250 
retary of Health and Human Services shall, in consulta-
tion with representatives of States, physicians, health care 
practitioners, and patient advocates, encourage and facili-
tate the adoption of provisions allowing for multistate 
practitioner practice across State lines. 
(b) DEFINITIONS.—In subsection (a): 
(1) TELEHEALTH
SERVICE.—The term ‘‘tele-
health service’’ has the meaning given that term in 
subparagraph (F) of section 1834(m)(4) of the So-
cial Security Act (42 U.S.C. 1395m(m)(4)). 
(2) PHYSICIAN, 
PRACTITIONER.—The terms 
‘‘physician’’ and ‘‘practitioner’’ have the meaning 
given those terms in subparagraphs (D) and (E), re-
spectively, of such section. 
(3) MEDICARE PROGRAM.—The term ‘‘Medicare 
program’’ means the program of health insurance 
administered by the Secretary of Health and Human 
Services under title XVIII of the Social Security Act 
(42 U.S.C. 1395 et seq.). 
SEC. 429. SCORING OF PREVENTIVE HEALTH SAVINGS. 
Section 202 of the Congressional Budget and Im-
poundment Control Act of 1974 (2 U.S.C. 602) is amend-
ed by adding at the end the following new subsection: 
‘‘(h) SCORING OF PREVENTIVE HEALTH SAVINGS.— 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00250
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
251 
‘‘(1) DETERMINATION
BY
THE
DIRECTOR.— 
Upon a request by the chairman or ranking minority 
member of the Committee on the Budget of the Sen-
ate, or by the chairman or ranking minority member 
of the Committee on the Budget of the House of 
Representatives, the Director shall determine if a 
proposed measure would result in reductions in 
budget outlays in budgetary outyears through the 
use of preventive health and preventive health serv-
ices. 
‘‘(2) PROJECTIONS.—If the Director determines 
that a measure would result in substantial reduc-
tions in budget outlays as described in paragraph 
(1), the Director— 
‘‘(A) shall include, in any projection pre-
pared by the Director, a description and esti-
mate of the reductions in budget outlays in the 
budgetary outyears and a description of the 
basis for such conclusions; and 
‘‘(B) may prepare a budget projection that 
includes some or all of the budgetary outyears, 
notwithstanding the time periods for projections 
described in subsection (e) and sections 308, 
402, and 424. 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00251
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
252 
‘‘(3) DEFINITIONS.—As used in this sub-
section— 
‘‘(A) the term ‘preventive health’ means an 
action that focuses on the health of the public, 
individuals, and defined populations in order to 
protect, promote, and maintain health, wellness, 
and functional ability, and prevent disease, dis-
ability, and premature death that is dem-
onstrated by credible and publicly available epi-
demiological projection models, incorporating 
clinical trials or observational studies in hu-
mans, to avoid future health care costs; and 
‘‘(B) the term ‘budgetary outyears’ means 
the 2 consecutive 10-year periods beginning 
with the first fiscal year that is 10 years after 
the budget year provided for in the most re-
cently agreed to concurrent resolution on the 
budget.’’. 
SEC. 430. SENSE OF CONGRESS. 
It is the sense of the Congress that— 
(1) the maintenance of effort (MOE) provisions 
added to sections 1902 and 2105(d) of the Social 
Security Act by sections 2001(b) and 2101(b) of the 
Patient Protection and Affordable Care Act were 
written to maintain the eligibility standards for the 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00252
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
253 
Medicaid program and Children’s Health Insurance 
Program until the American Health Benefit Ex-
changes in the States are fully operational; 
(2) it is imperative that the MOE provisions are 
enforced to the strict standard intended by the Con-
gress; 
(3) waiving the MOE provisions should not be 
permitted, except in the case of a request for a waiv-
er that meets the explicit nonapplication require-
ments; 
(4) the MOE provisions ensure the continued 
success of the Medicaid program and CHIP and 
were written deliberately to specifically protect vul-
nerable and disabled individuals, children, and senior 
citizens, many of whom are also members of commu-
nities of color; and 
(5) the MOE provisions must be strictly en-
forced and proposals to weaken the MOE provisions 
must not be considered in this time of recession. 
SEC. 431. REPEAL OF REQUIREMENT FOR DOCUMENTA-
TION EVIDENCING CITIZENSHIP OR NATION-
ALITY UNDER THE MEDICAID PROGRAM. 
(a) REPEAL.—Subsections (i)(22) and (x) of section 
1903 of the Social Security Act (42 U.S.C. 1396b), as 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00253
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
254 
added by section 6036 of the Deficit Reduction Act of 
2005, are each repealed. 
(b) CONFORMING AMENDMENTS.— 
(1) Section 1903 of the Social Security Act (42 
U.S.C. 1396b) is amended— 
(A) in subsection (i)— 
(i) in paragraph (20), by adding ‘‘or’’ 
after the semicolon at the end; and 
(ii) in paragraph (21), by striking ‘‘; 
or’’ and inserting a period; 
(B) by redesignating subsection (y), as 
added by section 6043(b) of the Deficit Reduc-
tion Act of 2005, as subsection (x); and 
(C) by redesignating subsection (z), as 
added by section 6081(a) of the Deficit Reduc-
tion Act of 2005, as subsection (y). 
(2) Subsection (c) of section 6036 of the Deficit 
Reduction Act of 2005 is repealed. 
(c) EFFECTIVE DATE.—The repeals and amend-
ments made by this section shall take effect as if included 
in the enactment of the Deficit Reduction Act of 2005. 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00254
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
255 
SEC. 432. OFFICE OF MINORITY HEALTH IN VETERANS 
HEALTH ADMINISTRATION OF DEPARTMENT 
OF VETERANS AFFAIRS. 
(a) ESTABLISHMENT AND FUNCTIONS.—Subchapter 
I of chapter 73 of title 38, United States Code, is amended 
by adding at the end the following new section: 
‘‘§ 7309. Office of Minority Health 
‘‘(a) ESTABLISHMENT.—There is established in the 
Department within the Office of the Under Secretary for 
Health an office to be known as the ‘Office of Minority 
Health’ (in this section referred to as the ‘Office’). 
‘‘(b) HEAD.—The Director of the Office of Minority 
Health shall be the head of the Office. The Director of 
the Office of Minority Health shall be appointed by the 
Under Secretary of Health from among individuals quali-
fied to perform the duties of the position. 
‘‘(c) FUNCTIONS.—The functions of the Office are as 
follows: 
‘‘(1) To establish short-range and long-range 
goals and objectives and coordinate all other activi-
ties within the Veterans Health Administration that 
relate to disease prevention, health promotion, health 
care services delivery, and health care research con-
cerning veterans who are members of a racial or eth-
nic minority group. 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00255
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
256 
‘‘(2) To support research, demonstrations, and 
evaluations to test new and innovative models for 
the discharge of activities described in paragraph 
(1). 
‘‘(3) To increase knowledge and understanding 
of health risk factors for veterans who are members 
of a racial or ethnic minority group. 
‘‘(4) To develop mechanisms that support bet-
ter health care information dissemination, education, 
prevention, and services delivery to veterans from 
disadvantaged backgrounds, including veterans who 
are members of a racial or ethnic minority group. 
‘‘(5) To enter into contracts or agreements with 
appropriate public and nonprofit private entities to 
develop and carry out programs to provide bilingual 
or interpretive services to assist veterans who are 
members of a racial or ethnic minority group and 
who lack proficiency in speaking the English lan-
guage in accessing and receiving health care services 
through the Veterans Health Administration. 
‘‘(6) To carry out programs to improve access 
to health care services through the Veterans Health 
Administration for veterans with limited proficiency 
in speaking the English language, including the de-
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00256
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
257 
velopment and evaluation of demonstration and pilot 
projects for that purpose. 
‘‘(7) To advise the Under Secretary of Health 
on matters relating to the development, implementa-
tion, and evaluation of health professions education 
in decreasing disparities in health care outcomes be-
tween veterans who are members of a racial or eth-
nic minority group and other veterans, including 
cutural competency as a method of eliminating such 
health disparities. 
‘‘(8) To perform such other functions and du-
ties as the Secretary or the Under Secretary for 
Health considers appropriate. 
‘‘(d) DEFINITIONS.—In this section: 
‘‘(1) The term ‘racial or ethnic minority group’ 
means the following: 
‘‘(A) American Indians (including Alaska 
Natives, Eskimos, and Aleuts). 
‘‘(B) Asian Americans. 
‘‘(C) Native Hawaiians and other Pacific 
Islanders. 
‘‘(D) Blacks. 
‘‘(E) Hispanics. 
‘‘(2) The term ‘Hispanic’ means individuals 
whose origin is Mexican, Puerto Rican, Cuban, Cen-
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00257
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
258 
tral or South American, or any other Spanish-speak-
ing country.’’. 
SEC. 433. ACCESS FOR NATIVE AMERICANS UNDER PPACA. 
(a) IN GENERAL.—Title I of the Patient Protection 
and Affordable Care Act is amended— 
(1) in section 1311(c)(6)(D), by striking ‘‘(as 
defined in section 4 of the Indian Health Care Im-
provement Act)’’ and inserting ‘‘(as defined in sec-
tion 447.50(b)(1) of title 42 of the Code of Federal 
Regulations, as in effect on July 1, 2010)’’; and 
(2) in section 1402(d)(1), by striking ‘‘(as de-
fined in section 4(d) of the Indian Self-Determina-
tion and Education Assistance Act (25 U.S.C. 
450b(d)))’’ and inserting (f) ‘‘(as defined in section 
447.50(b)(1) of title 42 of the Code of Federal Reg-
ulations, as in effect on July 1, 2010)’’. 
(b) INDIVIDUAL MANDATE.—In section 5000A(e)(3) 
of the Internal Revenue Code of 1986, by striking ‘‘(as 
defined in section 45A(c)(6))’’ and inserting ‘‘(as defined 
in section 447.50(b)(1) of title 42 of the Code of Federal 
Regulations, as in effect on July 1, 2010)’’. 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00258
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
259 
TITLE V—IMPROVING HEALTH 
OUTCOMES 
FOR 
WOMEN, 
CHILDREN, AND FAMILIES 
SEC. 501. GRANTS TO PROMOTE POSITIVE HEALTH BEHAV-
IORS IN WOMEN AND CHILDREN. 
Part Q of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 399Z–2. GRANTS TO PROMOTE POSITIVE HEALTH BE-
HAVIORS IN WOMEN AND CHILDREN. 
‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col-
laboration with the Director of the Centers for Disease 
Control and Prevention and other Federal officials deter-
mined appropriate by the Secretary, is authorized to 
award grants to eligible entities to promote positive health 
behaviors for women and children in target populations, 
especially racial and ethnic minority women and children 
in medically underserved communities. 
‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 
subsection (a) may be used to support community health 
workers— 
‘‘(1) to educate and provide outreach regarding 
enrollment in health insurance including the State 
Children’s Health Insurance Program under title 
XXI of the Social Security Act, Medicare under title 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00259
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
260 
XVIII of such Act, and Medicaid under title XIX of 
such Act; 
‘‘(2) to educate, guide, and provide outreach in 
a community setting regarding health problems prev-
alent among women and children and especially 
among racial and ethnic minority women and chil-
dren; 
‘‘(3) to educate, guide, and provide experiential 
learning opportunities that target behavioral risk 
factors including— 
‘‘(A) poor nutrition; 
‘‘(B) physical inactivity; 
‘‘(C) being overweight or obese; 
‘‘(D) tobacco use; 
‘‘(E) alcohol and substance use; 
‘‘(F) injury and violence; 
‘‘(G) risky sexual behavior; 
‘‘(H) mental health problems; 
‘‘(I) musculoskeletal health; 
‘‘(J) dental and oral health problems; and 
‘‘(K) understanding informed consent; 
‘‘(4) to educate and guide regarding effective 
strategies to promote positive health behaviors with-
in the family; 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00260
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
261 
‘‘(5) to promote community wellness and aware-
ness; and 
‘‘(6) to educate and refer target populations to 
appropriate health care agencies and community- 
based programs and organizations in order to in-
crease access to quality health care services, includ-
ing preventive health services. 
‘‘(c) APPLICATION.— 
‘‘(1) IN
GENERAL.—Each eligible entity that 
desires to receive a grant under subsection (a) shall 
submit an application to the Secretary, at such time, 
in such manner, and accompanied by such additional 
information as the Secretary may require. 
‘‘(2) CONTENTS.—Each application submitted 
pursuant to paragraph (1) shall— 
‘‘(A) describe the activities for which as-
sistance under this section is sought; 
‘‘(B) contain an assurance that with re-
spect to each community health worker pro-
gram receiving funds under the grant awarded, 
such program provides training and supervision 
to community health workers to enable such 
workers to provide authorized program services; 
‘‘(C) contain an assurance that the appli-
cant will evaluate the effectiveness of commu-
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00261
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
262 
nity health worker programs receiving funds 
under the grant; 
‘‘(D) contain an assurance that each com-
munity health worker program receiving funds 
under the grant will provide services in the cul-
tural context most appropriate for the individ-
uals served by the program; 
‘‘(E) contain a plan to document and dis-
seminate project description and results to 
other States and organizations as identified by 
the Secretary; and 
‘‘(F) describe plans to enhance the capac-
ity of individuals to utilize health services and 
health-related social services under Federal, 
State, and local programs by— 
‘‘(i) assisting individuals in estab-
lishing eligibility under the programs and 
in receiving the services or other benefits 
of the programs; and 
‘‘(ii) providing other services as the 
Secretary determines to be appropriate, 
that may include transportation and trans-
lation services. 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00262
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
263 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Secretary shall give priority to those appli-
cants— 
‘‘(1) who propose to target geographic areas— 
‘‘(A) with a high percentage of residents 
who are eligible for health insurance but are 
uninsured or underinsured; and 
‘‘(B) with a high percentage of families for 
whom English is not their primary language; 
‘‘(2) with experience in providing health or 
health-related social services to individuals who are 
underserved with respect to such services; and 
‘‘(3) with documented community activity and 
experience with community health workers. 
‘‘(e) COLLABORATION WITH ACADEMIC INSTITU-
TIONS.—The Secretary shall encourage community health 
worker programs receiving funds under this section to col-
laborate with academic institutions, including minority- 
serving institutions. Nothing in this section shall be con-
strued to require such collaboration. 
‘‘(f) 
QUALITY
ASSURANCE
AND 
COSTEFFECTIVENESS.—The Secretary shall establish 
guidelines for assuring the quality of the training and su-
pervision of community health workers under the pro-
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00263
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
264 
grams funded under this section and for assuring the 
costeffectiveness of such programs. 
‘‘(g) MONITORING.—The Secretary shall monitor 
community health worker programs identified in approved 
applications and shall determine whether such programs 
are in compliance with the guidelines established under 
subsection (f). 
‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 
provide technical assistance to community health worker 
programs identified in approved applications with respect 
to planning, developing, and operating programs under the 
grant. 
‘‘(i) REPORT TO CONGRESS.— 
‘‘(1) IN
GENERAL.—Not later than 4 years 
after the date on which the Secretary first awards 
grants under subsection (a), the Secretary shall sub-
mit to Congress a report regarding the grant 
project. 
‘‘(2) CONTENTS.—The report required under 
paragraph (1) shall include the following: 
‘‘(A) A description of the programs for 
which grant funds were used. 
‘‘(B) The number of individuals served. 
‘‘(C) An evaluation of— 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00264
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
265 
‘‘(i) the effectiveness of these pro-
grams; 
‘‘(ii) the cost of these programs; and 
‘‘(iii) the impact of the project on the 
health outcomes of the community resi-
dents. 
‘‘(D) Recommendations for sustaining the 
community health worker programs developed 
or assisted under this section. 
‘‘(E) Recommendations regarding training 
to enhance career opportunities for community 
health workers. 
‘‘(j) DEFINITIONS.—In this section: 
‘‘(1) COMMUNITY HEALTH WORKER.—The term 
‘community health worker’ means an individual who 
promotes health or nutrition within the community 
in which the individual resides— 
‘‘(A) by serving as a liaison between com-
munities and health care agencies; 
‘‘(B) by providing guidance and social as-
sistance to community residents; 
‘‘(C) by enhancing community residents’ 
ability to effectively communicate with health 
care providers; 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00265
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
266 
‘‘(D) by providing culturally and linguis-
tically appropriate health or nutrition edu-
cation; 
‘‘(E) by advocating for individual and com-
munity health, including dental, oral, mental, 
and environmental health, or nutrition needs; 
and 
‘‘(F) by providing referral and followup 
services. 
‘‘(2) COMMUNITY SETTING.—The term ‘commu-
nity setting’ means a home or a community organi-
zation located in the neighborhood in which a partic-
ipant resides. 
‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means— 
‘‘(A) a unit of State, territorial, local, or 
tribal government (including a federally recog-
nized tribe or Alaska Native village); or 
‘‘(B) a community-based organization. 
‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 
The term ‘medically underserved community’ means 
a community— 
‘‘(A) that has a substantial number of in-
dividuals who are members of a medically un-
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00266
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
267 
derserved population, as defined by section 
330(b)(3); and 
‘‘(B) a significant portion of which is a 
health professional shortage area as designated 
under section 332. 
‘‘(5) SUPPORT.—The term ‘support’ means the 
provision of training, supervision, and materials 
needed to effectively deliver the services described in 
subsection (b), reimbursement for services, and 
other benefits. 
‘‘(6) TARGET POPULATION.—The term ‘target 
population’ means women of reproductive age, re-
gardless of their current childbearing status and 
children under 21 years of age. 
‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$15,000,000 for each of fiscal years 2012 through 2016.’’. 
SEC. 502. REMOVING BARRIERS TO HEALTH CARE AND NU-
TRITION ASSISTANCE FOR CHILDREN, PREG-
NANT WOMEN, AND LAWFULLY PRESENT IN-
DIVIDUALS. 
(a) MEDICAID.—Section 1903(v) of the Social Secu-
rity Act (42 U.S.C. 1396b(v)) is amended by striking 
paragraph (4) and inserting the following new paragraph: 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00267
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
268 
‘‘(4)(A) 
Notwithstanding 
sections 
401(a), 
402(b), 403, and 421 of the Personal Responsibility 
and Work Opportunity Reconciliation Act of 1996, 
payment shall be made under this section for care 
and services that are furnished to aliens, including 
those described in paragraph (1), if they otherwise 
meet the eligibility requirements for medical assist-
ance under the State plan approved under this sub-
chapter (other than the requirement of the receipt of 
aid or assistance under title IV, supplemental secu-
rity income benefits under title XVI, or a State sup-
plementary payment), and are— 
‘‘(i) lawfully present in the United 
States; 
‘‘(ii) children under 21 years of age, 
including any optional targeted low-income 
child (as such term is defined in section 
1905(u)(2)(B)); or 
‘‘(iii) pregnant women during preg-
nancy and during the 60-day period begin-
ning on the last day of the pregnancy. 
‘‘(B) No debt shall accrue under an affidavit of 
support against any sponsor of such an alien on the 
basis of provision of assistance to such alien under 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00268
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
269 
this paragraph and the cost of such assistance shall 
not be considered as an unreimbursed cost.’’. 
(b) SCHIP.—Section 2107(e)(1) of the Social Secu-
rity Act (42 U.S.C. 1397gg(e)(1)) is amended by amend-
ing subparagraph (J) to read as follows: 
‘‘(J) Paragraph (4) of section 1903(v) (re-
lating to individuals who, but for sections 
401(a), 403, and 421 of the Personal Responsi-
bility and Work Opportunity Reconciliation Act 
of 1996, would be eligible for medical assistance 
under title XXI).’’. 
(c) SUPPLEMENTAL NUTRITION ASSISTANCE.—Not-
withstanding sections 401(a), 402(a), and 403(a) of the 
Personal Responsibility and Work Opportunity Reconcili-
ation Act of 1996 (8 U.S.C. 1611(a); 1612(a); 1613(a)) 
and section 6(f) of the Food and Nutrition Act of 2008 
(7 U.S.C. 2015(f)), persons who are lawfully present in 
the United States shall be not be ineligible for benefits 
under the supplemental nutrition assistance program on 
the basis of their immigration status or date of entry into 
the United States. 
(d) ELIGIBILITY FOR FAMILIES WITH CHILDREN.— 
Section of the 421(d)(3) of the Personal Responsibility 
and Work Opportunity Reconciliation Act of 1996 (8 
U.S.C. 1631(d)(3)) is amended by striking ‘‘to the extent 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00269
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
270 
that 
a 
qualified 
alien 
is 
eligible 
under 
section 
402(a)(2)(J)’’ and inserting, ‘‘to the extent that a child 
is a member of a household under the supplemental nutri-
tion assistance program’’. 
(e) 
ENSURING
PROPER
SCREENING.—Section 
11(e)(2)(B) of the Food and Nutrition Act of 2008 (7 
U.S.C. 2020(e)(2)(B)) is amended— 
(1) by redesignating clauses (vi) and (vii) as 
clauses (vii) and (viii); and 
(2) by inserting after clause (v) the following: 
‘‘(vi) shall provide a method for imple-
menting section 421 of the Personal Re-
sponsibility and Work Opportunity Rec-
onciliation Act of 1996 (8 U.S.C. 1631) 
that does not require any unnecessary in-
formation from persons who may be ex-
empt from that provision;’’. 
SEC. 503. REPEAL OF DENIAL OF BENEFITS. 
Section 115 of the Personal Responsibility and Work 
Opportunity Reconciliation Act of 1996 (21 U.S.C. 862a) 
is amended— 
(1) in subsection (a) by striking paragraph (2); 
(2) in subsection (b) by striking paragraph (2); 
and 
(3) in subsection (e) by striking paragraph (2). 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00270
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
271 
SEC. 504. BIRTH DEFECTS PREVENTION, RISK REDUCTION, 
AND AWARENESS. 
(a) IN GENERAL.—The Secretary shall establish and 
implement a birth defects prevention and public awareness 
program, consisting of the activities described in sub-
sections (c) and (d). 
(b) DEFINITIONS.—In this section: 
(1) The term ‘‘pregnancy and breastfeeding in-
formation services’’ includes only— 
(A) information services to provide accu-
rate, evidence-based, clinical information re-
garding maternal exposures during pregnancy 
that may be associated with birth defects or 
other health risks, such as exposures to medica-
tions, chemicals, infections, foodborne patho-
gens, illnesses, nutrition, or lifestyle factors; 
(B) information services to provide accu-
rate, evidence-based, clinical information re-
garding maternal exposures during breast-
feeding that may be associated with health risks 
to a breast-fed infant, such as exposures to 
medications, chemicals, infections, foodborne 
pathogens, illnesses, nutrition, or lifestyle fac-
tors; 
(C) the provision of accurate, evidence- 
based information weighing risks of exposures 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00271
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
272 
during breastfeeding against the benefits of 
breastfeeding; and 
(D) the provision of information described 
in subparagraph (A), (B), or (C) through coun-
selors, Web sites, fact sheets, telephonic or elec-
tronic communication, community outreach ef-
forts, or other appropriate means. 
(2) The term ‘‘Secretary’’ means the Secretary 
of Health and Human Services, acting through the 
Director of the Centers for Disease Control and Pre-
vention. 
(c) NATIONWIDE MEDIA CAMPAIGN.—In carrying out 
subsection (a), the Secretary shall conduct or support a 
nationwide media campaign to increase awareness among 
health care providers and at-risk populations about preg-
nancy and breastfeeding information services. 
(d) GRANTS FOR PREGNANCY AND BREASTFEEDING 
INFORMATION SERVICES.— 
(1) IN GENERAL.—In carrying out subsection 
(a), the Secretary shall award grants to State or re-
gional agencies or organizations for any of the fol-
lowing: 
(A) INFORMATION SERVICES.—The provi-
sion of, or campaigns to increase awareness 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00272
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
273 
about, pregnancy and breastfeeding information 
services. 
(B) SURVEILLANCE AND RESEARCH.—The 
conduct or support of— 
(i) surveillance of or research on— 
(I) maternal exposures and ma-
ternal health conditions that may in-
fluence the risk of birth defects, pre-
maturity, or other adverse pregnancy 
outcomes; and 
(II) maternal exposures that may 
influence health risks to a breastfed 
infant; or 
(ii) networking to facilitate surveil-
lance or research described in this sub-
paragraph. 
(2) PREFERENCE FOR CERTAIN STATES.—The 
Secretary, in making any grant under this sub-
section, shall give preference to States, otherwise 
equally qualified, that have or had a pregnancy and 
breastfeeding information service in place on or after 
January 1, 2006. 
(3) MATCHING
FUNDS.—The Secretary may 
only award a grant under this subsection to a State 
or regional agency or organization that agrees, with 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00273
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
274 
respect to the costs to be incurred in carrying out 
the grant activities, to make available (directly or 
through donations from public or private entities) 
non-Federal funds toward such costs in an amount 
equal to not less than 25 percent of the amount of 
the grant. 
(4) COORDINATION.—The Secretary shall en-
sure that activities funded through a grant under 
this subsection are coordinated, to the maximum ex-
tent practicable, with other birth defects prevention 
and environmental health activities of the Federal 
Government, including with respect to pediatric envi-
ronmental health specialty units and children’s envi-
ronmental health centers. 
(e) EVALUATION.—In furtherance of the program 
under subsection (a), the Secretary shall provide for an 
evaluation of pregnancy and breastfeeding information 
services to identify efficient and effective models of— 
(1) providing information; 
(2) raising awareness and increasing knowledge 
about birth defects prevention measures; 
(3) modifying risk behaviors; or 
(4) other outcome measures as determined ap-
propriate by the Secretary. 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00274
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
275 
(f) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
$5,000,000 for fiscal year 2012, $6,000,000 for fiscal year 
2013, $7,000,000 for fiscal year 2014, $8,000,000 for fis-
cal year 2015, and $9,000,000 for fiscal year 2016. 
SEC. 505. UNIFORM STATE MATERNAL MORTALITY REVIEW 
COMMITTEES 
ON 
PREGNANCY-RELATED 
DEATHS. 
(a) CONDITION OF RECEIPT OF PAYMENTS FROM 
ALLOTMENT UNDER MATERNAL
AND CHILD HEALTH 
SERVICE BLOCK GRANT.—Title V of the Social Security 
Act (42 U.S.C. 701 et seq.) is amended by adding at the 
end the following new section: 
‘‘SEC. 514. UNIFORM STATE MATERNAL MORTALITY RE-
VIEW 
COMMITTEES 
ON 
PREGNANCY-RE-
LATED DEATHS. 
‘‘(a) GRANTS.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of this title, for each of fiscal years 2012 
through 2018, in addition to payments from allot-
ments for States under section 502 for such year, 
the Secretary shall, subject to paragraph (3) and in 
accordance with the criteria established under para-
graph (2), award grants to States to— 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00275
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
276 
‘‘(A) carry out the activities described in 
subsection (b)(1); 
‘‘(B) establish a State maternal mortality 
review committee, in accordance with subsection 
(b)(2), to carry out the activities described in 
subsection (b)(2)(A), and to establish the proc-
esses described in subsection (b)(1); 
‘‘(C) ensure the State department of 
health carries out the applicable activities de-
scribed in subsection (b)(3), with respect to 
pregnancy-related deaths occurring within the 
State during such fiscal year; 
‘‘(D) implement and use the comprehensive 
case abstraction form developed under sub-
section (c), in accordance with such subsection; 
and 
‘‘(E) provide for public disclosure of infor-
mation, in accordance with subsection (e). 
‘‘(2) CRITERIA.—The Secretary shall establish 
criteria for determining eligibility for and the 
amount of a grant awarded to a State under para-
graph (1). Such criteria shall provide that in the 
case of a State that receives such a grant for a fiscal 
year and is determined by the Secretary to have not 
used such grant in accordance with this section, 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00276
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
277 
such State shall not be eligible for such a grant for 
any subsequent fiscal year. 
‘‘(3) AUTHORIZATION
OF
APPROPRIATIONS.— 
For purposes of carrying out the grant program 
under this section, including for administrative pur-
poses, there is authorized to be appropriated 
$10,000,000 for each of fiscal years 2012 through 
2018. 
‘‘(b) PREGNANCY-RELATED DEATH REVIEW.— 
‘‘(1) REVIEW OF PREGNANCY-RELATED DEATH 
AND PREGNANCY-ASSOCIATED DEATH CASES.—For 
purposes of subsection (a), with respect to a State 
that receives a grant under subsection (a), the fol-
lowing shall apply: 
‘‘(A) MANDATORY
REPORTING
OF
PREG-
NANCY-RELATED DEATHS.— 
‘‘(i) IN GENERAL.—The State shall, 
through the State maternal mortality re-
view committee, develop a process, sepa-
rate from any reporting process established 
by the State department of health prior to 
the date of the enactment of this section, 
that provides for mandatory and confiden-
tial case reporting by individuals and enti-
ties described in clause (ii) of pregnancy- 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00277
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
278 
related deaths to the State department of 
health. 
‘‘(ii) INDIVIDUALS AND ENTITIES DE-
SCRIBED.—Individuals and entities de-
scribed in this clause include each of the 
following: 
‘‘(I) Health care providers. 
‘‘(II) Medical examiners. 
‘‘(III) Medical coroners. 
‘‘(IV) Hospitals. 
‘‘(V) Free-standing birth centers. 
‘‘(VI) Other health care facilities. 
‘‘(VII) Any other individuals re-
sponsible for completing death certifi-
cates. 
‘‘(VIII) Any other appropriate in-
dividuals or entities specified by the 
Secretary. 
‘‘(B) VOLUNTARY
REPORTING
OF
PREG-
NANCY-RELATED AND PREGNANCY-ASSOCIATED 
DEATHS.— 
‘‘(i) The State shall, through the 
State maternal mortality review committee, 
develop a process for and encourage, sepa-
rate from any reporting process established 
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00278
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS
279 
by the State department of health prior to 
the date of the enactment of this section, 
voluntary and confidential case reporting 
by individuals described in clause (ii) of 
pregnancy-associated deaths to the State 
department of health. 
‘‘(ii) The State shall, through the 
State maternal mortality review committee, 
develop a process for voluntary and con-
fidential reporting by family members of 
the deceased and by other individuals on 
possible pregnancy-related and pregnancy- 
associated deaths to the State department 
of health. Such process shall include— 
‘‘(I) making publicly available on 
the Internet Web site of the State de-
partment of health a telephone num-
ber, Internet Web link, and email ad-
dress for such reporting; and 
‘‘(II) publicizing to local profes-
sional organizations, community orga-
nizations, and social services agencies 
the availability of the telephone num-
ber, Internet Web link, and email ad-
VerDate Mar 15 2010 
22:29 Sep 20, 2011
Jkt 099200
PO 00000
Frm 00279
Fmt 6652
Sfmt 6201
E:\BILLS\H2954.IH
H2954
emcdonald on DSK5VPTVN1PROD with BILLS