H. R. 3590—228 
each grant period, a report to the Secretary that describes how 
grant funds were used during such period. 
‘‘(e) TECHNICAL ASSISTANCE.—The Secretary may provide tech-
nical assistance to entities seeking a grant under this section in 
order to assist such entities in complying with the requirements 
of this section. 
‘‘(f) APPLICATION OF OTHER PROVISIONS OF TITLE.— 
‘‘(1) IN GENERAL.—Except as provided in paragraph (2), 
the other provisions of this title shall not apply to a grant 
made under this section. 
‘‘(2) EXCEPTIONS.—The following provisions of this title 
shall apply to a grant made under this section to the same 
extent and in the same manner as such provisions apply to 
allotments made under section 502(c): 
‘‘(A) Section 504(b)(6) (relating to prohibition on pay-
ments to excluded individuals and entities). 
‘‘(B) Section 504(c) (relating to the use of funds for 
the purchase of technical assistance). 
‘‘(C) Section 504(d) (relating to a limitation on adminis-
trative expenditures). 
‘‘(D) Section 506 (relating to reports and audits), but 
only to the extent determined by the Secretary to be appro-
priate for grants made under this section. 
‘‘(E) Section 507 (relating to penalties for false state-
ments). 
‘‘(F) Section 508 (relating to nondiscrimination). 
‘‘(G) Section 509(a) (relating to the administration of 
the grant program). 
‘‘(g) DEFINITIONS.—In this section: 
‘‘(1) The term ‘eligible entity’— 
‘‘(A) means a public or nonprofit private entity; and 
‘‘(B) includes a State or local government, public-pri-
vate partnership, recipient of a grant under section 330H 
of the Public Health Service Act (relating to the Healthy 
Start Initiative), public or nonprofit private hospital, 
community-based organization, hospice, ambulatory care 
facility, community health center, migrant health center, 
public housing primary care center, or homeless health 
center. 
‘‘(2) The term ‘postpartum condition’ means postpartum 
depression or postpartum psychosis.’’. 
(c) GENERAL PROVISIONS.— 
(1) AUTHORIZATION OF APPROPRIATIONS.—To carry out this 
section and the amendment made by subsection (b), there are 
authorized to be appropriated, in addition to such other sums 
as may be available for such purpose— 
(A) $3,000,000 for fiscal year 2010; and 
(B) such sums as may be necessary for fiscal years 
2011 and 2012. 
(2) REPORT BY THE SECRETARY.— 
(A) STUDY.—The Secretary shall conduct a study on 
the benefits of screening for postpartum conditions. 
(B) REPORT.—Not later than 2 years after the date 
of the enactment of this Act, the Secretary shall complete 
the study required by subparagraph (A) and submit a 
report to the Congress on the results of such study.
H. R. 3590—229 
SEC. 2953. PERSONAL RESPONSIBILITY EDUCATION. 
Title V of the Social Security Act (42 U.S.C. 701 et seq.), 
as amended by sections 2951 and 2952(c), is amended by adding 
at the end the following: 
‘‘SEC. 513. PERSONAL RESPONSIBILITY EDUCATION. 
‘‘(a) ALLOTMENTS TO STATES.— 
‘‘(1) AMOUNT.— 
‘‘(A) IN GENERAL.—For the purpose described in sub-
section (b), subject to the succeeding provisions of this 
section, for each of fiscal years 2010 through 2014, the 
Secretary shall allot to each State an amount equal to 
the product of— 
‘‘(i) the amount appropriated under subsection (f) 
for the fiscal year and available for allotments to States 
after the application of subsection (c); and 
‘‘(ii) the State youth population percentage deter-
mined under paragraph (2). 
‘‘(B) MINIMUM ALLOTMENT.— 
‘‘(i) IN GENERAL.—Each State allotment under this 
paragraph for a fiscal year shall be at least $250,000. 
‘‘(ii) PRO RATA ADJUSTMENTS.—The Secretary shall 
adjust on a pro rata basis the amount of the State 
allotments determined under this paragraph for a fiscal 
year to the extent necessary to comply with clause 
(i). 
‘‘(C) APPLICATION REQUIRED TO ACCESS ALLOTMENTS.— 
‘‘(i) IN GENERAL.—A State shall not be paid from 
its allotment for a fiscal year unless the State submits 
an application to the Secretary for the fiscal year and 
the Secretary approves the application (or requires 
changes to the application that the State satisfies) 
and meets such additional requirements as the Sec-
retary may specify. 
‘‘(ii) REQUIREMENTS.—The State application shall 
contain an assurance that the State has complied with 
the requirements of this section in preparing and 
submitting the application and shall include the fol-
lowing as well as such additional information as the 
Secretary may require: 
‘‘(I) Based on data from the Centers for Dis-
ease Control and Prevention National Center for 
Health Statistics, the most recent pregnancy rates 
for the State for youth ages 10 to 14 and youth 
ages 15 to 19 for which data are available, the 
most recent birth rates for such youth populations 
in the State for which data are available, and 
trends in those rates for the most recently pre-
ceding 5-year period for which such data are avail-
able. 
‘‘(II) State-established goals for reducing the 
pregnancy rates and birth rates for such youth 
populations. 
‘‘(III) A description of the State’s plan for using 
the State allotments provided under this section 
to achieve such goals, especially among youth
H. R. 3590—230 
populations that are the most high-risk or vulner-
able for pregnancies or otherwise have special cir-
cumstances, including youth in foster care, home-
less youth, youth with HIV/AIDS, pregnant youth 
who are under 21 years of age, mothers who are 
under 21 years of age, and youth residing in areas 
with high birth rates for youth. 
‘‘(2) STATE YOUTH POPULATION PERCENTAGE.— 
‘‘(A) IN GENERAL.—For purposes of paragraph (1)(A)(ii), 
the State youth population percentage is, with respect to 
a State, the proportion (expressed as a percentage) of— 
‘‘(i) the number of individuals who have attained 
age 10 but not attained age 20 in the State; to 
‘‘(ii) the number of such individuals in all States. 
‘‘(B) DETERMINATION
OF
NUMBER
OF
YOUTH.—The 
number of individuals described in clauses (i) and (ii) of 
subparagraph (A) in a State shall be determined on the 
basis of the most recent Bureau of the Census data. 
‘‘(3) AVAILABILITY OF STATE ALLOTMENTS.—Subject to para-
graph (4)(A), amounts allotted to a State pursuant to this 
subsection for a fiscal year shall remain available for expendi-
ture by the State through the end of the second succeeding 
fiscal year. 
‘‘(4) AUTHORITY TO AWARD GRANTS FROM STATE ALLOTMENTS 
TO LOCAL ORGANIZATIONS AND ENTITIES IN NONPARTICIPATING 
STATES.— 
‘‘(A) GRANTS
FROM
UNEXPENDED
ALLOTMENTS.—If a 
State does not submit an application under this section 
for fiscal year 2010 or 2011, the State shall no longer 
be eligible to submit an application to receive funds from 
the amounts allotted for the State for each of fiscal years 
2010 through 2014 and such amounts shall be used by 
the Secretary to award grants under this paragraph for 
each of fiscal years 2012 through 2014. The Secretary also 
shall use any amounts from the allotments of States that 
submit applications under this section for a fiscal year 
that remain unexpended as of the end of the period in 
which the allotments are available for expenditure under 
paragraph (3) for awarding grants under this paragraph. 
‘‘(B) 3-YEAR GRANTS.— 
‘‘(i) IN
GENERAL.—The Secretary shall solicit 
applications to award 3-year grants in each of fiscal 
years 2012, 2013, and 2014 to local organizations and 
entities to conduct, consistent with subsection (b), pro-
grams and activities in States that do not submit an 
application for an allotment under this section for fiscal 
year 2010 or 2011. 
‘‘(ii) FAITH-BASED ORGANIZATIONS OR CONSORTIA.— 
The Secretary may solicit and award grants under 
this paragraph to faith-based organizations or con-
sortia. 
‘‘(C) EVALUATION.—An organization or entity awarded 
a grant under this paragraph shall agree to participate 
in a rigorous Federal evaluation. 
‘‘(5) MAINTENANCE OF EFFORT.—No payment shall be made 
to a State from the allotment determined for the State under 
this subsection or to a local organization or entity awarded
H. R. 3590—231 
a grant under paragraph (4), if the expenditure of non-federal 
funds by the State, organization, or entity for activities, pro-
grams, or initiatives for which amounts from allotments and 
grants under this subsection may be expended is less than 
the amount expended by the State, organization, or entity 
for such programs or initiatives for fiscal year 2009. 
‘‘(6) DATA COLLECTION AND REPORTING.—A State or local 
organization or entity receiving funds under this section shall 
cooperate with such requirements relating to the collection 
of data and information and reporting on outcomes regarding 
the programs and activities carried out with such funds, as 
the Secretary shall specify. 
‘‘(b) PURPOSE.— 
‘‘(1) IN GENERAL.—The purpose of an allotment under sub-
section (a)(1) to a State is to enable the State (or, in the 
case of grants made under subsection (a)(4)(B), to enable a 
local organization or entity) to carry out personal responsibility 
education programs consistent with this subsection. 
‘‘(2) PERSONAL RESPONSIBILITY EDUCATION PROGRAMS.— 
‘‘(A) IN GENERAL.—In this section, the term ‘personal 
responsibility education program’ means a program that 
is designed to educate adolescents on— 
‘‘(i) both abstinence and contraception for the 
prevention of pregnancy and sexually transmitted 
infections, including HIV/AIDS, consistent with the 
requirements of subparagraph (B); and 
‘‘(ii) at least 3 of the adulthood preparation subjects 
described in subparagraph (C). 
‘‘(B) 
REQUIREMENTS.—The 
requirements 
of 
this 
subparagraph are the following: 
‘‘(i) The program replicates evidence-based effective 
programs or substantially incorporates elements of 
effective programs that have been proven on the basis 
of rigorous scientific research to change behavior, 
which means delaying sexual activity, increasing 
condom or contraceptive use for sexually active youth, 
or reducing pregnancy among youth. 
‘‘(ii) The program is medically-accurate and com-
plete. 
‘‘(iii) The program includes activities to educate 
youth who are sexually active regarding responsible 
sexual behavior with respect to both abstinence and 
the use of contraception. 
‘‘(iv) The program places substantial emphasis on 
both abstinence and contraception for the prevention 
of pregnancy among youth and sexually transmitted 
infections. 
‘‘(v) 
The 
program 
provides 
age-appropriate 
information and activities. 
‘‘(vi) The information and activities carried out 
under the program are provided in the cultural context 
that is most appropriate for individuals in the par-
ticular population group to which they are directed. 
‘‘(C) ADULTHOOD PREPARATION SUBJECTS.—The adult-
hood preparation subjects described in this subparagraph 
are the following:
H. R. 3590—232 
‘‘(i) Healthy relationships, such as positive self- 
esteem and relationship dynamics, friendships, dating, 
romantic involvement, marriage, and family inter-
actions. 
‘‘(ii) Adolescent development, such as the develop-
ment of healthy attitudes and values about adolescent 
growth and development, body image, racial and ethnic 
diversity, and other related subjects. 
‘‘(iii) Financial literacy. 
‘‘(iv) Parent-child communication. 
‘‘(v) Educational and career success, such as devel-
oping skills for employment preparation, job seeking, 
independent living, financial self-sufficiency, and work-
place productivity. 
‘‘(vi) Healthy life skills, such as goal-setting, deci-
sion making, negotiation, communication and inter-
personal skills, and stress management. 
‘‘(c) RESERVATIONS OF FUNDS.— 
‘‘(1) GRANTS TO IMPLEMENT INNOVATIVE STRATEGIES.—From 
the amount appropriated under subsection (f) for the fiscal 
year, the Secretary shall reserve $10,000,000 of such amount 
for purposes of awarding grants to entities to implement innova-
tive youth pregnancy prevention strategies and target services 
to high-risk, vulnerable, and culturally under-represented youth 
populations, including youth in foster care, homeless youth, 
youth with HIV/AIDS, pregnant women who are under 21 
years of age and their partners, mothers who are under 21 
years of age and their partners, and youth residing in areas 
with high birth rates for youth. An entity awarded a grant 
under this paragraph shall agree to participate in a rigorous 
Federal evaluation of the activities carried out with grant funds. 
‘‘(2) OTHER RESERVATIONS.—From the amount appropriated 
under subsection (f) for the fiscal year that remains after the 
application of paragraph (1), the Secretary shall reserve the 
following amounts: 
‘‘(A) GRANTS FOR INDIAN TRIBES OR TRIBAL ORGANIZA-
TIONS.—The Secretary shall reserve 5 percent of such 
remainder for purposes of awarding grants to Indian tribes 
and tribal organizations in such manner, and subject to 
such requirements, as the Secretary, in consultation with 
Indian tribes and tribal organizations, determines appro-
priate. 
‘‘(B) SECRETARIAL RESPONSIBILITIES.— 
‘‘(i) RESERVATION OF FUNDS.—The Secretary shall 
reserve 10 percent of such remainder for expenditures 
by the Secretary for the activities described in clauses 
(ii) and (iii). 
‘‘(ii) PROGRAM SUPPORT.—The Secretary shall pro-
vide, directly or through a competitive grant process, 
research, training and technical assistance, including 
dissemination of research and information regarding 
effective and promising practices, providing consulta-
tion and resources on a broad array of teen pregnancy 
prevention strategies, including abstinence and contra-
ception, and developing resources and materials to sup-
port the activities of recipients of grants and other 
State, tribal, and community organizations working
H. R. 3590—233 
to reduce teen pregnancy. In carrying out such func-
tions, the Secretary shall collaborate with a variety 
of entities that have expertise in the prevention of 
teen pregnancy, HIV and sexually transmitted infec-
tions, healthy relationships, financial literacy, and 
other topics addressed through the personal responsi-
bility education programs. 
‘‘(iii) EVALUATION.—The Secretary shall evaluate 
the programs and activities carried out with funds 
made available through allotments or grants under 
this section. 
‘‘(d) ADMINISTRATION.— 
‘‘(1) IN GENERAL.—The Secretary shall administer this sec-
tion through the Assistant Secretary for the Administration 
for Children and Families within the Department of Health 
and Human Services. 
‘‘(2) APPLICATION OF OTHER PROVISIONS OF TITLE.— 
‘‘(A) IN GENERAL.—Except as provided in subparagraph 
(B), the other provisions of this title shall not apply to 
allotments or grants made under this section. 
‘‘(B) EXCEPTIONS.—The following provisions of this title 
shall apply to allotments and grants made under this sec-
tion to the same extent and in the same manner as such 
provisions apply to allotments made under section 502(c): 
‘‘(i) Section 504(b)(6) (relating to prohibition on 
payments to excluded individuals and entities). 
‘‘(ii) Section 504(c) (relating to the use of funds 
for the purchase of technical assistance). 
‘‘(iii) Section 504(d) (relating to a limitation on 
administrative expenditures). 
‘‘(iv) Section 506 (relating to reports and audits), 
but only to the extent determined by the Secretary 
to be appropriate for grants made under this section. 
‘‘(v) Section 507 (relating to penalties for false 
statements). 
‘‘(vi) Section 508 (relating to nondiscrimination). 
‘‘(e) DEFINITIONS.—In this section: 
‘‘(1) AGE-APPROPRIATE.—The term ‘age-appropriate’, with 
respect to the information in pregnancy prevention, means 
topics, messages, and teaching methods suitable to particular 
ages or age groups of children and adolescents, based on devel-
oping cognitive, emotional, and behavioral capacity typical for 
the age or age group. 
‘‘(2) MEDICALLY
ACCURATE
AND
COMPLETE.—The term 
‘medically accurate and complete’ means verified or supported 
by the weight of research conducted in compliance with accepted 
scientific methods and— 
‘‘(A) published in peer-reviewed journals, where 
applicable; or 
‘‘(B) comprising information that leading professional 
organizations and agencies with relevant expertise in the 
field recognize as accurate, objective, and complete. 
‘‘(3) INDIAN
TRIBES; TRIBAL
ORGANIZATIONS.—The terms 
‘Indian tribe’ and ‘Tribal organization’ have the meanings given 
such terms in section 4 of the Indian Health Care Improvement 
Act (25 U.S.C. 1603)).
H. R. 3590—234 
‘‘(4) YOUTH.—The term ‘youth’ means an individual who 
has attained age 10 but has not attained age 20. 
‘‘(f) APPROPRIATION.—For the purpose of carrying out this sec-
tion, there is appropriated, out of any money in the Treasury 
not otherwise appropriated, $75,000,000 for each of fiscal years 
2010 through 2014. Amounts appropriated under this subsection 
shall remain available until expended.’’. 
SEC. 2954. RESTORATION OF FUNDING FOR ABSTINENCE EDUCATION. 
Section 510 of the Social Security Act (42 U.S.C. 710) is 
amended— 
(1) in subsection (a), by striking ‘‘fiscal year 1998 and 
each subsequent fiscal year’’ and inserting ‘‘each of fiscal years 
2010 through 2014’’; and 
(2) in subsection (d)— 
(A) in the first sentence, by striking ‘‘1998 through 
2003’’ and inserting ‘‘2010 through 2014’’; and 
(B) in the second sentence, by inserting ‘‘(except that 
such appropriation shall be made on the date of enactment 
of the Patient Protection and Affordable Care Act in the 
case of fiscal year 2010)’’ before the period. 
SEC. 2955. INCLUSION OF INFORMATION ABOUT THE IMPORTANCE 
OF HAVING A HEALTH CARE POWER OF ATTORNEY IN 
TRANSITION PLANNING FOR CHILDREN AGING OUT OF 
FOSTER CARE AND INDEPENDENT LIVING PROGRAMS. 
(a) TRANSITION PLANNING.—Section 475(5)(H) of the Social 
Security Act (42 U.S.C. 675(5)(H)) is amended by inserting ‘‘includes 
information about the importance of designating another individual 
to make health care treatment decisions on behalf of the child 
if the child becomes unable to participate in such decisions and 
the child does not have, or does not want, a relative who would 
otherwise be authorized under State law to make such decisions, 
and provides the child with the option to execute a health care 
power of attorney, health care proxy, or other similar document 
recognized under State law,’’ after ‘‘employment services,’’. 
(b) INDEPENDENT LIVING EDUCATION.—Section 477(b)(3) of such 
Act (42 U.S.C. 677(b)(3)) is amended by adding at the end the 
following: 
‘‘(K) A certification by the chief executive officer of 
the State that the State will ensure that an adolescent 
participating in the program under this section are pro-
vided with education about the importance of designating 
another individual to make health care treatment decisions 
on behalf of the adolescent if the adolescent becomes unable 
to participate in such decisions and the adolescent does 
not have, or does not want, a relative who would otherwise 
be authorized under State law to make such decisions, 
whether a health care power of attorney, health care proxy, 
or other similar document is recognized under State law, 
and how to execute such a document if the adolescent 
wants to do so.’’. 
(c) HEALTH OVERSIGHT
AND COORDINATION PLAN.—Section 
422(b)(15)(A) of such Act (42 U.S.C. 622(b)(15)(A)) is amended— 
(1) in clause (v), by striking ‘‘and’’ at the end; and 
(2) by adding at the end the following: 
‘‘(vii) steps to ensure that the components of the 
transition plan development process required under
H. R. 3590—235 
section 475(5)(H) that relate to the health care needs 
of children aging out of foster care, including the 
requirements to include options for health insurance, 
information about a health care power of attorney, 
health care proxy, or other similar document recog-
nized under State law, and to provide the child with 
the option to execute such a document, are met; and’’. 
(d) EFFECTIVE DATE.—The amendments made by this section 
take effect on October 1, 2010. 
TITLE III—IMPROVING THE QUALITY 
AND EFFICIENCY OF HEALTH CARE 
Subtitle A—Transforming the Health Care 
Delivery System 
PART I—LINKING PAYMENT TO QUALITY 
OUTCOMES UNDER THE MEDICARE PROGRAM 
SEC. 3001. HOSPITAL VALUE-BASED PURCHASING PROGRAM. 
(a) PROGRAM.— 
(1) IN GENERAL.—Section 1886 of the Social Security Act 
(42 U.S.C. 1395ww), as amended by section 4102(a) of the 
HITECH Act (Public Law 111–5), is amended by adding at 
the end the following new subsection: 
‘‘(o) HOSPITAL VALUE-BASED PURCHASING PROGRAM.— 
‘‘(1) ESTABLISHMENT.— 
‘‘(A) IN GENERAL.—Subject to the succeeding provisions 
of this subsection, the Secretary shall establish a hospital 
value-based purchasing program (in this subsection 
referred to as the ‘Program’) under which value-based 
incentive payments are made in a fiscal year to hospitals 
that meet the performance standards under paragraph (3) 
for the performance period for such fiscal year (as estab-
lished under paragraph (4)). 
‘‘(B) PROGRAM
TO
BEGIN
IN
FISCAL
YEAR
2013.—The 
Program shall apply to payments for discharges occurring 
on or after October 1, 2012. 
‘‘(C) APPLICABILITY OF PROGRAM TO HOSPITALS.— 
‘‘(i) IN GENERAL.—For purposes of this subsection, 
subject to clause (ii), the term ‘hospital’ means a sub-
section (d) hospital (as defined in subsection (d)(1)(B)). 
‘‘(ii) EXCLUSIONS.—The term ‘hospital’ shall not 
include, with respect to a fiscal year, a hospital— 
‘‘(I) that is subject to the payment reduction 
under subsection (b)(3)(B)(viii)(I) for such fiscal 
year; 
‘‘(II) for which, during the performance period 
for such fiscal year, the Secretary has cited defi-
ciencies that pose immediate jeopardy to the health 
or safety of patients;
H. R. 3590—236 
‘‘(III) for which there are not a minimum 
number (as determined by the Secretary) of meas-
ures that apply to the hospital for the performance 
period for such fiscal year; or 
‘‘(IV) for which there are not a minimum 
number (as determined by the Secretary) of cases 
for the measures that apply to the hospital for 
the performance period for such fiscal year. 
‘‘(iii) INDEPENDENT
ANALYSIS.—For purposes of 
determining the minimum numbers under subclauses 
(III) and (IV) of clause (ii), the Secretary shall have 
conducted an independent analysis of what numbers 
are appropriate. 
‘‘(iv) EXEMPTION.—In the case of a hospital that 
is paid under section 1814(b)(3), the Secretary may 
exempt such hospital from the application of this sub-
section if the State which is paid under such section 
submits an annual report to the Secretary describing 
how a similar program in the State for a participating 
hospital or hospitals achieves or surpasses the meas-
ured results in terms of patient health outcomes and 
cost savings established under this subsection. 
‘‘(2) MEASURES.— 
‘‘(A) IN GENERAL.—The Secretary shall select measures 
for purposes of the Program. Such measures shall be 
selected from the measures specified under subsection 
(b)(3)(B)(viii). 
‘‘(B) REQUIREMENTS.— 
‘‘(i) FOR FISCAL YEAR 2013.—For value-based incen-
tive payments made with respect to discharges occur-
ring during fiscal year 2013, the Secretary shall ensure 
the following: 
‘‘(I) CONDITIONS
OR
PROCEDURES.—Measures 
are selected under subparagraph (A) that cover 
at least the following 5 specific conditions or proce-
dures: 
‘‘(aa) Acute myocardial infarction (AMI). 
‘‘(bb) Heart failure. 
‘‘(cc) Pneumonia. 
‘‘(dd) Surgeries, as measured by the Sur-
gical Care Improvement Project (formerly 
referred to as ‘Surgical Infection Prevention’ 
for discharges occurring before July 2006). 
‘‘(ee) Healthcare-associated infections, as 
measured by the prevention metrics and tar-
gets established in the HHS Action Plan to 
Prevent Healthcare-Associated Infections (or 
any successor plan) of the Department of 
Health and Human Services. 
‘‘(II) 
HCAHPS.—Measures 
selected 
under 
subparagraph (A) shall be related to the Hospital 
Consumer Assessment of Healthcare Providers and 
Systems survey (HCAHPS). 
‘‘(ii) INCLUSION
OF
EFFICIENCY
MEASURES.—For 
value-based incentive payments made with respect to