# Patient Protection and Affordable Care Act/Title IV
## Subtitle A--Modernizing Disease Prevention and Public Health Systems
### SEC. 4001. NATIONAL PREVENTION, HEALTH PROMOTION AND PUBLIC HEALTH COUNCIL.

* (a) Establishment- The President shall establish, within the Department of Health and Human Services, a council to be known as the `National Prevention, Health Promotion and Public Health Council' (referred to in this section as the `Council').
* (b) Chairperson- The President shall appoint the Surgeon General to serve as the chairperson of the Council.
* (c) Composition- The Council shall be composed of--
** (1) the Secretary of Health and Human Services;
** (2) the Secretary of Agriculture;
** (3) the Secretary of Education;
** (4) the Chairman of the Federal Trade Commission;
** (5) the Secretary of Transportation;
** (6) the Secretary of Labor;
** (7) the Secretary of Homeland Security;
** (8) the Administrator of the Environmental Protection Agency;
** (9) the Director of the Office of National Drug Control Policy;
** (10) the Director of the Domestic Policy Council;
** (11) the Assistant Secretary for Indian Affairs;
** (12) the Chairman of the Corporation for National and Community Service; and
** (13) the head of any other Federal agency that the chairperson determines is appropriate.
* (d) Purposes and Duties- The Council shall--
** (1) provide coordination and leadership at the Federal level, and among all Federal departments and agencies, with respect to prevention, wellness and health promotion practices, the public health system, and integrative health care in the United States;
** (2) after obtaining input from relevant stakeholders, develop a national prevention, health promotion, public health, and integrative health care strategy that incorporates the most effective and achievable means of improving the health status of Americans and reducing the incidence of preventable illness and disability in the United States;
** (3) provide recommendations to the President and Congress concerning the most pressing health issues confronting the United States and changes in Federal policy to achieve national wellness, health promotion, and public health goals, including the reduction of tobacco use, sedentary behavior, and poor nutrition;
** (4) consider and propose evidence-based models, policies, and innovative approaches for the promotion of transformative models of prevention, integrative health, and public health on individual and community levels across the United States;
** (5) establish processes for continual public input, including input from State, regional, and local leadership communities and other relevant stakeholders, including Indian tribes and tribal organizations;
** (6) submit the reports required under subsection (g); and
** (7) carry out other activities determined appropriate by the President.
* (e) Meetings- The Council shall meet at the call of the Chairperson.
* (f) Advisory Group-
** (1) IN GENERAL- The President shall establish an Advisory Group to the Council to be known as the `Advisory Group on Prevention, Health Promotion, and Integrative and Public Health' (hereafter referred to in this section as the `Advisory Group'). The Advisory Group shall be within the Department of Health and Human Services and report to the Surgeon General.
** (2) COMPOSITION-
*** (A) IN GENERAL- The Advisory Group shall be composed of not more than 25 non-Federal members to be appointed by the President.
*** (B) REPRESENTATION- In appointing members under subparagraph (A), the President shall ensure that the Advisory Group includes a diverse group of licensed health professionals, including integrative health practitioners who have expertise in--
**** (i) worksite health promotion;
**** (ii) community services, including community health centers;
**** (iii) preventive medicine;
**** (iv) health coaching;
**** (v) public health education;
**** (vi) geriatrics; and
**** (vii) rehabilitation medicine.
** (3) PURPOSES AND DUTIES- The Advisory Group shall develop policy and program recommendations and advise the Council on lifestyle-based chronic disease prevention and management, integrative health care practices, and health promotion.
* (g) National Prevention and Health Promotion Strategy- Not later than 1 year after the date of enactment of this Act, the Chairperson, in consultation with the Council, shall develop and make public a national prevention, health promotion and public health strategy, and shall review and revise such strategy periodically. Such strategy shall--
** (1) set specific goals and objectives for improving the health of the United States through federally-supported prevention, health promotion, and public health programs, consistent with ongoing goal setting efforts conducted by specific agencies;
** (2) establish specific and measurable actions and timelines to carry out the strategy, and determine accountability for meeting those timelines, within and across Federal departments and agencies; and
** (3) make recommendations to improve Federal efforts relating to prevention, health promotion, public health, and integrative health care practices to ensure Federal efforts are consistent with available standards and evidence.
* (h) Report- Not later than July 1, 2010, and annually thereafter through January 1, 2015, the Council shall submit to the President and the relevant committees of Congress, a report that--
** (1) describes the activities and efforts on prevention, health promotion, and public health and activities to develop a national strategy conducted by the Council during the period for which the report is prepared;
** (2) describes the national progress in meeting specific prevention, health promotion, and public health goals defined in the strategy and further describes corrective actions recommended by the Council and taken by relevant agencies and organizations to meet these goals;
** (3) contains a list of national priorities on health promotion and disease prevention to address lifestyle behavior modification (smoking cessation, proper nutrition, appropriate exercise, mental health, behavioral health, substance use disorder, and domestic violence screenings) and the prevention measures for the 5 leading disease killers in the United States;
** (4) contains specific science-based initiatives to achieve the measurable goals of Healthy People 2010 regarding nutrition, exercise, and smoking cessation, and targeting the 5 leading disease killers in the United States;
** (5) contains specific plans for consolidating Federal health programs and Centers that exist to promote healthy behavior and reduce disease risk (including eliminating programs and offices determined to be ineffective in meeting the priority goals of Healthy People 2010);
** (6) contains specific plans to ensure that all Federal health care programs are fully coordinated with science-based prevention recommendations by the Director of the Centers for Disease Control and Prevention; and
** (7) contains specific plans to ensure that all non-Department of Health and Human Services prevention programs are based on the science-based guidelines developed by the Centers for Disease Control and Prevention under paragraph (4).
* (i) Periodic Reviews- The Secretary and the Comptroller General of the United States shall jointly conduct periodic reviews, not less than every 5 years, and evaluations of every Federal disease prevention and health promotion initiative, program, and agency. Such reviews shall be evaluated based on effectiveness in meeting metrics-based goals with an analysis posted on such agencies' public Internet websites.

### SEC. 4002. PREVENTION AND PUBLIC HEALTH FUND.

* (a) Purpose- It is the purpose of this section to establish a Prevention and Public Health Fund (referred to in this section as the `Fund'), to be administered through the Department of Health and Human Services, Office of the Secretary, to provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public sector health care costs.
* (b) Funding- There are hereby authorized to be appropriated, and appropriated, to the Fund, out of any monies in the Treasury not otherwise appropriated--
** (1) for fiscal year 2010, $500,000,000;
** (2) for fiscal year 2011, $750,000,000;
** (3) for fiscal year 2012, $1,000,000,000;
** (4) for fiscal year 2013, $1,250,000,000;
** (5) for fiscal year 2014, $1,500,000,000; and
** (6) for fiscal year 2015, and each fiscal year thereafter, $2,000,000,000.
* (c) Use of Fund- The Secretary shall transfer amounts in the Fund to accounts within the Department of Health and Human Services to increase funding, over the fiscal year 2008 level, for programs authorized by the Public Health Service Act, for prevention, wellness, and public health activities including prevention research and health screenings, such as the Community Transformation grant program, the Education and Outreach Campaign for Preventive Benefits, and immunization programs.
* (d) Transfer Authority- The Committee on Appropriations of the Senate and the Committee on Appropriations of the House of Representatives may provide for the transfer of funds in the Fund to eligible activities under this section, subject to subsection (c).

### SEC. 4003. CLINICAL AND COMMUNITY PREVENTIVE SERVICES.

* (a) Preventive Services Task Force- Section 915 of the Public Health Service Act (42 U.S.C. 299b-4) is amended by striking subsection (a) and inserting the following:
* (a) Preventive Services Task Force-
** (1) ESTABLISHMENT AND PURPOSE- The Director shall convene an independent Preventive Services Task Force (referred to in this subsection as the `Task Force') to be composed of individuals with appropriate expertise. Such Task Force shall review the scientific evidence related to the effectiveness, appropriateness, and cost-effectiveness of clinical preventive services for the purpose of developing recommendations for the health care community, and updating previous clinical preventive recommendations, to be published in the Guide to Clinical Preventive Services (referred to in this section as the `Guide'), for individuals and organizations delivering clinical services, including primary care professionals, health care systems, professional societies, employers, community organizations, non-profit organizations, Congress and other policy-makers, governmental public health agencies, health care quality organizations, and organizations developing national health objectives. Such recommendations shall consider clinical preventive best practice recommendations from the Agency for Healthcare Research and Quality, the National Institutes of Health, the Centers for Disease Control and Prevention, the Institute of Medicine, specialty medical associations, patient groups, and scientific societies.
** (2) DUTIES- The duties of the Task Force shall include--
*** (A) the development of additional topic areas for new recommendations and interventions related to those topic areas, including those related to specific sub-populations and age groups;
*** (B) at least once during every 5-year period, review interventions and update recommendations related to existing topic areas, including new or improved techniques to assess the health effects of interventions;
*** (C) improved integration with Federal Government health objectives and related target setting for health improvement;
*** (D) the enhanced dissemination of recommendations;
*** (E) the provision of technical assistance to those health care professionals, agencies and organizations that request help in implementing the Guide recommendations; and
*** (F) the submission of yearly reports to Congress and related agencies identifying gaps in research, such as preventive services that receive an insufficient evidence statement, and recommending priority areas that deserve further examination, including areas related to populations and age groups not adequately addressed by current recommendations.
** (3) ROLE OF AGENCY- The Agency shall provide ongoing administrative, research, and technical support for the operations of the Task Force, including coordinating and supporting the dissemination of the recommendations of the Task Force, ensuring adequate staff resources, and assistance to those organizations requesting it for implementation of the Guide's recommendations.
** (4) COORDINATION WITH COMMUNITY PREVENTIVE SERVICES TASK FORCE- The Task Force shall take appropriate steps to coordinate its work with the Community Preventive Services Task Force and the Advisory Committee on Immunization Practices, including the examination of how each task force's recommendations interact at the nexus of clinic and community.
** (5) OPERATION- Operation. In carrying out the duties under paragraph (2), the Task Force is not subject to the provisions of Appendix 2 of title 5, United States Code.
** (6) INDEPENDENCE- All members of the Task Force convened under this subsection, and any recommendations made by such members, shall be independent and, to the extent practicable, not subject to political pressure.
** (7) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated such sums as may be necessary for each fiscal year to carry out the activities of the Task Force.'.
* (b) Community Preventive Services Task Force-
** (1) IN GENERAL- Part P of title III of the Public Health Service Act, as amended by paragraph (2), is amended by adding at the end the following:

### SEC. 399U. COMMUNITY PREVENTIVE SERVICES TASK FORCE.

* (a) Establishment and Purpose- The Director of the Centers for Disease Control and Prevention shall convene an independent Community Preventive Services Task Force (referred to in this subsection as the `Task Force') to be composed of individuals with appropriate expertise. Such Task Force shall review the scientific evidence related to the effectiveness, appropriateness, and cost-effectiveness of community preventive interventions for the purpose of developing recommendations, to be published in the Guide to Community Preventive Services (referred to in this section as the `Guide'), for individuals and organizations delivering population-based services, including primary care professionals, health care systems, professional societies, employers, community organizations, non-profit organizations, schools, governmental public health agencies, Indian tribes, tribal organizations and urban Indian organizations, medical groups, Congress and other policy-makers. Community preventive services include any policies, programs, processes or activities designed to affect or otherwise affecting health at the population level.
* (b) Duties- The duties of the Task Force shall include--
** (1) the development of additional topic areas for new recommendations and interventions related to those topic areas, including those related to specific populations and age groups, as well as the social, economic and physical environments that can have broad effects on the health and disease of populations and health disparities among sub-populations and age groups;
** (2) at least once during every 5-year period, review interventions and update recommendations related to existing topic areas, including new or improved techniques to assess the health effects of interventions, including health impact assessment and population health modeling;
** (3) improved integration with Federal Government health objectives and related target setting for health improvement;
** (4) the enhanced dissemination of recommendations;
** (5) the provision of technical assistance to those health care professionals, agencies, and organizations that request help in implementing the Guide recommendations; and
** (6) providing yearly reports to Congress and related agencies identifying gaps in research and recommending priority areas that deserve further examination, including areas related to populations and age groups not adequately addressed by current recommendations.
* (c) Role of Agency- The Director shall provide ongoing administrative, research, and technical support for the operations of the Task Force, including coordinating and supporting the dissemination of the recommendations of the Task Force, ensuring adequate staff resources, and assistance to those organizations requesting it for implementation of Guide recommendations.
* (d) Coordination With Preventive Services Task Force- The Task Force shall take appropriate steps to coordinate its work with the U.S. Preventive Services Task Force and the Advisory Committee on Immunization Practices, including the examination of how each task force's recommendations interact at the nexus of clinic and community.
* (e) Operation- In carrying out the duties under subsection (b), the Task Force shall not be subject to the provisions of Appendix 2 of title 5, United States Code.
* (f) Authorization of Appropriations- There are authorized to be appropriated such sums as may be necessary for each fiscal year to carry out the activities of the Task Force.'.
** (2) TECHNICAL AMENDMENTS-
*** (A) Section 399R of the Public Health Service Act (as added by section 2 of the ALS Registry Act (Public Law 110-373; 122 Stat. 4047)) is redesignated as section 399S.
*** (B) Section 399R of such Act (as added by section 3 of the Prenatally and Postnatally Diagnosed Conditions Awareness Act (Public Law 110-374; 122 Stat. 4051)) is redesignated as section 399T.

### SEC. 4004. EDUCATION AND OUTREACH CAMPAIGN REGARDING PREVENTIVE BENEFITS.

* (a) In General- The Secretary of Health and Human Services (referred to in this section as the `Secretary') shall provide for the planning and implementation of a national public-private partnership for a prevention and health promotion outreach and education campaign to raise public awareness of health improvement across the life span. Such campaign shall include the dissemination of information that--
** (1) describes the importance of utilizing preventive services to promote wellness, reduce health disparities, and mitigate chronic disease;
** (2) promotes the use of preventive services recommended by the United States Preventive Services Task Force and the Community Preventive Services Task Force;
** (3) encourages healthy behaviors linked to the prevention of chronic diseases;
** (4) explains the preventive services covered under health plans offered through a Gateway;
** (5) describes additional preventive care supported by the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration, the Advisory Committee on Immunization Practices, and other appropriate agencies; and
** (6) includes general health promotion information.
* (b) Consultation- In coordinating the campaign under subsection (a), the Secretary shall consult with the Institute of Medicine to provide ongoing advice on evidence-based scientific information for policy, program development, and evaluation.
* (c) Media Campaign-
** (1) IN GENERAL- Not later than 1 year after the date of enactment of this Act, the Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall establish and implement a national science-based media campaign on health promotion and disease prevention.
** (2) REQUIREMENT OF CAMPAIGN- The campaign implemented under paragraph (1)--
*** (A) shall be designed to address proper nutrition, regular exercise, smoking cessation, obesity reduction, the 5 leading disease killers in the United States, and secondary prevention through disease screening promotion;
*** (B) shall be carried out through competitively bid contracts awarded to entities providing for the professional production and design of such campaign;
*** (C) may include the use of television, radio, Internet, and other commercial marketing venues and may be targeted to specific age groups based on peer-reviewed social research;
*** (D) shall not be duplicative of any other Federal efforts relating to health promotion and disease prevention; and
*** (E) may include the use of humor and nationally recognized positive role models.
** (3) EVALUATION- The Secretary shall ensure that the campaign implemented under paragraph (1) is subject to an independent evaluation every 2 years and shall report every 2 years to Congress on the effectiveness of such campaigns towards meeting science-based metrics.
* (d) Website- The Secretary, in consultation with private-sector experts, shall maintain or enter into a contract to maintain an Internet website to provide science-based information on guidelines for nutrition, regular exercise, obesity reduction, smoking cessation, and specific chronic disease prevention. Such website shall be designed to provide information to health care providers and consumers.
* (e) Dissemination of Information Through Providers- The Secretary, acting through the Centers for Disease Control and Prevention, shall develop and implement a plan for the dissemination of health promotion and disease prevention information consistent with national priorities, to health care providers who participate in Federal programs, including programs administered by the Indian Health Service, the Department of Veterans Affairs, the Department of Defense, and the Health Resources and Services Administration, and Medicare and Medicaid.
* (f) Personalized Prevention Plans-
** (1) CONTRACT- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall enter into a contract with a qualified entity for the development and operation of a Federal Internet website personalized prevention plan tool.
** (2) USE- The website developed under paragraph (1) shall be designed to be used as a source of the most up-to-date scientific evidence relating to disease prevention for use by individuals. Such website shall contain a component that enables an individual to determine their disease risk (based on personal health and family history, BMI, and other relevant information) relating to the 5 leading diseases in the United States, and obtain personalized suggestions for preventing such diseases.
* (g) Internet Portal- The Secretary shall establish an Internet portal for accessing risk-assessment tools developed and maintained by private and academic entities.
* (h) Priority Funding- Funding for the activities authorized under this section shall take priority over funding provided through the Centers for Disease Control and Prevention for grants to States and other entities for similar purposes and goals as provided for in this section. Not to exceed $500,000,000 shall be expended on the campaigns and activities required under this section.
* (i) Public Awareness of Preventive and Obesity-related Services-
** (1) INFORMATION TO STATES- The Secretary of Health and Human Services shall provide guidance and relevant information to States and health care providers regarding preventive and obesity-related services that are available to Medicaid enrollees, including obesity screening and counseling for children and adults.
** (2) INFORMATION TO ENROLLEES- Each State shall design a public awareness campaign to educate Medicaid enrollees regarding availability and coverage of such services, with the goal of reducing incidences of obesity.
** (3) REPORT- Not later than January 1, 2011, and every 3 years thereafter through January 1, 2017, the Secretary of Health and Human Services shall report to Congress on the status and effectiveness of efforts under paragraphs (1) and (2), including summaries of the States' efforts to increase awareness of coverage of obesity-related services.
* (j) Authorization of Appropriations- There are authorized to be appropriated such sums as may be necessary to carry out this section.

## Subtitle B--Increasing Access to Clinical Preventive Services
### SEC. 4101. SCHOOL-BASED HEALTH CENTERS.

* (a) Grants for the Establishment of School-based Health Centers-
** (1) PROGRAM- The Secretary of Health and Human Services (in this subsection referred to as the `Secretary') shall establish a program to award grants to eligible entities to support the operation of school-based health centers.
** (2) ELIGIBILITY- To be eligible for a grant under this subsection, an entity shall--
*** (A) be a school-based health center or a sponsoring facility of a school-based health center; and
*** (B) submit an application at such time, in such manner, and containing such information as the Secretary may require, including at a minimum an assurance that funds awarded under the grant shall not be used to provide any service that is not authorized or allowed by Federal, State, or local law.
** (3) PREFERENCE- In awarding grants under this section, the Secretary shall give preference to awarding grants for school-based health centers that serve a large population of children eligible for medical assistance under the State Medicaid plan under title XIX of the Social Security Act or under a waiver of such plan or children eligible for child health assistance under the State child health plan under title XXI of that Act (42 U.S.C. 1397aa et seq.).
** (4) LIMITATION ON USE OF FUNDS- An eligible entity shall use funds provided under a grant awarded under this subsection only for expenditures for facilities (including the acquisition or improvement of land, or the acquisition, construction, expansion, replacement, or other improvement of any building or other facility), equipment, or similar expenditures, as specified by the Secretary. No funds provided under a grant awarded under this section shall be used for expenditures for personnel or to provide health services.
** (5) APPROPRIATIONS- Out of any funds in the Treasury not otherwise appropriated, there is appropriated for each of fiscal years 2010 through 2013, $50,000,000 for the purpose of carrying out this subsection. Funds appropriated under this paragraph shall remain available until expended.
** (6) DEFINITIONS- In this subsection, the terms `school-based health center' and `sponsoring facility' have the meanings given those terms in section 2110(c)(9) of the Social Security Act (42 U.S.C. 1397jj(c)(9)).
* (b) Grants for the Operation of School-based Health Centers- Part Q of title III of the Public Health Service Act (42 U.S.C. 280h et seq.) is amended by adding at the end the following:

### SEC. 399Z-1. SCHOOL-BASED HEALTH CENTERS.

* (a) Definitions; Establishment of Criteria- In this section:
** (1) COMPREHENSIVE PRIMARY HEALTH SERVICES- The term `comprehensive primary health services' means the core services offered by school-based health centers, which shall include the following:
*** (A) PHYSICAL- Comprehensive health assessments, diagnosis, and treatment of minor, acute, and chronic medical conditions, and referrals to, and follow-up for, specialty care and oral health services.
*** (B) MENTAL HEALTH- Mental health and substance use disorder assessments, crisis intervention, counseling, treatment, and referral to a continuum of services including emergency psychiatric care, community support programs, inpatient care, and outpatient programs.
** (2) MEDICALLY UNDERSERVED CHILDREN AND ADOLESCENTS-
*** (A) IN GENERAL- The term `medically underserved children and adolescents' means a population of children and adolescents who are residents of an area designated as a medically underserved area or a health professional shortage area by the Secretary.
*** (B) CRITERIA- The Secretary shall prescribe criteria for determining the specific shortages of personal health services for medically underserved children and adolescents under subparagraph (A) that shall--
**** (i) take into account any comments received by the Secretary from the chief executive officer of a State and local officials in a State; and
**** (ii) include factors indicative of the health status of such children and adolescents of an area, including the ability of the residents of such area to pay for health services, the accessibility of such services, the availability of health professionals to such children and adolescents, and other factors as determined appropriate by the Secretary.
** (3) SCHOOL-BASED HEALTH CENTER- The term `school-based health center' means a health clinic that--
*** (A) meets the definition of a school-based health center under section 2110(c)(9)(A) of the Social Security Act and is administered by a sponsoring facility (as defined in section 2110(c)(9)(B) of the Social Security Act);
*** (B) provides, at a minimum, comprehensive primary health services during school hours to children and adolescents by health professionals in accordance with established standards, community practice, reporting laws, and other State laws, including parental consent and notification laws that are not inconsistent with Federal law; and
*** (C) does not perform abortion services.
* (b) Authority To Award Grants- The Secretary shall award grants for the costs of the operation of school-based health centers (referred to in this section as `SBHCs') that meet the requirements of this section.
* (c) Applications- To be eligible to receive a grant under this section, an entity shall--
** (1) be an SBHC (as defined in subsection (a)(3)); and
** (2) submit to the Secretary an application at such time, in such manner, and containing--
*** (A) evidence that the applicant meets all criteria necessary to be designated an SBHC;
*** (B) evidence of local need for the services to be provided by the SBHC;
*** (C) an assurance that--
**** (i) SBHC services will be provided to those children and adolescents for whom parental or guardian consent has been obtained in cooperation with Federal, State, and local laws governing health care service provision to children and adolescents;
**** (ii) the SBHC has made and will continue to make every reasonable effort to establish and maintain collaborative relationships with other health care providers in the catchment area of the SBHC;
**** (iii) the SBHC will provide on-site access during the academic day when school is in session and 24-hour coverage through an on-call system and through its backup health providers to ensure access to services on a year-round basis when the school or the SBHC is closed;
**** (iv) the SBHC will be integrated into the school environment and will coordinate health services with school personnel, such as administrators, teachers, nurses, counselors, and support personnel, as well as with other community providers co-located at the school;
**** (v) the SBHC sponsoring facility assumes all responsibility for the SBHC administration, operations, and oversight; and
**** (vi) the SBHC will comply with Federal, State, and local laws concerning patient privacy and student records, including regulations promulgated under the Health Insurance Portability and Accountability Act of 1996 and section 444 of the General Education Provisions Act; and
*** (D) such other information as the Secretary may require.
* (d) Preferences and Consideration- In reviewing applications:
** (1) The Secretary may give preference to applicants who demonstrate an ability to serve the following:
*** (A) Communities that have evidenced barriers to primary health care and mental health and substance use disorder prevention services for children and adolescents.
*** (B) Communities with high per capita numbers of children and adolescents who are uninsured, underinsured, or enrolled in public health insurance programs.
*** (C) Populations of children and adolescents that have historically demonstrated difficulty in accessing health and mental health and substance use disorder prevention services.
** (2) The Secretary may give consideration to whether an applicant has received a grant under subsection (a) of section 4101 of the Patient Protection and Affordable Care Act.
* (e) Waiver of Requirements- The Secretary may--
** (1) under appropriate circumstances, waive the application of all or part of the requirements of this subsection with respect to an SBHC for not to exceed 2 years; and
** (2) upon a showing of good cause, waive the requirement that the SBHC provide all required comprehensive primary health services for a designated period of time to be determined by the Secretary.
* (f) Use of Funds-
** (1) FUNDS- Funds awarded under a grant under this section--
*** (A) may be used for--
**** (i) acquiring and leasing equipment (including the costs of amortizing the principle of, and paying interest on, loans for such equipment);
**** (ii) providing training related to the provision of required comprehensive primary health services and additional health services;
**** (iii) the management and operation of health center programs;
**** (iv) the payment of salaries for physicians, nurses, and other personnel of the SBHC; and
*** (B) may not be used to provide abortions.
** (2) CONSTRUCTION- The Secretary may award grants which may be used to pay the costs associated with expanding and modernizing existing buildings for use as an SBHC, including the purchase of trailers or manufactured buildings to install on the school property.
** (3) LIMITATIONS-
*** (A) IN GENERAL- Any provider of services that is determined by a State to be in violation of a State law described in subsection (a)(3)(B) with respect to activities carried out at a SBHC shall not be eligible to receive additional funding under this section.
*** (B) NO OVERLAPPING GRANT PERIOD- No entity that has received funding under section 330 for a grant period shall be eligible for a grant under this section for with respect to the same grant period.
* (g) Matching Requirement-
** (1) IN GENERAL- Each eligible entity that receives a grant under this section shall provide, from non-Federal sources, an amount equal to 20 percent of the amount of the grant (which may be provided in cash or in-kind) to carry out the activities supported by the grant.
** (2) WAIVER- The Secretary may waive all or part of the matching requirement described in paragraph (1) for any fiscal year for the SBHC if the Secretary determines that applying the matching requirement to the SBHC would result in serious hardship or an inability to carry out the purposes of this section.
* (h) Supplement, Not Supplant- Grant funds provided under this section shall be used to supplement, not supplant, other Federal or State funds.
* (i) Evaluation- The Secretary shall develop and implement a plan for evaluating SBHCs and monitoring quality performance under the awards made under this section.
* (j) Age Appropriate Services- An eligible entity receiving funds under this section shall only provide age appropriate services through a SBHC funded under this section to an individual.
* (k) Parental Consent- An eligible entity receiving funds under this section shall not provide services through a SBHC funded under this section to an individual without the consent of the parent or guardian of such individual if such individual is considered a minor under applicable State law.
* (l) Authorization of Appropriations- For purposes of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2010 through 2014.'.

### SEC. 4102. ORAL HEALTHCARE PREVENTION ACTIVITIES.

* (a) In General- Title III of the Public Health Service Act (42 U.S.C. 241 et seq.), as amended by section 3025, is amended by adding at the end the following:

#### PART T--ORAL HEALTHCARE PREVENTION ACTIVITIES
### SEC. 399LL. ORAL HEALTHCARE PREVENTION EDUCATION CAMPAIGN.

* (a) Establishment- The Secretary, acting through the Director of the Centers for Disease Control and Prevention and in consultation with professional oral health organizations, shall, subject to the availability of appropriations, establish a 5-year national, public education campaign (referred to in this section as the `campaign') that is focused on oral healthcare prevention and education, including prevention of oral disease such as early childhood and other caries, periodontal disease, and oral cancer.
* (b) Requirements- In establishing the campaign, the Secretary shall--
** (1) ensure that activities are targeted towards specific populations such as children, pregnant women, parents, the elderly, individuals with disabilities, and ethnic and racial minority populations, including Indians, Alaska Natives and Native Hawaiians (as defined in section 4(c) of the Indian Health Care Improvement Act) in a culturally and linguistically appropriate manner; and
** (2) utilize science-based strategies to convey oral health prevention messages that include, but are not limited to, community water fluoridation and dental sealants.
* (c) Planning and Implementation- Not later than 2 years after the date of enactment of this section, the Secretary shall begin implementing the 5-year campaign. During the 2-year period referred to in the previous sentence, the Secretary shall conduct planning activities with respect to the campaign.

### SEC. 399LL-1. RESEARCH-BASED DENTAL CARIES DISEASE MANAGEMENT.

* (a) In General- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall award demonstration grants to eligible entities to demonstrate the effectiveness of research-based dental caries disease management activities.
* (b) Eligibility- To be eligible for a grant under this section, an entity shall--
** (1) be a community-based provider of dental services (as defined by the Secretary), including a Federally-qualified health center, a clinic of a hospital owned or operated by a State (or by an instrumentality or a unit of government within a State), a State or local department of health, a dental program of the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization (as such terms are defined in section 4 of the Indian Health Care Improvement Act), a health system provider, a private provider of dental services, medical, dental, public health, nursing, nutrition educational institutions, or national organizations involved in improving children's oral health; and
** (2) submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
* (c) Use of Funds- A grantee shall use amounts received under a grant under this section to demonstrate the effectiveness of research-based dental caries disease management activities.
* (d) Use of Information- The Secretary shall utilize information generated from grantees under this section in planning and implementing the public education campaign under section 399LL.

### SEC. 399LL-2. AUTHORIZATION OF APPROPRIATIONS.

* There is authorized to be appropriated to carry out this part, such sums as may be necessary.'.
* (b) School-based Sealant Programs- Section 317M(c)(1) of the Public Health Service Act (42 U.S.C. 247b-14(c)(1)) is amended by striking `may award grants to States and Indian tribes' and inserting `shall award a grant to each of the 50 States and territories and to Indians, Indian tribes, tribal organizations and urban Indian organizations (as such terms are defined in section 4 of the Indian Health Care Improvement Act)'.
* (c) Oral Health Infrastructure- Section 317M of the Public Health Service Act (42 U.S.C. 247b-14) is amended--
** (1) by redesignating subsections (d) and (e) as subsections (e) and (f), respectively; and
** (2) by inserting after subsection (c), the following:
* (d) Oral Health Infrastructure-
** (1) COOPERATIVE AGREEMENTS- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall enter into cooperative agreements with State, territorial, and Indian tribes or tribal organizations (as those terms are defined in section 4 of the Indian Health Care Improvement Act) to establish oral health leadership and program guidance, oral health data collection and interpretation, (including determinants of poor oral health among vulnerable populations), a multi-dimensional delivery system for oral health, and to implement science-based programs (including dental sealants and community water fluoridation) to improve oral health.
** (2) AUTHORIZATION OF APPROPRIATIONS- There is authorized to be appropriated such sums as necessary to carry out this subsection for fiscal years 2010 through 2014.'.
* (d) Updating National Oral Healthcare Surveillance Activities-
** (1) PRAMS-
*** (A) IN GENERAL- The Secretary of Health and Human Services (referred to in this subsection as the `Secretary') shall carry out activities to update and improve the Pregnancy Risk Assessment Monitoring System (referred to in this section as `PRAMS') as it relates to oral healthcare.
*** (B) STATE REPORTS AND MANDATORY MEASUREMENTS-
**** (i) IN GENERAL- Not later than 5 years after the date of enactment of this Act, and every 5 years thereafter, a State shall submit to the Secretary a report concerning activities conducted within the State under PRAMS.
**** (ii) MEASUREMENTS- The oral healthcare measurements developed by the Secretary for use under PRAMS shall be mandatory with respect to States for purposes of the State reports under clause (i).
*** (C) FUNDING- There is authorized to be appropriated to carry out this paragraph, such sums as may be necessary.
** (2) NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY- The Secretary shall develop oral healthcare components that shall include tooth-level surveillance for inclusion in the National Health and Nutrition Examination Survey. Such components shall be updated by the Secretary at least every 6 years. For purposes of this paragraph, the term `tooth-level surveillance' means a clinical examination where an examiner looks at each dental surface, on each tooth in the mouth and as expanded by the Division of Oral Health of the Centers for Disease Control and Prevention.
** (3) MEDICAL EXPENDITURES PANEL SURVEY- The Secretary shall ensure that the Medical Expenditures Panel Survey by the Agency for Healthcare Research and Quality includes the verification of dental utilization, expenditure, and coverage findings through conduct of a look-back analysis.
** (4) NATIONAL ORAL HEALTH SURVEILLANCE SYSTEM-
*** (A) APPROPRIATIONS- There is authorized to be appropriated, such sums as may be necessary for each of fiscal years 2010 through 2014 to increase the participation of States in the National Oral Health Surveillance System from 16 States to all 50 States, territories, and District of Columbia.
*** (B) REQUIREMENTS- The Secretary shall ensure that the National Oral Health Surveillance System include the measurement of early childhood caries.

### SEC. 4103. MEDICARE COVERAGE OF ANNUAL WELLNESS VISIT PROVIDING A PERSONALIZED PREVENTION PLAN.

* (a) Coverage of Personalized Prevention Plan Services-
** (1) IN GENERAL- Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is amended--
*** (A) in subparagraph (DD), by striking `and' at the end;
*** (B) in subparagraph (EE), by adding `and' at the end; and
*** (C) by adding at the end the following new subparagraph:
** (FF) personalized prevention plan services (as defined in subsection (hhh));'.
** (2) CONFORMING AMENDMENTS- Clauses (i) and (ii) of section 1861(s)(2)(K) of the Social Security Act (42 U.S.C. 1395x(s)(2)(K)) are each amended by striking `subsection (ww)(1)' and inserting `subsections (ww)(1) and (hhh)'.
* (b) Personalized Prevention Plan Services Defined- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection:

### Annual Wellness Visit

* (hhh)(1) The term `personalized prevention plan services' means the creation of a plan for an individual--
** (A) that includes a health risk assessment (that meets the guidelines established by the Secretary under paragraph (4)(A)) of the individual that is completed prior to or as part of the same visit with a health professional described in paragraph (3); and
** (B) that--
*** (i) takes into account the results of the health risk assessment; and
*** (ii) may contain the elements described in paragraph (2).
* (2) Subject to paragraph (4)(H), the elements described in this paragraph are the following:
** (A) The establishment of, or an update to, the individual's medical and family history.
** (B) A list of current providers and suppliers that are regularly involved in providing medical care to the individual (including a list of all prescribed medications).
** (C) A measurement of height, weight, body mass index (or waist circumference, if appropriate), blood pressure, and other routine measurements.
** (D) Detection of any cognitive impairment.
** (E) The establishment of, or an update to, the following:
*** (i) A screening schedule for the next 5 to 10 years, as appropriate, based on recommendations of the United States Preventive Services Task Force and the Advisory Committee on Immunization Practices, and the individual's health status, screening history, and age-appropriate preventive services covered under this title.
*** (ii) A list of risk factors and conditions for which primary, secondary, or tertiary prevention interventions are recommended or are underway, including any mental health conditions or any such risk factors or conditions that have been identified through an initial preventive physical examination (as described under subsection (ww)(1)), and a list of treatment options and their associated risks and benefits.
** (F) The furnishing of personalized health advice and a referral, as appropriate, to health education or preventive counseling services or programs aimed at reducing identified risk factors and improving self-management, or community-based lifestyle interventions to reduce health risks and promote self-management and wellness, including weight loss, physical activity, smoking cessation, fall prevention, and nutrition.
** (G) Any other element determined appropriate by the Secretary.
* (3) A health professional described in this paragraph is--
** (A) a physician;
** (B) a practitioner described in clause (i) of section 1842(b)(18)(C); or
** (C) a medical professional (including a health educator, registered dietitian, or nutrition professional) or a team of medical professionals, as determined appropriate by the Secretary, under the supervision of a physician.
* (4)(A) For purposes of paragraph (1)(A), the Secretary, not later than 1 year after the date of enactment of this subsection, shall establish publicly available guidelines for health risk assessments. Such guidelines shall be developed in consultation with relevant groups and entities and shall provide that a health risk assessment--
** (i) identify chronic diseases, injury risks, modifiable risk factors, and urgent health needs of the individual; and
** (ii) may be furnished--
*** (I) through an interactive telephonic or web-based program that meets the standards established under subparagraph (B);
*** (II) during an encounter with a health care professional;
*** (III) through community-based prevention programs; or
*** (IV) through any other means the Secretary determines appropriate to maximize accessibility and ease of use by beneficiaries, while ensuring the privacy of such beneficiaries.
* (B) Not later than 1 year after the date of enactment of this subsection, the Secretary shall establish standards for interactive telephonic or web-based programs used to furnish health risk assessments under subparagraph (A)(ii)(I). The Secretary may utilize any health risk assessment developed under section 4004(f) of the Patient Protection and Affordable Care Act as part of the requirement to develop a personalized prevention plan to comply with this subparagraph.
* (C)(i) Not later than 18 months after the date of enactment of this subsection, the Secretary shall develop and make available to the public a health risk assessment model. Such model shall meet the guidelines under subparagraph (A) and may be used to meet the requirement under paragraph (1)(A).
* (ii) Any health risk assessment that meets the guidelines under subparagraph (A) and is approved by the Secretary may be used to meet the requirement under paragraph (1)(A).
* (D) The Secretary may coordinate with community-based entities (including State Health Insurance Programs, Area Agencies on Aging, Aging and Disability Resource Centers, and the Administration on Aging) to--
** (i) ensure that health risk assessments are accessible to beneficiaries; and
** (ii) provide appropriate support for the completion of health risk assessments by beneficiaries.
* (E) The Secretary shall establish procedures to make beneficiaries and providers aware of the requirement that a beneficiary complete a health risk assessment prior to or at the same time as receiving personalized prevention plan services.
* (F) To the extent practicable, the Secretary shall encourage the use of, integration with, and coordination of health information technology (including use of technology that is compatible with electronic medical records and personal health records) and may experiment with the use of personalized technology to aid in the development of self-management skills and management of and adherence to provider recommendations in order to improve the health status of beneficiaries.
* (G)(i) A beneficiary shall only be eligible to receive an initial preventive physical examination (as defined under subsection (ww)(1)) at any time during the 12-month period after the date that the beneficiary's coverage begins under part B and shall be eligible to receive personalized prevention plan services under this subsection provided that the beneficiary has not received such services within the preceding 12-month period.
* (ii) The Secretary shall establish procedures to make beneficiaries aware of the option to select an initial preventive physical examination or personalized prevention plan services during the period of 12 months after the date that a beneficiary's coverage begins under part B, which shall include information regarding any relevant differences between such services.
* (H) The Secretary shall issue guidance that--
** (i) identifies elements under paragraph (2) that are required to be provided to a beneficiary as part of their first visit for personalized prevention plan services; and
** (ii) establishes a yearly schedule for appropriate provision of such elements thereafter.'.
* (c) Payment and Elimination of Cost-Sharing-
** (1) PAYMENT AND ELIMINATION OF COINSURANCE- Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended--
*** (A) in subparagraph (N), by inserting `other than personalized prevention plan services (as defined in section 1861(hhh)(1))' after `(as defined in section 1848(j)(3))';
*** (B) by striking `and' before `(W)'; and
*** (C) by inserting before the semicolon at the end the following: `, and (X) with respect to personalized prevention plan services (as defined in section 1861(hhh)(1)), the amount paid shall be 100 percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section 1848'.
** (2) PAYMENT UNDER PHYSICIAN FEE SCHEDULE- Section 1848(j)(3) of the Social Security Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting `(2)(FF) (including administration of the health risk assessment) ,' after `(2)(EE),'.
** (3) ELIMINATION OF COINSURANCE IN OUTPATIENT HOSPITAL SETTINGS-
*** (A) EXCLUSION FROM OPD FEE SCHEDULE- Section 1833(t)(1)(B)(iv) of the Social Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)) is amended by striking `and diagnostic mammography' and inserting `, diagnostic mammography, or personalized prevention plan services (as defined in section 1861(hhh)(1))'.
*** (B) CONFORMING AMENDMENTS- Section 1833(a)(2) of the Social Security Act (42 U.S.C. 1395l(a)(2)) is amended--
**** (i) in subparagraph (F), by striking `and' at the end;
**** (ii) in subparagraph (G)(ii), by striking the comma at the end and inserting `; and'; and
**** (iii) by inserting after subparagraph (G)(ii) the following new subparagraph:
*** (H) with respect to personalized prevention plan services (as defined in section 1861(hhh)(1)) furnished by an outpatient department of a hospital, the amount determined under paragraph (1)(X),'.
** (4) WAIVER OF APPLICATION OF DEDUCTIBLE- The first sentence of section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)) is amended--
*** (A) by striking `and' before `(9)'; and
*** (B) by inserting before the period the following: `, and (10) such deductible shall not apply with respect to personalized prevention plan services (as defined in section 1861(hhh)(1))'.
* (d) Frequency Limitation- Section 1862(a) of the Social Security Act (42 U.S.C. 1395y(a)) is amended--
** (1) in paragraph (1)--
*** (A) in subparagraph (N), by striking `and' at the end;
*** (B) in subparagraph (O), by striking the semicolon at the end and inserting `, and'; and
*** (C) by adding at the end the following new subparagraph:
** (P) in the case of personalized prevention plan services (as defined in section 1861(hhh)(1)), which are performed more frequently than is covered under such section;'; and
** (2) in paragraph (7), by striking `or (K)' and inserting `(K), or (P)'.
* (e) Effective Date- The amendments made by this section shall apply to services furnished on or after January 1, 2011.

### SEC. 4104. REMOVAL OF BARRIERS TO PREVENTIVE SERVICES IN MEDICARE.

* (a) Definition of Preventive Services- Section 1861(ddd) of the Social Security Act (42 U.S.C. 1395x(ddd)) is amended--
** (1) in the heading, by inserting `; Preventive Services' after `Services';
** (2) in paragraph (1), by striking `not otherwise described in this title' and inserting `not described in subparagraph (A) or (C) of paragraph (3)'; and
** (3) by adding at the end the following new paragraph:
* (3) The term `preventive services' means the following:
** (A) The screening and preventive services described in subsection (ww)(2) (other than the service described in subparagraph (M) of such subsection).
** (B) An initial preventive physical examination (as defined in subsection (ww)).
** (C) Personalized prevention plan services (as defined in subsection (hhh)(1)).'.
* (b) Coinsurance-
** (1) GENERAL APPLICATION-
*** (A) IN GENERAL- Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)), as amended by section 4103(c)(1), is amended--
**** (i) in subparagraph (T), by inserting `(or 100 percent if such services are recommended with a grade of A or B by the United States Preventive Services Task Force for any indication or population and are appropriate for the individual)' after `80 percent';
**** (ii) in subparagraph (W)--
***** (I) in clause (i), by inserting `(if such subparagraph were applied, by substituting `100 percent' for `80 percent')' after `subparagraph (D)'; and
***** (II) in clause (ii), by striking `80 percent' and inserting `100 percent';
**** (iii) by striking `and' before `(X)'; and
**** (iv) by inserting before the semicolon at the end the following: `, and (Y) with respect to preventive services described in subparagraphs (A) and (B) of section 1861(ddd)(3) that are appropriate for the individual and, in the case of such services described in subparagraph (A), are recommended with a grade of A or B by the United States Preventive Services Task Force for any indication or population, the amount paid shall be 100 percent of the lesser of the actual charge for the services or the amount determined under the fee schedule that applies to such services under this part'.
** (2) ELIMINATION OF COINSURANCE IN OUTPATIENT HOSPITAL SETTINGS-
*** (A) EXCLUSION FROM OPD FEE SCHEDULE- Section 1833(t)(1)(B)(iv) of the Social Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)), as amended by section 4103(c)(3)(A), is amended--
**** (i) by striking `or' before `personalized prevention plan services'; and
**** (ii) by inserting before the period the following: `, or preventive services described in subparagraphs (A) and (B) of section 1861(ddd)(3) that are appropriate for the individual and, in the case of such services described in subparagraph (A), are recommended with a grade of A or B by the United States Preventive Services Task Force for any indication or population'.
*** (B) CONFORMING AMENDMENTS- Section 1833(a)(2) of the Social Security Act (42 U.S.C. 1395l(a)(2)), as amended by section 4103(c)(3)(B), is amended--
**** (i) in subparagraph (G)(ii), by striking `and' after the semicolon at the end;
**** (ii) in subparagraph (H), by striking the comma at the end and inserting `; and'; and
**** (iii) by inserting after subparagraph (H) the following new subparagraph:
*** (I) with respect to preventive services described in subparagraphs (A) and (B) of section 1861(ddd)(3) that are appropriate for the individual and are furnished by an outpatient department of a hospital and, in the case of such services described in subparagraph (A), are recommended with a grade of A or B by the United States Preventive Services Task Force for any indication or population, the amount determined under paragraph (1)(W) or (1)(Y),'.
* (c) Waiver of Application of Deductible for Preventive Services and Colorectal Cancer Screening Tests- Section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)), as amended by section 4103(c)(4), is amended--
** (1) in paragraph (1), by striking `items and services described in section 1861(s)(10)(A)' and inserting `preventive services described in subparagraph (A) of section 1861(ddd)(3) that are recommended with a grade of A or B by the United States Preventive Services Task Force for any indication or population and are appropriate for the individual.'; and
** (2) by adding at the end the following new sentence: `Paragraph (1) of the first sentence of this subsection shall apply with respect to a colorectal cancer screening test regardless of the code that is billed for the establishment of a diagnosis as a result of the test, or for the removal of tissue or other matter or other procedure that is furnished in connection with, as a result of, and in the same clinical encounter as the screening test.'.
* (d) Effective Date- The amendments made by this section shall apply to items and services furnished on or after January 1, 2011.

### SEC. 4105. EVIDENCE-BASED COVERAGE OF PREVENTIVE SERVICES IN MEDICARE.

* (a) Authority To Modify or Eliminate Coverage of Certain Preventive Services- Section 1834 of the Social Security Act (42 U.S.C. 1395m) is amended by adding at the end the following new subsection:
* (n) Authority To Modify or Eliminate Coverage of Certain Preventive Services- Notwithstanding any other provision of this title, effective beginning on January 1, 2010, if the Secretary determines appropriate, the Secretary may--
** (1) modify--
*** (A) the coverage of any preventive service described in subparagraph (A) of section 1861(ddd)(3) to the extent that such modification is consistent with the recommendations of the United States Preventive Services Task Force; and
*** (B) the services included in the initial preventive physical examination described in subparagraph (B) of such section; and
** (2) provide that no payment shall be made under this title for a preventive service described in subparagraph (A) of such section that has not received a grade of A, B, C, or I by such Task Force.'.
* (b) Construction- Nothing in the amendment made by paragraph (1) shall be construed to affect the coverage of diagnostic or treatment services under title XVIII of the Social Security Act.

### SEC. 4106. IMPROVING ACCESS TO PREVENTIVE SERVICES FOR ELIGIBLE ADULTS IN MEDICAID.

* (a) Clarification of Inclusion of Services- Section 1905(a)(13) of the Social Security Act (42 U.S.C. 1396d(a)(13)) is amended to read as follows:
** (13) other diagnostic, screening, preventive, and rehabilitative services, including--
*** (A) any clinical preventive services that are assigned a grade of A or B by the United States Preventive Services Task Force;
*** (B) with respect to an adult individual, approved vaccines recommended by the Advisory Committee on Immunization Practices (an advisory committee established by the Secretary, acting through the Director of the Centers for Disease Control and Prevention) and their administration; and
*** (C) any medical or remedial services (provided in a facility, a home, or other setting) recommended by a physician or other licensed practitioner of the healing arts within the scope of their practice under State law, for the maximum reduction of physical or mental disability and restoration of an individual to the best possible functional level;'.
* (b) Increased Fmap- Section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)), as amended by sections 2001(a)(3)(A) and 2004(c)(1), is amended in the first sentence--
** (1) by striking `, and (4)' and inserting `, (4)'; and
** (2) by inserting before the period the following: `, and (5) in the case of a State that provides medical assistance for services and vaccines described in subparagraphs (A) and (B) of subsection (a)(13), and prohibits cost-sharing for such services and vaccines, the Federal medical assistance percentage, as determined under this subsection and subsection (y) (without regard to paragraph (1)(C) of such subsection), shall be increased by 1 percentage point with respect to medical assistance for such services and vaccines and for items and services described in subsection (a)(4)(D)'.
* (c) Effective Date- The amendments made under this section shall take effect on January 1, 2013.

### SEC. 4107. COVERAGE OF COMPREHENSIVE TOBACCO CESSATION SERVICES FOR PREGNANT WOMEN IN MEDICAID.

* (a) Requiring Coverage of Counseling and Pharmacotherapy for Cessation of Tobacco Use by Pregnant Women- Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by sections 2001(a)(3)(B) and 2303, is further amended--
** (1) in subsection (a)(4)--
*** (A) by striking `and' before `(C)'; and
*** (B) by inserting before the semicolon at the end the following new subparagraph: `; and (D) counseling and pharmacotherapy for cessation of tobacco use by pregnant women (as defined in subsection (bb))'; and
** (2) by adding at the end the following:
* (bb)(1) For purposes of this title, the term `counseling and pharmacotherapy for cessation of tobacco use by pregnant women' means diagnostic, therapy, and counseling services and pharmacotherapy (including the coverage of prescription and nonprescription tobacco cessation agents approved by the Food and Drug Administration) for cessation of tobacco use by pregnant women who use tobacco products or who are being treated for tobacco use that is furnished--
** (A) by or under the supervision of a physician; or
** (B) by any other health care professional who--
*** (i) is legally authorized to furnish such services under State law (or the State regulatory mechanism provided by State law) of the State in which the services are furnished; and
*** (ii) is authorized to receive payment for other services under this title or is designated by the Secretary for this purpose.
* (2) Subject to paragraph (3), such term is limited to--
** (A) services recommended with respect to pregnant women in `Treating Tobacco Use and Dependence: 2008 Update: A Clinical Practice Guideline', published by the Public Health Service in May 2008, or any subsequent modification of such Guideline; and
** (B) such other services that the Secretary recognizes to be effective for cessation of tobacco use by pregnant women.
* (3) Such term shall not include coverage for drugs or biologicals that are not otherwise covered under this title.'.
* (b) Exception From Optional Restriction Under Medicaid Prescription Drug Coverage- Section 1927(d)(2)(F) of the Social Security Act (42 U.S.C. 1396r-8(d)(2)(F)), as redesignated by section 2502(a), is amended by inserting before the period at the end the following: `, except, in the case of pregnant women when recommended in accordance with the Guideline referred to in section 1905(bb)(2)(A), agents approved by the Food and Drug Administration under the over-the-counter monograph process for purposes of promoting, and when used to promote, tobacco cessation'.
* (c) Removal of Cost-Sharing for Counseling and Pharmacotherapy for Cessation of Tobacco Use by Pregnant Women-
** (1) GENERAL COST-SHARING LIMITATIONS- Section 1916 of the Social Security Act (42 U.S.C. 1396o) is amended in each of subsections (a)(2)(B) and (b)(2)(B) by inserting `, and counseling and pharmacotherapy for cessation of tobacco use by pregnant women (as defined in section 1905(bb)) and covered outpatient drugs (as defined in subsection (k)(2) of section 1927 and including nonprescription drugs described in subsection (d)(2) of such section) that are prescribed for purposes of promoting, and when used to promote, tobacco cessation by pregnant women in accordance with the Guideline referred to in section 1905(bb)(2)(A)' after `complicate the pregnancy'.
** (2) APPLICATION TO ALTERNATIVE COST-SHARING- Section 1916A(b)(3)(B)(iii) of such Act (42 U.S.C. 1396o-1(b)(3)(B)(iii)) is amended by inserting `, and counseling and pharmacotherapy for cessation of tobacco use by pregnant women (as defined in section 1905(bb))' after `complicate the pregnancy'.
* (d) Effective Date- The amendments made by this section shall take effect on October 1, 2010.

### SEC. 4108. INCENTIVES FOR PREVENTION OF CHRONIC DISEASES IN MEDICAID.

* (a) Initiatives-
** (1) ESTABLISHMENT-
*** (A) IN GENERAL- The Secretary shall award grants to States to carry out initiatives to provide incentives to Medicaid beneficiaries who--
**** (i) successfully participate in a program described in paragraph (3); and
**** (ii) upon completion of such participation, demonstrate changes in health risk and outcomes, including the adoption and maintenance of healthy behaviors by meeting specific targets (as described in subsection (c)(2)).
*** (B) PURPOSE- The purpose of the initiatives under this section is to test approaches that may encourage behavior modification and determine scalable solutions.
** (2) DURATION-
*** (A) INITIATION OF PROGRAM; RESOURCES- The Secretary shall awards grants to States beginning on January 1, 2011, or beginning on the date on which the Secretary develops program criteria, whichever is earlier. The Secretary shall develop program criteria for initiatives under this section using relevant evidence-based research and resources, including the Guide to Community Preventive Services, the Guide to Clinical Preventive Services, and the National Registry of Evidence-Based Programs and Practices.
*** (B) DURATION OF PROGRAM- A State awarded a grant to carry out initiatives under this section shall carry out such initiatives within the 5-year period beginning on January 1, 2011, or beginning on the date on which the Secretary develops program criteria, whichever is earlier. Initiatives under this section shall be carried out by a State for a period of not less than 3 years.
** (3) PROGRAM DESCRIBED-
*** (A) IN GENERAL- A program described in this paragraph is a comprehensive, evidence-based, widely available, and easily accessible program, proposed by the State and approved by the Secretary, that is designed and uniquely suited to address the needs of Medicaid beneficiaries and has demonstrated success in helping individuals achieve one or more of the following:
**** (i) Ceasing use of tobacco products.
**** (ii) Controlling or reducing their weight.
**** (iii) Lowering their cholesterol.
**** (iv) Lowering their blood pressure.
**** (v) Avoiding the onset of diabetes or, in the case of a diabetic, improving the management of that condition.
*** (B) CO-MORBIDITIES- A program under this section may also address co-morbidities (including depression) that are related to any of the conditions described in subparagraph (A).
*** (C) WAIVER AUTHORITY- The Secretary may waive the requirements of section 1902(a)(1) (relating to statewideness) of the Social Security Act for a State awarded a grant to conduct an initiative under this section and shall ensure that a State makes any program described in subparagraph (A) available and accessible to Medicaid beneficiaries.
*** (D) FLEXIBILITY IN IMPLEMENTATION- A State may enter into arrangements with providers participating in Medicaid, community-based organizations, faith-based organizations, public-private partnerships, Indian tribes, or similar entities or organizations to carry out programs described in subparagraph (A).
** (4) APPLICATION- Following the development of program criteria by the Secretary, a State may submit an application, in such manner and containing such information as the Secretary may require, that shall include a proposal for programs described in paragraph (3)(A) and a plan to make Medicaid beneficiaries and providers participating in Medicaid who reside in the State aware and informed about such programs.
* (b) Education and Outreach Campaign-
** (1) STATE AWARENESS- The Secretary shall conduct an outreach and education campaign to make States aware of the grants under this section.
** (2) PROVIDER AND BENEFICIARY EDUCATION- A State awarded a grant to conduct an initiative under this section shall conduct an outreach and education campaign to make Medicaid beneficiaries and providers participating in Medicaid who reside in the State aware of the programs described in subsection (a)(3) that are to be carried out by the State under the grant.
* (c) Impact- A State awarded a grant to conduct an initiative under this section shall develop and implement a system to--
** (1) track Medicaid beneficiary participation in the program and validate changes in health risk and outcomes with clinical data, including the adoption and maintenance of health behaviors by such beneficiaries;
** (2) to the extent practicable, establish standards and health status targets for Medicaid beneficiaries participating in the program and measure the degree to which such standards and targets are met;
** (3) evaluate the effectiveness of the program and provide the Secretary with such evaluations;
** (4) report to the Secretary on processes that have been developed and lessons learned from the program; and
** (5) report on preventive services as part of reporting on quality measures for Medicaid managed care programs.
* (d) Evaluations and Reports-
** (1) INDEPENDENT ASSESSMENT- The Secretary shall enter into a contract with an independent entity or organization to conduct an evaluation and assessment of the initiatives carried out by States under this section, for the purpose of determining--
*** (A) the effect of such initiatives on the use of health care services by Medicaid beneficiaries participating in the program;
*** (B) the extent to which special populations (including adults with disabilities, adults with chronic illnesses, and children with special health care needs) are able to participate in the program;
*** (C) the level of satisfaction of Medicaid beneficiaries with respect to the accessibility and quality of health care services provided through the program; and
*** (D) the administrative costs incurred by State agencies that are responsible for administration of the program.
** (2) STATE REPORTING- A State awarded a grant to carry out initiatives under this section shall submit reports to the Secretary, on a semi-annual basis, regarding the programs that are supported by the grant funds. Such report shall include information, as specified by the Secretary, regarding--
*** (A) the specific uses of the grant funds;
*** (B) an assessment of program implementation and lessons learned from the programs;
*** (C) an assessment of quality improvements and clinical outcomes under such programs; and
*** (D) estimates of cost savings resulting from such programs.
** (3) INITIAL REPORT- Not later than January 1, 2014, the Secretary shall submit to Congress an initial report on such initiatives based on information provided by States through reports required under paragraph (2). The initial report shall include an interim evaluation of the effectiveness of the initiatives carried out with grants awarded under this section and a recommendation regarding whether funding for expanding or extending the initiatives should be extended beyond January 1, 2016.
** (4) FINAL REPORT- Not later than July 1, 2016, the Secretary shall submit to Congress a final report on the program that includes the results of the independent assessment required under paragraph (1), together with recommendations for such legislation and administrative action as the Secretary determines appropriate.
* (e) No Effect on Eligibility for, or Amount of, Medicaid or Other Benefits- Any incentives provided to a Medicaid beneficiary participating in a program described in subsection (a)(3) shall not be taken into account for purposes of determining the beneficiary's eligibility for, or amount of, benefits under the Medicaid program or any program funded in whole or in part with Federal funds.
* (f) Funding- Out of any funds in the Treasury not otherwise appropriated, there are appropriated for the 5-year period beginning on January 1, 2011, $100,000,000 to the Secretary to carry out this section. Amounts appropriated under this subsection shall remain available until expended.
* (g) Definitions- In this section:
** (1) MEDICAID BENEFICIARY- The term `Medicaid beneficiary' means an individual who is eligible for medical assistance under a State plan or waiver under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) and is enrolled in such plan or waiver.
** (2) STATE- The term `State' has the meaning given that term for purposes of title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).

## Subtitle C--Creating Healthier Communities
### SEC. 4201. COMMUNITY TRANSFORMATION GRANTS.

* (a) In General- The Secretary of Health and Human Services (referred to in this section as the `Secretary'), acting through the Director of the Centers for Disease Control and Prevention (referred to in this section as the `Director'), shall award competitive grants to State and local governmental agencies and community-based organizations for the implementation, evaluation, and dissemination of evidence-based community preventive health activities in order to reduce chronic disease rates, prevent the development of secondary conditions, address health disparities, and develop a stronger evidence-base of effective prevention programming.
* (b) Eligibility- To be eligible to receive a grant under subsection (a), an entity shall--
** (1) be--
*** (A) a State governmental agency;
*** (B) a local governmental agency;
*** (C) a national network of community-based organizations;
*** (D) a State or local non-profit organization; or
*** (E) an Indian tribe; and
** (2) submit to the Director an application at such time, in such a manner, and containing such information as the Director may require, including a description of the program to be carried out under the grant; and
** (3) demonstrate a history or capacity, if funded, to develop relationships necessary to engage key stakeholders from multiple sectors within and beyond health care and across a community, such as healthy futures corps and health care providers.
* (c) Use of Funds-
** (1) IN GENERAL- An eligible entity shall use amounts received under a grant under this section to carry out programs described in this subsection.
** (2) COMMUNITY TRANSFORMATION PLAN-
*** (A) IN GENERAL- An eligible entity that receives a grant under this section shall submit to the Director (for approval) a detailed plan that includes the policy, environmental, programmatic, and as appropriate infrastructure changes needed to promote healthy living and reduce disparities.
*** (B) ACTIVITIES- Activities within the plan may focus on (but not be limited to)--
**** (i) creating healthier school environments, including increasing healthy food options, physical activity opportunities, promotion of healthy lifestyle, emotional wellness, and prevention curricula, and activities to prevent chronic diseases;
**** (ii) creating the infrastructure to support active living and access to nutritious foods in a safe environment;
**** (iii) developing and promoting programs targeting a variety of age levels to increase access to nutrition, physical activity and smoking cessation, improve social and emotional wellness, enhance safety in a community, or address any other chronic disease priority area identified by the grantee;
**** (iv) assessing and implementing worksite wellness programming and incentives;
**** (v) working to highlight healthy options at restaurants and other food venues;
**** (vi) prioritizing strategies to reduce racial and ethnic disparities, including social, economic, and geographic determinants of health; and
**** (vii) addressing special populations needs, including all age groups and individuals with disabilities, and individuals in both urban and rural areas.
** (3) COMMUNITY-BASED PREVENTION HEALTH ACTIVITIES-
*** (A) IN GENERAL- An eligible entity shall use amounts received under a grant under this section to implement a variety of programs, policies, and infrastructure improvements to promote healthier lifestyles.
*** (B) ACTIVITIES- An eligible entity shall implement activities detailed in the community transformation plan under paragraph (2).
*** (C) IN-KIND SUPPORT- An eligible entity may provide in-kind resources such as staff, equipment, or office space in carrying out activities under this section.
** (4) EVALUATION-
*** (A) IN GENERAL- An eligible entity shall use amounts provided under a grant under this section to conduct activities to measure changes in the prevalence of chronic disease risk factors among community members participating in preventive health activities
*** (B) TYPES OF MEASURES- In carrying out subparagraph (A), the eligible entity shall, with respect to residents in the community, measure--
**** (i) changes in weight;
**** (ii) changes in proper nutrition;
**** (iii) changes in physical activity;
**** (iv) changes in tobacco use prevalence;
**** (v) changes in emotional well-being and overall mental health;
**** (vi) other factors using community-specific data from the Behavioral Risk Factor Surveillance Survey; and
**** (vii) other factors as determined by the Secretary.
*** (C) REPORTING- An eligible entity shall annually submit to the Director a report containing an evaluation of activities carried out under the grant.
** (5) DISSEMINATION- A grantee under this section shall--
*** (A) meet at least annually in regional or national meetings to discuss challenges, best practices, and lessons learned with respect to activities carried out under the grant; and
*** (B) develop models for the replication of successful programs and activities and the mentoring of other eligible entities.
* (d) Training-
** (1) IN GENERAL- The Director shall develop a program to provide training for eligible entities on effective strategies for the prevention and control of chronic disease and the link between physical, emotional, and social well-being.
** (2) COMMUNITY TRANSFORMATION PLAN- The Director shall provide appropriate feedback and technical assistance to grantees to establish community transformation plans
** (3) EVALUATION- The Director shall provide a literature review and framework for the evaluation of programs conducted as part of the grant program under this section, in addition to working with academic institutions or other entities with expertise in outcome evaluation.
* (e) Prohibition- A grantee shall not use funds provided under a grant under this section to create video games or to carry out any other activities that may lead to higher rates of obesity or inactivity.
* (f) Authorization of Appropriations- There are authorized to be appropriated to carry out this section, such sums as may be necessary for each fiscal years 2010 through 2014.

### SEC. 4202. HEALTHY AGING, LIVING WELL; EVALUATION OF COMMUNITY-BASED PREVENTION AND WELLNESS PROGRAMS FOR MEDICARE BENEFICIARIES.

* (a) Healthy Aging, Living Well-
** (1) IN GENERAL- The Secretary of Health and Human Services (referred to in this section as the `Secretary'), acting through the Director of the Centers for Disease Control and Prevention, shall award grants to State or local health departments and Indian tribes to carry out 5-year pilot programs to provide public health community interventions, screenings, and where necessary, clinical referrals for individuals who are between 55 and 64 years of age.
** (2) ELIGIBILITY- To be eligible to receive a grant under paragraph (1), an entity shall--
*** (A) be--
**** (i) a State health department;
**** (ii) a local health department; or
**** (iii) an Indian tribe;
*** (B) submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require including a description of the program to be carried out under the grant;
*** (C) design a strategy for improving the health of the 55-to-64 year-old population through community-based public health interventions; and
*** (D) demonstrate the capacity, if funded, to develop the relationships necessary with relevant health agencies, health care providers, community-based organizations, and insurers to carry out the activities described in paragraph (3), such relationships to include the identification of a community-based clinical partner, such as a community health center or rural health clinic.
** (3) USE OF FUNDS-
*** (A) IN GENERAL- A State or local health department shall use amounts received under a grant under this subsection to carry out a program to provide the services described in this paragraph to individuals who are between 55 and 64 years of age.
*** (B) PUBLIC HEALTH INTERVENTIONS-
**** (i) IN GENERAL- In developing and implementing such activities, a grantee shall collaborate with the Centers for Disease Control and Prevention and the Administration on Aging, and relevant local agencies and organizations.
**** (ii) TYPES OF INTERVENTION ACTIVITIES- Intervention activities conducted under this subparagraph may include efforts to improve nutrition, increase physical activity, reduce tobacco use and substance abuse, improve mental health, and promote healthy lifestyles among the target population.
*** (C) COMMUNITY PREVENTIVE SCREENINGS-
**** (i) IN GENERAL- In addition to community-wide public health interventions, a State or local health department shall use amounts received under a grant under this subsection to conduct ongoing health screening to identify risk factors for cardiovascular disease, cancer, stroke, and diabetes among individuals in both urban and rural areas who are between 55 and 64 years of age.
**** (ii) TYPES OF SCREENING ACTIVITIES- Screening activities conducted under this subparagraph may include--
***** (I) mental health/behavioral health and substance use disorders;
***** (II) physical activity, smoking, and nutrition; and
***** (III) any other measures deemed appropriate by the Secretary.
**** (iii) MONITORING- Grantees under this section shall maintain records of screening results under this subparagraph to establish the baseline data for monitoring the targeted population
*** (D) CLINICAL REFERRAL/TREATMENT FOR CHRONIC DISEASES-
**** (i) IN GENERAL- A State or local health department shall use amounts received under a grant under this subsection to ensure that individuals between 55 and 64 years of age who are found to have chronic disease risk factors through the screening activities described in subparagraph (C)(ii), receive clinical referral/treatment for follow-up services to reduce such risk.
**** (ii) MECHANISM-
***** (I) IDENTIFICATION AND DETERMINATION OF STATUS- With respect to each individual with risk factors for or having heart disease, stroke, diabetes, or any other condition for which such individual was screened under subparagraph (C), a grantee under this section shall determine whether or not such individual is covered under any public or private health insurance program.
***** (II) INSURED INDIVIDUALS- An individual determined to be covered under a health insurance program under subclause (I) shall be referred by the grantee to the existing providers under such program or, if such individual does not have a current provider, to a provider who is in-network with respect to the program involved.
***** (III) UNINSURED INDIVIDUALS- With respect to an individual determined to be uninsured under subclause (I), the grantee's community-based clinical partner described in paragraph (4)(D) shall assist the individual in determining eligibility for available public coverage options and identify other appropriate community health care resources and assistance programs.
**** (iii) PUBLIC HEALTH INTERVENTION PROGRAM- A State or local health department shall use amounts received under a grant under this subsection to enter into contracts with community health centers or rural health clinics and mental health and substance use disorder service providers to assist in the referral/treatment of at risk patients to community resources for clinical follow-up and help determine eligibility for other public programs.
*** (E) GRANTEE EVALUATION- An eligible entity shall use amounts provided under a grant under this subsection to conduct activities to measure changes in the prevalence of chronic disease risk factors among participants.
** (4) PILOT PROGRAM EVALUATION- The Secretary shall conduct an annual evaluation of the effectiveness of the pilot program under this subsection. In determining such effectiveness, the Secretary shall consider changes in the prevalence of uncontrolled chronic disease risk factors among new Medicare enrollees (or individuals nearing enrollment, including those who are 63 and 64 years of age) who reside in States or localities receiving grants under this section as compared with national and historical data for those States and localities for the same population.
** (5) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated to carry out this subsection, such sums as may be necessary for each of fiscal years 2010 through 2014.
* (b) Evaluation and Plan for Community-based Prevention and Wellness Programs for Medicare Beneficiaries-
** (1) IN GENERAL- The Secretary shall conduct an evaluation of community-based prevention and wellness programs and develop a plan for promoting healthy lifestyles and chronic disease self-management for Medicare beneficiaries.
** (2) MEDICARE EVALUATION OF PREVENTION AND WELLNESS PROGRAMS-
*** (A) IN GENERAL- The Secretary shall evaluate community prevention and wellness programs including those that are sponsored by the Administration on Aging, are evidence-based, and have demonstrated potential to help Medicare beneficiaries (particularly beneficiaries that have attained 65 years of age) reduce their risk of disease, disability, and injury by making healthy lifestyle choices, including exercise, diet, and self-management of chronic diseases.
*** (B) EVALUATION- The evaluation under subparagraph (A) shall consist of the following:
**** (i) EVIDENCE REVIEW- The Secretary shall review available evidence, literature, best practices, and resources that are relevant to programs that promote healthy lifestyles and reduce risk factors for the Medicare population. The Secretary may determine the scope of the evidence review and such issues to be considered, which shall include, at a minimum--
***** (I) physical activity, nutrition, and obesity;
***** (II) falls;
***** (III) chronic disease self-management; and
***** (IV) mental health.
**** (ii) INDEPENDENT EVALUATION OF EVIDENCE-BASED COMMUNITY PREVENTION AND WELLNESS PROGRAMS- The Administrator of the Centers for Medicare & Medicaid Services, in consultation with the Assistant Secretary for Aging, shall, to the extent feasible and practicable, conduct an evaluation of existing community prevention and wellness programs that are sponsored by the Administration on Aging to assess the extent to which Medicare beneficiaries who participate in such programs--
***** (I) reduce their health risks, improve their health outcomes, and adopt and maintain healthy behaviors;
***** (II) improve their ability to manage their chronic conditions; and
***** (III) reduce their utilization of health services and associated costs under the Medicare program for conditions that are amenable to improvement under such programs.
** (3) REPORT- Not later than September 30, 2013, the Secretary shall submit to Congress a report that includes--
*** (A) recommendations for such legislation and administrative action as the Secretary determines appropriate to promote healthy lifestyles and chronic disease self-management for Medicare beneficiaries;
*** (B) any relevant findings relating to the evidence review under paragraph (2)(B)(i); and
*** (C) the results of the evaluation under paragraph (2)(B)(ii).
** (4) FUNDING- For purposes of carrying out this subsection, the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplemental Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t), in such proportion as the Secretary determines appropriate, of $50,000,000 to the Centers for Medicare & Medicaid Services Program Management Account. Amounts transferred under the preceding sentence shall remain available until expended.
** (5) ADMINISTRATION- Chapter 35 of title 44, United States Code shall not apply to the this subsection.
** (6) MEDICARE BENEFICIARY- In this subsection, the term `Medicare beneficiary' means an individual who is entitled to benefits under part A of title XVIII of the Social Security Act and enrolled under part B of such title.

### SEC. 4203. REMOVING BARRIERS AND IMPROVING ACCESS TO WELLNESS FOR INDIVIDUALS WITH DISABILITIES.

* Title V of the Rehabilitation Act of 1973 (29 U.S.C. 791 et seq.) is amended by adding at the end of the following:

### SEC. 510. ESTABLISHMENT OF STANDARDS FOR ACCESSIBLE MEDICAL DIAGNOSTIC EQUIPMENT.

* (a) Standards- Not later than 24 months after the date of enactment of the Affordable Health Choices Act, the Architectural and Transportation Barriers Compliance Board shall, in consultation with the Commissioner of the Food and Drug Administration, promulgate regulatory standards in accordance with the Administrative Procedure Act (2 U.S.C. 551 et seq.) setting forth the minimum technical criteria for medical diagnostic equipment used in (or in conjunction with) physician's offices, clinics, emergency rooms, hospitals, and other medical settings. The standards shall ensure that such equipment is accessible to, and usable by, individuals with accessibility needs, and shall allow independent entry to, use of, and exit from the equipment by such individuals to the maximum extent possible.
* (b) Medical Diagnostic Equipment Covered- The standards issued under subsection (a) for medical diagnostic equipment shall apply to equipment that includes examination tables, examination chairs (including chairs used for eye examinations or procedures, and dental examinations or procedures), weight scales, mammography equipment, x-ray machines, and other radiological equipment commonly used for diagnostic purposes by health professionals.
* (c) Review and Amendment- The Architectural and Transportation Barriers Compliance Board, in consultation with the Commissioner of the Food and Drug Administration, shall periodically review and, as appropriate, amend the standards in accordance with the Administrative Procedure Act (2 U.S.C. 551 et seq.).'.

### SEC. 4204. IMMUNIZATIONS.

* (a) State Authority To Purchase Recommended Vaccines for Adults- Section 317 of the Public Health Service Act (42 U.S.C. 247b) is amended by adding at the end the following:
* (l) Authority to Purchase Recommended Vaccines for Adults-
** (1) IN GENERAL- The Secretary may negotiate and enter into contracts with manufacturers of vaccines for the purchase and delivery of vaccines for adults as provided for under subsection (e).
** (2) STATE PURCHASE- A State may obtain additional quantities of such adult vaccines (subject to amounts specified to the Secretary by the State in advance of negotiations) through the purchase of vaccines from manufacturers at the applicable price negotiated by the Secretary under this subsection.'.
* (b) Demonstration Program to Improve Immunization Coverage- Section 317 of the Public Health Service Act (42 U.S.C. 247b), as amended by subsection (a), is further amended by adding at the end the following:
* (m) Demonstration Program To Improve Immunization Coverage-
** (1) IN GENERAL- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall establish a demonstration program to award grants to States to improve the provision of recommended immunizations for children, adolescents, and adults through the use of evidence-based, population-based interventions for high-risk populations.
** (2) STATE PLAN- To be eligible for a grant under paragraph (1), a State shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require, including a State plan that describes the interventions to be implemented under the grant and how such interventions match with local needs and capabilities, as determined through consultation with local authorities.
** (3) USE OF FUNDS- Funds received under a grant under this subsection shall be used to implement interventions that are recommended by the Task Force on Community Preventive Services (as established by the Secretary, acting through the Director of the Centers for Disease Control and Prevention) or other evidence-based interventions, including--
*** (A) providing immunization reminders or recalls for target populations of clients, patients, and consumers;
*** (B) educating targeted populations and health care providers concerning immunizations in combination with one or more other interventions;
*** (C) reducing out-of-pocket costs for families for vaccines and their administration;
*** (D) carrying out immunization-promoting strategies for participants or clients of public programs, including assessments of immunization status, referrals to health care providers, education, provision of on-site immunizations, or incentives for immunization;
*** (E) providing for home visits that promote immunization through education, assessments of need, referrals, provision of immunizations, or other services;
*** (F) providing reminders or recalls for immunization providers;
*** (G) conducting assessments of, and providing feedback to, immunization providers;
*** (H) any combination of one or more interventions described in this paragraph; or
*** (I) immunization information systems to allow all States to have electronic databases for immunization records.
** (4) CONSIDERATION- In awarding grants under this subsection, the Secretary shall consider any reviews or recommendations of the Task Force on Community Preventive Services.
** (5) EVALUATION- Not later than 3 years after the date on which a State receives a grant under this subsection, the State shall submit to the Secretary an evaluation of progress made toward improving immunization coverage rates among high-risk populations within the State.
** (6) REPORT TO CONGRESS- Not later than 4 years after the date of enactment of the Affordable Health Choices Act, the Secretary shall submit to Congress a report concerning the effectiveness of the demonstration program established under this subsection together with recommendations on whether to continue and expand such program.
** (7) AUTHORIZATION OF APPROPRIATIONS- There is authorized to be appropriated to carry out this subsection, such sums as may be necessary for each of fiscal years 2010 through 2014.'.
* (c) Reauthorization of Immunization Program- Section 317(j) of the Public Health Service Act (42 U.S.C. 247b(j)) is amended--
** (1) in paragraph (1), by striking `for each of the fiscal years 1998 through 2005'; and
** (2) in paragraph (2), by striking `after October 1, 1997,'.
* (d) Rule of Construction Regarding Access to Immunizations- Nothing in this section (including the amendments made by this section), or any other provision of this Act (including any amendments made by this Act) shall be construed to decrease children's access to immunizations.
* (e) GAO Study and Report on Medicare Beneficiary Access to Vaccines-
** (1) STUDY- The Comptroller General of the United States (in this section referred to as the `Comptroller General') shall conduct a study on the ability of Medicare beneficiaries who were 65 years of age or older to access routinely recommended vaccines covered under the prescription drug program under part D of title XVIII of the Social Security Act over the period since the establishment of such program. Such study shall include the following:
*** (A) An analysis and determination of--
**** (i) the number of Medicare beneficiaries who were 65 years of age or older and were eligible for a routinely recommended vaccination that was covered under part D;
**** (ii) the number of such beneficiaries who actually received a routinely recommended vaccination that was covered under part D; and
**** (iii) any barriers to access by such beneficiaries to routinely recommended vaccinations that were covered under part D.
*** (B) A summary of the findings and recommendations by government agencies, departments, and advisory bodies (as well as relevant professional organizations) on the impact of coverage under part D of routinely recommended adult immunizations for access to such immunizations by Medicare beneficiaries.
** (2) REPORT- Not later than June 1, 2011, the Comptroller General shall submit to the appropriate committees of jurisdiction of the House of Representatives and the Senate a report containing the results of the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.
** (3) FUNDING- Out of any funds in the Treasury not otherwise appropriated, there are appropriated $1,000,000 for fiscal year 2010 to carry out this subsection.

### SEC. 4205. NUTRITION LABELING OF STANDARD MENU ITEMS AT CHAIN RESTAURANTS.

* (a) Technical Amendments- Section 403(q)(5)(A) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 343(q)(5)(A)) is amended--
** (1) in subitem (i), by inserting at the beginning `except as provided in clause (H)(ii)(III),'; and
** (2) in subitem (ii), by inserting at the beginning `except as provided in clause (H)(ii)(III),'.
* (b) Labeling Requirements- Section 403(q)(5) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 343(q)(5)) is amended by adding at the end the following:
* (H) Restaurants, Retail Food Establishments, and Vending Machines-
** (i) GENERAL REQUIREMENTS FOR RESTAURANTS AND SIMILAR RETAIL FOOD ESTABLISHMENTS- Except for food described in subclause (vii), in the case of food that is a standard menu item that is offered for sale in a restaurant or similar retail food establishment that is part of a chain with 20 or more locations doing business under the same name (regardless of the type of ownership of the locations) and offering for sale substantially the same menu items, the restaurant or similar retail food establishment shall disclose the information described in subclauses (ii) and (iii).
** (ii) INFORMATION REQUIRED TO BE DISCLOSED BY RESTAURANTS AND RETAIL FOOD ESTABLISHMENTS- Except as provided in subclause (vii), the restaurant or similar retail food establishment shall disclose in a clear and conspicuous manner--
*** (I)(aa) in a nutrient content disclosure statement adjacent to the name of the standard menu item, so as to be clearly associated with the standard menu item, on the menu listing the item for sale, the number of calories contained in the standard menu item, as usually prepared and offered for sale; and
*** (bb) a succinct statement concerning suggested daily caloric intake, as specified by the Secretary by regulation and posted prominently on the menu and designed to enable the public to understand, in the context of a total daily diet, the significance of the caloric information that is provided on the menu;
*** (II)(aa) in a nutrient content disclosure statement adjacent to the name of the standard menu item, so as to be clearly associated with the standard menu item, on the menu board, including a drive-through menu board, the number of calories contained in the standard menu item, as usually prepared and offered for sale; and
*** (bb) a succinct statement concerning suggested daily caloric intake, as specified by the Secretary by regulation and posted prominently on the menu board, designed to enable the public to understand, in the context of a total daily diet, the significance of the nutrition information that is provided on the menu board;
** (III) in a written form, available on the premises of the restaurant or similar retail establishment and to the consumer upon request, the nutrition information required under clauses (C) and (D) of subparagraph (1); and
** (IV) on the menu or menu board, a prominent, clear, and conspicuous statement regarding the availability of the information described in item (III).
** (iii) SELF-SERVICE FOOD AND FOOD ON DISPLAY- Except as provided in subclause (vii), in the case of food sold at a salad bar, buffet line, cafeteria line, or similar self-service facility, and for self-service beverages or food that is on display and that is visible to customers, a restaurant or similar retail food establishment shall place adjacent to each food offered a sign that lists calories per displayed food item or per serving.
** (iv) REASONABLE BASIS- For the purposes of this clause, a restaurant or similar retail food establishment shall have a reasonable basis for its nutrient content disclosures, including nutrient databases, cookbooks, laboratory analyses, and other reasonable means, as described in section 101.10 of title 21, Code of Federal Regulations (or any successor regulation) or in a related guidance of the Food and Drug Administration.
** (v) MENU VARIABILITY AND COMBINATION MEALS- The Secretary shall establish by regulation standards for determining and disclosing the nutrient content for standard menu items that come in different flavors, varieties, or combinations, but which are listed as a single menu item, such as soft drinks, ice cream, pizza, doughnuts, or children's combination meals, through means determined by the Secretary, including ranges, averages, or other methods.
** (vi) ADDITIONAL INFORMATION- If the Secretary determines that a nutrient, other than a nutrient required under subclause (ii)(III), should be disclosed for the purpose of providing information to assist consumers in maintaining healthy dietary practices, the Secretary may require, by regulation, disclosure of such nutrient in the written form required under subclause (ii)(III).
** (vii) NONAPPLICABILITY TO CERTAIN FOOD-
*** (I) IN GENERAL- Subclauses (i) through (vi) do not apply to--
**** (aa) items that are not listed on a menu or menu board (such as condiments and other items placed on the table or counter for general use);
**** (bb) daily specials, temporary menu items appearing on the menu for less than 60 days per calendar year, or custom orders; or
**** (cc) such other food that is part of a customary market test appearing on the menu for less than 90 days, under terms and conditions established by the Secretary.
*** (II) WRITTEN FORMS- Subparagraph (5)(C) shall apply to any regulations promulgated under subclauses (ii)(III) and (vi).
** (viii) VENDING MACHINES-
*** (I) IN GENERAL- In the case of an article of food sold from a vending machine that--
**** (aa) does not permit a prospective purchaser to examine the Nutrition Facts Panel before purchasing the article or does not otherwise provide visible nutrition information at the point of purchase; and
**** (bb) is operated by a person who is engaged in the business of owning or operating 20 or more vending machines,
*** the vending machine operator shall provide a sign in close proximity to each article of food or the selection button that includes a clear and conspicuous statement disclosing the number of calories contained in the article.
** (ix) VOLUNTARY PROVISION OF NUTRITION INFORMATION-
*** (I) IN GENERAL- An authorized official of any restaurant or similar retail food establishment or vending machine operator not subject to the requirements of this clause may elect to be subject to the requirements of such clause, by registering biannually the name and address of such restaurant or similar retail food establishment or vending machine operator with the Secretary, as specified by the Secretary by regulation.
*** (II) REGISTRATION- Within 120 days of enactment of this clause, the Secretary shall publish a notice in the Federal Register specifying the terms and conditions for implementation of item (I), pending promulgation of regulations.
*** (III) RULE OF CONSTRUCTION- Nothing in this subclause shall be construed to authorize the Secretary to require an application, review, or licensing process for any entity to register with the Secretary, as described in such item.
** (x) REGULATIONS-
*** (I) PROPOSED REGULATION- Not later than 1 year after the date of enactment of this clause, the Secretary shall promulgate proposed regulations to carry out this clause.
*** (II) CONTENTS- In promulgating regulations, the Secretary shall--
**** (aa) consider standardization of recipes and methods of preparation, reasonable variation in serving size and formulation of menu items, space on menus and menu boards, inadvertent human error, training of food service workers, variations in ingredients, and other factors, as the Secretary determines; and
**** (bb) specify the format and manner of the nutrient content disclosure requirements under this subclause.
*** (III) REPORTING- The Secretary shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a quarterly report that describes the Secretary's progress toward promulgating final regulations under this subparagraph.
** (xi) DEFINITION- In this clause, the term `menu' or `menu board' means the primary writing of the restaurant or other similar retail food establishment from which a consumer makes an order selection.'
* (c) National Uniformity- Section 403A(a)(4) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 343-1(a)(4)) is amended by striking `except a requirement for nutrition labeling of food which is exempt under subclause (i) or (ii) of section 403(q)(5)(A)' and inserting `except that this paragraph does not apply to food that is offered for sale in a restaurant or similar retail food establishment that is not part of a chain with 20 or more locations doing business under the same name (regardless of the type of ownership of the locations) and offering for sale substantially the same menu items unless such restaurant or similar retail food establishment complies with the voluntary provision of nutrition information requirements under section 403(q)(5)(H)(ix)'.
* (d) Rule of Construction- Nothing in the amendments made by this section shall be construed--
** (1) to preempt any provision of State or local law, unless such provision establishes or continues into effect nutrient content disclosures of the type required under section 403(q)(5)(H) of the Federal Food, Drug, and Cosmetic Act (as added by subsection (b)) and is expressly preempted under subsection (a)(4) of such section;
** (2) to apply to any State or local requirement respecting a statement in the labeling of food that provides for a warning concerning the safety of the food or component of the food; or
** (3) except as provided in section 403(q)(5)(H)(ix) of the Federal Food, Drug, and Cosmetic Act (as added by subsection (b)), to apply to any restaurant or similar retail food establishment other than a restaurant or similar retail food establishment described in section 403(q)(5)(H)(i) of such Act.

### SEC. 4206. DEMONSTRATION PROJECT CONCERNING INDIVIDUALIZED WELLNESS PLAN.

* Section 330 of the Public Health Service Act (42 U.S.C. 245b) is amended by adding at the end the following:
* (s) Demonstration Program for Individualized Wellness Plans-
** (1) IN GENERAL- The Secretary shall establish a pilot program to test the impact of providing at-risk populations who utilize community health centers funded under this section an individualized wellness plan that is designed to reduce risk factors for preventable conditions as identified by a comprehensive risk-factor assessment.
** (2) AGREEMENTS- The Secretary shall enter into agreements with not more than 10 community health centers funded under this section to conduct activities under the pilot program under paragraph (1).
** (3) WELLNESS PLANS-
*** (A) IN GENERAL- An individualized wellness plan prepared under the pilot program under this subsection may include one or more of the following as appropriate to the individual's identified risk factors:
**** (i) Nutritional counseling.
**** (ii) A physical activity plan.
**** (iii) Alcohol and smoking cessation counseling and services.
**** (iv) Stress management.
**** (v) Dietary supplements that have health claims approved by the Secretary.
**** (vi) Compliance assistance provided by a community health center employee.
*** (B) RISK FACTORS- Wellness plan risk factors shall include--
**** (i) weight;
**** (ii) tobacco and alcohol use;
**** (iii) exercise rates;
**** (iv) nutritional status; and
**** (v) blood pressure.
*** (C) COMPARISONS- Individualized wellness plans shall make comparisons between the individual involved and a control group of individuals with respect to the risk factors described in subparagraph (B).
** (4) AUTHORIZATION OF APPROPRIATIONS- There is authorized to be appropriated to carry out this subsection, such sums as may be necessary.'.

### SEC. 4207. REASONABLE BREAK TIME FOR NURSING MOTHERS.

* Section 7 of the Fair Labor Standards Act of 1938 (29 U.S.C. 207) is amended by adding at the end the following:
* (r)(1) An employer shall provide--
** (A) a reasonable break time for an employee to express breast milk for her nursing child for 1 year after the child's birth each time such employee has need to express the milk; and
** (B) a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk.
* (2) An employer shall not be required to compensate an employee receiving reasonable break time under paragraph (1) for any work time spent for such purpose.
* (3) An employer that employs less than 50 employees shall not be subject to the requirements of this subsection, if such requirements would impose an undue hardship by causing the employer significant difficulty or expense when considered in relation to the size, financial resources, nature, or structure of the employer's business.
* (4) Nothing in this subsection shall preempt a State law that provides greater protections to employees than the protections provided for under this subsection.'.

## Subtitle D--Support for Prevention and Public Health Innovation
### SEC. 4301. RESEARCH ON OPTIMIZING THE DELIVERY OF PUBLIC HEALTH SERVICES.

* (a) In General- The Secretary of Health and Human Services (referred to in this section as the `Secretary'), acting through the Director of the Centers for Disease Control and Prevention, shall provide funding for research in the area of public health services and systems.
* (b) Requirements of Research- Research supported under this section shall include--
** (1) examining evidence-based practices relating to prevention, with a particular focus on high priority areas as identified by the Secretary in the National Prevention Strategy or Healthy People 2020, and including comparing community-based public health interventions in terms of effectiveness and cost;
** (2) analyzing the translation of interventions from academic settings to real world settings; and
** (3) identifying effective strategies for organizing, financing, or delivering public health services in real world community settings, including comparing State and local health department structures and systems in terms of effectiveness and cost.
* (c) Existing Partnerships- Research supported under this section shall be coordinated with the Community Preventive Services Task Force and carried out by building on existing partnerships within the Federal Government while also considering initiatives at the State and local levels and in the private sector.
* (d) Annual Report- The Secretary shall, on an annual basis, submit to Congress a report concerning the activities and findings with respect to research supported under this section.

### SEC. 4302. UNDERSTANDING HEALTH DISPARITIES: DATA COLLECTION AND ANALYSIS.

* (a) Uniform Categories and Collection Requirements- The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by adding at the end the following:

## TITLE XXXI--DATA COLLECTION, ANALYSIS, AND QUALITY
### SEC. 3101. DATA COLLECTION, ANALYSIS, AND QUALITY.

* (a) Data Collection-
** (1) IN GENERAL- The Secretary shall ensure that, by not later than 2 years after the date of enactment of this title, any federally conducted or supported health care or public health program, activity or survey (including Current Population Surveys and American Community Surveys conducted by the Bureau of Labor Statistics and the Bureau of the Census) collects and reports, to the extent practicable--
*** (A) data on race, ethnicity, sex, primary language, and disability status for applicants, recipients, or participants;
*** (B) data at the smallest geographic level such as State, local, or institutional levels if such data can be aggregated;
*** (C) sufficient data to generate statistically reliable estimates by racial, ethnic, sex, primary language, and disability status subgroups for applicants, recipients or participants using, if needed, statistical oversamples of these subpopulations; and
*** (D) any other demographic data as deemed appropriate by the Secretary regarding health disparities.
** (2) COLLECTION STANDARDS- In collecting data described in paragraph (1), the Secretary or designee shall--
*** (A) use Office of Management and Budget standards, at a minimum, for race and ethnicity measures;
*** (B) develop standards for the measurement of sex, primary language, and disability status;
*** (C) develop standards for the collection of data described in paragraph (1) that, at a minimum--
**** (i) collects self-reported data by the applicant, recipient, or participant; and
**** (ii) collects data from a parent or legal guardian if the applicant, recipient, or participant is a minor or legally incapacitated;
*** (D) survey health care providers and establish other procedures in order to assess access to care and treatment for individuals with disabilities and to identify--
**** (i) locations where individuals with disabilities access primary, acute (including intensive), and long-term care;
**** (ii) the number of providers with accessible facilities and equipment to meet the needs of the individuals with disabilities, including medical diagnostic equipment that meets the minimum technical criteria set forth in section 510 of the Rehabilitation Act of 1973; and
**** (iii) the number of employees of health care providers trained in disability awareness and patient care of individuals with disabilities; and
*** (E) require that any reporting requirement imposed for purposes of measuring quality under any ongoing or federally conducted or supported health care or public health program, activity, or survey includes requirements for the collection of data on individuals receiving health care items or services under such programs activities by race, ethnicity, sex, primary language, and disability status.
** (3) DATA MANAGEMENT- In collecting data described in paragraph (1), the Secretary, acting through the National Coordinator for Health Information Technology shall--
*** (A) develop national standards for the management of data collected; and
*** (B) develop interoperability and security systems for data management.
* (b) Data Analysis-
** (1) IN GENERAL- For each federally conducted or supported health care or public health program or activity, the Secretary shall analyze data collected under paragraph (a) to detect and monitor trends in health disparities (as defined for purposes of section 485E) at the Federal and State levels.
* (c) Data Reporting and Dissemination-
** (1) IN GENERAL- The Secretary shall make the analyses described in (b) available to--
*** (A) the Office of Minority Health;
*** (B) the National Center on Minority Health and Health Disparities;
*** (C) the Agency for Healthcare Research and Quality;
*** (D) the Centers for Disease Control and Prevention;
*** (E) the Centers for Medicare & Medicaid Services;
*** (F) the Indian Health Service and epidemiology centers funded under the Indian Health Care Improvement Act;
*** (G) the Office of Rural health;
*** (H) other agencies within the Department of Health and Human Services; and
*** (I) other entities as determined appropriate by the Secretary.
** (2) REPORTING OF DATA- The Secretary shall report data and analyses described in (a) and (b) through--
*** (A) public postings on the Internet websites of the Department of Health and Human Services; and
*** (B) any other reporting or dissemination mechanisms determined appropriate by the Secretary.
** (3) AVAILABILITY OF DATA- The Secretary may make data described in (a) and (b) available for additional research, analyses, and dissemination to other Federal agencies, non-governmental entities, and the public, in accordance with any Federal agency's data user agreements.
* (d) Limitations on Use of Data- Nothing in this section shall be construed to permit the use of information collected under this section in a manner that would adversely affect any individual.
* (e) Protection and Sharing of Data-
** (1) PRIVACY AND OTHER SAFEGUARDS- The Secretary shall ensure (through the promulgation of regulations or otherwise) that--
*** (A) all data collected pursuant to subsection (a) is protected--
**** (i) under privacy protections that are at least as broad as those that the Secretary applies to other health data under the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191; 110 Stat. 2033); and
**** (ii) from all inappropriate internal use by any entity that collects, stores, or receives the data, including use of such data in determinations of eligibility (or continued eligibility) in health plans, and from other inappropriate uses, as defined by the Secretary; and
*** (B) all appropriate information security safeguards are used in the collection, analysis, and sharing of data collected pursuant to subsection (a).
** (2) DATA SHARING- The Secretary shall establish procedures for sharing data collected pursuant to subsection (a), measures relating to such data, and analyses of such data, with other relevant Federal and State agencies including the agencies, centers, and entities within the Department of Health and Human Services specified in subsection (c)(1)..
* (f) Data on Rural Underserved Populations- The Secretary shall ensure that any data collected in accordance with this section regarding racial and ethnic minority groups are also collected regarding underserved rural and frontier populations.
* (g) Authorization of Appropriations- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2010 through 2014.
* (h) Requirement for Implementation- Notwithstanding any other provision of this section, data may not be collected under this section unless funds are directly appropriated for such purpose in an appropriations Act.
* (i) Consultation- The Secretary shall consult with the Director of the Office of Personnel Management, the Secretary of Defense, the Secretary of Veterans Affairs, the Director of the Bureau of the Census, the Commissioner of Social Security, and the head of other appropriate Federal agencies in carrying out this section.'.
* (b) Addressing Health Care Disparities in Medicaid and CHIP-
** (1) STANDARDIZED COLLECTION REQUIREMENTS INCLUDED IN STATE PLANS-
*** (A) MEDICAID- Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)), as amended by section 2001(d), is amended--
**** (i) in paragraph 4), by striking `and' at the end;
**** (ii) in paragraph (75), by striking the period at the end and inserting `; and'; and
**** (iii) by inserting after paragraph (75) the following new paragraph:
** (76) provide that any data collected under the State plan meets the requirements of section 3101 of the Public Health Service Act.'.
*** (B) CHIP- Section 2108(e) of the Social Security Act (42 U.S.C. 1397hh(e)) is amended by adding at the end the following new paragraph:
** (7) Data collected and reported in accordance with section 3101 of the Public Health Service Act, with respect to individuals enrolled in the State child health plan (and, in the case of enrollees under 19 years of age, their parents or legal guardians), including data regarding the primary language of such individuals, parents, and legal guardians.'.
** (2) EXTENDING MEDICARE REQUIREMENT TO ADDRESS HEALTH DISPARITIES DATA COLLECTION TO MEDICAID AND CHIP- Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), as amended by section 2703 is amended by adding at the end the following new section:

### SEC. 1946. ADDRESSING HEALTH CARE DISPARITIES.

* (a) Evaluating Data Collection Approaches- The Secretary shall evaluate approaches for the collection of data under this title and title XXI, to be performed in conjunction with existing quality reporting requirements and programs under this title and title XXI, that allow for the ongoing, accurate, and timely collection and evaluation of data on disparities in health care services and performance on the basis of race, ethnicity, sex, primary language, and disability status. In conducting such evaluation, the Secretary shall consider the following objectives:
** (1) Protecting patient privacy.
** (2) Minimizing the administrative burdens of data collection and reporting on States, providers, and health plans participating under this title or title XXI.
** (3) Improving program data under this title and title XXI on race, ethnicity, sex, primary language, and disability status.
* (b) Reports to Congress-
** (1) REPORT ON EVALUATION- Not later than 18 months after the date of the enactment of this section, the Secretary shall submit to Congress a report on the evaluation conducted under subsection (a). Such report shall, taking into consideration the results of such evaluation--
*** (A) identify approaches (including defining methodologies) for identifying and collecting and evaluating data on health care disparities on the basis of race, ethnicity, sex, primary language, and disability status for the programs under this title and title XXI; and
*** (B) include recommendations on the most effective strategies and approaches to reporting HEDIS quality measures as required under section 1852(e)(3) and other nationally recognized quality performance measures, as appropriate, on such bases.
** (2) REPORTS ON DATA ANALYSES- Not later than 4 years after the date of the enactment of this section, and 4 years thereafter, the Secretary shall submit to Congress a report that includes recommendations for improving the identification of health care disparities for beneficiaries under this title and under title XXI based on analyses of the data collected under subsection (c).
* (c) Implementing Effective Approaches- Not later than 24 months after the date of the enactment of this section, the Secretary shall implement the approaches identified in the report submitted under subsection (b)(1) for the ongoing, accurate, and timely collection and evaluation of data on health care disparities on the basis of race, ethnicity, sex, primary language, and disability status.'.

### SEC. 4303. CDC AND EMPLOYER-BASED WELLNESS PROGRAMS.

* Title III of the Public Health Service Act (42 U.S.C. 241 et seq.), by section 4102, is further amended by adding at the end the following:

#### PART U--EMPLOYER-BASED WELLNESS PROGRAM
### SEC. 399MM. TECHNICAL ASSISTANCE FOR EMPLOYER-BASED WELLNESS PROGRAMS.

* In order to expand the utilization of evidence-based prevention and health promotion approaches in the workplace, the Director shall--
** (1) provide employers (including small, medium, and large employers, as determined by the Director) with technical assistance, consultation, tools, and other resources in evaluating such employers' employer-based wellness programs, including--
*** (A) measuring the participation and methods to increase participation of employees in such programs;
*** (B) developing standardized measures that assess policy, environmental and systems changes necessary to have a positive health impact on employees' health behaviors, health outcomes, and health care expenditures; and
*** (C) evaluating such programs as they relate to changes in the health status of employees, the absenteeism of employees, the productivity of employees, the rate of workplace injury, and the medical costs incurred by employees; and
** (2) build evaluation capacity among workplace staff by training employers on how to evaluate employer-based wellness programs by ensuring evaluation resources, technical assistance, and consultation are available to workplace staff as needed through such mechanisms as web portals, call centers, or other means.

### SEC. 399MM-1. NATIONAL WORKSITE HEALTH POLICIES AND PROGRAMS STUDY.

* (a) In General- In order to assess, analyze, and monitor over time data about workplace policies and programs, and to develop instruments to assess and evaluate comprehensive workplace chronic disease prevention and health promotion programs, policies and practices, not later than 2 years after the date of enactment of this part, and at regular intervals (to be determined by the Director) thereafter, the Director shall conduct a national worksite health policies and programs survey to assess employer-based health policies and programs.
* (b) Report- Upon the completion of each study under subsection (a), the Director shall submit to Congress a report that includes the recommendations of the Director for the implementation of effective employer-based health policies and programs.

### SEC. 399MM-2. PRIORITIZATION OF EVALUATION BY SECRETARY.

* The Secretary shall evaluate, in accordance with this part, all programs funded through the Centers for Disease Control and Prevention before conducting such an evaluation of privately funded programs unless an entity with a privately funded wellness program requests such an evaluation.

### SEC. 399MM-3. PROHIBITION OF FEDERAL WORKPLACE WELLNESS REQUIREMENTS.

* Notwithstanding any other provision of this part, any recommendations, data, or assessments carried out under this part shall not be used to mandate requirements for workplace wellness programs.'.

### SEC. 4304. EPIDEMIOLOGY-LABORATORY CAPACITY GRANTS.

* Title XXVIII of the Public Health Service Act (42 U.S.C. 300hh et seq.) is amended by adding at the end the following:

## Subtitle C--Strengthening Public Health Surveillance Systems
### SEC. 2821. EPIDEMIOLOGY-LABORATORY CAPACITY GRANTS.

* (a) In General- Subject to the availability of appropriations, the Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall establish an Epidemiology and Laboratory Capacity Grant Program to award grants to State health departments as well as local health departments and tribal jurisdictions that meet such criteria as the Director determines appropriate. Academic centers that assist State and eligible local and tribal health departments may also be eligible for funding under this section as the Director determines appropriate. Grants shall be awarded under this section to assist public health agencies in improving surveillance for, and response to, infectious diseases and other conditions of public health importance by--
** (1) strengthening epidemiologic capacity to identify and monitor the occurrence of infectious diseases and other conditions of public health importance;
** (2) enhancing laboratory practice as well as systems to report test orders and results electronically;
** (3) improving information systems including developing and maintaining an information exchange using national guidelines and complying with capacities and functions determined by an advisory council established and appointed by the Director; and
** (4) developing and implementing prevention and control strategies.
* (b) Authorization of Appropriations- There are authorized to be appropriated to carry out this section $190,000,000 for each of fiscal years 2010 through 2013, of which--
** (1) not less than $95,000,000 shall be made available each such fiscal year for activities under paragraphs (1) and (4) of subsection (a);
** (2) not less than $60,000,000 shall be made available each such fiscal year for activities under subsection (a)(3); and
** (3) not less than $32,000,000 shall be made available each such fiscal year for activities under subsection (a)(2).'.

### SEC. 4305. ADVANCING RESEARCH AND TREATMENT FOR PAIN CARE MANAGEMENT.

* (a) Institute of Medicine Conference on Pain-
** (1) CONVENING- Not later than 1 year after funds are appropriated to carry out this subsection, the Secretary of Health and Human Services shall seek to enter into an agreement with the Institute of Medicine of the National Academies to convene a Conference on Pain (in this subsection referred to as `the Conference').
** (2) PURPOSES- The purposes of the Conference shall be to--
*** (A) increase the recognition of pain as a significant public health problem in the United States;
*** (B) evaluate the adequacy of assessment, diagnosis, treatment, and management of acute and chronic pain in the general population, and in identified racial, ethnic, gender, age, and other demographic groups that may be disproportionately affected by inadequacies in the assessment, diagnosis, treatment, and management of pain;
*** (C) identify barriers to appropriate pain care;
*** (D) establish an agenda for action in both the public and private sectors that will reduce such barriers and significantly improve the state of pain care research, education, and clinical care in the United States.
** (3) OTHER APPROPRIATE ENTITY- If the Institute of Medicine declines to enter into an agreement under paragraph (1), the Secretary of Health and Human Services may enter into such agreement with another appropriate entity.
** (4) REPORT- A report summarizing the Conference's findings and recommendations shall be submitted to the Congress not later than June 30, 2011.
** (5) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this subsection, there is authorized to be appropriated such sums as may be necessary for each of fiscal years 2010 and 2011.
* (b) Pain Research at National Institutes of Health- Part B of title IV of the Public Health Service Act (42 U.S.C. 284 et seq.) is amended by adding at the end the following:

### SEC. 409J. PAIN RESEARCH.

* (a) Research Initiatives-
** (1) IN GENERAL- The Director of NIH is encouraged to continue and expand, through the Pain Consortium, an aggressive program of basic and clinical research on the causes of and potential treatments for pain.
** (2) ANNUAL RECOMMENDATIONS- Not less than annually, the Pain Consortium, in consultation with the Division of Program Coordination, Planning, and Strategic Initiatives, shall develop and submit to the Director of NIH recommendations on appropriate pain research initiatives that could be undertaken with funds reserved under section 402A(c)(1) for the Common Fund or otherwise available for such initiatives.
** (3) DEFINITION- In this subsection, the term `Pain Consortium' means the Pain Consortium of the National Institutes of Health or a similar trans-National Institutes of Health coordinating entity designated by the Secretary for purposes of this subsection.
* (b) Interagency Pain Research Coordinating Committee-
** (1) ESTABLISHMENT- The Secretary shall establish not later than 1 year after the date of the enactment of this section and as necessary maintain a committee, to be known as the Interagency Pain Research Coordinating Committee (in this section referred to as the `Committee'), to coordinate all efforts within the Department of Health and Human Services and other Federal agencies that relate to pain research.
** (2) MEMBERSHIP-
*** (A) IN GENERAL- The Committee shall be composed of the following voting members:
**** (i) Not more than 7 voting Federal representatives appoint by the Secretary from agencies that conduct pain care research and treatment.
**** (ii) 12 additional voting members appointed under subparagraph (B).
*** (B) ADDITIONAL MEMBERS- The Committee shall include additional voting members appointed by the Secretary as follows:
**** (i) 6 non-Federal members shall be appointed from among scientists, physicians, and other health professionals.
**** (ii) 6 members shall be appointed from members of the general public, who are representatives of leading research, advocacy, and service organizations for individuals with pain-related conditions.
*** (C) NONVOTING MEMBERS- The Committee shall include such nonvoting members as the Secretary determines to be appropriate.
** (3) CHAIRPERSON- The voting members of the Committee shall select a chairperson from among such members. The selection of a chairperson shall be subject to the approval of the Director of NIH.
** (4) MEETINGS- The Committee shall meet at the call of the chairperson of the Committee or upon the request of the Director of NIH, but in no case less often than once each year.
** (5) DUTIES- The Committee shall--
*** (A) develop a summary of advances in pain care research supported or conducted by the Federal agencies relevant to the diagnosis, prevention, and treatment of pain and diseases and disorders associated with pain;
*** (B) identify critical gaps in basic and clinical research on the symptoms and causes of pain;
*** (C) make recommendations to ensure that the activities of the National Institutes of Health and other Federal agencies are free of unnecessary duplication of effort;
*** (D) make recommendations on how best to disseminate information on pain care; and
*** (E) make recommendations on how to expand partnerships between public entities and private entities to expand collaborative, cross-cutting research.
** (6) REVIEW- The Secretary shall review the necessity of the Committee at least once every 2 years.'.
* (c) Pain Care Education and Training- Part D of title VII of the Public Health Service Act (42 U.S.C. 294 et seq.) is amended by adding at the end the following new section:

### SEC. 759. PROGRAM FOR EDUCATION AND TRAINING IN PAIN CARE.

* (a) In General- The Secretary may make awards of grants, cooperative agreements, and contracts to health professions schools, hospices, and other public and private entities for the development and implementation of programs to provide education and training to health care professionals in pain care.
* (b) Certain Topics- An award may be made under subsection (a) only if the applicant for the award agrees that the program carried out with the award will include information and education on--
** (1) recognized means for assessing, diagnosing, treating, and managing pain and related signs and symptoms, including the medically appropriate use of controlled substances;
** (2) applicable laws, regulations, rules, and policies on controlled substances, including the degree to which misconceptions and concerns regarding such laws, regulations, rules, and policies, or the enforcement thereof, may create barriers to patient access to appropriate and effective pain care;
** (3) interdisciplinary approaches to the delivery of pain care, including delivery through specialized centers providing comprehensive pain care treatment expertise;
** (4) cultural, linguistic, literacy, geographic, and other barriers to care in underserved populations; and
** (5) recent findings, developments, and improvements in the provision of pain care.
* (c) Evaluation of Programs- The Secretary shall (directly or through grants or contracts) provide for the evaluation of programs implemented under subsection (a) in order to determine the effect of such programs on knowledge and practice of pain care.
* (d) Pain Care Defined- For purposes of this section the term `pain care' means the assessment, diagnosis, treatment, or management of acute or chronic pain regardless of causation or body location.
* (e) Authorization of Appropriations- There is authorized to be appropriated to carry out this section, such sums as may be necessary for each of the fiscal years 2010 through 2012. Amounts appropriated under this subsection shall remain available until expended.'.

### SEC. 4306. FUNDING FOR CHILDHOOD OBESITY DEMONSTRATION PROJECT.

* Section 1139A(e)(8) of the Social Security Act (42 U.S.C. 1320b-9a(e)(8)) is amended to read as follows:
** (8) APPROPRIATION- Out of any funds in the Treasury not otherwise appropriated, there is appropriated to carry out this subsection, $25,000,000 for the period of fiscal years 2010 through 2014.'.

## Subtitle E--Miscellaneous Provisions
### SEC. 4401. SENSE OF THE SENATE CONCERNING CBO SCORING.

* (a) Finding- The Senate finds that the costs of prevention programs are difficult to estimate due in part because prevention initiatives are hard to measure and results may occur outside the 5 and 10 year budget windows.
* (b) Sense of Congress- It is the sense of the Senate that Congress should work with the Congressional Budget Office to develop better methodologies for scoring progress to be made in prevention and wellness programs.

### SEC. 4402. EFFECTIVENESS OF FEDERAL HEALTH AND WELLNESS INITIATIVES.

* To determine whether existing Federal health and wellness initiatives are effective in achieving their stated goals, the Secretary of Health and Human Services shall--
** (1) conduct an evaluation of such programs as they relate to changes in health status of the American public and specifically on the health status of the Federal workforce, including absenteeism of employees, the productivity of employees, the rate of workplace injury, and the medical costs incurred by employees, and health conditions, including workplace fitness, healthy food and beverages, and incentives in the Federal Employee Health Benefits Program; and
** (2) submit to Congress a report concerning such evaluation, which shall include conclusions concerning the reasons that such existing programs have proven successful or not successful and what factors contributed to such conclusions.