; (ii) the efficiency and cost effectiveness of health care delivery; (iii) patient satisfaction; (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 subsection (c) of section 1907 of this Act. (D) Recommendations, if any, regarding the extension of such project to the entire Medicare Program, subject to the provisions of section 1115A(c) of the Social Security Act ( 42 U.S.C. 1315a(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) English learner defined In this subsection, the term English learner has the meaning given such term in section 8101(20) of the Elementary and Secondary Education Act of 1965, except that subparagraphs (A), (B), and (D) of such section shall not apply. (b) Language 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 (B), by striking and at the end; (ii) by adding and at the end of subparagraph (C); and (iii) by inserting after subparagraph (C) the following new subparagraph: (D) language assistance services as defined in subsection (iii)(1),