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•AMDT. NO. 2786 
policies, and infrastructure improvements to 
promote healthier lifestyles. 
(B) ACTIVITIES.—An eligible entity shall 
implement activities detailed in the community 
transformation plan under paragraph (2). 
(C) IN-KIND SUPPORT.—An eligible entity 
may provide in-kind resources such as staff, 
equipment, or office space in carrying out ac-
tivities under this section. 
(4) EVALUATION.— 
(A) IN GENERAL.—An eligible entity shall 
use amounts provided under a grant under this 
section to conduct activities to measure changes 
in the prevalence of chronic disease risk factors 
among community members participating in 
preventive health activities 
(B) TYPES
OF
MEASURES.—In carrying 
out subparagraph (A), the eligible entity shall, 
with respect to residents in the community, 
measure— 
(i) changes in weight; 
(ii) changes in proper nutrition; 
(iii) changes in physical activity; 
(iv) changes in tobacco use prevalence; 
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•AMDT. NO. 2786 
(v) changes in emotional well-being 
and overall mental health; 
(vi) other factors using community- 
specific data from the Behavioral Risk 
Factor Surveillance Survey; and 
(vii) other factors as determined by 
the Secretary. 
(C) REPORTING.—An eligible entity shall 
annually submit to the Director a report con-
taining an evaluation of activities carried out 
under the grant. 
(5) DISSEMINATION.—A grantee under this sec-
tion shall— 
(A) meet at least annually in regional or 
national meetings to discuss challenges, best 
practices, and lessons learned with respect to 
activities carried out under the grant; and 
(B) develop models for the replication of 
successful programs and activities and the men-
toring of other eligible entities. 
(d) TRAINING.— 
(1) IN GENERAL.—The Director shall develop a 
program to provide training for eligible entities on 
effective strategies for the prevention and control of 
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•AMDT. NO. 2786 
chronic disease and the link between physical, emo-
tional, and social well-being. 
(2) COMMUNITY TRANSFORMATION PLAN.—The 
Director shall provide appropriate feedback and 
technical assistance to grantees to establish commu-
nity transformation plans 
(3) EVALUATION.—The Director shall provide a 
literature review and framework for the evaluation 
of programs conducted as part of the grant program 
under this section, in addition to working with aca-
demic institutions or other entities with expertise in 
outcome evaluation. 
(e) PROHIBITION.—A grantee shall not use funds 
provided under a grant under this section to create video 
games or to carry out any other activities that may lead 
to higher rates of obesity or inactivity. 
(f) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
such sums as may be necessary for each fiscal years 2010 
through 2014. 
SEC. 4202. HEALTHY AGING, LIVING WELL; EVALUATION OF 
COMMUNITY-BASED 
PREVENTION 
AND 
WELLNESS PROGRAMS FOR MEDICARE BENE-
FICIARIES. 
(a) HEALTHY AGING, LIVING WELL.— 
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•AMDT. NO. 2786 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (referred to in this section as the 
‘‘Secretary’’), acting through the Director of the 
Centers for Disease Control and Prevention, shall 
award grants to State or local health departments 
and Indian tribes to carry out 5-year pilot programs 
to provide public health community interventions, 
screenings, and where necessary, clinical referrals 
for individuals who are between 55 and 64 years of 
age. 
(2) ELIGIBILITY.—To be eligible to receive a 
grant under paragraph (1), an entity shall— 
(A) be— 
(i) a State health department; 
(ii) a local health department; or 
(iii) an Indian tribe; 
(B) submit to the Secretary an application 
at such time, in such manner, and containing 
such information as the Secretary may require 
including a description of the program to be 
carried out under the grant; 
(C) design a strategy for improving the 
health of the 55-to-64 year-old population 
through community-based public health inter-
ventions; and 
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•AMDT. NO. 2786 
(D) demonstrate the capacity, if funded, to 
develop the relationships necessary with rel-
evant health agencies, health care providers, 
community-based organizations, and insurers to 
carry out the activities described in paragraph 
(3), such relationships to include the identifica-
tion of a community-based clinical partner, such 
as a community health center or rural health 
clinic. 
(3) USE OF FUNDS.— 
(A) IN GENERAL.—A State or local health 
department shall use amounts received under a 
grant under this subsection to carry out a pro-
gram to provide the services described in this 
paragraph to individuals who are between 55 
and 64 years of age. 
(B) PUBLIC HEALTH INTERVENTIONS.— 
(i) IN GENERAL.—In developing and 
implementing such activities, a grantee 
shall collaborate with the Centers for Dis-
ease Control and Prevention and the Ad-
ministration on Aging, and relevant local 
agencies and organizations. 
(ii) TYPES OF INTERVENTION ACTIVI-
TIES.—Intervention 
activities 
conducted 
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•AMDT. NO. 2786 
under this subparagraph may include ef-
forts to improve nutrition, increase phys-
ical activity, reduce tobacco use and sub-
stance abuse, improve mental health, and 
promote healthy lifestyles among the target 
population. 
(C) 
COMMUNITY
PREVENTIVE 
SCREENINGS.— 
(i) IN GENERAL.—In addition to com-
munity-wide public health interventions, a 
State or local health department shall use 
amounts received under a grant under this 
subsection to conduct ongoing health 
screening to identify risk factors for car-
diovascular disease, cancer, stroke, and di-
abetes among individuals in both urban 
and rural areas who are between 55 and 
64 years of age. 
(ii) TYPES
OF
SCREENING
ACTIVI-
TIES.—Screening 
activities 
conducted 
under this subparagraph may include— 
(I) 
mental 
health/behavioral 
health and substance use disorders; 
(II) physical activity, smoking, 
and nutrition; and 
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•AMDT. NO. 2786 
(III) any other measures deemed 
appropriate by the Secretary. 
(iii) MONITORING.—Grantees under 
this section shall maintain records of 
screening results under this subparagraph 
to establish the baseline data for moni-
toring the targeted population 
(D) CLINICAL REFERRAL/TREATMENT FOR 
CHRONIC DISEASES.— 
(i) IN
GENERAL.—A State or local 
health department shall use amounts re-
ceived under a grant under this subsection 
to ensure that individuals between 55 and 
64 years of age who are found to have 
chronic disease risk factors through the 
screening activities described in subpara-
graph (C)(ii), receive clinical referral/treat-
ment for follow-up services to reduce such 
risk. 
(ii) MECHANISM.— 
(I) IDENTIFICATION AND DETER-
MINATION OF STATUS.—With respect 
to each individual with risk factors for 
or having heart disease, stroke, diabe-
tes, or any other condition for which 
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•AMDT. NO. 2786 
such individual was screened under 
subparagraph (C), a grantee under 
this section shall determine whether 
or not such individual is covered 
under any public or private health in-
surance program. 
(II) INSURED INDIVIDUALS.—An 
individual determined to be covered 
under a health insurance program 
under subclause (I) shall be referred 
by the grantee to the existing pro-
viders under such program or, if such 
individual does not have a current 
provider, to a provider who is in-net-
work with respect to the program in-
volved. 
(III) 
UNINSURED
INDIVID-
UALS.—With respect to an individual 
determined to be uninsured under 
subclause (I), the grantee’s commu-
nity-based clinical partner described 
in paragraph (4)(D) shall assist the 
individual in determining eligibility for 
available public coverage options and 
identify other appropriate community 
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•AMDT. NO. 2786 
health care resources and assistance 
programs. 
(iii) PUBLIC HEALTH INTERVENTION 
PROGRAM.—A State or local health depart-
ment shall use amounts received under a 
grant under this subsection to enter into 
contracts with community health centers or 
rural health clinics and mental health and 
substance use disorder service providers to 
assist in the referral/treatment of at risk 
patients to community resources for clin-
ical follow-up and help determine eligibility 
for other public programs. 
(E) GRANTEE
EVALUATION.—An eligible 
entity shall use amounts provided under a grant 
under this subsection to conduct activities to 
measure changes in the prevalence of chronic 
disease risk factors among participants. 
(4) PILOT PROGRAM EVALUATION.—The Sec-
retary shall conduct an annual evaluation of the ef-
fectiveness of the pilot program under this sub-
section. In determining such effectiveness, the Sec-
retary shall consider changes in the prevalence of 
uncontrolled chronic disease risk factors among new 
Medicare enrollees (or individuals nearing enroll-
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•AMDT. NO. 2786 
ment, including those who are 63 and 64 years of 
age) who reside in States or localities receiving 
grants under this section as compared with national 
and historical data for those States and localities for 
the same population. 
(5) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated to carry out 
this subsection, such sums as may be necessary for 
each of fiscal years 2010 through 2014. 
(b) EVALUATION AND PLAN FOR COMMUNITY-BASED 
PREVENTION AND WELLNESS PROGRAMS FOR MEDICARE 
BENEFICIARIES.— 
(1) IN GENERAL.—The Secretary shall conduct 
an evaluation of community-based prevention and 
wellness programs and develop a plan for promoting 
healthy lifestyles and chronic disease self-manage-
ment for Medicare beneficiaries. 
(2) MEDICARE
EVALUATION
OF
PREVENTION 
AND WELLNESS PROGRAMS.— 
(A) IN
GENERAL.—The Secretary shall 
evaluate community prevention and wellness 
programs including those that are sponsored by 
the Administration on Aging, are evidence- 
based, and have demonstrated potential to help 
Medicare beneficiaries (particularly beneficiaries 
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•AMDT. NO. 2786 
that have attained 65 years of age) reduce their 
risk of disease, disability, and injury by making 
healthy lifestyle choices, including exercise, diet, 
and self-management of chronic diseases. 
(B) EVALUATION.—The evaluation under 
subparagraph (A) shall consist of the following: 
(i) EVIDENCE
REVIEW.—The Sec-
retary shall review available evidence, lit-
erature, best practices, and resources that 
are relevant to programs that promote 
healthy lifestyles and reduce risk factors 
for the Medicare population. The Secretary 
may determine the scope of the evidence 
review and such issues to be considered, 
which shall include, at a minimum— 
(I) physical activity, nutrition, 
and obesity; 
(II) falls; 
(III) chronic disease self-manage-
ment; and 
(IV) mental health. 
(ii) INDEPENDENT
EVALUATION
OF 
EVIDENCE-BASED
COMMUNITY
PREVEN-
TION
AND
WELLNESS
PROGRAMS.—The 
Administrator of the Centers for Medicare 
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•AMDT. NO. 2786 
& Medicaid Services, in consultation with 
the Assistant Secretary for Aging, shall, to 
the extent feasible and practicable, conduct 
an evaluation of existing community pre-
vention and wellness programs that are 
sponsored by the Administration on Aging 
to assess the extent to which Medicare 
beneficiaries who participate in such pro-
grams— 
(I) reduce their health risks, im-
prove their health outcomes, and 
adopt and maintain healthy behaviors; 
(II) improve their ability to man-
age their chronic conditions; and 
(III) reduce their utilization of 
health services and associated costs 
under the Medicare program for con-
ditions that are amenable to improve-
ment under such programs. 
(3) REPORT.—Not later than September 30, 
2013, the Secretary shall submit to Congress a re-
port that includes— 
(A) recommendations for such legislation 
and administrative action as the Secretary de-
termines appropriate to promote healthy life-
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•AMDT. NO. 2786 
styles and chronic disease self-management for 
Medicare beneficiaries; 
(B) any relevant findings relating to the 
evidence review under paragraph (2)(B)(i); and 
(C) the results of the evaluation under 
paragraph (2)(B)(ii). 
(4) FUNDING.—For purposes of carrying out 
this subsection, the Secretary shall provide for the 
transfer, from the Federal Hospital Insurance Trust 
Fund under section 1817 of the Social Security Act 
(42 U.S.C. 1395i) and the Federal Supplemental 
Medical Insurance Trust Fund under section 1841 
of such Act (42 U.S.C. 1395t), in such proportion 
as 
the 
Secretary 
determines 
appropriate, 
of 
$50,000,000 to the Centers for Medicare & Medicaid 
Services Program Management Account. Amounts 
transferred under the preceding sentence shall re-
main available until expended. 
(5) ADMINISTRATION.—Chapter 35 of title 44, 
United States Code shall not apply to the this sub-
section. 
(6) MEDICARE
BENEFICIARY.—In this sub-
section, the term ‘‘Medicare beneficiary’’ means an 
individual who is entitled to benefits under part A 
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•AMDT. NO. 2786 
of title XVIII of the Social Security Act and enrolled 
under part B of such title. 
SEC. 4203. REMOVING BARRIERS AND IMPROVING ACCESS 
TO WELLNESS FOR INDIVIDUALS WITH DIS-
ABILITIES. 
Title V of the Rehabilitation Act of 1973 (29 U.S.C. 
791 et seq.) is amended by adding at the end of the fol-
lowing: 
‘‘SEC. 510. ESTABLISHMENT OF STANDARDS FOR ACCES-
SIBLE MEDICAL DIAGNOSTIC EQUIPMENT. 
‘‘(a) STANDARDS.—Not later than 24 months after 
the date of enactment of the Affordable Health Choices 
Act, the Architectural and Transportation Barriers Com-
pliance Board shall, in consultation with the Commis-
sioner of the Food and Drug Administration, promulgate 
regulatory standards in accordance with the Administra-
tive Procedure Act (2 U.S.C. 551 et seq.) setting forth 
the minimum technical criteria for medical diagnostic 
equipment used in (or in conjunction with) physician’s of-
fices, clinics, emergency rooms, hospitals, and other med-
ical settings. The standards shall ensure that such equip-
ment is accessible to, and usable by, individuals with ac-
cessibility needs, and shall allow independent entry to, use 
of, and exit from the equipment by such individuals to the 
maximum extent possible. 
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•AMDT. NO. 2786 
‘‘(b) 
MEDICAL
DIAGNOSTIC
EQUIPMENT
COV-
ERED.—The standards issued under subsection (a) for 
medical diagnostic equipment shall apply to equipment 
that includes examination tables, examination chairs (in-
cluding chairs used for eye examinations or procedures, 
and dental examinations or procedures), weight scales, 
mammography equipment, x-ray machines, and other radi-
ological equipment commonly used for diagnostic purposes 
by health professionals. 
‘‘(c) REVIEW AND AMENDMENT.—The Architectural 
and Transportation Barriers Compliance Board, in con-
sultation with the Commissioner of the Food and Drug 
Administration, shall periodically review and, as appro-
priate, amend the standards in accordance with the Ad-
ministrative Procedure Act (2 U.S.C. 551 et seq.).’’. 
SEC. 4204. IMMUNIZATIONS. 
(a) 
STATE
AUTHORITY
TO
PURCHASE
REC-
OMMENDED VACCINES FOR ADULTS.—Section 317 of the 
Public Health Service Act (42 U.S.C. 247b) is amended 
by adding at the end the following: 
‘‘(l) AUTHORITY TO PURCHASE RECOMMENDED VAC-
CINES FOR ADULTS.— 
‘‘(1) IN GENERAL.—The Secretary may nego-
tiate and enter into contracts with manufacturers of 
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•AMDT. NO. 2786 
vaccines for the purchase and delivery of vaccines 
for adults as provided for under subsection (e). 
‘‘(2) STATE PURCHASE.—A State may obtain 
additional quantities of such adult vaccines (subject 
to amounts specified to the Secretary by the State 
in advance of negotiations) through the purchase of 
vaccines from manufacturers at the applicable price 
negotiated by the Secretary under this subsection.’’. 
(b) DEMONSTRATION PROGRAM TO IMPROVE IMMU-
NIZATION COVERAGE.—Section 317 of the Public Health 
Service Act (42 U.S.C. 247b), as amended by subsection 
(a), is further amended by adding at the end the following: 
‘‘(m) DEMONSTRATION PROGRAM TO IMPROVE IM-
MUNIZATION COVERAGE.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Director of the Centers for Disease 
Control and Prevention, shall establish a demonstra-
tion program to award grants to States to improve 
the provision of recommended immunizations for 
children, adolescents, and adults through the use of 
evidence-based, population-based interventions for 
high-risk populations. 
‘‘(2) STATE PLAN.—To be eligible for a grant 
under paragraph (1), a State shall submit to the 
Secretary an application at such time, in such man-
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•AMDT. NO. 2786 
ner, and containing such information as the Sec-
retary may require, including a State plan that de-
scribes the interventions to be implemented under 
the grant and how such interventions match with 
local needs and capabilities, as determined through 
consultation with local authorities. 
‘‘(3) USE OF FUNDS.—Funds received under a 
grant under this subsection shall be used to imple-
ment interventions that are recommended by the 
Task Force on Community Preventive Services (as 
established by the Secretary, acting through the Di-
rector of the Centers for Disease Control and Pre-
vention) or other evidence-based interventions, in-
cluding— 
‘‘(A) providing immunization reminders or 
recalls for target populations of clients, pa-
tients, and consumers; 
‘‘(B) educating targeted populations and 
health care providers concerning immunizations 
in combination with one or more other interven-
tions; 
‘‘(C) reducing out-of-pocket costs for fami-
lies for vaccines and their administration; 
‘‘(D) carrying out immunization-promoting 
strategies for participants or clients of public 
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•AMDT. NO. 2786 
programs, including assessments of immuniza-
tion status, referrals to health care providers, 
education, provision of on-site immunizations, 
or incentives for immunization; 
‘‘(E) providing for home visits that pro-
mote immunization through education, assess-
ments of need, referrals, provision of immuniza-
tions, or other services; 
‘‘(F) providing reminders or recalls for im-
munization providers; 
‘‘(G) conducting assessments of, and pro-
viding feedback to, immunization providers; 
‘‘(H) any combination of one or more 
interventions described in this paragraph; or 
‘‘(I) immunization information systems to 
allow all States to have electronic databases for 
immunization records. 
‘‘(4) CONSIDERATION.—In awarding grants 
under this subsection, the Secretary shall consider 
any reviews or recommendations of the Task Force 
on Community Preventive Services. 
‘‘(5) EVALUATION.—Not later than 3 years 
after the date on which a State receives a grant 
under this subsection, the State shall submit to the 
Secretary an evaluation of progress made toward im-
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•AMDT. NO. 2786 
proving immunization coverage rates among high- 
risk populations within the State. 
‘‘(6) REPORT TO CONGRESS.—Not later than 4 
years after the date of enactment of the Affordable 
Health Choices Act, the Secretary shall submit to 
Congress a report concerning the effectiveness of the 
demonstration program established under this sub-
section together with recommendations on whether 
to continue and expand such program. 
‘‘(7) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated to carry out 
this subsection, such sums as may be necessary for 
each of fiscal years 2010 through 2014.’’. 
(c) REAUTHORIZATION
OF
IMMUNIZATION
PRO-
GRAM.—Section 317(j) of the Public Health Service Act 
(42 U.S.C. 247b(j)) is amended— 
(1) in paragraph (1), by striking ‘‘for each of 
the fiscal years 1998 through 2005’’; and 
(2) in paragraph (2), by striking ‘‘after October 
1, 1997,’’. 
(d) RULE OF CONSTRUCTION REGARDING ACCESS TO 
IMMUNIZATIONS.—Nothing in this section (including the 
amendments made by this section), or any other provision 
of this Act (including any amendments made by this Act) 
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•AMDT. NO. 2786 
shall be construed to decrease children’s access to immuni-
zations. 
(e) GAO STUDY AND REPORT ON MEDICARE BENE-
FICIARY ACCESS TO VACCINES.— 
(1) STUDY.—The Comptroller General of the 
United States (in this section referred to as the 
‘‘Comptroller General’’) shall conduct a study on the 
ability of Medicare beneficiaries who were 65 years 
of age or older to access routinely recommended vac-
cines covered under the prescription drug program 
under part D of title XVIII of the Social Security 
Act over the period since the establishment of such 
program. Such study shall include the following: 
(A) An analysis and determination of— 
(i) the number of Medicare bene-
ficiaries who were 65 years of age or older 
and were eligible for a routinely rec-
ommended vaccination that was covered 
under part D; 
(ii) the number of such beneficiaries 
who actually received a routinely rec-
ommended vaccination that was covered 
under part D; and 
(iii) any barriers to access by such 
beneficiaries to routinely recommended 
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•AMDT. NO. 2786 
vaccinations that were covered under part 
D. 
(B) A summary of the findings and rec-
ommendations by government agencies, depart-
ments, and advisory bodies (as well as relevant 
professional organizations) on the impact of 
coverage under part D of routinely rec-
ommended adult immunizations for access to 
such immunizations by Medicare beneficiaries. 
(2) REPORT.—Not later than June 1, 2011, the 
Comptroller General shall submit to the appropriate 
committees of jurisdiction of the House of Rep-
resentatives and the Senate a report containing the 
results of the study conducted under paragraph (1), 
together with recommendations for such legislation 
and administrative action as the Comptroller Gen-
eral determines appropriate. 
(3) FUNDING.—Out of any funds in the Treas-
ury not otherwise appropriated, there are appro-
priated $1,000,000 for fiscal year 2010 to carry out 
this subsection. 
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•AMDT. NO. 2786 
SEC. 4205. NUTRITION LABELING OF STANDARD MENU 
ITEMS AT CHAIN RESTAURANTS. 
(a) 
TECHNICAL
AMENDMENTS.—Section 
403(q)(5)(A) of the Federal Food, Drug, and Cosmetic 
Act (21 U.S.C. 343(q)(5)(A)) is amended— 
(1) in subitem (i), by inserting at the beginning 
‘‘except as provided in clause (H)(ii)(III),’’; and 
(2) in subitem (ii), by inserting at the begin-
ning ‘‘except as provided in clause (H)(ii)(III),’’. 
(b) LABELING REQUIREMENTS.—Section 403(q)(5) 
of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
343(q)(5)) is amended by adding at the end the following: 
‘‘(H) RESTAURANTS, RETAIL FOOD ESTABLISH-
MENTS, AND VENDING MACHINES.— 
‘‘(i) 
GENERAL
REQUIREMENTS
FOR
RES-
TAURANTS AND SIMILAR RETAIL FOOD ESTABLISH-
MENTS.—Except for food described in subclause 
(vii), in the case of food that is a standard menu 
item that is offered for sale in a restaurant or simi-
lar retail food establishment that is part of a chain 
with 20 or more locations doing business under the 
same name (regardless of the type of ownership of 
the locations) and offering for sale substantially the 
same menu items, the restaurant or similar retail 
food establishment shall disclose the information de-
scribed in subclauses (ii) and (iii). 
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•AMDT. NO. 2786 
‘‘(ii) INFORMATION
REQUIRED
TO
BE
DIS-
CLOSED BY RESTAURANTS AND RETAIL FOOD ES-
TABLISHMENTS.—Except as provided in subclause 
(vii), the restaurant or similar retail food establish-
ment shall disclose in a clear and conspicuous man-
ner— 
‘‘(I)(aa) in a nutrient content disclosure 
statement adjacent to the name of the standard 
menu item, so as to be clearly associated with 
the standard menu item, on the menu listing 
the item for sale, the number of calories con-
tained in the standard menu item, as usually 
prepared and offered for sale; and 
‘‘(bb) a succinct statement concerning sug-
gested daily caloric intake, as specified by the 
Secretary by regulation and posted prominently 
on the menu and designed to enable the public 
to understand, in the context of a total daily 
diet, the significance of the caloric information 
that is provided on the menu; 
‘‘(II)(aa) in a nutrient content disclosure 
statement adjacent to the name of the standard 
menu item, so as to be clearly associated with 
the standard menu item, on the menu board, 
including a drive-through menu board, the 
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•AMDT. NO. 2786 
number of calories contained in the standard 
menu item, as usually prepared and offered for 
sale; and 
‘‘(bb) a succinct statement concerning sug-
gested daily caloric intake, as specified by the 
Secretary by regulation and posted prominently 
on the menu board, designed to enable the pub-
lic to understand, in the context of a total daily 
diet, the significance of the nutrition informa-
tion that is provided on the menu board; 
‘‘(III) in a written form, available on the prem-
ises of the restaurant or similar retail establishment 
and to the consumer upon request, the nutrition in-
formation required under clauses (C) and (D) of 
subparagraph (1); and 
‘‘(IV) on the menu or menu board, a promi-
nent, clear, and conspicuous statement regarding the 
availability of the information described in item 
(III). 
‘‘(iii) SELF-SERVICE FOOD AND FOOD ON DIS-
PLAY.—Except as provided in subclause (vii), in the 
case of food sold at a salad bar, buffet line, cafeteria 
line, or similar self-service facility, and for self-serv-
ice beverages or food that is on display and that is 
visible to customers, a restaurant or similar retail 
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•AMDT. NO. 2786 
food establishment shall place adjacent to each food 
offered a sign that lists calories per displayed food 
item or per serving. 
‘‘(iv) REASONABLE BASIS.—For the purposes of 
this clause, a restaurant or similar retail food estab-
lishment shall have a reasonable basis for its nutri-
ent content disclosures, including nutrient databases, 
cookbooks, laboratory analyses, and other reasonable 
means, as described in section 101.10 of title 21, 
Code of Federal Regulations (or any successor regu-
lation) or in a related guidance of the Food and 
Drug Administration. 
‘‘(v) MENU
VARIABILITY
AND
COMBINATION 
MEALS.—The Secretary shall establish by regulation 
standards for determining and disclosing the nutri-
ent content for standard menu items that come in 
different flavors, varieties, or combinations, but 
which are listed as a single menu item, such as soft 
drinks, ice cream, pizza, doughnuts, or children’s 
combination meals, through means determined by 
the Secretary, including ranges, averages, or other 
methods. 
‘‘(vi) ADDITIONAL INFORMATION.—If the Sec-
retary determines that a nutrient, other than a nu-
trient required under subclause (ii)(III), should be 
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•AMDT. NO. 2786 
disclosed for the purpose of providing information to 
assist consumers in maintaining healthy dietary 
practices, the Secretary may require, by regulation, 
disclosure of such nutrient in the written form re-
quired under subclause (ii)(III). 
‘‘(vii) NONAPPLICABILITY TO CERTAIN FOOD.— 
‘‘(I) IN GENERAL.—Subclauses (i) through 
(vi) do not apply to— 
‘‘(aa) items that are not listed on a 
menu or menu board (such as condiments 
and other items placed on the table or 
counter for general use); 
‘‘(bb) daily specials, temporary menu 
items appearing on the menu for less than 
60 days per calendar year, or custom or-
ders; or 
‘‘(cc) such other food that is part of 
a customary market test appearing on the 
menu for less than 90 days, under terms 
and conditions established by the Sec-
retary. 
‘‘(II) 
WRITTEN
FORMS.—Subparagraph 
(5)(C) shall apply to any regulations promul-
gated under subclauses (ii)(III) and (vi). 
‘‘(viii) VENDING MACHINES.— 
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•AMDT. NO. 2786 
‘‘(I) IN GENERAL.—In the case of an arti-
cle of food sold from a vending machine that— 
‘‘(aa) does not permit a prospective 
purchaser to examine the Nutrition Facts 
Panel before purchasing the article or does 
not otherwise provide visible nutrition in-
formation at the point of purchase; and 
‘‘(bb) is operated by a person who is 
engaged in the business of owning or oper-
ating 20 or more vending machines, 
the vending machine operator shall provide a 
sign in close proximity to each article of food or 
the selection button that includes a clear and 
conspicuous statement disclosing the number of 
calories contained in the article. 
‘‘(ix) VOLUNTARY PROVISION OF NUTRITION IN-
FORMATION.— 
‘‘(I) IN GENERAL.—An authorized official 
of any restaurant or similar retail food estab-
lishment or vending machine operator not sub-
ject to the requirements of this clause may elect 
to be subject to the requirements of such 
clause, by registering biannually the name and 
address of such restaurant or similar retail food 
establishment or vending machine operator with 
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•AMDT. NO. 2786 
the Secretary, as specified by the Secretary by 
regulation. 
‘‘(II) REGISTRATION.—Within 120 days of 
enactment of this clause, the Secretary shall 
publish a notice in the Federal Register speci-
fying the terms and conditions for implementa-
tion of item (I), pending promulgation of regu-
lations. 
‘‘(III) RULE OF CONSTRUCTION.—Nothing 
in this subclause shall be construed to authorize 
the Secretary to require an application, review, 
or licensing process for any entity to register 
with the Secretary, as described in such item. 
‘‘(x) REGULATIONS.— 
‘‘(I) PROPOSED
REGULATION.—Not later 
than 1 year after the date of enactment of this 
clause, the Secretary shall promulgate proposed 
regulations to carry out this clause. 
‘‘(II) CONTENTS.—In promulgating regula-
tions, the Secretary shall— 
‘‘(aa) consider standardization of rec-
ipes and methods of preparation, reason-
able variation in serving size and formula-
tion of menu items, space on menus and 
menu boards, inadvertent human error, 
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