I 

111TH CONGRESS 

1ST SESSION H. R. 1940 

To amend the Public Health Service Act to establish a Wellness Trust. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 2, 2009 

Ms. MATSUI (for herself, Mr. BRALEY of Iowa, Mrs. CAPPS, and Mr. SARBANES) introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to establish a 

Wellness Trust. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Wellness Trust Act’’. 

5 SEC. 2. FINDINGS AND PURPOSE. 

6 (a) FINDINGS.—Congress finds as follows: 

7 (1) Preventable and chronic diseases are the 

8 epidemic of the 21st century. The number of people 

9 with chronic conditions is rapidly increasing and it 

10 is estimated that, if there is no intervention now, by 


pwalker on PROD1PC71 with BILLS
2 

•HR 1940 IH

1 2025 nearly half of the United States population will 

2 suffer from at least 1 chronic disease. About 70 per3 cent of deaths and health costs in the United States 

4 are attributable to chronic diseases (such as cardio5 vascular disease and cancer), some of which may be 

6 preventable. Nearly 90 percent of Medicare bene7 ficiaries have some type of chronic illness. 

8 (2) This affects Americans’ health. The United 

9 States has the highest rate of preventable deaths 

10 among 19 industrialized nations and lags behind 28 

11 other nations in life expectancy. For example, obe12 sity, which is rising rapidly, contributes to a wide 

13 range of problems, from diabetes to stroke to cancer. 

14 The life expectancy for a 20-year old man may be 

15 reduced by 17 percent due to obesity. If trends con16 tinue, children’s life spans may be shorter than 

17 those of their parents for the first time in about a 

18 century. 

19 (3) The wellness gap also affects health care 

20 costs. About 78 percent of all health spending in the 

21 United States is attributable to chronic illness, much 

22 of which is preventable. Chronic diseases cost the 

23 United States an additional $1,000,000,000,000 

24 each year in lost productivity, and are a major con25 tributing factor to the overall poor health that is 


pwalker on PROD1PC71 with BILLS
3 

•HR 1940 IH

1 placing the Nation’s economic security and competi2 tiveness in jeopardy. 

3 (4) Unlike some health care challenges, proven 

4 preventive services and programs exist. If effective 

5 risk reduction were implemented and sustained by 

6 2015, the death rate due to cancer could drop by 29 

7 percent. Improved blood sugar control for people 

8 with diabetes could reduce the risk for eye disease, 

9 kidney disease, and nerve disease by 40 percent. 

10 Similarly, blood pressure control could reduce the 

11 risk for heart disease and stroke by 33 to 50 per12 cent. 

13 (5) Yet, only half of recommended clinical pre14 ventive services are provided to adults. About 20 

15 percent of children do not receive all recommended 

16 immunizations, with higher rates in certain areas. 

17 Nearly 70 percent of people with high blood pressure 

18 do not now control it. And racial disparities in use 

19 of prevention exist. 

20 (6) The United States faces low use of preven21 tive services because of the low value placed on pre22 vention, a delivery system bent toward fixing rather 

23 than preventing problems, and financial disincentives 

24 for prevention. Insurers have little incentive to invest 

25 in preventive services today that will benefit other 


pwalker on PROD1PC71 with BILLS
4 

•HR 1940 IH

1 insurers tomorrow. This is especially true for those 

2 preventive services that reduce chronic diseases that 

3 develop over a period of several years or decades. 

4 The costs of prevention are incurred immediately 

5 but most of its benefits are realized later, often by 

6 Medicare. 

7 (7) There is a low investment in prevention. 

8 The United States spends only an estimated 1 to 3 

9 percent of national health expenditures on preventive 

10 health care services and health promotion. This has 

11 not increased as much as one might expect since 

12 1929, 1.4 percent, despite the development of expen13 sive screenings, early interventions, and the growth 

14 of the preventable disease burden. 

15 (8) The workforce to deliver prevention is also 

16 insufficient. The supply of providers who are trained 

17 to emphasize prevention is shrinking. Between 1997 

18 and 2005, the number of medical school graduates 

19 entering family practice residencies dropped by 50 

20 percent. There is an acute shortage of community 

21 health workers. Between 25 and 50 percent of the 

22 existing Federal, State, and local public health work23 force is eligible for retirement in the next 5 years. 

24 As of 2008, more than 75 percent of the existing 

25 public health workforce has no formal public health 


pwalker on PROD1PC71 with BILLS
5 

•HR 1940 IH

1 or prevention training. There is no national, uniform 

2 credentialing system for public health or prevention 

3 workers that would ensure that these workers are 

4 trained in the basics of preventive care. 

5 (9) A system that promoted full use of high-pri6 ority prevention could save lives. A recent com7 prehensive assessment found that 1,200,000 quality8 adjusted life years could be saved by achieving 90 

9 percent use of just the following 3 services: 

10 (A) Smoking cessation counseling. 

11 (B) Use of aspirin to prevent heart at12 tacks. 

13 (C) Screening for colorectal cancer. 

14 (10) A system that promoted full use of high15 priority prevention could reduce costs. For example, 

16 complete, routine childhood vaccination could save 

17 up to $40,000,000,000 in direct and societal costs 

18 over time. Promoting screenings and behavioral 

19 modifications in the workplace can lower absentee20 ism and, in most cases, health costs to firms. Pre21 ventive health care services could reduce government 

22 spending on health care. If all elderly received a flu 

23 vaccine, health costs could be reduced by nearly 

24 $1,000,000,000 per year. Over 25 years, Medicare 

25 could save an estimated $890,000,000,000 from efVerDate Nov 24 2008 22:23 Apr 06, 2009 Jkt 079200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1940.IH H1940

pwalker on PROD1PC71 with BILLS
6 

•HR 1940 IH

1 fective control of hypertension, and 

2 $1,000,000,000,000 from returning to levels of obe3 sity observed in the 1980s. 

4 (11) Investing in community-level interventions 

5 that promote and enable proper nutrition, increased 

6 access to physical activity, and smoking cessation 

7 programs can prevent and mitigate chronic diseases, 

8 improve quality of life, increase economic produc9 tivity, and reduce healthcare costs. 

10 (b) PURPOSE.—The purpose of this Act is to create 

11 a 21st century prevention system called the Wellness 

12 Trust that assures access to clinical and community-level 

13 prevention services that improve health, quality of life, and 

14 reduce healthcare costs. 

15 SEC. 3. WELLNESS TRUST. 

16 Title III of the Public Health Service Act (21 U.S.C. 

17 241 et seq.) is amended by adding at the end the fol18 lowing: 

19 ‘‘PART S—WELLNESS TRUST 

20 ‘‘SEC. 399KK. DEFINITIONS; ESTABLISHMENT OF WELLNESS 

21 TRUST. 

22 ‘‘(a) DEFINITIONS.—In this part: 

23 ‘‘(1) CERTIFIED PREVENTION HEALTH WORK24 ER.—The term ‘certified prevention health worker’ 

25 means a licensed health professional, a public health 


pwalker on PROD1PC71 with BILLS
7 

•HR 1940 IH

1 professional employed by a State or local public 

2 health agency, or any other health worker deemed 

3 certified by the Trustees. 

4 ‘‘(2) PREVENTION HEALTH ENTITY.—The term 

5 ‘prevention health entity’ means a State or local 

6 public health agency or other community-based pre7 vention entity deemed to be an eligible Trust partici8 pant by the Trustees. 

9 ‘‘(3) TRUST.—The term ‘Trust’ means the 

10 Wellness Trust established under subsection (b). 

11 ‘‘(4) TRUSTEES.—The term ‘Trustees’ means 

12 the members of the Trust Fund Board appointed 

13 under section 399LL(b). 

14 ‘‘(b) ESTABLISHMENT OF THE WELLNESS TRUST.— 

15 There is established within the Centers for Disease Con16 trol and Prevention the Wellness Trust. 

17 ‘‘SEC. 399LL. STRUCTURE. 

18 ‘‘(a) TRUST FUND BOARD.—The Trust shall be 

19 headed by the Trust Fund Board. 

20 ‘‘(b) COMPOSITION.—The Trust Fund Board shall be 

21 composed of 7 members appointed by the President by and 

22 with the advice and consent of the Senate. 

23 ‘‘(c) DATE OF APPOINTMENTS.—The initial 7 Trust24 ees shall be appointed not later than December 31, 2009. 


pwalker on PROD1PC71 with BILLS
8 

•HR 1940 IH

1 ‘‘(d) STAGGERED TERMS.—Of the members first ap2 pointed under subsection (c)— 

3 ‘‘(1) 4 shall be appointed for a period of 4 

4 years; and 

5 ‘‘(2) 3 shall be appointed for a period of 3 

6 years. 

7 ‘‘(e) VACANCIES.—A vacancy on the Trust Fund 

8 Board— 

9 ‘‘(1) shall not affect the powers of the Trust 

10 Fund Board; and 

11 ‘‘(2) shall be filled in the same manner as the 

12 original appointment was made. 

13 ‘‘(f) MEETINGS.—The Trust Fund Board shall meet 

14 at the call of the Chairperson. 

15 ‘‘(g) QUORUM; REQUIRED VOTES.—A majority of 

16 Trustees shall constitute a quorum for purposes of voting, 

17 but a lesser number of members may hold hearings. The 

18 Chairperson shall require a vote of the Trustees on major 

19 decisions regarding prevention priorities, resource alloca20 tion, delivery system structure, and other Trust functions. 

21 ‘‘(h) CHAIRPERSON AND VICE CHAIRPERSON.—The 

22 Trust Fund Board shall select a Chairperson and Vice 

23 Chairperson from among the Trustees. 

24 ‘‘(i) REMOVAL.—A Trustee may be removed by the 

25 President only for cause. 


pwalker on PROD1PC71 with BILLS
9 

•HR 1940 IH

1 ‘‘(j) RECOMMENDATIONS.—The Trustees may submit 

2 recommendations directly to Congress, without oppor3 tunity for comment or change by the Secretary. 

4 ‘‘(k) STAFF.—The Trustees may employ and fix the 

5 compensation of personnel as necessary. Not more than 

6 5 percent of the funds appropriated in a fiscal year to 

7 the Trust Fund established under section 399NN may be 

8 used to fund the staff, operations, and other purposes as 

9 the Trustees determine appropriate of the Trust Fund 

10 Board, subject to the oversight of the Secretary. 

11 ‘‘SEC. 399MM. REPORTS; PLAN FOR DELIVERY SYSTEMS. 

12 ‘‘(a) DEVELOPMENT OF KEY REPORTS.—Not later 

13 than 1 year after the appointment of the Trustees under 

14 section 399LL(c), the Trustees shall submit to Congress 

15 and make publicly available the following reports: 

16 ‘‘(1) REPORT ON BROADENING THE PREVEN17 TION WORKFORCE.—A report that develops and de18 scribes a system for certification and recertification 

19 of ‘prevention health workers’ to complement the 

20 health system and public health infrastructure as in 

21 existence at the time of such report. Such system 

22 may expand certification efforts in existence at the 

23 time of such report for the public health workforce 

24 and community health workers. Such report shall 

25 also examine the impact of State licensing requireVerDate Nov 24 2008 22:23 Apr 06, 2009 Jkt 079200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1940.IH H1940

pwalker on PROD1PC71 with BILLS
10 

•HR 1940 IH

1 ments and explore and describe options for health 

2 profession training and continuing education, 1 or 

3 more registries of certified prevention health work4 ers, and an employment structure that encourages 

5 flexible deployment but protects prevention health 

6 workers’ benefits. 

7 ‘‘(2) REPORT ON ALIGNING PAYMENTS WITH

8 PREVENTION GOALS.—A report that examines and 

9 describes payment methodologies and presents op10 tions for paying certified prevention health workers 

11 for clinical preventive care that aligns incentives 

12 with goals, as well as payment methodologies for 

13 community organizations involved in the provision of 

14 prevention services. Such report shall address the 

15 shortfalls of the payment systems in existence at the 

16 time of such report that have not proven effective at 

17 encouraging the provision of prevention services. 

18 ‘‘(3) REPORT ON IDENTIFYING EXISTING FUND19 ING FOR PREVENTION.—A report that examines and 

20 describes the amount of money spent on prevention 

21 by public health, public and private health insurers, 

22 and applicable self-insured health plans (as defined 

23 in section 399OO) during the most recent year for 

24 which such data is available. 


pwalker on PROD1PC71 with BILLS
11 

•HR 1940 IH

1 ‘‘(b) PLAN FOR DELIVERY SYSTEMS.—Not later than 

2 1 year after the appointment of the Trustees under section 

3 399LL(c), the Trustees shall establish a plan for deliv4 ering and financing prevention priorities and imple5 menting pilot programs. Such plan shall include— 

6 ‘‘(1) identifying effective delivery systems based 

7 on evidence and expert judgment to determine how 

8 best to deliver priority clinical and community-based 

9 prevention activities; 

10 ‘‘(2) assessing the current capacity of effective 

11 delivery systems and community infrastructure and 

12 actions necessary to ensure adequate infrastructure 

13 and capacity to deliver priority clinical and commu14 nity-based prevention activities as determined by the 

15 Trust; and 

16 ‘‘(3) identifying cost-saving clinical and commu17 nity-based interventions to implement before Decem18 ber 31, 2011, which shall include evidence-based 

19 interventions in obesity, diabetes, heart disease, and 

20 cancer. 

21 ‘‘SEC. 399NN. INFRASTRUCTURE AND PRIORITIES. 

22 ‘‘(a) DESIGNATING NATIONAL PREVENTION PRIOR23 ITIES.—The Trustees shall issue and annually update a 

24 ranked list of designated ‘prevention priorities’. The inclu25 sion of an activity on such list shall be based on the potenVerDate Nov 24 2008 22:23 Apr 06, 2009 Jkt 079200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1940.IH H1940

pwalker on PROD1PC71 with BILLS
12 

•HR 1940 IH

1 tial of such activity to improve health and the cost effec2 tiveness of such activity. Such list shall— 

3 ‘‘(1) include clinical preventive services and 

4 community-based interventions; and 

5 ‘‘(2) be used by the Trustees to— 

6 ‘‘(A) determine what prevention services 

7 and community-based interventions shall be 

8 paid for through the Trust Fund under section 

9 399OO; 

10 ‘‘(B) allocate resources within the Trust; 

11 ‘‘(C) educate the public on critical preven12 tion priorities; and 

13 ‘‘(D) emphasize coverage and use within 

14 existing authorities. 

15 ‘‘(b) CREATION AND SUPPORT OF INFRASTRUC16 TURE.—The Trustees shall establish and otherwise sup17 port and sustain the infrastructure for an effective 

18 wellness system, including the following components: 

19 ‘‘(1) CENTRAL SOURCE OF PREVENTION INFOR20 MATION.—A centralized, national, easily accessible 

21 information clearinghouse on prevention priorities 

22 and community-based interventions that shall— 

23 ‘‘(A) be made available in multiple media; 

24 ‘‘(B) be updated regularly; and 


pwalker on PROD1PC71 with BILLS
13 

•HR 1940 IH

1 ‘‘(C) connect individuals, health care pro2 viders, State and local health departments, and 

3 others to national and local resources that sup4 port the designated prevention priorities under 

5 subsection (a). 

6 ‘‘(2) QUALIFIED ELECTRONIC HEALTH

7 RECORDS.—The use and integration of qualified 

8 electronic health records (as defined in section 

9 3000(13))— 

10 ‘‘(A) to track provision of prevention over 

11 the course of individuals’ lifetimes; 

12 ‘‘(B) to facilitate reimbursement of cer13 tified prevention health workers and prevention 

14 health entities; and 

15 ‘‘(C) to assist in evaluations of the efficacy 

16 of the policies of the Wellness Trust. 

17 ‘‘(3) SYSTEM FOR TRAINING AND

18 CREDENTIALING PREVENTION HEALTH WORKERS.— 

19 A system for training and credentialing prevention 

20 health workers and prevention health entities 

21 through agencies such as the Health Resources and 

22 Services Administration and the Centers for Disease 

23 Control and Prevention. In establishing and imple24 menting such system, the Trustees shall— 


pwalker on PROD1PC71 with BILLS
14 

•HR 1940 IH

1 ‘‘(A) provide funding to such agencies 

2 through the Trust Fund under section 399OO; 

3 ‘‘(B) establish a central registry of cer4 tified prevention health workers and prevention 

5 health entities; and 

6 ‘‘(C) encourage such workers to access ad7 ditional training. 

8 ‘‘SEC. 399OO. FUNDING FOR WELLNESS TRUST. 

9 ‘‘(a) INITIAL FUNDING.—There is authorized to be 

10 appropriated and there is appropriated to the Trust Fund 

11 Board such sums as may be necessary to carry out sec12 tions 399MM and 399NN and other activities necessary 

13 for the implementation of this part. 

14 ‘‘(b) ESTABLISHMENT OF WELLNESS TRUST

15 FUND.—Not later than January 1, 2011, there shall be 

16 established in the Treasury of the United States a trust 

17 fund to be known as the ‘Wellness Trust Fund’ (referred 

18 to in this section as the ‘Trust Fund’), consisting of such 

19 amounts as are appropriated or credited to the Fund as 

20 provided under this section. 

21 ‘‘(c) APPROPRIATIONS TO THE FUND.— 

22 ‘‘(1) FISCAL YEAR 2011.—There is hereby ap23 propriated to the Trust Fund for fiscal year 2011 an 

24 amount equal to the amount spent by all Federal 

25 health programs to pay for prevention services (as 


pwalker on PROD1PC71 with BILLS
15 

•HR 1940 IH

1 defined by the Preventive Services Task Force con2 vened under section 915, except the definition of 

3 such services shall not be limited to those designated 

4 by the Task Force) in the most recent year for 

5 which complete data is available, as estimated by the 

6 Trustees. 

7 ‘‘(2) FISCAL YEAR 2012.—There is hereby ap8 propriated to the Trust Fund for fiscal year 2012 

9 the amount appropriated to the Trust Fund for the 

10 previous fiscal year, increased by the annual percent11 age increase in the medical care component of the 

12 consumer price index (United States city average) 

13 for the 12-month period ending with April of the 

14 preceding fiscal year. 

15 ‘‘(3) FISCAL YEAR 2013 AND SUBSEQUENT

16 YEARS.—There is hereby appropriated to the Trust 

17 Fund for fiscal year 2013 and each subsequent fiscal 

18 year an amount equal to the sum of— 

19 ‘‘(A) the amount appropriated to the Trust 

20 Fund for the previous fiscal year, increased by 

21 the annual percentage increase in the medical 

22 care component of the consumer price index 

23 (United States city average) for the 12-month 

24 period ending with April of the preceding fiscal 

25 year; 


pwalker on PROD1PC71 with BILLS
16 

•HR 1940 IH

1 ‘‘(B) the amount collected by the Secretary 

2 from health insurance issuers and applicable 

3 self-insured health plans under subsection (d) 

4 for the fiscal year; and 

5 ‘‘(C) the amount associated with preven6 tion priorities for State and local spending, 

7 under-use, and the uninsured for the fiscal 

8 year, as estimated by the Trustees (which shall 

9 not exceed the amount equal to 10 percent of 

10 the amount otherwise appropriated to the Trust 

11 Fund for the fiscal year). 

12 ‘‘(4) AVAILABILITY.—Amounts appropriated 

13 pursuant to this subsection shall remain available 

14 until expended. 

15 ‘‘(d) ASSESSMENT OF HEALTH INSURANCE ISSUERS

16 AND APPLICABLE SELF-INSURED HEALTH PLANS.— 

17 ‘‘(1) IN GENERAL.—Beginning in fiscal year 

18 2013 and on an annual basis thereafter, the Sec19 retary shall, subject to paragraph (2), assess and 

20 collect a fee from each health insurance issuer and 

21 each applicable self-insured health plan in an 

22 amount equal to the estimated amount spent by 

23 such health insurance issuer and self-insured health 

24 plan, respectively, for prevention services (as defined 

25 by the Trustees). 


pwalker on PROD1PC71 with BILLS
17 

•HR 1940 IH

1 ‘‘(2) COLLECTION AMOUNT ADJUSTMENT BE2 GINNING IN FISCAL YEAR 2013.—The amount deter3 mined under paragraph (1) shall, on an annual 

4 basis, be increased by the annual percentage in5 crease in the medical care component of the con6 sumer price index (United States city average) for 

7 the 12-month period ending with April of the pre8 ceding fiscal year. 

9 ‘‘(e) DEFINITIONS.—In this section: 

10 ‘‘(1) APPLICABLE SELF-INSURED HEALTH

11 PLAN.—The term ‘applicable self-insured health 

12 plan’ means any plan for providing accident or 

13 health coverage if— 

14 ‘‘(A) any portion of such coverage is pro15 vided other than through an insurance policy; 

16 and 

17 ‘‘(B) such plan is established or main18 tained— 

19 ‘‘(i) by 1 or more employers for the 

20 benefit of their employees or former em21 ployees; 

22 ‘‘(ii) by 1 or more employee organiza23 tions for the benefit of their members or 

24 former members; 


pwalker on PROD1PC71 with BILLS
18 

•HR 1940 IH

1 ‘‘(iii) jointly by 1 or more employers 

2 and 1 or more employee organizations for 

3 the benefit of employees or former employ4 ees; 

5 ‘‘(iv) by a voluntary employees’ bene6 ficiary association described in section 

7 501(c)(9) of the Internal Revenue Code of 

8 1986; 

9 ‘‘(v) by any organization described in 

10 section 501(c)(6) of such Code; or 

11 ‘‘(vi) in the case of a plan not de12 scribed in the preceding clauses, by a mul13 tiple employer welfare arrangement (as de14 fined in section 3(40) of the Employee Re15 tirement Income Security Act of 1974), a 

16 rural electric cooperative (as defined in 

17 section 3(40)(B)(iv) of such Act), or a 

18 rural telephone cooperative association (as 

19 defined in section 3(40)(B)(v) of such 

20 Act). 

21 ‘‘(2) HEALTH INSURANCE ISSUER.—The term 

22 ‘health insurance issuer’ means an insurance com23 pany, insurance service, or insurance organization 

24 (including a health maintenance organization, as de25 fined in paragraph (3)) which is licensed to engage 


pwalker on PROD1PC71 with BILLS
19 

•HR 1940 IH

1 in the business of insurance in a State and which is 

2 subject to State law which regulates insurance (with3 in the meaning of section 514(b)(2) of the Employee 

4 Retirement Income Security Act of 1974). 

5 ‘‘(3) HEALTH MAINTENANCE ORGANIZATION.— 

6 The term ‘health maintenance organization’ 

7 means— 

8 ‘‘(A) a Federally qualified health mainte9 nance organization (as defined in section 

10 1301(a)); 

11 ‘‘(B) an organization recognized under 

12 State law as a health maintenance organization; 

13 or 

14 ‘‘(C) a similar organization regulated 

15 under State law for solvency in the same man16 ner and to the same extent as such a health 

17 maintenance organization. 

18 ‘‘SEC. 399PP. INSURING PREVENTION PRIORITIES. 

19 ‘‘(a) WELLNESS TRUST AS PRIMARY PAYER FOR

20 PREVENTION SERVICES.—The Trust shall enter into con21 tracts with certified prevention health workers and preven22 tion health entities to reimburse such workers and entities 

23 for the prevention services and community-based interven24 tions designated by the Trustees under section 399NN as 

25 prevention priorities. 


pwalker on PROD1PC71 with BILLS
20 

•HR 1940 IH

1 ‘‘(b) PRIORITIES.—The Trustees shall develop annual 

2 and 5-year budget targets for the designated prevention 

3 priorities under section 399NN, including clinical preven4 tive services and community-based interventions. The 

5 Trustees shall publish annually a list indicating which of 

6 these prevention priorities are eligible for funding through 

7 the Fund. 

8 ‘‘(c) ELIGIBLE INDIVIDUALS AND ENTITIES.—Pursu9 ant to the contracts described under subsection (a), the 

10 Trust shall reimburse certified prevention health workers 

11 and prevention health entities for the prevention services 

12 and community-based interventions described under such 

13 subsection provided to all individuals who are United 

14 States citizens or legal immigrants, without regard to the 

15 insurance status of such individuals. 

16 ‘‘(d) DEVELOPMENT, REFINEMENT, AND CHANGE OF

17 PAYMENT SYSTEMS.—The Trustees shall determine pay18 ment methodologies for prevention priorities. Such pay19 ment methodologies shall correspond to the following tiers 

20 of activity: 

21 ‘‘(1) COMPETITIVE CONTRACTING AUTHOR22 ITY.—The Trustees shall have a competitive con23 tracting authority for the national delivery system 

24 activities. 


pwalker on PROD1PC71 with BILLS
21 

•HR 1940 IH

1 ‘‘(2) DIRECT PAYMENT SYSTEMS.—The Trust2 ees shall develop different payment methodologies 

3 for the various designated prevention services and 

4 community-based interventions. These payment sys5 tems shall take into account existing rates, rates for 

6 similar services, and whether geographic adjustment 

7 is needed. Such systems shall link the priority of the 

8 service with payments. 

9 ‘‘(3) USE OF STATE AND LOCAL GRANT SYS10 TEMS.—The Trustees shall utilize existing grant 

11 programs where feasible to distribute funds from the 

12 Trust Fund for prevention priorities. 

13 ‘‘(4) REPORTS FROM FEDERAL PROGRAMS.— 

14 Programs that receive funding for prevention prior15 ities through the Trust Fund shall report annually 

16 to Congress on the extent to which this funding dis17 places existing spending on prevention priorities. 

18 ‘‘(e) PARTNERSHIP WITH MEDICARE AND OTHER IN19 SURERS.—The Trustees shall determine the most efficient 

20 way to transfer funds from the Trust Fund to certified 

21 prevention health workers and prevention health entities. 

22 In making such determination, the Trustees shall carry 

23 out the following: 

24 ‘‘(1) COORDINATION WITH MEDICARE.—The 

25 Trustees shall examine the use of Medicare systems 


pwalker on PROD1PC71 with BILLS
22 

•HR 1940 IH

1 for direct payments to certified prevention health 

2 workers and prevention health entities. Any addi3 tional administrative cost associated with the use of 

4 the payment systems, including those of a broader 

5 set of providers, shall come from the Trust Fund. 

6 ‘‘(2) CONTRACT WITH OTHER INSURERS.—To 

7 the extent that the Medicare program, private insur8 ers, or States prove that such program, insurer, or 

9 State has the capacity to deliver prevention priorities 

10 in a cost effective manner, the Trustees may con11 tract with such entity for delivery of prevention serv12 ices covered under this Trust Fund.’’. 

13 SEC. 4. INTEGRATION OF PREVENTION HEALTH RECORD. 

14 Title XXX of the Public Health Service Act (42 

15 U.S.C. 300jj et seq.) is amended— 

16 (1) in section 3000(13)(B)— 

17 (A) in clause (iii), by striking ‘‘and’’ at the 

18 end; 

19 (B) in clause (iv), by striking the period at 

20 the end and inserting ‘‘; and’’; and 

21 (C) by adding at the end the following: 

22 ‘‘(v) to track the provision of preven23 tion health care over the course of the indi24 vidual’s lifetime and assist in evaluations 


pwalker on PROD1PC71 with BILLS
23 

•HR 1940 IH

1 of the efficacy of prevention priorities des2 ignated under section 399NN.’’; 

3 (2) in section 3002(b)(2)(B), add at the end 

4 the following: 

5 ‘‘(ix) The integration and inclusion of 

6 preventive and community-based health 

7 care services in any qualified electronic 

8 health record, in order to allow individuals 

9 and caregivers to track the provision of 

10 preventive health care services.’’; and 

11 (3) in section 3011(a), add at the end the fol12 lowing: 

13 ‘‘(8) Integration of prevention health priorities, 

14 prevention data, and tracking of the provision of 

15 preventive care by means of qualified electronic 

16 health records.’’. 

Æ 


pwalker on PROD1PC71 with BILLS