I 

111TH CONGRESS 

1ST SESSION H. R. 3158 

To reform health care delivery by providing incentives for place-based health 

care, which seeks to bring health services to the patient by locating 

community health centers, federally qualified health centers, and community integrated health centers in or near settings that already serve 

a particular target population, such as schools, workplaces, and senior 

services facilities. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 9, 2009 

Mr. SARBANES introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on 

Ways and Means and Education and Labor, for a period to be subsequently determined by the Speaker, in each case for consideration of such 

provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To reform health care delivery by providing incentives for 

place-based health care, which seeks to bring health services to the patient by locating community health centers, 

federally qualified health centers, and community integrated health centers in or near settings that already 

serve a particular target population, such as schools, 

workplaces, and senior services facilities. 

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


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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

3 ‘‘Place Based Health Care Act of 2009’’. 

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

5 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—COMMUNITY INTEGRATED HEALTH CENTERS 

Sec. 101. Definitions. 

Sec. 102. Funding benefits. 

TITLE II—SCHOOL-BASED HEALTH CENTERS 

Sec. 201. Assurance of payment under Medicaid and CHIP for covered items 

and services furnished by certain school-based health clinics. 

TITLE III—TAX CREDIT FOR EMPLOYER-PROVIDED HEALTH AND 

WELLNESS BENEFITS 

Sec. 301. Credit for employer-provided health and wellness benefits. 

TITLE IV—EVIDENCE-BASED DISEASE PREVENTION AND 

HEALTH PROMOTION PROGRAM; SENIOR HOUSING FACILITY 

PLAN OPTION 

Sec. 301. Evidence-based disease prevention and health promotion grant program. 

Sec. 302. Offering Medicare Advantage plan in a senior housing facility. 

TITLE V—COMMUNITY HEALTH CENTER EXPANSION OF 

PRIORITIES 

Sec. 401. Community health center expansion. 

6 TITLE I—COMMUNITY 

7 INTEGRATED HEALTH CENTERS 

8 SEC. 101. DEFINITIONS. 

9 In this Act: 

10 (1) COMMUNITY INTEGRATED HEALTH CEN11 TER.—The term ‘‘Community Integrated Health 

12 Center’’ means an organization that— 


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1 (A) seeks to fully integrate its services into 

2 the community by locating in or near settings 

3 that serve particular target populations, such as 

4 schools, workplaces, or senior service facilities; 

5 (B) is owned or controlled by, or comprised 

6 of, two or more institutional providers or 

7 groups of health care professionals that are eli8 gible for participation in part A or part B of 

9 Medicare; 

10 (C) is organized for the purpose of pro11 viding health care, improving the quality of 

12 health care, and reducing costs associated with 

13 the provision of health care provided to Center 

14 patients; 

15 (D) participates in Medicare and Medicaid; 

16 (E) requires all of its participating pro17 viders to participate in Medicare and Medicaid; 

18 (F) is not excluded or precluded from par19 ticipation in any Federal or State health care 

20 program; 

21 (G) is organized to receive payment from 

22 government and private health plans in a man23 ner that promotes cost reductions, including— 

24 (i) accepting global or bundled pay25 ments; and 


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1 (ii) accepting fixed-fee or capitated 

2 payments; 

3 (H) accepts all patients enrolled in Medi4 care and Medicaid; 

5 (I) does not discriminate on the basis of 

6 any prohibited criteria; 

7 (J) does not discriminate with respect to 

8 the provision of care to patients of the Center 

9 on the basis of the patient’s insurance status or 

10 ability to pay; 

11 (K) maintains an affiliation with an acute 

12 care hospital; 

13 (L) maintains an affiliation with health 

14 care providers as necessary to meet the needs 

15 of its enrollees; 

16 (M) maintains a qualified workforce; 

17 (N) has a qualified medical director; 

18 (O) coordinates inpatient and outpatient 

19 care for its enrollees, including coordination of 

20 wellness and prevention services and care for 

21 chronic disease; 

22 (P) offers wellness, prevention, and health23 promotion services; 


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1 (Q) develops, and requires its participating 

2 providers to follow, guidelines, protocols, evi3 dence-based medicine, and clinical pathways; 

4 (R) utilizes electronic medical records by 

5 the deadline set forth in the amendments made 

6 by the American Recovery and Reinvestment 

7 Act of 2009; 

8 (S) requires its participating providers to 

9 utilize electronic medical records by such dead10 lines; and 

11 (T) qualifies as an ‘‘organized health care 

12 arrangement’’ pursuant parts 160, 162, and 

13 164 of title 45, Code of Federal Regulations. 

14 (2) MEDICARE; MEDICAID.—The terms ‘‘Medi15 care’’ and ‘‘Medicaid’’ mean the programs under ti16 tles XVIII and XIX, respectively, of the Social Secu17 rity Act. 

18 (3) SECRETARY.—The term ‘‘Secretary’’ means 

19 the Secretary of Health and Human Services. 

20 SEC. 102. FUNDING BENEFITS. 

21 (a) LISTING.—A facility may obtain the benefits of 

22 this section by becoming listed as a Community Integrated 

23 Health Center by the Secretary. The Secretary shall list 

24 such a facility that— 


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1 (1) certifies to the Secretary that it meets the 

2 requirements for a Community Integrated Health 

3 Center under section 101(1); and 

4 (2) every three years demonstrates to the satis5 faction of the Secretary that the facility continues to 

6 meet such requirements. 

7 (b) COMMUNITY INTEGRATED HEALTH CENTER AS8 SISTANCE.— 

9 (1) ELIGIBLE COMMUNITY INTEGRATED

10 HEALTH CENTER DEFINED.—In this subsection, the 

11 term ‘‘Eligible Community Integrated Health Cen12 ter’’ means an Community Integrated Health Center 

13 that has been listed under subsection (a). 

14 (2) GRANT PROGRAM.— 

15 (A) IN GENERAL.—The Secretary shall use 

16 such sums as may be necessary to carry out a 

17 program of grants to assist Eligible Community 

18 Integrated Health Centers with start-up and 

19 operating costs. 

20 (B) ADMINISTRATION.—The Secretary 

21 shall make grants to Eligible Community Inte22 grated Health Centers under this subsection on 

23 a competitive basis, to such Centers that dem24 onstrate to the satisfaction of the Secretary 

25 that the Center will— 


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1 (i) use the funds to— 

2 (I) promote the integration of 

3 health care providers; 

4 (II) promote coordination of pa5 tient care; 

6 (III) provide greater access to 

7 health care by patients within the 

8 Center’s geographic service area; 

9 (IV) locate services in or near a 

10 setting that serves their target popu11 lation, such as schools, workplaces, or 

12 senior services facilities; 

13 (V) reduce the cost of providing 

14 care; and 

15 (VI) improve the quality of care 

16 provided to patients within the Cen17 ter’s geographic service area; and 

18 (ii) not later than 12 months after the 

19 date on which the Secretary provides as20 sistance to the Center, submit to the Sec21 retary a report that describes— 

22 (I) the manner in which the as23 sistance was spent; 


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1 (II) the manner in which the fac2 tors outlined in clause (i) have been 

3 monitored; and 

4 (III) any measurable change in 

5 the factors outlined in such clause as 

6 a result of the Center’s receipt of as7 sistance. 

8 (C) TIMING.—Not later than 180 days 

9 after the date of enactment of this Act, the Sec10 retary shall make grants to provide assistance 

11 under this subsection. 

12 (3) REPORT TO CONGRESS.—Not later than 18 

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

14 Secretary shall submit to the appropriate committees 

15 of Congress a report that— 

16 (A) describes in detail the manner in which 

17 this grant program has been carried out; and 

18 (B) includes the information reported to 

19 the Secretary under paragraph (2)(B)(ii). 


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1 TITLE II—SCHOOL-BASED 

2 HEALTH CENTERS 

3 SEC. 201. ASSURANCE OF PAYMENT UNDER MEDICAID AND 

4 CHIP FOR COVERED ITEMS AND SERVICES 

5 FURNISHED BY CERTAIN SCHOOL-BASED 

6 HEALTH CLINICS. 

7 (a) STATE PLAN REQUIREMENT.—Section 1902(a) 

8 of the Social Security Act (42 U.S.C. 1396a(a)), as 

9 amended by section 5006(e)(2)(A) of division B of the 

10 American Recovery and Reinvestment Act of 2009 (Public 

11 Law 111–5), is amended— 

12 (1) in paragraph (72), by striking ‘‘and’’ at the 

13 end; 

14 (2) in paragraph (73)(B), by striking the period 

15 at the end and inserting ‘‘; and’’; and 

16 (3) by inserting after paragraph (73), the fol17 lowing new paragraph: 

18 ‘‘(74) provide that the State shall certify to the 

19 Secretary that the State has implemented proce20 dures to pay for medical assistance (including care 

21 and services described in subsections (a)(4)(B) and 

22 (r) of section 1905 and provided in accordance with 

23 section 1902(a)(43)) furnished in a school-based 

24 health clinic, if payment would be made under the 

25 State plan for the same items and services if furVerDate Nov 24 2008 03:13 Jul 13, 2009 Jkt 079200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3158.IH H3158

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1 nished in a physician’s office or other outpatient 

2 clinic (including if such payment would be included 

3 in the determination of a prepaid capitation or other 

4 risk-based rate of payment to an entity under a con5 tract pursuant to section 1903(m)).’’. 

6 (b) SCHOOL-BASED HEALTH CLINIC DEFINED.— 

7 Section 1905 of such Act (42 U.S.C. 1396d) is amended 

8 by adding at the end the following new subsection: 

9 ‘‘(y)(1) The term ‘school-based health clinic’ means 

10 a health clinic that— 

11 ‘‘(A) is located in or near a school facility of a 

12 school district or board or of an Indian tribe or trib13 al organization; 

14 ‘‘(B) is organized through school, community, 

15 and health provider relationships; 

16 ‘‘(C) is administered by a sponsoring facility; 

17 ‘‘(D) provides through health professionals pri18 mary health services to children in accordance with 

19 State and local law, including laws relating to licen20 sure and certification; and 

21 ‘‘(E) satisfies such other requirements as a 

22 State may establish for the operation of such a clin23 ic. 

24 ‘‘(2) For purposes of paragraph (1)(D), the term ‘pri25 mary health services’ means the core services offered by 


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1 a school-based health clinic, which shall include the fol2 lowing: 

3 ‘‘(A) Comprehensive health assessments, diag4 nosis, and treatment of minor, acute, and chronic 

5 medical conditions and referrals to, and follow-up 

6 for, specialty care. 

7 ‘‘(B) Mental health assessments, crisis interven8 tion, counseling, treatment, and referral to a con9 tinuum of services including emergency psychiatric 

10 care, community support programs, inpatient care, 

11 and outpatient programs. 

12 ‘‘(C) Additional services, which may include 

13 oral health, social, and health education services. 

14 ‘‘(3) For purposes of paragraph (1)(C), the term 

15 ‘sponsoring facility’ is a community-based organization, 

16 which may include— 

17 ‘‘(A) a hospital; 

18 ‘‘(B) a public health department; 

19 ‘‘(C) a community health center; 

20 ‘‘(D) a nonprofit health care agency; 

21 ‘‘(E) a school or school system; or 

22 ‘‘(F) a program administered by the Indian 

23 Health Service or the Bureau of Indian Affairs or 

24 operated by an Indian tribe or a tribal organization 

25 under the Indian Self-Determination and Education 


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1 Assistance Act (25 U.S.C. 450), a Native Hawaiian 

2 entity, or an Urban Indian program under title V of 

3 the Indian Health Care Improvement Act (25 U.S.C. 

4 1601).’’. 

5 (c) APPLICATION TO CHIP.—Section 2107(e)(1) of 

6 the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 

7 amended— 

8 (1) by redesignating subparagraphs (B) 

9 through (D) as subparagraphs (C) through (E), re10 spectively; and 

11 (2) by inserting after subparagraph (A), the fol12 lowing new subparagraph: 

13 ‘‘(B) Section 1902(a)(74) (relating to pro14 cedures to ensure payment for covered services 

15 furnished in a school-based health clinic, as de16 fined in section 1905(y)).’’. 

17 (d) RULE OF CONSTRUCTION.—Nothing in this sec18 tion or the amendments made by this section shall be con19 strued to preempt or supersede State or local law with 

20 respect to whether a school-based health clinic provides 

21 family planning services and supplies. 

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

23 this section take effect on October 1, 2009. 


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1 TITLE III—TAX CREDIT FOR EM2 PLOYER-PROVIDED HEALTH 

3 AND WELLNESS BENEFITS 

4 SEC. 301. CREDIT FOR EMPLOYER-PROVIDED HEALTH AND 

5 WELLNESS BENEFITS. 

6 (a) IN GENERAL.—Subpart D of part IV of sub7 chapter A of chapter 1 of the Internal Revenue Code of 

8 1986 (relating to business-related credits) is amended by 

9 adding at the end the following new section: 

10 ‘‘SEC. 45R. CREDIT FOR EMPLOYER-PROVIDED HEALTH 

11 AND WELLNESS BENEFITS. 

12 ‘‘(a) IN GENERAL.—For purposes of section 38, the 

13 employer-provided health and wellness benefits credit de14 termined under this section for the taxable year is an 

15 amount equal to 25 percent of the qualified health and 

16 wellness expenditures of the taxpayer for such taxable 

17 year. 

18 ‘‘(b) DOLLAR LIMITATION.—The credit allowable 

19 under subsection (a) for any taxable year shall not exceed 

20 $150,000. 

21 ‘‘(c) DEFINITIONS.—For purposes of this section— 

22 ‘‘(1) QUALIFIED HEALTH AND WELLNESS EX23 PENDITURE.— 


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

2 health and wellness expenditure’ means any 

3 amount paid or incurred— 

4 ‘‘(i) to acquire, construct, rehabilitate, 

5 or expand property— 

6 ‘‘(I) which is to be used as part 

7 of a qualified health and wellness fa8 cility of the taxpayer, and 

9 ‘‘(II) with respect to which a de10 duction for depreciation (or amortiza11 tion in lieu of depreciation) is allow12 able, 

13 ‘‘(ii) for the operating costs of a quali14 fied health and wellness facility of the tax15 payer, or 

16 ‘‘(iii) under a contract with a qualified 

17 health and wellness facility to provide 

18 health and wellness services to employees 

19 of the taxpayer. 

20 ‘‘(B) FAIR MARKET VALUE.—The term 

21 ‘qualified health and wellness expenditures’ 

22 shall not include expenses in excess of the fair 

23 market value of such care. 

24 ‘‘(2) QUALIFIED HEALTH AND WELLNESS FA25 CILITY.— 


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

2 health and wellness facility’ means a facility— 

3 ‘‘(i) the principal use of which is to 

4 provide medical care (including preventive 

5 care), and 

6 ‘‘(ii) which meets the requirements of 

7 all applicable laws and regulations of the 

8 State or local government in which it is lo9 cated. 

10 ‘‘(B) SPECIAL RULES WITH RESPECT TO A

11 TAXPAYER.—A facility shall not be treated as a 

12 qualified health and wellness facility with re13 spect to a taxpayer unless— 

14 ‘‘(i) enrollment in the facility is open 

15 to employees of the taxpayer during the 

16 taxable year, and 

17 ‘‘(ii) the use of such facility (or the 

18 eligibility to use such facility) does not dis19 criminate in favor of employees of the tax20 payer who are highly compensated employ21 ees (within the meaning of section 414(q)). 

22 ‘‘(d) RECAPTURE OF ACQUISITION AND CONSTRUC23 TION CREDIT.— 

24 ‘‘(1) IN GENERAL.—If, as of the close of any 

25 taxable year, there is a recapture event with respect 


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1 to any qualified health and wellness facility of the 

2 taxpayer, then the tax of the taxpayer under this 

3 chapter for such taxable year shall be increased by 

4 an amount equal to the product of— 

5 ‘‘(A) the applicable recapture percentage, 

6 and 

7 ‘‘(B) the aggregate decrease in the credits 

8 allowed under section 38 for all prior taxable 

9 years which would have resulted if the qualified 

10 health and wellness expenditures of the tax11 payer described in subsection (c)(1)(A) with re12 spect to such facility had been zero. 

13 ‘‘(2) APPLICABLE RECAPTURE PERCENTAGE.— 

14 ‘‘(A) IN GENERAL.—For purposes of this 

15 subsection, the applicable recapture percentage 

16 shall be determined from the following table: 

‘‘If the recapture event occurs in: The applicable recapture 

percentage is: 

Years 1–3 ..................................................................................... 100 

Year 4 .......................................................................................... 85 

Year 5 .......................................................................................... 70 

Year 6 .......................................................................................... 55 

Year 7 .......................................................................................... 40 

Year 8 .......................................................................................... 25 

Years 9 and 10 ............................................................................ 10 

Years 11 and thereafter ............................................................... 0. 

17 ‘‘(B) YEARS.—For purposes of subpara18 graph (A), year 1 shall begin on the first day 

19 of the taxable year in which the qualified health 


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1 and wellness facility is placed in service by the 

2 taxpayer. 

3 ‘‘(3) RECAPTURE EVENT DEFINED.—For pur4 poses of this subsection, the term ‘recapture event’ 

5 means— 

6 ‘‘(A) CESSATION OF OPERATION.—The 

7 cessation of the operation of the facility as a 

8 qualified health and wellness facility. 

9 ‘‘(B) CHANGE IN OWNERSHIP.— 

10 ‘‘(i) IN GENERAL.—Except as pro11 vided in clause (ii), the disposition of a 

12 taxpayer’s interest in a qualified health 

13 and wellness facility with respect to which 

14 the credit described in subsection (a) was 

15 allowable. 

16 ‘‘(ii) AGREEMENT TO ASSUME RECAP17 TURE LIABILITY.—Clause (i) shall not 

18 apply if the person acquiring such interest 

19 in the facility agrees in writing to assume 

20 the recapture liability of the person dis21 posing of such interest in effect imme22 diately before such disposition. In the 

23 event of such an assumption, the person 

24 acquiring the interest in the facility shall 

25 be treated as the taxpayer for purposes of 


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1 assessing any recapture liability (computed 

2 as if there had been no change in owner3 ship). 

4 ‘‘(4) SPECIAL RULES.— 

5 ‘‘(A) TAX BENEFIT RULE.—The tax for 

6 the taxable year shall be increased under para7 graph (1) only with respect to credits allowed 

8 by reason of this section which were used to re9 duce tax liability. In the case of credits not so 

10 used to reduce tax liability, the carryforwards 

11 and carrybacks under section 39 shall be appro12 priately adjusted. 

13 ‘‘(B) NO CREDITS AGAINST TAX.—Any in14 crease in tax under this subsection shall not be 

15 treated as a tax imposed by this chapter for 

16 purposes of determining the amount of any 

17 credit under this chapter or for purposes of sec18 tion 55. 

19 ‘‘(C) NO RECAPTURE BY REASON OF CAS20 UALTY LOSS.—The increase in tax under this 

21 subsection shall not apply to a cessation of op22 eration of the facility as a qualified child care 

23 facility by reason of a casualty loss to the ex24 tent such loss is restored by reconstruction or 


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1 replacement within a reasonable period estab2 lished by the Secretary. 

3 ‘‘(e) SPECIAL RULES.—For purposes of this sec4 tion— 

5 ‘‘(1) AGGREGATION RULES.—All persons which 

6 are treated as a single employer under subsections 

7 (a) and (b) of section 52 shall be treated as a single 

8 taxpayer. 

9 ‘‘(2) PASS-THRU IN THE CASE OF ESTATES AND

10 TRUSTS.—Under regulations prescribed by the Sec11 retary, rules similar to the rules of subsection (d) of 

12 section 52 shall apply. 

13 ‘‘(3) ALLOCATION IN THE CASE OF PARTNER14 SHIPS.—In the case of partnerships, the credit shall 

15 be allocated among partners under regulations pre16 scribed by the Secretary. 

17 ‘‘(f) NO DOUBLE BENEFIT.— 

18 ‘‘(1) REDUCTION IN BASIS.—For purposes of 

19 this subtitle— 

20 ‘‘(A) IN GENERAL.—If a credit is deter21 mined under this section with respect to any 

22 property by reason of expenditures described in 

23 subsection (c)(1)(A), the basis of such property 

24 shall be reduced by the amount of the credit so 

25 determined. 


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1 ‘‘(B) CERTAIN DISPOSITIONS.—If, during 

2 any taxable year, there is a recapture amount 

3 determined with respect to any property the 

4 basis of which was reduced under subparagraph 

5 (A), the basis of such property (immediately be6 fore the event resulting in such recapture) shall 

7 be increased by an amount equal to such recap8 ture amount. For purposes of the preceding 

9 sentence, the term ‘recapture amount’ means 

10 any increase in tax (or adjustment in 

11 carrybacks or carryovers) determined under 

12 subsection (d). 

13 ‘‘(2) OTHER DEDUCTIONS AND CREDITS.—No 

14 deduction or credit shall be allowed under any other 

15 provision of this chapter with respect to the amount 

16 of the credit determined under this section.’’. 

17 (b) CREDIT TO BE PART OF GENERAL BUSINESS

18 CREDIT.—Subsection (b) of section 38 of such Code (re19 lating to general business credit) is amended by striking 

20 ‘‘plus’’ at the end of paragraph (34), by striking the period 

21 at the end of paragraph (35) and inserting ‘‘, plus’’ , and 

22 by adding at the end the following new paragraph: 

23 ‘‘(36) the employer-provided health and 

24 wellness benefits credit determined under section 

25 45R(a).’’. 


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1 (c) CLERICAL AMENDMENT.—The table of sections 

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

3 of such Code is amended by inserting after the item relat4 ing to section 45Q the following new item: 

‘‘Sec. 45R. Credit for employer-provided health and wellness benefits.’’. 

5 (d) EFFECTIVE DATE.—The amendments made by 

6 this section shall apply to taxable years beginning after 

7 the date of the enactment of this Act. 

8 TITLE IV—EVIDENCE-BASED DIS9 EASE PREVENTION AND 

10 HEALTH PROMOTION PRO11 GRAM; SENIOR HOUSING FA12 CILITY PLAN OPTION 

13 SEC. 301. EVIDENCE-BASED DISEASE PREVENTION AND 

14 HEALTH PROMOTION GRANT PROGRAM. 

15 Part D of title III of the Older Americans Act of 

16 1965 (42 U.S.C. 3030m et seq.) is amended— 

17 (1) by inserting the following before section 

18 361: 

19 ‘‘Subpart 1—Services’’; and 

20 (2) by adding at the end the following: 


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1 ‘‘Subpart 2—Evidence-based Disease Prevention and 

2 Health Promotion Program 

3 ‘‘SEC. 365. EVIDENCE-BASED DISEASE PREVENTION AND 

4 HEALTH PROMOTION GRANTS PROGRAM. 

5 ‘‘(a) GRANT PROGRAM.—From a portion of the funds 

6 allotted to carry out this part, the Assistant Secretary 

7 shall establish an evidence-based disease prevention and 

8 health promotion program to make grants to States to 

9 carry out— 

10 ‘‘(1) evidence-based disease prevention pro11 grams; 

12 ‘‘(2) evidence-based chronic disease manage13 ment programs; 

14 ‘‘(3) evidence-based chronic disease self-man15 agement programs; 

16 ‘‘(4) evidence-based health services and health 

17 promotion services and supports; 

18 ‘‘(5) a disease self-management program such 

19 as the Stanford University Chronic Disease Self20 Management Program (CDSMP). 

21 ‘‘(b) APPLICATION FOR GRANT.—To request a grant 

22 under subsection (a), a State shall, after consulting and 

23 coordinating with area agencies on aging in the State in24 volved, submit an application to the Secretary at such 

25 time, in such manner, and containing the following infor26 mation: 


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1 ‘‘(1) A description of the evidence-based disease 

2 prevention and health promotion programs the State 

3 agency proposes to carry out with such grant. 

4 ‘‘(2) Sufficient information to demonstrate that 

5 the infrastructure exists to support the proposed 

6 programs. 

7 ‘‘(3) Such other information as the Secretary 

8 determines appropriate. 

9 ‘‘(c) SUBGRANTS.— 

10 ‘‘(1) GRANTS TO AREA AGENCIES ON AGING.— 

11 With funds received under subsection (b), the State 

12 agency shall make grants to area agencies on aging 

13 that demonstrate performance capacity to carry out 

14 programs and activities described in subsection (a), 

15 to carry out evidence-based disease prevention and 

16 health promotion programs under this section either 

17 directly or through contracts with— 

18 ‘‘(A) organizations that are providers of di19 rect services to older individuals and that re20 ceive funding under this Act; or 

21 ‘‘(B) Federally Qualified Health Centers or 

22 Community Health Centers (as such terms are 

23 used in relation to section 330 of the Public 

24 Health Service Act) or Community Integrated 


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1 Health Centers (as defined in section 101 of 

2 the Place Based Health Care Act of 2009). 

3 ‘‘(2) DIRECT GRANTS TO OTHER ENTITIES.—If 

4 an area agency on aging does not receive a grant 

5 under paragraph (1), the State agency may make a 

6 subgrant to carry out evidence-based disease preven7 tion and health promotion programs under this sec8 tion in the planning and service area of such agency, 

9 to— 

10 ‘‘(A) organizations that are providers of di11 rect services to older individuals and that re12 ceive funding under this Act; or 

13 ‘‘(B) Federally Qualified Health Centers or 

14 Community Health Centers (as such terms are 

15 used in relation to section 330 of the Public 

16 Health Service Act) or Community Integrated 

17 Health Centers (as defined in section 101 of 

18 the Place Based Health Care Act of 2009). 

19 that demonstrate performance capacity to carry out 

20 the programs and activities described in subsection 

21 (a). 

22 ‘‘(d) USES OF FUNDS.—A grant or subgrant received 

23 under this section may be used to carry out— 

24 ‘‘(1) an evidence-based chronic disease manage25 ment program; 


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1 ‘‘(2) an evidence-based chronic disease self2 management program; or 

3 ‘‘(3) an evidence-based disease prevention and 

4 health promotion program. 

5 ‘‘(e) DEFINITION.—In this section, the term ‘health 

6 services and health promotion services and supports’ 

7 means any service, any onsite primary care service, any 

8 in-home service, a case management service, or any evi9 dence-based intervention that is— 

10 ‘‘(1) furnished in settings that serve the popu11 lation of older individuals such as— 

12 ‘‘(A) a private home or residence; 

13 ‘‘(B) a community based organization (as 

14 defined in section 1901 of the Elementary and 

15 Secondary Education Act of 1965 (20 U.S.C. 

16 7801)); 

17 ‘‘(C) a Community Integrated Health Cen18 ter (as defined in section 101(1) of the Place 

19 Based Health Care Act of 2009); 

20 ‘‘(D) a faith-based organization; 

21 ‘‘(E) a community-care setting (including a 

22 small community care setting as defined in sub23 section (g)(1), and a large community care set24 ting as defined in subsection (h)(1), of section 


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1 1929 of the Social Security Act (42 U.S.C. 

2 1396t)); 

3 ‘‘(F) a board and care facility; 

4 ‘‘(G) a long-term care facility; 

5 ‘‘(H) a multi-purpose senior center; or 

6 ‘‘(I) a community center (as defined in sec7 tion 670G of the State Dependent Care Devel8 opment Grants Act (42 U.S.C. 9877)); 

9 ‘‘(2) furnished to diagnose, treat, or cure a 

10 medical disease or condition; and 

11 ‘‘(3) intended to assist older individuals with 

12 carrying out activities of daily living (as defined in 

13 section 802 of the Cranston-Gonzalez National Af14 fordable Housing Act (42 U.S.C. 8011).’’. 

15 SEC. 302. OFFERING MEDICARE ADVANTAGE PLAN IN A 

16 SENIOR HOUSING FACILITY. 

17 Section 1851(b)(1) of the Social Security Act (42 

18 U.S.C. 1395w–21(b)(1)) is amended by adding at the end 

19 the following new subparagraph: 

20 ‘‘(D) SPECIAL RULE FOR SENIOR CITIZEN

21 FACILITIES.—Notwithstanding any other provi22 sion of this part, a Medicare Advantage organi23 zation may operate a Medicare Advantage plan 

24 exclusively within a geographic area that is lim25 ited to a senior housing facility if the plan— 


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1 ‘‘(i) provides services only to bene2 ficiaries who either— 

3 ‘‘(I) are under a long-term resi4 dency contract as described in section 

5 1919(c)(5)(B)(v); or 

6 ‘‘(II) reside in supportive housing 

7 for the elderly as described in section 

8 202 of the Housing Act of 1959 or 

9 housing supported by the low income 

10 housing tax credit program described 

11 in section 42 of the Internal Revenue 

12 Code of 1986, and qualify for assist13 ance under section 8 of the United 

14 States Housing Act of 1937; 

15 ‘‘(ii) provides onsite primary care 

16 services with a ratio of accessible physi17 cians to beneficiaries that is deemed to be 

18 adequate by the Secretary; 

19 ‘‘(iii) provides transportation services 

20 for patients to specialty providers outside 

21 the community; 

22 ‘‘(iv) makes meaningful use of health 

23 information technology; and 

24 ‘‘(v) if offered to continuing care re25 tirement or life care community residents 


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1 as described in clause (i)(I), has partici2 pated in a Centers for Medicare & Med3 icaid Services demonstration initiative for 

4 a minimum of one year.’’. 

5 TITLE V—COMMUNITY HEALTH 

6 CENTER EXPANSION OF PRI7 ORITIES 

8 SEC. 401. COMMUNITY HEALTH CENTER EXPANSION. 

9 Section 330 of the Public Health Service Act (42 

10 U.S.C. 254b) is amended by adding at the end the fol11 lowing new subsections: 

12 ‘‘(s) SCHOOL-BASED HEALTH CENTERS.— 

13 ‘‘(1) IN GENERAL.—The Secretary may award 

14 grants for the purposes described in subparagraphs 

15 (c), (e), and (f) of this section for the planning and 

16 delivery of services to a special medically under17 served population comprised of school-aged children 

18 in a school-based health center. 

19 ‘‘(2) SCHOOL-BASED HEALTH CENTER DE20 FINED.—In this section, the term ‘school-based 

21 health center’ means a health center that— 

22 ‘‘(A) is located within an elementary or 

23 secondary school facility; 

24 ‘‘(B) is operated in collaboration with the 

25 school in which such center is located; 


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1 ‘‘(C) is administered by a community2 based organization including a hospital, public 

3 health department, community health center, or 

4 nonprofit health care agency; 

5 ‘‘(D) at a minimum, provides to school6 aged children— 

7 ‘‘(i) primary health care services, in8 cluding comprehensive health assessments, 

9 and diagnosis and treatment of minor, 

10 acute, and chronic medical conditions and 

11 Healthy Start benefits; 

12 ‘‘(ii) mental health services, including 

13 crisis intervention, counseling, and emer14 gency psychiatric care at the school or by 

15 referral; 

16 ‘‘(iii) the availability of services at the 

17 school when the school is open and 24-hour 

18 coverage through an on-call system with 

19 other providers to ensure access when the 

20 school or health center is closed; 

21 ‘‘(iv) services through the use of a 

22 qualified and appropriately credentialed in23 dividual, including a nurse practitioner or 

24 physician assistant, a mental health profesVerDate Nov 24 2008 03:13 Jul 13, 2009 Jkt 079200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\H3158.IH H3158

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1 sional, a physician, and a health assistant; 

2 and 

3 ‘‘(E) may provide optional preventive den4 tal services, consistent with State licensure law, 

5 through the use of dental hygienists or dental 

6 assistants that provide preventive services such 

7 as basic oral exams, cleanings, and sealants. 

8 ‘‘(3) SUPPLEMENT NOT SUPPLANT.—A grant 

9 awarded under this subsection shall be expended to 

10 supplement, and not supplant, the expenditures of 

11 the health center and the value of in kind contribu12 tions for the delivery of services to the population 

13 described in paragraph (1). 

14 ‘‘(4) AUTHORIZATION OF APPROPRIATIONS.— 

15 There are authorized to be appropriated to carry out 

16 this subsection, in addition to any funds authorized 

17 to be appropriated or appropriated for health centers 

18 under any other subsection of this section, such 

19 sums as may be necessary for each of fiscal years 

20 2009 through 2014. 

21 ‘‘(t) RESIDENTS OF NATURALLY OCCURRING RE22 TIREMENT COMMUNITIES, RAPIDLY AGING COMMU23 NITIES, PATRONS OF MULTIPURPOSE SENIOR CEN24 TERS.— 


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1 ‘‘(1) IN GENERAL.—The Secretary may award 

2 grants for the purposes described in subsections (c), 

3 (e), and (f) of this section for the planning and de4 livery of services to a special medically underserved 

5 population comprised of residents of Naturally Oc6 curring Retirement Communities and patrons of 

7 multipurpose senior centers and individuals living in 

8 areas and facilities immediately accessible to such 

9 Naturally Occurring Retirement Communities and 

10 such centers. 

11 ‘‘(2) SUPPLEMENT NOT SUPPLANT.—A grant 

12 awarded under this subsection shall be expended to 

13 supplement, and not supplant, the expenditures of 

14 the health center and the value of in kind contribu15 tions for the delivery of services to the population 

16 described in paragraph (1). 

17 ‘‘(3) CONSULTATION WITH AREA AGENCIES ON

18 AGING.—The Secretary may not make a grant under 

19 paragraph (1) unless, with respect to the residents 

20 of Naturally Occurring Retirement Communities and 

21 patrons of multipurpose senior centers involved, the 

22 applicant for the grant— 

23 ‘‘(A) has consulted with the Area Agency 

24 on Aging in the preparation of the application 

25 for the grant; and 


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1 ‘‘(B) agrees to provide for ongoing con2 sultation with the Area Agency on Aging re3 garding the planning and administration of the 

4 program carried out with the grant. 

5 ‘‘(4) AUTHORIZATION OF APPROPRIATIONS.— 

6 There are authorized to be appropriated to carry out 

7 this subsection, in addition to any funds authorized 

8 to be appropriated or appropriated for health centers 

9 under any other subsection of this section, such 

10 sums as may be necessary for each of fiscal years 

11 2009 through 2014. 

12 ‘‘(5) NATURALLY OCCURRING RETIREMENT

13 COMMUNITY AND MULTIPURPOSE SENIOR CENTER

14 DEFINED.—In this subsection, the terms ‘Naturally 

15 Occurring Retirement Community’ and ‘multipur16 pose senior center’ have the meanings given such 

17 terms for purposes of the Older Americans Act of 

18 1965 (42 U.S.C. 3001 et seq).’’. 

Æ 


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