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‘‘(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 ade-
quate staff resources, and assistance to those organiza-
tions requesting it for implementation of the Guide’s 
recommendations. 
‘‘(4) COORDINATION WITH COMMUNITY PREVEN-
TIVE 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 Practices, in-
cluding the examination of how each task force’s rec-
ommendations interact at the nexus of clinic and 
community. 
‘‘(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 rec-
ommendations made by such members, shall be inde-
pendent and, to the extent practicable, not subject to 
political pressure. 
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‘‘(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 Pub-
lic 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 con-
vene an independent Community Preventive Services Task 
Force (referred to in this subsection as the ‘Task Force’) 
to be composed of individuals with appropriate expertise. 
Such Task Force shall review the scientific evidence related 
to the effectiveness, appropriateness, and cost-effectiveness 
of community preventive interventions for the purpose of 
developing recommendations, to be published in the Guide 
to Community Preventive Services (referred to in this sec-
tion as the ‘Guide’), for individuals and organizations de-
livering population-based services, including primary care 
professionals, health care systems, professional societies, em-
ployers, community organizations, non-profit organiza-
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tions, schools, governmental public health agencies, Indian 
tribes, tribal organizations and urban Indian organiza-
tions, medical groups, Congress and other policy-makers. 
Community preventive services include any policies, pro-
grams, processes or activities designed to affect or otherwise 
affecting health at the population level. 
‘‘(b) DUTIES.—The duties of the Task Force shall in-
clude— 
‘‘(1) the development of additional topic areas 
for new recommendations and interventions related to 
those topic areas, including those related to specific 
populations and age groups, as well as the social, eco-
nomic and physical environments that can have 
broad effects on the health and disease of populations 
and health disparities among sub-populations and 
age groups; 
‘‘(2) at least once during every 5-year period, re-
view interventions and update recommendations re-
lated to existing topic areas, including new or im-
proved techniques to assess the health effects of inter-
ventions, including health impact assessment and 
population health modeling; 
‘‘(3) improved integration with Federal Govern-
ment health objectives and related target setting for 
health improvement; 
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‘‘(4) the enhanced dissemination of recommenda-
tions; 
‘‘(5) the provision of technical assistance to those 
health care professionals, agencies, and organizations 
that request help in implementing the Guide rec-
ommendations; and 
‘‘(6) providing yearly reports to Congress and 
related agencies identifying gaps in research and rec-
ommending priority areas that deserve further exam-
ination, including areas related to populations and 
age groups not adequately addressed by current rec-
ommendations. 
‘‘(c) ROLE OF AGENCY.—The Director shall provide 
ongoing administrative, research, and technical support for 
the operations of the Task Force, including coordinating 
and supporting the dissemination of the recommendations 
of the Task Force, ensuring adequate staff resources, and 
assistance to those organizations requesting it for imple-
mentation 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 Services 
Task Force and the Advisory Committee on Immunization 
Practices, including the examination of how each task 
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force’s recommendations interact at the nexus of clinic 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 nec-
essary for each fiscal year to carry out the activities of the 
Task Force.’’. 
(2) TECHNICAL AMENDMENTS.— 
(A) Section 399R of the Public Health Serv-
ice Act (as added by section 2 of the ALS Reg-
istry Act (Public Law 110–373; 122 Stat. 4047)) 
is redesignated as section 399S. 
(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 sec-
tion 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 implementation 
of a national public–private partnership for a prevention 
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and health promotion outreach and education campaign to 
raise public awareness of health improvement across the life 
span. Such campaign shall include the dissemination of in-
formation 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; 
(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 Preven-
tion, the Health Resources and Services Administra-
tion, the Substance Abuse and Mental Health Services 
Administration, the Advisory Committee on Immuni-
zation Practices, and other appropriate agencies; and 
(6) includes general health promotion informa-
tion. 
(b) CONSULTATION.—In coordinating the campaign 
under subsection (a), the Secretary shall consult with the 
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Institute of Medicine to provide ongoing advice on evidence- 
based scientific information for policy, program develop-
ment, 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)— 
(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 design 
of such campaign; 
(C) may include the use of television, radio, 
Internet, and other commercial marketing venues 
and may be targeted to specific age groups based 
on peer-reviewed social research; 
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(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. 
(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 exer-
cise, 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 PRO-
VIDERS.—The Secretary, acting through the Centers for 
Disease Control and Prevention, shall develop and imple-
ment a plan for the dissemination of health promotion and 
disease prevention information consistent with national 
priorities, to health care providers who participate in Fed-
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eral programs, including programs administered by the In-
dian Health Service, the Department of Veterans Affairs, 
the Department of Defense, and the Health Resources 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 
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 dis-
ease 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 diseases in the 
United States, and obtain personalized suggestions for 
preventing such diseases. 
(g) INTERNET PORTAL.—The Secretary shall establish 
an Internet portal for accessing risk-assessment tools devel-
oped and maintained by private and academic entities. 
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(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 campaigns 
and activities required under this section. 
(i) PUBLIC AWARENESS OF PREVENTIVE AND OBE-
SITY-RELATED SERVICES.— 
(1) INFORMATION TO STATES.—The Secretary of 
Health and Human Services shall provide guidance 
and relevant information to States and health care 
providers regarding preventive and obesity-related 
services that are available to Medicaid enrollees, in-
cluding 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 effectiveness 
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of efforts under paragraphs (1) and (2), including 
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 nec-
essary to carry out this section. 
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 
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under the grant shall not be used to provide any 
service that is not authorized or allowed by Fed-
eral, 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 
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 waiver 
of such plan or children eligible for child health as-
sistance 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 eligible 
entity shall use funds provided under a grant award-
ed under this subsection only for expenditures for fa-
cilities (including the acquisition or improvement of 
land, or the acquisition, construction, expansion, re-
placement, or other improvement of any building or 
other facility), equipment, or similar expenditures, 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 serv-
ices. 
(5) APPROPRIATIONS.—Out of any funds in the 
Treasury not otherwise appropriated, there is appro-
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priated for each of fiscal years 2010 through 2013, 
$50,000,000 for the purpose of carrying out this sub-
section. Funds appropriated under this paragraph 
shall remain available until expended. 
(6) DEFINITIONS.—In this subsection, the terms 
‘‘school-based health center’’ and ‘‘sponsoring facility’’ 
have the meanings given those terms in section 
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 serv-
ices’ means the core services offered by school-based 
health centers, which shall include the following: 
‘‘(A) PHYSICAL.—Comprehensive health as-
sessments, diagnosis, and treatment of minor, 
acute, and chronic medical conditions, and refer-
rals to, and follow-up for, specialty care and oral 
health services. 
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‘‘(B) MENTAL HEALTH.—Mental health and 
substance use disorder assessments, crisis inter-
vention, counseling, treatment, and referral to a 
continuum of services including emergency psy-
chiatric care, community support programs, in-
patient 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 short-
ages of personal health services for medically un-
derserved children and adolescents under sub-
paragraph (A) that shall— 
‘‘(i) take into account any comments 
received by the Secretary from the chief ex-
ecutive officer of a State and local officials 
in a State; and 
‘‘(ii) include factors indicative of the 
health status of such children and adoles-
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cents of an area, including the ability of the 
residents of such area to pay for health serv-
ices, the accessibility of such services, the 
availability of health professionals to 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 standards, 
community practice, reporting laws, and other 
State laws, including parental consent and noti-
fication laws that are not inconsistent with Fed-
eral law; and 
‘‘(C) does not perform abortion services. 
‘‘(b) AUTHORITY TO AWARD GRANTS.—The Secretary 
shall award grants for the costs of the operation of school- 
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based health centers (referred to in this section as ‘SBHCs’) 
that meet the requirements of this section. 
‘‘(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 pa-
rental or guardian consent has been ob-
tained in cooperation with Federal, State, 
and local laws governing health care service 
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; 
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‘‘(iii) the SBHC will provide on-site 
access during the academic day when school 
is in session and 24-hour coverage 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, including 
regulations promulgated under the Health 
Insurance Portability and Accountability 
Act of 1996 and section 444 of the General 
Education Provisions Act; and 
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‘‘(D) such other information as the Sec-
retary may require. 
‘‘(d) PREFERENCES AND CONSIDERATION.—In review-
ing applications: 
‘‘(1) The Secretary may give preference to appli-
cants who demonstrate an ability to serve the fol-
lowing: 
‘‘(A) Communities that have evidenced bar-
riers 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 un-
insured, 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 sub-
section (a) of section 4101 of the Patient Protection 
and Affordable Care Act. 
‘‘(e) WAIVER
OF
REQUIREMENTS.—The Secretary 
may— 
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‘‘(1) under appropriate circumstances, waive the 
application of all or part of the requirements of this 
subsection with respect to an SBHC for not to exceed 
2 years; and 
‘‘(2) upon a showing of good cause, waive the re-
quirement that the SBHC provide all required com-
prehensive primary health services for a designated 
period of time to be determined by the Secretary. 
‘‘(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 physi-
cians, nurses, and other personnel of the 
SBHC; and 
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‘‘(B) may not be used to provide abortions. 
‘‘(2) CONSTRUCTION.—The Secretary may award 
grants which may be used to pay the costs associated 
with expanding and modernizing existing buildings 
for use as an SBHC, including the purchase of trail-
ers 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 section 
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 
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in cash or in-kind) to carry out the activities sup-
ported by the grant. 
‘‘(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 Sec-
retary determines that applying the matching re-
quirement to the SBHC would result in serious hard-
ship 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 sec-
tion. 
‘‘(j) AGE APPROPRIATE SERVICES.—An eligible entity 
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 individual 
without the consent of the parent or guardian of such indi-
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vidual if such individual is considered a minor under ap-
plicable State law. 
‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—For pur-
poses 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 Serv-
ice 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 Preven-
tion and in consultation with professional oral health orga-
nizations, shall, subject to the availability of appropria-
tions, establish a 5-year national, public education cam-
paign (referred to in this section as the ‘campaign’) that 
is focused on oral healthcare prevention and education, in-
cluding 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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‘‘(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 campaign. 
During the 2-year period referred to in the previous sen-
tence, 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 Prevention, 
shall award demonstration grants to eligible entities to 
demonstrate the effectiveness of research-based dental caries 
disease management activities. 
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‘‘(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 program 
of the Indian Health Service, an Indian tribe or trib-
al organization, or an urban Indian organization (as 
such terms are defined in section 4 of the Indian 
Health Care Improvement Act), a health system pro-
vider, a private provider of dental services, medical, 
dental, public health, nursing, nutrition educational 
institutions, or national organizations involved 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 re-
ceived under a grant under this section to demonstrate the 
effectiveness of research-based dental caries disease manage-
ment activities. 
‘‘(d) USE OF INFORMATION.—The Secretary shall uti-
lize information generated from grantees under this section 
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in planning and implementing the public education cam-
paign 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 Indi-
ans, Indian tribes, tribal organizations and urban Indian 
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 coop-
erative agreements with State, territorial, and Indian 
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tribes or tribal organizations (as those terms are de-
fined in section 4 of the Indian Health Care Improve-
ment Act) to establish oral health leadership and pro-
gram guidance, oral health data collection and inter-
pretation, (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 improve 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 sub-
section as the ‘‘Secretary’’) shall carry out ac-
tivities 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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(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 concerning 
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 EXAMINA-
TION
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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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 Expendi-
tures Panel Survey by the Agency for Healthcare Re-
search and Quality includes the verification of dental 
utilization, 
expenditure, 
and 
coverage 
findings 
through conduct of a look-back analysis. 
(4) NATIONAL ORAL HEALTH SURVEILLANCE SYS-
TEM.— 
(A) APPROPRIATIONS.—There is authorized 
to be appropriated, such sums as may be nec-
essary for each of fiscal years 2010 through 2014 
to increase the participation of States in the Na-
tional 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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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 So-
cial Security Act (42 U.S.C. 1395x(s)(2)) is amend-
ed— 
(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 Security 
Act (42 U.S.C. 1395x(s)(2)(K)) are each amended by 
striking ‘‘subsection (ww)(1)’’ and inserting ‘‘sub-
sections (ww)(1) and (hhh)’’. 
(b) PERSONALIZED PREVENTION PLAN SERVICES DE-
FINED.—Section 1861 of the Social Security Act (42 U.S.C. 
1395x) is amended by adding at the end the following new 
subsection: 
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‘‘Annual Wellness Visit 
‘‘(hhh)(1) The term ‘personalized prevention plan serv-
ices’ means the creation of a plan for an individual— 
‘‘(A) that includes a health risk assessment (that 
meets the guidelines established by the Secretary 
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 paragraph (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. 
‘‘(D) Detection of any cognitive impairment. 
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‘‘(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 recommenda-
tions of the United States Preventive Services 
Task Force and the Advisory Committee on Im-
munization Practices, and the individual’s 
health status, screening history, and age-appro-
priate preventive services covered under this title. 
‘‘(ii) A list of risk factors and conditions for 
which primary, secondary, or tertiary preven-
tion interventions are recommended or are un-
derway, including any mental health conditions 
or any such risk factors or conditions that have 
been identified through an initial preventive 
physical examination (as described under sub-
section (ww)(1)), and a list of treatment options 
and their associated risks and benefits. 
‘‘(F) The furnishing of personalized health advice 
and a referral, as appropriate, to health education or 
preventive counseling services or programs aimed at 
reducing identified risk factors and improving self- 
management, or community-based lifestyle interven-
tions to reduce health risks and promote self-manage-
ment and wellness, including weight loss, physical ac-
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tivity, smoking cessation, fall prevention, and nutri-
tion. 
‘‘(G) Any other element determined appropriate 
by the Secretary. 
‘‘(3) A health professional described in this paragraph 
is— 
‘‘(A) a physician; 
‘‘(B) a practitioner described in clause (i) of sec-
tion 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 super-
vision 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, modi-
fiable risk factors, and urgent health needs of the in-
dividual; and 
‘‘(ii) may be furnished— 
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management skills and management of and adherence 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 personalized 
prevention plan services under this subsection provided that 
the beneficiary has not received such services within the pre-
ceding 12-month period. 
‘‘(ii) The Secretary shall establish procedures to make 
beneficiaries aware of the option to select an initial preven-
tive 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 differences be-
tween 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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(c) PAYMENT AND ELIMINATION OF COST-SHARING.— 
(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 services 
(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 per-
sonalized prevention plan services (as defined 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 determined 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.— 
(A) EXCLUSION
FROM
OPD
FEE
SCHED-
ULE.—Section 1833(t)(1)(B)(iv) of the Social 
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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 DEDUCTIBLE.— 
The first sentence of section 1833(b) of the Social Se-
curity Act (42 U.S.C. 1395l(b)) is amended— 
(A) by striking ‘‘and’’ before ‘‘(9)’’; and 
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(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 amended— 
(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)’’. 
(e) EFFECTIVE DATE.—The amendments made by this 
section shall apply to services furnished on or after January 
1, 2011. 
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SEC. 4104. REMOVAL OF BARRIERS TO PREVENTIVE SERV-
ICES IN MEDICARE. 
(a) DEFINITION OF PREVENTIVE SERVICES.—Section 
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 para-
graph: 
‘‘(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.— 
(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— 
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(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 re-
spect to preventive services described in sub-
paragraphs 
(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 
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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 sched-
ule 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 amended— 
(i) by striking ‘‘or’’ before ‘‘personal-
ized prevention plan services’’; and 
(ii) by inserting before the period the 
following: ‘‘, or preventive services described 
in 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’’. 
(B) CONFORMING
AMENDMENTS.—Section 
1833(a)(2) of the Social Security Act (42 U.S.C. 
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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 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 Security 
Act (42 U.S.C. 1395l(b)), as amended by section 4103(c)(4), 
is amended— 
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(1) in paragraph (1), by striking ‘‘items and 
services described in section 1861(s)(10)(A)’’ and in-
serting ‘‘preventive services described in subparagraph 
(A) of section 1861(ddd)(3) that are recommended 
with a grade of A or B by the United States Preven-
tive Services Task Force for any indication or popu-
lation and are appropriate for the individual.’’; and 
(2) by adding at the end the following new sen-
tence: ‘‘Paragraph (1) of the first sentence of this sub-
section 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 matter or other 
procedure that is furnished in connection with, as a 
result of, and in the same clinical encounter as the 
screening test.’’. 
(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 COVERAGE 
OF CERTAIN PREVENTIVE SERVICES.—Section 1834 of the 
Social Security Act (42 U.S.C. 1395m) is amended by add-
ing at the end the following new subsection: 
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‘‘(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 modification 
is consistent with the recommendations of the 
United States Preventive Services Task Force; 
and 
‘‘(B) the services included in the initial pre-
ventive physical examination described in sub-
paragraph (B) of such section; and 
‘‘(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. 
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SEC. 4106. IMPROVING ACCESS TO PREVENTIVE SERVICES 
FOR ELIGIBLE ADULTS IN MEDICAID. 
(a) CLARIFICATION OF INCLUSION OF SERVICES.—Sec-
tion 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 Advisory 
Committee on Immunization Practices (an advi-
sory committee established by the Secretary, act-
ing through the Director of the Centers for Dis-
ease Control and Prevention) and their adminis-
tration; 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 prac-
titioner of the healing arts within the scope of 
their practice under State law, for the maximum 
reduction of physical or mental disability and 
restoration of an individual to the best possible 
functional level;’’. 
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(b) INCREASED FMAP.—Section 1905(b) of the Social 
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 sen-
tence— 
(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 medical 
assistance for services and vaccines described in sub-
paragraphs (A) and (B) of subsection (a)(13), and 
prohibits cost-sharing for such services and vaccines, 
the Federal medical assistance percentage, as deter-
mined under this subsection and subsection (y) (with-
out regard to paragraph (1)(C) of such subsection), 
shall be increased by 1 percentage point 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 
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PREGNANT WOMEN.—Section 1905 of the Social Security 
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 cessation 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 ‘counseling 
and pharmacotherapy for cessation of tobacco use by preg-
nant women’ means diagnostic, therapy, and counseling 
services and pharmacotherapy (including the coverage of 
prescription and nonprescription tobacco cessation agents 
approved by the Food and Drug Administration) for ces-
sation 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 regulatory 
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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 preg-
nant women in ‘Treating Tobacco Use and Depend-
ence: 2008 Update: A Clinical Practice Guideline’, 
published by the Public Health Service in May 2008, 
or any subsequent modification of such Guideline; 
and 
‘‘(B) such other services that the Secretary recog-
nizes 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 
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in accordance with the Guideline referred to in section 
1905(bb)(2)(A), agents approved by the Food and Drug Ad-
ministration under the over-the-counter monograph process 
for purposes of promoting, and when used to promote, to-
bacco cessation’’. 
(c) REMOVAL
OF COST-SHARING
FOR COUNSELING 
AND PHARMACOTHERAPY FOR CESSATION OF TOBACCO USE 
BY PREGNANT WOMEN.— 
(1) GENERAL COST-SHARING LIMITATIONS.—Sec-
tion 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 preg-
nant women (as defined in section 1905(bb)) and cov-
ered outpatient drugs (as defined in subsection (k)(2) 
of section 1927 and including nonprescription drugs 
described in subsection (d)(2) of such section) that are 
prescribed for purposes of promoting, and when used 
to promote, tobacco cessation 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-
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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 
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 deter-
mine scalable solutions. 
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(2) DURATION.— 
(A) 
INITIATION
OF
PROGRAM; 
RE-
SOURCES.—The Secretary shall awards grants to 
States beginning on January 1, 2011, or begin-
ning on the date on which the Secretary develops 
program criteria, whichever is earlier. The Sec-
retary shall develop program criteria for initia-
tives under this section using relevant evidence- 
based research and resources, including the 
Guide to Community Preventive Services, the 
Guide to Clinical Preventive Services, and the 
National Registry of Evidence-Based Programs 
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 Sec-
retary 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- 
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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 helping 
individuals achieve one or more of the following: 
(i) Ceasing use of tobacco products. 
(ii) Controlling or reducing their 
weight. 
(iii) Lowering their cholesterol. 
(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 So-
cial Security Act for a State awarded a grant to 
conduct an initiative under this section and 
shall ensure that a State makes any program de-
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scribed in subparagraph (A) available and acces-
sible 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 sub-
mit an application, in such manner and containing 
such information as the Secretary may require, that 
shall include a proposal for programs described in 
paragraph (3)(A) and a plan to make Medicaid bene-
ficiaries and providers participating in Medicaid who 
reside in the State aware and informed 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 EDUCATION.—A 
State awarded a grant to conduct an initiative under 
this section shall conduct an outreach and education 
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campaign to make Medicaid beneficiaries and pro-
viders participating in Medicaid who reside in the 
State aware of the programs described 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 
and maintenance of health behaviors by such bene-
ficiaries; 
(2) to the extent practicable, establish standards 
and health status targets for Medicaid beneficiaries 
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. 
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(d) EVALUATIONS AND REPORTS.— 
(1) INDEPENDENT ASSESSMENT.—The Secretary 
shall enter into a contract with an independent entity 
or organization to conduct an evaluation and assess-
ment of the initiatives carried out by States under 
this section, for the purpose of determining— 
(A) the effect of such initiatives on the use 
of health care services by Medicaid beneficiaries 
participating in the program; 
(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 
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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. 
(3) INITIAL REPORT.—Not later than January 1, 
2014, the Secretary shall submit to Congress an ini-
tial report on such initiatives based on information 
provided by States through reports required under 
paragraph (2). The initial report shall include an in-
terim evaluation of the effectiveness of the initiatives 
carried out with grants awarded under this section 
and a recommendation regarding whether funding for 
expanding or extending the initiatives should be ex-
tended 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 paragraph 
(1), together with recommendations for such legisla-
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tion and administrative action as the Secretary deter-
mines appropriate. 
(e) NO EFFECT ON ELIGIBILITY FOR, OR AMOUNT OF, 
MEDICAID OR OTHER BENEFITS.—Any incentives provided 
to a Medicaid beneficiary participating in a program de-
scribed in subsection (a)(3) shall not be taken into account 
for purposes of determining the beneficiary’s eligibility for, 
or amount of, benefits under the Medicaid program or any 
program funded in whole or in part with Federal funds. 
(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 eligi-
ble 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 meaning 
given that term for purposes of title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.). 
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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 Dis-
ease Control and Prevention (referred to in this section as 
the ‘‘Director’’), shall award competitive grants to State 
and local governmental agencies and community-based or-
ganizations for the implementation, evaluation, and dis-
semination of evidence-based community preventive health 
activities in order to reduce chronic disease rates, prevent 
the development of secondary conditions, address health dis-
parities, 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 
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(2) submit to the Director an application at such 
time, in such a manner, and containing such infor-
mation as the Director may require, including a de-
scription of the program to be carried out under the 
grant; and 
(3) demonstrate a history or capacity, if funded, 
to develop relationships necessary to engage key stake-
holders from multiple sectors within and beyond 
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 re-
duce disparities. 
(B) ACTIVITIES.—Activities within the plan 
may focus on (but not be limited to)— 
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(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; 
(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 determinants 
of health; and 
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(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 AC-
TIVITIES.— 
(A) IN GENERAL.—An eligible entity shall 
use amounts received under a grant under this 
section to implement a variety of programs, poli-
cies, and infrastructure improvements to pro-
mote 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 activi-
ties 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 
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(B) TYPES OF MEASURES.—In carrying out 
subparagraph (A), the eligible entity shall, with 
respect to residents in the community, meas-
ure— 
(i) changes in weight; 
(ii) changes in proper nutrition; 
(iii) changes in physical activity; 
(iv) changes in tobacco use prevalence; 
(v) changes in emotional well-being 
and overall mental health; 
(vi) other factors using community- 
specific data from the Behavioral Risk Fac-
tor 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 ac-
tivities carried out under the grant; and 
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(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 ef-
fective strategies for the prevention and control of 
chronic disease and the link between physical, emo-
tional, and social well-being. 
(2) COMMUNITY
TRANSFORMATION
PLAN.—The 
Director shall provide appropriate feedback and tech-
nical assistance to grantees to establish community 
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 pro-
vided 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 
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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.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (referred to in this section as the 
‘‘Secretary’’), acting through the Director of the Cen-
ters for Disease Control and Prevention, shall award 
grants to State or local health departments and In-
dian tribes to carry out 5-year pilot programs to pro-
vide 
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 
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including a description of the program to be car-
ried 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 interven-
tions; and 
(D) demonstrate the capacity, if funded, to 
develop the relationships necessary with relevant 
health agencies, health care providers, commu-
nity-based organizations, and insurers to carry 
out the activities described in paragraph (3), 
such relationships to include the identification 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-
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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 
under this subparagraph may include ef-
forts to improve nutrition, increase physical 
activity, reduce tobacco use and substance 
abuse, improve mental health, and promote 
healthy lifestyles among the target popu-
lation. 
(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 screen-
ing to identify risk factors for cardio-
vascular disease, cancer, stroke, and diabe-
tes among individuals in both urban and 
rural areas who are between 55 and 64 
years of age. 
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(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 
(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 monitoring 
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-
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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, diabetes, 
or any other condition for which such 
individual was screened under sub-
paragraph (C), a grantee under this 
section shall determine whether or not 
such individual is covered under any 
public or private health insurance pro-
gram. 
(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 providers 
under such program or, if such indi-
vidual does not have a current pro-
vider, to a provider who is in-network 
with respect to the program involved. 
(III) UNINSURED INDIVIDUALS.— 
With respect to an individual deter-
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mined to be uninsured under subclause 
(I), the grantee’s community-based 
clinical partner described in para-
graph (4)(D) shall assist the indi-
vidual in determining eligibility for 
available public coverage options and 
identify other appropriate community 
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 clinical 
follow-up and help determine eligibility for 
other public programs. 
(E) GRANTEE EVALUATION.—An eligible en-
tity shall use amounts provided under a grant 
under this subsection to conduct activities to 
measure changes in the prevalence of chronic dis-
ease risk factors among participants. 
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(4) PILOT
PROGRAM
EVALUATION.—The Sec-
retary shall conduct an annual evaluation of the effec-
tiveness of the pilot program under this subsection. In 
determining such effectiveness, the Secretary shall 
consider changes in the prevalence of uncontrolled 
chronic disease risk factors among new Medicare en-
rollees (or individuals nearing enrollment, 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-management 
for Medicare beneficiaries. 
(2) MEDICARE EVALUATION OF PREVENTION AND 
WELLNESS PROGRAMS.— 
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(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 Medi-
care beneficiaries (particularly beneficiaries 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 Secretary 
shall review available evidence, literature, 
best practices, and resources that are rel-
evant to programs that promote healthy life-
styles and reduce risk factors for the Medi-
care population. The Secretary may deter-
mine the scope of the evidence review and 
such issues to be considered, which shall in-
clude, at a minimum— 
(I) physical activity, nutrition, 
and obesity; 
(II) falls; 
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(III) chronic disease self-manage-
ment; and 
(IV) mental health. 
(ii) INDEPENDENT
EVALUATION
OF 
EVIDENCE-BASED
COMMUNITY
PREVENTION 
AND WELLNESS PROGRAMS.—The Adminis-
trator of the Centers for Medicare & Med-
icaid Services, in consultation with the As-
sistant Secretary for Aging, shall, to the ex-
tent feasible and practicable, conduct an 
evaluation of existing community preven-
tion and wellness programs that are spon-
sored by the Administration on Aging to as-
sess the extent to which Medicare bene-
ficiaries 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 condi-
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tions that are amenable to improve-
ment under such programs. 
(3) REPORT.—Not later than September 30, 
2013, the Secretary shall submit to Congress a report 
that includes— 
(A) recommendations for such legislation 
and administrative action as the Secretary de-
termines appropriate to promote healthy life-
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 para-
graph (2)(B)(ii). 
(4) FUNDING.—For purposes of carrying out this 
subsection, the Secretary shall provide for the trans-
fer, 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 Sec-
retary determines appropriate, of $50,000,000 to the 
Centers for Medicare & Medicaid Services Program 
Management Account. Amounts transferred under the 
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preceding sentence shall remain available until ex-
pended. 
(5) ADMINISTRATION.—Chapter 35 of title 44, 
United States Code shall not apply to the this sub-
section. 
(6) MEDICARE BENEFICIARY.—In this subsection, 
the term ‘‘Medicare beneficiary’’ means an individual 
who is entitled to benefits under part A 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 Compliance 
Board shall, in consultation with the Commissioner of the 
Food and Drug Administration, promulgate regulatory 
standards in accordance with the Administrative Procedure 
Act (2 U.S.C. 551 et seq.) setting forth the minimum tech-
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nical criteria for medical diagnostic equipment used in (or 
in conjunction with) physician’s offices, clinics, emergency 
rooms, hospitals, and other medical settings. The standards 
shall ensure that such equipment is accessible to, and usable 
by, individuals with accessibility needs, and shall allow 
independent entry to, use of, and exit from the equipment 
by such individuals to the maximum extent possible. 
‘‘(b) MEDICAL DIAGNOSTIC EQUIPMENT COVERED.— 
The standards issued under subsection (a) for medical diag-
nostic equipment shall apply to equipment that includes ex-
amination tables, examination chairs (including chairs 
used for eye examinations or procedures, and dental exami-
nations or procedures), weight scales, mammography equip-
ment, x-ray machines, and other radiological equipment 
commonly used for diagnostic purposes by health profes-
sionals. 
‘‘(c) REVIEW AND AMENDMENT.—The Architectural 
and Transportation Barriers Compliance Board, in con-
sultation with the Commissioner of the Food and Drug Ad-
ministration, shall periodically review and, as appropriate, 
amend the standards in accordance with the Administrative 
Procedure Act (2 U.S.C. 551 et seq.).’’. 
SEC. 4204. IMMUNIZATIONS. 
(a) STATE AUTHORITY TO PURCHASE RECOMMENDED 
VACCINES FOR ADULTS.—Section 317 of the Public Health 
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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 negotiate 
and enter into contracts with manufacturers of vac-
cines 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 vac-
cines from manufacturers at the applicable price ne-
gotiated by the Secretary under this subsection.’’. 
(b) DEMONSTRATION PROGRAM TO IMPROVE IMMUNI-
ZATION 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 IMMU-
NIZATION COVERAGE.— 
‘‘(1) 
IN
GENERAL.—The 
Secretary, 
acting 
through the Director of the Centers for Disease Con-
trol and Prevention, shall establish a demonstration 
program to award grants to States to improve the 
provision of recommended immunizations for chil-
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dren, adolescents, and adults through the use of evi-
dence-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 Sec-
retary an application at such time, in such manner, 
and containing such information as the Secretary 
may require, including a State plan that describes 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 estab-
lished by the Secretary, acting through the Director of 
the Centers for Disease Control and Prevention) or 
other evidence-based interventions, including— 
‘‘(A) providing immunization reminders or 
recalls for target populations of clients, patients, 
and consumers; 
‘‘(B) educating targeted populations and 
health care providers concerning immunizations 
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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 
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 promote 
immunization through education, assessments of 
need, referrals, provision of immunizations, 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 inter-
ventions 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 
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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 improving immu-
nization 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 
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(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) 
shall be construed to decrease children’s access to immuniza-
tions. 
(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 vaccines 
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; 
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(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 vac-
cinations 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 cov-
erage under part D of routinely recommended 
adult immunizations for access to such immuni-
zations 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 Representa-
tives and the Senate a report containing the results 
of the study conducted under paragraph (1), together 
with recommendations for such legislation and ad-
ministrative action as the Comptroller General deter-
mines appropriate. 
(3) FUNDING.—Out of any funds in the Treas-
ury not otherwise appropriated, there are appro-
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priated $1,000,000 for fiscal year 2010 to carry out 
this subsection. 
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 beginning 
‘‘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 ESTABLISHMENTS, 
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 similar 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 
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items, the restaurant or similar retail food establish-
ment shall disclose the information described in sub-
clauses (ii) and (iii). 
‘‘(ii) INFORMATION REQUIRED TO BE DISCLOSED 
BY
RESTAURANTS
AND
RETAIL
FOOD
ESTABLISH-
MENTS.—Except as provided in subclause (vii), the 
restaurant or similar retail food establishment shall 
disclose in a clear and conspicuous manner— 
‘‘(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 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 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 
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standard menu item, on the menu board, includ-
ing a drive-through menu board, the 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 public 
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 infor-
mation required under clauses (C) and (D) of sub-
paragraph (1); and 
‘‘(IV) on the menu or menu board, a prominent, 
clear, and conspicuous statement regarding the avail-
ability 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-service 
beverages or food that is on display and that is visible 
to customers, a restaurant or similar retail food es-
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tablishment 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 nutrient 
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 regulation) 
or in a related guidance of the Food and Drug Ad-
ministration. 
‘‘(v) MENU
VARIABILITY
AND
COMBINATION 
MEALS.—The Secretary shall establish by regulation 
standards for determining and disclosing the nutrient 
content for standard menu items that come in dif-
ferent flavors, varieties, or combinations, but which 
are listed as a single menu item, such as soft drinks, 
ice cream, pizza, doughnuts, or children’s combina-
tion meals, through means determined by the Sec-
retary, including ranges, averages, or other methods. 
‘‘(vi) ADDITIONAL
INFORMATION.—If the Sec-
retary determines that a nutrient, other than a nutri-
ent required under subclause (ii)(III), should be dis-
closed for the purpose of providing information to as-
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sist consumers in maintaining healthy dietary prac-
tices, the Secretary may require, by regulation, disclo-
sure of such nutrient in the written form required 
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 Secretary. 
‘‘(II) 
WRITTEN
FORMS.—Subparagraph 
(5)(C) shall apply to any regulations promul-
gated under subclauses (ii)(III) and (vi). 
‘‘(viii) VENDING MACHINES.— 
‘‘(I) IN GENERAL.—In the case of an article 
of food sold from a vending machine that— 
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‘‘(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 establish-
ment or vending machine operator not subject to 
the requirements of this clause may elect to be 
subject to the requirements of such clause, by reg-
istering biannually the name and address of 
such restaurant or similar retail food establish-
ment or vending machine operator with the Sec-
retary, as specified by the Secretary by regula-
tion. 
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‘‘(II) REGISTRATION.—Within 120 days of 
enactment of this clause, the Secretary shall pub-
lish a notice in the Federal Register specifying 
the terms and conditions for implementation of 
item (I), pending promulgation of regulations. 
‘‘(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, reasonable 
variation in serving size and formulation of 
menu items, space on menus and menu 
boards, inadvertent human error, training 
of food service workers, variations in ingre-
dients, and other factors, as the Secretary 
determines; and 
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‘‘(bb) specify the format and manner of 
the nutrient content disclosure requirements 
under this subclause. 
‘‘(III) REPORTING.—The Secretary shall 
submit to the Committee on Health, Education, 
Labor, and Pensions of the Senate and the Com-
mittee on Energy and Commerce of the House of 
Representatives a quarterly report that describes 
the Secretary’s progress toward promulgating 
final regulations under this subparagraph. 
‘‘(xi) DEFINITION.—In this clause, the term 
‘menu’ or ‘menu board’ means the primary writing of 
the restaurant or other similar retail food establish-
ment from which a consumer makes an order selec-
tion.’’ 
(c) NATIONAL UNIFORMITY.—Section 403A(a)(4) of 
the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 343– 
1(a)(4)) is amended by striking ‘‘except a requirement for 
nutrition labeling of food which is exempt under subclause 
(i) or (ii) of section 403(q)(5)(A)’’ and inserting ‘‘except 
that this paragraph does not apply to food that is offered 
for sale in a restaurant or similar retail food establishment 
that is not 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 substan-
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tially the same menu items unless such restaurant or simi-
lar retail food establishment complies with the voluntary 
provision of nutrition information requirements under sec-
tion 403(q)(5)(H)(ix)’’. 
(d) RULE OF CONSTRUCTION.—Nothing in the amend-
ments made by this section shall be construed— 
(1) to preempt any provision of State or local 
law, unless such provision establishes or continues 
into effect nutrient content disclosures of the type re-
quired under section 403(q)(5)(H) of the Federal 
Food, Drug, and Cosmetic Act (as added by sub-
section (b)) and is expressly preempted under sub-
section (a)(4) of such section; 
(2) to apply to any State or local requirement 
respecting a statement in the labeling of food that 
provides for a warning concerning the safety of the 
food or component of the food; or 
(3) 
except 
as 
provided 
in 
section 
403(q)(5)(H)(ix) of the Federal Food, Drug, and Cos-
metic Act (as added by subsection (b)), to apply to 
any restaurant or similar retail food establishment 
other than a restaurant or similar retail food estab-
lishment described in section 403(q)(5)(H)(i) of such 
Act. 
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SEC. 4206. DEMONSTRATION PROJECT CONCERNING INDI-
VIDUALIZED WELLNESS PLAN. 
Section 330 of the Public Health Service Act (42 
U.S.C. 245b) is amended by adding at the end the following: 
‘‘(s) DEMONSTRATION PROGRAM FOR INDIVIDUALIZED 
WELLNESS PLANS.— 
‘‘(1) IN GENERAL.—The Secretary shall establish 
a pilot program to test the impact of providing at- 
risk populations who utilize community health centers 
funded under this section an individualized wellness 
plan that is designed to reduce risk factors for pre-
ventable conditions as identified by a comprehensive 
risk-factor assessment. 
‘‘(2) AGREEMENTS.—The Secretary shall enter 
into agreements with not more than 10 community 
health centers funded under this section to conduct ac-
tivities under the pilot program under paragraph (1). 
‘‘(3) WELLNESS PLANS.— 
‘‘(A) 
IN
GENERAL.—An 
individualized 
wellness plan prepared under the pilot program 
under this subsection may include one or more 
of the following as appropriate to the individ-
ual’s identified risk factors: 
‘‘(i) Nutritional counseling. 
‘‘(ii) A physical activity plan. 
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‘‘(iii) Alcohol and smoking cessation 
counseling and services. 
‘‘(iv) Stress management. 
‘‘(v) Dietary supplements that have 
health claims approved by the Secretary. 
‘‘(vi) Compliance assistance provided 
by a community health center employee. 
‘‘(B) RISK
FACTORS.—Wellness plan risk 
factors shall include— 
‘‘(i) weight; 
‘‘(ii) tobacco and alcohol use; 
‘‘(iii) exercise rates; 
‘‘(iv) nutritional status; and 
‘‘(v) blood pressure. 
‘‘(C) 
COMPARISONS.—Individualized 
wellness plans shall make comparisons between 
the individual involved and a control group of 
individuals with respect to the risk factors de-
scribed in subparagraph (B). 
‘‘(4) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated to carry out 
this subsection, such sums as may be necessary.’’. 
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SEC. 4207. REASONABLE BREAK TIME FOR NURSING MOTH-
ERS. 
Section 7 of the Fair Labor Standards Act of 1938 
(29 U.S.C. 207) is amended by adding at the end the fol-
lowing: 
‘‘(r)(1) An employer shall provide— 
‘‘(A) a reasonable break time for an employee to 
express breast milk for her nursing child for 1 year 
after the child’s birth each time such employee has 
need to express the milk; and 
‘‘(B) a place, other than a bathroom, that is 
shielded from view and free from intrusion from co-
workers and the public, which may be used by an em-
ployee to express breast milk. 
‘‘(2) An employer shall not be required to compensate 
an employee receiving reasonable break time under para-
graph (1) for any work time spent for such purpose. 
‘‘(3) An employer that employs less than 50 employees 
shall not be subject to the requirements of this subsection, 
if such requirements would impose an undue hardship by 
causing the employer significant difficulty or expense when 
considered in relation to the size, financial resources, na-
ture, or structure of the employer’s business. 
‘‘(4) Nothing in this subsection shall preempt a State 
law that provides greater protections to employees than the 
protections provided for under this subsection.’’. 
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Subtitle D—Support for Prevention 
and Public Health Innovation 
SEC. 4301. RESEARCH ON OPTIMIZING THE DELIVERY OF 
PUBLIC HEALTH SERVICES. 
(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 Dis-
ease Control and Prevention, shall provide funding for re-
search in the area of public health services and systems. 
(b) REQUIREMENTS
OF RESEARCH.—Research sup-
ported under this section shall include— 
(1) examining evidence-based practices relating 
to prevention, with a particular focus on high pri-
ority areas as identified by the Secretary in the Na-
tional Prevention Strategy or Healthy People 2020, 
and including comparing community-based public 
health interventions in terms of effectiveness and cost; 
(2) analyzing the translation of interventions 
from academic settings to real world settings; and 
(3) identifying effective strategies for organizing, 
financing, or delivering public health services in real 
world community settings, including comparing State 
and local health department structures and systems 
in terms of effectiveness and cost. 
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(c) EXISTING PARTNERSHIPS.—Research supported 
under this section shall be coordinated with the Community 
Preventive Services Task Force and carried out by building 
on existing partnerships within the Federal Government 
while also considering initiatives at the State and local lev-
els and in the private sector. 
(d) ANNUAL REPORT.—The Secretary shall, on an an-
nual basis, submit to Congress a report concerning the ac-
tivities and findings with respect to research supported 
under this section. 
SEC. 4302. UNDERSTANDING HEALTH DISPARITIES: DATA 
COLLECTION AND ANALYSIS. 
(a) UNIFORM CATEGORIES
AND COLLECTION RE-
QUIREMENTS.—The Public Health Service Act (42 U.S.C. 
201 et seq.) is amended by adding at the end the following: 
‘‘TITLE 
XXXI—DATA 
COLLEC-
TION, ANALYSIS, AND QUAL-
ITY 
‘‘SEC. 3101. DATA COLLECTION, ANALYSIS, AND QUALITY. 
‘‘(a) DATA COLLECTION.— 
‘‘(1) IN GENERAL.—The Secretary shall ensure 
that, by not later than 2 years after the date of enact-
ment of this title, any federally conducted or sup-
ported health care or public health program, activity 
or survey (including Current Population Surveys and 
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American Community Surveys conducted by the Bu-
reau of Labor Statistics and the Bureau of the Cen-
sus) collects and reports, to the extent practicable— 
‘‘(A) data on race, ethnicity, sex, primary 
language, and disability status for applicants, 
recipients, or participants; 
‘‘(B) data at the smallest geographic level 
such as State, local, or institutional levels if such 
data can be aggregated; 
‘‘(C) sufficient data to generate statistically 
reliable estimates by racial, ethnic, sex, primary 
language, and disability status subgroups for ap-
plicants, recipients or participants using, if 
needed, statistical oversamples of these sub-
populations; and 
‘‘(D) any other demographic data as deemed 
appropriate by the Secretary regarding health 
disparities. 
‘‘(2) COLLECTION
STANDARDS.—In collecting 
data described in paragraph (1), the Secretary or des-
ignee shall— 
‘‘(A) use Office of Management and Budget 
standards, at a minimum, for race and ethnicity 
measures; 
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‘‘(B) develop standards for the measurement 
of sex, primary language, and disability status; 
‘‘(C) develop standards for the collection of 
data described in paragraph (1) that, at a min-
imum— 
‘‘(i) collects self-reported data by the 
applicant, recipient, or participant; and 
‘‘(ii) collects data from a parent or 
legal guardian if the applicant, recipient, 
or participant is a minor or legally inca-
pacitated; 
‘‘(D) survey health care providers and es-
tablish other procedures in order to assess access 
to care and treatment for individuals with dis-
abilities and to identify— 
‘‘(i) locations where individuals with 
disabilities access primary, acute (including 
intensive), and long-term care; 
‘‘(ii) the number of providers with ac-
cessible facilities and equipment to meet the 
needs of the individuals with disabilities, 
including medical diagnostic equipment 
that meets the minimum technical criteria 
set forth in section 510 of the Rehabilitation 
Act of 1973; and 
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‘‘(iii) the number of employees of 
health care providers trained in disability 
awareness and patient care of individuals 
with disabilities; and 
‘‘(E) require that any reporting require-
ment imposed for purposes of measuring quality 
under any ongoing or federally conducted or 
supported health care or public health program, 
activity, or survey includes requirements for the 
collection of data on individuals receiving health 
care items or services under such programs ac-
tivities by race, ethnicity, sex, primary language, 
and disability status. 
‘‘(3) DATA MANAGEMENT.—In collecting data de-
scribed in paragraph (1), the Secretary, acting 
through the National Coordinator for Health Infor-
mation Technology shall— 
‘‘(A) develop national standards for the 
management of data collected; and 
‘‘(B) develop interoperability and security 
systems for data management. 
‘‘(b) DATA ANALYSIS.— 
‘‘(1) IN GENERAL.—For each federally conducted 
or supported health care or public health program or 
activity, the Secretary shall analyze data collected 
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under paragraph (a) to detect and monitor trends in 
health disparities (as defined for purposes of section 
485E) at the Federal and State levels. 
‘‘(c) DATA REPORTING AND DISSEMINATION.— 
‘‘(1) IN GENERAL.—The Secretary shall make the 
analyses described in (b) available to— 
‘‘(A) the Office of Minority Health; 
‘‘(B) the National Center on Minority 
Health and Health Disparities; 
‘‘(C) the Agency for Healthcare Research 
and Quality; 
‘‘(D) the Centers for Disease Control and 
Prevention; 
‘‘(E) the Centers for Medicare & Medicaid 
Services; 
‘‘(F) the Indian Health Service and epide-
miology centers funded under the Indian Health 
Care Improvement Act; 
‘‘(G) the Office of Rural health; 
‘‘(H) other agencies within the Department 
of Health and Human Services; and 
‘‘(I) other entities as determined appro-
priate by the Secretary. 
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‘‘(2) REPORTING OF DATA.—The Secretary shall 
report data and analyses described in (a) and (b) 
through— 
‘‘(A) public postings on the Internet 
websites of the Department of Health and 
Human Services; and 
‘‘(B) any other reporting or dissemination 
mechanisms determined appropriate by the Sec-
retary. 
‘‘(3) AVAILABILITY
OF
DATA.—The Secretary 
may make data described in (a) and (b) available for 
additional research, analyses, and dissemination to 
other Federal agencies, non-governmental entities, 
and the public, in accordance with any Federal agen-
cy’s data user agreements. 
‘‘(d) LIMITATIONS ON USE OF DATA.—Nothing in this 
section shall be construed to permit the use of information 
collected under this section in a manner that would ad-
versely affect any individual. 
‘‘(e) PROTECTION AND SHARING OF DATA.— 
‘‘(1) PRIVACY
AND
OTHER
SAFEGUARDS.—The 
Secretary shall ensure (through the promulgation of 
regulations or otherwise) that— 
‘‘(A) all data collected pursuant to sub-
section (a) is protected— 
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‘‘(i) under privacy protections that are 
at least as broad as those that the Secretary 
applies to other health data under the regu-
lations promulgated under section 264(c) of 
the Health Insurance Portability and Ac-
countability Act of 1996 (Public Law 104– 
191; 110 Stat. 2033); and 
‘‘(ii) from all inappropriate internal 
use by any entity that collects, stores, or re-
ceives the data, including use of such data 
in determinations of eligibility (or contin-
ued eligibility) in health plans, and from 
other inappropriate uses, as defined by the 
Secretary; and 
‘‘(B) all appropriate information security 
safeguards are used in the collection, analysis, 
and sharing of data collected pursuant to sub-
section (a). 
‘‘(2) DATA SHARING.—The Secretary shall estab-
lish procedures for sharing data collected pursuant to 
subsection (a), measures relating to such data, and 
analyses of such data, with other relevant Federal 
and State agencies including the agencies, centers, 
and entities within the Department of Health and 
Human Services specified in subsection (c)(1).. 
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‘‘(f) DATA ON RURAL UNDERSERVED POPULATIONS.— 
The Secretary shall ensure that any data collected in ac-
cordance with this section regarding racial and ethnic mi-
nority groups are also collected regarding underserved rural 
and frontier populations. 
‘‘(g) 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 fiscal years 2010 through 2014. 
‘‘(h) REQUIREMENT FOR IMPLEMENTATION.—Notwith-
standing any other provision of this section, data may not 
be collected under this section unless funds are directly ap-
propriated for such purpose in an appropriations Act. 
‘‘(i) CONSULTATION.—The Secretary shall consult with 
the Director of the Office of Personnel Management, the Sec-
retary of Defense, the Secretary of Veterans Affairs, the Di-
rector of the Bureau of the Census, the Commissioner of So-
cial Security, and the head of other appropriate Federal 
agencies in carrying out this section.’’. 
(b) ADDRESSING HEALTH CARE DISPARITIES IN MED-
ICAID AND CHIP.— 
(1) STANDARDIZED COLLECTION REQUIREMENTS 
INCLUDED IN STATE PLANS.— 
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(A) MEDICAID.—Section 1902(a) of the So-
cial Security Act (42 U.S.C. 1396a(a)), as 
amended by section 2001(d), is amended— 
(i) in paragraph 4), by striking ‘‘and’’ 
at the end; 
(ii) in paragraph (75), by striking the 
period at the end and inserting ‘‘; and’’; 
and 
(iii) by inserting after paragraph (75) 
the following new paragraph: 
‘‘(76) provide that any data collected under the 
State plan meets the requirements of section 3101 of 
the Public Health Service Act.’’. 
(B) CHIP.—Section 2108(e) of the Social 
Security Act (42 U.S.C. 1397hh(e)) is amended 
by adding at the end the following new para-
graph: 
‘‘(7) Data collected and reported in accordance 
with section 3101 of the Public Health Service Act, 
with respect to individuals enrolled in the State child 
health plan (and, in the case of enrollees under 19 
years of age, their parents or legal guardians), in-
cluding data regarding the primary language of such 
individuals, parents, and legal guardians.’’. 
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(2) EXTENDING MEDICARE REQUIREMENT TO AD-
DRESS HEALTH DISPARITIES DATA COLLECTION TO 
MEDICAID AND CHIP.—Title XIX of the Social Secu-
rity Act (42 U.S.C. 1396 et seq.), as amended by sec-
tion 2703 is amended by adding at the end the fol-
lowing new section: 
‘‘SEC. 1946. ADDRESSING HEALTH CARE DISPARITIES. 
‘‘(a) EVALUATING DATA COLLECTION APPROACHES.— 
The Secretary shall evaluate approaches for the collection 
of data under this title and title XXI, to be performed in 
conjunction with existing quality reporting requirements 
and programs under this title and title XXI, that allow for 
the ongoing, accurate, and timely collection and evaluation 
of data on disparities in health care services and perform-
ance on the basis of race, ethnicity, sex, primary language, 
and disability status. In conducting such evaluation, the 
Secretary shall consider the following objectives: 
‘‘(1) Protecting patient privacy. 
‘‘(2) Minimizing the administrative burdens of 
data collection and reporting on States, providers, 
and health plans participating under this title or title 
XXI. 
‘‘(3) Improving program data under this title 
and title XXI on race, ethnicity, sex, primary lan-
guage, and disability status. 
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‘‘(b) REPORTS TO CONGRESS.— 
‘‘(1) REPORT ON EVALUATION.—Not later than 
18 months after the date of the enactment of this sec-
tion, the Secretary shall submit to Congress a report 
on the evaluation conducted under subsection (a). 
Such report shall, taking into consideration the re-
sults of such evaluation— 
‘‘(A) identify approaches (including defin-
ing methodologies) for identifying and collecting 
and evaluating data on health care disparities 
on the basis of race, ethnicity, sex, primary lan-
guage, and disability status for the programs 
under this title and title XXI; and 
‘‘(B) include recommendations on the most 
effective strategies and approaches to reporting 
HEDIS quality measures as required under sec-
tion 1852(e)(3) and other nationally recognized 
quality performance measures, as appropriate, 
on such bases. 
‘‘(2) REPORTS ON DATA ANALYSES.—Not later 
than 4 years after the date of the enactment of this 
section, and 4 years thereafter, the Secretary shall 
submit to Congress a report that includes rec-
ommendations for improving the identification of 
health care disparities for beneficiaries under this 
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title and under title XXI based on analyses of the 
data collected under subsection (c). 
‘‘(c) IMPLEMENTING EFFECTIVE APPROACHES.—Not 
later than 24 months after the date of the enactment of this 
section, the Secretary shall implement the approaches iden-
tified in the report submitted under subsection (b)(1) for 
the ongoing, accurate, and timely collection and evaluation 
of data on health care disparities on the basis of race, eth-
nicity, sex, primary language, and disability status.’’. 
SEC. 4303. CDC AND EMPLOYER-BASED WELLNESS PRO-
GRAMS. 
Title III of the Public Health Service Act (42 U.S.C. 
241 et seq.), by section 4102, is further amended by adding 
at the end the following: 
‘‘PART U—EMPLOYER-BASED WELLNESS 
PROGRAM 
‘‘SEC. 399MM. TECHNICAL ASSISTANCE FOR EMPLOYER- 
BASED WELLNESS PROGRAMS. 
‘‘In order to expand the utilization of evidence-based 
prevention and health promotion approaches in the work-
place, the Director shall— 
‘‘(1) provide employers (including small, me-
dium, and large employers, as determined by the Di-
rector) with technical assistance, consultation, tools, 
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and other resources in evaluating such employers’ em-
ployer-based wellness programs, including— 
‘‘(A) measuring the participation and meth-
ods to increase participation of employees in 
such programs; 
‘‘(B) developing standardized measures that 
assess policy, environmental and systems changes 
necessary to have a positive health impact on 
employees’ health behaviors, health outcomes, and 
health care expenditures; and 
‘‘(C) evaluating such programs as they re-
late to changes in the health status of employees, 
the absenteeism of employees, the productivity of 
employees, the rate of workplace injury, and the 
medical costs incurred by employees; and 
‘‘(2) build evaluation capacity among workplace 
staff by training employers on how to evaluate em-
ployer-based wellness programs by ensuring evalua-
tion resources, technical assistance, and consultation 
are available to workplace staff as needed through 
such mechanisms as web portals, call centers, or other 
means. 
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‘‘SEC. 399MM–1. NATIONAL WORKSITE HEALTH POLICIES 
AND PROGRAMS STUDY. 
‘‘(a) IN GENERAL.—In order to assess, analyze, and 
monitor over time data about workplace policies and pro-
grams, and to develop instruments to assess and evaluate 
comprehensive workplace chronic disease prevention and 
health promotion programs, policies and practices, not later 
than 2 years after the date of enactment of this part, and 
at regular intervals (to be determined by the Director) 
thereafter, the Director shall conduct a national worksite 
health policies and programs survey to assess employer- 
based health policies and programs. 
‘‘(b) REPORT.—Upon the completion of each study 
under subsection (a), the Director shall submit to Congress 
a report that includes the recommendations of the Director 
for the implementation of effective employer-based health 
policies and programs. 
‘‘SEC. 399MM–2. PRIORITIZATION OF EVALUATION BY SEC-
RETARY. 
‘‘The Secretary shall evaluate, in accordance with this 
part, all programs funded through the Centers for Disease 
Control and Prevention before conducting such an evalua-
tion of privately funded programs unless an entity with a 
privately funded wellness program requests such an evalua-
tion. 
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‘‘SEC. 399MM–3. PROHIBITION OF FEDERAL WORKPLACE 
WELLNESS REQUIREMENTS. 
‘‘Notwithstanding any other provision of this part, 
any recommendations, data, or assessments carried out 
under this part shall not be used to mandate requirements 
for workplace wellness programs.’’. 
SEC. 
4304. 
EPIDEMIOLOGY-LABORATORY 
CAPACITY 
GRANTS. 
Title XXVIII of the Public Health Service Act (42 
U.S.C. 300hh et seq.) is amended by adding at the end the 
following: 
‘‘Subtitle C—Strengthening Public 
Health Surveillance Systems 
‘‘SEC. 
2821. 
EPIDEMIOLOGY-LABORATORY 
CAPACITY 
GRANTS. 
‘‘(a) IN GENERAL.—Subject to the availability of ap-
propriations, the Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, shall estab-
lish an Epidemiology and Laboratory Capacity Grant Pro-
gram to award grants to State health departments as well 
as local health departments and tribal jurisdictions that 
meet such criteria as the Director determines appropriate. 
Academic centers that assist State and eligible local and 
tribal health departments may also be eligible for funding 
under this section as the Director determines appropriate. 
Grants shall be awarded under this section to assist public 
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health agencies in improving surveillance for, and response 
to, infectious diseases and other conditions of public health 
importance by— 
‘‘(1) strengthening epidemiologic capacity to 
identify and monitor the occurrence of infectious dis-
eases and other conditions of public health impor-
tance; 
‘‘(2) enhancing laboratory practice as well as 
systems to report test orders and results electronically; 
‘‘(3) improving information systems including 
developing and maintaining an information exchange 
using national guidelines and complying with capac-
ities and functions determined by an advisory council 
established and appointed by the Director; and 
‘‘(4) developing and implementing prevention 
and control strategies. 
‘‘(b) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$190,000,000 for each of fiscal years 2010 through 2013, 
of which— 
‘‘(1) not less than $95,000,000 shall be made 
available each such fiscal year for activities under 
paragraphs (1) and (4) of subsection (a); 
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‘‘(2) not less than $60,000,000 shall be made 
available each such fiscal year for activities under 
subsection (a)(3); and 
‘‘(3) not less than $32,000,000 shall be made 
available each such fiscal year for activities under 
subsection (a)(2).’’. 
SEC. 4305. ADVANCING RESEARCH AND TREATMENT FOR 
PAIN CARE MANAGEMENT. 
(a) INSTITUTE OF MEDICINE CONFERENCE ON PAIN.— 
(1) CONVENING.—Not later than 1 year after 
funds are appropriated to carry out this subsection, 
the Secretary of Health and Human Services shall 
seek to enter into an agreement with the Institute of 
Medicine of the National Academies to convene a Con-
ference on Pain (in this subsection referred to as ‘‘the 
Conference’’). 
(2) PURPOSES.—The purposes of the Conference 
shall be to— 
(A) increase the recognition of pain as a 
significant public health problem in the United 
States; 
(B) evaluate the adequacy of assessment, di-
agnosis, treatment, and management of acute 
and chronic pain in the general population, and 
in identified racial, ethnic, gender, age, and 
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other demographic groups that may be dis-
proportionately affected by inadequacies in the 
assessment, diagnosis, treatment, and manage-
ment of pain; 
(C) identify barriers to appropriate pain 
care; 
(D) establish an agenda for action in both 
the public and private sectors that will reduce 
such barriers and significantly improve the state 
of pain care research, education, and clinical 
care in the United States. 
(3) OTHER APPROPRIATE ENTITY.—If the Insti-
tute of Medicine declines to enter into an agreement 
under paragraph (1), the Secretary of Health and 
Human Services may enter into such agreement with 
another appropriate entity. 
(4) REPORT.—A report summarizing the Con-
ference’s findings and recommendations shall be sub-
mitted to the Congress not later than June 30, 2011. 
(5) AUTHORIZATION OF APPROPRIATIONS.—For 
the purpose of carrying out this subsection, there is 
authorized to be appropriated such sums as may be 
necessary for each of fiscal years 2010 and 2011. 
(b) PAIN RESEARCH AT NATIONAL INSTITUTES OF 
HEALTH.—Part B of title IV of the Public Health Service 
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Act (42 U.S.C. 284 et seq.) is amended by adding at the 
end the following: 
‘‘SEC. 409J. PAIN RESEARCH. 
‘‘(a) RESEARCH INITIATIVES.— 
‘‘(1) IN GENERAL.—The Director of NIH is en-
couraged to continue and expand, through the Pain 
Consortium, an aggressive program of basic and clin-
ical research on the causes of and potential treatments 
for pain. 
‘‘(2) ANNUAL RECOMMENDATIONS.—Not less than 
annually, the Pain Consortium, in consultation with 
the Division of Program Coordination, Planning, and 
Strategic Initiatives, shall develop and submit to the 
Director of NIH recommendations on appropriate 
pain research initiatives that could be undertaken 
with funds reserved under section 402A(c)(1) for the 
Common Fund or otherwise available for such initia-
tives. 
‘‘(3) DEFINITION.—In this subsection, the term 
‘Pain Consortium’ means the Pain Consortium of the 
National Institutes of Health or a similar trans-Na-
tional Institutes of Health coordinating entity des-
ignated by the Secretary for purposes of this sub-
section. 
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‘‘(b) INTERAGENCY PAIN RESEARCH COORDINATING 
COMMITTEE.— 
‘‘(1) ESTABLISHMENT.—The Secretary shall es-
tablish not later than 1 year after the date of the en-
actment of this section and as necessary maintain a 
committee, to be known as the Interagency Pain Re-
search Coordinating Committee (in this section re-
ferred to as the ‘Committee’), to coordinate all efforts 
within the Department of Health and Human Serv-
ices and other Federal agencies that relate to pain re-
search. 
‘‘(2) MEMBERSHIP.— 
‘‘(A) IN GENERAL.—The Committee shall be 
composed of the following voting members: 
‘‘(i) Not more than 7 voting Federal 
representatives appoint by the Secretary 
from agencies that conduct pain care re-
search and treatment. 
‘‘(ii) 12 additional voting members ap-
pointed under subparagraph (B). 
‘‘(B) ADDITIONAL
MEMBERS.—The Com-
mittee shall include additional voting members 
appointed by the Secretary as follows: 
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‘‘(i) 6 non-Federal members shall be 
appointed from among scientists, physi-
cians, and other health professionals. 
‘‘(ii) 6 members shall be appointed 
from members of the general public, who are 
representatives of leading research, advo-
cacy, and service organizations for individ-
uals with pain-related conditions. 
‘‘(C) NONVOTING
MEMBERS.—The Com-
mittee shall include such nonvoting members as 
the Secretary determines to be appropriate. 
‘‘(3) CHAIRPERSON.—The voting members of the 
Committee shall select a chairperson from among such 
members. The selection of a chairperson shall be sub-
ject to the approval of the Director of NIH. 
‘‘(4) MEETINGS.—The Committee shall meet at 
the call of the chairperson of the Committee or upon 
the request of the Director of NIH, but in no case less 
often than once each year. 
‘‘(5) DUTIES.—The Committee shall— 
‘‘(A) develop a summary of advances in 
pain care research supported or conducted by the 
Federal agencies relevant to the diagnosis, pre-
vention, and treatment of pain and diseases and 
disorders associated with pain; 
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‘‘(B) identify critical gaps in basic and 
clinical research on the symptoms and causes of 
pain; 
‘‘(C) make recommendations to ensure that 
the activities of the National Institutes of Health 
and other Federal agencies are free of unneces-
sary duplication of effort; 
‘‘(D) make recommendations on how best to 
disseminate information on pain care; and 
‘‘(E) make recommendations on how to ex-
pand partnerships between public entities and 
private entities to expand collaborative, cross- 
cutting research. 
‘‘(6) REVIEW.—The Secretary shall review the 
necessity of the Committee at least once every 2 
years.’’. 
(c) PAIN CARE EDUCATION AND TRAINING.—Part D 
of title VII of the Public Health Service Act (42 U.S.C. 294 
et seq.) is amended by adding at the end the following new 
section: 
‘‘SEC. 759. PROGRAM FOR EDUCATION AND TRAINING IN 
PAIN CARE. 
‘‘(a) IN GENERAL.—The Secretary may make awards 
of grants, cooperative agreements, and contracts to health 
professions schools, hospices, and other public and private 
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entities for the development and implementation of pro-
grams to provide education and training to health care pro-
fessionals in pain care. 
‘‘(b) CERTAIN TOPICS.—An award may be made under 
subsection (a) only if the applicant for the award agrees 
that the program carried out with the award will include 
information and education on— 
‘‘(1) recognized means for assessing, diagnosing, 
treating, and managing pain and related signs and 
symptoms, including the medically appropriate use of 
controlled substances; 
‘‘(2) applicable laws, regulations, rules, and poli-
cies on controlled substances, including the degree to 
which misconceptions and concerns regarding such 
laws, regulations, rules, and policies, or the enforce-
ment thereof, may create barriers to patient access to 
appropriate and effective pain care; 
‘‘(3) interdisciplinary approaches to the delivery 
of pain care, including delivery through specialized 
centers providing comprehensive pain care treatment 
expertise; 
‘‘(4) cultural, linguistic, literacy, geographic, 
and other barriers to care in underserved populations; 
and 
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‘‘(5) recent findings, developments, and improve-
ments in the provision of pain care. 
‘‘(c) EVALUATION OF PROGRAMS.—The Secretary shall 
(directly or through grants or contracts) provide for the 
evaluation of programs implemented under subsection (a) 
in order to determine the effect of such programs on knowl-
edge and practice of pain care. 
‘‘(d) PAIN CARE DEFINED.—For purposes of this sec-
tion the term ‘pain care’ means the assessment, diagnosis, 
treatment, or management of acute or chronic pain regard-
less of causation or body location. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section, such 
sums as may be necessary for each of the fiscal years 2010 
through 2012. Amounts appropriated under this subsection 
shall remain available until expended.’’. 
SEC. 4306. FUNDING FOR CHILDHOOD OBESITY DEM-
ONSTRATION PROJECT. 
Section 1139A(e)(8) of the Social Security Act (42 
U.S.C. 1320b–9a(e)(8)) is amended to read as follows: 
‘‘(8) APPROPRIATION.—Out of any funds in the 
Treasury not otherwise appropriated, there is appro-
priated to carry out this subsection, $25,000,000 for 
the period of fiscal years 2010 through 2014.’’. 
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Subtitle E—Miscellaneous 
Provisions 
SEC. 4401. SENSE OF THE SENATE CONCERNING CBO SCOR-
ING. 
(a) FINDING.—The Senate finds that the costs of pre-
vention programs are difficult to estimate due in part be-
cause prevention initiatives are hard to measure and results 
may occur outside the 5 and 10 year budget windows. 
(b) SENSE OF CONGRESS.—It is the sense of the Senate 
that Congress should work with the Congressional Budget 
Office to develop better methodologies for scoring progress 
to be made in prevention and wellness programs. 
SEC. 4402. EFFECTIVENESS OF FEDERAL HEALTH AND 
WELLNESS INITIATIVES. 
To determine whether existing Federal health and 
wellness initiatives are effective in achieving their stated 
goals, the Secretary of Health and Human Services shall— 
(1) conduct an evaluation of such programs as 
they relate to changes in health status of the Amer-
ican public and specifically on the health status of the 
Federal workforce, including absenteeism of employ-
ees, the productivity of employees, the rate of work-
place injury, and the medical costs incurred by em-
ployees, and health conditions, including workplace 
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fitness, healthy food and beverages, and incentives in 
the Federal Employee Health Benefits Program; and 
(2) submit to Congress a report concerning such 
evaluation, which shall include conclusions con-
cerning the reasons that such existing programs have 
proven successful or not successful and what factors 
contributed to such conclusions. 
TITLE V—HEALTH CARE 
WORKFORCE 
Subtitle A—Purpose and 
Definitions 
SEC. 5001. PURPOSE. 
The purpose of this title is to improve access to and 
the delivery of health care services for all individuals, par-
ticularly low income, underserved, uninsured, minority, 
health disparity, and rural populations by— 
(1) gathering and assessing comprehensive data 
in order for the health care workforce to meet the 
health care needs of individuals, including research 
on the supply, demand, distribution, diversity, and 
skills needs of the health care workforce; 
(2) increasing the supply of a qualified health 
care workforce to improve access to and the delivery 
of health care services for all individuals; 
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(3) enhancing health care workforce education 
and training to improve access to and the delivery of 
health care services for all individuals; and 
(4) providing support to the existing health care 
workforce to improve access to and the delivery of 
health care services for all individuals. 
SEC. 5002. DEFINITIONS. 
(a) THIS TITLE.—In this title: 
(1) ALLIED HEALTH PROFESSIONAL.—The term 
‘‘allied health professional’’ means an allied health 
professional as defined in section 799B(5) of the Pub-
lic Heath Service Act (42 U.S.C. 295p(5)) who— 
(A) has graduated and received an allied 
health professions degree or certificate from an 
institution of higher education; and 
(B) is employed with a Federal, State, local 
or tribal public health agency, or in a setting 
where patients might require health care services, 
including acute care facilities, ambulatory care 
facilities, personal residences, and other settings 
located in health professional shortage areas, 
medically underserved areas, or medically under-
served populations, as recognized by the Sec-
retary of Health and Human Services. 
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(2) HEALTH CARE CAREER PATHWAY.—The term 
‘‘healthcare career pathway’’ means a rigorous, en-
gaging, and high quality set of courses and services 
that— 
(A) includes an articulated sequence of aca-
demic and career courses, including 21st century 
skills; 
(B) is aligned with the needs of healthcare 
industries in a region or State; 
(C) prepares students for entry into the full 
range of postsecondary education options, in-
cluding registered apprenticeships, and careers; 
(D) provides academic and career coun-
seling in student-to-counselor ratios that allow 
students to make informed decisions about aca-
demic and career options; 
(E) meets State academic standards, State 
requirements for secondary school graduation 
and is aligned with requirements for entry into 
postsecondary education, and applicable indus-
try standards; and 
(F) leads to 2 or more credentials, includ-
ing— 
(i) a secondary school diploma; and 
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(ii) a postsecondary degree, an appren-
ticeship or other occupational certification, 
a certificate, or a license. 
(3) INSTITUTION OF HIGHER EDUCATION.—The 
term ‘‘institution of higher education’’ has the mean-
ing given the term in sections 101 and 102 of the 
Higher Education Act of 1965 (20 U.S.C. 1001 and 
1002). 
(4) LOW
INCOME
INDIVIDUAL, STATE
WORK-
FORCE INVESTMENT BOARD, AND LOCAL WORKFORCE 
INVESTMENT BOARD.— 
(A) LOW-INCOME
INDIVIDUAL.—The term 
‘‘low-income individual’’ has the meaning given 
that term in section 101 of the Workforce invest-
ment Act of 1998 (29 U.S.C. 2801). 
(B) 
STATE
WORKFORCE
INVESTMENT 
BOARD; 
LOCAL
WORKFORCE
INVESTMENT 
BOARD.—The terms ‘‘State workforce investment 
board’’ and ‘‘local workforce investment board’’, 
refer to a State workforce investment board es-
tablished under section 111 of the Workforce In-
vestment Act of 1998 (29 U.S.C. 2821) and a 
local workforce investment board established 
under section 117 of such Act (29 U.S.C. 2832), 
respectively. 
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(5) POSTSECONDARY
EDUCATION.—The term 
‘‘postsecondary education’’ means— 
(A) a 4-year program of instruction, or not 
less than a 1-year program of instruction that is 
acceptable for credit toward an associate or a 
baccalaureate degree, offered by an institution of 
higher education; or 
(B) a certificate or registered apprentice-
ship program at the postsecondary level offered 
by an institution of higher education or a non- 
profit educational institution. 
(6) REGISTERED APPRENTICESHIP PROGRAM.— 
The term ‘‘registered apprenticeship program’’ means 
an industry skills training program at the postsec-
ondary level that combines technical and theoretical 
training through structure on the job learning with 
related instruction (in a classroom or through dis-
tance learning) while an individual is employed, 
working under the direction of qualified personnel or 
a mentor, and earning incremental wage increases 
aligned to enhance job proficiency, resulting in the 
acquisition of a nationally recognized and portable 
certificate, under a plan approved by the Office of 
Apprenticeship or a State agency recognized by the 
Department of Labor. 
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(b) TITLE VII OF THE PUBLIC HEALTH SERVICE 
ACT.—Section 799B of the Public Health Service Act (42 
U.S.C. 295p) is amended— 
(1) by striking paragraph (3) and inserting the 
following: 
‘‘(3) PHYSICIAN
ASSISTANT
EDUCATION
PRO-
GRAM.—The term ‘physician assistant education pro-
gram’ means an educational program in a public or 
private institution in a State that— 
‘‘(A) has as its objective the education of in-
dividuals who, upon completion of their studies 
in the program, be qualified to provide primary 
care medical services with the supervision of a 
physician; and 
‘‘(B) is accredited by the Accreditation Re-
view Commission on Education for the Physi-
cian Assistant.’’; and 
(2) by adding at the end the following: 
‘‘(12) AREA HEALTH EDUCATION CENTER.—The 
term ‘area health education center’ means a public or 
nonprofit private organization that has a cooperative 
agreement or contract in effect with an entity that 
has received an award under subsection (a)(1) or 
(a)(2) of section 751, satisfies the requirements in sec-
tion 751(d)(1), and has as one of its principal func-
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tions the operation of an area health education center. 
Appropriate organizations may include hospitals, 
health organizations with accredited primary care 
training programs, accredited physician assistant 
educational programs associated with a college or 
university, and universities or colleges not operating 
a school of medicine or osteopathic medicine. 
‘‘(13) AREA HEALTH EDUCATION CENTER PRO-
GRAM.—The term ‘area health education center pro-
gram’ means cooperative program consisting of an 
entity that has received an award under subsection 
(a)(1) or (a)(2) of section 751 for the purpose of plan-
ning, developing, operating, and evaluating an area 
health education center program and one or more 
area health education centers, which carries out the 
required activities described in section 751(c), satis-
fies the program requirements in such section, has as 
one of its principal functions identifying and imple-
menting strategies and activities that address health 
care workforce needs in its service area, in coordina-
tion with the local workforce investment boards. 
‘‘(14) CLINICAL
SOCIAL
WORKER.—The term 
‘clinical social worker’ has the meaning given the 
term in section 1861(hh)(1) of the Social Security Act 
(42 U.S.C. 1395x(hh)(1)). 
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‘‘(15) CULTURAL COMPETENCY.—The term ‘cul-
tural competency’ shall be defined by the Secretary in 
a manner consistent with section 1707(d)(3). 
‘‘(16) DIRECT CARE WORKER.—The term ‘direct 
care worker’ has the meaning given that term in the 
2010 Standard Occupational Classifications of the 
Department of Labor for Home Health Aides [31– 
1011], Psychiatric Aides [31–1013], Nursing Assist-
ants [31–1014], and Personal Care Aides [39–9021]. 
‘‘(17) FEDERALLY
QUALIFIED
HEALTH
CEN-
TER.—The term ‘Federally qualified health center’ 
has the meaning given that term in section 1861(aa) 
of the Social Security Act (42 U.S.C. 1395x(aa)). 
‘‘(18) FRONTIER HEALTH PROFESSIONAL SHORT-
AGE
AREA.—The term ‘frontier health professional 
shortage area’ means an area— 
‘‘(A) with a population density less than 6 
persons per square mile within the service area; 
and 
‘‘(B) with respect to which the distance or 
time for the population to access care is exces-
sive. 
‘‘(19) GRADUATE PSYCHOLOGY.—The term ‘grad-
uate psychology’ means an accredited program in 
professional psychology. 
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‘‘(20) HEALTH
DISPARITY
POPULATION.—The 
term ‘health disparity population’ has the meaning 
given such term in section 903(d)(1). 
‘‘(21) HEALTH LITERACY.—The term ‘health lit-
eracy’ means the degree to which an individual has 
the capacity to obtain, communicate, process, and un-
derstand health information and services in order to 
make appropriate health decisions. 
‘‘(22) 
MENTAL
HEALTH
SERVICE
PROFES-
SIONAL.—The term ‘mental health service profes-
sional’ means an individual with a graduate or post-
graduate degree from an accredited institution of 
higher education in psychiatry, psychology, school 
psychology, behavioral pediatrics, psychiatric nurs-
ing, social work, school social work, substance abuse 
disorder prevention and treatment, marriage and 
family counseling, school counseling, or professional 
counseling. 
‘‘(23) ONE-STOP DELIVERY SYSTEM CENTER.— 
The term ‘one-stop delivery system’ means a one-stop 
delivery system described in section 134(c) of the 
Workforce Investment Act of 1998 (29 U.S.C. 
2864(c)). 
‘‘(24) PARAPROFESSIONAL CHILD AND ADOLES-
CENT MENTAL HEALTH WORKER.—The term ‘para-
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professional child and adolescent mental health work-
er’ means an individual who is not a mental or be-
havioral health service professional, but who works at 
the first stage of contact with children and families 
who are seeking mental or behavioral health services, 
including substance abuse prevention and treatment 
services. 
‘‘(25) RACIAL AND ETHNIC MINORITY GROUP; RA-
CIAL AND ETHNIC MINORITY POPULATION.—The terms 
‘racial and ethnic minority group’ and ‘racial and 
ethnic minority population’ have the meaning given 
the term ‘racial and ethnic minority group’ in section 
1707. 
‘‘(26) RURAL HEALTH CLINIC.—The term ‘rural 
health clinic’ has the meaning given that term in sec-
tion 1861(aa) of the Social Security Act (42 U.S.C. 
1395x(aa)).’’. 
(c) TITLE VIII OF THE PUBLIC HEALTH SERVICE 
ACT.—Section 801 of the Public Health Service Act (42 
U.S.C. 296) is amended— 
(1) in paragraph (2)— 
(A) by striking ‘‘means a’’ and inserting 
‘‘means an accredited (as defined in paragraph 
6)’’; and 
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(B) by striking the period as inserting the 
following: ‘‘where graduates are— 
‘‘(A) authorized to sit for the National 
Council 
Licensure 
EXamination-Registered 
Nurse (NCLEX–RN); or 
‘‘(B) licensed registered nurses who will re-
ceive a graduate or equivalent degree or training 
to become an advanced education nurse as de-
fined by section 811(b).’’; and 
(2) by adding at the end the following: 
‘‘(16) ACCELERATED
NURSING
DEGREE
PRO-
GRAM.—The term ‘accelerated nursing degree pro-
gram’ means a program of education in professional 
nursing offered by an accredited school of nursing in 
which an individual holding a bachelors degree in an-
other discipline receives a BSN or MSN degree in an 
accelerated time frame as determined by the accred-
ited school of nursing. 
‘‘(17) BRIDGE
OR
DEGREE
COMPLETION
PRO-
GRAM.—The term ‘bridge or degree completion pro-
gram’ means a program of education in professional 
nursing offered by an accredited school of nursing, as 
defined in paragraph (2), that leads to a bacca-
laureate degree in nursing. Such programs may in-
clude, Registered Nurse (RN) to Bachelor’s of Science 
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of Nursing (BSN) programs, RN to MSN (Master of 
Science of Nursing) programs, or BSN to Doctoral 
programs.’’. 
Subtitle B—Innovations in the 
Health Care Workforce 
SEC. 5101. NATIONAL HEALTH CARE WORKFORCE COMMIS-
SION. 
(a) PURPOSE.—It is the purpose of this section to es-
tablish a National Health Care Workforce Commission 
that— 
(1) serves as a national resource for Congress, 
the President, States, and localities; 
(2) communicates and coordinates with the De-
partments of Health and Human Services, Labor, 
Veterans Affairs, Homeland Security, and Education 
on related activities administered by one or more of 
such Departments; 
(3) develops and commissions evaluations of edu-
cation and training activities to determine whether 
the demand for health care workers is being met; 
(4) identifies barriers to improved coordination 
at the Federal, State, and local levels and recommend 
ways to address such barriers; and 
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(5) encourages innovations to address population 
needs, constant changes in technology, and other envi-
ronmental factors. 
(b) ESTABLISHMENT.—There is hereby established the 
National Health Care Workforce Commission (in this sec-
tion referred to as the ‘‘Commission’’). 
(c) MEMBERSHIP.— 
(1) NUMBER AND APPOINTMENT.—The Commis-
sion shall be composed of 15 members to be appointed 
by the Comptroller General, without regard to section 
5 of the Federal Advisory Committee Act (5 U.S.C. 
App.). 
(2) QUALIFICATIONS.— 
(A) IN GENERAL.—The membership of the 
Commission shall include individuals— 
(i) with national recognition for their 
expertise in health care labor market anal-
ysis, including health care workforce anal-
ysis; health care finance and economics; 
health care facility management; health care 
plans and integrated delivery systems; 
health care workforce education and train-
ing; health care philanthropy; providers of 
health care services; and other related fields; 
and 
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year institutions, or registered appren-
ticeship programs). 
(ii) ADDITIONAL
MEMBERS.—The re-
maining membership may include addi-
tional representatives from clause (i) and 
other individuals as determined appropriate 
by the Comptroller General of the United 
States. 
(C) MAJORITY
NON-PROVIDERS.—Individ-
uals who are directly involved in health profes-
sions education or practice shall not constitute a 
majority of the membership of the Commission. 
(D) ETHICAL
DISCLOSURE.—The Comp-
troller General shall establish a system for public 
disclosure by members of the Commission of fi-
nancial and other potential conflicts of interest 
relating to such members. Members of the Com-
mission shall be treated as employees of Congress 
for purposes of applying title I of the Ethics in 
Government Act of 1978. Members of the Com-
mission shall not be treated as special govern-
ment employees under title 18, United States 
Code. 
(3) TERMS.— 
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(A) IN GENERAL.—The terms of members of 
the Commission shall be for 3 years except that 
the Comptroller General shall designate staggered 
terms for the members first appointed. 
(B) VACANCIES.—Any member appointed to 
fill a vacancy occurring before the expiration of 
the term for which the member’s predecessor was 
appointed shall be appointed only for the re-
mainder of that term. A member may serve after 
the expiration of that member’s term until a suc-
cessor has taken office. A vacancy in the Com-
mission shall be filled in the manner in which 
the original appointment was made. 
(C) INITIAL
APPOINTMENTS.—The Comp-
troller General shall make initial appointments 
of members to the Commission not later than 
September 30, 2010. 
(4) COMPENSATION.—While serving on the busi-
ness of the Commission (including travel time), a 
member of the Commission shall be entitled to com-
pensation at the per diem equivalent of the rate pro-
vided for level IV of the Executive Schedule under sec-
tion 5315 of tile 5, United States Code, and while so 
serving away from home and the member’s regular 
place of business, a member may be allowed travel ex-
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penses, as authorized by the Chairman of the Com-
mission. Physicians serving as personnel of the Com-
mission may be provided a physician comparability 
allowance by the Commission in the same manner as 
Government physicians may be provided such an al-
lowance by an agency under section 5948 of title 5, 
United States Code, and for such purpose subsection 
(i) of such section shall apply to the Commission in 
the same manner as it applies to the Tennessee Valley 
Authority. For purposes of pay (other than pay of 
members of the Commission) and employment bene-
fits, rights, and privileges, all personnel of the Com-
mission shall be treated as if they were employees of 
the United States Senate. Personnel of the Commis-
sion shall not be treated as employees of the Govern-
ment Accountability Office for any purpose. 
(5) CHAIRMAN, VICE
CHAIRMAN.—The Comp-
troller General shall designate a member of the Com-
mission, at the time of appointment of the member, 
as Chairman and a member as Vice Chairman for 
that term of appointment, except that in the case of 
vacancy of the chairmanship or vice chairmanship, 
the Comptroller General may designate another mem-
ber for the remainder of that member’s term. 
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(6) MEETINGS.—The Commission shall meet at 
the call of the chairman, but no less frequently than 
on a quarterly basis. 
(d) DUTIES.— 
(1) RECOGNITION, DISSEMINATION, AND COMMU-
NICATION.—The Commission shall— 
(A) recognize efforts of Federal, State, and 
local partnerships to develop and offer health 
care career pathways of proven effectiveness; 
(B) disseminate information on promising 
retention practices for health care professionals; 
and 
(C) communicate information on important 
policies and practices that affect the recruitment, 
education and training, and retention of the 
health care workforce. 
(2) REVIEW OF HEALTH CARE WORKFORCE AND 
ANNUAL REPORTS.—In order to develop a fiscally sus-
tainable integrated workforce that supports a high- 
quality, readily accessible health care delivery system 
that meets the needs of patients and populations, the 
Commission, in consultation with relevant Federal, 
State, and local agencies, shall— 
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(A) review current and projected health care 
workforce supply and demand, including the top-
ics described in paragraph (3); 
(B) make recommendations to Congress and 
the Administration concerning national health 
care workforce priorities, goals, and policies; 
(C) by not later than October 1 of each year 
(beginning with 2011), submit a report to Con-
gress and the Administration containing the re-
sults of such reviews and recommendations con-
cerning related policies; and 
(D) by not later than April 1 of each year 
(beginning with 2011), submit a report to Con-
gress and the Administration containing a re-
view of, and recommendations on, at a min-
imum one high priority area as described in 
paragraph (4). 
(3) SPECIFIC
TOPICS
TO
BE
REVIEWED.—The 
topics described in this paragraph include— 
(A) current health care workforce supply 
and distribution, including demographics, skill 
sets, and demands, with projected demands dur-
ing the subsequent 10 and 25 year periods; 
(B) health care workforce education and 
training capacity, including the number of stu-
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dents who have completed education and train-
ing, including registered apprenticeships; the 
number of qualified faculty; the education and 
training infrastructure; and the education and 
training demands, with projected demands dur-
ing the subsequent 10 and 25 year periods; 
(C) the education loan and grant programs 
in titles VII and VIII of the Public Health Serv-
ice Act (42 U.S.C. 292 et seq. and 296 et seq.), 
with recommendations on whether such programs 
should become part of the Higher Education Act 
of 1965 (20 U.S.C. 1001 et seq); 
(D) the implications of new and existing 
Federal policies which affect the health care 
workforce, including Medicare and Medicaid 
graduate medical education policies, titles VII 
and VIII of the Public Health Service Act (42 
U.S.C. 292 et seq. and 296 et seq.), the National 
Health Service Corps (with recommendations for 
aligning such programs with national health 
workforce priorities and goals), and other health 
care workforce programs, including those sup-
ported through the Workforce Investment Act of 
1998 (29 U.S.C. 2801 et seq.), the Carl D. Per-
kins Career and Technical Education Act of 
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2006 (20 U.S.C. 2301 et seq.), the Higher Edu-
cation Act of 1965 (20 U.S.C. 1001 et seq.), and 
any other Federal health care workforce pro-
grams; 
(E) the health care workforce needs of spe-
cial populations, such as minorities, rural popu-
lations, medically underserved populations, gen-
der specific needs, individuals with disabilities, 
and geriatric and pediatric populations with 
recommendations for new and existing Federal 
policies to meet the needs of these special popu-
lations; and 
(F) recommendations creating or revising 
national loan repayment programs and scholar-
ship programs to require low-income, minority 
medical students to serve in their home commu-
nities, if designated as medical underserved com-
munity. 
(4) HIGH PRIORITY AREAS.— 
(A) IN GENERAL.—The initial high priority 
topics described in this paragraph include each 
of the following: 
(i) Integrated health care workforce 
planning that identifies health care profes-
sional skills needed and maximizes the skill 
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sets of health care professionals across dis-
ciplines. 
(ii) An analysis of the nature, scopes of 
practice, and demands for health care work-
ers in the enhanced information technology 
and management workplace. 
(iii) An analysis of how to align Medi-
care and Medicaid graduate medical edu-
cation policies with national workforce 
goals. 
(iv) The education and training capac-
ity, projected demands, and integration 
with the health care delivery system of each 
of the following: 
(I) Nursing workforce capacity at 
all levels. 
(II) Oral health care workforce ca-
pacity at all levels. 
(III) 
Mental 
and 
behavioral 
health care workforce capacity at all 
levels. 
(IV) Allied health and public 
health care workforce capacity at all 
levels. 
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(V) Emergency medical service 
workforce capacity, including the re-
tention and recruitment of the volun-
teer workforce, at all levels. 
(VI) The geographic distribution 
of health care providers as compared to 
the identified health care workforce 
needs of States and regions. 
(B) FUTURE DETERMINATIONS.—The Com-
mission may require that additional topics be 
included under subparagraph (A). The appro-
priate committees of Congress may recommend to 
the Commission the inclusion of other topics for 
health care workforce development areas that re-
quire special attention. 
(5) GRANT PROGRAM.—The Commission shall— 
(A) review implementation progress reports 
on, and report to Congress about, the State 
Health Care Workforce Development Grant pro-
gram established in section 5102; 
(B) in collaboration with the Department of 
Labor and in coordination with the Department 
of Education and other relevant Federal agen-
cies, make recommendations to the fiscal and ad-
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ministrative agent under section 5102(b) for 
grant recipients under section 5102; 
(C) assess the implementation of the grants 
under such section; and 
(D) collect performance and report informa-
tion, including identified models and best prac-
tices, on grants from the fiscal and administra-
tive agent under such section and distribute this 
information to Congress, relevant Federal agen-
cies, and to the public. 
(6) STUDY.—The Commission shall study effec-
tive mechanisms for financing education and training 
for careers in health care, including public health and 
allied health. 
(7) RECOMMENDATIONS.—The Commission shall 
submit recommendations to Congress, the Department 
of Labor, and the Department of Health and Human 
Services about improving safety, health, and worker 
protections in the workplace for the health care work-
force. 
(8) ASSESSMENT.—The Commission shall assess 
and receive reports from the National Center for 
Health Care Workforce Analysis established under sec-
tion 761(b) of the Public Service Health Act (as 
amended by section 5103). 
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(e) CONSULTATION
WITH
FEDERAL, STATE, AND 
LOCAL AGENCIES, CONGRESS, AND OTHER ORGANIZA-
TIONS.— 
(1) IN GENERAL.—The Commission shall consult 
with Federal agencies (including the Departments of 
Health and Human Services, Labor, Education, Com-
merce, Agriculture, Defense, and Veterans Affairs and 
the Environmental Protection Agency), Congress, the 
Medicare Payment Advisory Commission, the Med-
icaid and CHIP Payment and Access Commission, 
and, to the extent practicable, with State and local 
agencies, Indian tribes, voluntary health care organi-
zations, professional societies, and other relevant pub-
lic-private health care partnerships. 
(2) OBTAINING OFFICIAL DATA.—The Commis-
sion, consistent with established privacy rules, may 
secure directly from any department or agency of the 
Executive Branch information necessary to enable the 
Commission to carry out this section. 
(3) DETAIL OF FEDERAL GOVERNMENT EMPLOY-
EES.—An employee of the Federal Government may 
be detailed to the Commission without reimbursement. 
The detail of such an employee shall be without inter-
ruption or loss of civil service status. 
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(f) DIRECTOR AND STAFF; EXPERTS AND CONSULT-
ANTS.—Subject to such review as the Comptroller General 
of the United States determines to be necessary to ensure 
the efficient administration of the Commission, the Com-
mission may— 
(1) employ and fix the compensation of an exec-
utive director that shall not exceed the rate of basic 
pay payable for level V of the Executive Schedule and 
such other personnel as may be necessary to carry out 
its duties (without regard to the provisions of title 5, 
United States Code, governing appointments in the 
competitive service); 
(2) seek such assistance and support as may be 
required in the performance of its duties from appro-
priate Federal departments and agencies; 
(3) enter into contracts or make other arrange-
ments, as may be necessary for the conduct of the 
work of the Commission (without regard to section 
3709 of the Revised Statutes (41 U.S.C. 5)); 
(4) make advance, progress, and other payments 
which relate to the work of the Commission; 
(5) provide transportation and subsistence for 
persons serving without compensation; and 
(6) prescribe such rules and regulations as the 
Commission determines to be necessary with respect 
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to the internal organization and operation of the 
Commission. 
(g) POWERS.— 
(1) DATA COLLECTION.—In order to carry out 
its functions under this section, the Commission 
shall— 
(A) utilize existing information, both pub-
lished and unpublished, where possible, collected 
and assessed either by its own staff or under 
other arrangements made in accordance with 
this section, including coordination with the Bu-
reau of Labor Statistics; 
(B) carry out, or award grants or contracts 
for the carrying out of, original research and de-
velopment, where existing information is inad-
equate, and 
(C) adopt procedures allowing interested 
parties to submit information for the Commis-
sion’s use in making reports and recommenda-
tions. 
(2) ACCESS
OF
THE
GOVERNMENT
ACCOUNT-
ABILITY OFFICE TO INFORMATION.—The Comptroller 
General of the United States shall have unrestricted 
access to all deliberations, records, and data of the 
Commission, immediately upon request. 
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(3) PERIODIC AUDIT.—The Commission shall be 
subject to periodic audit by an independent public ac-
countant under contract to the Commission. 
(h) AUTHORIZATION OF APPROPRIATIONS.— 
(1) REQUEST FOR APPROPRIATIONS.—The Com-
mission shall submit requests for appropriations in 
the same manner as the Comptroller General of the 
United States submits requests for appropriations. 
Amounts so appropriated for the Commission shall be 
separate from amounts appropriated for the Comp-
troller General. 
(2) AUTHORIZATION.—There are authorized to be 
appropriated such sums as may be necessary to carry 
out this section. 
(3) GIFTS
AND
SERVICES.—The Commission 
may not accept gifts, bequeaths, or donations of prop-
erty, but may accept and use donations of services for 
purposes of carrying out this section. 
(i) DEFINITIONS.—In this section: 
(1) HEALTH
CARE
WORKFORCE.—The term 
‘‘health care workforce’’ includes all health care pro-
viders with direct patient care and support respon-
sibilities, such as physicians, nurses, nurse practi-
tioners, primary care providers, preventive medicine 
physicians, optometrists, ophthalmologists, physician 
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assistants, pharmacists, dentists, dental hygienists, 
and other oral healthcare professionals, allied health 
professionals, doctors of chiropractic, community 
health workers, health care paraprofessionals, direct 
care workers, psychologists and other behavioral and 
mental health professionals (including substance 
abuse prevention and treatment providers), social 
workers, physical and occupational therapists, cer-
tified nurse midwives, podiatrists, the EMS workforce 
(including professional and volunteer ambulance per-
sonnel and firefighters who perform emergency med-
ical services), licensed complementary and alternative 
medicine providers, integrative health practitioners, 
public health professionals, and any other health pro-
fessional that the Comptroller General of the United 
States determines appropriate. 
(2) HEALTH PROFESSIONALS.—The term ‘‘health 
professionals’’ includes— 
(A) dentists, dental hygienists, primary 
care providers, specialty physicians, nurses, 
nurse practitioners, physician assistants, psy-
chologists and other behavioral and mental 
health professionals (including substance abuse 
prevention and treatment providers), social 
workers, physical and occupational therapists, 
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public health professionals, clinical pharmacists, 
allied health professionals, doctors of chiro-
practic, 
community 
health 
workers, 
school 
nurses, certified nurse midwives, podiatrists, li-
censed complementary and alternative medicine 
providers, the EMS workforce (including profes-
sional and volunteer ambulance personnel and 
firefighters who perform emergency medical serv-
ices), and integrative health practitioners; 
(B) national representatives of health pro-
fessionals; 
(C) representatives of schools of medicine, 
osteopathy, nursing, dentistry, optometry, phar-
macy, chiropractic, allied health, educational 
programs for public health professionals, behav-
ioral and mental health professionals (as so de-
fined), social workers, pharmacists, physical and 
occupational therapists, oral health care indus-
try dentistry and dental hygiene, and physician 
assistants; 
(D) representatives of public and private 
teaching hospitals, and ambulatory health facili-
ties, including Federal medical facilities; and 
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(E) any other health professional the Comp-
troller General of the United States determines 
appropriate. 
SEC. 5102. STATE HEALTH CARE WORKFORCE DEVELOP-
MENT GRANTS. 
(a) ESTABLISHMENT.—There is established a competi-
tive health care workforce development grant program (re-
ferred to in this section as the ‘‘program’’) for the purpose 
of enabling State partnerships to complete comprehensive 
planning and to carry out activities leading to coherent and 
comprehensive health care workforce development strategies 
at the State and local levels. 
(b) FISCAL
AND
ADMINISTRATIVE
AGENT.—The 
Health Resources and Services Administration of the De-
partment of Health and Human Services (referred to in this 
section as the ‘‘Administration’’) shall be the fiscal and ad-
ministrative agent for the grants awarded under this sec-
tion. The Administration is authorized to carry out the pro-
gram, in consultation with the National Health Care Work-
force Commission (referred to in this section as the ‘‘Com-
mission’’), which shall review reports on the development, 
implementation, and evaluation activities of the grant pro-
gram, including— 
(1) administering the grants; 
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(2) providing technical assistance to grantees; 
and 
(3) reporting performance information to the 
Commission. 
(c) PLANNING GRANTS.— 
(1) AMOUNT AND DURATION.—A planning grant 
shall be awarded under this subsection for a period of 
not more than one year and the maximum award 
may not be more than $150,000. 
(2) ELIGIBILITY.—To be eligible to receive a 
planning grant, an entity shall be an eligible partner-
ship. An eligible partnership shall be a State work-
force investment board, if it includes or modifies the 
members to include at least one representative from 
each of the following: health care employer, labor or-
ganization, a public 2-year institution of higher edu-
cation, a public 4-year institution of higher edu-
cation, the recognized State federation of labor, the 
State public secondary education agency, the State 
P–16 or P–20 Council if such a council exists, and 
a philanthropic organization that is actively engaged 
in providing learning, mentoring, and work opportu-
nities to recruit, educate, and train individuals for, 
and retain individuals in, careers in health care and 
related industries. 
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(3) FISCAL AND ADMINISTRATIVE AGENT.—The 
Governor of the State receiving a planning grant has 
the authority to appoint a fiscal and an administra-
tive agency for the partnership. 
(4) APPLICATION.—Each State partnership de-
siring a planning grant shall submit an application 
to the Administrator of the Administration at such 
time and in such manner, and accompanied by such 
information as the Administrator may reasonable re-
quire. Each application submitted for a planning 
grant shall describe the members of the State partner-
ship, the activities for which assistance is sought, the 
proposed performance benchmarks to be used to meas-
ure progress under the planning grant, a budget for 
use of the funds to complete the required activities de-
scribed in paragraph (5), and such additional assur-
ance and information as the Administrator deter-
mines to be essential to ensure compliance with the 
grant program requirements. 
(5) REQUIRED ACTIVITIES.—A State partnership 
receiving a planning grant shall carry out the fol-
lowing: 
(A) Analyze State labor market information 
in order to create health care career pathways 
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for students and adults, including dislocated 
workers. 
(B) Identify current and projected high de-
mand State or regional health care sectors for 
purposes of planning career pathways. 
(C) Identify existing Federal, State, and 
private resources to recruit, educate or train, 
and retain a skilled health care workforce and 
strengthen partnerships. 
(D) Describe the academic and health care 
industry skill standards for high school gradua-
tion, for entry into postsecondary education, and 
for various credentials and licensure. 
(E) Describe State secondary and postsec-
ondary education and training policies, models, 
or practices for the health care sector, including 
career information and guidance counseling. 
(F) Identify Federal or State policies or 
rules to developing a coherent and comprehensive 
health care workforce development strategy and 
barriers and a plan to resolve these barriers. 
(G) Participate in the Administration’s 
evaluation and reporting activities. 
(6) PERFORMANCE AND EVALUATION.—Before the 
State partnership receives a planning grant, such 
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partnership and the Administrator of the Administra-
tion shall jointly determine the performance bench-
marks that will be established for the purposes of the 
planning grant. 
(7) MATCH.—Each State partnership receiving a 
planning grant shall provide an amount, in cash or 
in kind, that is not less that 15 percent of the amount 
of the grant, to carry out the activities supported by 
the grant. The matching requirement may be provided 
from funds available under other Federal, State, local 
or private sources to carry out the activities. 
(8) REPORT.— 
(A) REPORT
TO
ADMINISTRATION.—Not 
later than 1 year after a State partnership re-
ceives a planning grant, the partnership shall 
submit a report to the Administration on the 
State’s performance of the activities under the 
grant, including the use of funds, including 
matching funds, to carry out required activities, 
and a description of the progress of the State 
workforce investment board in meeting the per-
formance benchmarks. 
(B) REPORT TO CONGRESS.—The Adminis-
tration shall submit a report to Congress ana-
lyzing the planning activities, performance, and 
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fund utilization of each State grant recipient, 
including an identification of promising prac-
tices and a profile of the activities of each State 
grant recipient. 
(d) IMPLEMENTATION GRANTS.— 
(1) IN GENERAL.—The Administration shall— 
(A) competitively award implementation 
grants to State partnerships to enable such part-
nerships to implement activities that will result 
in a coherent and comprehensive plan for health 
workforce development that will address current 
and projected workforce demands within the 
State; and 
(B) inform the Commission and Congress 
about the awards made. 
(2) DURATION.—An implementation grant shall 
be awarded for a period of no more than 2 years, ex-
cept in those cases where the Administration deter-
mines that the grantee is high performing and the ac-
tivities supported by the grant warrant up to 1 addi-
tional year of funding. 
(3) ELIGIBILITY.—To be eligible for an imple-
mentation grant, a State partnership shall have— 
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(A) received a planning grant under sub-
section (c) and completed all requirements of 
such grant; or 
(B) completed a satisfactory application, 
including a plan to coordinate with required 
partners and complete the required activities 
during the 2 year period of the implementation 
grant. 
(4) FISCAL
AND
ADMINISTRATIVE
AGENT.—A 
State partnership receiving an implementation grant 
shall appoint a fiscal and an administration agent 
for the implementation of such grant. 
(5) APPLICATION.—Each eligible State partner-
ship desiring an implementation grant shall submit 
an application to the Administration at such time, in 
such manner, and accompanied by such information 
as the Administration may reasonably require. Each 
application submitted shall include— 
(A) a description of the members of the 
State partnership; 
(B) a description of how the State partner-
ship completed the required activities under the 
planning grant, if applicable; 
(C) a description of the activities for which 
implementation grant funds are sought, includ-
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ing grants to regions by the State partnership to 
advance coherent and comprehensive regional 
health care workforce planning activities; 
(D) a description of how the State partner-
ship will coordinate with required partners and 
complete the required partnership activities dur-
ing the duration of an implementation grant; 
(E) a budget proposal of the cost of the ac-
tivities supported by the implementation grant 
and a timeline for the provision of matching 
funds required; 
(F) proposed performance benchmarks to be 
used to assess and evaluate the progress of the 
partnership activities; 
(G) a description of how the State partner-
ship will collect data to report progress in grant 
activities; and 
(H) such additional assurances as the Ad-
ministration determines to be essential to ensure 
compliance with grant requirements. 
(6) REQUIRED ACTIVITIES.— 
(A) IN GENERAL.—A State partnership that 
receives an implementation grant may reserve 
not less than 60 percent of the grant funds to 
make grants to be competitively awarded by the 
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State partnership, consistent with State procure-
ment rules, to encourage regional partnerships to 
address health care workforce development needs 
and to promote innovative health care workforce 
career pathway activities, including career coun-
seling, learning, and employment. 
(B) ELIGIBLE PARTNERSHIP DUTIES.—An 
eligible State partnership receiving an imple-
mentation grant shall— 
(i) identify and convene regional lead-
ership to discuss opportunities to engage in 
statewide health care workforce development 
planning, including the potential use of 
competitive grants to improve the develop-
ment, distribution, and diversity of the re-
gional health care workforce; the alignment 
of curricula for health care careers; and the 
access to quality career information and 
guidance and education and training op-
portunities; 
(ii) in consultation with key stake-
holders and regional leaders, take appro-
priate steps to reduce Federal, State, or 
local barriers to a comprehensive and coher-
ent strategy, including changes in State or 
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local policies to foster coherent and com-
prehensive health care workforce develop-
ment activities, including health care career 
pathways at the regional and State levels, 
career planning information, retraining for 
dislocated workers, and as appropriate, re-
quests for Federal program or administra-
tive waivers; 
(iii) develop, disseminate, and review 
with key stakeholders a preliminary state-
wide strategy that addresses short- and 
long-term health care workforce development 
supply versus demand; 
(iv) convene State partnership mem-
bers on a regular basis, and at least on a 
semiannual basis; 
(v) assist leaders at the regional level 
to form partnerships, including technical 
assistance and capacity building activities; 
(vi) collect and assess data on and re-
port on the performance benchmarks selected 
by the State partnership and the Adminis-
tration for implementation activities car-
ried out by regional and State partnerships; 
and 
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(vii) participate in the Administra-
tion’s evaluation and reporting activities. 
(7) PERFORMANCE AND EVALUATION.—Before the 
State partnership receives an implementation grant, 
it and the Administrator shall jointly determine the 
performance benchmarks that shall be established for 
the purposes of the implementation grant. 
(8) MATCH.—Each State partnership receiving 
an implementation grant shall provide an amount, in 
cash or in kind that is not less than 25 percent of the 
amount of the grant, to carry out the activities sup-
ported by the grant. The matching funds may be pro-
vided from funds available from other Federal, State, 
local, or private sources to carry out such activities. 
(9) REPORTS.— 
(A) REPORT
TO
ADMINISTRATION.—For 
each year of the implementation grant, the State 
partnership receiving the implementation grant 
shall submit a report to the Administration on 
the performance of the State of the grant activi-
ties, including a description of the use of the 
funds, including matched funds, to complete ac-
tivities, and a description of the performance of 
the State partnership in meeting the perform-
ance benchmarks. 
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(B) REPORT TO CONGRESS.—The Adminis-
tration shall submit a report to Congress ana-
lyzing implementation activities, performance, 
and fund utilization of the State grantees, in-
cluding an identification of promising practices 
and a profile of the activities of each State 
grantee. 
(e) AUTHORIZATION FOR APPROPRIATIONS.— 
(1) PLANNING GRANTS.—There are authorized to 
be appropriated to award planning grants under sub-
section (c) $8,000,000 for fiscal year 2010, and such 
sums as may be necessary for each subsequent fiscal 
year. 
(2) IMPLEMENTATION
GRANTS.—There are au-
thorized to be appropriated to award implementation 
grants under subsection (d), $150,000,000 for fiscal 
year 2010, and such sums as may be necessary for 
each subsequent fiscal year. 
SEC. 5103. HEALTH CARE WORKFORCE ASSESSMENT. 
(a) IN GENERAL.—Section 761 of the Public Health 
Service Act (42 U.S.C. 294m) is amended— 
(1) by redesignating subsection (c) as subsection 
(e); 
(2) by striking subsection (b) and inserting the 
following: 
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‘‘(b) NATIONAL CENTER FOR HEALTH CARE WORK-
FORCE ANALYSIS.— 
‘‘(1) ESTABLISHMENT.—The Secretary shall es-
tablish the National Center for Health Workforce 
Analysis (referred to in this section as the ‘National 
Center’). 
‘‘(2) PURPOSES.—The National Center, in co-
ordination to the extent practicable with the National 
Health Care Workforce Commission (established in 
section 5101 of the Patient Protection and Affordable 
Care Act), and relevant regional and State centers 
and agencies, shall— 
‘‘(A) provide for the development of infor-
mation describing and analyzing the health care 
workforce and workforce related issues; 
‘‘(B) carry out the activities under section 
792(a); 
‘‘(C) annually evaluate programs under this 
title; 
‘‘(D) develop and publish performance 
measures and benchmarks for programs under 
this title; and 
‘‘(E) establish, maintain, and publicize a 
national Internet registry of each grant awarded 
under this title and a database to collect data 
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