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•AMDT. NO. 2786 
the previous fiscal year increased by the annual 
percentage increase in the Consumer Price 
Index for All Urban Consumers (all items; 
United States city average) as of June of the 
previous fiscal year. 
‘‘(2) FROM
TRUST
FUNDS.—Sixty percent of 
amounts appropriated under paragraph (1) shall be 
derived by transfer from the Federal Hospital Insur-
ance Trust Fund under section 1817 and 40 percent 
of amounts appropriated under such paragraph shall 
be derived by transfer from the Federal Supple-
mentary Medical Insurance Trust Fund under sec-
tion 1841.’’. 
(2) LOBBYING COOLING-OFF PERIOD FOR MEM-
BERS OF THE INDEPENDENT MEDICARE ADVISORY 
BOARD.—Section 207(c) of title 18, United States 
Code, is amended by inserting at the end the fol-
lowing: 
‘‘(3) MEMBERS OF THE INDEPENDENT MEDI-
CARE ADVISORY BOARD.— 
‘‘(A) IN
GENERAL.—Paragraph (1) shall 
apply to a member of the Independent Medicare 
Advisory Board under section 1899A. 
‘‘(B) AGENCIES AND CONGRESS.—For pur-
poses of paragraph (1), the agency in which the 
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individual described in subparagraph (A) served 
shall be considered to be the Independent Medi-
care Advisory Board, the Department of Health 
and Human Services, and the relevant commit-
tees of jurisdiction of Congress, including the 
Committee on Ways and Means and the Com-
mittee on Energy and Commerce of the House 
of Representatives and the Committee on Fi-
nance of the Senate.’’. 
(b) GAO STUDY AND REPORT ON DETERMINATION 
AND IMPLEMENTATION
OF PAYMENT
AND COVERAGE 
POLICIES UNDER THE MEDICARE PROGRAM.— 
(1) INITIAL STUDY AND REPORT.— 
(A) STUDY.—The Comptroller General of 
the United States (in this section referred to as 
the ‘‘Comptroller General’’) shall conduct a 
study on changes to payment policies, meth-
odologies, and rates and coverage policies and 
methodologies under the Medicare program 
under title XVIII of the Social Security Act as 
a result of the recommendations contained in 
the proposals made by the Independent Medi-
care Advisory Board under section 1899A of 
such Act (as added by subsection (a)), including 
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an analysis of the effect of such recommenda-
tions on— 
(i) Medicare beneficiary access to pro-
viders and items and services; 
(ii) the affordability of Medicare pre-
miums 
and 
cost-sharing 
(including 
deductibles, coinsurance, and copayments); 
(iii) the potential impact of changes 
on other government or private-sector pur-
chasers and payers of care; and 
(iv) quality of patient care, including 
patient experience, outcomes, and other 
measures of care. 
(B) REPORT.—Not later than July 1, 
2015, the Comptroller General shall submit to 
Congress a report containing the results of the 
study conducted under subparagraph (A), to-
gether with recommendations for such legisla-
tion and administrative action as the Comp-
troller General determines appropriate. 
(2) SUBSEQUENT STUDIES AND REPORTS.—The 
Comptroller General shall periodically conduct such 
additional studies and submit reports to Congress on 
changes to Medicare payments policies, methodolo-
gies, and rates and coverage policies and methodolo-
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gies as the Comptroller General determines appro-
priate, in consultation with the Committee on Ways 
and Means and the Committee on Energy and Com-
merce of the House of Representatives and the Com-
mittee on Finance of the Senate. 
(c) CONFORMING AMENDMENTS.—Section 1805(b) 
of the Social Security Act (42 U.S.C. 1395b–6(b)) is 
amended— 
(1) by redesignating paragraphs (4) through 
(8) as paragraphs (5) through (9), respectively; and 
(2) by inserting after paragraph (3) the fol-
lowing: 
‘‘(4) REVIEW
AND
COMMENT
ON
THE
INDE-
PENDENT MEDICARE ADVISORY BOARD OR SECRE-
TARIAL
PROPOSAL.—If the Independent Medicare 
Advisory Board (as established under subsection (a) 
of section 1899A) or the Secretary submits a pro-
posal to the Commission under such section in a 
year, the Commission shall review the proposal and, 
not later than March 1 of that year, submit to the 
Committee on Ways and Means and the Committee 
on Energy and Commerce of the House of Rep-
resentatives and the Committee on Finance of the 
Senate written comments on such proposal. Such 
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comments may include such recommendations as the 
Commission deems appropriate.’’. 
Subtitle F—Health Care Quality 
Improvements 
SEC. 3501. HEALTH CARE DELIVERY SYSTEM RESEARCH; 
QUALITY IMPROVEMENT TECHNICAL ASSIST-
ANCE. 
Part D of title IX of the Public Health Service Act, 
as amended by section 3013, is further amended by adding 
at the end the following: 
‘‘Subpart II—Health Care Quality Improvement 
Programs 
‘‘SEC. 933. HEALTH CARE DELIVERY SYSTEM RESEARCH. 
‘‘(a) PURPOSE.—The purposes of this section are 
to— 
‘‘(1) enable the Director to identify, develop, 
evaluate, disseminate, and provide training in inno-
vative methodologies and strategies for quality im-
provement practices in the delivery of health care 
services that represent best practices (referred to as 
‘best practices’) in health care quality, safety, and 
value; and 
‘‘(2) ensure that the Director is accountable for 
implementing a model to pursue such research in a 
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collaborative manner with other related Federal 
agencies. 
‘‘(b) GENERAL FUNCTIONS OF THE CENTER.—The 
Center for Quality Improvement and Patient Safety of the 
Agency for Healthcare Research and Quality (referred to 
in this section as the ‘Center’), or any other relevant agen-
cy or department designated by the Director, shall— 
‘‘(1) carry out its functions using research from 
a variety of disciplines, which may include epidemi-
ology, health services, sociology, psychology, human 
factors engineering, biostatistics, health economics, 
clinical research, and health informatics; 
‘‘(2) conduct or support activities consistent 
with the purposes described in subsection (a), and 
for— 
‘‘(A) best practices for quality improve-
ment practices in the delivery of health care 
services; and 
‘‘(B) that include changes in processes of 
care and the redesign of systems used by pro-
viders that will reliably result in intended health 
outcomes, improve patient safety, and reduce 
medical errors (such as skill development for 
health care providers in team-based health care 
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delivery and rapid cycle process improvement) 
and facilitate adoption of improved workflow; 
‘‘(3) identify health care providers, including 
health care systems, single institutions, and indi-
vidual providers, that— 
‘‘(A) deliver consistently high-quality, effi-
cient health care services (as determined by the 
Secretary); and 
‘‘(B) employ best practices that are adapt-
able and scalable to diverse health care settings 
or effective in improving care across diverse set-
tings; 
‘‘(4) assess research, evidence, and knowledge 
about what strategies and methodologies are most 
effective in improving health care delivery; 
‘‘(5) find ways to translate such information 
rapidly and effectively into practice, and document 
the sustainability of those improvements; 
‘‘(6) create strategies for quality improvement 
through the development of tools, methodologies, 
and interventions that can successfully reduce vari-
ations in the delivery of health care; 
‘‘(7) identify, measure, and improve organiza-
tional, human, or other causative factors, including 
those related to the culture and system design of a 
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health care organization, that contribute to the suc-
cess and sustainability of specific quality improve-
ment and patient safety strategies; 
‘‘(8) provide for the development of best prac-
tices in the delivery of health care services that— 
‘‘(A) have a high likelihood of success, 
based on structured review of empirical evi-
dence; 
‘‘(B) are specified with sufficient detail of 
the individual processes, steps, training, skills, 
and knowledge required for implementation and 
incorporation into workflow of health care prac-
titioners in a variety of settings; 
‘‘(C) are designed to be readily adapted by 
health care providers in a variety of settings; 
and 
‘‘(D) where applicable, assist health care 
providers in working with other health care pro-
viders across the continuum of care and in en-
gaging patients and their families in improving 
the care and patient health outcomes; 
‘‘(9) provide for the funding of the activities of 
organizations with recognized expertise and excel-
lence in improving the delivery of health care serv-
ices, including children’s health care, by involving 
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multiple disciplines, managers of health care entities, 
broad development and training, patients, caregivers 
and families, and frontline health care workers, in-
cluding activities for the examination of strategies to 
share best quality improvement practices and to pro-
mote excellence in the delivery of health care serv-
ices; and 
‘‘(10) build capacity at the State and commu-
nity level to lead quality and safety efforts through 
education, training, and mentoring programs to 
carry out the activities under paragraphs (1) 
through (9). 
‘‘(c) RESEARCH FUNCTIONS OF CENTER.— 
‘‘(1) IN GENERAL.—The Center shall support, 
such as through a contract or other mechanism, re-
search on health care delivery system improvement 
and the development of tools to facilitate adoption of 
best practices that improve the quality, safety, and 
efficiency of health care delivery services. Such sup-
port may include establishing a Quality Improve-
ment Network Research Program for the purpose of 
testing, scaling, and disseminating of interventions 
to improve quality and efficiency in health care. Re-
cipients of funding under the Program may include 
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national, State, multi-State, or multi-site quality im-
provement networks. 
‘‘(2) 
RESEARCH
REQUIREMENTS.—The 
re-
search conducted pursuant to paragraph (1) shall— 
‘‘(A) address the priorities identified by 
the Secretary in the national strategic plan es-
tablished under section 399HH; 
‘‘(B) identify areas in which evidence is in-
sufficient to identify strategies and methodolo-
gies, taking into consideration areas of insuffi-
cient evidence identified by the entity with a 
contract under section 1890(a) of the Social Se-
curity Act in the report required under section 
399JJ; 
‘‘(C) address concerns identified by health 
care institutions and providers and commu-
nicated through the Center pursuant to sub-
section (d); 
‘‘(D) reduce preventable morbidity, mor-
tality, and associated costs of morbidity and 
mortality by building capacity for patient safety 
research; 
‘‘(E) support the discovery of processes for 
the reliable, safe, efficient, and responsive deliv-
ery of health care, taking into account discov-
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eries from clinical research and comparative ef-
fectiveness research; 
‘‘(F) allow communication of research find-
ings and translate evidence into practice rec-
ommendations that are adaptable to a variety 
of settings, and which, as soon as practicable 
after the establishment of the Center, shall in-
clude— 
‘‘(i) the implementation of a national 
application of Intensive Care Unit improve-
ment projects relating to the adult (includ-
ing geriatric), pediatric, and neonatal pa-
tient populations; 
‘‘(ii) practical methods for addressing 
health care associated infections, including 
Methicillin-Resistant 
Staphylococcus 
Aureus 
and 
Vancomycin-Resistant 
Entercoccus infections and other emerging 
infections; and 
‘‘(iii) practical methods for reducing 
preventable hospital admissions and re-
admissions; 
‘‘(G) expand demonstration projects for 
improving the quality of children’s health care 
and the use of health information technology, 
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such as through Pediatric Quality Improvement 
Collaboratives and Learning Networks, con-
sistent with provisions of section 1139A of the 
Social Security Act for assessing and improving 
quality, where applicable; 
‘‘(H) identify and mitigate hazards by— 
‘‘(i) analyzing events reported to pa-
tient safety reporting systems and patient 
safety organizations; and 
‘‘(ii) using the results of such analyses 
to develop scientific methods of response to 
such events; 
‘‘(I) include the conduct of systematic re-
views of existing practices that improve the 
quality, safety, and efficiency of health care de-
livery, as well as new research on improving 
such practices; and 
‘‘(J) include the examination of how to 
measure and evaluate the progress of quality 
and patient safety activities. 
‘‘(d) DISSEMINATION OF RESEARCH FINDINGS.— 
‘‘(1) PUBLIC
AVAILABILITY.—The Director 
shall make the research findings of the Center avail-
able to the public through multiple media and appro-
priate formats to reflect the varying needs of health 
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care providers and consumers and diverse levels of 
health literacy. 
‘‘(2) LINKAGE TO HEALTH INFORMATION TECH-
NOLOGY.—The Secretary shall ensure that research 
findings and results generated by the Center are 
shared with the Office of the National Coordinator 
of Health Information Technology and used to in-
form the activities of the health information tech-
nology extension program under section 3012, as 
well as any relevant standards, certification criteria, 
or implementation specifications. 
‘‘(e) PRIORITIZATION.—The Director shall identify 
and regularly update a list of processes or systems on 
which to focus research and dissemination activities of the 
Center, taking into account— 
‘‘(1) the cost to Federal health programs; 
‘‘(2) consumer assessment of health care experi-
ence; 
‘‘(3) provider assessment of such processes or 
systems and opportunities to minimize distress and 
injury to the health care workforce; 
‘‘(4) the potential impact of such processes or 
systems on health status and function of patients, 
including vulnerable populations including children; 
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‘‘(5) the areas of insufficient evidence identified 
under subsection (c)(2)(B); and 
‘‘(6) the evolution of meaningful use of health 
information technology, as defined in section 3000. 
‘‘(f) COORDINATION.—The Center shall coordinate 
its activities with activities conducted by the Center for 
Medicare and Medicaid Innovation established under sec-
tion 1115A of the Social Security Act. 
‘‘(g) FUNDING.—There is authorized to be appro-
priated to carry out this section $20,000,000 for fiscal 
years 2010 through 2014. 
‘‘SEC. 934. QUALITY IMPROVEMENT TECHNICAL ASSIST-
ANCE AND IMPLEMENTATION. 
‘‘(a) IN GENERAL.—The Director, through the Cen-
ter for Quality Improvement and Patient Safety of the 
Agency for Healthcare Research and Quality (referred to 
in this section as the ‘Center’), shall award— 
‘‘(1) technical assistance grants or contracts to 
eligible entities to provide technical support to insti-
tutions that deliver health care and health care pro-
viders (including rural and urban providers of serv-
ices and suppliers with limited infrastructure and fi-
nancial resources to implement and support quality 
improvement activities, providers of services and 
suppliers with poor performance scores, and pro-
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viders of services and suppliers for which there are 
disparities in care among subgroups of patients) so 
that such institutions and providers understand, 
adapt, and implement the models and practices iden-
tified in the research conducted by the Center, in-
cluding the Quality Improvement Networks Research 
Program; and 
‘‘(2) implementation grants or contracts to eli-
gible entities to implement the models and practices 
described under paragraph (1). 
‘‘(b) ELIGIBLE ENTITIES.— 
‘‘(1) TECHNICAL ASSISTANCE AWARD.—To be 
eligible to receive a technical assistance grant or 
contract under subsection (a)(1), an entity— 
‘‘(A) may be a health care provider, health 
care provider association, professional society, 
health care worker organization, Indian health 
organization, quality improvement organization, 
patient safety organization, local quality im-
provement collaborative, the Joint Commission, 
academic health center, university, physician- 
based research network, primary care extension 
program established under section 399W, a 
Federal Indian Health Service program or a 
health program operated by an Indian tribe (as 
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‘‘(i) charging fees to institutions and 
providers that receive technical support 
from the entity; and 
‘‘(ii) reducing or eliminating such fees 
for such institutions and providers that 
serve low-income populations; and 
‘‘(B) such other information as the Direc-
tor may require. 
‘‘(2) IMPLEMENTATION AWARD.—To receive a 
grant or contract under subsection (a)(2), an eligible 
entity shall submit an application to the Secretary at 
such time, in such manner, and containing— 
‘‘(A) a plan for implementation of a model 
or practice identified in the research conducted 
by the Center including— 
‘‘(i) financial cost, staffing require-
ments, and timeline for implementation; 
and 
‘‘(ii) pre- and projected post-imple-
mentation quality measure performance 
data in targeted improvement areas identi-
fied by the Secretary; and 
‘‘(B) such other information as the Direc-
tor may require. 
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‘‘(d) MATCHING FUNDS.—The Director may not 
award a grant or contract under this section to an entity 
unless the entity agrees that it will make available (di-
rectly or through contributions from other public or pri-
vate entities) non-Federal contributions toward the activi-
ties to be carried out under the grant or contract in an 
amount equal to $1 for each $5 of Federal funds provided 
under the grant or contract. Such non-Federal matching 
funds may be provided directly or through donations from 
public or private entities and may be in cash or in-kind, 
fairly evaluated, including plant, equipment, or services. 
‘‘(e) EVALUATION.— 
‘‘(1) IN GENERAL.—The Director shall evaluate 
the performance of each entity that receives a grant 
or contract under this section. The evaluation of an 
entity shall include a study of— 
‘‘(A) the success of such entity in achiev-
ing the implementation, by the health care in-
stitutions and providers assisted by such entity, 
of the models and practices identified in the re-
search conducted by the Center under section 
933; 
‘‘(B) the perception of the health care in-
stitutions and providers assisted by such entity 
regarding the value of the entity; and 
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•AMDT. NO. 2786 
‘‘(C) where practicable, better patient 
health outcomes and lower cost resulting from 
the assistance provided by such entity. 
‘‘(2) EFFECT OF EVALUATION.—Based on the 
outcome of the evaluation of the entity under para-
graph (1), the Director shall determine whether to 
renew a grant or contract with such entity under 
this section. 
‘‘(f) COORDINATION.—The entities that receive a 
grant or contract under this section shall coordinate with 
health information technology regional extension centers 
under section 3012(c) and the primary care extension pro-
gram established under section 399W regarding the dis-
semination of quality improvement, system delivery re-
form, and best practices information.’’. 
SEC. 3502. ESTABLISHING COMMUNITY HEALTH TEAMS TO 
SUPPORT THE PATIENT-CENTERED MEDICAL 
HOME. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’) shall establish a program to provide grants to or 
enter into contracts with eligible entities to establish com-
munity-based interdisciplinary, interprofessional teams 
(referred to in this section as ‘‘health teams’’) to support 
primary care practices, including obstetrics and gyne-
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cology practices, within the hospital service areas served 
by the eligible entities. Grants or contracts shall be used 
to— 
(1) establish health teams to provide support 
services to primary care providers; and 
(2) provide capitated payments to primary care 
providers as determined by the Secretary. 
(b) ELIGIBLE ENTITIES.—To be eligible to receive a 
grant or contract under subsection (a), an entity shall— 
(1)(A) be a State or State-designated entity; or 
(B) be an Indian tribe or tribal organization, as 
defined in section 4 of the Indian Health Care Im-
provement Act; 
(2) submit a plan for achieving long-term finan-
cial sustainability within 3 years; 
(3) submit a plan for incorporating prevention 
initiatives and patient education and care manage-
ment resources into the delivery of health care that 
is integrated with community-based prevention and 
treatment resources, where available; 
(4) ensure that the health team established by 
the entity includes an interdisciplinary, interprofes-
sional team of health care providers, as determined 
by the Secretary; such team may include medical 
specialists, nurses, pharmacists, nutritionists, dieti-
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cians, social workers, behavioral and mental health 
providers (including substance use disorder preven-
tion and treatment providers), doctors of chiro-
practic, licensed complementary and alternative med-
icine practitioners, and physicians’ assistants; 
(5) agree to provide services to eligible individ-
uals with chronic conditions, as described in section 
1945 of the Social Security Act (as added by section 
2703), in accordance with the payment methodology 
established under subsection (c) of such section; and 
(6) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
(c) REQUIREMENTS FOR HEALTH TEAMS.—A health 
team established pursuant to a grant or contract under 
subsection (a) shall— 
(1) establish contractual agreements with pri-
mary care providers to provide support services; 
(2) support patient-centered medical homes, de-
fined as a mode of care that includes— 
(A) personal physicians; 
(B) whole person orientation; 
(C) coordinated and integrated care; 
(D) safe and high-quality care through evi-
dence-informed medicine, appropriate use of 
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•AMDT. NO. 2786 
health information technology, and continuous 
quality improvements; 
(E) expanded access to care; and 
(F) payment that recognizes added value 
from additional components of patient-centered 
care; 
(3) collaborate with local primary care providers 
and existing State and community based resources 
to coordinate disease prevention, chronic disease 
management, transitioning between health care pro-
viders and settings and case management for pa-
tients, including children, with priority given to 
those amenable to prevention and with chronic dis-
eases or conditions identified by the Secretary; 
(4) in collaboration with local health care pro-
viders, develop and implement interdisciplinary, 
interprofessional care plans that integrate clinical 
and community preventive and health promotion 
services for patients, including children, with a pri-
ority given to those amenable to prevention and with 
chronic diseases or conditions identified by the Sec-
retary; 
(5) incorporate health care providers, patients, 
caregivers, and authorized representatives in pro-
gram design and oversight; 
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(6) provide support necessary for local primary 
care providers to— 
(A) coordinate and provide access to high- 
quality health care services; 
(B) coordinate and provide access to pre-
ventive and health promotion services; 
(C) provide access to appropriate specialty 
care and inpatient services; 
(D) provide quality-driven, cost-effective, 
culturally appropriate, and patient- and family- 
centered health care; 
(E) provide access to pharmacist-delivered 
medication 
management 
services, 
including 
medication reconciliation; 
(F) provide coordination of the appropriate 
use of complementary and alternative (CAM) 
services to those who request such services; 
(G) promote effective strategies for treat-
ment planning, monitoring health outcomes and 
resource use, sharing information, treatment 
decision support, and organizing care to avoid 
duplication of service and other medical man-
agement approaches intended to improve qual-
ity and value of health care services; 
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(H) provide local access to the continuum 
of health care services in the most appropriate 
setting, including access to individuals that im-
plement the care plans of patients and coordi-
nate care, such as integrative health care prac-
titioners; 
(I) collect and report data that permits 
evaluation of the success of the collaborative ef-
fort on patient outcomes, including collection of 
data on patient experience of care, and identi-
fication of areas for improvement; and 
(J) establish a coordinated system of early 
identification and referral for children at risk 
for developmental or behavioral problems such 
as through the use of infolines, health informa-
tion technology, or other means as determined 
by the Secretary; 
(7) provide 24-hour care management and sup-
port during transitions in care settings including— 
(A) a transitional care program that pro-
vides onsite visits from the care coordinator, as-
sists with the development of discharge plans 
and medication reconciliation upon admission to 
and discharge from the hospitals, nursing home, 
or other institution setting; 
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•AMDT. NO. 2786 
(B) discharge planning and counseling 
support to providers, patients, caregivers, and 
authorized representatives; 
(C) assuring that post-discharge care plans 
include medication management, as appro-
priate; 
(D) referrals for mental and behavioral 
health services, which may include the use of 
infolines; and 
(E) transitional health care needs from 
adolescence to adulthood; 
(8) serve as a liaison to community prevention 
and treatment programs; 
(9) demonstrate a capacity to implement and 
maintain health information technology that meets 
the requirements of certified EHR technology (as 
defined in section 3000 of the Public Health Service 
Act (42 U.S.C. 300jj)) to facilitate coordination 
among members of the applicable care team and af-
filiated primary care practices; and 
(10) where applicable, report to the Secretary 
information on quality measures used under section 
399JJ of the Public Health Service Act. 
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(d) REQUIREMENT
FOR
PRIMARY
CARE
PRO-
VIDERS.—A provider who contracts with a care team 
shall— 
(1) provide a care plan to the care team for 
each patient participant; 
(2) provide access to participant health records; 
and 
(3) meet regularly with the care team to ensure 
integration of care. 
(e) REPORTING TO SECRETARY.—An entity that re-
ceives a grant or contract under subsection (a) shall sub-
mit to the Secretary a report that describes and evaluates, 
as requested by the Secretary, the activities carried out 
by the entity under subsection (c). 
(f) DEFINITION OF PRIMARY CARE.—In this section, 
the term ‘‘primary care’’ means the provision of inte-
grated, accessible health care services by clinicians who 
are accountable for addressing a large majority of personal 
health care needs, developing a sustained partnership with 
patients, and practicing in the context of family and com-
munity. 
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•AMDT. NO. 2786 
SEC. 
3503. 
MEDICATION 
MANAGEMENT 
SERVICES 
IN 
TREATMENT OF CHRONIC DISEASE. 
Title IX of the Public Health Service Act (42 U.S.C. 
299 et seq.), as amended by section 3501, is further 
amended by inserting after section 934 the following: 
‘‘SEC. 935. GRANTS OR CONTRACTS TO IMPLEMENT MEDI-
CATION MANAGEMENT SERVICES IN TREAT-
MENT OF CHRONIC DISEASES. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Patient Safety Research Center established in section 
933 (referred to in this section as the ‘Center’), shall es-
tablish a program to provide grants or contracts to eligible 
entities to implement medication management (referred to 
in this section as ‘MTM’) services provided by licensed 
pharmacists, as a collaborative, multidisciplinary, inter- 
professional approach to the treatment of chronic diseases 
for targeted individuals, to improve the quality of care and 
reduce overall cost in the treatment of such diseases. The 
Secretary shall commence the program under this section 
not later than May 1, 2010. 
‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 
a grant or contract under subsection (a), an entity shall— 
‘‘(1) provide a setting appropriate for MTM 
services, as recommended by the experts described in 
subsection (e); 
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•AMDT. NO. 2786 
‘‘(2) submit to the Secretary a plan for achiev-
ing long-term financial sustainability; 
‘‘(3) where applicable, submit a plan for coordi-
nating MTM services through local community 
health teams established in section 3502 of the Pa-
tient Protection and Affordable Care Act or in col-
laboration with primary care extension programs es-
tablished in section 399W; 
‘‘(4) submit a plan for meeting the require-
ments under subsection (c); and 
‘‘(5) submit to the Secretary such other infor-
mation as the Secretary may require. 
‘‘(c) MTM SERVICES TO TARGETED INDIVIDUALS.— 
The MTM services provided with the assistance of a grant 
or contract awarded under subsection (a) shall, as allowed 
by State law including applicable collaborative pharmacy 
practice agreements, include— 
‘‘(1) performing or obtaining necessary assess-
ments of the health and functional status of each 
patient receiving such MTM services; 
‘‘(2) formulating a medication treatment plan 
according to therapeutic goals agreed upon by the 
prescriber and the patient or caregiver or authorized 
representative of the patient; 
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•AMDT. NO. 2786 
‘‘(3) selecting, initiating, modifying, recom-
mending changes to, or administering medication 
therapy; 
‘‘(4) monitoring, which may include access to, 
ordering, or performing laboratory assessments, and 
evaluating the response of the patient to therapy, in-
cluding safety and effectiveness; 
‘‘(5) performing an initial comprehensive medi-
cation review to identify, resolve, and prevent medi-
cation-related problems, including adverse drug 
events, quarterly targeted medication reviews for on-
going monitoring, and additional followup interven-
tions on a schedule developed collaboratively with 
the prescriber; 
‘‘(6) documenting the care delivered and com-
municating essential information about such care, 
including a summary of the medication review, and 
the recommendations of the pharmacist to other ap-
propriate health care providers of the patient in a 
timely fashion; 
‘‘(7) providing education and training designed 
to enhance the understanding and appropriate use of 
the medications by the patient, caregiver, and other 
authorized representative; 
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•AMDT. NO. 2786 
‘‘(8) providing information, support services, 
and resources and strategies designed to enhance 
patient adherence with therapeutic regimens; 
‘‘(9) coordinating and integrating MTM serv-
ices within the broader health care management 
services provided to the patient; and 
‘‘(10) such other patient care services allowed 
under pharmacist scopes of practice in use in other 
Federal programs that have implemented MTM 
services. 
‘‘(d) TARGETED INDIVIDUALS.—MTM services pro-
vided by licensed pharmacists under a grant or contract 
awarded under subsection (a) shall be offered to targeted 
individuals who— 
‘‘(1) take 4 or more prescribed medications (in-
cluding over-the-counter medications and dietary 
supplements); 
‘‘(2) take any ‘high risk’ medications; 
‘‘(3) have 2 or more chronic diseases, as identi-
fied by the Secretary; or 
‘‘(4) have undergone a transition of care, or 
other factors, as determined by the Secretary, that 
are likely to create a high risk of medication-related 
problems. 
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•AMDT. NO. 2786 
‘‘(e) CONSULTATION WITH EXPERTS.—In designing 
and implementing MTM services provided under grants or 
contracts awarded under subsection (a), the Secretary 
shall consult with Federal, State, private, public-private, 
and academic entities, pharmacy and pharmacist organi-
zations, health care organizations, consumer advocates, 
chronic disease groups, and other stakeholders involved 
with the research, dissemination, and implementation of 
pharmacist-delivered MTM services, as the Secretary de-
termines appropriate. The Secretary, in collaboration with 
this group, shall determine whether it is possible to incor-
porate rapid cycle process improvement concepts in use 
in other Federal programs that have implemented MTM 
services. 
‘‘(f) REPORTING TO THE SECRETARY.—An entity 
that receives a grant or contract under subsection (a) shall 
submit to the Secretary a report that describes and evalu-
ates, as requested by the Secretary, the activities carried 
out under subsection (c), including quality measures en-
dorsed by the entity with a contract under section 1890 
of the Social Security Act, as determined by the Secretary. 
‘‘(g) EVALUATION
AND REPORT.—The Secretary 
shall submit to the relevant committees of Congress a re-
port which shall— 
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•AMDT. NO. 2786 
‘‘(1) assess the clinical effectiveness of phar-
macist-provided services under the MTM services 
program, as compared to usual care, including an 
evaluation of whether enrollees maintained better 
health with fewer hospitalizations and emergency 
room visits than similar patients not enrolled in the 
program; 
‘‘(2) assess changes in overall health care re-
source use by targeted individuals; 
‘‘(3) assess patient and prescriber satisfaction 
with MTM services; 
‘‘(4) assess the impact of patient-cost sharing 
requirements on medication adherence and rec-
ommendations for modifications; 
‘‘(5) identify and evaluate other factors that 
may impact clinical and economic outcomes, includ-
ing demographic characteristics, clinical characteris-
tics, and health services use of the patient, as well 
as characteristics of the regimen, pharmacy benefit, 
and MTM services provided; and 
‘‘(6) evaluate the extent to which participating 
pharmacists who maintain a dispensing role have a 
conflict of interest in the provision of MTM services, 
and if such conflict is found, provide recommenda-
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•AMDT. NO. 2786 
tions on how such a conflict might be appropriately 
addressed. 
‘‘(h) GRANTS OR CONTRACTS TO FUND DEVELOP-
MENT
OF PERFORMANCE MEASURES.—The Secretary 
may, through the quality measure development program 
under section 931 of the Public Health Service Act, award 
grants or contracts to eligible entities for the purpose of 
funding the development of performance measures that as-
sess the use and effectiveness of medication therapy man-
agement services.’’. 
SEC. 3504. DESIGN AND IMPLEMENTATION OF REGIONAL-
IZED SYSTEMS FOR EMERGENCY CARE. 
(a) IN GENERAL.—Title XII of the Public Health 
Service Act (42 U.S.C. 300d et seq.) is amended— 
(1) in section 1203— 
(A) in the section heading, by inserting 
‘‘FOR TRAUMA SYSTEMS’’ after ‘‘GRANTS’’; 
and 
(B) in subsection (a), by striking ‘‘Admin-
istrator of the Health Resources and Services 
Administration’’ and inserting ‘‘Assistant Sec-
retary for Preparedness and Response’’; 
(2) by inserting after section 1203 the fol-
lowing: 
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•AMDT. NO. 2786 
‘‘SEC. 1204. COMPETITIVE GRANTS FOR REGIONALIZED SYS-
TEMS FOR EMERGENCY CARE RESPONSE. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Assistant Secretary for Preparedness and Response, 
shall award not fewer than 4 multiyear contracts or com-
petitive grants to eligible entities to support pilot projects 
that design, implement, and evaluate innovative models of 
regionalized, comprehensive, and accountable emergency 
care and trauma systems. 
‘‘(b) ELIGIBLE ENTITY; REGION.—In this section: 
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means— 
‘‘(A) a State or a partnership of 1 or more 
States and 1 or more local governments; or 
‘‘(B) an Indian tribe (as defined in section 
4 of the Indian Health Care Improvement Act) 
or a partnership of 1 or more Indian tribes. 
‘‘(2) REGION.—The term ‘region’ means an 
area within a State, an area that lies within multiple 
States, or a similar area (such as a multicounty 
area), as determined by the Secretary. 
‘‘(3) EMERGENCY SERVICES.—The term ‘emer-
gency services’ includes acute, prehospital, and trau-
ma care. 
‘‘(c) PILOT PROJECTS.—The Secretary shall award 
a contract or grant under subsection (a) to an eligible enti-
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•AMDT. NO. 2786 
ty that proposes a pilot project to design, implement, and 
evaluate an emergency medical and trauma system that— 
‘‘(1) coordinates with public health and safety 
services, emergency medical services, medical facili-
ties, trauma centers, and other entities in a region 
to develop an approach to emergency medical and 
trauma system access throughout the region, includ-
ing 9–1–1 Public Safety Answering Points and 
emergency medical dispatch; 
‘‘(2) includes a mechanism, such as a regional 
medical direction or transport communications sys-
tem, that operates throughout the region to ensure 
that the patient is taken to the medically appro-
priate facility (whether an initial facility or a higher- 
level facility) in a timely fashion; 
‘‘(3) allows for the tracking of prehospital and 
hospital resources, including inpatient bed capacity, 
emergency department capacity, trauma center ca-
pacity, on-call specialist coverage, ambulance diver-
sion status, and the coordination of such tracking 
with regional communications and hospital destina-
tion decisions; and 
‘‘(4) 
includes 
a 
consistent 
region-wide 
prehospital, hospital, and interfacility data manage-
ment system that— 
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•AMDT. NO. 2786 
‘‘(A) submits data to the National EMS 
Information System, the National Trauma Data 
Bank, and others; 
‘‘(B) reports data to appropriate Federal 
and State databanks and registries; and 
‘‘(C) contains information sufficient to 
evaluate key elements of prehospital care, hos-
pital destination decisions, including initial hos-
pital and interfacility decisions, and relevant 
health outcomes of hospital care. 
‘‘(d) APPLICATION.— 
‘‘(1) IN
GENERAL.—An eligible entity that 
seeks a contract or grant described in subsection (a) 
shall submit to the Secretary an application at such 
time and in such manner as the Secretary may re-
quire. 
‘‘(2) APPLICATION INFORMATION.—Each appli-
cation shall include— 
‘‘(A) an assurance from the eligible entity 
that the proposed system— 
‘‘(i) has been coordinated with the ap-
plicable State Office of Emergency Medical 
Services (or equivalent State office); 
‘‘(ii) includes consistent indirect and 
direct medical oversight of prehospital, 
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•AMDT. NO. 2786 
hospital, 
and 
interfacility 
transport 
throughout the region; 
‘‘(iii) coordinates prehospital treat-
ment and triage, hospital destination, and 
interfacility transport throughout the re-
gion; 
‘‘(iv) includes a categorization or des-
ignation system for special medical facili-
ties throughout the region that is inte-
grated with transport and destination pro-
tocols; 
‘‘(v) includes a regional medical direc-
tion, patient tracking, and resource alloca-
tion system that supports day-to-day emer-
gency care and surge capacity and is inte-
grated with other components of the na-
tional and State emergency preparedness 
system; and 
‘‘(vi) addresses pediatric concerns re-
lated to integration, planning, prepared-
ness, and coordination of emergency med-
ical services for infants, children and ado-
lescents; and 
‘‘(B) such other information as the Sec-
retary may require. 
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•AMDT. NO. 2786 
‘‘(e) REQUIREMENT OF MATCHING FUNDS.— 
‘‘(1) IN
GENERAL.—The Secretary may not 
make a grant under this section unless the State (or 
consortia of States) involved agrees, with respect to 
the costs to be incurred by the State (or consortia) 
in carrying out the purpose for which such grant 
was made, to make available non-Federal contribu-
tions (in cash or in kind under paragraph (2)) to-
ward such costs in an amount equal to not less than 
$1 for each $3 of Federal funds provided in the 
grant. Such contributions may be made directly or 
through donations from public or private entities. 
‘‘(2) 
NON-FEDERAL
CONTRIBUTIONS.—Non- 
Federal contributions required in paragraph (1) may 
be in cash or in kind, fairly evaluated, including 
equipment or services (and excluding indirect or 
overhead costs). Amounts provided by the Federal 
Government, or services assisted or subsidized to 
any significant extent by the Federal Government, 
may not be included in determining the amount of 
such non-Federal contributions. 
‘‘(f) PRIORITY.—The Secretary shall give priority for 
the award of the contracts or grants described in sub-
section (a) to any eligible entity that serves a population 
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•AMDT. NO. 2786 
in a medically underserved area (as defined in section 
330(b)(3)). 
‘‘(g) REPORT.—Not later than 90 days after the com-
pletion of a pilot project under subsection (a), the recipi-
ent of such contract or grant described in shall submit 
to the Secretary a report containing the results of an eval-
uation of the program, including an identification of— 
‘‘(1) the impact of the regional, accountable 
emergency care and trauma system on patient health 
outcomes for various critical care categories, such as 
trauma, stroke, cardiac emergencies, neurological 
emergencies, and pediatric emergencies; 
‘‘(2) the system characteristics that contribute 
to the effectiveness and efficiency of the program (or 
lack thereof); 
‘‘(3) methods of assuring the long-term finan-
cial sustainability of the emergency care and trauma 
system; 
‘‘(4) the State and local legislation necessary to 
implement and to maintain the system; 
‘‘(5) the barriers to developing regionalized, ac-
countable emergency care and trauma systems, as 
well as the methods to overcome such barriers; and 
‘‘(6) recommendations on the utilization of 
available funding for future regionalization efforts. 
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•AMDT. NO. 2786 
‘‘(h) DISSEMINATION OF FINDINGS.—The Secretary 
shall, as appropriate, disseminate to the public and to the 
appropriate Committees of the Congress, the information 
contained in a report made under subsection (g).’’; and 
(3) in section 1232— 
(A) in subsection (a), by striking ‘‘appro-
priated’’ and all that follows through the period 
at 
the 
end 
and 
inserting 
‘‘appropriated 
$24,000,000 for each of fiscal years 2010 
through 2014.’’; and 
(B) by inserting after subsection (c) the 
following: 
‘‘(d) AUTHORITY.—For the purpose of carrying out 
parts A through C, beginning on the date of enactment 
of the Patient Protection and Affordable Care Act, the 
Secretary shall transfer authority in administering grants 
and related authorities under such parts from the Admin-
istrator of the Health Resources and Services Administra-
tion to the Assistant Secretary for Preparedness and Re-
sponse.’’. 
(b) SUPPORT
FOR
EMERGENCY
MEDICINE
RE-
SEARCH.—Part H of title IV of the Public Health Service 
Act (42 U.S.C. 289 et seq.) is amended by inserting after 
the section 498C the following: 
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•AMDT. NO. 2786 
‘‘SEC. 498D. SUPPORT FOR EMERGENCY MEDICINE RE-
SEARCH. 
‘‘(a) EMERGENCY MEDICAL RESEARCH.—The Sec-
retary shall support Federal programs administered by the 
National Institutes of Health, the Agency for Healthcare 
Research and Quality, the Health Resources and Services 
Administration, the Centers for Disease Control and Pre-
vention, and other agencies involved in improving the 
emergency care system to expand and accelerate research 
in emergency medical care systems and emergency medi-
cine, including— 
‘‘(1) the basic science of emergency medicine; 
‘‘(2) the model of service delivery and the com-
ponents of such models that contribute to enhanced 
patient health outcomes; 
‘‘(3) the translation of basic scientific research 
into improved practice; and 
‘‘(4) the development of timely and efficient de-
livery of health services. 
‘‘(b) 
PEDIATRIC
EMERGENCY
MEDICAL
RE-
SEARCH.—The Secretary shall support Federal programs 
administered by the National Institutes of Health, the 
Agency for Healthcare Research and Quality, the Health 
Resources and Services Administration, the Centers for 
Disease Control and Prevention, and other agencies to co-
ordinate and expand research in pediatric emergency med-
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•AMDT. NO. 2786 
ical care systems and pediatric emergency medicine, in-
cluding— 
‘‘(1) an examination of the gaps and opportuni-
ties in pediatric emergency care research and a 
strategy for the optimal organization and funding of 
such research; 
‘‘(2) the role of pediatric emergency services as 
an integrated component of the overall health sys-
tem; 
‘‘(3) system-wide pediatric emergency care plan-
ning, preparedness, coordination, and funding; 
‘‘(4) pediatric training in professional edu-
cation; and 
‘‘(5) research in pediatric emergency care, spe-
cifically on the efficacy, safety, and health outcomes 
of medications used for infants, children, and adoles-
cents in emergency care settings in order to improve 
patient safety. 
‘‘(c) IMPACT RESEARCH.—The Secretary shall sup-
port research to determine the estimated economic impact 
of, and savings that result from, the implementation of 
coordinated emergency care systems. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
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•AMDT. NO. 2786 
such sums as may be necessary for each of fiscal years 
2010 through 2014.’’. 
SEC. 3505. TRAUMA CARE CENTERS AND SERVICE AVAIL-
ABILITY. 
(a) TRAUMA CARE CENTERS.— 
(1) GRANTS
FOR
TRAUMA
CARE
CENTERS.— 
Section 1241 of the Public Health Service Act (42 
U.S.C. 300d–41) is amended by striking subsections 
(a) and (b) and inserting the following: 
‘‘(a) IN GENERAL.—The Secretary shall establish 3 
programs to award grants to qualified public, nonprofit 
Indian Health Service, Indian tribal, and urban Indian 
trauma centers— 
‘‘(1) to assist in defraying substantial uncom-
pensated care costs; 
‘‘(2) to further the core missions of such trau-
ma centers, including by addressing costs associated 
with patient stabilization and transfer, trauma edu-
cation and outreach, coordination with local and re-
gional trauma systems, essential personnel and other 
fixed costs, and expenses associated with employee 
and non-employee physician services; and 
‘‘(3) to provide emergency relief to ensure the 
continued and future availability of trauma services. 
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•AMDT. NO. 2786 
‘‘(b) MINIMUM QUALIFICATIONS OF TRAUMA CEN-
TERS.— 
‘‘(1) PARTICIPATION IN TRAUMA CARE SYSTEM 
OPERATING UNDER CERTAIN PROFESSIONAL GUIDE-
LINES.—Except as provided in paragraph (2), the 
Secretary may not award a grant to a trauma center 
under subsection (a) unless the trauma center is a 
participant in a trauma system that substantially 
complies with section 1213. 
‘‘(2) EXEMPTION.—Paragraph (1) shall not 
apply to trauma centers that are located in States 
with no existing trauma care system. 
‘‘(3) QUALIFICATION
FOR
SUBSTANTIAL
UN-
COMPENSATED
CARE
COSTS.—The Secretary shall 
award substantial uncompensated care grants under 
subsection (a)(1) only to trauma centers meeting at 
least 1 of the criteria in 1 of the following 3 cat-
egories: 
‘‘(A) CATEGORY A.—The criteria for cat-
egory A are as follows: 
‘‘(i) At least 40 percent of the visits 
in the emergency department of the hos-
pital in which the trauma center is located 
were charity or self-pay patients. 
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•AMDT. NO. 2786 
‘‘(ii) At least 50 percent of the visits 
in such emergency department were Med-
icaid (under title XIX of the Social Secu-
rity Act (42 U.S.C. 1396 et seq.)) and 
charity and self-pay patients combined. 
‘‘(B) CATEGORY B.—The criteria for cat-
egory B are as follows: 
‘‘(i) At least 35 percent of the visits 
in the emergency department were charity 
or self-pay patients. 
‘‘(ii) At least 50 percent of the visits 
in the emergency department were Med-
icaid and charity and self-pay patients 
combined. 
‘‘(C) CATEGORY C.—The criteria for cat-
egory C are as follows: 
‘‘(i) At least 20 percent of the visits 
in the emergency department were charity 
or self-pay patients. 
‘‘(ii) At least 30 percent of the visits 
in the emergency department were Med-
icaid and charity and self-pay patients 
combined. 
‘‘(4) TRAUMA
CENTERS
IN
1115
WAIVER 
STATES.—Notwithstanding paragraph (3), the Sec-
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•AMDT. NO. 2786 
retary may award a substantial uncompensated care 
grant to a trauma center under subsection (a)(1) if 
the trauma center qualifies for funds under a Low 
Income Pool or Safety Net Care Pool established 
through a waiver approved under section 1115 of the 
Social Security Act (42 U.S.C. 1315). 
‘‘(5) DESIGNATION.—The Secretary may not 
award a grant to a trauma center unless such trau-
ma center is verified by the American College of 
Surgeons or designated by an equivalent State or 
local agency. 
‘‘(c) ADDITIONAL REQUIREMENTS.—The Secretary 
may not award a grant to a trauma center under sub-
section (a)(1) unless such trauma center— 
‘‘(1) submits to the Secretary a plan satisfac-
tory to the Secretary that demonstrates a continued 
commitment to serving trauma patients regardless of 
their ability to pay; and 
‘‘(2) has policies in place to assist patients who 
cannot pay for part or all of the care they receive, 
including a sliding fee scale, and to ensure fair bill-
ing and collection practices.’’. 
(2) CONSIDERATIONS
IN
MAKING
GRANTS.— 
Section 1242 of the Public Health Service Act (42 
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•AMDT. NO. 2786 
U.S.C. 300d–42) is amended by striking subsections 
(a) and (b) and inserting the following: 
‘‘(a) 
SUBSTANTIAL
UNCOMPENSATED
CARE 
AWARDS.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish an award basis for each eligible trauma center 
for grants under section 1241(a)(1) according to the 
percentage described in paragraph (2), subject to the 
requirements of section 1241(b)(3). 
‘‘(2) PERCENTAGES.—The applicable percent-
ages are as follows: 
‘‘(A) With respect to a category A trauma 
center, 100 percent of the uncompensated care 
costs. 
‘‘(B) With respect to a category B trauma 
center, not more than 75 percent of the uncom-
pensated care costs. 
‘‘(C) With respect to a category C trauma 
center, not more than 50 percent of the uncom-
pensated care costs. 
‘‘(b) CORE MISSION AWARDS.— 
‘‘(1) IN GENERAL.—In awarding grants under 
section 1241(a)(2), the Secretary shall— 
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•AMDT. NO. 2786 
‘‘(A) reserve 25 percent of the amount al-
located for core mission awards for Level III 
and Level IV trauma centers; and 
‘‘(B) reserve 25 percent of the amount al-
located for core mission awards for large urban 
Level I and II trauma centers— 
‘‘(i) that have at least 1 graduate 
medical education fellowship in trauma or 
trauma related specialties for which de-
mand is exceeding supply; 
‘‘(ii) for which— 
‘‘(I) annual uncompensated care 
costs exceed $10,000,000; or 
‘‘(II) at least 20 percent of emer-
gency department visits are charity or 
self-pay or Medicaid patients; and 
‘‘(iii) that are not eligible for substan-
tial uncompensated care awards under sec-
tion 1241(a)(1). 
‘‘(c) EMERGENCY AWARDS.—In awarding grants 
under section 1241(a)(3), the Secretary shall— 
‘‘(1) give preference to any application sub-
mitted by a trauma center that provides trauma care 
in a geographic area in which the availability of 
trauma care has significantly decreased or will sig-
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•AMDT. NO. 2786 
nificantly decrease if the center is forced to close or 
downgrade service or growth in demand for trauma 
services exceeds capacity; and 
‘‘(2) reallocate any emergency awards funds not 
obligated due to insufficient, or a lack of qualified, 
applications to the significant uncompensated care 
award program.’’. 
(3) CERTAIN AGREEMENTS.—Section 1243 of 
the Public Health Service Act (42 U.S.C. 300d–43) 
is amended by striking subsections (a), (b), and (c) 
and inserting the following: 
‘‘(a) MAINTENANCE OF FINANCIAL SUPPORT.—The 
Secretary may require a trauma center receiving a grant 
under section 1241(a) to maintain access to trauma serv-
ices at comparable levels to the prior year during the grant 
period. 
‘‘(b) TRAUMA CARE REGISTRY.—The Secretary may 
require the trauma center receiving a grant under section 
1241(a) to provide data to a national and centralized reg-
istry of trauma cases, in accordance with guidelines devel-
oped by the American College of Surgeons, and as the Sec-
retary may otherwise require.’’. 
(4) GENERAL
PROVISIONS.—Section 1244 of 
the Public Health Service Act (42 U.S.C. 300d–44) 
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•AMDT. NO. 2786 
is amended by striking subsections (a), (b), and (c) 
and inserting the following: 
‘‘(a) APPLICATION.—The Secretary may not award 
a grant to a trauma center under section 1241(a) unless 
such center submits an application for the grant to the 
Secretary and the application is in such form, is made in 
such manner, and contains such agreements, assurances, 
and information as the Secretary determines to be nec-
essary to carry out this part. 
‘‘(b) LIMITATION ON DURATION OF SUPPORT.—The 
period during which a trauma center receives payments 
under a grant under section 1241(a)(3) shall be for 3 fis-
cal years, except that the Secretary may waive such re-
quirement for a center and authorize such center to re-
ceive such payments for 1 additional fiscal year. 
‘‘(c) LIMITATION ON AMOUNT OF GRANT.—Notwith-
standing section 1242(a), a grant under section 1241 may 
not be made in an amount exceeding $2,000,000 for each 
fiscal year. 
‘‘(d) ELIGIBILITY.—Except as provided in section 
1242(b)(1)(B)(iii), acquisition of, or eligibility for, a grant 
under section 1241(a) shall not preclude a trauma center 
from being eligible for other grants described in such sec-
tion. 
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•AMDT. NO. 2786 
‘‘(e) FUNDING DISTRIBUTION.—Of the total amount 
appropriated for a fiscal year under section 1245, 70 per-
cent shall be used for substantial uncompensated care 
awards under section 1241(a)(1), 20 percent shall be used 
for core mission awards under section 1241(a)(2), and 10 
percent shall be used for emergency awards under section 
1241(a)(3). 
‘‘(f) MINIMUM ALLOWANCE.—Notwithstanding sub-
section (e), if the amount appropriated for a fiscal year 
under section 1245 is less than $25,000,000, all available 
funding for such fiscal year shall be used for substantial 
uncompensated care awards under section 1241(a)(1). 
‘‘(g) SUBSTANTIAL UNCOMPENSATED CARE AWARD 
DISTRIBUTION
AND PROPORTIONAL SHARE.—Notwith-
standing section 1242(a), of the amount appropriated for 
substantial uncompensated care grants for a fiscal year, 
the Secretary shall— 
‘‘(1) make available— 
‘‘(A) 50 percent of such funds for category 
A trauma center grantees; 
‘‘(B) 35 percent of such funds for category 
B trauma center grantees; and 
‘‘(C) 15 percent of such funds for category 
C trauma center grantees; and 
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•AMDT. NO. 2786 
‘‘(2) provide available funds within each cat-
egory in a manner proportional to the award basis 
specified in section 1242(a)(2) to each eligible trau-
ma center. 
‘‘(h) REPORT.—Beginning 2 years after the date of 
enactment of the Patient Protection and Affordable Care 
Act, and every 2 years thereafter, the Secretary shall bien-
nially report to Congress regarding the status of the 
grants made under section 1241 and on the overall finan-
cial stability of trauma centers.’’. 
(5) AUTHORIZATION
OF
APPROPRIATIONS.— 
Section 1245 of the Public Health Service Act (42 
U.S.C. 300d–45) is amended to read as follows: 
‘‘SEC. 1245. AUTHORIZATION OF APPROPRIATIONS. 
‘‘For the purpose of carrying out this part, there are 
authorized to be appropriated $100,000,000 for fiscal year 
2009, and such sums as may be necessary for each of fis-
cal years 2010 through 2015. Such authorization of ap-
propriations is in addition to any other authorization of 
appropriations or amounts that are available for such pur-
pose.’’. 
(6) DEFINITION.—Part D of title XII of the 
Public Health Service Act (42 U.S.C. 300d–41 et 
seq.) is amended by adding at the end the following: 
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•AMDT. NO. 2786 
‘‘SEC. 1246. DEFINITION. 
‘‘In this part, the term ‘uncompensated care costs’ 
means unreimbursed costs from serving self-pay, charity, 
or Medicaid patients, without regard to payment under 
section 1923 of the Social Security Act, all of which are 
attributable to emergency care and trauma care, including 
costs related to subsequent inpatient admissions to the 
hospital.’’. 
(b) TRAUMA SERVICE AVAILABILITY.—Title XII of 
the Public Health Service Act (42 U.S.C. 300d et seq.) 
is amended by adding at the end the following: 
‘‘PART H—TRAUMA SERVICE AVAILABILITY 
‘‘SEC. 1281. GRANTS TO STATES. 
‘‘(a) ESTABLISHMENT.—To promote universal access 
to trauma care services provided by trauma centers and 
trauma-related physician specialties, the Secretary shall 
provide funding to States to enable such States to award 
grants to eligible entities for the purposes described in this 
section. 
‘‘(b) AWARDING
OF GRANTS
BY STATES.—Each 
State may award grants to eligible entities within the 
State for the purposes described in subparagraph (d). 
‘‘(c) ELIGIBILITY.— 
‘‘(1) IN GENERAL.—To be eligible to receive a 
grant under subsection (b) an entity shall— 
‘‘(A) be— 
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•AMDT. NO. 2786 
‘‘(i) a public or nonprofit trauma cen-
ter or consortium thereof that meets that 
requirements of paragraphs (1), (2), and 
(5) of section 1241(b); 
‘‘(ii) a safety net public or nonprofit 
trauma center that meets the requirements 
of paragraphs (1) through (5) of section 
1241(b); or 
‘‘(iii) a hospital in an underserved 
area (as defined by the State) that seeks 
to establish new trauma services; and 
‘‘(B) submit to the State an application at 
such time, in such manner, and containing such 
information as the State may require. 
‘‘(2) LIMITATION.—A State shall use at least 
40 percent of the amount available to the State 
under this part for a fiscal year to award grants to 
safety net trauma centers described in paragraph 
(1)(A)(ii). 
‘‘(d) USE OF FUNDS.—The recipient of a grant under 
subsection (b) shall carry out 1 or more of the following 
activities consistent with subsection (b): 
‘‘(1) Providing trauma centers with funding to 
support physician compensation in trauma-related 
physician specialties where shortages exist in the re-
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•AMDT. NO. 2786 
gion involved, with priority provided to safety net 
trauma centers described in subsection (c)(1)(A)(ii). 
‘‘(2) Providing for individual safety net trauma 
center fiscal stability and costs related to having 
service that is available 24 hours a day, 7 days a 
week, with priority provided to safety net trauma 
centers described in subsection (c)(1)(A)(ii) located 
in urban, border, and rural areas. 
‘‘(3) Reducing trauma center overcrowding at 
specific trauma centers related to throughput of 
trauma patients. 
‘‘(4) Establishing new trauma services in un-
derserved areas as defined by the State. 
‘‘(5) Enhancing collaboration between trauma 
centers and other hospitals and emergency medical 
services personnel related to trauma service avail-
ability. 
‘‘(6) Making capital improvements to enhance 
access and expedite trauma care, including providing 
helipads and associated safety infrastructure. 
‘‘(7) Enhancing trauma surge capacity at spe-
cific trauma centers. 
‘‘(8) Ensuring expedient receipt of trauma pa-
tients transported by ground or air to the appro-
priate trauma center. 
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•AMDT. NO. 2786 
‘‘(9) Enhancing interstate trauma center col-
laboration. 
‘‘(e) LIMITATION.— 
‘‘(1) IN GENERAL.—A State may use not more 
than 20 percent of the amount available to the State 
under this part for a fiscal year for administrative 
costs associated with awarding grants and related 
costs. 
‘‘(2) MAINTENANCE
OF
EFFORT.—The Sec-
retary may not provide funding to a State under this 
part unless the State agrees that such funds will be 
used to supplement and not supplant State funding 
otherwise available for the activities and costs de-
scribed in this part. 
‘‘(f) DISTRIBUTION OF FUNDS.—The following shall 
apply with respect to grants provided in this part: 
‘‘(1) LESS THAN $10,000,000.—If the amount of 
appropriations for this part in a fiscal year is less 
than $10,000,000, the Secretary shall divide such 
funding evenly among only those States that have 1 
or more trauma centers eligible for funding under 
section 1241(b)(3)(A). 
‘‘(2) LESS THAN $20,000,000.—If the amount of 
appropriations in a fiscal year is less than 
$20,000,000, the Secretary shall divide such funding 
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•AMDT. NO. 2786 
evenly among only those States that have 1 or more 
trauma centers eligible for funding under subpara-
graphs (A) and (B) of section 1241(b)(3). 
‘‘(3) LESS THAN $30,000,000.—If the amount of 
appropriations for this part in a fiscal year is less 
than $30,000,000, the Secretary shall divide such 
funding evenly among only those States that have 1 
or more trauma centers eligible for funding under 
section 1241(b)(3). 
‘‘(4) $30,000,000 OR MORE.—If the amount of 
appropriations for this part in a fiscal year is 
$30,000,000 or more, the Secretary shall divide such 
funding evenly among all States. 
‘‘SEC. 1282. AUTHORIZATION OF APPROPRIATIONS. 
‘‘For the purpose of carrying out this part, there is 
authorized to be appropriated $100,000,000 for each of 
fiscal years 2010 through 2015.’’. 
SEC. 3506. PROGRAM TO FACILITATE SHARED DECISION-
MAKING. 
Part D of title IX of the Public Health Service Act, 
as amended by section 3503, is further amended by adding 
at the end the following: 
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•AMDT. NO. 2786 
‘‘SEC. 936. PROGRAM TO FACILITATE SHARED DECISION-
MAKING. 
‘‘(a) PURPOSE.—The purpose of this section is to fa-
cilitate collaborative processes between patients, caregivers 
or authorized representatives, and clinicians that engages 
the patient, caregiver or authorized representative in deci-
sionmaking, provides patients, caregivers or authorized 
representatives with information about trade-offs among 
treatment options, and facilitates the incorporation of pa-
tient preferences and values into the medical plan. 
‘‘(b) DEFINITIONS.—In this section: 
‘‘(1) PATIENT DECISION AID.—The term ‘pa-
tient decision aid’ means an educational tool that 
helps patients, caregivers or authorized representa-
tives understand and communicate their beliefs and 
preferences related to their treatment options, and 
to decide with their health care provider what treat-
ments are best for them based on their treatment 
options, scientific evidence, circumstances, beliefs, 
and preferences. 
‘‘(2) PREFERENCE SENSITIVE CARE.—The term 
‘preference sensitive care’ means medical care for 
which the clinical evidence does not clearly support 
one treatment option such that the appropriate 
course of treatment depends on the values of the pa-
tient or the preferences of the patient, caregivers or 
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•AMDT. NO. 2786 
authorized representatives regarding the benefits, 
harms and scientific evidence for each treatment op-
tion, the use of such care should depend on the in-
formed patient choice among clinically appropriate 
treatment options. 
‘‘(c) ESTABLISHMENT OF INDEPENDENT STANDARDS 
FOR PATIENT DECISION AIDS FOR PREFERENCE SEN-
SITIVE CARE.— 
‘‘(1) CONTRACT WITH ENTITY TO ESTABLISH 
STANDARDS
AND
CERTIFY
PATIENT
DECISION 
AIDS.— 
‘‘(A) IN GENERAL.—For purposes of sup-
porting consensus-based standards for patient 
decision aids for preference sensitive care and a 
certification process for patient decision aids for 
use in the Federal health programs and by 
other interested parties, the Secretary shall 
have in effect a contract with the entity with a 
contract under section 1890 of the Social Secu-
rity Act. Such contract shall provide that the 
entity perform the duties described in para-
graph (2). 
‘‘(B) TIMING FOR FIRST CONTRACT.—As 
soon as practicable after the date of the enact-
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•AMDT. NO. 2786 
ment of this section, the Secretary shall enter 
into the first contract under subparagraph (A). 
‘‘(C) PERIOD OF CONTRACT.—A contract 
under subparagraph (A) shall be for a period of 
18 months (except such contract may be re-
newed after a subsequent bidding process). 
‘‘(2) DUTIES.—The following duties are de-
scribed in this paragraph: 
‘‘(A) DEVELOP AND IDENTIFY STANDARDS 
FOR PATIENT DECISION AIDS.—The entity shall 
synthesize evidence and convene a broad range 
of experts and key stakeholders to develop and 
identify consensus-based standards to evaluate 
patient decision aids for preference sensitive 
care. 
‘‘(B) ENDORSE PATIENT DECISION AIDS.— 
The entity shall review patient decision aids 
and develop a certification process whether pa-
tient decision aids meet the standards developed 
and identified under subparagraph (A). The en-
tity shall give priority to the review and certifi-
cation of patient decision aids for preference 
sensitive care. 
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•AMDT. NO. 2786 
‘‘(d) PROGRAM TO DEVELOP, UPDATE AND PATIENT 
DECISION AIDS TO ASSIST HEALTH CARE PROVIDERS 
AND PATIENTS.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Director, and in coordination with heads 
of other relevant agencies, such as the Director of 
the Centers for Disease Control and Prevention and 
the Director of the National Institutes of Health, 
shall establish a program to award grants or con-
tracts— 
‘‘(A) to develop, update, and produce pa-
tient decision aids for preference sensitive care 
to assist health care providers in educating pa-
tients, caregivers, and authorized representa-
tives concerning the relative safety, relative ef-
fectiveness (including possible health outcomes 
and impact on functional status), and relative 
cost of treatment or, where appropriate, pallia-
tive care options; 
‘‘(B) to test such materials to ensure such 
materials are balanced and evidence based in 
aiding health care providers and patients, care-
givers, and authorized representatives to make 
informed decisions about patient care and can 
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•AMDT. NO. 2786 
be easily incorporated into a broad array of 
practice settings; and 
‘‘(C) to educate providers on the use of 
such materials, including through academic cur-
ricula. 
‘‘(2) REQUIREMENTS
FOR
PATIENT
DECISION 
AIDS.—Patient decision aids developed and produced 
pursuant to a grant or contract under paragraph 
(1)— 
‘‘(A) shall be designed to engage patients, 
caregivers, and authorized representatives in in-
formed decisionmaking with health care pro-
viders; 
‘‘(B) shall present up-to-date clinical evi-
dence about the risks and benefits of treatment 
options in a form and manner that is age-ap-
propriate and can be adapted for patients, care-
givers, and authorized representatives from a 
variety of cultural and educational backgrounds 
to reflect the varying needs of consumers and 
diverse levels of health literacy; 
‘‘(C) shall, where appropriate, explain why 
there is a lack of evidence to support one treat-
ment option over another; and 
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•AMDT. NO. 2786 
‘‘(D) shall address health care decisions 
across the age span, including those affecting 
vulnerable populations including children. 
‘‘(3) DISTRIBUTION.—The Director shall ensure 
that patient decision aids produced with grants or 
contracts under this section are available to the pub-
lic. 
‘‘(4) NONDUPLICATION OF EFFORTS.—The Di-
rector shall ensure that the activities under this sec-
tion of the Agency and other agencies, including the 
Centers for Disease Control and Prevention and the 
National Institutes of Health, are free of unneces-
sary duplication of effort. 
‘‘(e) GRANTS
TO
SUPPORT
SHARED
DECISION-
MAKING IMPLEMENTATION.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish a program to provide for the phased-in develop-
ment, implementation, and evaluation of shared deci-
sionmaking using patient decision aids to meet the 
objective of improving the understanding of patients 
of their medical treatment options. 
‘‘(2) SHARED DECISIONMAKING RESOURCE CEN-
TERS.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
provide grants for the establishment and sup-
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•AMDT. NO. 2786 
port of Shared Decisionmaking Resource Cen-
ters (referred to in this subsection as ‘Centers’) 
to provide technical assistance to providers and 
to develop and disseminate best practices and 
other information to support and accelerate 
adoption, implementation, and effective use of 
patient decision aids and shared decisionmaking 
by providers. 
‘‘(B) OBJECTIVES.—The objective of a 
Center is to enhance and promote the adoption 
of patient decision aids and shared decision-
making through— 
‘‘(i) providing assistance to eligible 
providers with the implementation and ef-
fective use of, and training on, patient de-
cision aids; and 
‘‘(ii) the dissemination of best prac-
tices and research on the implementation 
and effective use of patient decision aids. 
‘‘(3) SHARED DECISIONMAKING PARTICIPATION 
GRANTS.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
provide grants to health care providers for the 
development and implementation of shared deci-
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•AMDT. NO. 2786 
sionmaking techniques and to assess the use of 
such techniques. 
‘‘(B) PREFERENCE.—In order to facilitate 
the use of best practices, the Secretary shall 
provide a preference in making grants under 
this subsection to health care providers who 
participate in training by Shared Decision-
making Resource Centers or comparable train-
ing. 
‘‘(C) 
LIMITATION.—Funds 
under 
this 
paragraph shall not be used to purchase or im-
plement use of patient decision aids other than 
those certified under the process identified in 
subsection (c). 
‘‘(4) GUIDANCE.—The Secretary may issue 
guidance to eligible grantees under this subsection 
on the use of patient decision aids. 
‘‘(f) FUNDING.—For purposes of carrying out this 
section there are authorized to be appropriated such sums 
as may be necessary for fiscal year 2010 and each subse-
quent fiscal year.’’. 
SEC. 3507. PRESENTATION OF PRESCRIPTION DRUG BEN-
EFIT AND RISK INFORMATION. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
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•AMDT. NO. 2786 
retary’’), acting through the Commissioner of Food and 
Drugs, shall determine whether the addition of quan-
titative summaries of the benefits and risks of prescription 
drugs in a standardized format (such as a table or drug 
facts box) to the promotional labeling or print advertising 
of such drugs would improve health care decisionmaking 
by clinicians and patients and consumers. 
(b) REVIEW AND CONSULTATION.—In making the 
determination under subsection (a), the Secretary shall re-
view all available scientific evidence and research on deci-
sionmaking and social and cognitive psychology and con-
sult with drug manufacturers, clinicians, patients and con-
sumers, experts in health literacy, representatives of racial 
and ethnic minorities, and experts in women’s and pedi-
atric health. 
(c) REPORT.—Not later than 1 year after the date 
of enactment of this Act, the Secretary shall submit to 
Congress a report that provides— 
(1) the determination by the Secretary under 
subsection (a); and 
(2) the reasoning and analysis underlying that 
determination. 
(d) AUTHORITY.—If the Secretary determines under 
subsection (a) that the addition of quantitative summaries 
of the benefits and risks of prescription drugs in a stand-
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•AMDT. NO. 2786 
ardized format (such as a table or drug facts box) to the 
promotional labeling or print advertising of such drugs 
would improve health care decisionmaking by clinicians 
and patients and consumers, then the Secretary, not later 
than 3 years after the date of submission of the report 
under subsection (c), shall promulgate proposed regula-
tions as necessary to implement such format. 
(e) CLARIFICATION.—Nothing in this section shall be 
construed to restrict the existing authorities of the Sec-
retary with respect to benefit and risk information. 
SEC. 3508. DEMONSTRATION PROGRAM TO INTEGRATE 
QUALITY IMPROVEMENT AND PATIENT SAFE-
TY TRAINING INTO CLINICAL EDUCATION OF 
HEALTH PROFESSIONALS. 
(a) IN GENERAL.—The Secretary may award grants 
to eligible entities or consortia under this section to carry 
out demonstration projects to develop and implement aca-
demic curricula that integrates quality improvement and 
patient safety in the clinical education of health profes-
sionals. Such awards shall be made on a competitive basis 
and pursuant to peer review. 
(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity or consortium shall— 
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•AMDT. NO. 2786 
(1) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require; 
(2) be or include— 
(A) a health professions school; 
(B) a school of public health; 
(C) a school of social work; 
(D) a school of nursing; 
(E) a school of pharmacy; 
(F) an institution with a graduate medical 
education program; or 
(G) a school of health care administration; 
(3) collaborate in the development of curricula 
described in subsection (a) with an organization that 
accredits such school or institution; 
(4) provide for the collection of data regarding 
the effectiveness of the demonstration project; and 
(5) provide matching funds in accordance with 
subsection (c). 
(c) MATCHING FUNDS.— 
(1) IN GENERAL.—The Secretary may award a 
grant to an entity or consortium under this section 
only if the entity or consortium agrees to make 
available non-Federal contributions toward the costs 
of the program to be funded under the grant in an 
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•AMDT. NO. 2786 
amount that is not less than $1 for each $5 of Fed-
eral funds provided under the grant. 
(2) DETERMINATION
OF
AMOUNT
CONTRIB-
UTED.—Non-Federal contributions under paragraph 
(1) may be in cash or in-kind, fairly evaluated, in-
cluding equipment or services. Amounts provided by 
the Federal Government, or services assisted or sub-
sidized to any significant extent by the Federal Gov-
ernment, may not be included in determining the 
amount of such contributions. 
(d) EVALUATION.—The Secretary shall take such ac-
tion as may be necessary to evaluate the projects funded 
under this section and publish, make publicly available, 
and disseminate the results of such evaluations on as wide 
a basis as is practicable. 
(e) REPORTS.—Not later than 2 years after the date 
of enactment of this section, and annually thereafter, the 
Secretary shall submit to the Committee on Health, Edu-
cation, Labor, and Pensions and the Committee on Fi-
nance of the Senate and the Committee on Energy and 
Commerce and the Committee on Ways and Means of the 
House of Representatives a report that— 
(1) describes the specific projects supported 
under this section; and 
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•AMDT. NO. 2786 
(2) contains recommendations for Congress 
based on the evaluation conducted under subsection 
(d). 
SEC. 3509. IMPROVING WOMEN’S HEALTH. 
(a) HEALTH
AND HUMAN SERVICES OFFICE
ON 
WOMEN’S HEALTH.— 
(1) ESTABLISHMENT.—Part A of title II of the 
Public Health Service Act (42 U.S.C. 202 et seq.) 
is amended by adding at the end the following: 
‘‘SEC. 229. HEALTH AND HUMAN SERVICES OFFICE ON 
WOMEN’S HEALTH. 
‘‘(a) ESTABLISHMENT OF OFFICE.—There is estab-
lished within the Office of the Secretary, an Office on 
Women’s Health (referred to in this section as the ‘Of-
fice’). The Office shall be headed by a Deputy Assistant 
Secretary for Women’s Health who may report to the Sec-
retary. 
‘‘(b) DUTIES.—The Secretary, acting through the Of-
fice, with respect to the health concerns of women, shall— 
‘‘(1) establish short-range and long-range goals 
and objectives within the Department of Health and 
Human Services and, as relevant and appropriate, 
coordinate with other appropriate offices on activi-
ties within the Department that relate to disease 
prevention, health promotion, service delivery, re-
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•AMDT. NO. 2786 
search, and public and health care professional edu-
cation, for issues of particular concern to women 
throughout their lifespan; 
‘‘(2) provide expert advice and consultation to 
the Secretary concerning scientific, legal, ethical, 
and policy issues relating to women’s health; 
‘‘(3) monitor the Department of Health and 
Human Services’ offices, agencies, and regional ac-
tivities regarding women’s health and identify needs 
regarding the coordination of activities, including in-
tramural and extramural multidisciplinary activities; 
‘‘(4) establish a Department of Health and 
Human Services Coordinating Committee on Wom-
en’s Health, which shall be chaired by the Deputy 
Assistant Secretary for Women’s Health and com-
posed of senior level representatives from each of the 
agencies and offices of the Department of Health 
and Human Services; 
‘‘(5) establish a National Women’s Health In-
formation Center to— 
‘‘(A) facilitate the exchange of information 
regarding matters relating to health informa-
tion, health promotion, preventive health serv-
ices, research advances, and education in the 
appropriate use of health care; 
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•AMDT. NO. 2786 
‘‘(B) facilitate access to such information; 
‘‘(C) assist in the analysis of issues and 
problems relating to the matters described in 
this paragraph; and 
‘‘(D) provide technical assistance with re-
spect to the exchange of information (including 
facilitating the development of materials for 
such technical assistance); 
‘‘(6) coordinate efforts to promote women’s 
health programs and policies with the private sector; 
and 
‘‘(7) through publications and any other means 
appropriate, provide for the exchange of information 
between the Office and recipients of grants, con-
tracts, and agreements under subsection (c), and be-
tween the Office and health professionals and the 
general public. 
‘‘(c) GRANTS
AND CONTRACTS REGARDING DU-
TIES.— 
‘‘(1) AUTHORITY.—In carrying out subsection 
(b), the Secretary may make grants to, and enter 
into cooperative agreements, contracts, and inter-
agency agreements with, public and private entities, 
agencies, and organizations. 
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•AMDT. NO. 2786 
‘‘(2) EVALUATION AND DISSEMINATION.—The 
Secretary shall directly or through contracts with 
public and private entities, agencies, and organiza-
tions, provide for evaluations of projects carried out 
with financial assistance provided under paragraph 
(1) and for the dissemination of information devel-
oped as a result of such projects. 
‘‘(d) REPORTS.—Not later than 1 year after the date 
of enactment of this section, and every second year there-
after, the Secretary shall prepare and submit to the appro-
priate committees of Congress a report describing the ac-
tivities carried out under this section during the period 
for which the report is being prepared. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out this section, there are authorized 
to be appropriated such sums as may be necessary for 
each of the fiscal years 2010 through 2014.’’. 
(2) TRANSFER
OF
FUNCTIONS.—There are 
transferred to the Office on Women’s Health (estab-
lished under section 229 of the Public Health Serv-
ice Act, as added by this section), all functions exer-
cised by the Office on Women’s Health of the Public 
Health Service prior to the date of enactment of this 
section, including all personnel and compensation 
authority, all delegation and assignment authority, 
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•AMDT. NO. 2786 
and all remaining appropriations. All orders, deter-
minations, rules, regulations, permits, agreements, 
grants, contracts, certificates, licenses, registrations, 
privileges, and other administrative actions that— 
(A) have been issued, made, granted, or al-
lowed to become effective by the President, any 
Federal agency or official thereof, or by a court 
of competent jurisdiction, in the performance of 
functions transferred under this paragraph; and 
(B) are in effect at the time this section 
takes effect, or were final before the date of en-
actment of this section and are to become effec-
tive on or after such date, 
shall continue in effect according to their terms until 
modified, terminated, superseded, set aside, or re-
voked in accordance with law by the President, the 
Secretary, or other authorized official, a court of 
competent jurisdiction, or by operation of law. 
(b) CENTERS FOR DISEASE CONTROL AND PREVEN-
TION OFFICE OF WOMEN’S HEALTH.—Part A of title III 
of the Public Health Service Act (42 U.S.C. 241 et seq.) 
is amended by adding at the end the following: 
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•AMDT. NO. 2786 
‘‘SEC. 310A. CENTERS FOR DISEASE CONTROL AND PREVEN-
TION OFFICE OF WOMEN’S HEALTH. 
‘‘(a) ESTABLISHMENT.—There is established within 
the Office of the Director of the Centers for Disease Con-
trol and Prevention, an office to be known as the Office 
of Women’s Health (referred to in this section as the ‘Of-
fice’). The Office shall be headed by a director who shall 
be appointed by the Director of such Centers. 
‘‘(b) PURPOSE.—The Director of the Office shall— 
‘‘(1) report to the Director of the Centers for 
Disease Control and Prevention on the current level 
of the Centers’ activity regarding women’s health 
conditions across, where appropriate, age, biological, 
and sociocultural contexts, in all aspects of the Cen-
ters’ work, including prevention programs, public 
and professional education, services, and treatment; 
‘‘(2) establish short-range and long-range goals 
and objectives within the Centers for women’s health 
and, as relevant and appropriate, coordinate with 
other appropriate offices on activities within the 
Centers that relate to prevention, research, edu-
cation and training, service delivery, and policy de-
velopment, for issues of particular concern to 
women; 
‘‘(3) identify projects in women’s health that 
should be conducted or supported by the Centers; 
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•AMDT. NO. 2786 
‘‘(4) consult with health professionals, non-
governmental organizations, consumer organizations, 
women’s health professionals, and other individuals 
and groups, as appropriate, on the policy of the Cen-
ters with regard to women; and 
‘‘(5) serve as a member of the Department of 
Health and Human Services Coordinating Com-
mittee on Women’s Health (established under sec-
tion 229(b)(4)). 
‘‘(c) DEFINITION.—As used in this section, the term 
‘women’s health conditions’, with respect to women of all 
age, ethnic, and racial groups, means diseases, disorders, 
and conditions— 
‘‘(1) unique to, significantly more serious for, 
or significantly more prevalent in women; and 
‘‘(2) for which the factors of medical risk or 
type of medical intervention are different for women, 
or for which there is reasonable evidence that indi-
cates that such factors or types may be different for 
women. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out this section, there are authorized 
to be appropriated such sums as may be necessary for 
each of the fiscal years 2010 through 2014.’’. 
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•AMDT. NO. 2786 
(c) OFFICE OF WOMEN’S HEALTH RESEARCH.—Sec-
tion 486(a) of the Public Health Service Act (42 U.S.C. 
287d(a)) is amended by inserting ‘‘and who shall report 
directly to the Director’’ before the period at the end 
thereof. 
(d) SUBSTANCE
ABUSE
AND
MENTAL
HEALTH 
SERVICES ADMINISTRATION.—Section 501(f) of the Pub-
lic Health Service Act (42 U.S.C. 290aa(f)) is amended— 
(1) in paragraph (1), by inserting ‘‘who shall 
report directly to the Administrator’’ before the pe-
riod; 
(2) by redesignating paragraph (4) as para-
graph (5); and 
(3) by inserting after paragraph (3), the fol-
lowing: 
‘‘(4) OFFICE.—Nothing in this subsection shall 
be construed to preclude the Secretary from estab-
lishing within the Substance Abuse and Mental 
Health Administration an Office of Women’s 
Health.’’. 
(e) AGENCY
FOR HEALTHCARE RESEARCH
AND 
QUALITY ACTIVITIES REGARDING WOMEN’S HEALTH.— 
Part C of title IX of the Public Health Service Act (42 
U.S.C. 299c et seq.) is amended— 
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•AMDT. NO. 2786 
(1) by redesignating sections 925 and 926 as 
sections 926 and 927, respectively; and 
(2) by inserting after section 924 the following: 
‘‘SEC. 925. ACTIVITIES REGARDING WOMEN’S HEALTH. 
‘‘(a) ESTABLISHMENT.—There is established within 
the Office of the Director, an Office of Women’s Health 
and Gender-Based Research (referred to in this section 
as the ‘Office’). The Office shall be headed by a director 
who shall be appointed by the Director of Healthcare and 
Research Quality. 
‘‘(b) PURPOSE.—The official designated under sub-
section (a) shall— 
‘‘(1) report to the Director on the current 
Agency level of activity regarding women’s health, 
across, where appropriate, age, biological, and 
sociocultural contexts, in all aspects of Agency work, 
including the development of evidence reports and 
clinical practice protocols and the conduct of re-
search into patient outcomes, delivery of health care 
services, quality of care, and access to health care; 
‘‘(2) establish short-range and long-range goals 
and objectives within the Agency for research impor-
tant to women’s health and, as relevant and appro-
priate, coordinate with other appropriate offices on 
activities within the Agency that relate to health 
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•AMDT. NO. 2786 
services and medical effectiveness research, for 
issues of particular concern to women; 
‘‘(3) identify projects in women’s health that 
should be conducted or supported by the Agency; 
‘‘(4) consult with health professionals, non-
governmental organizations, consumer organizations, 
women’s health professionals, and other individuals 
and groups, as appropriate, on Agency policy with 
regard to women; and 
‘‘(5) serve as a member of the Department of 
Health and Human Services Coordinating Com-
mittee on Women’s Health (established under sec-
tion 229(b)(4)).’’. 
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out this section, there are authorized 
to be appropriated such sums as may be necessary for 
each of the fiscal years 2010 through 2014.’’. 
(f) HEALTH RESOURCES AND SERVICES ADMINIS-
TRATION OFFICE OF WOMEN’S HEALTH.—Title VII of 
the Social Security Act (42 U.S.C. 901 et seq.) is amended 
by adding at the end the following: 
‘‘SEC. 713. OFFICE OF WOMEN’S HEALTH. 
‘‘(a) ESTABLISHMENT.—The Secretary shall estab-
lish within the Office of the Administrator of the Health 
Resources and Services Administration, an office to be 
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•AMDT. NO. 2786 
known as the Office of Women’s Health. The Office shall 
be headed by a director who shall be appointed by the Ad-
ministrator. 
‘‘(b) PURPOSE.—The Director of the Office shall— 
‘‘(1) report to the Administrator on the current 
Administration level of activity regarding women’s 
health across, where appropriate, age, biological, and 
sociocultural contexts; 
‘‘(2) establish short-range and long-range goals 
and objectives within the Health Resources and 
Services Administration for women’s health and, as 
relevant and appropriate, coordinate with other ap-
propriate offices on activities within the Administra-
tion that relate to health care provider training, 
health service delivery, research, and demonstration 
projects, for issues of particular concern to women; 
‘‘(3) identify projects in women’s health that 
should be conducted or supported by the bureaus of 
the Administration; 
‘‘(4) consult with health professionals, non-
governmental organizations, consumer organizations, 
women’s health professionals, and other individuals 
and groups, as appropriate, on Administration policy 
with regard to women; and 
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•AMDT. NO. 2786 
‘‘(5) serve as a member of the Department of 
Health and Human Services Coordinating Com-
mittee on Women’s Health (established under sec-
tion 229(b)(4) of the Public Health Service Act). 
‘‘(c) CONTINUED ADMINISTRATION
OF EXISTING 
PROGRAMS.—The Director of the Office shall assume the 
authority for the development, implementation, adminis-
tration, and evaluation of any projects carried out through 
the Health Resources and Services Administration relat-
ing to women’s health on the date of enactment of this 
section. 
‘‘(d) DEFINITIONS.—For purposes of this section: 
‘‘(1) ADMINISTRATION.—The term ‘Administra-
tion’ means the Health Resources and Services Ad-
ministration. 
‘‘(2) ADMINISTRATOR.—The term ‘Adminis-
trator’ means the Administrator of the Health Re-
sources and Services Administration. 
‘‘(3) OFFICE.—The term ‘Office’ means the Of-
fice of Women’s Health established under this sec-
tion in the Administration. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out this section, there are authorized 
to be appropriated such sums as may be necessary for 
each of the fiscal years 2010 through 2014.’’. 
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•AMDT. NO. 2786 
(g) FOOD AND DRUG ADMINISTRATION OFFICE OF 
WOMEN’S HEALTH.—Chapter X of the Federal Food, 
Drug, and Cosmetic Act (21 U.S.C. 391 et seq.) is amend-
ed by adding at the end the following: 
‘‘SEC. 1011. OFFICE OF WOMEN’S HEALTH. 
‘‘(a) ESTABLISHMENT.—There is established within 
the Office of the Commissioner, an office to be known as 
the Office of Women’s Health (referred to in this section 
as the ‘Office’). The Office shall be headed by a director 
who shall be appointed by the Commissioner of Food and 
Drugs. 
‘‘(b) PURPOSE.—The Director of the Office shall— 
‘‘(1) report to the Commissioner of Food and 
Drugs on current Food and Drug Administration 
(referred to in this section as the ‘Administration’) 
levels of activity regarding women’s participation in 
clinical trials and the analysis of data by sex in the 
testing of drugs, medical devices, and biological 
products across, where appropriate, age, biological, 
and sociocultural contexts; 
‘‘(2) establish short-range and long-range goals 
and objectives within the Administration for issues 
of particular concern to women’s health within the 
jurisdiction of the Administration, including, where 
relevant and appropriate, adequate inclusion of 
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•AMDT. NO. 2786 
women and analysis of data by sex in Administration 
protocols and policies; 
‘‘(3) provide information to women and health 
care providers on those areas in which differences 
between men and women exist; 
‘‘(4) consult with pharmaceutical, biologics, and 
device manufacturers, health professionals with ex-
pertise in women’s issues, consumer organizations, 
and women’s health professionals on Administration 
policy with regard to women; 
‘‘(5) make annual estimates of funds needed to 
monitor clinical trials and analysis of data by sex in 
accordance with needs that are identified; and 
‘‘(6) serve as a member of the Department of 
Health and Human Services Coordinating Com-
mittee on Women’s Health (established under sec-
tion 229(b)(4) of the Public Health Service Act). 
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out this section, there are authorized 
to be appropriated such sums as may be necessary for 
each of the fiscal years 2010 through 2014.’’. 
(h) NO NEW REGULATORY AUTHORITY.—Nothing in 
this section and the amendments made by this section may 
be construed as establishing regulatory authority or modi-
fying any existing regulatory authority. 
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•AMDT. NO. 2786 
(i) LIMITATION ON TERMINATION.—Notwithstanding 
any other provision of law, a Federal office of women’s 
health (including the Office of Research on Women’s 
Health of the National Institutes of Health) or Federal 
appointive position with primary responsibility over wom-
en’s health issues (including the Associate Administrator 
for Women’s Services under the Substance Abuse and 
Mental Health Services Administration) that is in exist-
ence on the date of enactment of this section shall not 
be terminated, reorganized, or have any of it’s powers or 
duties transferred unless such termination, reorganization, 
or transfer is approved by Congress through the adoption 
of a concurrent resolution of approval. 
(j) RULE OF CONSTRUCTION.—Nothing in this sec-
tion (or the amendments made by this section) shall be 
construed to limit the authority of the Secretary of Health 
and Human Services with respect to women’s health, or 
with respect to activities carried out through the Depart-
ment of Health and Human Services on the date of enact-
ment of this section. 
SEC. 3510. PATIENT NAVIGATOR PROGRAM. 
Section 340A of the Public Health Service Act (42 
U.S.C. 256a) is amended— 
(1) by striking subsection (d)(3) and inserting 
the following: 
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‘‘(3) LIMITATIONS ON GRANT PERIOD.—In car-
rying out this section, the Secretary shall ensure 
that the total period of a grant does not exceed 4 
years.’’; 
(2) in subsection (e), by adding at the end the 
following: 
‘‘(3) MINIMUM
CORE
PROFICIENCIES.—The 
Secretary shall not award a grant to an entity under 
this section unless such entity provides assurances 
that patient navigators recruited, assigned, trained, 
or employed using grant funds meet minimum core 
proficiencies, as defined by the entity that submits 
the application, that are tailored for the main focus 
or intervention of the navigator involved.’’; and 
(3) in subsection (m)— 
(A) in paragraph (1), by striking ‘‘and 
$3,500,000 for fiscal year 2010.’’ and inserting 
‘‘$3,500,000 for fiscal year 2010, and such 
sums as may be necessary for each of fiscal 
years 2011 through 2015.’’; and 
(B) in paragraph (2), by striking ‘‘2010’’ 
and inserting ‘‘2015’’. 
SEC. 3511. AUTHORIZATION OF APPROPRIATIONS. 
Except where otherwise provided in this subtitle (or 
an amendment made by this subtitle), there is authorized 
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to be appropriated such sums as may be necessary to carry 
out this subtitle (and such amendments made by this sub-
title). 
TITLE 
IV—PREVENTION 
OF 
CHRONIC DISEASE AND IM-
PROVING PUBLIC HEALTH 
Subtitle 
A—Modernizing 
Disease 
Prevention and Public Health 
Systems 
SEC. 4001. NATIONAL PREVENTION, HEALTH PROMOTION 
AND PUBLIC HEALTH COUNCIL. 
(a) ESTABLISHMENT.—The President shall establish, 
within the Department of Health and Human Services, 
a council to be known as the ‘‘National Prevention, Health 
Promotion and Public Health Council’’ (referred to in this 
section as the ‘‘Council’’). 
(b) CHAIRPERSON.—The President shall appoint the 
Surgeon General to serve as the chairperson of the Coun-
cil. 
(c) COMPOSITION.—The Council shall be composed 
of— 
(1) the Secretary of Health and Human Serv-
ices; 
(2) the Secretary of Agriculture; 
(3) the Secretary of Education; 
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(4) the Chairman of the Federal Trade Com-
mission; 
(5) the Secretary of Transportation; 
(6) the Secretary of Labor; 
(7) the Secretary of Homeland Security; 
(8) the Administrator of the Environmental 
Protection Agency; 
(9) the Director of the Office of National Drug 
Control Policy; 
(10) the Director of the Domestic Policy Coun-
cil; 
(11) the Assistant Secretary for Indian Affairs; 
(12) the Chairman of the Corporation for Na-
tional and Community Service; and 
(13) the head of any other Federal agency that 
the chairperson determines is appropriate. 
(d) PURPOSES AND DUTIES.—The Council shall— 
(1) provide coordination and leadership at the 
Federal level, and among all Federal departments 
and agencies, with respect to prevention, wellness 
and health promotion practices, the public health 
system, and integrative health care in the United 
States; 
(2) after obtaining input from relevant stake-
holders, develop a national prevention, health pro-
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motion, public health, and integrative health care 
strategy that incorporates the most effective and 
achievable means of improving the health status of 
Americans and reducing the incidence of preventable 
illness and disability in the United States; 
(3) provide recommendations to the President 
and Congress concerning the most pressing health 
issues confronting the United States and changes in 
Federal policy to achieve national wellness, health 
promotion, and public health goals, including the re-
duction of tobacco use, sedentary behavior, and poor 
nutrition; 
(4) consider and propose evidence-based models, 
policies, and innovative approaches for the pro-
motion of transformative models of prevention, inte-
grative health, and public health on individual and 
community levels across the United States; 
(5) establish processes for continual public 
input, including input from State, regional, and local 
leadership communities and other relevant stake-
holders, including Indian tribes and tribal organiza-
tions; 
(6) submit the reports required under sub-
section (g); and 
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(7) carry out other activities determined appro-
priate by the President. 
(e) MEETINGS.—The Council shall meet at the call 
of the Chairperson. 
(f) ADVISORY GROUP.— 
(1) IN GENERAL.—The President shall establish 
an Advisory Group to the Council to be known as 
the ‘‘Advisory Group on Prevention, Health Pro-
motion, and Integrative and Public Health’’ (here-
after referred to in this section as the ‘‘Advisory 
Group’’). The Advisory Group shall be within the 
Department of Health and Human Services and re-
port to the Surgeon General. 
(2) COMPOSITION.— 
(A) IN
GENERAL.—The Advisory Group 
shall be composed of not more than 25 non- 
Federal members to be appointed by the Presi-
dent. 
(B) 
REPRESENTATION.—In 
appointing 
members under subparagraph (A), the Presi-
dent shall ensure that the Advisory Group in-
cludes a diverse group of licensed health profes-
sionals, including integrative health practi-
tioners who have expertise in— 
(i) worksite health promotion; 
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(ii) community services, including 
community health centers; 
(iii) preventive medicine; 
(iv) health coaching; 
(v) public health education; 
(vi) geriatrics; and 
(vii) rehabilitation medicine. 
(3) PURPOSES
AND
DUTIES.—The Advisory 
Group shall develop policy and program rec-
ommendations and advise the Council on lifestyle- 
based chronic disease prevention and management, 
integrative health care practices, and health pro-
motion. 
(g) NATIONAL PREVENTION
AND HEALTH PRO-
MOTION STRATEGY.—Not later than 1 year after the date 
of enactment of this Act, the Chairperson, in consultation 
with the Council, shall develop and make public a national 
prevention, health promotion and public health strategy, 
and shall review and revise such strategy periodically. 
Such strategy shall— 
(1) set specific goals and objectives for improv-
ing the health of the United States through feder-
ally-supported prevention, health promotion, and 
public health programs, consistent with ongoing goal 
setting efforts conducted by specific agencies; 
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•AMDT. NO. 2786 
(2) establish specific and measurable actions 
and timelines to carry out the strategy, and deter-
mine accountability for meeting those timelines, 
within and across Federal departments and agencies; 
and 
(3) make recommendations to improve Federal 
efforts relating to prevention, health promotion, pub-
lic health, and integrative health care practices to 
ensure Federal efforts are consistent with available 
standards and evidence. 
(h) REPORT.—Not later than July 1, 2010, and an-
nually thereafter through January 1, 2015, the Council 
shall submit to the President and the relevant committees 
of Congress, a report that— 
(1) describes the activities and efforts on pre-
vention, health promotion, and public health and ac-
tivities to develop a national strategy conducted by 
the Council during the period for which the report 
is prepared; 
(2) describes the national progress in meeting 
specific prevention, health promotion, and public 
health goals defined in the strategy and further de-
scribes corrective actions recommended by the Coun-
cil and taken by relevant agencies and organizations 
to meet these goals; 
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•AMDT. NO. 2786 
(3) contains a list of national priorities on 
health promotion and disease prevention to address 
lifestyle behavior modification (smoking cessation, 
proper nutrition, appropriate exercise, mental health, 
behavioral health, substance use disorder, and do-
mestic violence screenings) and the prevention meas-
ures for the 5 leading disease killers in the United 
States; 
(4) contains specific science-based initiatives to 
achieve the measurable goals of Healthy People 
2010 regarding nutrition, exercise, and smoking ces-
sation, and targeting the 5 leading disease killers in 
the United States; 
(5) contains specific plans for consolidating 
Federal health programs and Centers that exist to 
promote healthy behavior and reduce disease risk 
(including eliminating programs and offices deter-
mined to be ineffective in meeting the priority goals 
of Healthy People 2010); 
(6) contains specific plans to ensure that all 
Federal health care programs are fully coordinated 
with science-based prevention recommendations by 
the Director of the Centers for Disease Control and 
Prevention; and 
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(7) contains specific plans to ensure that all 
non-Department of Health and Human Services pre-
vention programs are based on the science-based 
guidelines developed by the Centers for Disease Con-
trol and Prevention under paragraph (4). 
(i) PERIODIC REVIEWS.—The Secretary and the 
Comptroller General of the United States shall jointly con-
duct periodic reviews, not less than every 5 years, and 
evaluations of every Federal disease prevention and health 
promotion initiative, program, and agency. Such reviews 
shall be evaluated based on effectiveness in meeting 
metrics-based goals with an analysis posted on such agen-
cies’ public Internet websites. 
SEC. 4002. PREVENTION AND PUBLIC HEALTH FUND. 
(a) PURPOSE.—It is the purpose of this section to 
establish a Prevention and Public Health Fund (referred 
to in this section as the ‘‘Fund’’), to be administered 
through the Department of Health and Human Services, 
Office of the Secretary, to provide for expanded and sus-
tained national investment in prevention and public health 
programs to improve health and help restrain the rate of 
growth in private and public sector health care costs. 
(b) FUNDING.—There are hereby authorized to be 
appropriated, and appropriated, to the Fund, out of any 
monies in the Treasury not otherwise appropriated— 
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(1) for fiscal year 2010, $500,000,000; 
(2) for fiscal year 2011, $750,000,000; 
(3) for fiscal year 2012, $1,000,000,000; 
(4) for fiscal year 2013, $1,250,000,000; 
(5) for fiscal year 2014, $1,500,000,000; and 
(6) for fiscal year 2015, and each fiscal year 
thereafter, $2,000,000,000. 
(c) USE OF FUND.—The Secretary shall transfer 
amounts in the Fund to accounts within the Department 
of Health and Human Services to increase funding, over 
the fiscal year 2008 level, for programs authorized by the 
Public Health Service Act, for prevention, wellness, and 
public health activities including prevention research and 
health screenings, such as the Community Transformation 
grant program, the Education and Outreach Campaign for 
Preventive Benefits, and immunization programs. 
(d) TRANSFER AUTHORITY .—The Committee on Ap-
propriations of the Senate and the Committee on Appro-
priations of the House of Representatives may provide for 
the transfer of funds in the Fund to eligible activities 
under this section, subject to subsection (c). 
SEC. 4003. CLINICAL AND COMMUNITY PREVENTIVE SERV-
ICES. 
(a) PREVENTIVE SERVICES TASK FORCE.—Section 
915 of the Public Health Service Act (42 U.S.C. 299b- 
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4) is amended by striking subsection (a) and inserting the 
following: 
‘‘(a) PREVENTIVE SERVICES TASK FORCE.— 
‘‘(1) ESTABLISHMENT AND PURPOSE.—The Di-
rector shall convene an independent Preventive Serv-
ices Task Force (referred to in this subsection as the 
‘Task Force’) to be composed of individuals with ap-
propriate expertise. Such Task Force shall review 
the scientific evidence related to the effectiveness, 
appropriateness, and cost-effectiveness of clinical 
preventive services for the purpose of developing rec-
ommendations for the health care community, and 
updating previous clinical preventive recommenda-
tions, to be published in the Guide to Clinical Pre-
ventive Services (referred to in this section as the 
‘Guide’), for individuals and organizations delivering 
clinical services, including primary care profes-
sionals, health care systems, professional societies, 
employers, community organizations, non-profit or-
ganizations, Congress and other policy-makers, gov-
ernmental public health agencies, health care quality 
organizations, and organizations developing national 
health objectives. Such recommendations shall con-
sider clinical preventive best practice recommenda-
tions from the Agency for Healthcare Research and 
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Quality, the National Institutes of Health, the Cen-
ters for Disease Control and Prevention, the Insti-
tute of Medicine, specialty medical associations, pa-
tient groups, and scientific societies. 
‘‘(2) DUTIES.—The duties of the Task Force 
shall include— 
‘‘(A) the development of additional topic 
areas for new recommendations and interven-
tions related to those topic areas, including 
those related to specific sub-populations and 
age groups; 
‘‘(B) at least once during every 5-year pe-
riod, review interventions and update rec-
ommendations related to existing topic areas, 
including new or improved techniques to assess 
the health effects of interventions; 
‘‘(C) improved integration with Federal 
Government health objectives and related target 
setting for health improvement; 
‘‘(D) the enhanced dissemination of rec-
ommendations; 
‘‘(E) the provision of technical assistance 
to those health care professionals, agencies and 
organizations that request help in implementing 
the Guide recommendations; and 
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‘‘(F) the submission of yearly reports to 
Congress and related agencies identifying gaps 
in research, such as preventive services that re-
ceive an insufficient evidence statement, and 
recommending priority areas that deserve fur-
ther examination, including areas related to 
populations and age groups not adequately ad-
dressed by current recommendations. 
‘‘(3) ROLE OF AGENCY.—The Agency shall pro-
vide ongoing administrative, research, and technical 
support for the operations of the Task Force, includ-
ing coordinating and supporting the dissemination of 
the recommendations of the Task Force, ensuring 
adequate staff resources, and assistance to those or-
ganizations requesting it for implementation of the 
Guide’s recommendations. 
‘‘(4) COORDINATION
WITH
COMMUNITY
PRE-
VENTIVE SERVICES TASK FORCE.—The Task Force 
shall take appropriate steps to coordinate its work 
with the Community Preventive Services Task Force 
and the Advisory Committee on Immunization Prac-
tices, including the examination of how each task 
force’s recommendations interact at the nexus of 
clinic and community. 
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•AMDT. NO. 2786 
‘‘(5) OPERATION.—Operation. In carrying out 
the duties under paragraph (2), the Task Force is 
not subject to the provisions of Appendix 2 of title 
5, United States Code. 
‘‘(6) INDEPENDENCE.—All members of the 
Task Force convened under this subsection, and any 
recommendations made by such members, shall be 
independent and, to the extent practicable, not sub-
ject to political pressure. 
‘‘(7) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated such sums 
as may be necessary for each fiscal year to carry out 
the activities of the Task Force.’’. 
(b) COMMUNITY
PREVENTIVE
SERVICES
TASK 
FORCE.— 
(1) IN GENERAL.—Part P of title III of the 
Public Health Service Act, as amended by paragraph 
(2), is amended by adding at the end the following: 
‘‘SEC. 399U. COMMUNITY PREVENTIVE SERVICES TASK 
FORCE. 
‘‘(a) ESTABLISHMENT AND PURPOSE.—The Director 
of the Centers for Disease Control and Prevention shall 
convene an independent Community Preventive Services 
Task Force (referred to in this subsection as the ‘Task 
Force’) to be composed of individuals with appropriate ex-
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•AMDT. NO. 2786 
pertise. Such Task Force shall review the scientific evi-
dence related to the effectiveness, appropriateness, and 
cost-effectiveness of community preventive interventions 
for the purpose of developing recommendations, to be pub-
lished in the Guide to Community Preventive Services (re-
ferred to in this section as the ‘Guide’), for individuals 
and organizations delivering population-based services, in-
cluding primary care professionals, health care systems, 
professional societies, employers, community organiza-
tions, non-profit organizations, schools, governmental pub-
lic health agencies, Indian tribes, tribal organizations and 
urban Indian organizations, medical groups, Congress and 
other policy-makers. Community preventive services in-
clude any policies, programs, processes or activities de-
signed to affect or otherwise affecting health at the popu-
lation level. 
‘‘(b) DUTIES.—The duties of the Task Force shall 
include— 
‘‘(1) the development of additional topic areas 
for new recommendations and interventions related 
to those topic areas, including those related to spe-
cific populations and age groups, as well as the so-
cial, economic and physical environments that can 
have broad effects on the health and disease of pop-
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•AMDT. NO. 2786 
ulations and health disparities among sub-popu-
lations and age groups; 
‘‘(2) at least once during every 5-year period, 
review interventions and update recommendations 
related to existing topic areas, including new or im-
proved techniques to assess the health effects of 
interventions, including health impact assessment 
and population health modeling; 
‘‘(3) improved integration with Federal Govern-
ment health objectives and related target setting for 
health improvement; 
‘‘(4) the enhanced dissemination of rec-
ommendations; 
‘‘(5) the provision of technical assistance to 
those health care professionals, agencies, and organi-
zations that request help in implementing the Guide 
recommendations; and 
‘‘(6) providing yearly reports to Congress and 
related agencies identifying gaps in research and 
recommending priority areas that deserve further ex-
amination, including areas related to populations 
and age groups not adequately addressed by current 
recommendations. 
‘‘(c) ROLE OF AGENCY.—The Director shall provide 
ongoing administrative, research, and technical support 
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•AMDT. NO. 2786 
for the operations of the Task Force, including coordi-
nating and supporting the dissemination of the rec-
ommendations of the Task Force, ensuring adequate staff 
resources, and assistance to those organizations request-
ing it for implementation of Guide recommendations. 
‘‘(d) COORDINATION WITH PREVENTIVE SERVICES 
TASK FORCE.—The Task Force shall take appropriate 
steps to coordinate its work with the U.S. Preventive Serv-
ices Task Force and the Advisory Committee on Immuni-
zation Practices, including the examination of how each 
task force’s recommendations interact at the nexus of clin-
ic and community. 
‘‘(e) OPERATION.—In carrying out the duties under 
subsection (b), the Task Force shall not be subject to the 
provisions of Appendix 2 of title 5, United States Code. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary for each fiscal year to carry out the activities 
of the Task Force.’’. 
(2) TECHNICAL AMENDMENTS.— 
(A) Section 399R of the Public Health 
Service Act (as added by section 2 of the ALS 
Registry Act (Public Law 110-373; 122 Stat. 
4047)) is redesignated as section 399S. 
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•AMDT. NO. 2786 
(B) Section 399R of such Act (as added by 
section 3 of the Prenatally and Postnatally Di-
agnosed Conditions Awareness Act (Public Law 
110–374; 122 Stat. 4051)) is redesignated as 
section 399T. 
SEC. 4004. EDUCATION AND OUTREACH CAMPAIGN RE-
GARDING PREVENTIVE BENEFITS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’) shall provide for the planning and implementa-
tion of a national public–private partnership for a preven-
tion and health promotion outreach and education cam-
paign to raise public awareness of health improvement 
across the life span. Such campaign shall include the dis-
semination of information that— 
(1) describes the importance of utilizing preven-
tive services to promote wellness, reduce health dis-
parities, and mitigate chronic disease; 
(2) promotes the use of preventive services rec-
ommended by the United States Preventive Services 
Task Force and the Community Preventive Services 
Task Force; 
(3) encourages healthy behaviors linked to the 
prevention of chronic diseases; 
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(4) explains the preventive services covered 
under health plans offered through a Gateway; 
(5) describes additional preventive care sup-
ported by the Centers for Disease Control and Pre-
vention, the Health Resources and Services Adminis-
tration, the Substance Abuse and Mental Health 
Services Administration, the Advisory Committee on 
Immunization Practices, and other appropriate agen-
cies; and 
(6) includes general health promotion informa-
tion. 
(b) CONSULTATION.—In coordinating the campaign 
under subsection (a), the Secretary shall consult with the 
Institute of Medicine to provide ongoing advice on evi-
dence-based scientific information for policy, program de-
velopment, and evaluation. 
(c) MEDIA CAMPAIGN.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of enactment of this Act, the Secretary, act-
ing through the Director of the Centers for Disease 
Control and Prevention, shall establish and imple-
ment a national science-based media campaign on 
health promotion and disease prevention. 
(2) REQUIREMENT OF CAMPAIGN.—The cam-
paign implemented under paragraph (1)— 
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(A) shall be designed to address proper nu-
trition, regular exercise, smoking cessation, obe-
sity reduction, the 5 leading disease killers in 
the United States, and secondary prevention 
through disease screening promotion; 
(B) shall be carried out through competi-
tively bid contracts awarded to entities pro-
viding for the professional production and de-
sign of such campaign; 
(C) may include the use of television, 
radio, Internet, and other commercial mar-
keting venues and may be targeted to specific 
age groups based on peer-reviewed social re-
search; 
(D) shall not be duplicative of any other 
Federal efforts relating to health promotion and 
disease prevention; and 
(E) may include the use of humor and na-
tionally recognized positive role models. 
(3) EVALUATION.—The Secretary shall ensure 
that the campaign implemented under paragraph (1) 
is subject to an independent evaluation every 2 years 
and shall report every 2 years to Congress on the ef-
fectiveness of such campaigns towards meeting 
science-based metrics. 
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(d) WEBSITE.—The Secretary, in consultation with 
private-sector experts, shall maintain or enter into a con-
tract to maintain an Internet website to provide science- 
based information on guidelines for nutrition, regular ex-
ercise, obesity reduction, smoking cessation, and specific 
chronic disease prevention. Such website shall be designed 
to provide information to health care providers and con-
sumers. 
(e) DISSEMINATION
OF INFORMATION THROUGH 
PROVIDERS.—The Secretary, acting through the Centers 
for Disease Control and Prevention, shall develop and im-
plement a plan for the dissemination of health promotion 
and disease prevention information consistent with na-
tional priorities, to health care providers who participate 
in Federal programs, including programs administered by 
the Indian Health Service, the Department of Veterans 
Affairs, the Department of Defense, and the Health Re-
sources and Services Administration, and Medicare and 
Medicaid. 
(f) PERSONALIZED PREVENTION PLANS.— 
(1) CONTRACT.—The Secretary, acting through 
the Director of the Centers for Disease Control and 
Prevention, shall enter into a contract with a quali-
fied entity for the development and operation of a 
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Federal Internet website personalized prevention 
plan tool. 
(2) USE.—The website developed under para-
graph (1) shall be designed to be used as a source 
of the most up-to-date scientific evidence relating to 
disease prevention for use by individuals. Such 
website shall contain a component that enables an 
individual to determine their disease risk (based on 
personal health and family history, BMI, and other 
relevant information) relating to the 5 leading dis-
eases in the United States, and obtain personalized 
suggestions for preventing such diseases. 
(g) INTERNET PORTAL.—The Secretary shall estab-
lish an Internet portal for accessing risk-assessment tools 
developed and maintained by private and academic enti-
ties. 
(h) PRIORITY FUNDING.—Funding for the activities 
authorized under this section shall take priority over fund-
ing provided through the Centers for Disease Control and 
Prevention for grants to States and other entities for simi-
lar purposes and goals as provided for in this section. Not 
to exceed $500,000,000 shall be expended on the cam-
paigns and activities required under this section. 
(i) PUBLIC AWARENESS OF PREVENTIVE AND OBE-
SITY-RELATED SERVICES.— 
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(1) INFORMATION TO STATES.—The Secretary 
of Health and Human Services shall provide guid-
ance and relevant information to States and health 
care providers regarding preventive and obesity-re-
lated services that are available to Medicaid enroll-
ees, including obesity screening and counseling for 
children and adults. 
(2) INFORMATION TO ENROLLEES.—Each State 
shall design a public awareness campaign to educate 
Medicaid enrollees regarding availability and cov-
erage of such services, with the goal of reducing 
incidences of obesity. 
(3) REPORT.—Not later than January 1, 2011, 
and every 3 years thereafter through January 1, 
2017, the Secretary of Health and Human Services 
shall report to Congress on the status and effective-
ness of efforts under paragraphs (1) and (2), includ-
ing summaries of the States’ efforts to increase 
awareness of coverage of obesity-related services. 
(j) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary to carry out this section. 
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•AMDT. NO. 2786 
Subtitle B—Increasing Access to 
Clinical Preventive Services 
SEC. 4101. SCHOOL-BASED HEALTH CENTERS. 
(a) GRANTS FOR THE ESTABLISHMENT OF SCHOOL- 
BASED HEALTH CENTERS.— 
(1) PROGRAM.—The Secretary of Health and 
Human Services (in this subsection referred to as 
the ‘‘Secretary’’) shall establish a program to award 
grants to eligible entities to support the operation of 
school-based health centers. 
(2) ELIGIBILITY.—To be eligible for a grant 
under this subsection, an entity shall— 
(A) be a school-based health center or a 
sponsoring facility of a school-based health cen-
ter; and 
(B) submit an application at such time, in 
such manner, and containing such information 
as the Secretary may require, including at a 
minimum an assurance that funds awarded 
under the grant shall not be used to provide 
any service that is not authorized or allowed by 
Federal, State, or local law. 
(3) PREFERENCE.—In awarding grants under 
this section, the Secretary shall give preference to 
awarding grants for school-based health centers that 
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serve a large population of children eligible for med-
ical assistance under the State Medicaid plan under 
title XIX of the Social Security Act or under a waiv-
er of such plan or children eligible for child health 
assistance under the State child health plan under 
title XXI of that Act (42 U.S.C. 1397aa et seq.). 
(4) LIMITATION ON USE OF FUNDS.—An eligi-
ble entity shall use funds provided under a grant 
awarded under this subsection only for expenditures 
for facilities (including the acquisition or improve-
ment of land, or the acquisition, construction, expan-
sion, replacement, or other improvement of any 
building or other facility), equipment, or similar ex-
penditures, as specified by the Secretary. No funds 
provided under a grant awarded under this section 
shall be used for expenditures for personnel or to 
provide health services. 
(5) APPROPRIATIONS.—Out of any funds in the 
Treasury not otherwise appropriated, there is appro-
priated for each of fiscal years 2010 through 2013, 
$50,000,000 for the purpose of carrying out this 
subsection. Funds appropriated under this para-
graph shall remain available until expended. 
(6) DEFINITIONS.—In this subsection, the 
terms ‘‘school-based health center’’ and ‘‘sponsoring 
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facility’’ have the meanings given those terms in sec-
tion 2110(c)(9) of the Social Security Act (42 
U.S.C. 1397jj(c)(9)). 
(b) GRANTS FOR THE OPERATION OF SCHOOL-BASED 
HEALTH CENTERS.—Part Q of title III of the Public 
Health Service Act (42 U.S.C. 280h et seq.) is amended 
by adding at the end the following: 
‘‘SEC. 399Z–1. SCHOOL-BASED HEALTH CENTERS. 
‘‘(a) DEFINITIONS; ESTABLISHMENT OF CRITERIA.— 
In this section: 
‘‘(1) COMPREHENSIVE PRIMARY HEALTH SERV-
ICES.—The term ‘comprehensive primary health 
services’ means the core services offered by school- 
based health centers, which shall include the fol-
lowing: 
‘‘(A) PHYSICAL.—Comprehensive health 
assessments, diagnosis, and treatment of minor, 
acute, and chronic medical conditions, and re-
ferrals to, and follow-up for, specialty care and 
oral health services. 
‘‘(B) MENTAL
HEALTH.—Mental health 
and substance use disorder assessments, crisis 
intervention, counseling, treatment, and referral 
to a continuum of services including emergency 
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psychiatric care, community support programs, 
inpatient care, and outpatient programs. 
‘‘(2) MEDICALLY
UNDERSERVED
CHILDREN 
AND ADOLESCENTS.— 
‘‘(A) IN GENERAL.—The term ‘medically 
underserved children and adolescents’ means a 
population of children and adolescents who are 
residents of an area designated as a medically 
underserved area or a health professional short-
age area by the Secretary. 
‘‘(B) CRITERIA.—The Secretary shall pre-
scribe criteria for determining the specific 
shortages of personal health services for medi-
cally underserved children and adolescents 
under subparagraph (A) that shall— 
‘‘(i) take into account any comments 
received by the Secretary from the chief 
executive officer of a State and local offi-
cials in a State; and 
‘‘(ii) include factors indicative of the 
health status of such children and adoles-
cents of an area, including the ability of 
the residents of such area to pay for health 
services, the accessibility of such services, 
the availability of health professionals to 
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•AMDT. NO. 2786 
such children and adolescents, and other 
factors as determined appropriate by the 
Secretary. 
‘‘(3) SCHOOL-BASED
HEALTH
CENTER.—The 
term ‘school-based health center’ means a health 
clinic that— 
‘‘(A) meets the definition of a school-based 
health center under section 2110(c)(9)(A) of 
the Social Security Act and is administered by 
a sponsoring facility (as defined in section 
2110(c)(9)(B) of the Social Security Act); 
‘‘(B) provides, at a minimum, comprehen-
sive primary health services during school hours 
to children and adolescents by health profes-
sionals in accordance with established stand-
ards, community practice, reporting laws, and 
other State laws, including parental consent 
and notification laws that are not inconsistent 
with Federal law; and 
‘‘(C) does not perform abortion services. 
‘‘(b) AUTHORITY
TO AWARD GRANTS.—The Sec-
retary shall award grants for the costs of the operation 
of school-based health centers (referred to in this section 
as ‘SBHCs’) that meet the requirements of this section. 
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‘‘(c) APPLICATIONS.—To be eligible to receive a grant 
under this section, an entity shall— 
‘‘(1) be an SBHC (as defined in subsection 
(a)(3)); and 
‘‘(2) submit to the Secretary an application at 
such time, in such manner, and containing— 
‘‘(A) evidence that the applicant meets all 
criteria necessary to be designated an SBHC; 
‘‘(B) evidence of local need for the services 
to be provided by the SBHC; 
‘‘(C) an assurance that— 
‘‘(i) SBHC services will be provided to 
those children and adolescents for whom 
parental or guardian consent has been ob-
tained in cooperation with Federal, State, 
and local laws governing health care serv-
ice provision to children and adolescents; 
‘‘(ii) the SBHC has made and will 
continue to make every reasonable effort to 
establish and maintain collaborative rela-
tionships with other health care providers 
in the catchment area of the SBHC; 
‘‘(iii) the SBHC will provide on-site 
access during the academic day when 
school is in session and 24-hour coverage 
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through an on-call system and through its 
backup health providers to ensure access to 
services on a year-round basis when the 
school or the SBHC is closed; 
‘‘(iv) the SBHC will be integrated into 
the school environment and will coordinate 
health services with school personnel, such 
as administrators, teachers, nurses, coun-
selors, and support personnel, as well as 
with other community providers co-located 
at the school; 
‘‘(v) the SBHC sponsoring facility as-
sumes all responsibility for the SBHC ad-
ministration, operations, and oversight; 
and 
‘‘(vi) the SBHC will comply with Fed-
eral, State, and local laws concerning pa-
tient privacy and student records, includ-
ing regulations promulgated under the 
Health Insurance Portability and Account-
ability Act of 1996 and section 444 of the 
General Education Provisions Act; and 
‘‘(D) such other information as the Sec-
retary may require. 
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‘‘(d) PREFERENCES AND CONSIDERATION.—In re-
viewing applications: 
‘‘(1) The Secretary may give preference to ap-
plicants who demonstrate an ability to serve the fol-
lowing: 
‘‘(A) Communities that have evidenced 
barriers to primary health care and mental 
health and substance use disorder prevention 
services for children and adolescents. 
‘‘(B) Communities with high per capita 
numbers of children and adolescents who are 
uninsured, underinsured, or enrolled in public 
health insurance programs. 
‘‘(C) Populations of children and adoles-
cents that have historically demonstrated dif-
ficulty in accessing health and mental health 
and substance use disorder prevention services. 
‘‘(2) The Secretary may give consideration to 
whether an applicant has received a grant under 
subsection (a) of section 4101 of the Patient Protec-
tion and Affordable Care Act. 
‘‘(e) WAIVER
OF REQUIREMENTS.—The Secretary 
may— 
‘‘(1) under appropriate circumstances, waive 
the application of all or part of the requirements of 
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•AMDT. NO. 2786 
this subsection with respect to an SBHC for not to 
exceed 2 years; and 
‘‘(2) upon a showing of good cause, waive the 
requirement that the SBHC provide all required 
comprehensive primary health services for a des-
ignated period of time to be determined by the Sec-
retary. 
‘‘(f) USE OF FUNDS.— 
‘‘(1) FUNDS.—Funds awarded under a grant 
under this section— 
‘‘(A) may be used for— 
‘‘(i) acquiring and leasing equipment 
(including the costs of amortizing the prin-
ciple of, and paying interest on, loans for 
such equipment); 
‘‘(ii) providing training related to the 
provision of required comprehensive pri-
mary health services and additional health 
services; 
‘‘(iii) the management and operation 
of health center programs; 
‘‘(iv) the payment of salaries for phy-
sicians, nurses, and other personnel of the 
SBHC; and 
‘‘(B) may not be used to provide abortions. 
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•AMDT. NO. 2786 
‘‘(2) 
CONSTRUCTION.—The 
Secretary 
may 
award grants which may be used to pay the costs as-
sociated with expanding and modernizing existing 
buildings for use as an SBHC, including the pur-
chase of trailers or manufactured buildings to install 
on the school property. 
‘‘(3) LIMITATIONS.— 
‘‘(A) IN GENERAL.—Any provider of serv-
ices that is determined by a State to be in viola-
tion of a State law described in subsection 
(a)(3)(B) with respect to activities carried out 
at a SBHC shall not be eligible to receive addi-
tional funding under this section. 
‘‘(B) NO OVERLAPPING GRANT PERIOD.— 
No entity that has received funding under sec-
tion 330 for a grant period shall be eligible for 
a grant under this section for with respect to 
the same grant period. 
‘‘(g) MATCHING REQUIREMENT.— 
‘‘(1) IN GENERAL.—Each eligible entity that re-
ceives a grant under this section shall provide, from 
non-Federal sources, an amount equal to 20 percent 
of the amount of the grant (which may be provided 
in cash or in-kind) to carry out the activities sup-
ported by the grant. 
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‘‘(2) WAIVER.—The Secretary may waive all or 
part of the matching requirement described in para-
graph (1) for any fiscal year for the SBHC if the 
Secretary determines that applying the matching re-
quirement to the SBHC would result in serious 
hardship or an inability to carry out the purposes of 
this section. 
‘‘(h) SUPPLEMENT, NOT SUPPLANT.—Grant funds 
provided under this section shall be used to supplement, 
not supplant, other Federal or State funds. 
‘‘(i) EVALUATION.—The Secretary shall develop and 
implement a plan for evaluating SBHCs and monitoring 
quality performance under the awards made under this 
section. 
‘‘(j) AGE APPROPRIATE SERVICES.—An eligible enti-
ty receiving funds under this section shall only provide age 
appropriate services through a SBHC funded under this 
section to an individual. 
‘‘(k) PARENTAL CONSENT.—An eligible entity receiv-
ing funds under this section shall not provide services 
through a SBHC funded under this section to an indi-
vidual without the consent of the parent or guardian of 
such individual if such individual is considered a minor 
under applicable State law. 
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•AMDT. NO. 2786 
‘‘(l) AUTHORIZATION
OF
APPROPRIATIONS.—For 
purposes of carrying out this section, there are authorized 
to be appropriated such sums as may be necessary for 
each of the fiscal years 2010 through 2014.’’. 
SEC. 4102. ORAL HEALTHCARE PREVENTION ACTIVITIES. 
(a) IN GENERAL.—Title III of the Public Health 
Service Act (42 U.S.C. 241 et seq.), as amended by section 
3025, is amended by adding at the end the following: 
‘‘PART T—ORAL HEALTHCARE PREVENTION 
ACTIVITIES 
‘‘SEC. 399LL. ORAL HEALTHCARE PREVENTION EDUCATION 
CAMPAIGN. 
‘‘(a) 
ESTABLISHMENT.—The 
Secretary, 
acting 
through the Director of the Centers for Disease Control 
and Prevention and in consultation with professional oral 
health organizations, shall, subject to the availability of 
appropriations, establish a 5-year national, public edu-
cation campaign (referred to in this section as the ‘cam-
paign’) that is focused on oral healthcare prevention and 
education, including prevention of oral disease such as 
early childhood and other caries, periodontal disease, and 
oral cancer. 
‘‘(b) REQUIREMENTS.—In establishing the campaign, 
the Secretary shall— 
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•AMDT. NO. 2786 
‘‘(1) ensure that activities are targeted towards 
specific populations such as children, pregnant 
women, parents, the elderly, individuals with disabil-
ities, and ethnic and racial minority populations, in-
cluding Indians, Alaska Natives and Native Hawai-
ians (as defined in section 4(c) of the Indian Health 
Care Improvement Act) in a culturally and linguis-
tically appropriate manner; and 
‘‘(2) utilize science-based strategies to convey 
oral health prevention messages that include, but are 
not limited to, community water fluoridation and 
dental sealants. 
‘‘(c) PLANNING AND IMPLEMENTATION.—Not later 
than 2 years after the date of enactment of this section, 
the Secretary shall begin implementing the 5-year cam-
paign. During the 2-year period referred to in the previous 
sentence, the Secretary shall conduct planning activities 
with respect to the campaign. 
‘‘SEC. 399LL-1. RESEARCH-BASED DENTAL CARIES DISEASE 
MANAGEMENT. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Director of the Centers for Disease Control and Pre-
vention, shall award demonstration grants to eligible enti-
ties to demonstrate the effectiveness of research-based 
dental caries disease management activities. 
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•AMDT. NO. 2786 
‘‘(b) ELIGIBILITY.—To be eligible for a grant under 
this section, an entity shall— 
‘‘(1) be a community-based provider of dental 
services (as defined by the Secretary), including a 
Federally-qualified health center, a clinic of a hos-
pital owned or operated by a State (or by an instru-
mentality or a unit of government within a State), 
a State or local department of health, a dental pro-
gram of the Indian Health Service, an Indian tribe 
or tribal organization, or an urban Indian organiza-
tion (as such terms are defined in section 4 of the 
Indian Health Care Improvement Act), a health sys-
tem provider, a private provider of dental services, 
medical, dental, public health, nursing, nutrition 
educational institutions, or national organizations in-
volved in improving children’s oral health; and 
‘‘(2) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.—A grantee shall use amounts 
received under a grant under this section to demonstrate 
the effectiveness of research-based dental caries disease 
management activities. 
‘‘(d) USE OF INFORMATION.—The Secretary shall 
utilize information generated from grantees under this 
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section in planning and implementing the public education 
campaign under section 399LL. 
‘‘SEC. 399LL-2. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There is authorized to be appropriated to carry out 
this part, such sums as may be necessary.’’. 
(b) SCHOOL-BASED SEALANT PROGRAMS.—Section 
317M(c)(1) of the Public Health Service Act (42 U.S.C. 
247b-14(c)(1)) is amended by striking ‘‘may award grants 
to States and Indian tribes’’ and inserting ‘‘shall award 
a grant to each of the 50 States and territories and to 
Indians, Indian tribes, tribal organizations and urban In-
dian organizations (as such terms are defined in section 
4 of the Indian Health Care Improvement Act)’’. 
(c) 
ORAL
HEALTH
INFRASTRUCTURE.—Section 
317M of the Public Health Service Act (42 U.S.C. 247b- 
14) is amended— 
(1) by redesignating subsections (d) and (e) as 
subsections (e) and (f), respectively; and 
(2) by inserting after subsection (c), the fol-
lowing: 
‘‘(d) ORAL HEALTH INFRASTRUCTURE.— 
‘‘(1) COOPERATIVE
AGREEMENTS.—The Sec-
retary, acting through the Director of the Centers 
for Disease Control and Prevention, shall enter into 
cooperative agreements with State, territorial, and 
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•AMDT. NO. 2786 
Indian tribes or tribal organizations (as those terms 
are defined in section 4 of the Indian Health Care 
Improvement Act) to establish oral health leadership 
and program guidance, oral health data collection 
and interpretation, (including determinants of poor 
oral health among vulnerable populations), a multi- 
dimensional delivery system for oral health, and to 
implement science-based programs (including dental 
sealants and community water fluoridation) to im-
prove oral health. 
‘‘(2) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated such sums as 
necessary to carry out this subsection for fiscal years 
2010 through 2014.’’. 
(d) UPDATING NATIONAL ORAL HEALTHCARE SUR-
VEILLANCE ACTIVITIES.— 
(1) PRAMS.— 
(A) 
IN
GENERAL.—The 
Secretary 
of 
Health and Human Services (referred to in this 
subsection as the ‘‘Secretary’’) shall carry out 
activities to update and improve the Pregnancy 
Risk Assessment Monitoring System (referred 
to in this section as ‘‘PRAMS’’) as it relates to 
oral healthcare. 
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•AMDT. NO. 2786 
(B) STATE
REPORTS
AND
MANDATORY 
MEASUREMENTS.— 
(i) IN GENERAL.—Not later than 5 
years after the date of enactment of this 
Act, and every 5 years thereafter, a State 
shall submit to the Secretary a report con-
cerning activities conducted within the 
State under PRAMS. 
(ii) 
MEASUREMENTS.—The 
oral 
healthcare measurements developed by the 
Secretary for use under PRAMS shall be 
mandatory with respect to States for pur-
poses of the State reports under clause (i). 
(C) FUNDING.—There is authorized to be 
appropriated to carry out this paragraph, such 
sums as may be necessary. 
(2) NATIONAL HEALTH AND NUTRITION EXAM-
INATION SURVEY.—The Secretary shall develop oral 
healthcare components that shall include tooth-level 
surveillance for inclusion in the National Health and 
Nutrition Examination Survey. Such components 
shall be updated by the Secretary at least every 6 
years. For purposes of this paragraph, the term 
‘‘tooth-level surveillance’’ means a clinical examina-
tion where an examiner looks at each dental surface, 
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•AMDT. NO. 2786 
on each tooth in the mouth and as expanded by the 
Division of Oral Health of the Centers for Disease 
Control and Prevention. 
(3) MEDICAL EXPENDITURES PANEL SURVEY.— 
The Secretary shall ensure that the Medical Expend-
itures Panel Survey by the Agency for Healthcare 
Research and Quality includes the verification of 
dental utilization, expenditure, and coverage findings 
through conduct of a look-back analysis. 
(4) NATIONAL
ORAL
HEALTH
SURVEILLANCE 
SYSTEM.— 
(A) APPROPRIATIONS.—There is author-
ized to be appropriated, such sums as may be 
necessary for each of fiscal years 2010 through 
2014 to increase the participation of States in 
the National Oral Health Surveillance System 
from 16 States to all 50 States, territories, and 
District of Columbia. 
(B) REQUIREMENTS.—The Secretary shall 
ensure that the National Oral Health Surveil-
lance System include the measurement of early 
childhood caries. 
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•AMDT. NO. 2786 
SEC. 4103. MEDICARE COVERAGE OF ANNUAL WELLNESS 
VISIT PROVIDING A PERSONALIZED PREVEN-
TION PLAN. 
(a) COVERAGE
OF
PERSONALIZED
PREVENTION 
PLAN SERVICES.— 
(1) IN
GENERAL.—Section 1861(s)(2) of the 
Social Security Act (42 U.S.C. 1395x(s)(2)) is 
amended— 
(A) in subparagraph (DD), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (EE), by adding 
‘‘and’’ at the end; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(FF) personalized prevention plan services (as 
defined in subsection (hhh));’’. 
(2) CONFORMING
AMENDMENTS.—Clauses (i) 
and (ii) of section 1861(s)(2)(K) of the Social Secu-
rity Act (42 U.S.C. 1395x(s)(2)(K)) are each 
amended by striking ‘‘subsection (ww)(1)’’ and in-
serting ‘‘subsections (ww)(1) and (hhh)’’. 
(b) PERSONALIZED PREVENTION PLAN SERVICES 
DEFINED.—Section 1861 of the Social Security Act (42 
U.S.C. 1395x) is amended by adding at the end the fol-
lowing new subsection: 
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•AMDT. NO. 2786 
‘‘Annual Wellness Visit 
‘‘(hhh)(1) The term ‘personalized prevention plan 
services’ means the creation of a plan for an individual— 
‘‘(A) that includes a health risk assessment 
(that meets the guidelines established by the Sec-
retary under paragraph (4)(A)) of the individual 
that is completed prior to or as part of the same 
visit with a health professional described in para-
graph (3); and 
‘‘(B) that— 
‘‘(i) takes into account the results of the 
health risk assessment; and 
‘‘(ii) may contain the elements described in 
paragraph (2). 
‘‘(2) Subject to paragraph (4)(H), the elements de-
scribed in this paragraph are the following: 
‘‘(A) The establishment of, or an update to, the 
individual’s medical and family history. 
‘‘(B) A list of current providers and suppliers 
that are regularly involved in providing medical care 
to the individual (including a list of all prescribed 
medications). 
‘‘(C) A measurement of height, weight, body 
mass index (or waist circumference, if appropriate), 
blood pressure, and other routine measurements. 
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•AMDT. NO. 2786 
‘‘(D) Detection of any cognitive impairment. 
‘‘(E) The establishment of, or an update to, the 
following: 
‘‘(i) A screening schedule for the next 5 to 
10 years, as appropriate, based on rec-
ommendations of the United States Preventive 
Services Task Force and the Advisory Com-
mittee on Immunization Practices, and the indi-
vidual’s health status, screening history, and 
age-appropriate 
preventive 
services 
covered 
under this title. 
‘‘(ii) A list of risk factors and conditions 
for which primary, secondary, or tertiary pre-
vention interventions are recommended or are 
underway, including any mental health condi-
tions or any such risk factors or conditions that 
have been identified through an initial preven-
tive physical examination (as described under 
subsection (ww)(1)), and a list of treatment op-
tions and their associated risks and benefits. 
‘‘(F) The furnishing of personalized health ad-
vice and a referral, as appropriate, to health edu-
cation or preventive counseling services or programs 
aimed at reducing identified risk factors and improv-
ing self-management, or community-based lifestyle 
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•AMDT. NO. 2786 
interventions to reduce health risks and promote 
self-management and wellness, including weight loss, 
physical activity, smoking cessation, fall prevention, 
and nutrition. 
‘‘(G) Any other element determined appropriate 
by the Secretary. 
‘‘(3) A health professional described in this para-
graph is— 
‘‘(A) a physician; 
‘‘(B) a practitioner described in clause (i) of 
section 1842(b)(18)(C); or 
‘‘(C) a medical professional (including a health 
educator, registered dietitian, or nutrition profes-
sional) or a team of medical professionals, as deter-
mined appropriate by the Secretary, under the su-
pervision of a physician. 
‘‘(4)(A) For purposes of paragraph (1)(A), the Sec-
retary, not later than 1 year after the date of enactment 
of this subsection, shall establish publicly available guide-
lines for health risk assessments. Such guidelines shall be 
developed in consultation with relevant groups and entities 
and shall provide that a health risk assessment— 
‘‘(i) identify chronic diseases, injury risks, 
modifiable risk factors, and urgent health needs of 
the individual; and 
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•AMDT. NO. 2786 
‘‘(ii) may be furnished— 
‘‘(I) through an interactive telephonic or 
web-based program that meets the standards 
established under subparagraph (B); 
‘‘(II) during an encounter with a health 
care professional; 
‘‘(III) through community-based preven-
tion programs; or 
‘‘(IV) through any other means the Sec-
retary determines appropriate to maximize ac-
cessibility and ease of use by beneficiaries, while 
ensuring the privacy of such beneficiaries. 
‘‘(B) Not later than 1 year after the date of enact-
ment of this subsection, the Secretary shall establish 
standards for interactive telephonic or web-based pro-
grams used to furnish health risk assessments under sub-
paragraph (A)(ii)(I). The Secretary may utilize any health 
risk assessment developed under section 4004(f) of the 
Patient Protection and Affordable Care Act as part of the 
requirement to develop a personalized prevention plan to 
comply with this subparagraph. 
‘‘(C)(i) Not later than 18 months after the date of 
enactment of this subsection, the Secretary shall develop 
and make available to the public a health risk assessment 
model. Such model shall meet the guidelines under sub-
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•AMDT. NO. 2786 
paragraph (A) and may be used to meet the requirement 
under paragraph (1)(A). 
‘‘(ii) Any health risk assessment that meets the 
guidelines under subparagraph (A) and is approved by the 
Secretary may be used to meet the requirement under 
paragraph (1)(A). 
‘‘(D) The Secretary may coordinate with community- 
based entities (including State Health Insurance Pro-
grams, Area Agencies on Aging, Aging and Disability Re-
source Centers, and the Administration on Aging) to— 
‘‘(i) ensure that health risk assessments are ac-
cessible to beneficiaries; and 
‘‘(ii) provide appropriate support for the com-
pletion of health risk assessments by beneficiaries. 
‘‘(E) The Secretary shall establish procedures to 
make beneficiaries and providers aware of the requirement 
that a beneficiary complete a health risk assessment prior 
to or at the same time as receiving personalized prevention 
plan services. 
‘‘(F) To the extent practicable, the Secretary shall 
encourage the use of, integration with, and coordination 
of health information technology (including use of tech-
nology that is compatible with electronic medical records 
and personal health records) and may experiment with the 
use of personalized technology to aid in the development 
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•AMDT. NO. 2786 
of self-management skills and management of and adher-
ence to provider recommendations in order to improve the 
health status of beneficiaries. 
‘‘(G)(i) A beneficiary shall only be eligible to receive 
an initial preventive physical examination (as defined 
under subsection (ww)(1)) at any time during the 12- 
month period after the date that the beneficiary’s coverage 
begins under part B and shall be eligible to receive person-
alized prevention plan services under this subsection pro-
vided that the beneficiary has not received such services 
within the preceding 12-month period. 
‘‘(ii) The Secretary shall establish procedures to 
make beneficiaries aware of the option to select an initial 
preventive physical examination or personalized prevention 
plan services during the period of 12 months after the date 
that a beneficiary’s coverage begins under part B, which 
shall include information regarding any relevant dif-
ferences between such services. 
‘‘(H) The Secretary shall issue guidance that— 
‘‘(i) identifies elements under paragraph (2) 
that are required to be provided to a beneficiary as 
part of their first visit for personalized prevention 
plan services; and 
‘‘(ii) establishes a yearly schedule for appro-
priate provision of such elements thereafter.’’. 
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•AMDT. NO. 2786 
(c) PAYMENT
AND ELIMINATION
OF COST-SHAR-
ING.— 
(1) PAYMENT AND ELIMINATION OF COINSUR-
ANCE.—Section 1833(a)(1) of the Social Security 
Act (42 U.S.C. 1395l(a)(1)) is amended— 
(A) in subparagraph (N), by inserting 
‘‘other than personalized prevention plan serv-
ices (as defined in section 1861(hhh)(1))’’ after 
‘‘(as defined in section 1848(j)(3))’’; 
(B) by striking ‘‘and’’ before ‘‘(W)’’; and 
(C) by inserting before the semicolon at 
the end the following: ‘‘, and (X) with respect 
to personalized prevention plan services (as de-
fined in section 1861(hhh)(1)), the amount paid 
shall be 100 percent of the lesser of the actual 
charge for the services or the amount deter-
mined under the payment basis determined 
under section 1848’’. 
(2) PAYMENT UNDER PHYSICIAN FEE SCHED-
ULE.—Section 1848(j)(3) of the Social Security Act 
(42 U.S.C. 1395w–4(j)(3)) is amended by inserting 
‘‘(2)(FF) (including administration of the health 
risk assessment) ,’’ after ‘‘(2)(EE),’’. 
(3) ELIMINATION
OF
COINSURANCE
IN
OUT-
PATIENT HOSPITAL SETTINGS.— 
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•AMDT. NO. 2786 
(A) EXCLUSION FROM OPD FEE SCHED-
ULE.—Section 1833(t)(1)(B)(iv) of the Social 
Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)) is 
amended by striking ‘‘and diagnostic mammog-
raphy’’ and inserting ‘‘, diagnostic mammog-
raphy, or personalized prevention plan services 
(as defined in section 1861(hhh)(1))’’. 
(B) CONFORMING AMENDMENTS.—Section 
1833(a)(2) of the Social Security Act (42 
U.S.C. 1395l(a)(2)) is amended— 
(i) in subparagraph (F), by striking 
‘‘and’’ at the end; 
(ii) in subparagraph (G)(ii), by strik-
ing the comma at the end and inserting ‘‘; 
and’’; and 
(iii) by inserting after subparagraph 
(G)(ii) the following new subparagraph: 
‘‘(H) with respect to personalized preven-
tion plan services (as defined in section 
1861(hhh)(1)) furnished by an outpatient de-
partment of a hospital, the amount determined 
under paragraph (1)(X),’’. 
(4) WAIVER
OF
APPLICATION
OF
DEDUCT-
IBLE.—The first sentence of section 1833(b) of the 
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•AMDT. NO. 2786 
Social Security Act (42 U.S.C. 1395l(b)) is amend-
ed— 
(A) by striking ‘‘and’’ before ‘‘(9)’’; and 
(B) by inserting before the period the fol-
lowing: ‘‘, and (10) such deductible shall not 
apply with respect to personalized prevention 
plan 
services 
(as 
defined 
in 
section 
1861(hhh)(1))’’. 
(d) FREQUENCY LIMITATION.—Section 1862(a) of 
the Social Security Act (42 U.S.C. 1395y(a)) is amend-
ed— 
(1) in paragraph (1)— 
(A) in subparagraph (N), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (O), by striking the 
semicolon at the end and inserting ‘‘, and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(P) in the case of personalized prevention plan 
services (as defined in section 1861(hhh)(1)), which 
are performed more frequently than is covered under 
such section;’’; and 
(2) in paragraph (7), by striking ‘‘or (K)’’ and 
inserting ‘‘(K), or (P)’’. 
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•AMDT. NO. 2786 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
January 1, 2011. 
SEC. 4104. REMOVAL OF BARRIERS TO PREVENTIVE SERV-
ICES IN MEDICARE. 
(a) DEFINITION OF PREVENTIVE SERVICES.—Sec-
tion 1861(ddd) of the Social Security Act (42 U.S.C. 
1395x(ddd)) is amended— 
(1) in the heading, by inserting ‘‘; Preventive 
Services’’ after ‘‘Services’’; 
(2) in paragraph (1), by striking ‘‘not otherwise 
described in this title’’ and inserting ‘‘not described 
in subparagraph (A) or (C) of paragraph (3)’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(3) The term ‘preventive services’ means the fol-
lowing: 
‘‘(A) The screening and preventive services de-
scribed in subsection (ww)(2) (other than the service 
described in subparagraph (M) of such subsection). 
‘‘(B) An initial preventive physical examination 
(as defined in subsection (ww)). 
‘‘(C) Personalized prevention plan services (as 
defined in subsection (hhh)(1)).’’. 
(b) COINSURANCE.— 
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•AMDT. NO. 2786 
(1) GENERAL APPLICATION.— 
(A) IN GENERAL.—Section 1833(a)(1) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395l(a)(1)), as amended by section 4103(c)(1), 
is amended— 
(i) in subparagraph (T), by inserting 
‘‘(or 100 percent if such services are rec-
ommended with a grade of A or B by the 
United States Preventive Services Task 
Force for any indication or population and 
are appropriate for the individual)’’ after 
‘‘80 percent’’; 
(ii) in subparagraph (W)— 
(I) in clause (i), by inserting ‘‘(if 
such subparagraph were applied, by 
substituting ‘100 percent’ for ‘80 per-
cent’)’’ after ‘‘subparagraph (D)’’; 
and 
(II) in clause (ii), by striking ‘‘80 
percent’’ and inserting ‘‘100 percent’’; 
(iii) by striking ‘‘and’’ before ‘‘(X)’’; 
and 
(iv) by inserting before the semicolon 
at the end the following: ‘‘, and (Y) with 
respect to preventive services described in 
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•AMDT. NO. 2786 
subparagraphs (A) and (B) of section 
1861(ddd)(3) that are appropriate for the 
individual and, in the case of such services 
described in subparagraph (A), are rec-
ommended with a grade of A or B by the 
United States Preventive Services Task 
Force for any indication or population, the 
amount paid shall be 100 percent of the 
lesser of the actual charge for the services 
or the amount determined under the fee 
schedule that applies to such services 
under this part’’. 
(2) ELIMINATION
OF
COINSURANCE
IN
OUT-
PATIENT HOSPITAL SETTINGS.— 
(A) EXCLUSION FROM OPD FEE SCHED-
ULE.—Section 1833(t)(1)(B)(iv) of the Social 
Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)), as 
amended by section 4103(c)(3)(A), is amend-
ed— 
(i) by striking ‘‘or’’ before ‘‘personal-
ized prevention plan services’’; and 
(ii) by inserting before the period the 
following: ‘‘, or preventive services de-
scribed in subparagraphs (A) and (B) of 
section 1861(ddd)(3) that are appropriate 
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•AMDT. NO. 2786 
for the individual and, in the case of such 
services described in subparagraph (A), are 
recommended with a grade of A or B by 
the United States Preventive Services Task 
Force for any indication or population’’. 
(B) CONFORMING AMENDMENTS.—Section 
1833(a)(2) of the Social Security Act (42 
U.S.C. 1395l(a)(2)), as amended by section 
4103(c)(3)(B), is amended— 
(i) in subparagraph (G)(ii), by strik-
ing ‘‘and’’ after the semicolon at the end; 
(ii) in subparagraph (H), by striking 
the comma at the end and inserting ‘‘; 
and’’; and 
(iii) by inserting after subparagraph 
(H) the following new subparagraph: 
‘‘(I) with respect to preventive services de-
scribed in subparagraphs (A) and (B) of section 
1861(ddd)(3) that are appropriate for the indi-
vidual and are furnished by an outpatient de-
partment of a hospital and, in the case of such 
services described in subparagraph (A), are rec-
ommended with a grade of A or B by the 
United States Preventive Services Task Force 
for any indication or population, the amount 
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•AMDT. NO. 2786 
determined 
under 
paragraph 
(1)(W) 
or 
(1)(Y),’’. 
(c) WAIVER OF APPLICATION OF DEDUCTIBLE FOR 
PREVENTIVE
SERVICES
AND
COLORECTAL
CANCER 
SCREENING TESTS.—Section 1833(b) of the Social Secu-
rity Act (42 U.S.C. 1395l(b)), as amended by section 
4103(c)(4), is amended— 
(1) in paragraph (1), by striking ‘‘items and 
services described in section 1861(s)(10)(A)’’ and in-
serting ‘‘preventive services described in subpara-
graph (A) of section 1861(ddd)(3) that are rec-
ommended with a grade of A or B by the United 
States Preventive Services Task Force for any indi-
cation or population and are appropriate for the in-
dividual.’’; and 
(2) by adding at the end the following new sen-
tence: ‘‘Paragraph (1) of the first sentence of this 
subsection shall apply with respect to a colorectal 
cancer screening test regardless of the code that is 
billed for the establishment of a diagnosis as a result 
of the test, or for the removal of tissue or other mat-
ter or other procedure that is furnished in connec-
tion with, as a result of, and in the same clinical en-
counter as the screening test.’’. 
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•AMDT. NO. 2786 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished on 
or after January 1, 2011. 
SEC. 4105. EVIDENCE-BASED COVERAGE OF PREVENTIVE 
SERVICES IN MEDICARE. 
(a) AUTHORITY TO MODIFY OR ELIMINATE COV-
ERAGE
OF CERTAIN PREVENTIVE SERVICES.—Section 
1834 of the Social Security Act (42 U.S.C. 1395m) is 
amended by adding at the end the following new sub-
section: 
‘‘(n) AUTHORITY TO MODIFY OR ELIMINATE COV-
ERAGE OF CERTAIN PREVENTIVE SERVICES.—Notwith-
standing any other provision of this title, effective begin-
ning on January 1, 2010, if the Secretary determines ap-
propriate, the Secretary may— 
‘‘(1) modify— 
‘‘(A) the coverage of any preventive service 
described in subparagraph (A) of section 
1861(ddd)(3) to the extent that such modifica-
tion is consistent with the recommendations of 
the United States Preventive Services Task 
Force; and 
‘‘(B) the services included in the initial 
preventive physical examination described in 
subparagraph (B) of such section; and 
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•AMDT. NO. 2786 
‘‘(2) provide that no payment shall be made 
under this title for a preventive service described in 
subparagraph (A) of such section that has not re-
ceived a grade of A, B, C, or I by such Task 
Force.’’. 
(b) CONSTRUCTION.—Nothing in the amendment 
made by paragraph (1) shall be construed to affect the 
coverage of diagnostic or treatment services under title 
XVIII of the Social Security Act. 
SEC. 4106. IMPROVING ACCESS TO PREVENTIVE SERVICES 
FOR ELIGIBLE ADULTS IN MEDICAID. 
(a) CLARIFICATION OF INCLUSION OF SERVICES.— 
Section 1905(a)(13) of the Social Security Act (42 U.S.C. 
1396d(a)(13)) is amended to read as follows: 
‘‘(13) other diagnostic, screening, preventive, 
and rehabilitative services, including— 
‘‘(A) any clinical preventive services that 
are assigned a grade of A or B by the United 
States Preventive Services Task Force; 
‘‘(B) with respect to an adult individual, 
approved vaccines recommended by the Advi-
sory Committee on Immunization Practices (an 
advisory committee established by the Sec-
retary, acting through the Director of the Cen-
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•AMDT. NO. 2786 
ters for Disease Control and Prevention) and 
their administration; and 
‘‘(C) any medical or remedial services (pro-
vided in a facility, a home, or other setting) rec-
ommended by a physician or other licensed 
practitioner of the healing arts within the scope 
of their practice under State law, for the max-
imum reduction of physical or mental disability 
and restoration of an individual to the best pos-
sible functional level;’’. 
(b) INCREASED FMAP.—Section 1905(b) of the So-
cial Security Act (42 U.S.C. 1396d(b)), as amended by 
sections 2001(a)(3)(A) and 2004(c)(1), is amended in the 
first sentence— 
(1) by striking ‘‘, and (4)’’ and inserting ‘‘, 
(4)’’; and 
(2) by inserting before the period the following: 
‘‘, and (5) in the case of a State that provides med-
ical assistance for services and vaccines described in 
subparagraphs (A) and (B) of subsection (a)(13), 
and prohibits cost-sharing for such services and vac-
cines, the Federal medical assistance percentage, as 
determined under this subsection and subsection (y) 
(without regard to paragraph (1)(C) of such sub-
section), shall be increased by 1 percentage point 
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•AMDT. NO. 2786 
with respect to medical assistance for such services 
and vaccines and for items and services described in 
subsection (a)(4)(D)’’. 
(c) EFFECTIVE
DATE.—The amendments made 
under this section shall take effect on January 1, 2013. 
SEC. 4107. COVERAGE OF COMPREHENSIVE TOBACCO CES-
SATION SERVICES FOR PREGNANT WOMEN IN 
MEDICAID. 
(a) REQUIRING COVERAGE
OF COUNSELING
AND 
PHARMACOTHERAPY FOR CESSATION OF TOBACCO USE 
BY PREGNANT WOMEN.—Section 1905 of the Social Secu-
rity Act (42 U.S.C. 1396d), as amended by sections 
2001(a)(3)(B) and 2303, is further amended— 
(1) in subsection (a)(4)— 
(A) by striking ‘‘and’’ before ‘‘(C)’’; and 
(B) by inserting before the semicolon at 
the end the following new subparagraph: ‘‘; and 
(D) counseling and pharmacotherapy for ces-
sation of tobacco use by pregnant women (as 
defined in subsection (bb))’’; and 
(2) by adding at the end the following: 
‘‘(bb)(1) For purposes of this title, the term ‘coun-
seling and pharmacotherapy for cessation of tobacco use 
by pregnant women’ means diagnostic, therapy, and coun-
seling services and pharmacotherapy (including the cov-
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•AMDT. NO. 2786 
erage of prescription and nonprescription tobacco ces-
sation agents approved by the Food and Drug Administra-
tion) for cessation of tobacco use by pregnant women who 
use tobacco products or who are being treated for tobacco 
use that is furnished— 
‘‘(A) by or under the supervision of a physician; 
or 
‘‘(B) by any other health care professional 
who— 
‘‘(i) is legally authorized to furnish such 
services under State law (or the State regu-
latory mechanism provided by State law) of the 
State in which the services are furnished; and 
‘‘(ii) is authorized to receive payment for 
other services under this title or is designated 
by the Secretary for this purpose. 
‘‘(2) Subject to paragraph (3), such term is limited 
to— 
‘‘(A) services recommended with respect to 
pregnant women in ‘Treating Tobacco Use and De-
pendence: 2008 Update: A Clinical Practice Guide-
line’, published by the Public Health Service in May 
2008, or any subsequent modification of such Guide-
line; and 
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‘‘(B) such other services that the Secretary rec-
ognizes to be effective for cessation of tobacco use 
by pregnant women. 
‘‘(3) Such term shall not include coverage for drugs 
or biologicals that are not otherwise covered under this 
title.’’. 
(b) EXCEPTION
FROM
OPTIONAL
RESTRICTION 
UNDER MEDICAID PRESCRIPTION DRUG COVERAGE.— 
Section 1927(d)(2)(F) of the Social Security Act (42 
U.S.C. 1396r–8(d)(2)(F)), as redesignated by section 
2502(a), is amended by inserting before the period at the 
end the following: ‘‘, except, in the case of pregnant 
women when recommended in accordance with the Guide-
line referred to in section 1905(bb)(2)(A), agents ap-
proved by the Food and Drug Administration under the 
over-the-counter monograph process for purposes of pro-
moting, and when used to promote, tobacco cessation’’. 
(c) REMOVAL OF COST-SHARING FOR COUNSELING 
AND PHARMACOTHERAPY FOR CESSATION OF TOBACCO 
USE BY PREGNANT WOMEN.— 
(1) GENERAL
COST-SHARING
LIMITATIONS.— 
Section 1916 of the Social Security Act (42 U.S.C. 
1396o) is amended in each of subsections (a)(2)(B) 
and (b)(2)(B) by inserting ‘‘, and counseling and 
pharmacotherapy for cessation of tobacco use by 
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•AMDT. NO. 2786 
pregnant women (as defined in section 1905(bb)) 
and covered outpatient drugs (as defined in sub-
section (k)(2) of section 1927 and including non-
prescription drugs described in subsection (d)(2) of 
such section) that are prescribed for purposes of 
promoting, and when used to promote, tobacco ces-
sation by pregnant women in accordance with the 
Guideline referred to in section 1905(bb)(2)(A)’’ 
after ‘‘complicate the pregnancy’’. 
(2) APPLICATION TO ALTERNATIVE COST-SHAR-
ING.—Section 1916A(b)(3)(B)(iii) of such Act (42 
U.S.C. 1396o–1(b)(3)(B)(iii)) is amended by insert-
ing ‘‘, and counseling and pharmacotherapy for ces-
sation of tobacco use by pregnant women (as defined 
in section 1905(bb))’’ after ‘‘complicate the preg-
nancy’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on October 1, 2010. 
SEC. 4108. INCENTIVES FOR PREVENTION OF CHRONIC DIS-
EASES IN MEDICAID. 
(a) INITIATIVES.— 
(1) ESTABLISHMENT.— 
(A) IN
GENERAL.—The Secretary shall 
award grants to States to carry out initiatives 
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•AMDT. NO. 2786 
to provide incentives to Medicaid beneficiaries 
who— 
(i) successfully participate in a pro-
gram described in paragraph (3); and 
(ii) upon completion of such participa-
tion, demonstrate changes in health risk 
and outcomes, including the adoption and 
maintenance of healthy behaviors by meet-
ing specific targets (as described in sub-
section (c)(2)). 
(B) PURPOSE.—The purpose of the initia-
tives under this section is to test approaches 
that may encourage behavior modification and 
determine scalable solutions. 
(2) DURATION.— 
(A) 
INITIATION
OF
PROGRAM; 
RE-
SOURCES.—The Secretary shall awards grants 
to States beginning on January 1, 2011, or be-
ginning on the date on which the Secretary de-
velops program criteria, whichever is earlier. 
The Secretary shall develop program criteria for 
initiatives under this section using relevant evi-
dence-based research and resources, including 
the Guide to Community Preventive Services, 
the Guide to Clinical Preventive Services, and 
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•AMDT. NO. 2786 
the National Registry of Evidence-Based Pro-
grams and Practices. 
(B) DURATION
OF
PROGRAM.—A State 
awarded a grant to carry out initiatives under 
this section shall carry out such initiatives with-
in the 5-year period beginning on January 1, 
2011, or beginning on the date on which the 
Secretary develops program criteria, whichever 
is earlier. Initiatives under this section shall be 
carried out by a State for a period of not less 
than 3 years. 
(3) PROGRAM DESCRIBED.— 
(A) IN GENERAL.—A program described in 
this paragraph is a comprehensive, evidence- 
based, widely available, and easily accessible 
program, proposed by the State and approved 
by the Secretary, that is designed and uniquely 
suited to address the needs of Medicaid bene-
ficiaries and has demonstrated success in help-
ing individuals achieve one or more of the fol-
lowing: 
(i) Ceasing use of tobacco products. 
(ii) Controlling or reducing their 
weight. 
(iii) Lowering their cholesterol. 
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•AMDT. NO. 2786 
(iv) Lowering their blood pressure. 
(v) Avoiding the onset of diabetes or, 
in the case of a diabetic, improving the 
management of that condition. 
(B) CO-MORBIDITIES.—A program under 
this section may also address co-morbidities (in-
cluding depression) that are related to any of 
the conditions described in subparagraph (A). 
(C) WAIVER AUTHORITY.—The Secretary 
may 
waive 
the 
requirements 
of 
section 
1902(a)(1) (relating to statewideness) of the 
Social Security Act for a State awarded a grant 
to conduct an initiative under this section and 
shall ensure that a State makes any program 
described in subparagraph (A) available and ac-
cessible to Medicaid beneficiaries. 
(D) FLEXIBILITY IN IMPLEMENTATION.— 
A State may enter into arrangements with pro-
viders participating in Medicaid, community- 
based organizations, faith-based organizations, 
public-private partnerships, Indian tribes, or 
similar entities or organizations to carry out 
programs described in subparagraph (A). 
(4) APPLICATION.—Following the development 
of program criteria by the Secretary, a State may 
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•AMDT. NO. 2786 
submit an application, in such manner and con-
taining such information as the Secretary may re-
quire, that shall include a proposal for programs de-
scribed in paragraph (3)(A) and a plan to make 
Medicaid beneficiaries and providers participating in 
Medicaid who reside in the State aware and in-
formed about such programs. 
(b) EDUCATION AND OUTREACH CAMPAIGN.— 
(1) STATE AWARENESS.—The Secretary shall 
conduct an outreach and education campaign to 
make States aware of the grants under this section. 
(2) 
PROVIDER
AND
BENEFICIARY
EDU-
CATION.—A State awarded a grant to conduct an 
initiative under this section shall conduct an out-
reach and education campaign to make Medicaid 
beneficiaries and providers participating in Medicaid 
who reside in the State aware of the programs de-
scribed in subsection (a)(3) that are to be carried 
out by the State under the grant. 
(c) IMPACT.—A State awarded a grant to conduct an 
initiative under this section shall develop and implement 
a system to— 
(1) track Medicaid beneficiary participation in 
the program and validate changes in health risk and 
outcomes with clinical data, including the adoption 
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•AMDT. NO. 2786 
and maintenance of health behaviors by such bene-
ficiaries; 
(2) to the extent practicable, establish stand-
ards and health status targets for Medicaid bene-
ficiaries participating in the program and measure 
the degree to which such standards and targets are 
met; 
(3) evaluate the effectiveness of the program 
and provide the Secretary with such evaluations; 
(4) report to the Secretary on processes that 
have been developed and lessons learned from the 
program; and 
(5) report on preventive services as part of re-
porting on quality measures for Medicaid managed 
care programs. 
(d) EVALUATIONS AND REPORTS.— 
(1) INDEPENDENT
ASSESSMENT.—The Sec-
retary shall enter into a contract with an inde-
pendent entity or organization to conduct an evalua-
tion and assessment of the initiatives carried out by 
States under this section, for the purpose of deter-
mining— 
(A) the effect of such initiatives on the use 
of health care services by Medicaid beneficiaries 
participating in the program; 
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•AMDT. NO. 2786 
(B) the extent to which special populations 
(including adults with disabilities, adults with 
chronic illnesses, and children with special 
health care needs) are able to participate in the 
program; 
(C) the level of satisfaction of Medicaid 
beneficiaries with respect to the accessibility 
and quality of health care services provided 
through the program; and 
(D) the administrative costs incurred by 
State agencies that are responsible for adminis-
tration of the program. 
(2) STATE
REPORTING.—A State awarded a 
grant to carry out initiatives under this section shall 
submit reports to the Secretary, on a semi-annual 
basis, regarding the programs that are supported by 
the grant funds. Such report shall include informa-
tion, as specified by the Secretary, regarding— 
(A) the specific uses of the grant funds; 
(B) an assessment of program implementa-
tion and lessons learned from the programs; 
(C) an assessment of quality improvements 
and clinical outcomes under such programs; and 
(D) estimates of cost savings resulting 
from such programs. 
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•AMDT. NO. 2786 
(3) INITIAL REPORT.—Not later than January 
1, 2014, the Secretary shall submit to Congress an 
initial report on such initiatives based on informa-
tion provided by States through reports required 
under paragraph (2). The initial report shall include 
an interim evaluation of the effectiveness of the ini-
tiatives carried out with grants awarded under this 
section and a recommendation regarding whether 
funding for expanding or extending the initiatives 
should be extended beyond January 1, 2016. 
(4) FINAL
REPORT.—Not later than July 1, 
2016, the Secretary shall submit to Congress a final 
report on the program that includes the results of 
the independent assessment required under para-
graph (1), together with recommendations for such 
legislation and administrative action as the Sec-
retary determines appropriate. 
(e) NO EFFECT ON ELIGIBILITY FOR, OR AMOUNT 
OF, MEDICAID
OR OTHER BENEFITS.—Any incentives 
provided to a Medicaid beneficiary participating in a pro-
gram described in subsection (a)(3) shall not be taken into 
account for purposes of determining the beneficiary’s eligi-
bility for, or amount of, benefits under the Medicaid pro-
gram or any program funded in whole or in part with Fed-
eral funds. 
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•AMDT. NO. 2786 
(f) FUNDING.—Out of any funds in the Treasury not 
otherwise appropriated, there are appropriated for the 5- 
year period beginning on January 1, 2011, $100,000,000 
to the Secretary to carry out this section. Amounts appro-
priated under this subsection shall remain available until 
expended. 
(g) DEFINITIONS.—In this section: 
(1) MEDICAID BENEFICIARY.—The term ‘‘Med-
icaid beneficiary’’ means an individual who is eligible 
for medical assistance under a State plan or waiver 
under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) and is enrolled in such plan or 
waiver. 
(2) STATE.—The term ‘‘State’’ has the mean-
ing given that term for purposes of title XIX of the 
Social Security Act (42 U.S.C. 1396 et seq.). 
Subtitle C—Creating Healthier 
Communities 
SEC. 4201. COMMUNITY TRANSFORMATION GRANTS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’), acting through the Director of the Centers for 
Disease Control and Prevention (referred to in this section 
as the ‘‘Director’’), shall award competitive grants to 
State and local governmental agencies and community- 
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•AMDT. NO. 2786 
based organizations for the implementation, evaluation, 
and dissemination of evidence-based community preventive 
health activities in order to reduce chronic disease rates, 
prevent the development of secondary conditions, address 
health disparities, and develop a stronger evidence-base of 
effective prevention programming. 
(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
(1) be— 
(A) a State governmental agency; 
(B) a local governmental agency; 
(C) a national network of community-based 
organizations; 
(D) a State or local non-profit organiza-
tion; or 
(E) an Indian tribe; and 
(2) submit to the Director an application at 
such time, in such a manner, and containing such 
information as the Director may require, including a 
description of the program to be carried out under 
the grant; and 
(3) demonstrate a history or capacity, if fund-
ed, to develop relationships necessary to engage key 
stakeholders from multiple sectors within and be-
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•AMDT. NO. 2786 
yond health care and across a community, such as 
healthy futures corps and health care providers. 
(c) USE OF FUNDS.— 
(1) IN GENERAL.—An eligible entity shall use 
amounts received under a grant under this section to 
carry out programs described in this subsection. 
(2) COMMUNITY TRANSFORMATION PLAN.— 
(A) IN GENERAL.—An eligible entity that 
receives a grant under this section shall submit 
to the Director (for approval) a detailed plan 
that includes the policy, environmental, pro-
grammatic, and as appropriate infrastructure 
changes needed to promote healthy living and 
reduce disparities. 
(B) ACTIVITIES.—Activities within the 
plan may focus on (but not be limited to)— 
(i) creating healthier school environ-
ments, including increasing healthy food 
options, physical activity opportunities, 
promotion of healthy lifestyle, emotional 
wellness, and prevention curricula, and ac-
tivities to prevent chronic diseases; 
(ii) creating the infrastructure to sup-
port active living and access to nutritious 
foods in a safe environment; 
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•AMDT. NO. 2786 
(iii) developing and promoting pro-
grams targeting a variety of age levels to 
increase access to nutrition, physical activ-
ity and smoking cessation, improve social 
and emotional wellness, enhance safety in 
a community, or address any other chronic 
disease priority area identified by the 
grantee; 
(iv) assessing and implementing work-
site wellness programming and incentives; 
(v) working to highlight healthy op-
tions at restaurants and other food venues; 
(vi) prioritizing strategies to reduce 
racial and ethnic disparities, including so-
cial, economic, and geographic deter-
minants of health; and 
(vii) addressing special populations 
needs, including all age groups and individ-
uals with disabilities, and individuals in 
both urban and rural areas. 
(3) COMMUNITY-BASED
PREVENTION
HEALTH 
ACTIVITIES.— 
(A) IN GENERAL.—An eligible entity shall 
use amounts received under a grant under this 
section to implement a variety of programs, 
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