H. R. 3590—807 
(3) MAINTENANCE
OF
ELIGIBILITY
REQUIREMENTS.—The 
State does not apply eligibility standards, methodologies, or 
procedures for determining eligibility for medical assistance 
for non-institutionally-based long-term services and supports 
described in subsection (f)(1)(B) under the State Medicaid pro-
gram that are more restrictive than the eligibility standards, 
methodologies, or procedures in effect for such purposes on 
December 31, 2010. 
(4) USE OF ADDITIONAL FUNDS.—The State agrees to use 
the additional Federal funds paid to the State as a result 
of this section only for purposes of providing new or expanded 
offerings of non-institutionally-based long-term services and 
supports described in subsection (f)(1)(B) under the State Med-
icaid program. 
(5) STRUCTURAL CHANGES.—The State agrees to make, not 
later than the end of the 6-month period that begins on the 
date the State submits an application under this section, the 
following changes: 
(A) ‘‘NO WRONG DOOR—SINGLE ENTRY POINT SYSTEM’’.— 
Development of a statewide system to enable consumers 
to access all long-term services and supports through an 
agency, organization, coordinated network, or portal, in 
accordance with such standards as the State shall establish 
and that shall provide information regarding the avail-
ability of such services, how to apply for such services, 
referral services for services and supports otherwise avail-
able in the community, and determinations of financial 
and functional eligibility for such services and supports, 
or assistance with assessment processes for financial and 
functional eligibility. 
(B) CONFLICT-FREE CASE MANAGEMENT SERVICES.—Con-
flict-free case management services to develop a service 
plan, arrange for services and supports, support the bene-
ficiary (and, if appropriate, the beneficiary’s caregivers) 
in directing the provision of services and supports for the 
beneficiary, and conduct ongoing monitoring to assure that 
services and supports are delivered to meet the bene-
ficiary’s needs and achieve intended outcomes. 
(C) CORE STANDARDIZED ASSESSMENT INSTRUMENTS.— 
Development of core standardized assessment instruments 
for determining eligibility for non-institutionally-based 
long-term services and supports described in subsection 
(f)(1)(B), which shall be used in a uniform manner through-
out the State, to determine a beneficiary’s needs for 
training, support services, medical care, transportation, and 
other services, and develop an individual service plan to 
address such needs. 
(6) DATA COLLECTION.—The State agrees to collect from 
providers of services and through such other means as the 
State determines appropriate the following data: 
(A) SERVICES DATA.—Services data from providers of 
non-institutionally-based long-term services and supports 
described in subsection (f)(1)(B) on a per-beneficiary basis 
and in accordance with such standardized coding proce-
dures as the State shall establish in consultation with 
the Secretary.
H. R. 3590—808 
(B) QUALITY
DATA.—Quality data on a selected set 
of core quality measures agreed upon by the Secretary 
and the State that are linked to population-specific out-
comes measures and accessible to providers. 
(C) OUTCOMES MEASURES.—Outcomes measures data 
on a selected set of core population-specific outcomes meas-
ures agreed upon by the Secretary and the State that 
are accessible to providers and include— 
(i) measures of beneficiary and family caregiver 
experience with providers; 
(ii) measures of beneficiary and family caregiver 
satisfaction with services; and 
(iii) measures for achieving desired outcomes 
appropriate to a specific beneficiary, including employ-
ment, participation in community life, health stability, 
and prevention of loss in function. 
(d) APPLICABLE PERCENTAGE POINTS INCREASE IN FMAP.—The 
applicable percentage points increase is— 
(1) in the case of a balancing incentive payment State 
subject to the target spending percentage described in sub-
section (c)(2)(A), 5 percentage points; and 
(2) in the case of any other balancing incentive payment 
State, 2 percentage points. 
(e) ELIGIBLE MEDICAL ASSISTANCE EXPENDITURES.— 
(1) IN GENERAL.—Subject to paragraph (2), medical assist-
ance described in this subsection is medical assistance for non- 
institutionally-based long-term services and supports described 
in subsection (f)(1)(B) that is provided by a balancing incentive 
payment State under its State Medicaid program during the 
balancing incentive payment period. 
(2) LIMITATION ON PAYMENTS.—In no case may the aggre-
gate amount of payments made by the Secretary to balancing 
incentive payment States under this section during the bal-
ancing incentive period exceed $3,000,000,000. 
(f) DEFINITIONS.—In this section: 
(1) LONG-TERM
SERVICES
AND
SUPPORTS
DEFINED.—The 
term ‘‘long-term services and supports’’ has the meaning given 
that term by Secretary and may include any of the following 
(as defined for purposes of State Medicaid programs): 
(A) INSTITUTIONALLY-BASED LONG-TERM SERVICES AND 
SUPPORTS.—Services provided in an institution, including 
the following: 
(i) Nursing facility services. 
(ii) Services in an intermediate care facility for 
the mentally retarded described in subsection (a)(15) 
of section 1905 of such Act. 
(B) NON-INSTITUTIONALLY-BASED LONG-TERM SERVICES 
AND SUPPORTS.—Services not provided in an institution, 
including the following: 
(i) Home and community-based services provided 
under subsection (c), (d), or (i) of section 1915 of such 
Act or under a waiver under section 1115 of such 
Act. 
(ii) Home health care services. 
(iii) Personal care services.
H. R. 3590—809 
(iv) Services described in subsection (a)(26) of sec-
tion 1905 of such Act (relating to PACE program serv-
ices). 
(v) 
Self-directed 
personal 
assistance 
services 
described in section 1915(j) of such Act. 
(2) BALANCING INCENTIVE PERIOD.—The term ‘‘balancing 
incentive period’’ means the period that begins on October 
1, 2011, and ends on September 30, 2015. 
(3) POVERTY
LINE.—The term ‘‘poverty line’’ has the 
meaning given that term in section 2110(c)(5) of the Social 
Security Act (42 U.S.C. 1397jj(c)(5)). 
(4) STATE MEDICAID PROGRAM.—The term ‘‘State Medicaid 
program’’ means the State program for medical assistance pro-
vided under a State plan under title XIX of the Social Security 
Act and under any waiver approved with respect to such State 
plan. 
SEC. 10203. EXTENSION OF FUNDING FOR CHIP THROUGH FISCAL YEAR 
2015 AND OTHER CHIP-RELATED PROVISIONS. 
(a) Section 1311(c)(1) of this Act is amended by striking ‘‘and’’ 
at the end of subparagraph (G), by striking the period at the 
end of subparagraph (H) and inserting ‘‘; and’’, and by adding 
at the end the following: 
‘‘(I) report to the Secretary at least annually and in 
such manner as the Secretary shall require, pediatric 
quality reporting measures consistent with the pediatric 
quality reporting measures established under section 
1139A of the Social Security Act.’’. 
(b) Effective as if included in the enactment of the Children’s 
Health Insurance Program Reauthorization Act of 2009 (Public 
Law 111–3): 
(1) Section 1906(e)(2) of the Social Security Act (42 U.S.C. 
1396e(e)(2)) is amended by striking ‘‘means’’ and all that follows 
through the period and inserting ‘‘has the meaning given that 
term in section 2105(c)(3)(A).’’. 
(2)(A) Section 1906A(a) of the Social Security Act (42 U.S.C. 
1396e–1(a)), is amended by inserting before the period the 
following: ‘‘and the offering of such a subsidy is cost-effective, 
as defined for purposes of section 2105(c)(3)(A)’’. 
(B) This Act shall be applied without regard to subpara-
graph (A) of section 2003(a)(1) of this Act and that subpara-
graph and the amendment made by that subparagraph are 
hereby deemed null, void, and of no effect. 
(3) Section 2105(c)(10) of the Social Security Act (42 U.S.C. 
1397ee(c)(10)) is amended— 
(A) in subparagraph (A), in the first sentence, by 
inserting before the period the following: ‘‘if the offering 
of such a subsidy is cost-effective, as defined for purposes 
of paragraph (3)(A)’’; 
(B) by striking subparagraph (M); and 
(C) by redesignating subparagraph (N) as subpara-
graph (M). 
(4) Section 2105(c)(3)(A) of the Social Security Act (42 
U.S.C. 1397ee(c)(3)(A)) is amended— 
(A) in the matter preceding clause (i), by striking ‘‘to’’ 
and inserting ‘‘to—’’; and
H. R. 3590—810 
(B) in clause (ii), by striking the period and inserting 
a semicolon. 
(c) Section 2105 of the Social Security Act (42 U.S.C. 1397ee), 
as amended by section 2101, is amended— 
(1) in subsection (b), in the second sentence, by striking 
‘‘2013’’ and inserting ‘‘2015’’; and 
(2) in subsection (d)(3)— 
(A) in subparagraph (A)— 
(i) in the first sentence, by inserting ‘‘as a condition 
of receiving payments under section 1903(a),’’ after 
‘‘2019,’’; 
(ii) in clause (i), by striking ‘‘or’’ at the end; 
(iii) by redesignating clause (ii) as clause (iii); and 
(iv) by inserting after clause (i), the following: 
‘‘(ii) after September 30, 2015, enrolling children 
eligible to be targeted low-income children under the 
State child health plan in a qualified health plan that 
has been certified by the Secretary under subparagraph 
(C); or’’; 
(B) in subparagraph (B), by striking ‘‘provided cov-
erage’’ and inserting ‘‘screened for eligibility for medical 
assistance under the State plan under title XIX or a waiver 
of that plan and, if found eligible, enrolled in such plan 
or a waiver. In the case of such children who, as a result 
of such screening, are determined to not be eligible for 
medical assistance under the State plan or a waiver under 
title XIX, the State shall establish procedures to ensure 
that the children are enrolled in a qualified health plan 
that has been certified by the Secretary under subpara-
graph (C) and is offered’’; and 
(C) by adding at the end the following: 
‘‘(C) CERTIFICATION OF COMPARABILITY OF PEDIATRIC 
COVERAGE
OFFERED
BY
QUALIFIED
HEALTH
PLANS.—With 
respect to each State, the Secretary, not later than April 
1, 2015, shall review the benefits offered for children and 
the cost-sharing imposed with respect to such benefits by 
qualified health plans offered through an Exchange estab-
lished by the State under section 1311 of the Patient Protec-
tion and Affordable Care Act and shall certify those plans 
that offer benefits for children and impose cost-sharing 
with respect to such benefits that the Secretary determines 
are at least comparable to the benefits offered and cost- 
sharing protections provided under the State child health 
plan.’’. 
(d)(1) Section 2104(a) of such Act (42 U.S.C. 1397dd(a)) is 
amended— 
(A) in paragraph (15), by striking ‘‘and’’ at the end; and 
(B) by striking paragraph (16) and inserting the following: 
‘‘(16) for fiscal year 2013, $17,406,000,000; 
‘‘(17) for fiscal year 2014, $19,147,000,000; and 
‘‘(18) for fiscal year 2015, for purposes of making 2 semi- 
annual allotments— 
‘‘(A) $2,850,000,000 for the period beginning on October 
1, 2014, and ending on March 31, 2015, and 
‘‘(B) $2,850,000,000 for the period beginning on April 
1, 2015, and ending on September 30, 2015.’’.
H. R. 3590—811 
(2)(A) Section 2104(m) of such Act (42 U.S.C. 1397dd(m)), as 
amended by section 2102(a)(1), is amended— 
(i) in the subsection heading, by striking ‘‘2013’’ and 
inserting ‘‘2015’’; 
(ii) in paragraph (2)— 
(I) in the paragraph heading, by striking ‘‘2012’’ and 
inserting ‘‘2014’’; and 
(II) by adding at the end the following: 
‘‘(B) FISCAL
YEARS
2013
AND
2014.—Subject to para-
graphs (4) and (6), from the amount made available under 
paragraphs (16) and (17) of subsection (a) for fiscal years 
2013 and 2014, respectively, the Secretary shall compute 
a State allotment for each State (including the District 
of Columbia and each commonwealth and territory) for 
each such fiscal year as follows: 
‘‘(i) REBASING IN FISCAL YEAR 2013.—For fiscal year 
2013, the allotment of the State is equal to the Federal 
payments to the State that are attributable to (and 
countable towards) the total amount of allotments 
available under this section to the State in fiscal year 
2012 (including payments made to the State under 
subsection (n) for fiscal year 2012 as well as amounts 
redistributed to the State in fiscal year 2012), multi-
plied by the allotment increase factor under paragraph 
(5) for fiscal year 2013. 
‘‘(ii) GROWTH
FACTOR
UPDATE
FOR
FISCAL
YEAR 
2014.—For fiscal year 2014, the allotment of the State 
is equal to the sum of— 
‘‘(I) the amount of the State allotment under 
clause (i) for fiscal year 2013; and 
‘‘(II) the amount of any payments made to 
the State under subsection (n) for fiscal year 2013, 
multiplied by the allotment increase factor under para-
graph (5) for fiscal year 2014.’’; 
(iii) in paragraph (3)— 
(I) in the paragraph heading, by striking ‘‘2013’’ 
and inserting ‘‘2015’’; 
(II) in subparagraphs (A) and (B), by striking 
‘‘paragraph (16)’’ each place it appears and inserting 
‘‘paragraph (18)’’; 
(III) in subparagraph (C)— 
(aa) by striking ‘‘2012’’ each place it appears 
and inserting ‘‘2014’’; and 
(bb) by striking ‘‘2013’’ and inserting ‘‘2015’’; 
and 
(IV) in subparagraph (D)— 
(aa) in clause (i)(I), by striking ‘‘subsection 
(a)(16)(A)’’ and inserting ‘‘subsection (a)(18)(A)’’; 
and 
(bb) in clause (ii)(II), by striking ‘‘subsection 
(a)(16)(B)’’ and inserting ‘‘subsection (a)(18)(B)’’; 
(iv) in paragraph (4), by striking ‘‘2013’’ and inserting 
‘‘2015’’; 
(v) in paragraph (6)— 
(I) in subparagraph (A), by striking ‘‘2013’’ and 
inserting ‘‘2015’’; and
H. R. 3590—813 
for coverage of the family of the child would exceed 5 
percent of such family’s income for the year involved.’’. 
(E) Section 2113 of such Act (42 U.S.C. 1397mm) is amended— 
(i) in subsection (a)(1), by striking ‘‘2013’’ and inserting 
‘‘2015’’; and 
(ii) in subsection (g), by striking ‘‘$100,000,000 for the 
period of fiscal years 2009 through 2013’’ and inserting 
‘‘$140,000,000 for the period of fiscal years 2009 through 2015’’. 
(F) Section 108 of Public Law 111–3 is amended by striking 
‘‘$11,706,000,000’’ and all that follows through the second sentence 
and inserting ‘‘$15,361,000,000 to accompany the allotment made 
for the period beginning on October 1, 2014, and ending on March 
31, 2015, under section 2104(a)(18)(A) of the Social Security Act 
(42 U.S.C. 1397dd(a)(18)(A)), to remain available until expended. 
Such amount shall be used to provide allotments to States under 
paragraph (3) of section 2104(m) of the Social Security Act (42 
U.S.C. 1397dd(m)) for the first 6 months of fiscal year 2015 in 
the same manner as allotments are provided under subsection 
(a)(18)(A) of such section 2104 and subject to the same terms 
and conditions as apply to the allotments provided from such sub-
section (a)(18)(A).’’. 
PART II—SUPPORT FOR PREGNANT AND 
PARENTING TEENS AND WOMEN 
SEC. 10211. DEFINITIONS. 
In this part: 
(1) ACCOMPANIMENT.—The term ‘‘accompaniment’’ means 
assisting, representing, and accompanying a woman in seeking 
judicial relief for child support, child custody, restraining 
orders, and restitution for harm to persons and property, and 
in filing criminal charges, and may include the payment of 
court costs and reasonable attorney and witness fees associated 
therewith. 
(2) ELIGIBLE INSTITUTION OF HIGHER EDUCATION.—The term 
‘‘eligible institution of higher education’’ means an institution 
of higher education (as such term is defined in section 101 
of the Higher Education Act of 1965 (20 U.S.C. 1001)) that 
has established and operates, or agrees to establish and operate 
upon the receipt of a grant under this part, a pregnant and 
parenting student services office. 
(3) COMMUNITY SERVICE CENTER.—The term ‘‘community 
service center’’ means a non-profit organization that provides 
social services to residents of a specific geographical area via 
direct service or by contract with a local governmental agency. 
(4) HIGH
SCHOOL.—The term ‘‘high school’’ means any 
public or private school that operates grades 10 through 12, 
inclusive, grades 9 through 12, inclusive or grades 7 through 
12, inclusive. 
(5) INTERVENTION SERVICES.—The term ‘‘intervention serv-
ices’’ means, with respect to domestic violence, sexual violence, 
sexual assault, or stalking, 24-hour telephone hotline services 
for police protection and referral to shelters. 
(6) SECRETARY.—The term ‘‘Secretary’’ means the Secretary 
of Health and Human Services.
H. R. 3590—814 
(7) STATE.—The term ‘‘State’’ includes the District of 
Columbia, any commonwealth, possession, or other territory 
of the United States, and any Indian tribe or reservation. 
(8) SUPPORTIVE SOCIAL SERVICES.—The term ‘‘supportive 
social services’’ means transitional and permanent housing, 
vocational counseling, and individual and group counseling 
aimed at preventing domestic violence, sexual violence, sexual 
assault, or stalking. 
(9) VIOLENCE.—The term ‘‘violence’’ means actual violence 
and the risk or threat of violence. 
SEC. 10212. ESTABLISHMENT OF PREGNANCY ASSISTANCE FUND. 
(a) IN GENERAL.—The Secretary, in collaboration and coordina-
tion with the Secretary of Education (as appropriate), shall establish 
a Pregnancy Assistance Fund to be administered by the Secretary, 
for the purpose of awarding competitive grants to States to assist 
pregnant and parenting teens and women. 
(b) USE OF FUND.—A State may apply for a grant under sub-
section (a) to carry out any activities provided for in section 10213. 
(c) APPLICATIONS.—To be eligible to receive a grant under sub-
section (a), a State shall submit to the Secretary an application 
at such time, in such manner, and containing such information 
as the Secretary may require, including a description of the pur-
poses for which the grant is being requested and the designation 
of a State agency for receipt and administration of funding received 
under this part. 
SEC. 10213. PERMISSIBLE USES OF FUND. 
(a) IN GENERAL.—A State shall use amounts received under 
a grant under section 10212 for the purposes described in this 
section to assist pregnant and parenting teens and women. 
(b) INSTITUTIONS OF HIGHER EDUCATION.— 
(1) IN GENERAL.—A State may use amounts received under 
a grant under section 10212 to make funding available to 
eligible institutions of higher education to enable the eligible 
institutions to establish, maintain, or operate pregnant and 
parenting student services. Such funding shall be used to 
supplement, not supplant, existing funding for such services. 
(2) APPLICATION.—An eligible institution of higher edu-
cation that desires to receive funding under this subsection 
shall submit an application to the designated State agency 
at such time, in such manner, and containing such information 
as the State agency may require. 
(3) MATCHING
REQUIREMENT.—An eligible institution of 
higher education that receives funding under this subsection 
shall contribute to the conduct of the pregnant and parenting 
student services office supported by the funding an amount 
from non-Federal funds equal to 25 percent of the amount 
of the funding provided. The non-Federal share may be in 
cash or in-kind, fairly evaluated, including services, facilities, 
supplies, or equipment. 
(4) USE OF FUNDS FOR ASSISTING PREGNANT AND PARENTING 
COLLEGE STUDENTS.—An eligible institution of higher education 
that receives funding under this subsection shall use such 
funds to establish, maintain or operate pregnant and parenting 
student services and may use such funding for the following 
programs and activities:
H. R. 3590—815 
(A) Conduct a needs assessment on campus and within 
the local community— 
(i) to assess pregnancy and parenting resources, 
located on the campus or within the local community, 
that are available to meet the needs described in 
subparagraph (B); and 
(ii) to set goals for— 
(I) improving such resources for pregnant, par-
enting, and prospective parenting students; and 
(II) improving access to such resources. 
(B) Annually assess the performance of the eligible 
institution in meeting the following needs of students 
enrolled in the eligible institution who are pregnant or 
are parents: 
(i) The inclusion of maternity coverage and the 
availability of riders for additional family members 
in student health care. 
(ii) Family housing. 
(iii) Child care. 
(iv) Flexible or alternative academic scheduling, 
such as telecommuting programs, to enable pregnant 
or parenting students to continue their education or 
stay in school. 
(v) Education to improve parenting skills for moth-
ers and fathers and to strengthen marriages. 
(vi) Maternity and baby clothing, baby food 
(including formula), baby furniture, and similar items 
to assist parents and prospective parents in meeting 
the material needs of their children. 
(vii) Post-partum counseling. 
(C) Identify public and private service providers, 
located on the campus of the eligible institution or within 
the local community, that are qualified to meet the needs 
described in subparagraph (B), and establishes programs 
with qualified providers to meet such needs. 
(D) Assist pregnant and parenting students, fathers 
or spouses in locating and obtaining services that meet 
the needs described in subparagraph (B). 
(E) If appropriate, provide referrals for prenatal care 
and delivery, infant or foster care, or adoption, to a student 
who requests such information. An office shall make such 
referrals only to service providers that serve the following 
types of individuals: 
(i) Parents. 
(ii) Prospective parents awaiting adoption. 
(iii) Women who are pregnant and plan on par-
enting or placing the child for adoption. 
(iv) Parenting or prospective parenting couples. 
(5) REPORTING.— 
(A) ANNUAL REPORT BY INSTITUTIONS.— 
(i) IN
GENERAL.—For each fiscal year that an 
eligible institution of higher education receives funds 
under this subsection, the eligible institution shall pre-
pare and submit to the State, by the date determined 
by the State, a report that—
H. R. 3590—816 
(I) itemizes the pregnant and parenting stu-
dent services office’s expenditures for the fiscal 
year; 
(II) contains a review and evaluation of the 
performance of the office in fulfilling the require-
ments of this section, using the specific perform-
ance criteria or standards established under 
subparagraph (B)(i); and 
(III) describes the achievement of the office 
in meeting the needs listed in paragraph (4)(B) 
of the students served by the eligible institution, 
and the frequency of use of the office by such 
students. 
(ii) PERFORMANCE CRITERIA.—Not later than 180 
days before the date the annual report described in 
clause (i) is submitted, the State— 
(I) shall identify the specific performance cri-
teria or standards that shall be used to prepare 
the report; and 
(II) may establish the form or format of the 
report. 
(B) REPORT BY STATE.—The State shall annually pre-
pare and submit a report on the findings under this sub-
section, including the number of eligible institutions of 
higher education that were awarded funds and the number 
of students served by each pregnant and parenting student 
services office receiving funds under this section, to the 
Secretary. 
(c) SUPPORT FOR PREGNANT AND PARENTING TEENS.—A State 
may use amounts received under a grant under section 10212 
to make funding available to eligible high schools and community 
service centers to establish, maintain or operate pregnant and par-
enting services in the same general manner and in accordance 
with all conditions and requirements described in subsection (b), 
except that paragraph (3) of such subsection shall not apply for 
purposes of this subsection. 
(d) IMPROVING SERVICES FOR PREGNANT WOMEN WHO ARE VIC-
TIMS OF DOMESTIC VIOLENCE, SEXUAL VIOLENCE, SEXUAL ASSAULT, 
AND STALKING.— 
(1) IN GENERAL.—A State may use amounts received under 
a grant under section 10212 to make funding available tp 
its State Attorney General to assist Statewide offices in pro-
viding— 
(A) intervention services, accompaniment, and sup-
portive social services for eligible pregnant women who 
are victims of domestic violence, sexual violence, sexual 
assault, or stalking. 
(B) technical assistance and training (as described in 
subsection (c)) relating to violence against eligible pregnant 
women to be made available to the following: 
(i) Federal, State, tribal, territorial, and local 
governments, law enforcement agencies, and courts. 
(ii) Professionals working in legal, social service, 
and health care settings. 
(iii) Nonprofit organizations. 
(iv) Faith-based organizations.
H. R. 3590—817 
(2) ELIGIBILITY.—To be eligible for a grant under paragraph 
(1), a State Attorney General shall submit an application to 
the designated State agency at such time, in such manner, 
and containing such information, as specified by the State. 
(3) TECHNICAL ASSISTANCE AND TRAINING DESCRIBED.—For 
purposes of paragraph (1)(B), technical assistance and training 
is— 
(A) the identification of eligible pregnant women 
experiencing domestic violence, sexual violence, sexual 
assault, or stalking; 
(B) the assessment of the immediate and short-term 
safety of such a pregnant woman, the evaluation of the 
impact of the violence or stalking on the pregnant woman’s 
health, and the assistance of the pregnant woman in devel-
oping a plan aimed at preventing further domestic violence, 
sexual violence, sexual assault, or stalking, as appropriate; 
(C) the maintenance of complete medical or forensic 
records that include the documentation of any examination, 
treatment given, and referrals made, recording the location 
and nature of the pregnant woman’s injuries, and the 
establishment of mechanisms to ensure the privacy and 
confidentiality of those medical records; and 
(D) the identification and referral of the pregnant 
woman to appropriate public and private nonprofit entities 
that provide intervention services, accompaniment, and 
supportive social services. 
(4) ELIGIBLE PREGNANT WOMAN.—In this subsection, the 
term ‘‘eligible pregnant woman’’ means any woman who is 
pregnant on the date on which such woman becomes a victim 
of domestic violence, sexual violence, sexual assault, or stalking 
or who was pregnant during the one-year period before such 
date. 
(e) PUBLIC AWARENESS
AND EDUCATION.—A State may use 
amounts received under a grant under section 10212 to make 
funding available to increase public awareness and education con-
cerning any services available to pregnant and parenting teens 
and women under this part, or any other resources available to 
pregnant and parenting women in keeping with the intent and 
purposes of this part. The State shall be responsible for setting 
guidelines or limits as to how much of funding may be utilized 
for public awareness and education in any funding award. 
SEC. 10214. APPROPRIATIONS. 
There is authorized to be appropriated, and there are appro-
priated, $25,000,000 for each of fiscal years 2010 through 2019, 
to carry out this part. 
PART III—INDIAN HEALTH CARE 
IMPROVEMENT 
SEC. 10221. INDIAN HEALTH CARE IMPROVEMENT. 
(a) IN GENERAL.—Except as provided in subsection (b), S. 1790 
entitled ‘‘A bill to amend the Indian Health Care Improvement 
Act to revise and extend that Act, and for other purposes.’’, as 
reported by the Committee on Indian Affairs of the Senate in 
December 2009, is enacted into law. 
(b) AMENDMENTS.—
H. R. 3590—818 
(1) Section 119 of the Indian Health Care Improvement 
Act (as amended by section 111 of the bill referred to in sub-
section (a)) is amended— 
(A) in subsection (d)— 
(i) in paragraph (2), by striking ‘‘In establishing’’ 
and inserting ‘‘Subject to paragraphs (3) and (4), in 
establishing’’; and 
(ii) by adding at the end the following: 
‘‘(3) ELECTION OF INDIAN TRIBE OR TRIBAL ORGANIZATION.— 
‘‘(A) IN GENERAL.—Subparagraph (B) of paragraph (2) 
shall not apply in the case of an election made by an 
Indian tribe or tribal organization located in a State (other 
than Alaska) in which the use of dental health aide thera-
pist services or midlevel dental health provider services 
is authorized under State law to supply such services in 
accordance with State law. 
‘‘(B) ACTION
BY
SECRETARY.—On an election by an 
Indian tribe or tribal organization under subparagraph (A), 
the Secretary, acting through the Service, shall facilitate 
implementation of the services elected. 
‘‘(4) VACANCIES.—The Secretary shall not fill any vacancy 
for a certified dentist in a program operated by the Service 
with a dental health aide therapist.’’; and 
(B) by adding at the end the following: 
‘‘(e) EFFECT OF SECTION.—Nothing in this section shall restrict 
the ability of the Service, an Indian tribe, or a tribal organization 
to participate in any program or to provide any service authorized 
by any other Federal law.’’. 
(2) The Indian Health Care Improvement Act (as amended 
by section 134(b) of the bill referred to in subsection (a)) is 
amended by striking section 125 (relating to treatment of schol-
arships for certain purposes). 
(3) Section 806 of the Indian Health Care Improvement 
Act (25 U.S.C. 1676) is amended— 
(A) by striking ‘‘Any limitation’’ and inserting the fol-
lowing: 
‘‘(a) HHS APPROPRIATIONS.—Any limitation’’; and 
(B) by adding at the end the following: 
‘‘(b) LIMITATIONS PURSUANT
TO OTHER FEDERAL LAW.—Any 
limitation pursuant to other Federal laws on the use of Federal 
funds appropriated to the Service shall apply with respect to the 
performance or coverage of abortions.’’. 
(4) The bill referred to in subsection (a) is amended by 
striking section 201. 
Subtitle C—Provisions Relating to Title III 
SEC. 10301. PLANS FOR A VALUE-BASED PURCHASING PROGRAM FOR 
AMBULATORY SURGICAL CENTERS. 
(a) IN GENERAL.—Section 3006 is amended by adding at the 
end the following new subsection: 
‘‘(f) AMBULATORY SURGICAL CENTERS.— 
‘‘(1) IN GENERAL.—The Secretary shall develop a plan to 
implement a value-based purchasing program for payments 
under the Medicare program under title XVIII of the Social
H. R. 3590—819 
Security Act for ambulatory surgical centers (as described in 
section 1833(i) of the Social Security Act (42 U.S.C. 1395l(i))). 
‘‘(2) DETAILS.—In developing the plan under paragraph 
(1), the Secretary shall consider the following issues: 
‘‘(A) The ongoing development, selection, and modifica-
tion process for measures (including under section 1890 
of the Social Security Act (42 U.S.C. 1395aaa) and section 
1890A of such Act, as added by section 3014), to the extent 
feasible and practicable, of all dimensions of quality and 
efficiency in ambulatory surgical centers. 
‘‘(B) The reporting, collection, and validation of quality 
data. 
‘‘(C) The structure of value-based payment adjust-
ments, including the determination of thresholds or 
improvements in quality that would substantiate a pay-
ment adjustment, the size of such payments, and the 
sources of funding for the value-based bonus payments. 
‘‘(D) Methods for the public disclosure of information 
on the performance of ambulatory surgical centers. 
‘‘(E) Any other issues determined appropriate by the 
Secretary. 
‘‘(3) CONSULTATION.—In developing the plan under para-
graph (1), the Secretary shall— 
‘‘(A) consult with relevant affected parties; and 
‘‘(B) consider experience with such demonstrations that 
the Secretary determines are relevant to the value-based 
purchasing program described in paragraph (1). 
‘‘(4) REPORT TO CONGRESS.—Not later than January 1, 2011, 
the Secretary shall submit to Congress a report containing 
the plan developed under paragraph (1).’’. 
(b) TECHNICAL.—Section 3006(a)(2)(A) is amended by striking 
clauses (i) and (ii). 
SEC. 
10302. 
REVISION 
TO 
NATIONAL 
STRATEGY 
FOR 
QUALITY 
IMPROVEMENT IN HEALTH CARE. 
Section 399HH(a)(2)(B)(iii) of the Public Health Service Act, 
as added by section 3011, is amended by inserting ‘‘(taking into 
consideration the limitations set forth in subsections (c) and (d) 
of section 1182 of the Social Security Act)’’ after ‘‘information’’. 
SEC. 10303. DEVELOPMENT OF OUTCOME MEASURES. 
(a) DEVELOPMENT.—Section 931 of the Public Health Service 
Act, as added by section 3013(a), is amended by adding at the 
end the following new subsection: 
‘‘(f) DEVELOPMENT OF OUTCOME MEASURES.— 
‘‘(1) IN GENERAL.—The Secretary shall develop, and periodi-
cally update (not less than every 3 years), provider-level out-
come measures for hospitals and physicians, as well as other 
providers as determined appropriate by the Secretary. 
‘‘(2) CATEGORIES OF MEASURES.—The measures developed 
under this subsection shall include, to the extent determined 
appropriate by the Secretary— 
‘‘(A) outcome measurement for acute and chronic dis-
eases, including, to the extent feasible, the 5 most prevalent 
and resource-intensive acute and chronic medical condi-
tions; and 
‘‘(B) outcome measurement for primary and preventa-
tive care, including, to the extent feasible, measurements
H. R. 3590—820 
that cover provision of such care for distinct patient popu-
lations (such as healthy children, chronically ill adults, 
or infirm elderly individuals). 
‘‘(3) GOALS.—In developing such measures, the Secretary 
shall seek to— 
‘‘(A) address issues regarding risk adjustment, account-
ability, and sample size; 
‘‘(B) include the full scope of services that comprise 
a cycle of care; and 
‘‘(C) include multiple dimensions. 
‘‘(4) TIMEFRAME.— 
‘‘(A) ACUTE AND CHRONIC DISEASES.—Not later than 
24 months after the date of enactment of this Act, the 
Secretary shall develop not less than 10 measures described 
in paragraph (2)(A). 
‘‘(B) PRIMARY AND PREVENTIVE CARE.—Not later than 
36 months after the date of enactment of this Act, the 
Secretary shall develop not less than 10 measures described 
in paragraph (2)(B).’’. 
(b) HOSPITAL-ACQUIRED CONDITIONS.—Section 1890A of the 
Social Security Act, as amended by section 3013(b), is amended 
by adding at the end the following new subsection: 
‘‘(f) HOSPITAL ACQUIRED CONDITIONS.—The Secretary shall, to 
the extent practicable, publicly report on measures for hospital- 
acquired conditions that are currently utilized by the Centers for 
Medicare & Medicaid Services for the adjustment of the amount 
of payment to hospitals based on rates of hospital-acquired infec-
tions.’’. 
(c) CLINICAL PRACTICE GUIDELINES.—Section 304(b) of the Medi-
care Improvements for Patients and Providers Act of 2008 (Public 
Law 110–275) is amended by adding at the end the following 
new paragraph: 
‘‘(4) IDENTIFICATION.— 
‘‘(A) IN GENERAL.—Following receipt of the report sub-
mitted under paragraph (2), and not less than every 3 
years thereafter, the Secretary shall contract with the 
Institute to employ the results of the study performed 
under paragraph (1) and the best methods identified by 
the Institute for the purpose of identifying existing and 
new clinical practice guidelines that were developed using 
such best methods, including guidelines listed in the 
National Guideline Clearinghouse. 
‘‘(B) CONSULTATION.—In carrying out the identification 
process under subparagraph (A), the Secretary shall allow 
for consultation with professional societies, voluntary 
health care organizations, and expert panels.’’. 
SEC. 10304. SELECTION OF EFFICIENCY MEASURES. 
Sections 1890(b)(7) and 1890A of the Social Security Act, as 
added by section 3014, are amended by striking ‘‘quality’’ each 
place it appears and inserting ‘‘quality and efficiency’’. 
SEC. 10305. DATA COLLECTION; PUBLIC REPORTING. 
Section 399II(a) of the Public Health Service Act, as added 
by section 3015, is amended to read as follows: 
‘‘(a) IN GENERAL.—
H. R. 3590—821 
‘‘(1) ESTABLISHMENT OF STRATEGIC FRAMEWORK.—The Sec-
retary shall establish and implement an overall strategic frame-
work to carry out the public reporting of performance informa-
tion, as described in section 399JJ. Such strategic framework 
may include methods and related timelines for implementing 
nationally consistent data collection, data aggregation, and 
analysis methods. 
‘‘(2) COLLECTION
AND
AGGREGATION
OF
DATA.—The Sec-
retary shall collect and aggregate consistent data on quality 
and resource use measures from information systems used to 
support health care delivery, and may award grants or contracts 
for this purpose. The Secretary shall align such collection and 
aggregation efforts with the requirements and assistance 
regarding the expansion of health information technology sys-
tems, the interoperability of such technology systems, and 
related standards that are in effect on the date of enactment 
of the Patient Protection and Affordable Care Act. 
‘‘(3) SCOPE.—The Secretary shall ensure that the data 
collection, data aggregation, and analysis systems described 
in paragraph (1) involve an increasingly broad range of patient 
populations, providers, and geographic areas over time.’’. 
SEC. 10306. IMPROVEMENTS UNDER THE CENTER FOR MEDICARE AND 
MEDICAID INNOVATION. 
Section 1115A of the Social Security Act, as added by section 
3021, is amended— 
(1) in subsection (a), by inserting at the end the following 
new paragraph: 
‘‘(5) TESTING WITHIN CERTAIN GEOGRAPHIC AREAS.—For pur-
poses of testing payment and service delivery models under 
this section, the Secretary may elect to limit testing of a model 
to certain geographic areas.’’; 
(2) in subsection (b)(2)— 
(A) in subparagraph (A)— 
(i) in the second sentence, by striking ‘‘the pre-
ceding sentence may include’’ and inserting ‘‘this 
subparagraph may include, but are not limited to,’’; 
and 
(ii) by inserting after the first sentence the fol-
lowing new sentence: ‘‘The Secretary shall focus on 
models expected to reduce program costs under the 
applicable title while preserving or enhancing the 
quality of care received by individuals receiving bene-
fits under such title.’’; 
(B) in subparagraph (B), by adding at the end the 
following new clauses: 
‘‘(xix) Utilizing, in particular in entities located 
in medically underserved areas and facilities of the 
Indian Health Service (whether operated by such 
Service or by an Indian tribe or tribal organization 
(as those terms are defined in section 4 of the Indian 
Health Care Improvement Act)), telehealth services— 
‘‘(I) in treating behavioral health issues (such 
as post-traumatic stress disorder) and stroke; and 
‘‘(II) to improve the capacity of non-medical 
providers and non-specialized medical providers to