101 standards, transmission of data to CMS upon Medicare enrollment, annual congressional reporting on disparities, privacy protections, and authorization of $500 million for FY2027 plus $100 million annually thereafter.

This section directs the Secretary of Health and Human Services to revise HIPAA regulations on demographic data collection in health transactions within one year of enactment. It requires use of standards covering race, ethnicity, sex, primary language, sexual orientation, gender identity, age, disability status, and socioeconomic status, plus designation of related code sets for claims and enrollment data, with dissemination, technical assistance, and mandatory compliance within two years of final promulgation.

This section extends the authorization of appropriations for the National Center for Health Statistics through FY2027 (from FY2003 in paragraphs (1) and (2), and from FY2002 in paragraph (3)).

This section establishes a centralized electronic repository of Federal Government data on factors related to the health and well-being of the U.S. population. It requires each Federal department, agency, and office to submit data collected on race, ethnicity, sex, primary language, sexual orientation, gender identity, age, disability status, or socioeconomic status within 180 days of enactment and by January 31 annually thereafter. It directs the Secretary of Health and Human Services and specified officials to prepare and release public datasets on disparities in health status, access, quality, and outcomes by April 30, 2027, and each April 30 thereafter, identify them as “disparities” data, and report to Congress on their use by public stakeholders.

This section establishes a grant program under which 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, awards grants to eligible minority-serving institutions to access and analyze racial and ethnic data on health and health care disparities. Eligible entities are institutions with accredited public health, health policy, or health services research programs that qualify as part B institutions, Hispanic-serving institutions, Tribal Colleges or Universities, or Asian American and Native American Pacific Islander-serving institutions. It authorizes such sums as may be necessary for each of fiscal years 2027 through 2031.

This section requires preapproval investigations of racial or ethnic disparities in safety or effectiveness for drugs and biological products when such evidence exists, and mandates labeling updates if disparities are confirmed. It authorizes the Secretary to order postmarket studies on disparities, specify study design and participants, and modify requirements by order. It exempts abbreviated new drug applications from certain labeling requirements when disparity information is protected by patent or exclusivity, while allowing the Secretary to require contraindications or warnings. It deems a drug misbranded if the holder fails to complete required studies under the new section. It includes postmarket studies required under the new section in prescription drug user fee calculations.

This section establishes requirements to improve health data collection on Native Hawaiians and Pacific Islanders. It directs a preliminary survey of NHPI populations in the continental United States and specified Pacific jurisdictions, to be completed within 18 months, followed by development of a national strategy with stakeholder consultation within 180 days and a progress report to Congress within two years. It also requires a study on health care standards and performance in insular areas, with a report due within two years, and authorizes appropriations for fiscal years 2027 through 2031.

This section requires skilled nursing facilities to submit data on infections and resident demographics—including age, race, ethnicity, sex, sexual orientation, gender identity, socioeconomic status, disability status, and preferred language—within one year of a public health emergency declaration and monthly thereafter. It directs the Secretary of Health and Human Services to post aggregated state-level data on infections and deaths in skilled nursing facilities, nursing facilities, and other congregate settings on the Nursing Home Compare website. It establishes daily public disclosure of pandemic testing, treatment, outcomes, and vaccination data disaggregated by the same demographic categories, beginning within 60 days of a public health emergency determination.

This section establishes the Commission on Ensuring Data for Health Equity within 30 days of enactment, chaired by the Assistant Secretary for Preparedness and Response and including specified federal officials plus at least 11 appointed members with expertise in health equity and demographic disparities. The Commission must examine barriers to demographic data collection and use, analyze COVID-19 disparities by race, disability status, sex, sexual orientation, gender identity, and other factors, and submit a report with policy recommendations to Congress and on the HHS website within 1 year.

This section establishes the Task Force on Preventing AI and Algorithmic Bias in Health Care within 30 days after enactment. Chaired by the HHS Chief Information Officer, the task force includes specified federal health officials plus appointed state, tribal, and expert members on health equity and disparities. It must examine AI and algorithms in health care delivery, identify risks of bias and discrimination in access and outcomes, solicit public comments for at least 90 days, and submit a report with recommendations to Congress within one year for publication on the HHS website.

This section requires the Secretary of Health and Human Services to conduct a comprehensive study on the health patterns and outcomes of Middle Eastern and North African (MENA) populations in the United States. It mandates enumeration of MENA populations disaggregated by subpopulation, with detailed data on rates of health risk factors, chronic diseases, disabilities, maternal and reproductive health outcomes, nutritional and dental health, domestic violence, and morbidity and mortality, plus analyses of contributing factors, disparities, and the role of federal health programs. It requires consultation with the Census Bureau, CDC, NIH, SAMHSA, and stakeholders to determine subpopulations, and directs the Secretary to establish a public online portal cataloguing the study results and underlying data.

This section requires annual surveys on the national incidence and prevalence of mental illness and substance abuse to include Puerto Rico beginning in fiscal year 2027.

This section requires each federal agency that administers or provides financial assistance for a health program or activity to prepare a plan within 120 days of enactment and fully implement it within one year to improve culturally and linguistically appropriate access for individuals with limited English proficiency. Each plan must provide language assistance options, annual staff training and quality monitoring, translation of public materials into the top 15 non-English languages within 15 days (or 7 days during a national emergency or state disaster), competent document translation, interpreter services without using family or minor children, and resources for recipients of federal funds, with plans submitted to the Attorney General.

This section requires health programs or activities receiving any federal financial assistance or operated by executive agencies or Affordable Care Act entities to implement 12 standards for culturally and linguistically appropriate services. The standards include recruiting and retaining diverse staff and leadership, providing at least annual training on relevant policies and legal requirements, offering free language assistance by trained staff or interpreters at all points of contact during all operating hours, translating patient materials and notices into languages spoken by the lesser of 5 percent or 500 eligible individuals at a fifth-grade reading level, collecting and integrating demographic and language preference data into health records and interoperable systems, conducting annual community health assessments, and making annual public reports on implementation progress.

This section establishes a new title in the Public Health Service Act that defines 18 terms for culturally and linguistically appropriate health care, including bilingual, community health worker, cultural, effective communication, grievance resolution process, health care group, health care services, individual with limited English proficiency, integrated health care delivery system, interpreting, language access, and language assistance services.

This section establishes a 3-year pilot program authorizing the Secretary of Health and Human Services to award one grant each to 3 states for designing, implementing, and evaluating statewide onsite interpreter services under Medicaid plans. It authorizes $5 million in appropriations available without fiscal year limitation, requires participating states to directly fund such services after September 30, 2029, increases the federal matching rate to 100 percent (from 75 percent) for those states during the grant period, and prohibits use of funds for interpreter services provided outside the United States.

This section counts time spent by interns and residents in approved medical residency programs on education and training in culturally and linguistically appropriate service delivery—including for all medically underserved populations as defined in section 330(b)(3) of the Public Health Service Act—toward full-time equivalency determinations for both direct graduate medical education payments under section 1886(h) and indirect medical education payments under section 1886(d)(5)(B). The changes apply to hospital payments made on or after the date that is one year after enactment.

This section establishes a demonstration program, to be run consistent with the Center for Medicare and Medicaid Innovation’s testing authorities, under which the Secretary of Health and Human Services awards at least 24 three-year grants to Medicare providers to furnish culturally and linguistically appropriate services to limited English proficient beneficiaries in underserved communities. It requires at least 10 grants each to part A providers, part B providers, Medicare Advantage organizations, and PDP sponsors; gives priority to applicants partnering with community organizations; and limits grant funds to competent interpreter, translation, and bilingual provider services.

This section authorizes the Secretary of Health and Human Services to award grants to hospitals, health centers, clinics, health plans, and nonprofit minority health organizations to improve care for patients with low health literacy. It directs the Agency for Healthcare Research and Quality to fund research defining health literacy and its effects on outcomes, and directs the Health Resources and Services Administration to fund demonstration projects on interventions such as disease management programs, screening tools, and plain-language educational campaigns, and authorizes such sums as necessary for fiscal years 2027 through 2031.

This section requires covered entities operating health programs or activities with federal funds to provide individuals with limited English proficiency annual staff training on culturally and linguistically appropriate services, free and timely language assistance at all points of contact during operating hours, notice of rights in the patient's primary language, and qualified interpreters or translators. It exempts use of family or friends over age 18 when the entity obtains informed consent, evaluates competence, addresses conflicts of interest, and secures a witnessed waiver, and during medical emergencies until competent services become available.

This section directs the Secretary of Health and Human Services to contract with the National Academy of Medicine, beginning no later than one year after enactment and annually thereafter, for a report describing federal efforts to ensure meaningful access to culturally and linguistically appropriate health care services for individuals with limited English proficiency. The report must evaluate program activities, identify best practices and recommendations for providers, address health literacy and plain language standards, and analyze effects on care quality and associated costs. The section authorizes appropriations for fiscal years 2027 through 2031.

This section establishes a grant program under which the Secretary of Education awards funds to states and certain community-based organizations to develop and deliver free English as a second language instruction, including health care-related English, to individuals with limited English proficiency. It authorizes $250 million annually for fiscal years 2027 through 2031, requires recipients to integrate information on accessing the U.S. health care system, and directs the Secretary to collect annual data on federal, state, and local ESL spending and unmet needs and to report recommendations to Congress within one year.

This section authorizes persons injured by a state violation of this title, including its amendments, to bring civil actions in federal court. It makes available the same remedies as in actions against non-state parties and clarifies that the title does not limit existing obligations under title VI of the Civil Rights Act of 1964 or other federal statutes.

This section expands the essential health benefits package to include language access services, such as oral interpretation and written translations. It conditions eligibility for premium tax credits on employer-sponsored plans providing such services. It requires group health plans and issuers to furnish oral interpretation without thresholds, display notices in at least 15 non-English languages, and apply a 5 percent or 500-individual threshold for applicable languages in claims and appeals processes. It also directs the Secretary of Health and Human Services to collect preferred spoken and written language data on applications, require reporting of language assistance requests by navigators and counselors, and mandate annual hotline reports on interpreter wait times and complaints. The changes apply to plans beginning on or after the date of enactment.

This section redefines "medically underserved population" for purposes of the health center program under section 330 of the Public Health Service Act. The term now covers populations in urban or rural areas designated by the Secretary as having a shortage of personal health services, as well as any population of individuals designated by the Secretary as having such a shortage due to a specific demographic trait, even if not confined to one area.

This section requires the head of each federal agency to ensure individuals with limited English proficiency have meaningful access to agency programs and activities within 1 year of enactment, including by translating vital documents into frequently encountered and dominant U.S. languages, adding multilingual IT functionality, providing interpretation services, using qualified bilingual staff, notifying the public of assistance, and training employees. It directs the Attorney General to establish a public complaint system with agency responses required within 60 days and annual disaggregated reports, and requires each agency to adopt a language access plan after 60-day public comment.

This section establishes a national outreach and education strategy to promote behavioral health and reduce stigma associated with mental health and substance use disorders among Asian American, Native Hawaiian, and Pacific Islander populations. It requires the strategy to address cultural and language needs, increase awareness of symptoms within subgroups, provide information on evidence-based interventions, and adopt a public health approach addressing behavioral and physical health. It authorizes $3 million annually for fiscal years 2026 through 2030 and directs a systematic review of prevalence, risk factors, and treatment for behavioral health issues among AANHPI youth, with a report to Congress due within one year.

This section expresses the sense of Congress that a comprehensive public health approach to trauma and mental health care should focus on culturally and linguistically appropriate care delivery.

This section defines terms for use throughout the title, including “access” with respect to health information as described in 45 C.F.R. 164.524; “certified EHR technology” and “EHR” as having the meaning in 42 U.S.C. 300jj, including required health information infrastructure for interoperability, access, exchange, and use, and not limited to records maintained by doctors; “electronic health record” as a qualified electronic health record under 42 U.S.C. 300jj; and “interoperability” as defined in 42 U.S.C. 300jj.

This section prohibits discrimination 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 in any health program or activity receiving federal financial assistance or administered by an executive agency. It defines familial status to include individuals domiciled with blood or affinity relatives, those securing legal custody of another, or pregnant persons.

This section deems payments made under Medicare parts A, B, C, or D to a provider, physician, or supplier (including subcontractors) to be grants, not contracts of insurance or guaranty, for purposes of title VI of the Civil Rights Act of 1964.

This section renames the Office for Civil Rights of the Department of Health and Human Services as the Office for Civil Rights and Health Equity, headed by a presidentially appointed Director for Civil Rights and Health Equity. It expands the office’s duties to include developing and implementing an action plan addressing racial and ethnic health care disparities, conducting investigations and enforcement against intentional or disparate-impact discrimination, reviewing federal health data on disparities across race, ethnicity, gender identity, sexual orientation, disability, and other factors, providing outreach and technical assistance on title VI compliance, coordinating civil rights offices, and ensuring adherence to OMB and other data standards. It requires the Secretary to provide the office with adequate funding and staff with expertise in epidemiology, statistics, minority health, health equity, civil rights, and related determinants of health. It also establishes an advisory board to submit annual reports to Congress beginning December 31, 2027, on title VI complaints and related activities.

This section requires the United States Commission on Civil Rights to promote coordination among the Office of Justice Programs (including its Office for Civil Rights), the Department of Health and Human Services Office for Civil Rights, and the Department of Health and Human Services Office of Minority Health on activities in health care and correctional facilities to eliminate health disparities based on race or color. It authorizes appropriations of $30,000,000 for FY2027 and such sums as may be necessary for FY2028 through 2032.

This section expresses the sense of Congress that health disparities negatively affect national health and security, and that funding for the National Institute on Minority Health and Health Disparities, the HHS Office for Civil Rights, the National Institute of Nursing Research, and the Office of Minority Health should be doubled by fiscal year 2027. It further states that adequate funding by that year, with subsequent increases, should support specified training programs, the Racial and Ethnic Approaches to Community Health Initiative, the Minority HIV/AIDS Initiative, and related data collection and accountability measures.

This section requires the Comptroller General to study and report on racial and ethnic diversity among NIH grant applicants, recipients, and peer review panel members for 2027 through 2035, with the report due within six months of enactment. It requires the NIH Director, in collaboration with the National Institute on Minority Health and Health Disparities Director, to submit biennial reports on steps taken to coordinate minority health and health disparity research and the outcomes of those steps. It requires the Comptroller General to submit biennial reports on the racial and ethnic diversity of community-based organizations applying for PPACA enrollment funding, the share awarded such funding, and the impact on community insurance status. It requires the National Institute on Minority Health and Health Disparities Director to submit annual reports on institute activities, including progress and expenditures in health disparities research.

This section establishes an administrative complaint and conciliation process for allegations of inequitable health care provision. Aggrieved persons may file complaints with the Director for Civil Rights and Health Equity within one year of an alleged violation; the Director must serve notices, complete investigations within 180 days while accounting for social determinants of health, pursue conciliation, approve agreements that protect complainants and similarly situated persons, refer breaches to the Attorney General, and certify cases for immediate judicial action when warranted.

This section establishes the Federal Health Equity Commission, composed of 8 voting members appointed by the President (4), Senate leaders (2), and House leaders (2) with recognized expertise in racial and ethnic health inequities and no more than 4 from the same party, plus 4 nonvoting ex officio members from HHS agencies. It requires the Commission to monitor implementation of the Act, investigate progress toward health equity and elimination of disparities, and submit annual reports with recommendations to the President and Congress, and grants it authority to hold hearings and issue subpoenas.

This section nullifies Executive Orders 14148, 14158, 14151, 14168, 14173, 14183, 14185, 14201, 14212, and 14321 and prohibits the use of federal funds to implement, administer, enforce, or carry out any of them. It also reinstates any Executive orders or actions previously revoked or rescinded by those orders.

This section requires the Office of Minority Health at the Department of Health and Human Services, the Centers for Medicare & Medicaid Services, and the Food and Drug Administration, and the National Institute on Minority Health and Health Disparities, to employ at least as many staff and carry out all functions as each did on January 19, 2025, within 30 days of enactment. It reinstates the Institute director for a 5-year term. It establishes Offices of Health Equity at the Centers for Disease Control and Prevention and the Health Resources and Services Administration with equivalent staffing and functions as of that date. It restores retracted funding, websites, and data portals for these entities.

This section requires each Federal agency to restore all sociodemographic data collection systems, datasets, and reporting mechanisms on race, ethnicity, sex, sexual orientation, gender identity, disability status, income, and other protected characteristics to their form as of January 19, 2025, within 60 days of enactment. It further requires full restoration of any removed or modified datasets, publications, and web resources within 30 days, and directs the OMB Director to report to Congress within 90 days identifying all affected items and certifying their restoration.

This section reinstates equal employment opportunity and affirmative action obligations for Federal contractors under Executive Order 11246. It nullifies certification requirements from Executive Order 14173 that bar diversity, equity, and inclusion programs and prohibits any similar certifications as a condition of Federal contracts. It directs the Office of Federal Contract Compliance Programs to resume full enforcement consistent with the law in effect on January 19, 2025.

This section directs all Federal agencies to actively enforce disparate impact discrimination prohibitions under Federal statutory law consistent with regulations, guidance, and enforcement policies in effect on January 19, 2025. It prohibits any Executive action from directing agencies to deprioritize, suspend, or cease such enforcement and renders any such direction without force or effect.

This section prohibits Executive actions without express statutory authorization from abolishing, defunding, or reducing below minimum staffing levels any Federal office, agency, or program established by law; directing removal of sociodemographic data from Federal surveys, datasets, or public health surveillance systems; or terminating enforcement of the Civil Rights Act of 1964, Fair Housing Act, Americans with Disabilities Act of 1990, Age Discrimination in Employment Act of 1967, Voting Rights Act of 1965, or other Federal civil rights statutes. It requires the Office of Management and Budget to notify relevant congressional committees within 5 days of any Executive order affecting health equity, civil rights, anti-discrimination, or sociodemographic data collection. It also authorizes aggrieved persons to sue in Federal district court for declaratory and injunctive relief, with reasonable attorneys’ fees for prevailing plaintiffs.

This section provides that if any provision of this title is held invalid, the remainder of the title and its application to other persons or circumstances remain in effect.

This section authorizes such sums as may be necessary to carry out the title, restore all offices, programs, staffing levels, and data systems to their status as of January 19, 2025, and provide retroactive payments for all grants, contracts, awards, and employee compensation withheld or cancelled pursuant to specified Executive orders. It also prohibits the Executive branch from withholding, deferring, or rescinding any funds appropriated under the Act without following the procedures in the Impoundment Control Act of 1974.