II 

112TH CONGRESS 

1ST SESSION S. 174 

To improve the health of Americans and reduce health care costs by reorienting the Nation’s health care system toward prevention, wellness, and 

health promotion. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 25 (legislative day, JANUARY 5), 2011 

Mr. HARKIN introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To improve the health of Americans and reduce health care 

costs by reorienting the Nation’s health care system toward prevention, wellness, and health promotion. 

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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Healthy Lifestyles and Prevention America Act’’ or the 

6 ‘‘HeLP America Act’’. 

7 (b) TABLE OF CONTENTS.—The table of contents of 

8 this Act is as follows: 

Sec. 1. Short title; table of contents. 


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TITLE I—HEALTHIER KIDS AND SCHOOLS 

Sec. 101. Nutrition and physical activity in child care quality improvement. 

Sec. 102. Access to local foods and school gardens at preschools and child care. 

Sec. 103. Fresh fruit and vegetable program. 

Sec. 104. Equal physical activity opportunities for students with disabilities. 

TITLE II—HEALTHIER COMMUNITIES AND WORKPLACES 

Subtitle A—Creating Healthier Communities 

Sec. 201. Technical assistance for the development of joint use agreements. 

Sec. 202. Community sports programs for individuals with disabilities. 

Sec. 203. Community gardens. 

Sec. 204. Physical activity guidelines for Americans. 

Sec. 205. Tobacco taxes parity. 

Sec. 206. Leveraging and coordinating federal resources for improved health. 

Subtitle B—Incentives for a Healthier Workforce 

Sec. 211. Tax credit to employers for costs of implementing wellness programs. 

Sec. 212. Employer-provided off-premises athletic facilities. 

Sec. 213. Task force for the promotion of breastfeeding in the workplace. 

Sec. 214. Improving healthy eating and active living options in Federal workplaces. 

TITLE III—RESPONSIBLE MARKETING AND CONSUMER 

AWARENESS 

Sec. 301. Guidelines for reduction in sodium content in certain foods. 

Sec. 302. Nutrition labeling for food products sold principally for use in restaurants or other retail food establishments. 

Sec. 303. Front-label food guidance systems. 

Sec. 304. Rulemaking authority for advertising to children. 

Sec. 305. Health literacy: research, coordination and dissemination. 

Sec. 306. Disallowance of deductions for advertising and marketing expenses 

relating to tobacco product use. 

Sec. 307. Incentives to reduce tobacco use. 

TITLE IV—EXPANDED COVERAGE OF PREVENTIVE SERVICES 

Sec. 401. Required coverage of preventive services under the Medicaid program. 

Sec. 402. Coverage for comprehensive workplace wellness program and preventive services. 

Sec. 403. Health professional education and training in healthy eating. 

TITLE V—RESEARCH 

Sec. 501. Grants for Body Mass Index data analysis. 

Sec. 502. National assessment of mental health needs. 


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1 TITLE I—HEALTHIER KIDS AND 

2 SCHOOLS 

3 SEC. 101. NUTRITION AND PHYSICAL ACTIVITY IN CHILD 

4 CARE QUALITY IMPROVEMENT. 

5 Section 658G of the Child Care and Development 

6 Block Grant Act of 1990 (42 U.S.C. 9858e) is amended— 

7 (1) by striking ‘‘choice, and’’ and inserting 

8 ‘‘choice,’’; and 

9 (2) by inserting after ‘‘referral services)’’ the 

10 following: ‘‘, and the provision of resources to enable 

11 eligible child care providers to meet, exceed, or sus12 tain success in meeting or exceeding Federal or 

13 State high-quality program standards relating to 

14 health, mental health, nutrition, physical activity, 

15 and physical development’’. 

16 SEC. 102. ACCESS TO LOCAL FOODS AND SCHOOL GARDENS 

17 AT PRESCHOOLS AND CHILD CARE. 

18 Section 18(g) of the Richard B. Russell National 

19 School Lunch Act (42 U.S.C. 1769(g)) is amended— 

20 (1) by redesignating paragraphs (1) through 

21 (4) as paragraphs (2) through (5), respectively; 

22 (2) by inserting before paragraph (2) (as redes23 ignated by paragraph (1)) the following: 

24 ‘‘(1) DEFINITIONS.—In this subsection: 


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1 ‘‘(A) CHILD CARE CENTER.—The term 

2 ‘child care center’ means a child care center 

3 participating in the program under section 17 

4 (other than a child care center that solely par5 ticipates in the program under subsection (r) of 

6 that section). 

7 ‘‘(B) SPONSORING ORGANIZATION.—The 

8 term ‘sponsoring organization’ means an insti9 tution described in subparagraphs (C), (D), or 

10 (E) of section 17(a)(2).’’; 

11 (3) in paragraph (2) (as so redesignated)— 

12 (A) in the paragraph heading, by striking 

13 ‘‘IN GENERAL’’ and inserting ‘‘ASSISTANCE’’; 

14 (B) in the matter preceding subparagraph 

15 (A), by inserting ‘‘, child care centers, spon16 soring organizations for home-based care,’’ 

17 after ‘‘schools’’; and 

18 (C) in subparagraph (A), by inserting ‘‘, 

19 child care centers, sponsoring organizations for 

20 home-based care,’’ after ‘‘schools’’; 

21 (4) in paragraph (3) (as so redesignated), by 

22 striking ‘‘paragraph (1)’’ and inserting ‘‘paragraph 

23 (2)’’; and 

24 (5) in paragraph (4) (as so redesignated)— 

25 (A) in subparagraph (A)(i)— 


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1 (i) in subclause (I), by striking ‘‘or’’; 

2 (ii) in subclause (II), by striking the 

3 period at the end and inserting ‘‘; or’’; and 

4 (iii) by adding at the end the fol5 lowing: 

6 ‘‘(III) a consortium of at least 2 

7 child care centers or sponsoring orga8 nizations for home-based care with 

9 hands-on vegetable gardening and nu10 trition education that is incorporated 

11 into the curriculum for 1 or more age 

12 groups at 2 or more eligible centers or 

13 family child care homes supported by 

14 sponsoring organizations for home15 based care.’’; and 

16 (B) in subparagraph (F), by striking 

17 ‘‘paragraph (1)(H)’’ and inserting ‘‘paragraph 

18 (2)(H)’’. 

19 SEC. 103. FRESH FRUIT AND VEGETABLE PROGRAM. 

20 Section 19 of the Richard B. Russell National School 

21 Lunch Act (42 U.S.C. 1769a) is amended— 

22 (1) by striking subsections (c) and (d) and in23 serting the following: 

24 ‘‘(c) SCHOOL PARTICIPATION.— 


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1 ‘‘(1) IN GENERAL.—Each State shall carry out 

2 the program in each elementary school (as defined 

3 in section 9101 of the Elementary and Secondary 

4 Education Act of 1965 (20 U.S.C. 7801)) in the 

5 State— 

6 ‘‘(A) in which not less than 50 percent of 

7 the students are eligible for free or reduced 

8 price meals under this Act; and 

9 ‘‘(B) that submits an application in ac10 cordance with paragraph (2). 

11 ‘‘(2) APPLICATION.— 

12 ‘‘(A) IN GENERAL.—An interested elemen13 tary school shall submit to the State an applica14 tion containing— 

15 ‘‘(i) information pertaining to the per16 centage of students enrolled in the school 

17 who are eligible for free or reduced price 

18 school lunches under this Act; 

19 ‘‘(ii) a certification of support for par20 ticipation in the program signed by the 

21 school food manager, the school principal, 

22 and the district superintendent (or equiva23 lent positions, as determined by the 

24 school); 


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1 ‘‘(iii) a plan for implementation of the 

2 program, including efforts to integrate ac3 tivities carried out under this section with 

4 other efforts to promote sound health and 

5 nutrition, reduce overweight and obesity, 

6 or promote physical activity; and 

7 ‘‘(iv) such other information as may 

8 be requested by the Secretary. 

9 ‘‘(B) PARTNERSHIPS.—Each State shall 

10 encourage interested elementary schools to sub11 mit a plan for implementation of the program 

12 that includes a partnership with 1 or more enti13 ties that will provide non-Federal resources (in14 cluding entities representing the fruit and vege15 table industry).’’; 

16 (2) by striking subsection (i) and inserting the 

17 following: 

18 ‘‘(i) FUNDING.— 

19 ‘‘(1) IN GENERAL.—Out of any funds in the 

20 Treasury not otherwise appropriated, the Secretary 

21 of the Treasury shall transfer to the Secretary to 

22 carry out this section such sums as are necessary, 

23 to remain available until expended. 

24 ‘‘(2) RECEIPT AND ACCEPTANCE.—The Sec25 retary shall be entitled to receive, shall accept, and 


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1 shall use to carry out this section the funds trans2 ferred under paragraph (1), without further appro3 priation.’’; and 

4 (3) by redesignating subsections (e) through (i) 

5 as subsections (d) through (h), respectively. 

6 SEC. 104. EQUAL PHYSICAL ACTIVITY OPPORTUNITIES FOR 

7 STUDENTS WITH DISABILITIES. 

8 (a) IN GENERAL.—Title V of the Rehabilitation Act 

9 of 1973 (29 U.S.C. 791 et seq.) is amended by adding 

10 at the end the following: 

11 ‘‘SEC. 511. EQUAL PHYSICAL ACTIVITY OPPORTUNITIES 

12 FOR STUDENTS WITH DISABILITIES. 

13 ‘‘(a) IN GENERAL.—The Secretary shall promote 

14 equal opportunities for students with disabilities to be in15 cluded and to participate in physical education and extra16 curricular athletics implemented in, or in conjunction 

17 with, elementary schools, secondary schools, and institu18 tions of higher education, by ensuring the provision of ap19 propriate technical assistance and guidance for schools 

20 and institutions described in this subsection and their per21 sonnel. 

22 ‘‘(b) TECHNICAL ASSISTANCE AND GUIDANCE.—The 

23 provision of technical assistance and guidance described 

24 in subsection (a) shall include— 


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1 ‘‘(1) providing technical assistance to elemen2 tary schools, secondary schools, local educational 

3 agencies, State educational agencies, and institutions 

4 of higher education, regarding— 

5 ‘‘(A) inclusion and participation of stu6 dents with disabilities, in a manner equal to 

7 that of the other students, in physical education 

8 opportunities (including classes), and extra9 curricular athletics opportunities, including 

10 technical assistance on providing reasonable 

11 modifications to policies, practices, and proce12 dures, and providing supports to ensure such 

13 inclusion and participation; 

14 ‘‘(B) provision of adaptive sports pro15 grams, in the physical education and extra16 curricular athletics opportunities, including pro17 grams with competitive sports leagues or com18 petitions, for students with disabilities; and 

19 ‘‘(C) responsibilities of the schools, institu20 tions, and agencies involved under section 504, 

21 the Americans with Disabilities Act of 1990 (42 

22 U.S.C. 12101 et seq.), and any other applicable 

23 Federal law to provide students with disabilities 

24 equal access to extracurricular athletics; 


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1 ‘‘(2) facilitating information sharing among the 

2 schools, institutions, and agencies, and students with 

3 disabilities, on ways to provide inclusive opportuni4 ties in physical education and extracurricular ath5 letics for students with disabilities; and 

6 ‘‘(3) monitoring the extent to which physical 

7 education and extracurricular athletics opportunities 

8 for students with disabilities are implemented in, or 

9 in conjunction with, elementary schools, secondary 

10 schools, and institutions of higher education. 

11 ‘‘(c) DEFINITIONS.—In this section: 

12 ‘‘(1) AGENCIES.—The terms ‘local educational 

13 agency’ and ‘State educational agency’ have the 

14 meanings given the terms in section 9101 of the Ele15 mentary and Secondary Education Act of 1965 (20 

16 U.S.C. 7801). 

17 ‘‘(2) SCHOOLS.—The terms ‘elementary school’, 

18 ‘secondary school’, and ‘institution of higher edu19 cation’ mean an elementary school, secondary school, 

20 or institution of higher education, respectively (as 

21 defined in section 9101 of the Elementary and Sec22 ondary Education Act of 1965), that receives or has 

23 1 or more students that receive, Federal financial 

24 assistance. 

25 ‘‘(3) STUDENT WITH A DISABILITY.— 


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1 ‘‘(A) IN GENERAL.—The term ‘student 

2 with a disability’ means an individual who— 

3 ‘‘(i) attends an elementary school, sec4 ondary school, or institution of higher edu5 cation; and 

6 ‘‘(ii) who— 

7 ‘‘(I) is eligible for, and receiving, 

8 special education or related services 

9 under part B of the Individuals with 

10 Disabilities Education Act (20 U.S.C. 

11 1411 et seq.); or 

12 ‘‘(II) is an individual with a dis13 ability, for purposes of section 504 or 

14 the Americans with Disabilities Act of 

15 1990. 

16 ‘‘(B) STUDENTS WITH DISABILITIES.—The 

17 term ‘students with disabilities’ means more 

18 than 1 student with a disability.’’. 

19 (b) TABLE OF CONTENTS.—The table of contents in 

20 section 1(b) of the Rehabilitation Act of 1973 is amended 

21 by inserting after the item relating to section 509 the fol22 lowing: 

‘‘Sec. 510. Establishment of standards for accessible medical diagnostic equipment. 

‘‘Sec. 511. Equal physical activity opportunities for students with disabilities.’’. 


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1 TITLE II—HEALTHIER COMMU2 NITIES AND WORKPLACES 

3 Subtitle A—Creating Healthier 

4 Communities 

5 SEC. 201. TECHNICAL ASSISTANCE FOR THE DEVELOP6 MENT OF JOINT USE AGREEMENTS. 

7 (a) IN GENERAL.—The Secretary of Health and 

8 Human Services, acting through the Director of the Cen9 ters for Disease Control and Prevention and in coordina10 tion with the Secretary of Education and in consultation 

11 with leading national experts and organizations advancing 

12 healthy living in the school environment, shall develop and 

13 disseminate guidelines and best practices, including model 

14 documents, and provide technical assistance to elementary 

15 and secondary schools to assist such schools with the de16 velopment of joint use agreements so as to address liabil17 ity, operational and management, and cost issues that may 

18 otherwise impede the ability of community members to use 

19 school facilities for recreational and nutritional purposes 

20 during nonschool hours. 

21 (b) DEFINITION.—In this section, the term ‘‘joint use 

22 agreement’’ means a formal agreement between an ele23 mentary or secondary school and another entity relating 

24 to the use of the school’s facilities, equipment, or property, 

25 including recreational and food services facilities, equipVerDate Mar 15 2010 04:10 Feb 01, 2011 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S174.IS S174

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1 ment, and property, by individuals other than the school’s 

2 students or staff. 

3 SEC. 202. COMMUNITY SPORTS PROGRAMS FOR INDIVID4 UALS WITH DISABILITIES. 

5 Part P of title III of the Public Health Service Act 

6 (42 U.S.C. 280g et seq.) is amended by adding at the end 

7 the following: 

8 ‘‘SEC. 399V–5. COMMUNITY SPORTS PROGRAMS FOR INDI9 VIDUALS WITH DISABILITIES. 

10 ‘‘(a) IN GENERAL.— 

11 ‘‘(1) INDIVIDUAL WITH A DISABILITY DE12 FINED.—For purposes of this section, the term ‘in13 dividual with a disability’ means any person who has 

14 a disability as defined in section 3 of the Americans 

15 with Disabilities Act of 1990 (42 U.S.C. 12102). 

16 ‘‘(2) INDIVIDUAL WITH A PHYSICAL DIS17 ABILITY.—The term ‘individual with a physical dis18 ability’ means an individual with a disability that 

19 has a physical or visual disability. 

20 ‘‘(3) COMMUNITY SPORTS GRANTS PROGRAM.— 

21 The Secretary, in collaboration with the National 

22 Advisory Committee on Community Sports Pro23 grams for Individuals with Disabilities, may award 

24 grants on a competitive basis to public and nonprofit 

25 private entities to implement community-based, 


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1 sports and athletic programs for individuals with 

2 disabilities, including youth with disabilities. 

3 ‘‘(b) APPLICATION.—To be eligible to receive a grant 

4 under this section, a public or nonprofit private entity 

5 shall submit to the Secretary an application at such time, 

6 in such manner, and containing such agreements, assur7 ances, and information as the Secretary determines to be 

8 necessary to carry out this section. 

9 ‘‘(c) AUTHORIZED ACTIVITIES.—Amounts awarded 

10 under a grant under subsection (a) shall be used for— 

11 ‘‘(1) community-based sports programs, 

12 leagues, or competitions in individual or team sports 

13 for individuals with physical disabilities; 

14 ‘‘(2) regional sports programs or competitions 

15 in individual or team sports for individuals with 

16 physical disabilities; 

17 ‘‘(3) the development of competitive team and 

18 individual sports programs for individuals with dis19 abilities at the high school and collegiate level; or 

20 ‘‘(4) the development of mentoring programs to 

21 encourage participation in sports programs for indi22 viduals with disabilities, including individuals with 

23 recently acquired disabilities. 

24 ‘‘(d) PRIORITIES.— 


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1 ‘‘(1) ADVISORY COMMITTEE.—The Secretary 

2 shall establish a National Advisory Committee on 

3 Community Sports Programs for Individuals with 

4 Disabilities that shall— 

5 ‘‘(A) establish priorities for the implemen6 tation of this section; 

7 ‘‘(B) review grant proposals; 

8 ‘‘(C) make recommendations for distribu9 tion of the available appropriated funds to spe10 cific applicants; and 

11 ‘‘(D) annually evaluate the progress of pro12 grams carried out under this section in imple13 menting such priorities. 

14 ‘‘(2) REPRESENTATION.—The Advisory Com15 mittee established under paragraph (1) shall include 

16 representatives of— 

17 ‘‘(A) the Department of Health and 

18 Human Services Office on Disability; 

19 ‘‘(B) the United States Surgeon General; 

20 ‘‘(C) the Centers for Disease Control and 

21 Prevention; 

22 ‘‘(D) disabled sports organizations; 

23 ‘‘(E) organizations that represent the in24 terests of individuals with disabilities; and 


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1 ‘‘(F) individuals with disabilities (including 

2 athletes with physical disabilities) or their fam3 ily members. 

4 ‘‘(e) DISSEMINATION OF INFORMATION.—The Sec5 retary shall disseminate information about the availability 

6 of grants under this section in a manner that is designed 

7 to reach public entities and nonprofit private organizations 

8 that are dedicated to providing outreach, advocacy, or 

9 independent living services to individuals with disabilities. 

10 ‘‘(f) TECHNICAL ASSISTANCE.—The Secretary, in 

11 conjunction with the United States Olympic Committee 

12 and disabled sports organizations, shall establish a tech13 nical assistance center to provide training, support, and 

14 information to grantees under this section on establishing 

15 and operating community sports programs for individuals 

16 with disabilities. 

17 ‘‘(g) REPORT TO CONGRESS.—Not later than 180 

18 days after the date of the enactment of this section, and 

19 annually thereafter, the Secretary shall submit to Con20 gress a report summarizing activities, findings, outcomes, 

21 and recommendations resulting from the grant projects 

22 funded under this section during the year for which the 

23 report is being prepared. 

24 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.— 


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1 ‘‘(1) IN GENERAL.—To carry out this section, 

2 there are authorized to be appropriated such sums 

3 as may be necessary. 

4 ‘‘(2) LIMITATION.—Not to exceed 10 percent of 

5 the amount appropriated in each fiscal year shall be 

6 used to carry out activities under subsection 

7 (c)(4).’’. 

8 SEC. 203. COMMUNITY GARDENS. 

9 Subtitle D of title X of the Food, Conservation, and 

10 Energy Act of 2008 (Public Law 110–246; 122 Stat. 

11 2109) is amended by adding at the end the following: 

12 ‘‘SEC. 10405. COMMUNITY GARDEN GRANT PROGRAM. 

13 ‘‘(a) DEFINITIONS.—In this section: 

14 ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en15 tity’ means— 

16 ‘‘(A) a nonprofit organization; or 

17 ‘‘(B) a unit of general local government, or 

18 tribal government, located on tribal land or in 

19 a low-income community. 

20 ‘‘(2) LOW-INCOME COMMUNITY.—The term 

21 ‘low-income community’ means— 

22 ‘‘(A) a community in which not less than 

23 50 percent of children are eligible for free or re24 duced priced meals under the Richard B. RusVerDate Mar 15 2010 04:10 Feb 01, 2011 Jkt 099200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\S174.IS S174

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1 sell National School Lunch Act (42 U.S.C. 

2 1751 et seq.); or 

3 ‘‘(B) any other community determined by 

4 the Secretary to be low-income for purposes of 

5 this section. 

6 ‘‘(3) UNIT OF GENERAL LOCAL GOVERN7 MENT.—The term ‘unit of general local government’ 

8 has the meaning given the term in section 102 of the 

9 Housing and Community Development Act of 1974 

10 (42 U.S.C. 5302). 

11 ‘‘(b) PROGRAM ESTABLISHED.—Using such amounts 

12 as are appropriated to carry out this section, the Secretary 

13 shall award grants to eligible entities to expand, establish, 

14 or maintain community gardens. 

15 ‘‘(c) APPLICATION.—To be considered for a grant 

16 under this section, an eligible entity shall submit to the 

17 Secretary an application at such time, in such manner, 

18 and containing such information as the Secretary may re19 quire, including— 

20 ‘‘(1) an assurance that priority for hiring for 

21 jobs created by the expansion, establishment, or 

22 maintenance of a community garden funded with a 

23 grant received under this section will be given to in24 dividuals who reside in the community in which the 

25 garden is located; and 


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1 ‘‘(2) a demonstration that the eligible entity is 

2 committed to providing non-Federal financial or in3 kind support (such as providing a water supply) for 

4 the community garden for which the entity receives 

5 funds under this section.’’. 

6 SEC. 204. PHYSICAL ACTIVITY GUIDELINES FOR AMERI7 CANS. 

8 (a) REPORT.— 

9 (1) IN GENERAL.—At least every 5 years, the 

10 Secretary of Health and Human Services (in this 

11 Act referred to as the ‘‘Secretary’’) shall publish a 

12 report entitled ‘‘Physical Activity Guidelines for 

13 Americans’’. Each such report shall contain physical 

14 activity information and guidelines for the general 

15 public, and shall be promoted by each Federal agen16 cy in carrying out any Federal health program. 

17 (2) BASIS OF GUIDELINES.—The information 

18 and guidelines contained in each report required 

19 under paragraph (1) shall be based on the prepon20 derance of the scientific and medical knowledge 

21 which is current at the time the report is prepared, 

22 and shall include guidelines for identified population 

23 subgroups, including children, if the preponderance 

24 of scientific and medical knowledge indicates those 


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1 subgroups require different levels of physical activ2 ity. 

3 (b) APPROVAL BY SECRETARY.— 

4 (1) REVIEW.—Any Federal agency that pro5 poses to issue any physical activity guidance for the 

6 general population or identified population sub7 groups shall submit the text of such guidance to the 

8 Secretary for a 60-day review period. 

9 (2) BASIS OF REVIEW.— 

10 (A) IN GENERAL.—During the 60-day re11 view period established in paragraph (1), the 

12 Secretary shall review and approve or dis13 approve such guidance to assure that the guid14 ance either is consistent with the ‘‘Physical Ac15 tivity Guidelines for Americans’’ or that the 

16 guidance is based on medical or new scientific 

17 knowledge which is determined to be valid by 

18 the Secretary. If after such 60-day review pe19 riod the Secretary has not notified the pro20 posing agency that such guidance has been dis21 approved, then such guidance may be issued by 

22 the agency. If the Secretary disapproves such 

23 guidance, it shall be returned to the agency. If 

24 the Secretary finds that such guidance is incon25 sistent with the ‘‘Physical Activity Guidelines 


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1 for Americans’’ and so notifies the proposing 

2 agency, such agency shall follow the procedures 

3 set forth in this subsection before disseminating 

4 such proposal to the public in final form. If 

5 after such 60-day period, the Secretary dis6 approves such guidance as inconsistent with the 

7 ‘‘Physical Activity Guidelines for Americans’’ 

8 the proposing agency shall— 

9 (i) publish a notice in the Federal 

10 Register of the availability of the full text 

11 of the proposal and the preamble of such 

12 proposal which shall explain the basis and 

13 purpose for the proposed physical activity 

14 guidance; 

15 (ii) provide in such notice for a public 

16 comment period of 30 days; and 

17 (iii) make available for public inspec18 tion and copying during normal business 

19 hours any comment received by the agency 

20 during such comment period. 

21 (B) REVIEW OF COMMENTS.—After review 

22 of comments received during the comment pe23 riod, the Secretary may approve for dissemina24 tion by the proposing agency a final version of 

25 such physical activity guidance along with an 


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1 explanation of the basis and purpose for the 

2 final guidance which addresses significant and 

3 substantive comments as determined by the 

4 proposing agency. 

5 (C) ANNOUNCEMENT.—Any such final 

6 physical activity guidance to be disseminated 

7 under subparagraph (B) shall be announced in 

8 a notice published in the Federal Register, be9 fore public dissemination along with an address 

10 where copies may be obtained. 

11 (D) NOTIFICATION OF DISAPPROVAL.—If 

12 after the 30-day period for comment as pro13 vided under subparagraph (A)(ii), the Secretary 

14 disapproves a proposed physical activity guid15 ance, the Secretary shall notify the Federal 

16 agency submitting such guidance of such dis17 approval, and such guidance may not be issued, 

18 except as provided in subparagraph (E). 

19 (E) REVIEW OF DISAPPROVAL.—If a pro20 posed physical activity guidance is disapproved 

21 by the Secretary under subparagraph (D), the 

22 Federal agency proposing such guidance may, 

23 within 15 days after receiving notification of 

24 such disapproval under subparagraph (D), re25 quest the Secretary to review such disapproval. 


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1 Within 15 days after receiving a request for 

2 such a review, the Secretary shall conduct such 

3 review. If, pursuant to such review, the Sec4 retary approves such proposed physical activity 

5 guidance, such guidance may be issued by the 

6 Federal agency. 

7 (3) DEFINITIONS.—In this subsection: 

8 (A) The term ‘‘physical activity guidance 

9 for the general population’’ does not include 

10 any rule or regulation issued by a Federal agen11 cy. 

12 (B) The term ‘‘identified population sub13 groups’’ shall include, but not be limited to, 

14 groups based on factors such as age, sex, race, 

15 or physical disability. 

16 (c) EXISTING AUTHORITY NOT AFFECTED.—This 

17 section does not place any limitations on— 

18 (1) the conduct or support of any scientific or 

19 medical research by any Federal agency; or 

20 (2) the presentation of any scientific or medical 

21 findings or the exchange or review of scientific or 

22 medical information by any Federal agency. 

23 SEC. 205. TOBACCO TAXES PARITY. 

24 (a) INCREASE IN EXCISE TAX ON SMALL CIGA25 RETTES AND SMALL CIGARS.— 


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1 (1) Section 5701(a)(1) of the Internal Revenue 

2 Code of 1986 is amended by striking ‘‘$50.33’’ and 

3 inserting ‘‘$77.83’’. 

4 (2) Section 5701(b)(1) of the Internal Revenue 

5 Code of 1986 is amended by striking ‘‘$50.33’’ and 

6 inserting ‘‘$77.83’’ 

7 (b) TAX PARITY FOR PIPE TOBACCO AND ROLL8 YOUR-OWN TOBACCO.— 

9 (1) Section 5701(f) of the Internal Revenue 

10 Code of 1986 is amended by striking ‘‘$2.8311 

11 cents’’ and inserting ‘‘$38.32’’. 

12 (2) Section 5701(g) of the Internal Revenue 

13 Code of 1986 is amended by striking ‘‘$24.78’’ and 

14 inserting ‘‘$38.32’’. 

15 (c) CLARIFICATION OF DEFINITION OF SMALL CI16 GARS.—Paragraphs (1) and (2) of section 5701(a) of the 

17 Internal Revenue Code of 1986 are each amended by 

18 striking ‘‘three pounds per thousand’’ and inserting ‘‘four 

19 and one-half pounds per thousand’’. 

20 (d) CLARIFICATION OF DEFINITION OF CIGA21 RETTE.—Paragraph (2) of section 5702(b) of the Internal 

22 Revenue Code of 1986 is amended by insert before the 

23 final period the following: ‘‘, which includes any roll for 

24 smoking containing tobacco that weighs no more than four 

25 and a half pounds per thousand, unless it is wrapped in 


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1 whole tobacco leaf and does not have a cellulose acetate 

2 or other cigarette-style filter’’. 

3 (e) TAX PARITY FOR SMOKELESS TOBACCO.— 

4 (1) Section 5701(e) of the Internal Revenue 

5 Code of 1986 is amended— 

6 (A) in paragraph (1), by striking ‘‘$1.51’’ 

7 and inserting ‘‘$20.75’’; 

8 (B) in paragraph (2), by striking ‘‘50.33 

9 cents’’ and inserting ‘‘$8.30’’; and 

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

11 ‘‘(3) SMOKELESS TOBACCO SOLD IN DISCRETE

12 SINGLE-USE UNITS.—On discrete single-use units, 

13 $77.83 per each 1,000 single-use units.’’. 

14 (2) Section 5702(m) of the Internal Revenue 

15 Code of 1986 is amended— 

16 (A) in paragraph (1), ‘‘or chewing to17 bacco’’ and inserting ‘‘chewing tobacco, discrete 

18 single-use unit’’; 

19 (B) in paragraphs (2) and (3), by inserting 

20 ‘‘that is not a discrete single-use unit’’ before 

21 the period in each such paragraph; 

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

23 ‘‘(4) DISCRETE SINGLE-USE UNIT.—The term 

24 ‘discrete single-use unit’ means any product con25 taining tobacco that— 


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1 ‘‘(A) is intended or expected to be con2 sumed without being combusted; and 

3 ‘‘(B) is in the form of a lozenge, tablet, 

4 pill, pouch, dissolvable strip, or other discrete 

5 single-use or single-dose unit.’’. 

6 (f) CLARIFYING OTHER TOBACCO TAX DEFINI7 TIONS.— 

8 (1) TOBACCO PRODUCT DEFINITION.—Section 

9 5702(c) of the Internal Revenue Code of 1986 is 

10 amended by inserting before the period the fol11 lowing: ‘‘, and any other product containing tobacco 

12 that is intended or expected to be consumed’’. 

13 (2) CIGARETTE PAPER DEFINITION.—Section 

14 5702(e) of the Internal Revenue Code of 1986 is 

15 amended by striking ‘‘except tobacco,’’ and inserting 

16 ‘‘or cigar’’. 

17 (3) CIGARETTE TUBE DEFINITION.—Section 

18 5702(f) of the Internal Revenue Code of 1986 is 

19 amended by inserting before the period ‘‘or cigars’’. 

20 (4) IMPORTER DEFINITION.—Section 5702(k) 

21 of the Internal Revenue Code of 1986 is amended by 

22 inserting ‘‘or any other tobacco product’’ after ‘‘ci23 gars or cigarettes’’. 

24 (g) FLOOR STOCKS TAXES.— 


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1 (1) IMPOSITION OF TAX.—On tobacco products 

2 manufactured in or imported into the United States 

3 which are removed before any tax increase date and 

4 held on such date for sale by any person, there is 

5 hereby imposed a tax in an amount equal to the ex6 cess of— 

7 (A) the tax which would be imposed under 

8 section 5701 of the Internal Revenue Code of 

9 1986 on the article if the article had been re10 moved on such date, over 

11 (B) the prior tax (if any) imposed under 

12 section 5701 of such Code on such article. 

13 (2) CREDIT AGAINST TAX.—Each person shall 

14 be allowed as a credit against the taxes imposed by 

15 paragraph (1) an amount equal to $500. Such credit 

16 shall not exceed the amount of taxes imposed by 

17 paragraph (1) on such date for which such person 

18 is liable. 

19 (3) LIABILITY FOR TAX AND METHOD OF PAY20 MENT.— 

21 (A) LIABILITY FOR TAX.—A person hold22 ing tobacco products on any tax increase date 

23 to which any tax imposed by paragraph (1) ap24 plies shall be liable for such tax. 


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1 (B) METHOD OF PAYMENT.—The tax im2 posed by paragraph (1) shall be paid in such 

3 manner as the Secretary shall prescribe by reg4 ulations. 

5 (C) TIME FOR PAYMENT.—The tax im6 posed by paragraph (1) shall be paid on or be7 fore the date that is 120 days after the effective 

8 date of the tax rate increase. 

9 (4) ARTICLES IN FOREIGN TRADE ZONES.— 

10 Notwithstanding the Act of June 18, 1934 (com11 monly known as the Foreign Trade Zone Act, 48 

12 Stat. 998, 19 U.S.C. 81a et seq.) or any other provi13 sion of law, any article which is located in a foreign 

14 trade zone on any tax increase date shall be subject 

15 to the tax imposed by paragraph (1) if— 

16 (A) internal revenue taxes have been deter17 mined, or customs duties liquidated, with re18 spect to such article before such date pursuant 

19 to a request made under the 1st proviso of sec20 tion 3(a) of such Act, or 

21 (B) such article is held on such date under 

22 the supervision of an officer of the United 

23 States Customs and Border Protection of the 

24 Department of Homeland Security pursuant to 

25 the 2d proviso of such section 3(a). 


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1 (5) DEFINITIONS.—For purposes of this sub2 section— 

3 (A) IN GENERAL.—Any term used in this 

4 subsection which is also used in section 5702 of 

5 such Code shall have the same meaning as such 

6 term has in such section. 

7 (B) TAX INCREASE DATE.—The term ‘‘tax 

8 increase date’’ means the effective date of any 

9 increase in any tobacco product excise tax rate 

10 pursuant to the amendments made by this sec11 tion. 

12 (C) SECRETARY.—The term ‘‘Secretary’’ 

13 means the Secretary of the Treasury or the 

14 Secretary’s delegate. 

15 (6) CONTROLLED GROUPS.—Rules similar to 

16 the rules of section 5061(e)(3) of such Code shall 

17 apply for purposes of this subsection. 

18 (7) OTHER LAWS APPLICABLE.—All provisions 

19 of law, including penalties, applicable with respect to 

20 the taxes imposed by section 5701 of such Code 

21 shall, insofar as applicable and not inconsistent with 

22 the provisions of this subsection, apply to the floor 

23 stocks taxes imposed by paragraph (1), to the same 

24 extent as if such taxes were imposed by such section 

25 5701. The Secretary may treat any person who bore 


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1 the ultimate burden of the tax imposed by para2 graph (1) as the person to whom a credit or refund 

3 under such provisions may be allowed or made. 

4 (h) EFFECTIVE DATE.—The amendments made by 

5 this section shall apply to articles removed (as defined in 

6 section 5702(j) of the Internal Revenue Code of 1986) 

7 after December 31, 2010. 

8 SEC. 206. LEVERAGING AND COORDINATING FEDERAL RE9 SOURCES FOR IMPROVED HEALTH. 

10 (a) HEALTH IMPACTS OF NON-HEALTH LEGISLA11 TION.— 

12 (1) IN GENERAL.—Not later than 6 months 

13 after the date of enactment of this Act, the National 

14 Prevention, Health Promotion and Public Health 

15 Council, shall enter into a contract with the Institute 

16 of Medicine of the National Academy of Sciences for 

17 the conduct of a study to assess the potential health 

18 impacts of major non-health related legislation that 

19 is likely to be considered by Congress within a year 

20 of completion of the study. Such study shall identify 

21 the ways in which such legislation involved is likely 

22 to impact the health of Americans and shall contain 

23 recommendations to Congress on ways to maximize 

24 the positive health impacts and minimize the nega25 tive health impacts. 


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1 (2) TIMING.—The timing of the study under 

2 paragraph (1) shall be provide for in a manner that 

3 ensures that the results of the study will be available 

4 at least 3 months prior to the consideration of the 

5 legislation involved by Congress. 

6 (3) GUIDELINES.—To the extent practicable, 

7 the Council under paragraph (1) shall ensure that 

8 the study conducted under this subsection complies 

9 with the consensus guidelines on how to carry out a 

10 health impact assessment, including stakeholder en11 gagement guidelines, such as the HIA of the Amer12 icas Practice Guidelines and guidelines promulgated 

13 by the World Health Organization and other con14 sensus bodies. 

15 (4) REPORT.—Upon completion of the study 

16 under this subsection, the Institute of Medicine shall 

17 submit to the Council under paragraph (1), and 

18 make available to the general public, a report that— 

19 (A) summarizes the direct, indirect, and 

20 cumulative health impacts identified in the as21 sessment; and 

22 (B) contains recommendations for how to 

23 maximize positive health impacts and minimize 

24 negative health impacts of the legislation in25 volved. 


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1 (5) TYPE OF LEGISLATION.—For purposes of 

2 this subsection, the term ‘‘non-health related legisla3 tion’’ shall have the meaning given such term by the 

4 Council under paragraph (1), and shall include legis5 lation that is likely to have impacts on the health of 

6 Americans where such impacts are not likely to be 

7 considered by Congress to the extent required by 

8 their scope without the conduct of an assessment 

9 under this subsection. Examples of major non-health 

10 related legislation that could be the subject of the 

11 study include reauthorizations of the Safe, Account12 able, Flexible, Efficient Transportation Equity Act: 

13 A Legacy for Users (SAFETEA–LU; Public Law 

14 109–59), the Food, Conservation, and Energy Act of 

15 2008 (Public Law 110–246), and the Elementary 

16 and Secondary Education Act of 1965 (20 U.S.C. 

17 6301 et seq.). 

18 (b) IMPROVING HEALTH IMPACTS OF FEDERAL

19 AGENCY ACTIVITIES.— 

20 (1) IN GENERAL.—The Secretary, acting 

21 through the Director of the Centers for Disease 

22 Control and Prevention and in coordination with the 

23 National Prevention, Health Promotion and Public 

24 Health Council, shall detail employees of the Depart25 ment of Health and Human Services to policy and 


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1 program planning offices of other Federal depart2 ments and agencies, including the Department of 

3 Transportation, the Department of Housing and 

4 Urban Development, the Department of Agriculture, 

5 the Department of Education, and the Department 

6 of the Interior, in order to assist those departments 

7 and agencies to consider the impacts of their activi8 ties on the health of the populations served and to 

9 assist with the integration of health goals into the 

10 activities of the departments and agencies, as appro11 priate. 

12 (2) DUTIES.—Employees detailed under para13 graph (1) shall assist with assessments of the poten14 tial impacts of the programs and activities of the de15 partment or agency involved on the health and well16 being of the populations served, the development of 

17 metrics and performance standards that can be in18 corporated, as appropriate, into the activities, per19 formance measurements, and grant and contract 

20 standards of the department or agency, and the de21 velopment of the report detailed in paragraph (3). 

22 (3) REPORTS.—Not later than 1 year after the 

23 date of enactment of this Act, and annually there24 after, each department and agency with a detailee 

25 under this section shall submit to the National PreVerDate Mar 15 2010 04:10 Feb 01, 2011 Jkt 099200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\S174.IS S174

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1 vention, Health Promotion and Public Health Coun2 cil, the Committee on Health, Education, Labor, and 

3 Pensions of the Senate and the Committee on En4 ergy and Commerce of the House of Representatives 

5 a report detailing the health impacts of the depart6 ment or agency’s activities and any plans to improve 

7 those impacts. 

8 Subtitle B—Incentives for a 

9 Healthier Workforce 

10 SEC. 211. TAX CREDIT TO EMPLOYERS FOR COSTS OF IM11 PLEMENTING WELLNESS PROGRAMS. 

12 (a) IN GENERAL.—Subpart D of part IV of sub13 chapter A of chapter 1 of the Internal Revenue Code of 

14 1986 is amended by adding at the end the following: 

15 ‘‘SEC. 45S. WELLNESS PROGRAM CREDIT. 

16 ‘‘(a) ALLOWANCE OF CREDIT.— 

17 ‘‘(1) IN GENERAL.—For purposes of section 38, 

18 the wellness program credit determined under this 

19 section for any taxable year during the credit period 

20 with respect to an employer is an amount equal to 

21 50 percent of the costs paid or incurred by the em22 ployer in connection with a qualified wellness pro23 gram during the taxable year. 


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1 ‘‘(2) LIMITATION.—The amount of credit al2 lowed under paragraph (1) for any taxable year shall 

3 not exceed the sum of— 

4 ‘‘(A) the product of $200 and the number 

5 of employees of the employer not in excess of 

6 200 employees, plus 

7 ‘‘(B) the product of $100 and the number 

8 of employees of the employer in excess of 200 

9 employees. 

10 ‘‘(b) QUALIFIED WELLNESS PROGRAM.—For pur11 poses of this section— 

12 ‘‘(1) QUALIFIED WELLNESS PROGRAM.—The 

13 term ‘qualified wellness program’ means a program 

14 which— 

15 ‘‘(A) consists of any 3 of the wellness pro16 gram components described in subsection (c), 

17 and 

18 ‘‘(B) which is certified by the Secretary of 

19 Health and Human Services, in consultation 

20 with the Secretary of the Treasury and Sec21 retary of Labor, as a qualified wellness program 

22 under this section. 

23 ‘‘(2) PROGRAMS MUST BE CONSISTENT WITH

24 RESEARCH AND BEST PRACTICES.— 


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1 ‘‘(A) IN GENERAL.—The Secretary of 

2 Health and Human Services shall not certify a 

3 program as a qualified wellness program unless 

4 the program— 

5 ‘‘(i) is consistent with evidence-based 

6 research and best practices, as identified 

7 by persons with expertise in employer 

8 health promotion and wellness programs, 

9 ‘‘(ii) includes multiple, evidence-based 

10 strategies which are based on the existing 

11 and emerging research and careful sci12 entific reviews, including the Guide to 

13 Community Preventive Services, the Guide 

14 to Clinical Preventive Services, and the 

15 National Registry for Effective Programs, 

16 and 

17 ‘‘(iii) includes strategies which focus 

18 on employee populations with a dispropor19 tionate burden of health problems. 

20 ‘‘(B) PERIODIC UPDATING AND REVIEW.— 

21 The Secretary of Health and Human Services 

22 shall establish procedures for periodic review 

23 and recertifications of programs under this sub24 section. Such procedures shall require revisions 

25 of programs if necessary to ensure compliance 


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1 with the requirements of this section and re2 quire updating of the programs to the extent 

3 the Secretary, in consultation with the Sec4 retary of the Treasury and the Secretary of 

5 Labor, determines necessary to reflect new sci6 entific findings. 

7 ‘‘(3) HEALTH LITERACY.—The Secretary of 

8 Health and Human Services shall, as part of the 

9 certification process, encourage employers to make 

10 the programs culturally competent and to meet the 

11 health literacy needs of the employees covered by the 

12 programs. 

13 ‘‘(c) WELLNESS PROGRAM COMPONENTS.—For pur14 poses of this section, the wellness program components de15 scribed in this subsection are the following: 

16 ‘‘(1) HEALTH AWARENESS COMPONENT.—A 

17 health awareness component which provides for the 

18 following: 

19 ‘‘(A) HEALTH EDUCATION.—The dissemi20 nation of health information which addresses 

21 the specific needs and health risks of employees. 

22 ‘‘(B) HEALTH SCREENINGS.—The oppor23 tunity for periodic screenings for health prob24 lems and referrals for appropriate follow up 

25 measures. 


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1 ‘‘(2) EMPLOYEE ENGAGEMENT COMPONENT.— 

2 An employee engagement component which provides 

3 for— 

4 ‘‘(A) the establishment of a committee to 

5 actively engage employees in worksite wellness 

6 programs through worksite assessments and 

7 program planning, delivery, evaluation, and im8 provement efforts, and 

9 ‘‘(B) the tracking of employee participa10 tion. 

11 ‘‘(3) BEHAVIORAL CHANGE COMPONENT.—A 

12 behavioral change component which provides for al13 tering employee lifestyles to encourage healthy living 

14 through counseling, seminars, on-line programs, or 

15 self-help materials which provide technical assistance 

16 and problem solving skills. Such component may in17 clude programs relating to— 

18 ‘‘(A) tobacco use, 

19 ‘‘(B) overweight and obesity, 

20 ‘‘(C) stress management, 

21 ‘‘(D) physical activity, 

22 ‘‘(E) nutrition, 

23 ‘‘(F) substance abuse, 

24 ‘‘(G) depression, and 


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1 ‘‘(H) mental health promotion (including 

2 anxiety). 

3 ‘‘(4) SUPPORTIVE ENVIRONMENT COMPO4 NENT.—A supportive environment component which 

5 includes the following: 

6 ‘‘(A) ON-SITE POLICIES.—Policies and 

7 services at the worksite which promote a 

8 healthy lifestyle, including policies relating to— 

9 ‘‘(i) tobacco use at the worksite, 

10 ‘‘(ii) the nutrition of food available at 

11 the worksite through cafeterias and vend12 ing options, 

13 ‘‘(iii) minimizing stress and promoting 

14 positive mental health in the workplace, 

15 ‘‘(iv) where applicable, accessible and 

16 attractive stairs, and 

17 ‘‘(v) the encouragement of physical 

18 activity before, during, and after work 

19 hours. 

20 ‘‘(B) PARTICIPATION INCENTIVES.— 

21 ‘‘(i) IN GENERAL.—Qualified incentive 

22 benefits for each employee who participates 

23 in the health screenings described in para24 graph (1)(B) or the behavioral change pro25 grams described in paragraph (3). 


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1 ‘‘(ii) QUALIFIED INCENTIVE BEN2 EFIT.—For purposes of clause (i), the 

3 term ‘qualified incentive benefit’ means 

4 any benefit which is approved by the Sec5 retary of Health and Human Services, in 

6 consultation with the Secretary of the 

7 Treasury and the Secretary of Labor. Such 

8 benefit may include an adjustment in 

9 health insurance premiums or co-pays. 

10 ‘‘(C) EMPLOYEE INPUT.—The opportunity 

11 for employees to participate in the management 

12 of any qualified wellness program to which this 

13 section applies. 

14 ‘‘(d) PARTICIPATION REQUIREMENT.— 

15 ‘‘(1) IN GENERAL.—No credit shall be allowed 

16 under subsection (a) unless the Secretary of Health 

17 and Human Services, in consultation with the Sec18 retary of the Treasury and Secretary of Labor, as 

19 a part of any certification described in subsection 

20 (b), that each wellness program component of the 

21 qualified wellness program applies to all qualified 

22 employees of the employer. The Secretary of Health 

23 and Human Services shall prescribe rules under 

24 which an employer shall not be treated as failing to 

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1 cause the employer provides specialized programs for 

2 employees with specific health needs or unusual em3 ployment requirements or provides a pilot program 

4 to test new wellness strategies. 

5 ‘‘(2) QUALIFIED EMPLOYEE.—For purposes of 

6 paragraph (1), the term ‘qualified employee’ means 

7 an employee who works an average of not less than 

8 25 hours per week during the taxable year. 

9 ‘‘(e) OTHER DEFINITIONS AND SPECIAL RULES.— 

10 For purposes of this section— 

11 ‘‘(1) EMPLOYEE AND EMPLOYER.— 

12 ‘‘(A) PARTNERS AND PARTNERSHIPS.— 

13 The term ‘employee’ includes a partner and the 

14 term ‘employer’ includes a partnership. 

15 ‘‘(B) CERTAIN RULES TO APPLY.—Rules 

16 similar to the rules of section 52 shall apply. 

17 ‘‘(2) CERTAIN COSTS NOT INCLUDED.—Costs 

18 paid or incurred by an employer for food or health 

19 insurance shall not be taken into account under sub20 section (a). 

21 ‘‘(3) NO CREDIT WHERE GRANT AWARDED.— 

22 No credit shall be allowable under subsection (a) 

23 with respect to any qualified wellness program of 

24 any taxpayer (other than an eligible employer de25 scribed in subsection (f)(2)(A)) who receives a grant 


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1 provided by the United States, a State, or a political 

2 subdivision of a State for use in connection with 

3 such program. The Secretary shall prescribe rules 

4 providing for the waiver of this paragraph with re5 spect to any grant which does not constitute a sig6 nificant portion of the funding for the qualified 

7 wellness program. 

8 ‘‘(4) CREDIT PERIOD.— 

9 ‘‘(A) IN GENERAL.—The term ‘credit pe10 riod’ means the period of 10 consecutive taxable 

11 years beginning with the taxable year in which 

12 the qualified wellness program is first certified 

13 under this section. 

14 ‘‘(B) SPECIAL RULE FOR EXISTING PRO15 GRAMS.—In the case of an employer (or prede16 cessor) which operates a wellness program for 

17 its employees on the date of the enactment of 

18 this section, subparagraph (A) shall be applied 

19 by substituting ‘3 consecutive taxable years’ for 

20 ‘10 consecutive taxable years’. The Secretary 

21 shall prescribe rules under which this sub22 section shall not apply if an employer is re23 quired to make substantial modifications in the 

24 existing wellness program in order to qualify 


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1 such program for certification as a qualified 

2 wellness program. 

3 ‘‘(C) CONTROLLED GROUPS.—For pur4 poses of this paragraph, all persons treated as 

5 a single employer under subsection (b), (c), 

6 (m), or (o) of section 414 shall be treated as a 

7 single employer. 

8 ‘‘(f) PORTION OF CREDIT MADE REFUNDABLE.— 

9 ‘‘(1) IN GENERAL.—In the case of an eligible 

10 employer of an employee, the aggregate credits al11 lowed to a taxpayer under subpart C shall be in12 creased by the lesser of— 

13 ‘‘(A) the credit which would be allowed 

14 under this section without regard to this sub15 section and the limitation under section 38(c), 

16 or 

17 ‘‘(B) the amount by which the aggregate 

18 amount of credits allowed by this subpart (de19 termined without regard to this subsection) 

20 would increase if the limitation imposed by sec21 tion 38(c) for any taxable year were increased 

22 by the amount of employer payroll taxes im23 posed on the taxpayer during the calendar year 

24 in which the taxable year begins. 


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1 The amount of the credit allowed under this sub2 section shall not be treated as a credit allowed under 

3 this subpart and shall reduce the amount of the 

4 credit otherwise allowable under subsection (a) with5 out regard to section 38(c). 

6 ‘‘(2) ELIGIBLE EMPLOYER.—For purposes of 

7 this subsection, the term ‘eligible employer’ means 

8 an employer which is— 

9 ‘‘(A) a State or political subdivision there10 of, the District of Columbia, a possession of the 

11 United States, or an agency or instrumentality 

12 of any of the foregoing, or 

13 ‘‘(B) any organization described in section 

14 501(c) of the Internal Revenue Code of 1986 

15 which is exempt from taxation under section 

16 501(a) of such Code. 

17 ‘‘(3) EMPLOYER PAYROLL TAXES.—For pur18 poses of this subsection— 

19 ‘‘(A) IN GENERAL.—The term ‘employer 

20 payroll taxes’ means the taxes imposed by— 

21 ‘‘(i) section 3111(b), and 

22 ‘‘(ii) sections 3211(a) and 3221(a) 

23 (determined at a rate equal to the rate 

24 under section 3111(b)). 


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1 ‘‘(B) SPECIAL RULE.—A rule similar to 

2 the rule of section 24(d)(2)(C) shall apply for 

3 purposes of subparagraph (A). 

4 ‘‘(g) TERMINATION.—This section shall not apply to 

5 any amount paid or incurred after December 31, 2017.’’. 

6 (b) TREATMENT AS GENERAL BUSINESS CREDIT.— 

7 Subsection (b) of section 38 of the Internal Revenue Code 

8 of 1986 is amended by striking ‘‘plus’’ at the end of para9 graph (35), by striking the period at the end of paragraph 

10 (36) and inserting ‘‘, plus’’, and by adding at the end the 

11 following: 

12 ‘‘(37) the wellness program credit determined 

13 under section 45S.’’. 

14 (c) DENIAL OF DOUBLE BENEFIT.—Section 280C of 

15 the Internal Revenue Code of 1986 is amended by adding 

16 at the end the following new subsection: 

17 ‘‘(j) WELLNESS PROGRAM CREDIT.— 

18 ‘‘(1) IN GENERAL.—No deduction shall be al19 lowed for that portion of the costs paid or incurred 

20 for a qualified wellness program (within the meaning 

21 of section 45S) allowable as a deduction for the tax22 able year which is equal to the amount of the credit 

23 allowable for the taxable year under section 45S. 

24 ‘‘(2) SIMILAR RULE WHERE TAXPAYER CAP25 ITALIZES RATHER THAN DEDUCTS EXPENSES.—If— 


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1 ‘‘(A) the amount of the credit determined 

2 for the taxable year under section 45S, exceeds 

3 ‘‘(B) the amount allowable as a deduction 

4 for such taxable year for a qualified wellness 

5 program, 

6 the amount chargeable to capital account for the 

7 taxable year for such expenses shall be reduced by 

8 the amount of such excess. 

9 ‘‘(3) CONTROLLED GROUPS.—In the case of a 

10 corporation which is a member of a controlled group 

11 of corporations (within the meaning of section 

12 41(f)(5)) or a trade or business which is treated as 

13 being under common control with other trades or 

14 business (within the meaning of section 

15 41(f)(1)(B)), this subsection shall be applied under 

16 rules prescribed by the Secretary similar to the rules 

17 applicable under subparagraphs (A) and (B) of sec18 tion 41(f)(1).’’. 

19 (d) CLERICAL AMENDMENT.—The table of sections 

20 for subpart D of part IV of subchapter A of chapter 1 

21 of the Internal Revenue Code of 1986 is amended by add22 ing at the end the following: 

‘‘Sec. 45S. Wellness program credit.’’. 

23 (e) EFFECTIVE DATE.—The amendments made by 

24 this section shall apply to taxable years beginning after 

25 the date of enactment of this Act. 


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1 (f) OUTREACH.— 

2 (1) IN GENERAL.—The Secretary of the Treas3 ury, in conjunction with the Director of the Centers 

4 for Disease Control and members of the business 

5 community, shall institute an outreach program to 

6 inform businesses about the availability of the 

7 wellness program credit under section 45S of the In8 ternal Revenue Code of 1986 as well as to educate 

9 businesses on how to develop programs according to 

10 recognized and promising practices and on how to 

11 measure the success of implemented programs. 

12 (2) AUTHORIZATION OF APPROPRIATIONS.— 

13 There are authorized to be appropriated such sums 

14 as are necessary to carry out the outreach program 

15 described in paragraph (1). 

16 SEC. 212. EMPLOYER-PROVIDED OFF-PREMISES ATHLETIC 

17 FACILITIES. 

18 (a) TREATMENT AS FRINGE BENEFIT.—Subpara19 graph (A) of section 132(j)(4) of the Internal Revenue 

20 Code of 1986 is amended to read as follows: 

21 ‘‘(A) IN GENERAL.—Gross income shall 

22 not include— 

23 ‘‘(i) the value of any on-premises ath24 letic facility provided by an employer to its 

25 employees, and 


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1 ‘‘(ii) so much of the fees, dues, or 

2 membership expenses paid by an employer 

3 to an athletic or fitness facility described 

4 in subparagraph (C) on behalf of its em5 ployees as does not exceed $900 per em6 ployee per year.’’. 

7 (b) ATHLETIC FACILITIES DESCRIBED.—Paragraph 

8 (4) of section 132(j) of the Internal Revenue Code of 1986 

9 is amended by adding at the end the following new sub10 paragraph: 

11 ‘‘(C) CERTAIN ATHLETIC OR FITNESS FA12 CILITIES DESCRIBED.—For purposes of sub13 paragraph (A)(ii), an athletic or fitness facility 

14 described in this subparagraph is a facility— 

15 ‘‘(i) which provides instruction in a 

16 program of physical exercise, offers facili17 ties for the preservation, maintenance, en18 couragement, or development of physical 

19 fitness, or is the site of such a program of 

20 a State or local government, 

21 ‘‘(ii) which is not a private club owned 

22 and operated by its members, 

23 ‘‘(iii) which does not offer golf, hunt24 ing, sailing, or riding facilities, 


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1 ‘‘(iv) whose health or fitness facility is 

2 not incidental to its overall function and 

3 purpose, and 

4 ‘‘(v) which is fully compliant with the 

5 State of jurisdiction and Federal anti-dis6 crimination laws.’’. 

7 (c) EXCLUSION APPLIES TO HIGHLY COMPENSATED

8 EMPLOYEES ONLY IF NO DISCRIMINATION.—Section 

9 132(j)(1) of the Internal Revenue Code of 1986 is amend10 ed— 

11 (1) by striking ‘‘Paragraphs (1) and (2) of sub12 section (a)’’ and inserting ‘‘Subsections (a)(1), 

13 (a)(2), and (j)(4)’’, and 

14 (2) by striking the heading thereof through 

15 ‘‘APPLY’’ and inserting ‘‘CERTAIN EXCLUSIONS

16 APPLY’’. 

17 (d) EMPLOYER DEDUCTION FOR DUES TO CERTAIN

18 ATHLETIC FACILITIES.— 

19 (1) IN GENERAL.—Paragraph (3) of section 

20 274(a) of the Internal Revenue Code of 1986 is 

21 amended by adding at the end the following new 

22 sentence: ‘‘The preceding sentence shall not apply to 

23 so much of the fees, dues, or membership expenses 

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1 ing of section 132(j)(4)(C)) as does not exceed $900 

2 per employee per year.’’. 

3 (2) CONFORMING AMENDMENT.—The last sen4 tence of section 274(e)(4) of such Code is amended 

5 by inserting ‘‘the first sentence of’’ before ‘‘sub6 section (a)(3)’’. 

7 (e) EFFECTIVE DATE.—The amendments made by 

8 this section shall apply to taxable years beginning after 

9 the date of the enactment of this Act. 

10 SEC. 213. TASK FORCE FOR THE PROMOTION OF 

11 BREASTFEEDING IN THE WORKPLACE. 

12 (a) ESTABLISHMENT.—The Secretary of Health and 

13 Human Services and the Secretary of Labor, or their des14 ignees, shall convene a task force for the purpose of pro15 moting breastfeeding among working mothers (referred to 

16 in this section as the ‘‘Task Force’’). 

17 (b) MEMBERSHIP.—The Task Force shall be com18 posed of members who are— 

19 (1) expert staff from the Department of Labor 

20 with expertise in workforce issues; 

21 (2) expert staff from the Department of Health 

22 and Human Services with expertise in the areas of 

23 breastfeeding and breastfeeding promotion; 

24 (3) members of the United States Breastfeeding 

25 Committee; 


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1 (4) expert staff from the Department of Agri2 culture; and 

3 (5) appointed by the Secretary of Health and 

4 Human Services and the Secretary of Labor, includ5 ing— 

6 (A) working mothers who have experience 

7 in working and breastfeeding; and 

8 (B) representatives of the human resource 

9 departments of both large and small employers 

10 that have successfully promoted breastfeeding 

11 and breastmilk pumping support at work. 

12 (c) PERIOD OF APPOINTMENT; VACANCIES.—Mem13 bers shall be appointed for the life of the Task Force. Any 

14 vacancy in the Task Force shall not affects its powers, 

15 but shall be filled in the same manner as the original ap16 pointment. 

17 (d) CHAIR.—The Task Force shall be chaired jointly 

18 by the Secretary of Health and Human Services and the 

19 Secretary of Labor, or their designees. 

20 (e) DUTIES OF THE TASK FORCE.— 

21 (1) EXAMINATION.—Consistent with the De22 partment of Health and Human Services Blueprint 

23 for Action on Breastfeeding (2000), the Task Force 

24 shall examine the following issues: 


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1 (A) The challenges that mothers face with 

2 continuing breastfeeding when the mothers re3 turn to work after giving birth. 

4 (B) The challenges that employers face in 

5 accommodating mothers who seek to continue 

6 to breastfeed or to express milk when the moth7 ers re-enter the workforce, including different 

8 challenges that mothers of varying socio-eco9 nomic status and in different professions may 

10 face. 

11 (C) The benefits that accrue to mothers, 

12 babies, and to employers when mothers are able 

13 to continue to breastfeed or to express 

14 breastmilk at work after the mothers have re15 entered the workforce. 

16 (D) Federal and State statutes that may 

17 have the effect of reducing breastfeeding and 

18 breastfeeding retention rates among working 

19 mothers. 

20 (2) REPORTS.— 

21 (A) IN GENERAL.—Not later than 1 year 

22 after the date of enactment of this section, the 

23 Task Force shall issue a public report with rec24 ommendations on the following: 


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1 (i) Steps that can be taken to promote 

2 breastfeeding among working mothers and 

3 to remove barriers to breastfeeding among 

4 working mothers. 

5 (ii) Potential ways in which the Fed6 eral Government can work with employers 

7 to promote breastfeeding among working 

8 mothers. 

9 (iii) Areas in which changes to exist10 ing Federal, State, or local laws would 

11 likely have the effect of making it easier 

12 for working mothers to breastfeed or would 

13 remove impediments to breastfeeding that 

14 currently exist in such laws. 

15 (iv) Whether or not increased rates of 

16 breastfeeding among working mothers 

17 would likely have the result of reducing 

18 health care costs among such mothers and 

19 their children, and, in particular, whether 

20 increased rates of breastfeeding would be 

21 likely to result in lower Federal expendi22 tures on health care for such mothers and 

23 their children. 

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1 eral agencies, or changes to existing Fed2 eral law, can and should increase the Fed3 eral Government’s efforts to promote 

4 breastfeeding among working mothers. 

5 (B) COPY TO CONGRESS.—Upon comple6 tion of the report described in subparagraph 

7 (A), the Task Force shall submit a copy of the 

8 report to the Committee on Health, Education, 

9 Labor, and Pensions of the Senate, the Com10 mittee on Appropriations of the Senate, the 

11 Committee on Education and the Workforce of 

12 the House of Representatives, and the Com13 mittee on Appropriations of the House of Rep14 resentatives. 

15 (f) POWERS OF THE TASK FORCE.— 

16 (1) HEARINGS.—The Task Force may hold 

17 such hearings, sit and act at such times and places, 

18 take such testimony, and receive such evidence as 

19 the Task Force considers advisable to carry out this 

20 section. 

21 (2) INFORMATION FROM FEDERAL AGENCIES.— 

22 The Task Force may secure directly from any Fed23 eral department or agency such information as the 

24 Task Force considers necessary to carry out this 

25 section. Upon request of the Chair of the Task 


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1 Force, the head of such department or agency shall 

2 furnish such information to the Task Force. 

3 (3) POSTAL SERVICES.—The Task Force may 

4 use the United States mails in the same manner and 

5 under the same conditions as other departments and 

6 agencies of the Federal Government. 

7 (4) DONATIONS.—The Task Force may accept, 

8 use, and dispose of donations of services or property. 

9 (g) OPERATING EXPENSES.—The operating expenses 

10 of the Task Force, including travel expenses for members 

11 of the Task Force, shall be paid for from the general oper12 ating expenses funds of the Secretary of Health and 

13 Human Services and the Secretary of Labor. 

14 SEC. 214. IMPROVING HEALTHY EATING AND ACTIVE LIV15 ING OPTIONS IN FEDERAL WORKPLACES. 

16 (a) MENU LABELING IN FEDERAL FOOD ESTAB17 LISHMENTS.— 

18 (1) IN GENERAL.— 

19 (A) EXECUTIVE AND JUDICIAL BUILD20 INGS.—Section 403(q) of the Federal Food, 

21 Drug, and Cosmetic Act (21 U.S.C. 343(q)) is 

22 amended by adding at the end the following: 

23 ‘‘(6)(A) The requirements of subparagraph (5)(H) 

24 shall apply— 


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1 ‘‘(i) to a restaurant or similar retail food estab2 lishment located in a Federal building in the same 

3 manner as such subparagraph applies to a res4 taurant or similar retail food establishment that is 

5 part of a chain with 20 or more locations, as de6 scribed in subparagraph (5)(H)(i); and 

7 ‘‘(ii) to a person that operates a vending ma8 chine located in a Federal building in the same man9 ner as such subparagraph applies to a person who 

10 is engaged in the business of owning or operating 20 

11 or more vending machines, as described in subpara12 graph (5)(H)(viii). 

13 ‘‘(B) In this subparagraph, the term ‘Federal build14 ing’ means a building that is— 

15 ‘‘(i) under the control of the Federal agency (as 

16 defined in section 102 of title 40, United States 

17 Code); 

18 ‘‘(ii) owned by the Federal Government; and 

19 ‘‘(iii) located in a State, the District of Colum20 bia, Puerto Rico, or a territory or possession of the 

21 United States.’’. 

22 (B) APPLICABILITY.—The requirement in 

23 the amendment made by paragraph (1) shall 

24 apply to restaurants or similar retail food es25 tablishments and vending machines located in a 


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1 Federal building beginning 12 months after the 

2 date of enactment of this Act. 

3 (2) CONGRESSIONAL BUILDINGS.—The Archi4 tect of the Capitol, in coordination with the Com5 mittee on Rules and Administration of the Senate 

6 and the Committee on House Administration of the 

7 House of Representatives, shall establish a program 

8 to apply the requirements of section 403(q)(5)(H) of 

9 the Federal Food, Drug, and Cosmetic Act (21 

10 U.S.C. 343(q)(5)(H)) (as amended by paragraph 

11 (1)) to— 

12 (A) food that is served in restaurants or 

13 other similar retail food establishments that are 

14 located in Congressional buildings and installa15 tions; 

16 (B) food that is sold through vending ma17 chines that are operated in Congressional build18 ings and installations; and 

19 (C) food that is served to individuals with20 in Congressional buildings and installations 

21 pursuant to a contract with a private entity. 

22 (b) NUTRITIONAL STANDARDS FOR FOOD IN FED23 ERAL BUILDINGS.— 

24 (1) EXECUTIVE AND JUDICIAL BUILDINGS.— 

25 Subchapter V of chapter 5 of subtitle I of title 40, 


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1 United States Code, is amended by adding at the 

2 end the following: 

3 ‘‘SEC. 594. NUTRITIONAL STANDARDS FOR FOOD IN FED4 ERAL BUILDINGS. 

5 ‘‘(a) IN GENERAL.—The Administrator of General 

6 Services, in consultation with the Secretary of Health and 

7 Human Services, shall establish, by regulation, nutritional 

8 standards for all food products provided at Federal build9 ings and installations (including food products provided by 

10 contractors or vending machines). 

11 ‘‘(b) USE OF AMOUNTS.—Amounts appropriated to 

12 an executive agency for installation, repair, and mainte13 nance, generally, may be used to achieve compliance with 

14 the regulations promulgated pursuant to this section. 

15 ‘‘(c) LIABILITY.—Nothing in this section increases or 

16 enlarges the tort liability of the Federal Government for 

17 any injury to an individual or damage to property.’’. 

18 (2) CONGRESSIONAL BUILDINGS.—The Archi19 tect of the Capitol, in coordination with the Com20 mittee on Rules and Administration of the Senate 

21 and the Committee on House Administration of the 

22 House of Representatives shall establish nutritional 

23 standards for all food products provided at Congres24 sional buildings and installations (including food 


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1 products provided by contractors or vending ma2 chines). 

3 (c) ENCOURAGEMENT OF USE OF STAIRS.— 

4 (1) EXECUTIVE AND JUDICIAL BUILDINGS.— 

5 Subchapter V of chapter 5 of subtitle I of title 40, 

6 United States Code, as amended by subsection (b), 

7 is further amended by adding at the end the fol8 lowing: 

9 ‘‘SEC. 595. ENCOURAGEMENT OF USE OF STAIRS. 

10 ‘‘(a) IN GENERAL.—Each Federal agency shall in11 stall point-of-decision prompts encouraging individuals to 

12 use stairs wherever practicable at each relevant building 

13 and installation that is— 

14 ‘‘(1) under the control of the Federal agency; 

15 ‘‘(2) owned by the Federal Government; and 

16 ‘‘(3) located in a State, the District of Colum17 bia, Puerto Rico, or a territory or possession of the 

18 United States. 

19 ‘‘(b) REIMBURSEMENT.—Subsection (a) may be car20 ried out by— 

21 ‘‘(1) reimbursement to a State or political sub22 division of a State, the District of Columbia, Puerto 

23 Rico, or a territory or possession of the United 

24 States; or 

25 ‘‘(2) a means other than reimbursement. 


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1 ‘‘(c) REGULATIONS.—Subsection (a) shall be carried 

2 out in accordance with such regulations as the Adminis3 trator of General Services may promulgate, with the ap4 proval of the Director of the Office of Management and 

5 Budget. 

6 ‘‘(d) USE OF AMOUNTS.—Amounts appropriated to 

7 a Federal agency for installation, repair, and maintenance, 

8 generally, shall be available to carry out this section. 

9 ‘‘(e) LIABILITY.—Nothing in this section increases or 

10 enlarges the tort liability of the Federal Government for 

11 any injury to an individual or damage to property.’’. 

12 (2) CONGRESSIONAL BUILDINGS.—The Archi13 tect of the Capitol shall implement a program to in14 stall point-of-decision prompts encouraging individ15 uals to use stairs wherever practicable in Congres16 sional buildings and installations in the same man17 ner as established under section 595 of title 40, 

18 United States Code (as added by paragraph (1)). 

19 (d) ACCOMMODATIONS FOR BICYCLE COMMUTERS.— 

20 (1) EXECUTIVE AND JUDICIAL FEDERAL

21 BUILDINGS.—Subchapter V of chapter 5 of subtitle 

22 I of title 40, United States Code, as amended by 

23 subsection (c), is further amended by adding at the 

24 end the following: 


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1 ‘‘SEC. 596. ACCOMMODATIONS FOR BICYCLE COMMUTERS. 

2 ‘‘(a) IN GENERAL.—Each Federal agency shall in3 stall and maintain a bicycle storage area and equipment 

4 (such as a bicycle rack) and a shower for bicycle com5 muters at each relevant parking structure that is— 

6 ‘‘(1) under the control of the Federal agency; 

7 ‘‘(2) owned by the Federal Government; and 

8 ‘‘(3) located in a State, the District of Colum9 bia, Puerto Rico, or a territory or possession of the 

10 United States. 

11 ‘‘(b) REIMBURSEMENT.—Subsection (a) may be car12 ried out by— 

13 ‘‘(1) reimbursement to a State or political sub14 division of a State, the District of Columbia, Puerto 

15 Rico, or a territory or possession of the United 

16 States; or 

17 ‘‘(2) a means other than reimbursement. 

18 ‘‘(c) REGULATIONS.—Subsection (a) shall be carried 

19 out in accordance with such regulations as the Adminis20 trator of General Services may promulgate, with the ap21 proval of the Director of the Office of Management and 

22 Budget. 

23 ‘‘(d) USE OF AMOUNTS.—Amounts appropriated to 

24 a Federal agency for installation, repair, and maintenance, 

25 generally, shall be available to carry out this section. 


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1 ‘‘(e) LIABILITY.—Nothing in this section increases or 

2 enlarges the tort liability of the Federal Government for 

3 any injury to an individual or damage to property.’’. 

4 (2) CONGRESSIONAL BUILDINGS.—The Archi5 tect of the Capitol, in coordination with the Sergeant 

6 at Arms and Doorkeeper of the Senate, the Sergeant 

7 at Arms of the House of Representatives, and the 

8 United States Capitol Police, shall implement, within 

9 their respective jurisdictions, a program to make ac10 commodations for bicycle commuters on the United 

11 States Capitol complex in the same manner as estab12 lished under section 596 of title 40, United States 

13 Code (as added by paragraph (1)). 

14 TITLE III—RESPONSIBLE MAR15 KETING AND CONSUMER 

16 AWARENESS 

17 SEC. 301. GUIDELINES FOR REDUCTION IN SODIUM CON18 TENT IN CERTAIN FOODS. 

19 (a) IN GENERAL.—Not later than 180 days after the 

20 date of enactment of this Act, the Secretary of Health and 

21 Human Services shall promulgate regulations establishing 

22 guidelines for the reduction, over a 2 year period, in the 

23 sodium content of processed food and restaurant food fol24 lowing, as appropriate, the recommendations made by the 


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1 Institute of Medicine report entitled ‘‘Strategies to Reduce 

2 Sodium Intake in the United States’’. 

3 (b) DEFINITIONS.—For purposes of this section— 

4 (1) the term ‘‘processed food’’ has the meaning 

5 given such term in section 201(gg) of the Federal 

6 Food, Drug, and Cosmetic Act (21 U.S.C. 321(gg)); 

7 and 

8 (2) the term ‘‘restaurant food’’ means food sub9 ject to the requirements of section 403(q)(5)(H) of 

10 the Federal Food, Drug, and Cosmetic Act (21 

11 U.S.C. 343(q)(5)(H)). 

12 SEC. 302. NUTRITION LABELING FOR FOOD PRODUCTS 

13 SOLD PRINCIPALLY FOR USE IN RES14 TAURANTS OR OTHER RETAIL FOOD ESTAB15 LISHMENTS. 

16 Section 403(q)(5) of the Federal Food, Drug, and 

17 Cosmetic Act (21 U.S.C. 343(q)(5)) is amended by strik18 ing clause (G). 

19 SEC. 303. FRONT-LABEL FOOD GUIDANCE SYSTEMS. 

20 (a) IN GENERAL.—Not later than 6 months after the 

21 date of enactment of this Act, the Secretary of Health and 

22 Human Services (referred to in this section as the ‘‘Sec23 retary’’) shall begin soliciting public comments regard24 ing— 


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1 (1) the use of retail front-label food guidance 

2 systems to convey nutrition information to the public 

3 using logos, symbols, signs, emblems, insignia, or 

4 other graphic representations on the labeling of food 

5 intended for human consumption that are intended 

6 to provide simple, standardized, and understandable 

7 nutrition information to the public in graphic form; 

8 (2) appropriate nutrition standards by which a 

9 retail front-label food guidance system may convey 

10 the relative nutritional value of different foods in 

11 simple graphic form; and 

12 (3) whether American consumers would be bet13 ter served by establishing a single, standardized re14 tail front-label food guidance system regulated by 

15 the Food and Drug Administration, or by allowing 

16 individual food companies, trade associations, non17 profit organizations, and others to continue to de18 velop their own retail front-label food guidance sys19 tems. 

20 (b) EFFECT ON NUTRITION FACTS PANEL.—In solic21 iting public comments under subsection (a), the Secretary 

22 shall inform the public that any retail front-label food 

23 guidance system is intended to supplement, not replace, 

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1 suant to section 403(q) of the Federal Food, Drug, and 

2 Cosmetic Act (21 U.S.C. 343(q)). 

3 (c) PROPOSED REGULATION.—Not later than 12 

4 months following the closure of the public comment solici5 tation period under subsection (a), the Secretary shall— 

6 (1) publish a notice in the Federal Register 

7 that summarizes the public comments and describes 

8 the suggested retail front-label food guidance sys9 tems received through such solicitation; and 

10 (2) publish proposed regulations that— 

11 (A) establish a single, standardized retail 

12 front-label food guidance system; or 

13 (B) establish the conditions under which 

14 individual food companies, trade associations, 

15 nonprofit organizations, and other entities may 

16 continue to develop their own retail front-label 

17 food guidance systems. 

18 SEC. 304. RULEMAKING AUTHORITY FOR ADVERTISING TO 

19 CHILDREN. 

20 (a) PURPOSE.—The purpose of this section is to re21 store the authority of the Federal Trade Commission to 

22 issue regulations that restrict the marketing or advertising 

23 of foods and beverages to children under the age of 18 

24 years if the Federal Trade Commission determines that 


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1 there is evidence that consumption of certain foods and 

2 beverages is detrimental to the health of children. 

3 (b) AUTHORITY.—Section 18 of the Federal Trade 

4 Commission Act (15 U.S.C. 57a) is amended— 

5 (1) in subsection (a), by striking ‘‘Except as 

6 provided in subsection (h), the’’ and inserting 

7 ‘‘The’’; 

8 (2) by amending subsection (b) to read as fol9 lows: 

10 ‘‘(b) PROCEDURE APPLICABLE.—When prescribing a 

11 rule under subsection (a)(1)(B) of this section, the Com12 mission shall proceed in accordance with section 553 of 

13 title 5 (without regard to any reference in such section 

14 to sections 556 and 557 of such title).’’; 

15 (3) by striking subsections (c), (f), (h), (i), and 

16 (j); 

17 (4) by striking subsection (d) and inserting the 

18 following: 

19 ‘‘(c) When any rule under subsection (a)(1)(B) takes 

20 effect a subsequent violation thereof shall constitute an 

21 unfair or deceptive act or practice in violation of section 

22 5(a)(1) of this Act, unless the Commission otherwise ex23 pressly provides in such rule.’’; 

24 (5) by redesignating subsections (e) and (g) as 

25 subsections (d) and (e), respectively; and 


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1 (6) in subsection (d), as redesignated— 

2 (A) in paragraph (1)(B), by striking ‘‘the 

3 transcript required by subsection (c)(5),’’; 

4 (B) in paragraph (3), by striking ‘‘error)’’ 

5 and all that follows through the period at the 

6 end and inserting ‘‘error).’’; and 

7 (C) in paragraph (5), by striking subpara8 graph (C). 

9 SEC. 305. HEALTH LITERACY: RESEARCH, COORDINATION 

10 AND DISSEMINATION. 

11 (a) IN GENERAL.—Part A of title IX of the Public 

12 Health Service Act (42 U.S.C. 299 et seq.) is amended 

13 by adding at the end the following: 

14 ‘‘SEC. 904. HEALTH LITERACY: RESEARCH, COORDINATION 

15 AND DISSEMINATION. 

16 ‘‘(a) DEFINITION.—In this section, the term ‘health 

17 literacy’ means a consumer’s ability to obtain, process, 

18 and understand basic health information and services 

19 needed to make appropriate health care decisions and the 

20 adaptation of services to enhance a consumer’s under21 standing and navigation of applicable health care services. 

22 ‘‘(b) HEALTH LITERACY PROGRAM.— 

23 ‘‘(1) ESTABLISHMENT.—The Director shall es24 tablish within the Agency a program (referred to in 

25 this section as the ‘program’) to strengthen health 


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1 literacy by improving measurement, research, devel2 opment, and information dissemination. 

3 ‘‘(2) DUTIES.—In carrying out the program, 

4 the Director shall— 

5 ‘‘(A) gather health literacy resources from 

6 public and private sources and make such re7 sources available to researchers, health care 

8 providers, and the general public; 

9 ‘‘(B) identify and fill research gaps relat10 ing to health literacy that have direct applica11 bility to— 

12 ‘‘(i) prevention; 

13 ‘‘(ii) self-management of chronic dis14 ease; 

15 ‘‘(iii) quality improvement; 

16 ‘‘(iv) the barriers to health literacy; 

17 ‘‘(v) relationships between health lit18 eracy and health disparities, particularly 

19 with respect to language and cultural com20 petency; and 

21 ‘‘(vi) the utilization of information on 

22 comparative effectiveness of health treat23 ments; 

24 ‘‘(C) sponsor demonstration and evaluation 

25 projects with respect to interventions and tools 


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1 designed to strengthen health literacy, including 

2 projects focused on— 

3 ‘‘(i) the provision of simplified, pa4 tient-centered written materials; 

5 ‘‘(ii) technology-based communication 

6 techniques; 

7 ‘‘(iii) consumer navigation services; 

8 and 

9 ‘‘(iv) the training of health profes10 sional providers; 

11 ‘‘(D) give preference to health literacy ini12 tiatives that— 

13 ‘‘(i) focus on the particular needs of 

14 vulnerable populations such as the elderly, 

15 racial and ethnic minorities, children, indi16 viduals with limited English proficiency, 

17 and individuals with disabilities; and 

18 ‘‘(ii) partner with institutions in the 

19 community such as schools, libraries, sen20 ior centers, literacy groups, recreation cen21 ters, early childhood education centers, 

22 area health education centers, and public 

23 assistance programs; 

24 ‘‘(E) assist appropriate Federal agencies in 

25 establishing specific objectives and strategies 


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1 for carrying out the program, in monitoring the 

2 programs of such agencies, and incorporating 

3 health literacy into research design, human sub4 jects protections, and informed consent in clin5 ical research; 

6 ‘‘(F) seek to enter into implementation 

7 partnerships with organizations and agencies, 

8 including other agencies within the Department 

9 of Health and Human Services, such as the 

10 Centers for Medicare & Medicaid Services and 

11 the Health Resources and Services Administra12 tion, the Office of the Surgeon General, the 

13 Joint Commission on the Accreditation of 

14 Healthcare Organizations, the Office of the Na15 tional Coordinator for Health Information 

16 Technology, and the National Committee for 

17 Quality Assurance, to promote the adoption of 

18 interventions and tools developed under this 

19 section, particularly in the training of health 

20 professionals; and 

21 ‘‘(G) coordinate with other agencies within 

22 the Department of Health and Human Services 

23 to collect data that monitors national trends in 

24 health literacy by including relevant items in 

25 surveys such as the Medical Expenditure Panel 


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1 Survey, the National Health Interview Survey, 

2 and the National Hospital Discharge Survey. 

3 ‘‘(3) REPORT.—The Agency for Healthcare Re4 search and Quality shall annually submit to Con5 gress a report that includes— 

6 ‘‘(A) a comprehensive and detailed descrip7 tion of the operations, activities, financial condi8 tion, and accomplishments of the Agency in the 

9 field of health literacy; and 

10 ‘‘(B) a description of how plans for the op11 eration of the program for the succeeding fiscal 

12 year will facilitate achievement of the goals of 

13 the program. 

14 ‘‘(4) AUTHORIZATION OF APPROPRIATIONS.— 

15 There are authorized to be appropriated to carry out 

16 this subsection such sums as may be necessary for 

17 each of fiscal years 2012 through 2016. 

18 ‘‘(c) STATE HEALTH LITERACY GRANTS.— 

19 ‘‘(1) GRANTS.—The Director of the Agency 

20 shall award grants to eligible entities to facilitate 

21 State and community efforts to strengthen health 

22 literacy. 

23 ‘‘(2) USE OF FUNDS.—An entity receiving a 

24 grant under this subsection shall use amounts re25 ceived under such grant to— 


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1 ‘‘(A) support efforts to monitor and 

2 strengthen health literacy within a State or 

3 community; 

4 ‘‘(B) assist public and private efforts in 

5 the State or community in coordinating and de6 livering health literacy services; 

7 ‘‘(C) encourage partnerships among State 

8 and local governments, community organiza9 tions, non-profit entities, academic institutions, 

10 and businesses to coordinate efforts to strength11 en health literacy; 

12 ‘‘(D) provide technical and policy assist13 ance to State and local governments and service 

14 providers; and 

15 ‘‘(E) monitor and evaluate programs con16 ducted under this grant. 

17 ‘‘(3) REPORT.—Not later than September 30 of 

18 each fiscal year for which a grant is received by an 

19 entity under this section, the entity shall submit to 

20 the Director a report that describes the programs 

21 supported by the grant and the results of monitoring 

22 and evaluation of those programs. 

23 ‘‘(4) AUTHORIZATION OF APPROPRIATIONS.— 

24 There are authorized to be appropriated such sums 


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1 as may be necessary to carry out this subsection for 

2 each of fiscal years 2012 through 2016.’’. 

3 (b) INSTITUTE OF MEDICINE STUDY AND REPORT.— 

4 (1) STUDY.—The Secretary of Health and 

5 Human Services shall seek to enter into a contract 

6 with the Institute of Medicine to conduct a study 

7 identifying opportunities within the Department of 

8 Health and Human Services to strengthen the 

9 health literacy of health care providers and health 

10 care consumers in accordance with the Patient Pro11 tection and Affordable Care Act (Public Law 111– 

12 148). 

13 (2) REPORT.—A contract entered into under 

14 paragraph (1) shall include a provision requiring the 

15 Institute of Medicine, not later than 1 year after the 

16 date of enactment of this Act, to submit a report 

17 concerning the results of the study conducted under 

18 paragraph (1) to the Secretary of Health and 

19 Human Services and the appropriate committees of 

20 Congress.’’. 

21 SEC. 306. DISALLOWANCE OF DEDUCTIONS FOR ADVER22 TISING AND MARKETING EXPENSES RELAT23 ING TO TOBACCO PRODUCT USE. 

24 (a) IN GENERAL.—Part IX of subchapter B of chap25 ter 1 of subtitle A of the Internal Revenue Code of 1986 


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1 (relating to items not deductible) is amended by adding 

2 at the end the following new section: 

3 ‘‘SEC. 280I. DISALLOWANCE OF DEDUCTION FOR ADVER4 TISING AND MARKETING EXPENSES RELAT5 ING TO TOBACCO PRODUCT USE. 

6 ‘‘No deduction shall be allowed under this chapter for 

7 expenses relating to advertising or marketing cigars, ciga8 rettes, smokeless tobacco, pipe tobacco, or any other to9 bacco product. For purposes of this section, any term used 

10 in this section which is also used in section 5702 shall 

11 have the same meaning given such term by section 5702.’’. 

12 (b) CONFORMING AMENDMENT.—The table of sec13 tions for such part IX is amended by adding after the 

14 item relating to section 280H the following new item: 

‘‘Sec. 280I. Disallowance of deduction for tobacco advertising and marketing 

expenses.’’. 

15 (c) EFFECTIVE DATE.—The amendments made by 

16 this section shall apply to taxable years beginning after 

17 the date of the enactment of this Act. 

18 SEC. 307. INCENTIVES TO REDUCE TOBACCO USE. 

19 (a) CHILD TOBACCO USE SURVEYS.— 

20 (1) ANNUAL PERFORMANCE SURVEY.— 

21 (A) IN GENERAL.—Not later than August 

22 31, 2012, and annually thereafter, the Sec23 retary of Health and Human Services (referred 

24 to in this section as the ‘‘Secretary’’) shall pubVerDate Mar 15 2010 04:10 Feb 01, 2011 Jkt 099200 PO 00000 Frm 00074 Fmt 6652 Sfmt 6201 E:\BILLS\S174.IS S174

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1 lish the results of an annual tobacco use survey, 

2 to be carried out not later than 18 months after 

3 the date of enactment of this Act and completed 

4 on an annual basis thereafter, to determine— 

5 (i) the percentage of all young individ6 uals who used tobacco products within the 

7 30-day period prior to the conduct of the 

8 survey involved; and 

9 (ii) the percentage of young individ10 uals who identify each brand of each type 

11 of tobacco product as the usual brand used 

12 within such 30-day period. 

13 (B) YOUNG INDIVIDUALS.—For the pur14 poses of this section, the term ‘‘young individ15 uals’’ means individuals who are under 18 years 

16 of age. 

17 (2) SIZE AND METHODOLOGY.— 

18 (A) IN GENERAL.—The survey referred to 

19 in paragraph (1) may be the National Survey 

20 on Drug Use and Health or shall at least be 

21 comparable in size and methodology to the 

22 NSDUH that was completed in 2009 to meas23 ure the use of cigarettes (by brand) by youths 

24 under 18 years of age within the 30-day period 

25 prior to the conduct of the study. 


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1 (B) CONCLUSIVE ACCURATENESS.—A sur2 vey using the methodology described in sub3 paragraph (A) shall be deemed conclusively 

4 proper, correct, and accurate for purposes of 

5 this section. 

6 (C) DEFINITION.—In this section, the 

7 term ‘‘National Survey on Drug Use and 

8 Health’’ or ‘‘NSDUH’’ means the annual na9 tionwide survey of randomly selected individ10 uals, aged 12 and older, conducted by the Sub11 stance Abuse and Mental Health Services Ad12 ministration. 

13 (3) REDUCTION.—The Secretary, based on a 

14 comparison of the results of the first annual tobacco 

15 product survey referred to in paragraph (1) and the 

16 most recent NSDUH referred to in paragraph 

17 (2)(A) completed prior to the date of enactment of 

18 this Act, shall determine the percentage reduction (if 

19 any) in youth tobacco use for each manufacturer of 

20 tobacco products. 

21 (4) PARTICIPATION IN SURVEY.—Notwith22 standing any other provision of law, the Secretary 

23 may conduct a survey under this subsection involv24 ing minors if the results of such survey with respect 


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1 to such minors are kept confidential and not dis2 closed. 

3 (5) NONAPPLICABILITY.—Chapter 35 of title 

4 44, United States Code, shall not apply to informa5 tion required for the purposes of carrying out this 

6 section. 

7 (b) TOBACCO USE REDUCTION GOAL AND NON8 COMPLIANCE.— 

9 (1) GOAL.—It shall be the tobacco use reduc10 tion goal that youth tobacco use be reduced by at 

11 least 5 percent or a level determined significantly 

12 sufficient by the Secretary between the most recent 

13 NSDUH referred to in subsection (a)(2)(A) and the 

14 completion of the first annual cigarette survey (and 

15 such subsequent surveys as compared to the pre16 vious year’s survey) referred to in subsection (a)(1). 

17 (2) NONCOMPLIANCE.— 

18 (A) INDUSTRY-WIDE PENALTY.—If the 

19 Secretary determines that the tobacco use re20 duction goal under paragraph (1) has not been 

21 achieved, the Secretary shall, not later than 

22 September 10, 2012, and September 10 of each 

23 year thereafter, impose an industry-wide pen24 alty on the manufacturers of cigarettes in an 


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1 amount that is in the aggregate equal to 

2 $3,000,000,000. 

3 (B) PAYMENT.—The industry-wide penalty 

4 imposed under this subsection shall be paid by 

5 each manufacturer based on the brand share 

6 among youth ages 12–17 (as determined by the 

7 survey described in subsection (a)(1)) as such 

8 percentage relates to the total amount to be 

9 paid by all manufacturers. 

10 (C) FINAL DETERMINATION.—The deter11 mination of the Secretary as to the amount and 

12 allocation of a surcharge under this section 

13 shall be final and the manufacturer shall pay 

14 such surcharge within 10 days of the date on 

15 which the manufacturer is assessed. Such pay16 ment shall be retained by the Secretary pending 

17 final judicial review of what, if any, change in 

18 the surcharge is appropriate. 

19 (D) LIMITATION.—With respect to ciga20 rettes, a manufacturer with a market share of 

21 1 percent or less of youth tobacco use shall not 

22 be liable for the payment of a surcharge under 

23 this paragraph. 

24 (E) USE OF AMOUNTS.—Amounts collected 

25 under subparagraph (A) shall be deposited into 


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1 the Prevention and Public Health Fund estab2 lished under section 4002 of the Patient Protec3 tion and Affordable Care Act (42 U.S.C. 300u– 

4 11). Such funds shall remain available for 

5 transfer through September 30th of the fifth 

6 fiscal year following their collection, subject to 

7 the terms and conditions of such section 4002. 

8 (3) PENALTIES NONDEDUCTIBLE.—The pay9 ment of penalties under this section shall not be con10 sidered to be an ordinary and necessary expense in 

11 carrying on a trade or business for purposes of the 

12 Internal Revenue Code of 1986 and shall not be de13 ductible. 

14 (4) JUDICIAL REVIEW.— 

15 (A) AFTER PAYMENT.—A manufacturer of 

16 cigarettes may seek judicial review of any action 

17 under this section only after the assessment in18 volved has been paid by the manufacturer to 

19 the Department of the Treasury and only in the 

20 United States District Court for the District of 

21 Columbia. 

22 (B) REVIEW BY ATTORNEY GENERAL.— 

23 Prior to the filing of an action by a manufac24 turer seeking judicial review of an action under 

25 this section, the manufacturer shall notify the 


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1 Attorney General of such intent to file and the 

2 Attorney General shall have 30 days in which to 

3 respond to the action. 

4 (C) REVIEW.—The amount of any sur5 charge paid under this section shall be subject 

6 to judicial review by the United States Court of 

7 Appeals for the District of Columbia Circuit, 

8 based on the arbitrary and capricious standard 

9 of section 706 of title 5, United States Code. 

10 Notwithstanding any other provision of law, no 

11 court shall have the authority to stay any sur12 charge payment due to the Secretary under this 

13 section pending judicial review until the Sec14 retary has made or failed to make a compliance 

15 determination, as described under this section, 

16 that has adversely affected the person seeking 

17 the review. 

18 (c) ENFORCEMENT.— 

19 (1) INITIAL PENALTY.—There is hereby im20 posed an initial penalty on the failure of any manu21 facturer to make any payment required under this 

22 section not later than a period determined sufficient 

23 by the Secretary after the date on which such pay24 ment is due. 


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1 (2) AMOUNT OF PENALTY.—The amount of the 

2 penalty imposed by paragraph (1) on any failure 

3 with respect to a manufacturer shall be an amount 

4 equal to 2 percent of the penalty owed under sub5 section (b) for each day during the noncompliance 

6 period. 

7 (3) NONCOMPLIANCE PERIOD.—For purposes of 

8 this subsection, the term ‘‘noncompliance period’’ 

9 means, with respect to any failure to make the sur10 charge payment required under this section, the pe11 riod— 

12 (A) beginning on the due date for such 

13 payment; and 

14 (B) ending on the date on which such pay15 ment is paid in fall. 

16 (4) LIMITATIONS.—No penalty shall be imposed 

17 by paragraph (1) on— 

18 (A) any failure to make a surcharge pay19 ment under this section during any period for 

20 which it is established to the satisfaction of the 

21 Secretary that none of the persons responsible 

22 for such failure knew or, exercising reasonable 

23 diligence, would have known, that such failure 

24 existed; or 


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1 (B) any manufacturer that produces less 

2 than 1 percent of cigarettes used by youth in 

3 that year (as determined by the annual survey). 

4 TITLE IV—EXPANDED COV5 ERAGE OF PREVENTIVE 

6 SERVICES 

7 SEC. 401. REQUIRED COVERAGE OF PREVENTIVE SERVICES 

8 UNDER THE MEDICAID PROGRAM. 

9 (a) MANDATORY COVERAGE.—Section 1905 of the 

10 Social Security Act (42 U.S.C. 1396d), as amended by 

11 section 4107(a)(1) of the Patient Protection and Afford12 able Care Act (Public Law 111–148), is amended— 

13 (1) in subsection (a)(4)— 

14 (A) by striking ‘‘and’’ before ‘‘(D)’’; and 

15 (B) by inserting before the semicolon at 

16 the end the following new subparagraph: ‘‘; and 

17 (E) preventive services described in subsection 

18 (ee);’’; and 

19 (2) by adding at the end the following new sub20 section: 

21 ‘‘(ee) PREVENTIVE SERVICES.—For purposes of sub22 section (a)(4)(E), the preventives services described in this 

23 subsection are diagnostic, screening, preventive, and reha24 bilitative services not otherwise described in subsection (a) 

25 or (r) that the Secretary determines are appropriate for 


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1 individuals entitled to medical assistance under this title, 

2 including— 

3 ‘‘(1) evidence-based services that are assigned a 

4 grade of A or B by the United States Preventive 

5 Services Task Force; and 

6 ‘‘(2) with respect to an adult individual, ap7 proved vaccines recommended for routine use by the 

8 Advisory Committee on Immunization Practices of 

9 the Centers for Disease Control and Prevention.’’. 

10 (b) ELIMINATION OF COST-SHARING.— 

11 (1) Subsections (a)(2)(D) and (b)(2)(D) of sec12 tion 1916 of the Social Security Act (42 U.S.C. 

13 1396o) are each amended by inserting ‘‘preventive 

14 services described in section 1905(ee),’’ after ‘‘emer15 gency services (as defined by the Secretary),’’. 

16 (2) Section 1916A(a)(1) of such Act (42 U.S.C. 

17 1396o–1(a)(1)) is amended by inserting ‘‘, preven18 tive services described in section 1905(ee),’’ after 

19 ‘‘subsection (c)’’. 

20 (c) CONFORMING AMENDMENT.—Effective as if in21 cluded in the enactment of the Patient Protection and Af22 fordable Care Act (Public Law 111–148), the provisions 

23 of, and amendments made by, section 4106 of such Act 

24 are repealed. 


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1 (d) INTERVAL PERIOD FOR INCLUSION OF NEW REC2 OMMENDATIONS IN STATE PLANS.—With respect to a rec3 ommendation issued on or after the date of enactment of 

4 this Act by an organization described in subsection (ee) 

5 of section 1905 of the Social Security Act for a preventive 

6 service included under such subsection, the Secretary of 

7 Health and Human Services shall establish a minimum 

8 interval period, which shall be not less than 12 months, 

9 between the date on which the recommendation is issued 

10 and the plan year for which a State plan for medical as11 sistance under title XIX of the Social Security Act shall 

12 be required to include such preventive service. 

13 (e) EFFECTIVE DATE.— 

14 (1) IN GENERAL.—Except as provided in para15 graph (2), the amendments made by subsections (a) 

16 and (b) take effect on the date of enactment of this 

17 Act. 

18 (2) EXTENSION OF EFFECTIVE DATE FOR

19 STATE LAW AMENDMENT.—In the case of a State 

20 plan under title XIX of the Social Security Act (42 

21 U.S.C. 1396 et seq.) which the Secretary of Health 

22 and Human Services determines requires State legis23 lation or State regulation in order for the plan to 

24 meet the additional requirements imposed by the 

25 amendments made by subsections (a) and (b), the 


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1 State plan shall not be regarded as failing to comply 

2 with the requirements of such title solely on the 

3 basis of its failure to meet these additional require4 ments before the first day of the first calendar quar5 ter beginning after the close of the first regular ses6 sion of the State legislature that begins after the 

7 date of enactment of this Act. For purposes of the 

8 previous sentence, in the case of a State that has a 

9 2-year legislative session, each year of the session is 

10 considered to be a separate regular session of the 

11 State legislature. 

12 SEC. 402. COVERAGE FOR COMPREHENSIVE WORKPLACE 

13 WELLNESS PROGRAM AND PREVENTIVE 

14 SERVICES. 

15 Section 8904(a) of title 5, United States Code, is 

16 amended— 

17 (1) in paragraph (1), by adding at the end the 

18 following: 

19 ‘‘(G) Comprehensive workplace wellness 

20 program benefits that meet the requirements of 

21 section 10408 of the Patient Protection and Af22 fordable Care Act (Public Law 111–148). 

23 ‘‘(H) Preventive services benefits deemed 

24 an ‘A’ or ‘B’ service by the United States Pre25 ventive Services Taskforce. 


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1 ‘‘(I) Immunizations that have in effect a 

2 recommendation from the Advisory Committee 

3 on Immunization Practices of the Centers for 

4 Disease Control and Prevention with respect to 

5 the individuals involved. 

6 ‘‘(J) With respect to infants, children, and 

7 adolescents, evidence-informed preventive care 

8 and screenings provided for in the comprehen9 sive guidelines supported by the Health Re10 sources and Services Administration of the De11 partment of Health and Human Services.’’; and 

12 (2) in paragraph (2), by adding at the end the 

13 following: 

14 ‘‘(G) Comprehensive workplace wellness 

15 program benefits that meet the requirements of 

16 section 10408 of the Patient Protection and Af17 fordable Care Act (Public Law 111–148). 

18 ‘‘(H) Preventive services benefits deemed 

19 an ‘A’ or ‘B’ service by the United States Pre20 ventive Services Taskforce. 

21 ‘‘(I) Immunizations that have in effect a 

22 recommendation from the Advisory Committee 

23 on Immunization Practices of the Centers for 

24 Disease Control and Prevention with respect to 

25 the individuals involved. 


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1 ‘‘(J) With respect to infants, children, and 

2 adolescents, evidence-informed preventive care 

3 and screenings provided for in the comprehen4 sive guidelines supported by the Health Re5 sources and Services Administration of the De6 partment of Health and Human Services.’’. 

7 SEC. 403. HEALTH PROFESSIONAL EDUCATION AND TRAIN8 ING IN HEALTHY EATING. 

9 Part Q of title III of the Public Health Service Act 

10 (42 U.S.C. 280h et seq.) is amended by striking section 

11 399Z and inserting the following: 

12 ‘‘SEC. 399Z. HEALTH PROFESSIONAL EDUCATION AND 

13 TRAINING IN HEALTHY EATING. 

14 ‘‘(a) IN GENERAL.—The Secretary, acting through 

15 the Director of the Centers for Disease Control and Pre16 vention, in collaboration with the Administrator of the 

17 Health Resources and Services Administration and the 

18 heads of other agencies, and in consultation with appro19 priate health professional associations, shall develop and 

20 carry out a program to educate and train health profes21 sionals in effective strategies to— 

22 ‘‘(1) better identify patients at-risk of becoming 

23 overweight or obese or developing an eating disorder; 

24 ‘‘(2) detect overweight or obesity or eating dis25 orders among a diverse patient population; 


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1 ‘‘(3) counsel, refer, or treat patients with over2 weight or obesity or an eating disorder; 

3 ‘‘(4) educate patients and the families of pa4 tients about effective strategies to establish healthy 

5 eating habits and appropriate levels of physical ac6 tivity; and 

7 ‘‘(5) assist in the creation and administration of 

8 community-based overweight and obesity and eating 

9 disorder prevention efforts. 

10 ‘‘(b) EATING DISORDER.—In this section, the term 

11 ‘eating disorder’ includes anorexia nervosa, bulimia 

12 nervosa, binge eating disorder, and eating disorders not 

13 otherwise specified, as defined in the fourth edition of the 

14 Diagnostic and Statistical Manual of Mental Disorders or 

15 any subsequent edition. 

16 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

17 are authorized to be appropriated to carry out this section 

18 such sums as may be necessary for each of the fiscal years 

19 2012 through 2016.’’. 

20 TITLE V—RESEARCH 

21 SEC. 501. GRANTS FOR BODY MASS INDEX DATA ANALYSIS. 

22 (a) ESTABLISHMENT.—The Secretary of Health and 

23 Human Services may make grants to not more than 20 

24 eligible entities to analyze body mass index (hereinafter 


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1 in this section referred to as ‘‘BMI’’) measurements of 

2 children, ages 2 through 18. 

3 (b) ELIGIBILITY.—An eligible entity for purposes of 

4 this section is a State (including the District of Columbia, 

5 the Commonwealth of Puerto Rico, and each territory of 

6 the United States) that has a statewide immunization in7 formation system that— 

8 (1) has the capacity to store basic demographic 

9 information (including date of birth, gender, and ge10 ographic area of residence), height, weight, and im11 munization data for each resident of the State; 

12 (2) is accessible to doctors, nurses, other li13 censed medical professionals, and officials of the rel14 evant department in the State charged with main15 taining health and immunization records; and 

16 (3) has the capacity to integrate large amounts 

17 of data for the analysis of BMI measurements. 

18 (c) USE OF FUNDS.—A State that receives a grant 

19 under this section shall use the grant for the following 

20 purposes: 

21 (1) Analyzing the effectiveness of obesity pre22 vention programs and wellness policies carried out in 

23 the State. 


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1 (2) Purchasing new computers, computer equip2 ment, and software to upgrade computers to be used 

3 for a statewide immunization information system. 

4 (3) The hiring and employment of personnel to 

5 maintain and analyze BMI data. 

6 (4) The development and implementation of 

7 training programs for medical professionals to aid 

8 such professionals in taking BMI measurements and 

9 discussing such measurements with patients. 

10 (5) Providing information to parents and legal 

11 guardians in accordance with subsection (e)(2). 

12 (d) SELECTION CRITERIA.—In selecting recipients of 

13 grants under this section, the Secretary shall give priority 

14 to States in which a high percentage of public and private 

15 health care providers submit data to a statewide immuni16 zation information system that— 

17 (1) contains immunization data for not less 

18 than 20 percent of the population of such State that 

19 is under the age of 18; and 

20 (2) includes data collected from men and 

21 women who are of a wide variety of ages and who 

22 reside in a wide variety of geographic areas in a 

23 State (as determined by the Secretary). 

24 (e) CONDITIONS.—As a condition of receiving a grant 

25 under this section, a State shall— 


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1 (1) ensure that BMI measurements will be re2 corded for children ages 2 through 18— 

3 (A) on an annual basis by a licensed physi4 cian, nurse, nurse practitioner, or physicians as5 sistant during an annual physical examination, 

6 wellness visit, or similar visit with a physician; 

7 and 

8 (B) in accordance with data collection pro9 tocols published by the American Academy of 

10 Pediatrics in the 2007 Expert Committee Rec11 ommendations; and 

12 (2) for each child in the State for whom such 

13 measurements indicate a BMI greater than the 95th 

14 percentile for such child’s age and gender, provide to 

15 the parents or legal guardians of such child informa16 tion on how to lower BMI and information on State 

17 and local obesity prevention programs. 

18 (f) REPORTS.— 

19 (1) REPORTS TO THE SECRETARY.—Not later 

20 than 5 years after the receipt of a grant under this 

21 section, the State receiving such grant shall submit 

22 to the Secretary the following reports: 

23 (A) A report containing an analysis of 

24 BMI data collected using the grant, including— 


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1 (i) the differences in obesity trends by 

2 gender, disability, geographic area (as de3 termined by the State), and socioeconomic 

4 status within such State; and 

5 (ii) the demographic groups and geo6 graphic areas most affected by obesity 

7 within such State. 

8 (B) A report containing an analysis of the 

9 effectiveness of obesity prevention programs 

10 and State wellness policies, including— 

11 (i) an analysis of the success of such 

12 programs and policies prior to the receipt 

13 of the grant; and 

14 (ii) a discussion of the means to de15 termine the most effective strategies to 

16 combat obesity in the geographic areas 

17 identified under subparagraph (A). 

18 (2) REPORT TO CONGRESS AND CERTAIN EXEC19 UTIVE AGENCIES.—Not later than 1 year after the 

20 Secretary receives all the reports required pursuant 

21 to paragraph (1), the Secretary shall submit to the 

22 Secretary of Education, the Secretary of Agriculture, 

23 and to Congress a report that contains the following: 

24 (A) An analysis of trends in childhood obe25 sity, including how such trends vary across reVerDate Mar 15 2010 04:10 Feb 01, 2011 Jkt 099200 PO 00000 Frm 00092 Fmt 6652 Sfmt 6201 E:\BILLS\S174.IS S174

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1 gions of the United States, and how such 

2 trends vary by gender and socioeconomic status. 

3 (B) A description of any programs that— 

4 (i) the Secretary has determined sig5 nificantly lower childhood obesity rates for 

6 certain geographic areas in the United 

7 States, including urban, rural, and subur8 ban areas; and 

9 (ii) the Secretary recommends to be 

10 implemented by the States (including 

11 States that did not receive a grant under 

12 this section). 

13 (g) AUTHORIZATION OF APPROPRIATIONS.—There is 

14 authorized to be appropriated to the Secretary such sums 

15 as may be necessary to carry out this section for each of 

16 fiscal years 2012 through 2016. 

17 SEC. 502. NATIONAL ASSESSMENT OF MENTAL HEALTH 

18 NEEDS. 

19 Title V of the Public Health Service Act (42 U.S.C. 

20 290aa et seq.) is amended by inserting after section 506B 

21 (42 U.S.C. 290aa–5b) the following: 

22 ‘‘SEC. 506C. NATIONAL ASSESSMENT OF MENTAL HEALTH 

23 NEEDS. 

24 ‘‘(a) IN GENERAL.—The Secretary, acting through 

25 the Administrator, and in consultation with the Centers 


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1 for Disease Control and Prevention and the Director of 

2 the National Institutes of Health, shall establish and im3 plement public health monitoring measures to address the 

4 mental and behavioral health status of the population of 

5 the United States and other populations served by the Ad6 ministration, that include— 

7 ‘‘(1) monitoring the mental health status of the 

8 population, including the incidence and prevalence of 

9 mental and behavioral health conditions across the 

10 lifespan; 

11 ‘‘(2) monitoring access to appropriate diag12 nostic and treatment services for mental and behav13 ioral health conditions, including trends in unmet 

14 need for services; 

15 ‘‘(3) monitoring mental and behavioral health 

16 conditions as risk factors for obesity and chronic dis17 eases to the extent practicable; 

18 ‘‘(4) enhancing existing public health moni19 toring systems by including measures assessing men20 tal and behavioral health status and associated risk 

21 factors; and 

22 ‘‘(5) to the extent practicable, monitoring the 

23 immediate and long-term impact of disasters or cat24 astrophic events, whether natural or man-made on 


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1 the mental and behavioral health of affected popu2 lations. 

3 ‘‘(b) DISTINGUISHING AMONG AGE GROUPS.—In de4 signing and implementing the measures described in sub5 section (a) the Secretary shall ensure that data collection 

6 and reporting standards stratify data by age groups, in 

7 particular, to the extent practicable, children under the 

8 age of 5 years. 

9 ‘‘(c) REPORT.—Not later than 1 year after the date 

10 of enactment of this section, the Secretary shall submit 

11 a report to Congress that describes the progress on the 

12 implementation of the monitoring measures described in 

13 subsection (a). 

14 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

15 is authorized to be appropriated to carry out this section 

16 such sums as may be necessary to carry out this section 

17 for each of fiscal years 2012 through 2016.’’. 

Æ 


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