2027 
(4) OBSTETRICS.—Improving the provision of 
obstetrical and neonatal care, including the identi-
fication of interventions that are effective in reduc-
ing the risk of preterm and premature labor and the 
implementation of best practices for labor and deliv-
ery care. 
SEC. 2402. ASSISTANT SECRETARY FOR HEALTH INFORMA-
TION. 
(a) ESTABLISHMENT.—Title XVII (42 U.S.C. 300u 
et seq.) is amended— 
(1) by redesignating sections 1709 and 1710 as 
sections 1710 and 1711, respectively; and 
(2) by inserting after section 1708 the fol-
lowing: 
‘‘SEC. 1709. ASSISTANT SECRETARY FOR HEALTH INFORMA-
TION. 
‘‘(a) IN GENERAL.—There is established within the 
Department an Assistant Secretary for Health Informa-
tion (in this section referred to as the ‘Assistant Sec-
retary’), to be appointed by the Secretary. 
‘‘(b) RESPONSIBILITIES.—The Assistant Secretary 
shall— 
‘‘(1) ensure the collection, collation, reporting, 
and publishing of information (including full and 
complete statistics) on key health indicators regard-
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ing the Nation’s health and the performance of the 
Nation’s health care; 
‘‘(2) facilitate and coordinate the collection, col-
lation, reporting, and publishing of information re-
garding the Nation’s health and the performance of 
the Nation’s health care (other than information de-
scribed in paragraph (1)); 
‘‘(3)(A) develop standards for the collection of 
data regarding the Nation’s health and the perform-
ance of the Nation’s health care; and 
‘‘(B) in carrying out subparagraph (A)— 
‘‘(i) ensure appropriate specificity and 
standardization for data collection at the na-
tional, regional, State, and local levels; 
‘‘(ii) include standards, as appropriate, for 
the collection of accurate data on health and 
health care by race, ethnicity, primary lan-
guage, sex, sexual orientation, gender identity, 
disability, socioeconomic status, rural, urban, or 
other geographic setting, and any other popu-
lation or subpopulation determined appropriate 
by the Secretary; 
‘‘(iii) ensure, with respect to data on race 
and ethnicity, consistency with the 1997 Office 
of Management and Budget Standards for 
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Maintaining, Collecting and Presenting Federal 
Data on Race and Ethnicity (or any successor 
standards); and 
‘‘(iv) in consultation with the Director of 
the Office of Minority Health, and the Director 
of the Office of Civil Rights, of the Department, 
develop standards for the collection of data on 
health and health care with respect to data on 
primary language; 
‘‘(4) provide support to Federal departments 
and agencies whose programs have a significant im-
pact upon health (as determined by the Secretary) 
for the collection and collation of information de-
scribed in paragraphs (1) and (2); 
‘‘(5) ensure the sharing of information de-
scribed in paragraphs (1) and (2) among the agen-
cies of the Department; 
‘‘(6) facilitate the sharing of information de-
scribed in paragraphs (1) and (2) by Federal depart-
ments and agencies whose programs have a signifi-
cant impact upon health (as determined by the Sec-
retary); 
‘‘(7) identify gaps in information described in 
paragraphs (1) and (2) and the appropriate agency 
or entity to address such gaps; 
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‘‘(8) facilitate and coordinate identification and 
monitoring by the agencies of the Department of 
health disparities to inform program and policy ef-
forts to reduce such disparities, including facilitating 
and funding analyses conducted in cooperation with 
the Social Security Administration, the Bureau of 
the Census, and other appropriate agencies and enti-
ties; 
‘‘(9) consistent with privacy, proprietary, and 
other appropriate safeguards, facilitate public acces-
sibility of datasets (such as de-identified Medicare 
datasets or publicly available data on key health in-
dicators) by means of the Internet; and 
‘‘(10) award grants or contracts for the collec-
tion and collation of information described in para-
graphs (1) and (2) (including through statewide sur-
veys that provide standardized information). 
‘‘(c) KEY HEALTH INDICATORS.— 
‘‘(1) IN GENERAL.—In carrying out subsection 
(b)(1), the Assistant Secretary shall— 
‘‘(A) identify, and reassess at least once 
every 3 years, key health indicators described in 
such subsection; 
‘‘(B) publish statistics on such key health 
indicators for the public— 
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‘‘(i) not less than annually; and 
‘‘(ii) on a supplemental basis when-
ever warranted by— 
‘‘(I) the rate of change for a key 
health indicator; or 
‘‘(II) the need to inform policy 
regarding the Nation’s health and the 
performance of the Nation’s health 
care; and 
‘‘(C) ensure consistency with the national 
strategy developed by the Secretary under sec-
tion 3121 and consideration of the indicators 
specified in the reports under sections 308, 
903(a)(6), and 913(b)(2). 
‘‘(2) RELEASE OF KEY HEALTH INDICATORS.— 
The regulations, rules, processes, and procedures of 
the Office of Management and Budget governing the 
review, release, and dissemination of key health indi-
cators shall be the same as the regulations, rules, 
processes, and procedures of the Office of Manage-
ment and Budget governing the review, release, and 
dissemination of Principal Federal Economic Indica-
tors (or equivalent statistical data) by the Bureau of 
Labor Statistics. 
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‘‘(d) COORDINATION.—In carrying out this section, 
the Assistant Secretary shall coordinate with— 
‘‘(1) public and private entities that collect and 
disseminate information on health and health care, 
including foundations; and 
‘‘(2) the head of the Office of the National Co-
ordinator for Health Information Technology to en-
sure optimal use of health information technology. 
‘‘(e) REQUEST FOR INFORMATION FROM OTHER DE-
PARTMENTS AND AGENCIES.—Consistent with applicable 
law, the Assistant Secretary may secure directly from any 
Federal department or agency information necessary to 
enable the Assistant Secretary to carry out this section. 
‘‘(f) REPORT.— 
‘‘(1) SUBMISSION.—The Assistant Secretary 
shall submit to the Secretary and the Congress an 
annual report containing— 
‘‘(A) a description of national, regional, or 
State changes in health or health care, as re-
flected by the key health indicators identified 
under subsection (c)(1); 
‘‘(B) a description of gaps in the collection, 
collation, reporting, and publishing of informa-
tion regarding the Nation’s health and the per-
formance of the Nation’s health care; 
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‘‘(C) recommendations for addressing such 
gaps and identification of the appropriate agen-
cy within the Department or other entity to ad-
dress such gaps; 
‘‘(D) a description of analyses of health 
disparities, including the results of completed 
analyses, the status of ongoing longitudinal 
studies, and proposed or planned research; and 
‘‘(E) a plan for actions to be taken by the 
Assistant Secretary to address gaps described 
in subparagraph (B). 
‘‘(2) CONSIDERATION.—In preparing a report 
under paragraph (1), the Assistant Secretary shall 
take into consideration the findings and conclusions 
in the reports under sections 308, 903(a)(6), and 
913(b)(2). 
‘‘(g) PROPRIETARY AND PRIVACY PROTECTIONS.— 
Nothing in this section shall be construed to affect appli-
cable proprietary or privacy protections. 
‘‘(h) CONSULTATION.—In carrying out this section, 
the Assistant Secretary shall consult with— 
‘‘(1) the heads of appropriate health agencies 
and offices in the Department, including the Office 
of the Surgeon General of the Public Health Service, 
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the Office of Minority Health, and the Office on 
Women’s Health; and 
‘‘(2) as appropriate, the heads of other Federal 
departments and agencies whose programs have a 
significant impact upon health (as determined by the 
Secretary). 
‘‘(i) DEFINITION.—In this section: 
‘‘(1) The terms ‘agency’ and ‘agencies’ include 
an epidemiology center established under section 214 
of the Indian Health Care Improvement Act. 
‘‘(2) The term ‘Department’ means the Depart-
ment of Health and Human Services. 
‘‘(3) The term ‘health disparities’ has the 
meaning given to such term in section 3171.’’. 
(b) OTHER
COORDINATION
RESPONSIBILITIES.— 
Title III (42 U.S.C. 241 et seq.) is amended— 
(1) in paragraphs (1) and (2) of section 304(c) 
(42 U.S.C. 242b(c)), by inserting ‘‘, acting through 
the Assistant Secretary for Health Information,’’ 
after ‘‘The Secretary’’ each place it appears; and 
(2) in section 306(j) (42 U.S.C. 242k(j)), by in-
serting ‘‘, acting through the Assistant Secretary for 
Health Information,’’ after ‘‘of this section, the Sec-
retary’’. 
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SEC. 2403. AUTHORIZATION OF APPROPRIATIONS. 
Section 799C, as added and amended, is further 
amended by adding at the end the following: 
‘‘(e) QUALITY AND SURVEILLANCE.—For the pur-
pose of carrying out part D of title IX and section 1709, 
in addition to any other amounts authorized to be appro-
priated for such purpose, there is authorized to be appro-
priated, out of any monies in the Public Health Invest-
ment Fund, $300,000,000 for each of fiscal years 2010 
through 2014 and $330,000,000 for each of fiscal years 
2015 through 2019.’’. 
TITLE V—OTHER PROVISIONS 
Subtitle A—Drug Discount for 
Rural and Other Hospitals 
SEC. 2501. EXPANDED PARTICIPATION IN 340B PROGRAM. 
(a) EXPANSION OF COVERED ENTITIES RECEIVING 
DISCOUNTED PRICES.—Section 340B(a)(4) (42 U.S.C. 
256b(a)(4)) is amended by adding at the end the fol-
lowing: 
‘‘(M) A children’s hospital excluded from 
the Medicare prospective payment system pur-
suant to section 1886(d)(1)(B)(iii) of the Social 
Security Act which would meet the require-
ments of subparagraph (L), including the dis-
proportionate share adjustment percentage re-
quirement under subparagraph (L)(ii), if the 
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hospital were a subsection (d) hospital as de-
fined in section 1886(d)(1)(B) of the Social Se-
curity Act. 
‘‘(N) An entity that is a critical access hos-
pital (as determined under section 1820(c)(2) 
of the Social Security Act). 
‘‘(O) An entity receiving funds under title 
V of the Social Security Act (relating to mater-
nal and child health) for the provision of health 
services. 
‘‘(P) An entity receiving funds under sub-
part I of part B of title XIX of the Public 
Health Service Act (relating to comprehensive 
mental health services) for the provision of com-
munity mental health services. 
‘‘(Q) An entity receiving funds under sub-
part II of such part B (relating to the preven-
tion and treatment of substance abuse) for the 
provision of treatment services for substance 
abuse. 
‘‘(R) An entity that is a Medicare-depend-
ent, small rural hospital (as defined in section 
1886(d)(5)(G)(iv) of the Social Security Act). 
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‘‘(S) An entity that is a sole community 
hospital 
(as 
defined 
in 
section 
1886(d)(5)(D)(iii) of the Social Security Act). 
‘‘(T) An entity that is classified as a rural 
referral center under section 1886(d)(5)(C) of 
the Social Security Act.’’. 
(b) PROHIBITION ON GROUP PURCHASING ARRANGE-
MENTS.—Section 340B(a) (42 U.S.C. 256b(a)) is amend-
ed— 
(1) in paragraph (4)(L)— 
(A) by adding ‘‘and’’ at the end of clause 
(i); 
(B) by striking ‘‘; and’’ at the end of 
clause (ii) and inserting a period; and 
(C) by striking clause (iii); 
(2) in paragraph (5), by redesignating subpara-
graphs (C) and (D) as subparagraphs (D) and (E), 
respectively, and by inserting after subparagraph 
(B) the following: 
‘‘(C) PROHIBITING
USE
OF
GROUP
PUR-
CHASING ARRANGEMENTS.— 
‘‘(i) A hospital described in subpara-
graph (L), (M), (N), (R), (S), or (T) of 
paragraph (4) shall not obtain covered out-
patient drugs through a group purchasing 
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organization or other group purchasing ar-
rangement, except as permitted or pro-
vided pursuant to clause (ii). 
‘‘(ii) The Secretary shall establish rea-
sonable exceptions to the requirement of 
clause (i)— 
‘‘(I) with respect to a covered 
outpatient drug that is unavailable to 
be purchased through the program 
under this section due to a drug 
shortage problem, manufacturer non-
compliance, or any other reason be-
yond the hospital’s control; 
‘‘(II) to facilitate generic substi-
tution when a generic covered out-
patient drug is available at a lower 
price; and 
‘‘(III) to reduce in other ways 
the administrative burdens of man-
aging both inventories of drugs ob-
tained under this section and not 
under this section, if such exception 
does not create a duplicate discount 
problem in violation of subparagraph 
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(A) or a diversion problem in violation 
of subparagraph (B).’’. 
SEC. 2502. EXTENSION OF DISCOUNTS TO INPATIENT 
DRUGS. 
(a) IN GENERAL.—Section 340B (42 U.S.C. 256b) 
is amended— 
(1) in subsection (b)— 
(A) by striking ‘‘In this section, the terms’’ 
and inserting the following: ‘‘In this section: 
‘‘(1) IN GENERAL.—The terms’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(2) COVERED
DRUG.—The term ‘covered 
drug’— 
‘‘(A) means a covered outpatient drug (as 
defined in section 1927(k)(2) of the Social Se-
curity Act); and 
‘‘(B) includes, notwithstanding the section 
1927(k)(3)(A) of such Act, a drug used in con-
nection with an inpatient or outpatient service 
provided by a hospital described in subpara-
graph (L), (M), (N), (R), (S), or (T) of sub-
section (a)(4) that is enrolled to participate in 
the drug discount program under this section.’’; 
and 
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(2) in paragraphs (5), (7), and (9) of sub-
section (a), by striking ‘‘outpatient’’ each place it 
appears. 
(b) MEDICAID CREDITS ON INPATIENT DRUGS.— 
Subsection (c) of section 340B (42 U.S.C. 256b(c)) is 
amended to read as follows: 
‘‘(c) MEDICAID CREDITS ON INPATIENT DRUGS.— 
‘‘(1) IN GENERAL.—For the cost reporting pe-
riod covered by the most recently filed Medicare cost 
report under title XVIII of the Social Security Act, 
a hospital described in subparagraph (L), (M), (N), 
(R), (S), or (T) of subsection (a)(4) and enrolled to 
participate in the drug discount program under this 
section shall provide to each State under its plan 
under title XIX of such Act— 
‘‘(A) a credit on the estimated annual 
costs to such hospital of single source and inno-
vator multiple source drugs provided to Med-
icaid beneficiaries for inpatient use; and 
‘‘(B) a credit on the estimated annual 
costs to such hospital of noninnovator multiple 
source drugs provided to Medicaid beneficiaries 
for inpatient use. 
‘‘(2) AMOUNT OF CREDITS.— 
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‘‘(A) SINGLE
SOURCE
AND
INNOVATOR 
MULTIPLE
SOURCE
DRUGS.—For purposes of 
paragraph (1)(A)— 
‘‘(i) the credit under such paragraph 
shall be equal to the product of— 
‘‘(I) the annual value of single 
source and innovator multiple source 
drugs purchased under this section by 
the hospital based on the drugs’ aver-
age manufacturer price; 
‘‘(II) the estimated percentage of 
the hospital’s drug purchases attrib-
utable to Medicaid beneficiaries for in-
patient use; and 
‘‘(III) the minimum rebate per-
centage 
described 
in 
section 
1927(c)(1)(B) of the Social Security 
Act; 
‘‘(ii) the reference in clause (i)(I) to 
the annual value of single source and inno-
vator multiple source drugs purchased 
under this section by the hospital based on 
the drugs’ average manufacturer price 
shall be equal to the sum of— 
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‘‘(I) the annual quantity of each 
single source and innovator multiple 
source drug purchased during the cost 
reporting period, multiplied by 
‘‘(II) the average manufacturer 
price for that drug; 
‘‘(iii) the reference in clause (i)(II) to 
the estimated percentage of the hospital’s 
drug purchases attributable to Medicaid 
beneficiaries for inpatient use; shall be 
equal to— 
‘‘(I) the Medicaid inpatient drug 
charges as reported on the hospital’s 
most recently filed Medicare cost re-
port, divided by 
‘‘(II) total drug charges reported 
on the cost report; and 
‘‘(iv) the terms ‘single source drug’ 
and ‘innovator multiple source drug’ have 
the meanings given such terms in section 
1927(k)(7) of the Social Security Act. 
‘‘(B) NONINNOVATOR
MULTIPLE
SOURCE 
DRUGS.—For purposes of paragraph (1)(B)— 
‘‘(i) the credit under such paragraph 
shall be equal to the product of— 
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‘‘(I) the annual value of noninno-
vator multiple source drugs purchased 
under this section by the hospital 
based on the drugs’ average manufac-
turer price; 
‘‘(II) the estimated percentage of 
the hospital’s drug purchases attrib-
utable to Medicaid beneficiaries for in-
patient use; and 
‘‘(III) the applicable percentage 
as defined in section 1927(c)(3)(B) of 
the Social Security Act; 
‘‘(ii) the reference in clause (i)(I) to 
the annual value of noninnovator multiple 
source drugs purchased under this section 
by the hospital based on the drugs’ average 
manufacturer price shall be equal to the 
sum of— 
‘‘(I) the annual quantity of each 
noninnovator multiple source drug 
purchased during the cost reporting 
period, multiplied by 
‘‘(II) the average manufacturer 
price for that drug; 
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‘‘(iii) the reference in clause (i)(II) to 
the estimated percentage of the hospital’s 
drug purchases attributable to Medicaid 
beneficiaries for inpatient use shall be 
equal to— 
‘‘(I) the Medicaid inpatient drug 
charges as reported on the hospital’s 
most recently filed Medicare cost re-
port, divided by 
‘‘(II) total drug charges reported 
on the cost report; and 
‘‘(iv) the term ‘noninnovator multiple 
source drug’ has the meaning given such 
term in section 1927(k)(7) of the Social 
Security Act. 
‘‘(3) CALCULATION OF CREDITS.— 
‘‘(A) IN GENERAL.—Each State calculates 
credits under paragraph (1) and informs hos-
pitals of amount under section 1927(a)(5)(D) 
of the Social Security Act. 
‘‘(B) HOSPITAL PROVISION OF INFORMA-
TION.—Not later than 30 days after the date of 
the filing of the hospital’s most recently filed 
Medicare cost report, the hospital shall provide 
the State with the information described in 
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paragraphs (2)(A)(ii) and (2)(B)(ii). With re-
spect to each drug purchased during the cost 
reporting period, the hospital shall provide the 
dosage form, strength, package size, date of 
purchase and the number of units purchased. 
‘‘(4) PAYMENT
DEADLINE.—The credits pro-
vided by a hospital under paragraph (1) shall be 
paid within 60 days after receiving the information 
specified in paragraph (3)(A). 
‘‘(5) OPT
OUT.—A hospital shall not be re-
quired to provide the Medicaid credit required under 
paragraph (1) if it can demonstrate to the State 
that it will lose reimbursement under the State plan 
resulting from the extension of discounts to inpa-
tient drugs under subsection (b)(2) and that the loss 
of reimbursement will exceed the amount of the 
credit otherwise owed by the hospital. 
‘‘(6) OFFSET AGAINST MEDICAL ASSISTANCE.— 
Amounts received by a State under this subsection 
in any quarter shall be considered to be a reduction 
in the amount expended under the State plan in the 
quarter for medical assistance for purposes of sec-
tion 1903(a)(1) of the Social Security Act.’’. 
(c) CONFORMING AMENDMENTS.—Section 1927 of 
the Social Security Act (42 U.S.C. 1396r–8) is amended— 
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(1) in subsection (a)(5)(A), by striking ‘‘covered 
outpatient drugs’’ and inserting ‘‘covered drugs (as 
defined in section 340B(b)(2) of the Public Health 
Service Act)’’; 
(2) in subsection (a)(5), by striking subpara-
graph (D) and inserting the following: 
‘‘(D) STATE RESPONSIBILITY FOR CALCU-
LATING HOSPITAL CREDITS.—The State shall 
calculate the credits owed by the hospital under 
paragraph (1) of section 340B(c) of the Public 
Health Service Act and provide the hospital 
with both the amounts and an explanation of 
how it calculated the credits. In performing the 
calculations specified in paragraphs (2)(A)(ii) 
and (2)(B)(ii) of such section, the State shall 
use the average manufacturer price applicable 
to the calendar quarter in which the drug was 
purchased by the hospital.’’; and 
(3) in subsection (k)(1)— 
(A) in subparagraph (A), by striking ‘‘sub-
paragraph (B)’’ and inserting ‘‘subparagraphs 
(B) and (D)’’; and 
(B) by adding at the end the following: 
‘‘(D) 
CALCULATION
FOR
COVERED 
DRUGS.—With respect to a covered drug (as de-
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fined in section 340B(b)(2) of the Public 
Health Service Act), the average manufacturer 
price shall be determined in accordance with 
subparagraph (A) except that, in the event a 
covered drug is not distributed to the retail 
pharmacy class of trade, it shall mean the aver-
age price paid to the manufacturer for the drug 
in the United States by wholesalers for drugs 
distributed to the acute care class of trade, 
after deducting customary prompt pay dis-
counts.’’. 
SEC. 2503. EFFECTIVE DATE. 
(a) IN GENERAL.—The amendments made by this 
subtitle shall take effect on July 1, 2010, and shall apply 
to drugs dispensed on or after such date. 
(b) EFFECTIVENESS.—The amendments made by 
this subtitle shall be effective, and shall be taken into ac-
count in determining whether a manufacturer is deemed 
to meet the requirements of section 340B(a) of the Public 
Health Service Act (42 U.S.C. 256b(a)) and of section 
1927(a)(5) of the Social Security Act (42 U.S.C. 1396r– 
8(a)(5)), notwithstanding any other provision of law. 
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Subtitle B—School-Based Health 
Clinics 
SEC. 2511. SCHOOL-BASED HEALTH CLINICS. 
(a) IN GENERAL.—Part Q of title III (42 U.S.C. 
280h et seq.) is amended by adding at the end the fol-
lowing: 
‘‘SEC. 399Z–1. SCHOOL-BASED HEALTH CLINICS. 
‘‘(a) PROGRAM.—The Secretary shall establish a 
school-based health clinic program consisting of awarding 
grants to eligible entities to support the operation of 
school-based health clinics (referred to in this section as 
‘SBHCs’). 
‘‘(b) ELIGIBILITY.—To be eligible for a grant under 
this section, an entity shall— 
‘‘(1) be an SBHC (as defined in subsection 
(l)(4)); and 
‘‘(2) submit an application at such time, in 
such manner, and containing such information as 
the Secretary may require, including at a min-
imum— 
‘‘(A) evidence that the applicant meets all 
criteria necessary to be designated as an 
SBHC; 
‘‘(B) evidence of local need for the services 
to be provided by the SBHC; 
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‘‘(C) an assurance that— 
‘‘(i) SBHC services will be provided in 
accordance with Federal, State, and local 
laws governing— 
‘‘(I) obtaining parental or guard-
ian consent; and 
‘‘(II) patient privacy and student 
records, including section 264 of the 
Health Insurance Portability and Ac-
countability Act of 1996 and section 
444 of the General Education Provi-
sions Act; 
‘‘(ii) the SBHC has established and 
maintains collaborative relationships with 
other 
health 
care 
providers 
in 
the 
catchment area of the SBHC; 
‘‘(iii) the SBHC will provide on-site 
access during the academic day when 
school is in session and has an established 
network of support and access to services 
with backup health providers when the 
school or SBHC is closed; 
‘‘(iv) the SBHC will be integrated into 
the school environment and will coordinate 
health services with appropriate school per-
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sonnel and other community providers co- 
located at the school; and 
‘‘(v) the SBHC sponsoring facility as-
sumes all responsibility for the SBHC ad-
ministration, operations, and oversight; 
and 
‘‘(D) such other information as the Sec-
retary may require. 
‘‘(c) USE OF FUNDS.—Funds awarded under a grant 
under this section may be used for— 
‘‘(1) providing training related to the provision 
of comprehensive primary health services and addi-
tional health services; 
‘‘(2) the management and operation of SBHC 
programs; and 
‘‘(3) the payment of salaries for health profes-
sionals and other appropriate SBHC personnel. 
‘‘(d) CONSIDERATION OF NEED.—In determining the 
amount of a grant under this section, the Secretary shall 
take into consideration— 
‘‘(1) the financial need of the SBHC; 
‘‘(2) State, local, or other sources of funding 
provided to the SBHC; and 
‘‘(3) other factors as determined appropriate by 
the Secretary. 
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‘‘(e) PREFERENCES.—In awarding grants under this 
section, the Secretary shall give preference to SBHCs that 
have a demonstrated record of service to the following: 
‘‘(1) A high percentage of medically under-
served children and adolescents. 
‘‘(2) Communities or populations in which chil-
dren and adolescents have difficulty accessing health 
and mental health services. 
‘‘(3) Communities with high percentages of chil-
dren and adolescents who are uninsured, under-
insured, or eligible for medical assistance under Fed-
eral or State health benefits programs (including ti-
tles XIX and XXI of the Social Security Act). 
‘‘(f) MATCHING REQUIREMENT.—The Secretary may 
award a grant to an SBHC only if the SBHC agrees to 
provide, from non-Federal sources, an amount equal to 20 
percent of the amount of the grant (which may be pro-
vided in cash or in kind) to carry out the activities sup-
ported by the grant. 
‘‘(g) SUPPLEMENT, NOT SUPPLANT.—The Secretary 
may award a grant to an SBHC under this section only 
if the SBHC demonstrates to the satisfaction of the Sec-
retary that funds received through the grant will be ex-
pended only to supplement, and not supplant, non-Federal 
and Federal funds otherwise available to the SBHC for 
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operation of the SBHC (including each activity described 
in paragraph (1) or (2) of subsection (c)). 
‘‘(h) PAYOR OF LAST RESORT.—The Secretary may 
award a grant to an SBHC under this section only if the 
SBHC demonstrates to the satisfaction of the Secretary 
that funds received through the grant will not be expended 
for any activity to the extent that payment has been made, 
or can reasonably be expected to be made— 
‘‘(1) under any insurance policy; 
‘‘(2) under any Federal or State health benefits 
program (including titles XIX and XXI of the Social 
Security Act); or 
‘‘(3) by an entity which provides health services 
on a prepaid basis. 
‘‘(i) REGULATIONS REGARDING REIMBURSEMENT 
FOR HEALTH SERVICES.—The Secretary shall issue regu-
lations regarding the reimbursement for health services 
provided by SBHCs to individuals eligible to receive such 
services through the program under this section, including 
reimbursement under any insurance policy or any Federal 
or State health benefits program (including titles XIX and 
XXI of the Social Security Act). 
‘‘(j) TECHNICAL ASSISTANCE.—The Secretary shall 
provide (either directly or by grant or contract) technical 
and other assistance to SBHCs to assist such SBHCs to 
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meet the requirements of this section. Such assistance 
may include fiscal and program management assistance, 
training in fiscal and program management, operational 
and administrative support, and the provision of informa-
tion to the SBHCs of the variety of resources available 
under this title and how those resources can be best used 
to meet the health needs of the communities served by 
the SBHCs. 
‘‘(k) EVALUATION; REPORT.—The Secretary shall— 
‘‘(1) develop and implement a plan for evalu-
ating SBHCs and monitoring quality performances 
under the awards made under this section; and 
‘‘(2) submit to the Congress on an annual basis 
a report on the program under this section. 
‘‘(l) DEFINITIONS.—In this section: 
‘‘(1) COMPREHENSIVE PRIMARY HEALTH SERV-
ICES.—The term ‘comprehensive primary health 
services’ means the core services offered by SBHCs, 
which shall include the following: 
‘‘(A) PHYSICAL.—Comprehensive health 
assessments, diagnosis, and treatment of minor, 
acute, and chronic medical conditions and refer-
rals to, and follow-up for, specialty care. 
‘‘(B) MENTAL
HEALTH.—Mental health 
assessments, crisis intervention, counseling, 
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treatment, and referral to a continuum of serv-
ices including emergency psychiatric care, com-
munity support programs, inpatient care, and 
outpatient programs. 
‘‘(C) 
OPTIONAL
SERVICES.—Additional 
services, which may include oral health, social, 
and age-appropriate health education services, 
including nutritional counseling. 
‘‘(2) MEDICALLY
UNDERSERVED
CHILDREN 
AND
ADOLESCENTS.—The term ‘medically under-
served children and adolescents’ means a population 
of children and adolescents who are residents of an 
area designated by the Secretary as an area with a 
shortage of personal health services and health in-
frastructure for such children and adolescents. 
‘‘(3) SCHOOL-BASED
HEALTH
CLINIC.—The 
term ‘school-based health clinic’ means a health clin-
ic that— 
‘‘(A) is located in, or is adjacent to, a 
school facility of a local educational agency; 
‘‘(B) is organized through school, commu-
nity, and health provider relationships; 
‘‘(C) is administered by a sponsoring facil-
ity; and 
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‘‘(D) provides, at a minimum, comprehen-
sive primary health services during school hours 
to children and adolescents by health profes-
sionals in accordance with State and local laws 
and regulations, established standards, and 
community practice. 
‘‘(4) SPONSORING FACILITY.—The term ‘spon-
soring facility’ is— 
‘‘(A) a hospital; 
‘‘(B) a public health department; 
‘‘(C) a community health center; 
‘‘(D) a nonprofit health care agency; 
‘‘(E) a local educational agency; or 
‘‘(F) a program administered by the In-
dian Health Service or the Bureau of Indian 
Affairs or operated by an Indian tribe or a trib-
al organization under the Indian Self-Deter-
mination and Education Assistance Act, a Na-
tive Hawaiian entity, or an urban Indian pro-
gram under title V of the Indian Health Care 
Improvement Act. 
‘‘(m) AUTHORIZATION
OF APPROPRIATIONS.—For 
purposes of carrying out this section, there are authorized 
to be appropriated $50,000,000 for fiscal year 2010 and 
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such sums as may be necessary for each of the fiscal years 
2011 through 2014.’’. 
(b) EFFECTIVE DATE.—The Secretary of Health and 
Human Services shall begin awarding grants under section 
399Z–1 of the Public Health Service Act, as added by sub-
section (b), not later than July 1, 2010, without regard 
to whether or not final regulations have been issued under 
section 399Z–1(h) of such Act. 
Subtitle C—National Medical 
Device Registry 
SEC. 2521. NATIONAL MEDICAL DEVICE REGISTRY. 
(a) REGISTRY.— 
(1) IN GENERAL.—Section 519 of the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 360i) is 
amended— 
(A) by redesignating subsection (g) as sub-
section (h); and 
(B) by inserting after subsection (f) the 
following: 
‘‘National Medical Device Registry 
‘‘(g)(1) The Secretary shall establish a national med-
ical device registry (in this subsection referred to as the 
‘registry’) to facilitate analysis of postmarket safety and 
outcomes data on each device that— 
‘‘(A) is or has been used in or on a patient; and 
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‘‘(B) is— 
‘‘(i) a class III device; or 
‘‘(ii) a class II device that is implantable, 
life-supporting, or life-sustaining. 
‘‘(2) In developing the registry, the Secretary shall, 
in consultation with the Commissioner of Food and Drugs, 
the Administrator of the Centers for Medicare & Medicaid 
Services, the head of the Office of the National Coordi-
nator for Health Information Technology, and the Sec-
retary of Veterans Affairs, determine the best methods 
for— 
‘‘(A) including in the registry, in a manner con-
sistent with subsection (f), appropriate information 
to identify each device described in paragraph (1) by 
type, model, and serial number or other unique iden-
tifier; 
‘‘(B) validating methods for analyzing patient 
safety and outcomes data from multiple sources and 
for linking such data with the information included 
in the registry as described in subparagraph (A), in-
cluding, to the extent feasible, use of— 
‘‘(i) data provided to the Secretary under 
other provisions of this chapter; and 
‘‘(ii) information from public and private 
sources identified under paragraph (3); 
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‘‘(C) integrating the activities described in this 
subsection with— 
‘‘(i) activities under paragraph (3) of sec-
tion 505(k) (relating to active postmarket risk 
identification); 
‘‘(ii) activities under paragraph (4) of sec-
tion 505(k) (relating to advanced analysis of 
drug safety data); and 
‘‘(iii) other postmarket device surveillance 
activities of the Secretary authorized by this 
chapter; and 
‘‘(D) providing public access to the data and 
analysis collected or developed through the registry 
in a manner and form that protects patient privacy 
and proprietary information and is comprehensive, 
useful, and not misleading to patients, physicians, 
and scientists. 
‘‘(3)(A) To facilitate analyses of postmarket safety 
and patient outcomes for devices described in paragraph 
(1), the Secretary shall, in collaboration with public, aca-
demic, and private entities, develop methods to— 
‘‘(i) obtain access to disparate sources of 
patient safety and outcomes data, including— 
‘‘(I) Federal health-related electronic 
data (such as data from the Medicare pro-
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gram under title XVIII of the Social Secu-
rity Act or from the health systems of the 
Department of Veterans Affairs); 
‘‘(II) private sector health-related 
electronic data (such as pharmaceutical 
purchase data and health insurance claims 
data); and 
‘‘(III) other data as the Secretary 
deems necessary to permit postmarket as-
sessment of device safety and effectiveness; 
and 
‘‘(ii) link data obtained under clause (i) 
with information in the registry. 
‘‘(B) In this paragraph, the term ‘data’ refers to in-
formation respecting a device described in paragraph (1), 
including claims data, patient survey data, standardized 
analytic files that allow for the pooling and analysis of 
data from disparate data environments, electronic health 
records, and any other data deemed appropriate by the 
Secretary. 
‘‘(4) Not later than 36 months after the date of the 
enactment of this subsection, the Secretary shall promul-
gate regulations for establishment and operation of the 
registry under paragraph (1). Such regulations— 
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‘‘(A)(i) in the case of devices that are described 
in paragraph (1) and sold on or after the date of the 
enactment of this subsection, shall require manufac-
turers of such devices to submit information to the 
registry, including, for each such device, the type, 
model, and serial number or, if required under sub-
section (f), other unique device identifier; and 
‘‘(ii) in the case of devices that are described in 
paragraph (1) and sold before such date, may re-
quire manufacturers of such devices to submit such 
information to the registry, if deemed necessary by 
the Secretary to protect the public health; 
‘‘(B) shall establish procedures— 
‘‘(i) to permit linkage of information sub-
mitted pursuant to subparagraph (A) with pa-
tient safety and outcomes data obtained under 
paragraph (3); and 
‘‘(ii) to permit analyses of linked data; 
‘‘(C) may require device manufacturers to sub-
mit such other information as is necessary to facili-
tate postmarket assessments of device safety and ef-
fectiveness and notification of device risks; 
‘‘(D) shall establish requirements for regular 
and timely reports to the Secretary, which shall be 
included in the registry, concerning adverse event 
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trends, adverse event patterns, incidence and preva-
lence of adverse events, and other information the 
Secretary determines appropriate, which may include 
data on comparative safety and outcomes trends; 
and 
‘‘(E) shall establish procedures to permit public 
access to the information in the registry in a manner 
and form that protects patient privacy and propri-
etary information and is comprehensive, useful, and 
not misleading to patients, physicians, and sci-
entists. 
‘‘(5) To carry out this subsection, there are author-
ized to be appropriated such sums as may be necessary 
for fiscal years 2010 and 2011.’’. 
(2) 
EFFECTIVE
DATE.—The 
Secretary 
of 
Health and Human Services shall establish and 
begin implementation of the registry under section 
519(g) of the Federal Food, Drug, and Cosmetic 
Act, as added by paragraph (1), by not later than 
the date that is 36 months after the date of the en-
actment of this Act, without regard to whether or 
not final regulations to establish and operate the 
registry have been promulgated by such date. 
(3) 
CONFORMING
AMENDMENT.—Section 
303(f)(1)(B)(ii) of the Federal Food, Drug, and 
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Cosmetic Act (21 U.S.C. 333(f)(1)(B)(ii)) is amend-
ed by striking ‘‘519(g)’’ and inserting ‘‘519(h)’’. 
(b) ELECTRONIC EXCHANGE AND USE IN CERTIFIED 
ELECTRONIC HEALTH RECORDS
OF UNIQUE DEVICE 
IDENTIFIERS.— 
(1) 
RECOMMENDATIONS.—The 
HIT 
Policy 
Committee established under section 3002 of the 
Public Health Service Act (42 U.S.C. 300jj–12) 
shall recommend to the head of the Office of the Na-
tional Coordinator for Health Information Tech-
nology standards, implementation specifications, and 
certification criteria for the electronic exchange and 
use in certified electronic health records of a unique 
device identifier for each device described in section 
519(g)(1) of the Federal Food, Drug, and Cosmetic 
Act, as added by subsection (a). 
(2) STANDARDS, IMPLEMENTATION
CRITERIA, 
AND
CERTIFICATION
CRITERIA.—The Secretary of 
the Health Human Services, acting through the 
head of the Office of the National Coordinator for 
Health Information Technology, shall adopt stand-
ards, implementation specifications, and certification 
criteria for the electronic exchange and use in cer-
tified electronic health records of a unique device 
identifier for each device described in paragraph (1), 
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if such an identifier is required by section 519(f) of 
the Federal Food, Drug, and Cosmetic Act (21 
U.S.C. 360i(f)) for the device. 
Subtitle D—Grants for Comprehen-
sive Programs to Provide Edu-
cation to Nurses and Create a 
Pipeline to Nursing 
SEC. 2531. ESTABLISHMENT OF GRANT PROGRAM. 
(a) PURPOSES.—It is the purpose of this section to 
authorize grants to— 
(1) address the projected shortage of nurses by 
funding comprehensive programs to create a career 
ladder to nursing (including Certified Nurse Assist-
ants, Licensed Practical Nurses, Licensed Vocational 
Nurses, and Registered Nurses) for incumbent ancil-
lary health care workers; 
(2) increase the capacity for educating nurses 
by increasing both nurse faculty and clinical oppor-
tunities through collaborative programs between 
staff nurse organizations, health care providers, and 
accredited schools of nursing; and 
(3) provide training programs through edu-
cation and training organizations jointly adminis-
tered by health care providers and health care labor 
organizations or other organizations representing 
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staff nurses and frontline health care workers, work-
ing in collaboration with accredited schools of nurs-
ing and academic institutions. 
(b) GRANTS.—Not later than 6 months after the date 
of the enactment of this Act, the Secretary of Labor (re-
ferred to in this section as the ‘‘Secretary’’) shall establish 
a partnership grant program to award grants to eligible 
entities to carry out comprehensive programs to provide 
education to nurses and create a pipeline to nursing for 
incumbent ancillary health care workers who wish to ad-
vance their careers, and to otherwise carry out the pur-
poses of this section. 
(c) ELIGIBILITY.—To be eligible for a grant under 
this section, an entity shall be— 
(1) a health care entity that is jointly adminis-
tered by a health care employer and a labor union 
representing the health care employees of the em-
ployer and that carries out activities using labor 
management training funds as provided for under 
section 302(c)(6) of the Labor Management Rela-
tions Act, 1947 (29 U.S.C. 186(c)(6)); 
(2) an entity that operates a training program 
that is jointly administered by— 
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(A) one or more health care providers or 
facilities, or a trade association of health care 
providers; and 
(B) one or more organizations which rep-
resent the interests of direct care health care 
workers or staff nurses and in which the direct 
care health care workers or staff nurses have 
direct input as to the leadership of the organi-
zation; 
(3) a State training partnership program that 
consists of nonprofit organizations that include equal 
participation from industry, including public or pri-
vate employers, and labor organizations including 
joint labor-management training programs, and 
which may include representatives from local govern-
ments, worker investment agency one-stop career 
centers, community-based organizations, community 
colleges, and accredited schools of nursing; or 
(4) a school of nursing (as defined in section 
801 of the Public Health Service Act (42 U.S.C. 
296)). 
(d) ADDITIONAL REQUIREMENTS FOR HEALTH CARE 
EMPLOYER DESCRIBED IN SUBSECTION (c).—To be eligi-
ble for a grant under this section, a health care employer 
described in subsection (c) shall demonstrate that it— 
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(1) has an established program within their fa-
cility to encourage the retention of existing nurses; 
(2) provides wages and benefits to its nurses 
that are competitive for its market or that have been 
collectively bargained with a labor organization; and 
(3) supports programs funded under this sec-
tion through 1 or more of the following: 
(A) The provision of paid leave time and 
continued health coverage to incumbent health 
care workers to allow their participation in 
nursing career ladder programs, including cer-
tified nurse assistants, licensed practical nurses, 
licensed 
vocational 
nurses, 
and 
registered 
nurses. 
(B) Contributions to a joint labor-manage-
ment training fund which administers the pro-
gram involved. 
(C) The provision of paid release time, in-
centive compensation, or continued health cov-
erage to staff nurses who desire to work full- or 
part-time in a faculty position. 
(D) The provision of paid release time for 
staff nurses to enable them to obtain a bachelor 
of science in nursing degree, other advanced 
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nursing degrees, specialty training, or certifi-
cation program. 
(E) The payment of tuition assistance 
which is managed by a joint labor-management 
training fund or other jointly administered pro-
gram. 
(e) OTHER REQUIREMENTS.— 
(1) MATCHING REQUIREMENT.— 
(A) IN GENERAL.—The Secretary may not 
make a grant under this section unless the ap-
plicant involved agrees, with respect to the costs 
to be incurred by the applicant in carrying out 
the program under the grant, to make available 
non-Federal contributions (in cash or in kind 
under subparagraph (B)) toward such costs in 
an amount equal to not less than $1 for each 
$1 of Federal funds provided in the grant. Such 
contributions may be made directly or through 
donations from public or private entities, or 
may be provided through the cash equivalent of 
paid release time provided to incumbent worker 
students. 
(B) DETERMINATION OF AMOUNT OF NON- 
FEDERAL
CONTRIBUTION.—Non-Federal con-
tributions required in subparagraph (A) may be 
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in cash or in kind (including paid release time), 
fairly evaluated, including equipment or services 
(and excluding indirect or overhead costs). 
Amounts provided by the Federal Government, 
or services assisted or subsidized to any signifi-
cant extent by the Federal Government, may 
not be included in determining the amount of 
such non-Federal contributions. 
(2) REQUIRED COLLABORATION.—Entities car-
rying out or overseeing programs carried out with 
assistance provided under this section shall dem-
onstrate collaboration with accredited schools of 
nursing which may include community colleges and 
other academic institutions providing associate, 
bachelor’s, or advanced nursing degree programs or 
specialty training or certification programs. 
(f) USE OF FUNDS.—Amounts awarded to an entity 
under a grant under this section shall be used for the fol-
lowing: 
(1) To carry out programs that provide edu-
cation and training to establish nursing career lad-
ders to educate incumbent health care workers to be-
come nurses (including certified nurse assistants, li-
censed practical nurses, licensed vocational nurses, 
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and registered nurses). Such programs shall include 
one or more of the following: 
(A) Preparing incumbent workers to return 
to the classroom through English -as-a-second 
language education, GED education, pre-college 
counseling, college preparation classes, and sup-
port with entry level college classes that are a 
prerequisite to nursing. 
(B) Providing tuition assistance with pref-
erence for dedicated cohort classes in commu-
nity colleges, universities, accredited schools of 
nursing with supportive services including tu-
toring and counseling. 
(C) Providing assistance in preparing for 
and meeting all nursing licensure tests and re-
quirements. 
(D) 
Carrying 
out 
orientation 
and 
mentorship programs that assist newly grad-
uated nurses in adjusting to working at the 
bedside 
to 
ensure 
their 
retention 
postgraduation, and ongoing programs to sup-
port nurse retention. 
(E) Providing stipends for release time and 
continued health care coverage to enable incum-
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bent health care workers to participate in these 
programs. 
(2) To carry out programs that assist nurses in 
obtaining advanced degrees and completing specialty 
training or certification programs and to establish 
incentives for nurses to assume nurse faculty posi-
tions on a part-time or full-time basis. Such pro-
grams shall include one or more of the following: 
(A) Increasing the pool of nurses with ad-
vanced degrees who are interested in teaching 
by funding programs that enable incumbent 
nurses to return to school. 
(B) Establishing incentives for advanced 
degree bedside nurses who wish to teach in 
nursing programs so they can obtain a leave 
from their bedside position to assume a full- or 
part-time position as adjunct or full-time fac-
ulty without the loss of salary or benefits. 
(C) Collaboration with accredited schools 
of nursing which may include community col-
leges and other academic institutions providing 
associate, bachelor’s, or advanced nursing de-
gree programs, or specialty training or certifi-
cation programs, for nurses to carry out innova-
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tive nursing programs which meet the needs of 
bedside nursing and health care providers. 
(g) PREFERENCE.—In awarding grants under this 
section the Secretary shall give preference to programs 
that— 
(1) provide for improving nurse retention; 
(2) provide for improving the diversity of the 
new nurse graduates to reflect changes in the demo-
graphics of the patient population; 
(3) provide for improving the quality of nursing 
education to improve patient care and safety; 
(4) have demonstrated success in upgrading in-
cumbent health care workers to become nurses or 
which have established effective programs or pilots 
to increase nurse faculty; or 
(5) are modeled after or affiliated with such 
programs described in paragraph (4). 
(h) EVALUATION.— 
(1) PROGRAM
EVALUATIONS.—An entity that 
receives a grant under this section shall annually 
evaluate, and submit to the Secretary a report on, 
the activities carried out under the grant and the 
outcomes of such activities. Such outcomes may in-
clude— 
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(A) an increased number of incumbent 
workers entering an accredited school of nurs-
ing and in the pipeline for nursing programs; 
(B) an increasing number of graduating 
nurses and improved nurse graduation and li-
censure rates; 
(C) improved nurse retention; 
(D) an increase in the number of staff 
nurses at the health care facility involved; 
(E) an increase in the number of nurses 
with advanced degrees in nursing; 
(F) an increase in the number of nurse 
faculty; 
(G) improved measures of patient quality 
(which may include staffing ratios of nurses, 
patient satisfaction rates, patient safety meas-
ures); and 
(H) an increase in the diversity of new 
nurse graduates relative to the patient popu-
lation. 
(2) GENERAL REPORT.—Not later than 2 years 
after the date of the enactment of this Act, and an-
nually thereafter, the Secretary of Labor shall, using 
data and information from the reports received 
under paragraph (1), submit to the Congress a re-
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port concerning the overall effectiveness of the grant 
program carried out under this section. 
(i) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary. 
Subtitle E—States Failing To Ad-
here to Certain Employment Ob-
ligations 
SEC. 2541. LIMITATION ON FEDERAL FUNDS. 
A State is eligible for Federal funds under the provi-
sions of the Public Health Service Act (42 U.S.C. 201 et 
seq.) only if the State— 
(1) agrees to be subject in its capacity as an 
employer to each obligation under subdivision A of 
this division and the amendments made by such sub-
division applicable to persons in their capacity as an 
employer; and 
(2) assures that all political subdivisions in the 
State will do the same. 
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Subtitle F—Standards for Accessi-
bility to Medical Equipment for 
Individuals With Disabilities. 
SEC. 2541. ACCESS FOR INDIVIDUALS WITH DISABILITIES. 
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. STANDARDS FOR ACCESSIBILITY OF MEDICAL 
DIAGNOSTIC EQUIPMENT. 
‘‘(a) STANDARDS.—Not later than 9 months after the 
date of enactment of the America’s Affordable Health 
Choices Act of 2009, the Architectural and Transportation 
Barriers Compliance Board shall issue guidelines setting 
forth the minimum technical criteria for medical diag-
nostic equipment used in (or in conjunction with) physi-
cian’s offices, clinics, emergency rooms, hospitals, and 
other medical settings. The guidelines shall ensure that 
such equipment is accessible to, and usable by, individuals 
with disabilities, including provisions to ensure inde-
pendent entry to, use of, and exit from the equipment by 
such individuals to the maximum extent possible. 
‘‘(b) 
MEDICAL
DIAGNOSTIC
EQUIPMENT
COV-
ERED.—The guidelines issued under subsection (a) for 
medical diagnostic equipment shall apply to equipment 
that includes examination tables, examination chairs (in-
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cluding chairs used for eye examinations or procedures, 
and dental examinations or procedures), weight scales, 
mammography equipment, x-ray machines, and other 
equipment commonly used for diagnostic or examination 
purposes by health professionals. 
‘‘(c) INTERIM STANDARDS.—Until the date on which 
final regulations are issued under subsection (d), pur-
chases of examination tables, weight scales, and mammog-
raphy equipment and used in (or in conjunction with) 
medical settings described in subsection (a), shall adhere 
to the following interim accessibility requirements: 
‘‘(1) Examination tables shall be height-adjust-
able between a range of at least 18 inches to 37 
inches. 
‘‘(2) Weight scales shall be capable of weighing 
individuals who remain seated in a wheelchair or 
other personal mobility aid. 
‘‘(3) Mammography machines and equipment 
shall be capable of being used by individuals in a 
standing, seated, or recumbent position, including 
individuals who remain seated in a wheelchair or 
other personal mobility aid. 
‘‘(d) REGULATIONS.—Not later than 6 months after 
the date of the issuance of the guidelines under subsection 
(a), each appropriate Federal agency authorized to pro-
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mulgate regulations under this Act or under the Ameri-
cans with Disabilities Act shall— 
‘‘(1) prescribe regulations in an accessible for-
mat as necessary to carry out the provisions of such 
Act and section 504 of this Act that include accessi-
bility standards that are consistent with the guide-
lines issued under subsection (a); and 
‘‘(2) ensure that health care providers and 
health care plans covered by the America’s Afford-
able Health Choices Act of 2009 meet the require-
ments of the Americans with Disabilities Act and 
section 504, including provisions ensuring that indi-
viduals with disabilities receive equal access to all 
aspects of the health care delivery system. 
‘‘(e) REVIEW AND AMEND.—The Architectural and 
Transportation Barriers Compliance Board shall periodi-
cally review and, as appropriate, amend the guidelines as 
prescribed under subsection (a). Not later than 6 months 
after the date of the issuance of such revised guidelines, 
revised regulations consistent with such guidelines shall be 
promulgated in an accessible format by the appropriate 
Federal agencies described in subsection (d).’’. 
Subtitle G—Other Grant Programs 
SEC. 2551. REDUCING STUDENT-TO-SCHOOL NURSE RATIOS. 
(a) DEMONSTRATION GRANTS.— 
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(1) IN GENERAL.—The Secretary of Education, 
in consultation with the Secretary of Health and 
Human Services and the Director of the Centers for 
Disease Control and Prevention, may make dem-
onstration grants to eligible local education agencies 
for the purpose of reducing the student-to-school 
nurse ratio in public elementary and secondary 
schools. 
(2) SPECIAL
CONSIDERATION.—In awarding 
grants under this section, the Secretary of Edu-
cation shall give special consideration to applications 
submitted by high-need local educational agencies 
that demonstrate the greatest need for new or addi-
tional nursing services among children in the public 
elementary and secondary schools served by the 
agency, in part by providing information on current 
ratios of students to school nurses. 
(3) MATCHING FUNDS.—The Secretary of Edu-
cation may require recipients of grants under this 
subsection to provide matching funds from non-Fed-
eral sources, and shall permit the recipients to 
match funds in whole or in part with in-kind con-
tributions. 
(b) REPORT.—Not later than 24 months after the 
date on which assistance is first made available to local 
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educational agencies under this section, the Secretary of 
Education shall submit to the Congress a report on the 
results of the demonstration grant program carried out 
under this section, including an evaluation of the effective-
ness of the program in improving the student-to-school 
nurse ratios described in subsection (a) and an evaluation 
of the impact of any resulting enhanced health of students 
on learning. 
(c) DEFINITIONS.—For purposes of this section: 
(1) The terms ‘‘elementary school’’, ‘‘local edu-
cational agency’’, and ‘‘secondary school’’ have the 
meanings given to those terms in section 9101 of the 
Elementary and Secondary Education Act of 1965 
(20 U.S.C. 7801). 
(2) The term ‘‘eligible local educational agency’’ 
means a local educational agency in which the stu-
dent-to-school nurse ratio in the public elementary 
and secondary schools served by the agency is 750 
or more students to every school nurse. 
(3) The term ‘‘high-need local educational agen-
cy’’ means a local educational agency— 
(A) that serves not fewer than 10,000 chil-
dren from families with incomes below the pov-
erty line; or 
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(B) for which not less than 20 percent of 
the children served by the agency are from fam-
ilies with incomes below the poverty line. 
(4) The term ‘‘nurse’’ means a licensed nurse, 
as defined under State law. 
(d) AUTHORIZATION OF APPROPRIATIONS.—To carry 
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. 2552. WELLNESS PROGRAM GRANTS. 
(a) ALLOWANCE OF GRANT.— 
(1) IN GENERAL.—For purposes of this section, 
the Secretary of Labor shall award wellness grants 
as determined under this section. Wellness program 
grants shall be awarded to qualified employers for 
any plan year in an amount equal to 50 percent of 
the costs paid or incurred by the employer in con-
nection with a qualified wellness program during the 
plan year. For purposes of the preceding sentence, 
in the case of any qualified wellness program offered 
as part of an employment-based health plan, only 
costs attributable to the qualified wellness program 
and not to the health plan, or health insurance cov-
erage offered in connection with such a plan, may be 
taken into account. 
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(2) LIMITATION.—The amount of the grant al-
lowed under paragraph (1) for any plan year shall 
not exceed the sum of— 
(A) the product of $200 and the number 
of employees of the employer not in excess of 
200 employees; plus 
(B) the product of $100 and the number 
of employees of the employer in excess of 200 
employees. 
The wellness grants awarded to an employer under 
this section shall be for up to 3 years and shall not 
exceed $50,000. 
(b) QUALIFIED WELLNESS PROGRAM.—For purposes 
of this section: 
(1) QUALIFIED
WELLNESS
PROGRAM.—The 
term ‘‘qualified wellness program’’ means a program 
that — 
(A) includes any 3 wellness components de-
scribed in subsection (c); and 
(B) is be certified by the Secretary of 
Labor, in coordination with the Health Choices 
Commissioner and the Director of the Center 
for Disease Control and Prevention, as a quali-
fied wellness program under this section. 
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(2) PROGRAMS MUST BE CONSISTENT WITH RE-
SEARCH AND BEST PRACTICES.— 
(A) IN GENERAL.—The Secretary of Labor 
shall not certify a program as a qualified 
wellness program unless the program— 
(i) is newly established or in existence 
on the date of enactment of this Act but 
not yet meeting the requirements of this 
section; 
(ii) is consistent with evidenced-based 
researched and best practices, as identified 
by persons with expertise in employer 
health promotion and wellness programs; 
(iii) includes multiple, evidenced-based 
strategies which are based on the existing 
and emerging research and careful sci-
entific reviews, including the Guide to 
Community 
Preventative 
Services, 
the 
Guide to Clinical Preventative Services, 
and the National Registry for Effective 
Programs, and 
(iv) includes strategies which focus on 
prevention and support for employee popu-
lations at risk of poor health outcomes. 
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(B) PERIODIC UPDATING AND REVIEW.— 
The Secretary of Labor, in consultation with 
other appropriate agencies shall establish proce-
dures for periodic review, evaluation, and up-
date of the programs under this subsection. 
(3) HEALTH
LITERACY/ACCESSIBILITY.—The 
Secretary of Labor shall, as part of the certification 
process:— 
(A) ensure that employers make the pro-
grams culturally competent. physically and pro-
grammatically accessible (including for individ-
uals with disabilities), and appropriate to the 
health literacy needs of the employees covered 
by the programs; 
(B) require a health literacy component to 
provide special assistance and materials to em-
ployees with low literacy skills, limited English 
and from under-served populations; and 
(C) require the Secretary of Labor, in con-
sultation with Secretary of Health and Human 
Services, to compile and disseminate to em-
ployer health plans info on model health literacy 
curricula, instructional programs, and effective 
intervention strategies. 
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(c) WELLNESS PROGRAM COMPONENTS.—For pur-
poses of this section, the wellness program components de-
scribed in this subsection are the following: 
(1) 
HEALTH
AWARENESS
COMPONENT.—A 
health awareness component which provides for the 
following: 
(A) HEALTH EDUCATION.—The dissemina-
tion of health information which addresses the 
specific needs and health risks of employees. 
(B) HEALTH
SCREENINGS.—The oppor-
tunity for periodic screenings for health prob-
lems and referrals for appropriate follow up 
measures. 
(2) EMPLOYEE
ENGAGEMENT
COMPONENT.— 
An employee engagement component which provides 
for the active engagement of employees in worksite 
wellness programs through worksite assessments and 
program planning, onsite delivery, evaluation, and 
improvement efforts. 
(3) BEHAVIORAL CHANGE COMPONENT.—A be-
havioral change component which provides for alter-
ing employee lifestyles to encourage healthy living 
through counseling, seminars, on-line programs, or 
self-help materials which provide technical assistance 
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and problem solving skills. such component may in-
clude programs relating to— 
(A) tobacco use; 
(B) obesity; 
(C) stress management; 
(D) physical fitness; 
(E) nutrition; 
(F) substance abuse; 
(G) depression; and 
(H) mental health promotion (including 
anxiety). 
(4) SUPPORTIVE ENVIRONMENT COMPONENT.— 
A supportive environment component which includes 
the following: 
(A) ON-SITE POLICIES.—Policies and serv-
ices at the worksite which promote a healthy 
lifestyle, including policies relating to— 
(i) tobacco use at the worksite; 
(ii) the nutrition of food available at 
the worksite through cafeterias and vend-
ing options; 
(iii) minimizing stress and promoting 
positive mental health in the workplace; 
and 
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(iv) the encouragement of physical ac-
tivity before, during, and after work hours. 
(d) PARTICIPATION REQUIREMENT.—No grant shall 
be allowed under subsection (a) unless the Secretary of 
Labor in consultation with other appropriate agencies, cer-
tifies, as a part of any certification described in subsection 
(b), that each wellness program component of the qualified 
wellness program— 
(1) shall be available to all employees of the 
employer; 
(2) shall not mandate participation by employ-
ees; and 
(3) shall not require participation by individual 
employees as a condition to obtain a premium dis-
count, rebate, deductible reduction, or other finan-
cial reward. 
(e) PRIVACY PROTECTIONS.—Any employee health 
information collected through participation in an employer 
wellness program shall be confidential and available only 
to appropriately trained health professions as defined by 
the Secretary of Labor. Employers or employees of the 
employer sponsoring a wellness program shall have no ac-
cess to employee health data. All entities offering em-
ployer-sponsored wellness programs shall be considered 
‘‘business associates’’ pursuant to the American Reinvest-
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ment and Recovery Act and must comply with privacy pro-
tections restricting the release of personal medical infor-
mation. 
(f) DEFINITIONS AND SPECIAL RULES.—For pur-
poses of this section: 
(1) QUALIFIED EMPLOYER.—The term ‘‘quali-
fied employer’’ means an employer that offers a 
qualified health benefits plan to every employee (in-
cluding each employee required to be offered cov-
erage under a qualified health benefits plan under 
subtitle B of title III of subdivision A), and meets 
the health coverage participation requirements as de-
fined in section 312. 
(2) CERTAIN
COSTS
NOT
INCLUDED.—Costs 
paid or incurred by an employer for food or health 
insurance shall not be taken into account under sub-
section (a). 
(g) OUTREACH.— 
(1) IN GENERAL.—The Secretary of the Labor, 
in conjunction with other appropriate agencies and 
members of the business community, shall institute 
an outreach program to inform businesses about the 
availability of the wellness program grant as well as 
to educate businesses on how to develop programs 
according to recognized and promising practices and 
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on how to measure the success of implemented pro-
grams. 
(h) EFFECTIVE DATE.—This section shall take effect 
on January 1, 2013. 
(i) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as are nec-
essary to carry out this section. 
SEC. 2553. HEALTH PROFESSIONS TRAINING FOR DIVER-
SITY PROGRAMS. 
Section 171 of the Workforce Investment Act of 1998 
(29 U.S.C. 2916) is amended by adding at the end the 
following: 
‘‘(f) HEALTH PROFESSIONS TRAINING FOR DIVER-
SITY PROGRAM.— 
‘‘(1) IN GENERAL.—The Secretary shall make 
available 20 grants of no more than $1,000,000 an-
nually to nonprofit organizations for the purposes of 
providing workforce development training program 
for those who are currently employed in the health 
care workforce. 
‘‘(2) ELIGIBILITY.—For the purposes of pro-
viding assistance and services under the program es-
tablished in this subsection, grants are to be award-
ed to Area Health Education Centers or similar non-
profit organizations involved in the development and 
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implementation of health care workforce develop-
ment programs and that— 
‘‘(A) have a formal affiliation with a hos-
pital or community health center, and institu-
tion of higher education as defined by section 
101 of the Higher Education Act of 1965; 
‘‘(B) have a history of providing program 
services to minority populations; and 
‘‘(C) provide workforce development pro-
grams to low-income persons, veterans, or 
urban and rural underserved communities.’’. 
Subtitle H—Long-term Care and 
Family Caregiver Support 
SEC. 2561. LONG-TERM CARE AND FAMILY CAREGIVER SUP-
PORT. 
(a) AMENDMENTS TO THE OLDER AMERICANS ACT 
OF 1965.— 
(1) PROMOTION
OF
DIRECT
CARE
WORK-
FORCE.—Section 202(b)(1) of the Older Americans 
Act of 1965 (42 U.S.C. 3012(b)(1)) is amended by 
inserting before the semicolon the following: ‘‘, and, 
in carrying out the purposes of this paragraph, shall 
make recommendations to other Federal entities re-
garding appropriate and effective means of identi-
fying, promoting, and implementing investments in 
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the direct care workforce necessary to meet the 
growing demand for long-term health services and 
supports and assisting States in developing a com-
prehensive state workforce development plans with 
respect to such workforce including efforts to sys-
tematically assess, track, and report on workforce 
adequacy and capacity’’. 
(2) PERSONAL CARE ATTENDANT WORKFORCE 
ADVISORY
PANEL.—Section 202 of such Act (42 
U.S.C. 3012) is amended by adding at the end the 
following new subsection: 
‘‘(g)(1) The Assistant Secretary shall establish a Per-
sonal Care Attendant Workforce Advisory Panel and pilot 
program to improve working conditions and training for 
long term care workers, including home health aides, cer-
tified nurse aides, and personal care attendants. 
‘‘(2) The Panel shall include representatives from— 
‘‘(A) relevant health care agencies and facilities 
(including personal or home care agencies, home 
health care agencies, nursing homes and residential 
care facilities); 
‘‘(B) the disability community; 
‘‘(C) the nursing community; 
‘‘(D) direct care workers (which may include 
unions and national organizations); 
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‘‘(E) older individuals and family caregivers; 
‘‘(F) State and federal health care entities; and 
‘‘(G) experts in workforce development and 
adult learning. 
‘‘(3) Within one year after the establishment of the 
Panel, the Panel shall submit a report to the Assistant 
Secretary articulating core competencies for eligible per-
sonal or home care aides necessary to successfully provide 
long-term services and supports to eligible consumers, as 
well as recommended training curricula and resources. 
‘‘(4) Within 180 days after receipt by the Assistant 
Secretary of the report under paragraph (3), the Assistant 
Secretary shall establish a 3-year demonstration program 
in 4 states to pilot and evaluate the effectiveness of the 
competencies articulated by the Panel and the training 
curricula and training methods recommended by the 
Panel. 
‘‘(5) Not later than 1 year after the completion of 
the demonstration program under paragraph (4), the As-
sistant Secretary shall submit to each House of the Con-
gress a report containing the results of the evaluations by 
the Assistant Secretary pursuant to paragraph (4), to-
gether with such recommendations for legislation or ad-
ministrative action as the Assistant Secretary determines 
appropriate.’’. 
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(b) AUTHORIZATION
OF ADDITIONAL APPROPRIA-
TIONS FOR THE FAMILY CAREGIVER SUPPORT PROGRAM 
UNDER THE OLDER AMERICANS ACT OF 1965.—Section 
303(e)(2) of the Older Americans Act of 1965 (42 U.S.C. 
3023(e)(2)) is amended by striking ‘‘$173,000,000’’ and 
all that follows through ‘‘2011’’, and inserting ‘‘and 
$250,000,000 for each of the fiscal years 2010, 2011, and 
2012’’. 
(c) AUTHORIZATION
OF ADDITIONAL APPROPRIA-
TIONS FOR THE NATIONAL CLEARINGHOUSE FOR LONG- 
TERM CARE INFORMATION.—There is authorized to be 
appropriated $10,000,000 for each of the fiscal years 
2010, 2011, and 2012 for the operation of the National 
Clearinghouse for Long-Term Care Information estab-
lished by the Secretary of Health and Human Services 
under section 6021(d) of Public Law 109-171. 
Subtitle I—Online Resources 
SEC. 2571. WEB SITE ON HEALTH CARE LABOR MARKET 
AND RELATED EDUCATIONAL AND TRAINING 
OPPORTUNITIES. 
(a) IN GENERAL.—The Secretary of Labor, in con-
sultation with the National Center for Health Workforce 
Analysis, shall establish and maintain a Web site to serve 
as a comprehensive source of information, searchable by 
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workforce region, on the health care labor market and re-
lated educational and training opportunities. 
(b) CONTENTS.—The Web site maintained under this 
section shall include the following: 
(1) Information on the types of jobs that are 
currently or are projected to be in high demand in 
the health care field, including— 
(A) salary information; and 
(B) training requirements, such as require-
ments for educational credentials, licensure, or 
certification. 
(2) Information on training and educational op-
portunities within each region for the type jobs de-
scribed in paragraph (1), including by— 
(A) type of provider or program (such as 
public, private nonprofit, or private for-profit); 
(B) duration; 
(C) cost (such as tuition, fees, books, lab-
oratory expenses, and other mandatory costs); 
(D) performance outcomes (such as grad-
uation rates, job placement, average salary, job 
retention, and wage progression); 
(E) Federal financial aid participation; 
(F) average graduate loan debt; 
(G) student loan default rates; 
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(H) average institutional grant aid pro-
vided; 
(I) Federal and State accreditation infor-
mation; and 
(J) other information determined by the 
Secretary. 
(3) A mechanism for searching and comparing 
training and educational options for specific health 
care occupations to facilitate informed career and 
education choices. 
(4) Financial aid information, including with 
respect to loan forgiveness, loan cancellation, loan 
repayment, stipends, scholarships, and grants or 
other assistance authorized by this division or other 
Federal or State programs. 
(c) PUBLIC ACCESSIBILITY.—The Web site main-
tained under this section shall— 
(1) be publicly accessible; 
(2) be user friendly and convey information in 
a manner that is easily understandable; and 
(3) be in English and the second most prevalent 
language spoken based on the latest Census informa-
tion. 
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SEC. 2572. ONLINE HEALTH WORKFORCE TRAINING PRO-
GRAMS. 
Section 171 of the Workforce Investment Act of 1998 
(29 U.S.C. 2916) (as amended by section 2553) is further 
amended by adding at the end the following: 
‘‘(g) ONLINE HEALTH WORKFORCE TRAINING PRO-
GRAM.— 
‘‘(1) GRANT PROGRAM.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
award National Health Workforce Online 
Training Grants on a competitive basis to eligi-
ble entities to enable such entities to carry out 
training for individuals to attain or advance in 
health care occupations. An entity may leverage 
such grant with other Federal, State, local, and 
private resources, in order to expand the par-
ticipation of businesses, employees, and individ-
uals in such training programs. 
‘‘(B) ELIGIBILITY.—In order to receive a 
grant under the program established under this 
paragraph— 
‘‘(i) an entity shall be an educational 
institution, community-based organization, 
non-profit organization, workforce invest-
ment board, or local or county government; 
and 
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‘‘(ii) an entity shall provide online 
workforce training for individuals seeking 
to attain or advance in health care occupa-
tions, including nursing, nursing assist-
ants, dentistry, pharmacy, health care 
management and administration, public 
health, health information systems anal-
ysis, medical assistants, and other health 
care practitioner and support occupations. 
‘‘(C) PRIORITY.—Priority in awarding 
grants under this paragraph shall be given to 
entities that— 
‘‘(i) have demonstrated experience in 
implementing and operating online worker 
skills training and education programs; 
‘‘(ii) have demonstrated experience co-
ordinating activities, where appropriate, 
with the workforce investment system; and 
‘‘(iii) conduct training for occupations 
with national or local shortages. 
‘‘(D) DATA COLLECTION.—Grantees under 
this paragraph shall collect and report informa-
tion on— 
‘‘(i) the number of participants; 
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‘‘(ii) the services received by the par-
ticipants; 
‘‘(iii) program completion rates; 
‘‘(iv) factors determined as signifi-
cantly interfering with program participa-
tion or completion; 
‘‘(v) the rate of job placement; and 
‘‘(vi) other information as determined 
as needed by the Secretary. 
‘‘(E) OUTREACH.—Grantees under this 
paragraph shall conduct outreach activities to 
disseminate information about their program 
and results to workforce investment boards, 
local governments, educational institutions, and 
other workforce training organizations. 
‘‘(F) PERFORMANCE
LEVELS.—The Sec-
retary shall establish indicators of performance 
that will be used to evaluate the performance of 
grantees under this paragraph in carrying out 
the activities described in this paragraph. The 
Secretary shall negotiate and reach agreement 
with each grantee regarding the levels of per-
formance expected to be achieved by the grant-
ee on the indicators of performance. 
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‘‘(G) 
AUTHORIZATION
OF
APPROPRIA-
TIONS.—There are authorized to be appro-
priated to the Secretary to carry out this sub-
section $50,000,000 for fiscal years 2011 
through 2020. 
‘‘(2) ONLINE HEALTH PROFESSIONS TRAINING 
PROGRAM CLEARINGHOUSE.— 
‘‘(A) DESCRIPTION OF GRANT.—The Sec-
retary shall award one grant to an eligible post-
secondary educational institution to provide the 
services described in this paragraph. 
‘‘(B) ELIGIBILITY.—To be eligible to re-
ceive a grant under this paragraph, a postsec-
ondary educational institution shall— 
‘‘(i) have demonstrated the ability to 
disseminate research on best practices for 
implementing workforce investment pro-
grams; and 
‘‘(ii) be a national leader in producing 
cutting-edge research on technology related 
to workforce investment systems under 
subtitle B. 
‘‘(C) SERVICES.—The postsecondary edu-
cational institution that receives a grant under 
this paragraph shall use such grant— 
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‘‘(i) to provide technical assistance to 
entities that receive grants under para-
graph (1); 
‘‘(ii) to collect and nationally dissemi-
nate the data gathered by entities that re-
ceive grants under paragraph (1); and 
‘‘(iii) to disseminate the best practices 
identified by the National Health Work-
force Online Training Grant Program to 
other workforce training organizations. 
‘‘(D) 
AUTHORIZATION
OF
APPROPRIA-
TIONS.—There are authorized to be appro-
priated to the Secretary to carry out this sub-
section $1,000,000 for fiscal years 2011 
through 2020.’’. 
DIVISION 
III—HOUSE 
COM-
MITTEE ON EDUCATION AND 
LABOR: INVESTING IN EDU-
CATION 
SECTION 1. SHORT TITLE. 
This division may be cited as the ‘‘Student Aid and 
Fiscal Responsibility Act of 2009’’. 
SEC. 2. TABLE OF CONTENTS. 
The table of contents is as follows: 
Sec. 1. Short title. 
Sec. 2. Table of contents. 
Sec. 3. References. 
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TITLE I—INVESTING IN STUDENTS AND FAMILIES 
Subtitle A—Increasing College Access and Completion 
Sec. 101. Federal Pell Grants. 
Sec. 102. College Access and Completion Innovation Fund. 
Sec. 103. Investment in historically Black colleges and universities and other 
minority-serving institutions. 
Sec. 104. Investment in cooperative education. 
Sec. 105. Loan forgiveness for servicemembers activated for duty. 
Sec. 106. Veterans Educational Equity Supplemental Grant Program. 
Subtitle B—Student Financial Aid Form Simplification 
Sec. 121. General effective date. 
Sec. 122. Treatment of assets in need analysis. 
Sec. 123. Changes to total income; aid eligibility. 
TITLE II—STUDENT LOAN REFORM 
Subtitle A—Stafford Loan Reform 
Sec. 201. Federal Family Education Loan appropriations. 
Sec. 202. Scope and duration of Federal loan insurance program. 
Sec. 203. Applicable interest rates. 
Sec. 204. Federal payments to reduce student interest costs. 
Sec. 205. Federal PLUS Loans. 
Sec. 206. Federal Consolidation Loan. 
Sec. 207. Unsubsidized Stafford loans for middle-income borrowers. 
Sec. 208. Loan repayment for civil legal assistance attorneys. 
Sec. 209. Special allowances. 
Sec. 210. Revised special allowance calculation. 
Sec. 211. Origination of Direct Loans at institutions located outside the United 
States. 
Sec. 212. Agreements with institutions. 
Sec. 213. Terms and conditions of loans. 
Sec. 214. Contracts. 
Sec. 215. Interest rates. 
Subtitle B—Perkins Loan Reform 
Sec. 221. Federal Direct Perkins Loans terms and conditions. 
Sec. 222. Authorization of appropriations. 
Sec. 223. Allocation of funds. 
Sec. 224. Federal Direct Perkins Loan allocation. 
Sec. 225. Agreements with institutions of higher education. 
Sec. 226. Student loan information by eligible institutions. 
Sec. 227. Terms of loans. 
Sec. 228. Distribution of assets from student loan funds. 
Sec. 229. Implementation of non-title IV revenue requirement. 
Sec. 230. Administrative expenses. 
TITLE III—MODERNIZATION, RENOVATION, AND REPAIR 
Subtitle A—Elementary and Secondary Education 
Sec. 301. Definitions. 
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CHAPTER 1—GRANTS FOR MODERNIZATION, RENOVATION, OR REPAIR OF 
PUBLIC SCHOOL FACILITIES 
Sec. 311. Purpose. 
Sec. 312. Allocation of funds. 
Sec. 313. Allowable uses of funds. 
Sec. 314. Priority projects. 
CHAPTER 2—SUPPLEMENTAL GRANTS FOR LOUISIANA, MISSISSIPPI, AND 
ALABAMA 
Sec. 321. Purpose. 
Sec. 322. Allocation to local educational agencies. 
Sec. 323. Allowable uses of funds. 
CHAPTER 3—GENERAL PROVISIONS 
Sec. 331. Impermissible uses of funds. 
Sec. 332. Supplement, not supplant. 
Sec. 333. Prohibition regarding State aid. 
Sec. 334. Maintenance of effort. 
Sec. 335. Special rule on contracting. 
Sec. 336. Use of American iron, steel, and manufactured goods. 
Sec. 337. Labor standards. 
Sec. 338. Charter schools. 
Sec. 339. Green schools. 
Sec. 340. Reporting. 
Sec. 341. Special rules. 
Sec. 342. Promotion of employment experiences. 
Sec. 343. Advisory Council on Green, High-Performing Public School Facilities. 
Sec. 344. Education regarding projects. 
Sec. 345. Availability of funds. 
Subtitle B—Higher Education 
Sec. 351. Federal assistance for community college modernization and construc-
tion. 
TITLE IV—EARLY LEARNING CHALLENGE FUND 
Sec. 401. Purpose. 
Sec. 402. Programs authorized. 
Sec. 403. Quality pathways grants. 
Sec. 404. Development grants. 
Sec. 405. Research and evaluation. 
Sec. 406. Reporting requirements. 
Sec. 407. Construction. 
Sec. 408. Definitions. 
Sec. 409. Availability of funds. 
TITLE V—AMERICAN GRADUATION INITIATIVE 
Sec. 501. Authorization and appropriation. 
Sec. 502. Definitions; grant priority. 
Sec. 503. Grants to eligible entities for community college reform. 
Sec. 504. Grants to eligible States for community college programs. 
Sec. 505. National activities. 
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SEC. 3. REFERENCES. 
Except as otherwise expressly provided, whenever in 
this division an amendment or repeal is expressed in terms 
of an amendment to, or repeal of, a section or other provi-
sion, the reference shall be considered to be made to a 
section or other provision of the Higher Education Act of 
1965 (20 U.S.C. 1001 et seq.). 
TITLE I—INVESTING IN 
STUDENTS AND FAMILIES 
Subtitle A—Increasing College 
Access and Completion 
SEC. 101. FEDERAL PELL GRANTS. 
(a) AMOUNT
OF
GRANTS.—Section 401(b) (20 
U.S.C. 1070a(b)) is amended— 
(1) by amending paragraph (2)(A) to read as 
follows: 
‘‘(A) The amount of the Federal Pell 
Grant for a student eligible under this part 
shall be— 
‘‘(i) the maximum Federal Pell Grant, 
as specified in the last enacted appropria-
tion Act applicable to that award year, 
plus 
‘‘(ii) the amount of the increase cal-
culated under paragraph (8)(B) for that 
year, less 
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‘‘(iii) an amount equal to the amount 
determined to be the expected family con-
tribution with respect to that student for 
that year.’’; and 
(2) by amending paragraph (8), as amended by 
the Higher Education Opportunity Act (Public Law 
110–315), to read as follows: 
‘‘(8) ADDITIONAL FUNDS.— 
‘‘(A) IN GENERAL.—There are authorized 
to be appropriated, and there are appropriated, 
to carry out subparagraph (B) of this para-
graph (in addition to any other amounts appro-
priated to carry out this section and out of any 
money in the Treasury not otherwise appro-
priated) the following amounts— 
‘‘(i) $2,030,000,000 for fiscal year 
2008; 
‘‘(ii) $2,733,000,000 for fiscal year 
2009; and 
‘‘(iii) such sums as may be necessary 
for fiscal year 2010 and each subsequent 
fiscal year to provide the amount of in-
crease of the maximum Federal Pell Grant 
required by clauses (ii) and (iii) of sub-
paragraph (B). 
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‘‘(B) 
INCREASE
IN
FEDERAL
PELL 
GRANTS.—The amounts made available pursu-
ant to subparagraph (A) shall be used to in-
crease the amount of the maximum Federal 
Pell Grant for which a student shall be eligible 
during an award year, as specified in the last 
enacted appropriation Act applicable to that 
award year, by— 
‘‘(i) $490 for each of the award years 
2008–2009 and 2009–2010; 
‘‘(ii) $690 for the award year 2010– 
2011; and 
‘‘(iii) the amount determined under 
subparagraph (C) for each succeeding 
award year. 
‘‘(C) INFLATION-ADJUSTED AMOUNTS.— 
‘‘(i) AWARD
YEAR
2011–2012.—For 
award year 2011–2012, the amount deter-
mined under this subparagraph for pur-
poses of subparagraph (B)(iii) shall be 
equal to— 
‘‘(I) $5,550 or the total max-
imum Federal Pell Grant for the pre-
ceding award year (as determined 
under clause (iv)(II)), whichever is 
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greater, increased by a percentage 
equal to the annual adjustment per-
centage for award year 2011–2012; 
reduced by 
‘‘(II) $4,860 or the maximum 
Federal Pell Grant for which a stu-
dent was eligible for the preceding 
award year, as specified in the last en-
acted appropriation Act applicable to 
that year, whichever is greater; and 
‘‘(III) rounded to the nearest $5. 
‘‘(ii) SUBSEQUENT AWARD YEARS.— 
For award year 2012–2013 and each of 
the subsequent award years, the amount 
determined under this subparagraph for 
purposes of subparagraph (B)(iii) shall be 
equal to— 
‘‘(I) the total maximum Federal 
Pell Grant for the preceding award 
year (as determined under clause 
(iv)(II)), increased by a percentage 
equal to the annual adjustment per-
centage for the award year for which 
the amount under this subparagraph 
is being determined; reduced by 
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‘‘(II) $4,860 or the maximum 
Federal Pell Grant for which a stu-
dent was eligible for the preceding 
award year, as specified in the last en-
acted appropriation Act applicable to 
that year, whichever is greater; and 
‘‘(III) rounded to the nearest $5. 
‘‘(iii) LIMITATION ON DECREASES.— 
Notwithstanding clauses (i) and (ii), if the 
amount determined under clause (i) or (ii) 
for an award year is less than the amount 
determined under this paragraph for the 
preceding award year, the amount deter-
mined under such clause for such award 
year shall be the amount determined under 
this paragraph for the preceding award 
year. 
‘‘(iv) DEFINITIONS.—For purposes of 
this subparagraph— 
‘‘(I) the term ‘annual adjustment 
percentage’ as it applies to an award 
year is equal to the sum of— 
‘‘(aa) the estimated percent-
age change in the Consumer 
Price Index (as determined by 
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the Secretary, using the defini-
tion in section 478(f)) for the 
most recent calendar year ending 
prior to the beginning of that 
award year; and 
‘‘(bb) one percentage point; 
and 
‘‘(II) the term ‘total maximum 
Federal Pell Grant’ as it applies to a 
preceding award year is equal to the 
sum of— 
‘‘(aa) the maximum Federal 
Pell Grant for which a student is 
eligible during an award year, as 
specified in the last enacted ap-
propriation Act applicable to that 
preceding award year; and 
‘‘(bb) the amount of the in-
crease in the maximum Federal 
Pell Grant required by this para-
graph for that preceding award 
year. 
‘‘(D) PROGRAM REQUIREMENTS AND OP-
ERATIONS
OTHERWISE
UNAFFECTED.—Except 
as provided in subparagraphs (B) and (C), 
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nothing in this paragraph shall be construed to 
alter the requirements and operations of the 
Federal Pell Grant Program as authorized 
under this section, or to authorize the imposi-
tion of additional requirements or operations 
for the determination and allocation of Federal 
Pell Grants under this section. 
‘‘(E) 
AVAILABILITY
OF
FUNDS.—The 
amounts made available by subparagraph (A) 
for any fiscal year shall be available beginning 
on October 1 of that fiscal year, and shall re-
main available through September 30 of the 
succeeding fiscal year.’’. 
(b) CONFORMING
AMENDMENTS.—Title IV (20 
U.S.C. 1070 et seq.) is further amended— 
(1) in section 401(b)(6), as amended by the 
Higher Education Opportunity Act (Public Law 
110–315), by striking ‘‘the grant level specified in 
the appropriate Appropriation Act for this subpart 
for such year’’ and inserting ‘‘the Federal Pell Grant 
amount, determined under paragraph (2)(A), for 
which a student is eligible during such award year’’; 
(2) in section 402D(d)(1), by striking ‘‘exceed 
the maximum appropriated Pell Grant’’ and insert-
ing ‘‘exceed the Federal Pell Grant amount, deter-
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mined under section 401(b)(2)(A), for which a stu-
dent is eligible’’; 
(3) in section 435(a)(5)(A)(i)(I), by striking 
‘‘one-half the maximum Federal Pell Grant award 
for which a student would be eligible’’ and inserting 
‘‘one-half the Federal Pell Grant amount, deter-
mined under section 401(b)(2)(A), for which a stu-
dent would be eligible’’; 
(4) in section 483(e)(3)(ii), by striking ‘‘based 
on the maximum Federal Pell Grant award at the 
time of application’’ and inserting ‘‘based on the 
Federal Pell Grant amount, determined under sec-
tion 401(b)(2)(A), for which a student is eligible at 
the time of application’’; 
(5) in section 485E(b)(1)(A), by striking ‘‘of 
such students’ potential eligibility for a maximum 
Federal Pell Grant under subpart 1 of part A’’ and 
inserting ‘‘of such students’ potential eligibility for 
the Federal Pell Grant amount, determined under 
section 401(b)(2)(A), for which the student would be 
eligible’’; and 
(6) in section 894(f)(2)(C)(ii)(I), by striking 
‘‘the maximum Federal Pell Grant for each award 
year’’ and inserting ‘‘the Federal Pell Grant 
amount, determined under section 401(b)(2)(A), for 
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which a student may be eligible for each award 
year’’. 
(c) EFFECTIVE DATE.—The amendments made by 
subsections (a) and (b) of this section shall take effect on 
July 1, 2010. 
SEC. 102. COLLEGE ACCESS AND COMPLETION INNOVA-
TION FUND. 
(a) HEADER.—Part E of title VII (20 U.S.C. 1141 
et seq.) is amended by striking the header of such part 
and inserting the following: 
‘‘PART E—COLLEGE ACCESS AND COMPLETION 
INNOVATION FUND’’. 
(b) PURPOSE.—Part E of title VII (20 U.S.C. 1141 
et seq.) is further amended by inserting before section 781 
the following: 
‘‘SEC. 780. PURPOSES. 
‘‘The purposes of this part are— 
‘‘(1) to promote innovation in postsecondary 
education practices and policies by institutions of 
higher education, States, and nonprofit organiza-
tions to improve student success, completion, and 
post-completion employment, particularly for stu-
dents from groups that are underrepresented in 
postsecondary education; and 
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2110 
‘‘(2) to assist States in developing longitudinal 
data systems, common metrics, and reporting sys-
tems to enhance the quality and availability of infor-
mation about student success, completion, and post- 
completion employment.’’. 
(c) AUTHORIZATION AND APPROPRIATION.—Section 
781(a) (20 U.S.C. 1141(a)) is amended to read as follows: 
‘‘(a) AUTHORIZATION AND APPROPRIATION.— 
‘‘(1) IN GENERAL.—There are authorized to be 
appropriated, and there are appropriated, to carry 
out this part (in addition to any other amounts ap-
propriated to carry out this part and out of any 
money in the Treasury not otherwise appropriated), 
$600,000,000 for each of the fiscal years 2010 
through 2014. 
‘‘(2) ALLOCATIONS.—Of the amount appro-
priated for any fiscal year under paragraph (1)— 
‘‘(A) 25 percent shall be made available to 
carry out section 781; 
‘‘(B) 50 percent shall be made available to 
carry out section 782; 
‘‘(C) 23 percent shall be made available to 
carry out section 783; and 
‘‘(D) 2 percent shall be made available to 
carry out section 784.’’. 
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(d) STATE GRANTS AND GRANTS TO ELIGIBLE ENTI-
TIES.—Part E of title VII (20 U.S.C. 1141 et seq.) is 
further amended by adding at the end the following: 
‘‘SEC. 782. STATE INNOVATION COMPLETION GRANTS. 
‘‘(a) PROGRAM AUTHORIZATION.—From the amount 
appropriated under section 781(a)(2)(B) to carry out this 
section, the Secretary shall award grants to States on a 
competitive basis to promote student persistence in, and 
completion of, postsecondary education. 
‘‘(b) FEDERAL SHARE; NON-FEDERAL SHARE.— 
‘‘(1) FEDERAL
SHARE.—The amount of the 
Federal share under this section for a fiscal year 
shall be equal to 2⁄3 of the costs of the activities and 
services described in subsection (d)(1) that are car-
ried out under the grant. 
‘‘(2) NON-FEDERAL
SHARE.—The amount of 
the non-Federal share under this section shall be 
equal to 1⁄3 of the costs of the activities and services 
described in subsection (d)(1). The non-Federal 
share may be in cash or in kind, and may be pro-
vided from State resources, contributions from pri-
vate organizations, or both. 
‘‘(3) SUPPLEMENT, NOT SUPPLANT.—The Fed-
eral and non-Federal shares required by this para-
graph shall be used to supplement, and not sup-
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plant, State and private resources that would other-
wise be expended to carry out activities and services 
to promote student persistence in and completion of 
postsecondary education. 
‘‘(c) APPLICATION AND SELECTION.— 
‘‘(1) APPLICATION REQUIREMENTS.—For each 
fiscal year for which a State desires to receive a 
grant under this section, the State agency with ju-
risdiction over higher education, or another agency 
designated by the Governor or chief executive of the 
State to administer the grant program under this 
section, shall submit an application to the Secretary 
at such time, in such manner, and containing such 
information as the Secretary may require. Such ap-
plication shall include— 
‘‘(A) a description of the State’s capacity 
to administer the grant under this section; 
‘‘(B) a description of the State’s plans for 
using the grant funds for activities described in 
subsection (d)(1), including plans for how the 
State will make special efforts to provide bene-
fits to students in the State who are from 
groups that are underrepresented in postsec-
ondary education; 
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‘‘(C) a description of how the State will 
provide for the non-Federal share from State 
resources, private contributions, or both; 
‘‘(D) a description of— 
‘‘(i) the administrative system that 
the State has in place to administer the ac-
tivities and services described in subsection 
(d)(1); or 
‘‘(ii) the plan to develop such adminis-
trative system; 
‘‘(E) a description of the data system the 
State has or will have in place to measure the 
performance and progress toward the State’s 
goals included in the Access and Completion 
Plan submitted, or that will be submitted, 
under paragraph (2)(A); and 
‘‘(F) the assurances under paragraph (2). 
‘‘(2) STATE ASSURANCES.—The assurances re-
quired in paragraph (1)(F) shall include an assur-
ance of each of the following: 
‘‘(A) That the State will submit, not later 
than July 1, 2011, an Access and Completion 
Plan to increase the State’s rate of persistence 
in and completion of postsecondary education. 
Such plan shall include— 
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‘‘(i) the State’s annual and long-term 
quantifiable goals with respect to— 
‘‘(I) the rates of postsecondary 
enrollment, persistence, and comple-
tion, disaggregated by income, race, 
ethnicity, sex, disability, and age of 
students; 
‘‘(II) closing gaps in enrollment, 
persistence, and completion rates for 
students from groups that are under-
represented in postsecondary edu-
cation; 
‘‘(III) targeting education and 
training programs to address labor 
market needs in the State, as such 
needs are determined by the State, or 
the State in coordination with the 
State public employment service, the 
State workforce investment board, or 
industry or sector partnerships in the 
State; and 
‘‘(IV) improving coordination be-
tween two-year and four-year institu-
tions of higher education in the State, 
including supporting comprehensive 
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2115 
articulation agreements between such 
institutions; and 
‘‘(ii) the State’s plan to develop an 
interoperable statewide longitudinal data 
system that— 
‘‘(I) can be linked to other data 
systems, as applicable, including ele-
mentary and secondary education and 
workforce data systems; 
‘‘(II) 
will 
collect, 
maintain, 
disaggregate (by institution, income, 
race, ethnicity, sex, disability, and age 
of students), and analyze postsec-
ondary education and workforce infor-
mation, including— 
‘‘(aa) 
postsecondary 
edu-
cation 
enrollment, 
persistence, 
and completion information; 
‘‘(bb) post-completion em-
ployment outcomes of students 
who enrolled in postsecondary 
programs and training programs 
offered by eligible training pro-
viders under the Workforce In-
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2116 
vestment Act of 1998 (29 U.S.C. 
2801 et seq.); 
‘‘(cc) 
postsecondary 
edu-
cation and employment outcomes 
of students who move out of the 
State; and 
‘‘(dd) postsecondary instruc-
tional workforce information; and 
‘‘(III) makes the information de-
scribed in subclause (I) available to 
the general public in a manner that is 
transparent and user-friendly. 
‘‘(B) That the State has a comprehensive 
planning or policy formulation process with re-
spect to increasing postsecondary enrollment, 
persistence, and completion that— 
‘‘(i) encourages coordination between 
the State administration of grants under 
this section and similar State programs; 
‘‘(ii) encourages State policies that 
are designed to improve rates of enroll-
ment and persistence in, and completion 
of, postsecondary education for all cat-
egories of institutions of higher education 
described in section 132(d) in the State; 
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‘‘(iii) considers the postsecondary edu-
cation needs of students from groups that 
are underrepresented in postsecondary 
education; 
‘‘(iv) considers the resources of public 
and private institutions of higher edu-
cation, organizations, and agencies within 
the State that are capable of providing ac-
cess to postsecondary education opportuni-
ties within the State; and 
‘‘(v) provides for direct, equitable, and 
active participation in the comprehensive 
planning or policy formulation process or 
processes, through membership on State 
planning 
commissions, 
State 
advisory 
councils, or other State entities established 
by the State and consistent with State law, 
by representatives of— 
‘‘(I) institutions of higher edu-
cation, including at least one member 
from a junior or community college 
(as defined in section 312(f)); 
‘‘(II) students; 
‘‘(III) other providers of postsec-
ondary education services (including 
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organizations providing access to such 
services); 
‘‘(IV) the general public in the 
State; and 
‘‘(V) 
postsecondary 
education 
faculty members, including at least 
one faculty member whose primary re-
sponsibilities are teaching and schol-
arship. 
‘‘(C) That the State will incorporate poli-
cies and practices that, through the activities 
funded under this section, are determined to be 
effective in improving rates of postsecondary 
education enrollment, persistence, and comple-
tion into the future postsecondary education 
policies and practices of the State to ensure 
that the benefits achieved through the activities 
funded under this section continue beyond the 
period of the grant. 
‘‘(D) That the State will participate in the 
evaluation required under section 784. 
‘‘(3) SUBGRANTS
TO
NONPROFIT
ORGANIZA-
TIONS.—A State receiving a payment under this sec-
tion may elect to make a subgrant to one or more 
nonprofit organizations in the State, including agen-
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2119 
cies with agreements with the Secretary under sub-
sections (b) and (c) of section 428 on the date of the 
enactment of the Student Aid and Fiscal Responsi-
bility Act of 2009, or a partnership of such organi-
zations, to carry out activities and services described 
in subsection (d)(1), if the nonprofit organization or 
partnership— 
‘‘(A) was in existence on the day before the 
date of the enactment of the Student Aid and 
Fiscal Responsibility Act of 2009; and 
‘‘(B) as of such day, was participating in 
activities and services related to promoting per-
sistence in, and completion of, postsecondary 
education, such as the activities and services de-
scribed in subsection (d)(1). 
‘‘(4) PRIORITY.—In awarding grants under this 
section, the Secretary shall give priority to States 
that enter into a partnership with one of the fol-
lowing entities to carry out the activities and serv-
ices described in subsection (d)(1): 
‘‘(A) A philanthropic organization, as such 
term is defined in section 781(i)(1). 
‘‘(B) An agency with an agreement with 
the Secretary under subsections (b) and (c) of 
section 428 on the date of the enactment of 
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Student Aid and Fiscal Responsibility Act of 
2009. 
‘‘(d) USES OF FUNDS.— 
‘‘(1) AUTHORIZED USES.—A State receiving a 
grant under this section shall use the grant funds 
to— 
‘‘(A) provide programs in such State that 
increase persistence in, and completion of, post-
secondary education, which may include— 
‘‘(i) assisting institutions of higher 
education in providing financial literacy, 
education, and counseling to enrolled stu-
dents; 
‘‘(ii) assisting students enrolled in an 
institution of higher education to reduce 
the amount of loan debt incurred by such 
students; 
‘‘(iii) providing grants to students de-
scribed in section 415A(a)(1), in accord-
ance with the terms of that section; and 
‘‘(iv) carrying out the activities de-
scribed in section 415E(a); and 
‘‘(B) support the development and imple-
mentation of a statewide longitudinal data sys-
tem, as described in subsection (c)(2)(A)(ii). 
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‘‘(2) PROHIBITED
USES.—Funds made avail-
able under this section shall not be used to promote 
any lender’s loans. 
‘‘(3) RESTRICTIONS
ON
USE
OF
FUNDS.—A 
State— 
‘‘(A) shall use not less than 1⁄3 of the sum 
of the Federal and non-Federal share used for 
paragraph (1)(A) on activities that benefit stu-
dents enrolled in junior or community colleges 
(as defined in section 312(f)), two-year public 
institutions, or two-year programs of instruc-
tion at four-year public institutions; 
‘‘(B) may use not more than 10 percent of 
the sum of the Federal and non-Federal share 
under this section for activities described in 
paragraph (1)(B); and 
‘‘(C) may use not more than 6 percent of 
the sum of the Federal and non-Federal share 
under this section for administrative purposes 
relating to the grant under this section. 
‘‘(e) ANNUAL REPORT.—Each State receiving a 
grant under this section shall submit to the Secretary an 
annual report on— 
‘‘(1) the activities and services described in sub-
section (d)(1) that are carried out with such grant; 
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2150 
(3) by repealing subsection (d); and 
(4) in subsection (e), by striking ‘‘adjusted’’ 
both places it appears. 
SEC. 123. CHANGES TO TOTAL INCOME; AID ELIGIBILITY. 
(a) DEFINITION OF UNTAXED INCOME AND BENE-
FITS.—Section 480(b)(1) (20 U.S.C. 1087vv(b)(1)), as 
amended by the Higher Education Opportunity Act (Pub-
lic Law 110–315), is amended— 
(1) by striking subparagraphs (A), (B), (C), 
(E), (F), and (I); 
(2) by redesignating subparagraphs (D), (G), 
and (H) as subparagraphs (A), (B), and (C), respec-
tively; 
(3) in subparagraph (B) (as redesignated by 
paragraph (2)), by inserting ‘‘and’’ after the semi-
colon; and 
(4) in subparagraph (C) (as redesignated by 
paragraph (2)), by striking ‘‘; and’’ and inserting a 
period. 
(b) DEFINITION OF ASSETS.—Section 480(f)(2) (20 
U.S.C. 1087vv(f)(2)) is amended— 
(1) by striking ‘‘or’’ at the end of subparagraph 
(B); 
(2) by striking the period at the end of sub-
paragraph (C) and inserting ‘‘; or’’; and 
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2184 
subtraction shall not be less than zero or more 
than $8,000. 
‘‘(2) RATABLE REDUCTION ADJUSTMENTS.—If 
the sum of the base self-help need amounts of all eli-
gible institutions for an award year as determined 
under paragraph (1) exceeds 1⁄2 of the annual loan 
authority under subsection (b) for such award year, 
the Secretary shall ratably reduce the base self-help 
need amounts of all eligible institutions until the 
sum of such amounts is equal to the amount that is 
1⁄2 of the annual loan authority under subsection 
(b). 
‘‘(3) REQUIRED MINIMUM AMOUNT.—Notwith-
standing paragraph (2), the adjusted self-help need 
amount of each eligible institution shall not be less 
than the average of the institution’s total principal 
amount of loans made under this part for each of 
the 5 most recent award years. 
‘‘(4) ADDITIONAL ADJUSTMENTS.—If the Sec-
retary determines that a ratable reduction under 
paragraph (2) results in the adjusted self-help need 
amount of any eligible institution being reduced 
below the minimum amount required under para-
graph (3), the Secretary shall— 
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